On the last weekend of March Brighton Therapy Partnership hosted a CPD day exploring different aspects of the treatment of Trauma; eminent speakers, many colleagues and a chance to network and connect as well as explore the realm of trauma from some familiar and less familiar perspectives. Then Covid-19 took hold of the planet; country after country began to etch their own national and personal trauma stories, and the individual and collective lives of all of us in this vulnerable world, began spinning on a different axis. A collective trauma, whose impact we cannot yet predict, began to make itself known. Trauma is the response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope, causes feelings of helplessness, diminishes their sense of self and their ability to feel the full range of emotions and experiences.
According to Dr Dan Siegel from the Mindsight Institute,
“Sensorimotor Psychotherapy blends theory and technique from cognitive and dynamic therapy with straightforward somatic awareness and movement interventions… that promote empowerment and competency.”
Traditional psychotherapy addresses the cognitive and emotional elements of trauma, but lacks techniques that work directly with the physiological elements, despite the fact that trauma profoundly affects the body and many symptoms of traumatised individuals are somatically based. By using the body (rather than cognition or emotion) as a primary entry point in processing trauma, Sensorimotor Psychotherapy directly treats the effects of trauma on the body, which in turn facilitates emotional and cognitive processing.
In this article, we explore sensorimotor psychotherapy and the detail of the technique, as well as exploring some of the impacts for other understandings of working with traumatic memories and events.
What you need to know about Sensorimotor Psychotherapy
This is a growing body of knowledge, but we’ve broken down fifteen essential things that all therapists should come to understand about sensorimotor psychotherapy and how it impacts upon counselling and trauma.
1. The body keeps the score
The body is a place of storage and a place of release, it is our first place of contact and response and trauma cannot be resolved through the cognitive process alone. The observation of those in this field is that traditional psychotherapies prioritise the narrative and cognitive functions above the physiological and yet increasing evidence from neurobiology and alike suggests the role of the body in storing and expressing trauma is in fact vital in the successful processing and release of such experiences in our lives. Subtle and less subtle pathways of trauma are etched into gestures and somatic, physiological responses. In short as Bessel Van de Kolk says, the body will ‘keep the score’.
‘By using bodily experience as a primary entry point in trauma therapy, rather than the events or the “story,” we attend to how the body is processing information, and its interface with emotions and cognitive meaning-making’ Ogden, 2002; Fisher, 2003
When it comes to trauma, treatments often involve the cognitive and narrative aspects of our lives, but the body will subconsciously react in its own way and keep the score. Therefore, we must look at sensorimotor therapies in order to treat this aspect.
2. Trauma is a ‘bottom-up’ response.
There is an element of ‘survival’ to trauma. The fact that the definition of a trauma suggests a case of fear, survival and means part of the brain associated with reason and cognition etc. is shut down in order to survive means we therefore experience trauma first and foremost on a physiological level as we have no access to other more ‘rational’ parts of our brain. The hippocampus is inhibited and the frontal cortex shuts down to enable instinctive response while the amygdala, or the ‘fire alarm’ of our brain, initiates sympathetic nervous system response encodes the trauma. As a result of this, we physically react in similar and known ways when events occur in life that remind us or ‘trigger’ us back to a previously unprocessed traumatic event. The argument is then that it is the physiology, the familiar ways in which the body contracts, shifts, moves when we find ourselves reminded of past events, that points us towards the way we can process it.
3. A phase oriented approach can treat trauma
Therapy can be seen in terms of three ‘phases’. The first stage is where the counsellor supports the client to start building safety and trust. The second phase involves helping to control the symptoms and supporting the client to stabilise, and then the third phase is moving the client towards continued integration, rehabilitation, and personal growth.
In the ‘phase oriented treatment approach’ counsellors need to ensure we spend enough time in phase 3 and this is where clients can use their strengthened resources to develop a more resilient somatic sense of self. Late-phase therapy involves consolidation of gains, achieving a more solid and stable sense of self, and increasing skills in creating healthy interactions with the external world. This approach is based on the work of Pierre Janet in ‘A Psychology of Action’ as far back as 1898.
The phases can also be broken down in the following ways.
PHASE 1: Symptom reduction and stabilisation.
PHASE 2: Treatment of traumatic memory, as well as non-traumatic memories that pertain to attachment
PHASE 3: Personality integration limiting belief systems and meaning, social (re)connection, relationship and intimacy, life issues, risk-taking, and change.
4. Neuroception in the trauma response
How do we know when people or situations are ‘safe, dangerous or life threatening’?
Neuroception describes how neural circuits distinguish whether situations or people are safe, dangerous, or life threatening. Neuroception explains why a baby coos at a caregiver but cries at a stranger, or why a toddler enjoys a parent’s embrace but views a hug from a stranger as an assault. This is an important concept and helps explain our responses to situations.
Using “neuroception” (via neural circuits that sense or detect safety, danger and life threat), we instinctively evaluate and employ the most adaptive responses. Stephen Porges came up with the term and it helps us understand the role of the Ventral Vagal (Safety) and Dorsal Vagal (immobilising threat) in how we respond to stimuli. These ‘responses’ are found in the animal kingdom when faced with a threat to our safety or someone we care for we have flight, flight, freeze or feign dead (flop).
5. Building bodily connection through grounding
Grounding exercises are vital in supporting clients and therapists in developing and maintaining connection to the body.
An example of a grounding exercise is when you imagine the body as a tree, calming the system and allowing roots to extend deep into the earth while our branches extend into the sky. We become trees in a forest, able to withstand the storms of our own hearts and minds as well as of others and of our world. As we connect more deeply we can imagine our roots touching those of our neighbours and forming a forest of calm and protection.
Grounding exercises build powerful connections between the mind or body. A common exercise is to visualise being a tree within the forest. Stable, unwavering and majestic – how do you react to events both in your mind and externally?
6. Using Acts of Triumph
Moving our clients towards ‘Acts of Triumph’ is a way to somatically resolve stuck traumas.
An “Act of Triumph,” in working with single event trauma, is essentially the completion of an incomplete action that could not be executed during the time of the trauma. For example, these incomplete actions could be to want to push away an attacker but are unable to do so, or run away or move in some way to protect oneself… this is building on the work of Pierre Janet cited above.
“{Traumatised} patients … are continuing the action, or rather the attempt at action, which began when the thing happened, and they exhaust themselves in these everlasting recommencements.” 1919/25, p. 663 Pierre Janet
In phase 2 of the work, the ‘treatment of traumatic memory’ tension and impulse can be explored with interventions which lead the client towards these ‘Acts of Triumph’ thus allowing the effective somatic release of the trauma.
7. Embedded relational mindfulness is a way to embody and enable Acts of Triumph to occur
This leads to an understanding of the importance of ‘embedded relational mindfulness’ (ERM) where clients are encouraged to follow through with somatic movements or work through the trauma on the level of the body through mindfulness.
‘Embedded relational mindfulness privileges mindful awareness of present moment experience over “talking about,” conversation, and interpretation’ Ogden, 2014
This process focuses on what transpires in the relational field between client and therapist and is interwoven with attachment focused therapies where therapist & client together mindfully study the elements of the client’s present experience that emerge spontaneously in response to a selected stimulus or ‘triggers’.
8. Using the inner experience of sensation
The building blocks of present moment experience start with the inner experience of sensation.
This process, as it is described by practitioners of Sensorimotor Psychotherapy, maps directly onto the four foundations of mindfulness; the first being the mindfulness of the body. Cognition comes after emotion and sensation, and it is our last to access and therefore hardest to access for healing and ‘completion’ through the cognitive field alone.
- Inner body sensation: The physical feeling which is created as the various systems of the body monitor and give feedback about inner states.
- Movement: Including micro-movements and gross motor movement, voluntary and involuntary movement.
- Five-sense perception: Inner and outer sensory functions: smell, taste, sight, touch, and hearing.
- Emotion: The emotions and more subtle nuances of feeling tones, mood, “positive” and “negative”.
- Cognition: Thoughts and interpretations of stimuli, meanings, beliefs about ourselves, others, the world.
The sensations of the body are the easiest to access, whilst cognition and emotion are far deeper rooted, making them harder to access and harder to change. We can therefore use the body as a means to work with those deeper systems.
9. The key to this work is to (re)balance resources with traumatic reactions
Resources are those ‘skills, abilities, objects (things), relationships and services that provide support for maintaining safety, a sense of self and both connection and differentiation from others in our daily life regardless of what is happening in the environment’. This process in Phase 3 of the treatment is about enabling clients to develop a new centre, a new resilience when encountering traumatic triggers and events. We support the clients in building a toolkit of resources in the final stage to help them maintain a new consciousness and relationship to their somatic life.
10. We need to resource ourselves.
This is vital at this current moment in the human journey as over time when we ourselves could be lacking resources and dealing with the impact of trauma in our own lives so are in danger of becoming depleted in working with clients.
The ‘window of tolerance’ is a term used to describe space which a person is able to function most effectively. When people are within this arousal zone, they are typically able to readily receive, process, and integrate information and otherwise respond to the demands of everyday life without much difficulty. Resources for exploring the ‘window of tolerance’ include: Awareness of Body Sensation, Grounding, Orienting, Boundaries, Locomotion, Breath, Containment, Self-Soothing, and Movement Reaching Alignment Centering – all of which the therapist should have good access to also for their own personal resourcing and capacity to be with the client.
11. Understanding the experience
Some useful questions for determining existing resources for ourselves and others are:
“What got you through that experience?”
“How did you survive? What was of help?”
A powerful way to do this is to provide a menu exploring how someone got through difficult experiences with questions such as, ‘Maybe you had help, maybe you knew what to do, maybe you retreated into yourself, or turned to art, or sports’. We can all ask ourselves the same questions in the light of past and current traumas. You can put together a table with a client to list current internal and external resources that they already had in different areas of life such as: spiritual, through nature, creative or somatic.
12. Understand developmental disruptions vs trauma
We need to wear our ‘trauma bifocals’ and understand the difference between developmental disruptions and trauma.
Imagine putting on some glasses divided by a red line; the bottom half looking for signs and symptoms of trauma and the top of developmental injuries. The bottom half (the trauma) is characterised by an ‘animal brain activation and dysregulation’ and is a ‘survival responses for threat against life and limb’ whereas the top half (developmental disruptions) is, ‘usually learned patterns of embodied action systems and beliefs’. Inn other words ‘developmental injuries’ are attachment seeking or avoidance behaviours or ‘script’ (in Transactional Analysis terms) behaviours and decisions that come from adapted ways of being in the world in order to survive in our family as infants.
13. Understand attachment trauma
Attachment trauma is a ‘double bind’ and can involve ‘structural dissociation’.
Attachment trauma is harder to unravel and takes much time and trust with a skilled practitioner. Structural dissociation involves a lack of integration of the personality where at least two parts of ourselves develop. One part avoids the memory, and another part will be fixated on it. It can lead to the diagnosis of ‘Borderline Personality Disorder’. It is often the result of consistent developmental trauma and a disorganised attachment experience which means a coherent sense of self cannot be developed. Obviously, this form of trauma will take much time and committed work from the client and the counsellor to work through and process.
14. Completing Acts of Triumph
A completed ’Act of Triumph’ leaves us feeling complete, joyful and connected.
Counselling and Psychotherapy are about facilitating clients to make positive changes and feel differently about themselves, others and the world.
‘[An] important characteristic of the completed action, {or ‘Act of Triumph’} one we must do our utmost to obtain however difficult it may be, is pleasure… When an action is being functionally restored… we almost always notice at a certain moment that satisfaction reappears in one form or another, a sort of joy which gives interest to the action, and replaces the feelings of uselessness, absurdity, and futility which had formerly troubled the patient in connection with the action.’ Janet (1925, pp. 988-989)
Similar to Gestalt Cycle of Awareness where we have worked through and processed our unfinished business and can rest in the fertile void.
Sensorimotor Psychotherapy and today
There is much more that could be said on this fascinating topic, and for those interested we have further workshops with Tony Buckley.
The current crisis is no doubt an trauma in its unfolding. The shock and deep changes we have all had to make to our lives already, the impact on our family and friends and on the entire community locally and globally is beyond our capacity to comprehend. How we all process and come to terms with not only the current changes to our lives but the changes to the culture that will inevitably follow is an invitation to wake up in the somatic realm. We cannot change our current situation and indeed the narrative is one which may well be contributing to our collective fear and panic. Perhaps the one area we have constant access to, in the stillness and connection with ourselves or the intimacy with our clients, is our own body and how it reacts and responds to the world around us.
