All information and quotations taken from the intellectual property of Janina Fisher or the Sensorimotor Psychotherapy Institute will be appropriately attributed to the authors.
Trauma and the Body:
Sensorimotor Psychotherapy for Trauma
Janina Fisher, Ph.D.
Instructor, The Trauma Center , Boston , Mass. ; Faculty, Sensorimotor Psychotherapy Institute
Although most survivors of trauma have a longing to be heard, to have their traumatic experiences witnessed by another, telling their stories can often cause more overwhelm rather than resolve the symptoms and suffering. Describing the details of any experience, good or bad, usually evokes the feelings and body responses that are part of the memory. That is why we enjoy telling people about our positive experiences. But, when we verbalize the details of a traumatic experience, it stimulates the non-verbal, somatic components of the memory, leading to a re-experiencing of the intense, overwhelming emotions, involuntary movements, intrusive sensory experiences, internal sense of alarm or terror, and inability to think clearly. Even “thinking about thinking about” the memories is often enough to cause a reactivation of the nervous system as if the events were recurring in the here-and-now. In treatments that focus on working through traumatic event memory, this repetitive cycle of mind-body triggering can keep the past traumas more “alive,” prolonging rather than resolving the symptoms.
Sensorimotor Psychotherapy, a body-centered talking therapy for trauma, offers a way to address the somatically-based symptoms of trauma through approaches that “uncouple” the traumatic events from their legacy in the form of intense feelings, bodily responses, and punitive cognitions. Developed in the 1980s by Pat Ogden, Ph.D. (and enriched by contributions from the work of Alan Schore, Bessel van der Kolk, Daniel Siegel, Onno van der Hart, and Ellert Nijenhuis), Sensorimotor Psychotherapy combines traditional talking therapy techniques with body-centered interventions that directly address the neurobiological effects of trauma. By using just enough of the memory to evoke the trauma-related bodily experience and making that “sliver” of memory our focus in therapy, we attend first to how the body has “remembered” the trauma and only later to emotional meaning-making. Unlike most body-centered therapies, Sensorimotor Psychotherapy does not require the use of touch, making it easy to integrate into more traditional psychotherapy models. Instead, Sensorimotor work emphasizes the restoration of a “witnessing self” and the cultivation of new experiences that challenge the habitual trauma-related body responses, rather than repeat or re-activate them.
For example, “Annie,” an incest survivor, came into a therapy session some months ago literally trembling, filled with fear and hopelessness, her heart racing, her chest tight, her stomach in knots. She spoke of feeling “painfully alone,” rejected by everyone close to her, just wanting to give up and never wake up again. Forgotten completely were her two sons, her warm and comfortable home by the river, the neighborhood children who are familiar and welcome visitors every day. Like most survivors, she had interpreted the body sensations and painful emotions as evidence that something was terribly wrong with her present environment. Since the distress and accompanying beliefs and body responses were coming up in present time, unconnected to the original events that caused them, it was only natural that she would interpret them as data about her current situation, yet they made more sense if we understood them as “feeling memories” connected to a painfully lonely, horrifically traumatic childhood. In a traditional psychotherapy context, I would have made that comment to her, but, instead, using a sensorimotor paradigm, I simply asked her to notice that, each time she said the word, “lonely,” her agitation would increase. I asked Annie if she would be willing to try something different: to “let go” of the thoughts she was having to just attend to the feelings and sensations in her body. By using my questioning to help her focus on the minute details of the sensations themselves, she was able to describe the pounding of her heart, the twisting in her gut, and the trembling of her lip and chin. And, as often happens in Sensorimotor Psychotherapy, her nervous system began to settle and calm as we focused on these minute details of body experience and did not interpret their meaning.
Once her nervous system and body reactivity had calmed, I asked her to “rewind the memory tape” back to when she first started to feel these feelings and sensations a few days before. She recalled being out for a walk and finding herself noticing the fall light at dusk, then suddenly becoming activated and panicked, so much so that she literally ran home and then sat in a chair, trembling, unable to move. Next, we both acknowledged that the fall season is connected to a number of horrific traumatic events in her life, evoking a “sliver” of memory but refraining from discussing those events in detail. Annie noticed an immediate increase in her activation but agreed to just “study it.” As she observed the body responses, she noticed a strong muscular pull in her chest and stomach, and, when I asked her, “How would that pull like you to move?” she described a sense of wanting to curl up into a ball. “I just want to huddle down and wait for it to be over,” she said. I asked her to notice what happened in her body when she said those words, “Huddle and wait for it to be over,” and she observed that the pull to curl up into a ball got stronger, that there was a relationship between the trauma-related belief and the body responses.
In this vignette, you can see the elements of Sensorimotor Psychotherapy that seem to be most powerful in helping to resolve traumatic experience: the therapist's neutral stance toward the interpretation of the body responses, the curiosity the therapist tries to cultivate in the client, the encouraging of the client to “just notice” in a mindful way, the gentle direction to let go of cognitive interpretation in favor of mindful observation, standing back and observing the way the body holds a particular traumatic experience or set of experiences. As Bessel van der Kolk says, “You cannot be re-traumatized as long as you are able to have parallel processing.” The mindful noticing of the body's response to a sliver of memory is an example of parallel processing or dual awareness. Using dual awareness, the client learns to stand at a slight distance from what is happening emotionally and physically and just observe the sequence of feelings, thoughts and body sensations, the very ability that is lost at the moment of trauma when the ‘witnessing self' is replaced by the ‘animal defense self' and we fight, flee or submit instinctively and often unconsciously.
Next, as Annie continues to complete this piece of work, you will see another aspect of Sensorimotor work: the completion of old actions that “wanted to happen” and the practice of new ones.
Once Annie had observed the relationship between her thoughts and body experience, she herself became more curious about the “huddle and wait for it to be over” response she was having, and I could see that she was less in the memory and more in the present moment. Next, I encouraged her to sense in her body if there was any other movement impulse or action that “wanted to happen.” As she quietly studied her body's signals, she had an epiphany: “What my body needs is a small, new action that says, ‘You don't have to huddle and wait for it to be over!'” Using another Sensorimotor technique, that of practicing new responses and noticing their effects, she had the sense that it would be helpful to take one small step. That small step felt effortful, as if she were fighting with her body's wish to huddle up, but the next felt easier. Then she had the somatic sense that it would be helpful to take a step toward the door. Though I had the thought, “Yes, so you know you are not trapped ,” I held it back in favor of just noticing with her what it was like to take a step toward the door. She reported a feeling of greater solidity and strength in her legs and core. Taking another step toward the door, she found herself starting to feel more playful: “Maybe I'll just go out in the hallway and look at the magazines,” she said with a laugh. As often happens in Sensorimotor work, the next few minutes of the session became creative and playful. Annie took a series of steps that led her out into the hallway, then back into the office, and then out again. She even turned the tables by closing the door to my office from the hall, shutting me in the room by myself!
Finally, it was time to make meaning of the session, which is always done after a change has taken place. Annie became quieter and more serious for a moment: “Wow! That is a lot to take in . . . When I was triggered on that walk, my body freaked out—everything felt threatening and desperate—it wanted to do what worked when I was a child: ‘huddle down and wait for it to be over.' But when I do something a little bit different, my body gets to see other possibilities. All I have to do now, each time I'm triggered, is notice what my body is telling me to do—and then make a tiny movement or do one tiny thing differently.”
Notice the hallmarks of a body-centered psychotherapeutic approach: focusing on the body sensations, letting go of the thoughts and beliefs that intensify the sensations, trying to stay curious and in a state of dual awareness, and being willing to experiment with movements and actions that challenge the trauma responses just the ‘right amount' without triggering more traumatic activation. Last but not least, notice the results: a trauma survivor who ends a session with laughter and a sense of mastery in relationship to the overwhelming emotions and recurring pain.
Janina Fisher, Ph.D. is a licensed Clinical Psychologist and Instructor at the Trauma Center, an outpatient clinic and research center founded by Bessel van der Kolk. She is also a past president of the New England Society for the Treatment of Trauma and Dissociation, an EMDR International Association Credit Provider, a faculty member of the Sensorimotor Psychotherapy Institute, and former Instructor, Harvard Medical School . More information about Dr. Fisher is available at www.janinafisher.com . Information about Sensorimotor Psychotherapy is available at www.sensorimotor.org .
