As therapists, when working with clients who grapple with trauma, whether it’s developmental trauma or shock trauma, avoiding retraumatization or emotional overwhelm, poses a challenge.
Tempering Language in Therapy
It can be tempting to allow clients to “vent” or proceed full-speed into re-enacting or reliving their most traumatic moments and the accompanying emotions. What we truly want to accomplish in therapy is to help our clients feel more alive now. And re-enacting or rehashing the trauma stories repeatedly can unintentionally root the trauma experience more deeply. The chief complaint with trauma clients is often that their experience, either in childhood or with PTSD, interferes with their lives now – their ability to connect with loved ones, maintain healthy adult relationships, or be present for their children.
Trauma Lives in the Body
When we work with the symptoms of trauma within the body alongside establishing resourcing or grounding in a sense of safety, however, it can actually be a more positive and productive experience for both the client and the therapist by maintaining the open therapeutic opportunity without collapse or shutdown.
As the therapist, you must be very careful not to recreate devastating/disintegrating fragmentation or overwhelm in the sessions. The therapist must pace the processing so that the client stays within their window of tolerance and range of resiliency.
Body-Reading, Scanning, and Non-Verbal Cues in Therapy Sessions
What is your client not telling you? Or what might even they be unaware of? Tuning in to the body’s reaction as you move through your therapy session can tell you whether your client is in a high-arousal state before it explodes to the surface. Is their body open and receptive, or closed off and contracted? Are their fist clenched or fingers splayed? Are they trembling?
Listening to their tone of voice and tuning in to their state of well-being keeps the window of tolerance open by allowing the therapist the opportunity to back off. Is their voice becoming erratic or high-pitched? This might indicate fear.
Taking in the full view of the client’s body behaviors and actions, alongside what they are saying to you can help guide the session.
How Trauma Works in the Brain and Body
Trauma is an emotional response embedded in either explicit (conscious awareness) or implicit (unconscious awareness) memory in addition to memories contained within the body (procedural memory). Trauma occurs when something happens too much, too soon, or too fast for the nervous system to handle.
The body’s natural response to a perceived threat, our survival instinct, often includes increased blood flow, dilated pupils, and a burst of energy in the fight-flight response. When fight-flight proves ineffective, the freeze (complete shutdown) response, or feigned death, will release endorphins and reduce pain. Our instinct to survive is part of the sympathetic nervous system (SNS) and occurs unconsciously.
It’s necessary to calm the client’s overactive amygdala, which keeps the threat response engaged long after the original danger has passed. The client may have little or no control over the autonomic nervous system hypersensitivities.
By establishing a felt sense of safety within the body and a level of calm in the nervous system, clients can feel their bodies, their boundaries and access the resourcing and grounding necessary to prevent over-activation and dissociation in session and to develop resilience and aliveness.
Trauma and Somatic Experiencing®
Somatic Experiencing (SE) is a powerful holistic approach to trauma healing developed by Peter Levine, Ph.D., to focus on the resilience of the nervous system and its manifestations within the body. SE therapists conduct therapy with the continuous well-being of the client both during and after the session to avoid re-traumatization.
Helping clients access their perceived body sensations increases the flow and movement between the autonomic and somatic systems, opening the client to the healing process. Improving the awareness and connection of both mind and body affords two treatment routes by beginning with the brain’s trauma reaction, or starting first by calming and relaxing the body through deep breathing or other exercises.
People often think of trauma living in the mind, but it also lives within the body. To heal the trauma, the therapist must address both.
“Trauma is a fact of life. It does not have to be a life sentence.”
— Peter A. Levine, PhD
Trauma can occur in a single traumatic event through surgery, assault, abuse, violence, crime, accident, a medical event or from a cumulative experience of stress. You (or the client) may not even know the origin of the trauma. It’s unnecessary to know all or any of the story to treat trauma holistically using the nervous system-somatic system connection.
Establishing Resourcing and Grounding in the Clinical Therapy Session
In many types of therapy, clients can become over-activated or even shutdown when encouraged to relive their traumatic experiences and memories without installing essential safety measures or a “home base.” The charge of trauma energy becomes stuck within the body. Identifying the flood of somatic sensations can quickly become overwhelming, especially in instances of PTSD or other shock trauma. The key is to slow it down. Pacing, or titration, is taking one little part or piece of the experience at a time and examining it – both the emotions (fear, sadness, shame) and the somatic sensations.
You might begin sessions by asking the client to describe how their body feels in the space they are in now. What are the different sensations? Perhaps if they hold tension in their jaws or shoulders, we can do some relaxation exercises to reduce those tensions to open the self-awareness and perceptions to the body’s clues.
If a part of the body feels stuck, painful or tense, you might redirect their attention to a part of the body that feels better – finding their feet firmly planted on the floor, for example, might feel stable, safe or give off a warm sensation. Then go back to the symptomatic area for a brief check-in – and then back to the resourced area.
Titration and Pendulation in Therapy Sessions
Titrating the experience when working through trauma with a client assists in processing the trauma by pacing it slowly and in manageable doses for the nervous system to move gradually through trauma to safety, both autonomically and somatically.
Pendulation, a term coined by Dr. Levine, re-establishes the normal flow between opposing forces such as contraction and expansion. Scan the body and moving from a calm or resourced area to an area of distress, back and forth gently, improves resilience. Like any exercise at the gym, building the resilience muscle connects us with a sense of positivity and a renewed sense of managing negativity when it occurs. This movement back and forth between negative and positive experiences helps one remain present and feel capable of handling what comes.
It’s the moving through the process that re-opens the life force for the client rather than living in a perpetual state of reliving their trauma over and over again and staying stuck in time rather than moving forward.
Experiential Exercises in Therapy
Dr. Levine often uses exercises, like the “voo” sound, to manifest a feeling of calm and relaxation within the body. It interrupts the vicious trauma-cycle occurring within the body threat-fight-flight-freeze, restoring the breath to a usual calm rate that resonates deep in the gut. Dr. Levine likens the exercise to a lighthouse calling out a safe harbor to passing ships.
Below is a demonstration of Dr. Levine doing calming exercises in response to the pandemic.
EXPERIENTIAL EXERCISES 1 w/Dr. Levine from Peter A Levine, PhD on Vimeo.
The therapist might also begin with resourcing by installing imaginary but powerful safety using the “competent protector.” You can suggest the client surrounds themselves with the experience of having a sentinel watching out for them. Who would they choose to help them or watch over them during their trauma experience, and how would that have changed their feeling of fear, threat, shame or panic? What are the sensations in the body knowing that someone is there who has their back?
While clients know their competent protector is imaginary, the sensations in the body are genuine. The brain does not know the difference between an old memory and a new one, but the brain will reconsolidate the memory with the new, better feeling in the body. Healing the trauma in the body first is Dr. Levine’s “Bottom-Up” processing. Bottom-Up is designed to create new experiences in the body to contradict the tension, pain or stagnation caused by staying stuck in trauma. Success lies by addressing the sensations related to our feelings and addressing behavior patterns to improve the client’s overall whole self-experience and the ability to enthusiastically explore the richness of life.
