To acquire knowledge, one must study; but to acquire wisdom, one must observe.
—Marilyn vos Savant
You can observe a lot just by looking.
—Yogi Berra, catcher, New York Yankees (circa 1950s)
The therapist who is familiar with bodily feelings has a privileged window onto the primal life of the psyche and soul. No amount of talk alone can match this vantage point. Long before the advent of psychiatry, the French philosopher Pascal noted that “the body has its reasons that reason can not reason.” The Austrian Wittgenstein, in this same tradition, wrote that “the body is the best picture of the mind.” And the Australian F. M. Alexander, around the turn of the nineteenth century, made an extensive study of peoples’ postures and concluded, “When psychologists speak of the unconscious, it is the body that they are talking about.”
The current lack of the appreciation of the body in psychotherapy caused the analyst Musad Kahn96 to lament, “I have not come across any paper that discusses the contribution made to our knowledge and experience of a patient from our looking at him or her in their person as a body as against looking at merely the verbal material and affective responses in the analytic situation.”
Somatically oriented therapists provide their clients with carefully paced feedback in the form of invitations to explore their emerging bodily sensations. This feedback is based largely on the therapist’s ability to observe and track the postural, gestural, facial (emotional) and physiological shifts throughout a session in order to bring them into a client’s conscious awareness. This allows both client and therapist to uncover unconscious conflicts and traumas that are well beyond the reach of reason. Freud seems to have grasped this concept in his early work when he says, “The mind has forgotten, but the body has not—thankfully.” Yes, thankfully! Though Freud seems to have abandoned this premise, his student Wilhelm Reich spent his entire career studying how conflicts are lodged in the body. “When it comes to the consulting room,” he remarked, “there are really just two animals and two bodies.”97
In this chapter, I will use examples from my own cases to illustrate the principles outlined in Chapters 5 through 7. In the very beginning of session work, a client may not understand the therapist’s feedback about her unconscious attitudes. But as the client becomes more conscious of her sensations, she is able to use them to access innate resources and to deepen her capacity to “know” herself through the subtle promptings of her body. In the first case (Miriam), I introduce expressive, but hidden, body language. This case is relatively straightforward and demonstrates some basic body-oriented observational skills that therapists can utilize with their clients to facilitate their awakening and to enhance integration of their sensations, feelings, perceptions and meanings.
Miriam enters the room, tentatively sits down, and folds her arms tight across her chest. This posture gives the impression of rigid self-protection. Of course, one may have many reasons for folding one’s arms: she could be comforting herself or even keeping herself warm. It is the overall context that tells the story. Miriam is agitated, pumping her crossed legs repeatedly. Her face is visibly constricted; her lips are thin and pulled tight. Miriam offers that she feels discontented and resentful about her marriage and work situation. She finds herself “in bad moods a lot” and frequently has trouble staying asleep at night. When she wakes up, it is often because of cramps in her belly and restlessness in her legs. She describes this intrusive experience by grumbling, “It’s like they kick at night and wake me up.” Her family doctor thinks that she may have “restless leg syndrome” or depression, and suggested an antidepressant medication. However, she first wants to try and “talk things out.”
Miriam’s body language reflects both her distress and her “resistance.” This resistance is there for a reason: it is the physical expression of how she is protecting herself. In part, Miriam is defending herself as though from an outside “attack.” However, she is protecting herself primarily from her disowned sensations and feelings. Resistance needs to be worked with gently and indirectly. Frontal confrontation is generally ill advised: to “attack” resistance directly is likely to intensify it or to break it down precipitously. Such a sudden demolition of a defense is likely to bring with it overwhelm, chaos and possible retraumatization.
Observing resistance at the bodily level allows the therapist to monitor the person’s developing capacity to befriend her sensations and feelings as the session progresses; and, thus, to assess the efficacy and intensity of various therapeutic interventions, both verbal and nonverbal. As the client begins to feel safe enough (through appropriate reflection, pacing and mirroring), she begins to feel she is seen and respected; and then, naturally, her guarding postures will gradually diminish. If the client, on the other hand, tries too hard to open up (for example, by divulging more about herself than she is physically and emotionally ready to), her body will reflect that by intensifying resistance or in non-congruent changes in her nonverbal and verbal behaviors. However, when a therapist can track the client’s burgeoning awareness and provide support in tracking her self-protective somatic mechanisms (without pushing into—or backing away from—them), the deeper levels of the body’s unconscious communication system begin to speak, both to the therapist and to the client.
While, initially, Miriam is not conscious of her protective posture of habitually holding her arms crossed, it is still a relatively voluntary gesture. As she feels safer and more confident, these unspoken narrations emerge as more spontaneous, rather than habitual, expressions. As she gains deeper access to fledgling feelings, core issues begin to surface, ready to be explored.
Miriam continues to talk about her difficulties at work and with her husband, Henry. Although these are the same problems she was struggling with a few minutes ago, this time there is more animation in her voice. She gestures with her arms, extending them slightly outward in front of herself. Her hands are nearly at right angles to her wrists, almost as though she were pushing something away. I make a similar movement with my arms so as to “mirror” her movements and help her to feel and trust her own (disowned) movements.*
I bring Miriam’s attention to her extending her arms and bending her wrists and suggest that she repeat the movements slowly. I ask her to try to focus on how her arms feel when she makes the movement, so that she gets a sense of how the movement feels physically from the inside. At first, she seems puzzled. After a few times, she pauses, smiles and says, “It feels like I’m pushing something away … no, more like holding something away … I need more space, that’s what it’s really like.” She sweeps her arms from in front of herself and then off to both sides, creating a 180-degree range of free motion. She lets out a deep and spontaneous breath: “I don’t feel as suffocated, and my belly isn’t hurting like it was when we started.” She extends her arms, flexing her wrists again. This time she holds them out for several seconds, almost at arm’s length. “It’s the same problem … at work and with my husband, too.” She now places her hands gently on her thighs. “It’s so hard for me, I don’t know why but … I don’t feel like I have a right to do this … like I don’t have a right to my own space.”
I ask her if it’s more of a feeling or a thought. She pauses, giggles and replies, “Hah, I guess it’s really a thought.” Now there’s a deeper laughter.
By contacting her nonverbal bodily expression, Miriam is able to go beneath the veneer of her ruminative thoughts about Henry and her work, to explore freely the story her body is beginning to tell. With this emergent kinesthetic and proprioceptive awareness, she has begun to sense into the neuromuscular attitude that underlies her internal conflicts.
After settling into her bodily experience, Miriam starts to get wound up again. I observe her carotid pulse and notice an increase in her heart rate, along with pressured, rapid, shallow breathing. I ask her to put her questionings aside for a moment and place her focus back on her body. Relieved by this suggestion, she closes her eyes.
“I feel more solid now … like there’s more of me.”
When I ask her to try and identify where in her body she feels the solidity, she says, “I don’t know; I just feel that way.”
“Just take your time,” I suggest. “Don’t try too hard. Just settle inside your body and see what you begin to notice.”
Miriam closes her eyes. She seems a little confused and doesn’t speak for a minute or two. “Its mostly in my arms and legs … They feel like they have more substance … They feel more solid … I feel that way.”
At this point, Miriam initiates further, this time self-directed, exploration by closing her eyes without my suggestion. After a minute or two, her jaw begins to tremble almost imperceptibly. I wait to see if she will notice this on her own.
“I feel strange,” Miriam says, “kind of shaky inside … I don’t like this … It makes me feel kinda weird inside … like I’m getting out of control, like I’m not myself, like it’s not me.”
I reassure her by explaining that new sensations often feel uncomfortable and alien at first, and encourage her to “just let it happen … try to suspend labeling or judging sensations for a bit.” Miriam tells me that she’s feeling worse, even more uncomfortable. I acknowledge this but gently and firmly encourage her “to hang in a little bit longer,” to shift her attention to her arms and legs for a while—to the places in her body where she had been feeling rooted a short time ago.
“Huh, they don’t feel shaky … actually they feel strong … I feel my jaw shaking … That’s where I feel shaky … My legs feel solid.”
The juxtaposition of the empowering sensations of her arms and legs supports her ability to experience the “shaky” sensations associated with the weakness without being swallowed up by them. Her breathing is now deep, continuous and spontaneous. Her skin has a warm rosy glow, indicating that the social engagement system is starting to function, to come online.
I suggest that she slowly begin to open her eyes and look around.
“That’s funny,” she says. “Things seem a little clearer; the colors are brighter and … I think warmer, too. Actually, I feel a little warmer, and the trembling is less … or not so scary … It feels like I could go back inside now … Do you want me to do that?”
“That’s up to you,” I say, knowing how important the element of choice is. “What I can tell you, though, is that you are starting to be able to go inside yourself, and you seem less scared and helpless.”
She looks at me momentarily, but then averts her gaze downward to the floor. Slowly she looks upward, contacting my eyes. A single tear rolls down her cheek. “Yes that’s right, I don’t feel so scared … In some ways I feel a little excited … Yes I want to go on … It’s scary, but I think I can do it … I just need some help … your help.” More tears stream from her eyes. Her words stumble as she chokes: “It’s hard for me to ask … It feels emotional … I don’t think I have so much experience in asking for help.”
This acknowledgment lets me know that the social engagement system is operative, and that deeper exploration is possible. “Yes, I’m glad to give you support,” I respond. When I ask her if she has any ideas of what kind of support might be helpful, she responds that just to do what I’ve been doing is what she wants. I ask her to be more specific.
“I’m not sure,” she says. “Actually, I think it has to do with feeling that you’re here, here for me. When you give me feedback, that helps keep me in touch with what I feel … in a way with who I am.”
“When you say that,”—I see her face relax—“you seem to let go more deeply.” Miriam smiles, and I continue, “It’s different than a few minutes ago, when you spoke of not having had the experience of asking for help.”
“Yes,” she adds, “it’s really different to ask you for support in helping me to learn how to be there for myself … That way I don’t feel less than you, I feel more equal … I like that … I feel like if I didn’t want to do something that you suggested to do, I could tell you that now.” Without prompting, Miriam holds out her arms and hands again and sweeps them around in a horizontal semicircle. “Yes, these are my boundaries. I can set my limits—that feels good … and I can tell you what I need.”
We both smile. Miriam closes her eyes and sits quietly for several minutes. While it may seem simplistic, having the actual, kinesthetic, proprioceptive experience of being able to form and hold boundaries gives Miriam a significant physical experience that contradicts the pervasive sense of powerlessness that has driven her perception of the world. Rather than being folded defensively across her chest, her arms now lie resting on her legs—exemplifying a more open stance and a willingness to look inward.
Miriam continues, “First I started to feel the shaking again … It became more intense, but then it started to settle down on its own.” She is now beginning to self-regulate by moving through activation/deactivation cycles. “I felt some warmth starting in my belly and then spreading out in waves … That felt really good … I could even feel the warmth flowing into my hands and legs … but then my gut started to knot up. I started feeling a little sick, nauseous and queasy. I realized that I was thinking about Evan, my first husband. Actually, I saw a picture of him walking toward me. He was killed a month after we were married … I think that I never got over it … I couldn’t believe it happened … In a way I still don’t … I dream about Evan a lot. It’s always the same dream. He comes to me; I’m despondent. I ask him why he left me. He doesn’t answer me, but turns his back and walks away. I wake up wanting to cry, my throat is all tight, but I don’t want Henry to know. I feel so terrible; like there’s something wrong with me … I don’t want to cause him any pain.”
“Miriam, I’m going to ask you to say something and notice what happens inside when you say the words. But remember these are my words. They might not mean anything to you. I’m only asking you to try them out and then just to notice how your body responds. Try not to think too much about it; just do it. Does that feel OK to you?” I say this not because it is true (or false) but so that the person can observe the effect the sentence has on their body sensations and feelings.
She nods. “Yes, that’s OK. I’d like to do something about these feelings, these dreams, if I can.”
“Ok, here’s the sentence: ‘I don’t believe it happened; I don’t believe you’re really dead.’ ” The purpose of this is to bring into consciousness the direct body experience of denial so that it can be dealt with.
Miriam holds her breath and turns pale; her heart rate drops sharply, from about 80 to 60, indicating that the vagal immobility/shutdown system may have kicked in. “Are you OK, Miriam?” I ask.
“Yes … but my guts are queasy and tight … like a cold hard fist … I feel sick again … It’s worse this time … but I think that I can handle it. I’ll tell you if it’s too much.”
Wanting to reinforce her developing capacity to assess her capability to handle difficult sensations, I ask her, “What gives you that sense, Miriam, that you can handle it?”
“Well, mostly I feel it in my arms and legs again. They still feel strong now, even if they’re shaky.” With her eyes still closed, Miriam starts to tremble visibly.
“That’s OK,” I encourage. “Just try and be with it. Know that if you need to, you can open your eyes. OK if I place my foot next to yours?”†
“Yes, I would like that … Yes, that feels better.” The trembling increases in intensity; it settles, increases and settles several times. Miriam takes a deep spontaneous breath and then becomes still. She seems peaceful; the color of her hands and face indicates a significant rise in temperature. Sweat begins to break out on her forehead.
“How are you doing now, Miriam?”
“I feel really hot … like waves of heat burning me … It’s so intense, like nothing I’ve ever felt before; maybe once when I … was with … oh my god!”
“OK,” I offer, “just sit quietly; just let it settle.”
Tears start streaming as Miriam begins to cry softly. “It feels so deep. I couldn’t feel this before. It was just too much when he died. It’s different … I can feel the pain in my body and I won’t be destroyed … Actually the pain in my belly is completely gone … and it feels warm there … a soft kind of warm.” This is an example of linking islands of safety (see Step 2 in Chapter 5). The linking of resources starts with the sensations of strength and solidity in Miriam’s arms and legs as she is able to form boundaries. Then experiencing the visceral sensations of warmth and expansion gives her a developing sense of empowerment and of intact goodness. This “chaining” of resources allows her to gradually experience the sensations and feelings of paralysis and helplessness, which form the core of her traumatic experience. As she does this without being overwhelmed, time has in a sense moved ahead from the frozen past of denial into the present. In the following phase of the session, Miriam accesses the “unfinished business” of anger, loss and guilt. In moving from fixity to flow, she awakens her sensual aliveness.
At this point, I suggest to Miriam that she just sit quietly with her body, that she sort of meditate and wait for any sensations, feelings, pictures or words. She becomes rather still, but not frozen like she appeared earlier in the session. However, after a while she tightens up again:
“I don’t really have a picture … Well, I sort of do, but it’s more like I’m thinking about him, about my first husband. And I feel tense all over.”
“Look,” I suggest, “maybe sit with the tension a little longer and see what develops with the feeling that’s in your body.”
She seems to drop in again. “My belly feels so tight, it could explode.”
“And if it explodes?” I ask.
She is quiet; then, a torrent of tears. “I don’t really have a picture of him, but I do have that tightening in my gut again … What should I do?”
I suggest that she focus on the tightness and make the “voo” sound (see Chapter 6) to help her “open” her guts.
“You’re always inside of me. I can never get away from you … Why are you there? I don’t understand … Hmm,” she intones, becoming curious as she goes along. After a few minutes, her legs begin to tremble again. The shaking intensifies and spreads—this time, with little jerks into her shoulders. A deep spontaneous breath emerges, and tears stream from her eyes.
Miriam reaches out tentatively with her arms and quickly pulls them back. After another breath she speaks as if to her first husband: “Evan, I’m holding on to you. You’re in my guts. I won’t open to Henry … I just keep holding on to you.” She starts to cry, but then continues, “I think I’m mad at you. I can’t believe I’m saying it, but I’m mad at you for leaving. You left me alone. I hate that you died.” She clenches her hands and yells: “I hate you! I hate you! … Don’t leave me, damn it! … I hate you!” She begins to cry again, this time sobbing deeply.
When she starts to talk, I suggest that she should “maybe just let things settle.”
“Yeah, I think you’re right … There’s something I’m trying to get away from.” Some time passes, and Miriam cries gently, her legs trembling softly. “I haven’t opened to Henry. I’ve been pushing him away. No wonder we’re always in conflict. And when he tries to get physical, I just want to push him away … I felt guilty about that.”
Her hands make a pushing movement again. Gradually, her movements become softer: her hands open out into a supine position, and she gently brings them toward her chest in a gesture of reaching and taking into the heart a tentative embrace.
I don’t say anything, and Miriam continues, “I needed to protect myself … I felt so hurt and guilty.”
“And how do you feel inside now?” I ask to keep her in the moment.
“Well, actually I feel really good.”
“And how do you know that?”
“Well, it’s mostly that I feel a lot of space inside myself.”
“Where do you feel that?”
“I feel that in my belly and chest … My head feels like it’s got more room too, but mostly my belly and chest, they feel really open … It feels like a cool breeze is in my body. My legs feel really powerful, and I have a lot of … I feel shy to say it … I feel warm and tingling in my, in my … vagina … It feels like I really want Henry.” She pauses.
“I did what I had to do then,” she went on, “but it’s time to let go. I was so afraid of my hurt … but even more afraid of my anger. It’s like, if I felt what I felt, I might hurt Henry somehow … It doesn’t make sense logically, but that’s what was all twisted up inside of me.” She adds, “But I don’t need to do that anymore.”
Miriam takes a full easy breath and says with a broad joyful grin, “That breath took me and tickled me and laughed me.” She laughs freely, looks around the room, then slowly at my face.
She puts her hands to her face—first, to cover it in embarrassment, but then gently holds and strokes it shyly. Tears roll down her cheeks.
“I feel finished … for now, I mean,” she says. “I know there’s other stuff, but I just want to sit in your yard by the river for a few minutes, then take a walk … Thanks … See you next week.”
The mind has forgotten but the body has not—thankfully.
—Sigmund Freud
Bonnie is not an aggressive person, but she is by no means a pushover, either. Most of her peers and friends see her as well adjusted, even-handed and assertive. It was therefore surprising to her colleagues, and to herself, when for no apparent reason she became increasingly submissive and unpredictably explosive. At the point when her behavior threatened her relations with her colleagues, she became concerned.
During my Berkeley training class in 1974, Bonnie raised her hand when I requested a volunteer for a demonstration session. This was to be a demonstration that would start solely with symptoms or behavior issues rather than with any recall of a compelling event. I will frequently work without a historical link in order to prevent the client from bypassing bottom-up processing and prematurely jumping to an abstract, interpretational level. Neither I nor Bonnie’s classmates knew her “story” when she elected to work with me on her symptoms in front of the group. Bonnie herself did not make the connection between her behavioral changes and an event that had transpired a year and a half earlier and that, as far as she was concerned, was irrelevant.
I asked Bonnie to recall a recent encounter with a colleague that illustrated her sudden shift in behavior, and then we both noted her bodily reactions. Bonnie described feeling a sinking sensation in her belly. I noticed that her shoulders were hunched over and brought that to her attention. When asked to describe how she felt in that position, she replied, “It makes me hate myself.” Bonnie was taken aback by this sudden outburst of self-loathing. Rather than analyzing why she felt that way, I guided Bonnie back to the sensations in her body.‡ After a pause she reported that her “heart and mind were racing a million miles an hour.”
She then became disturbed by what she described as a “sweaty, smelly, hot sensation” on her back, which left her feeling nauseated. Bonnie now seemed more agitated—her face turned pale, and she felt an urge to get up and leave the room. After reassurance, Bonnie chose to remain and continued tracking her discomfort. It intensified and then gradually diminished. Following this ebb and flow, Bonnie became aware of another sensation—a tension in the back of her right arm and shoulder. When she focused her attention on this, she started to feel an urge to thrust her elbow backward. I offered a hand as a support and as a resistance so that Bonnie could safely feel the power in her arm as she pushed it slowly backward. After pushing for several seconds, her body began to shake and tremble as she broke out into a profuse sweat. Her legs also began moving up and down as if they were on sewing machine treadles.
As Bonnie’s arm continued its slow press backward, the body shaking decreased, and Bonnie felt as though her legs were getting stronger. She said that they felt “like they wanted to, and could, move.” She reported noticing a strong urge propelling her forward. Suddenly, a picture flashed before her—a streetlight and the image of the couple that had “helped her.” “I got away … I got away …,” she cried softly. It was then she remembered molding into the man’s torso as he held a knife to her throat. She went on, “I did that to make him think I was his … Then my body knew what to do, and it did it … That’s what let me escape.”
Then the story that her body had been telling emerged in words: eighteen months earlier, Bonnie had been the victim of an attempted rape. While walking home after visiting a friend in another neighborhood, a stranger had pulled her into an alley and threatened to kill her if she didn’t cooperate. Somehow, she was able to break free and run to a lighted street corner where two passersby yelled for the police. Bonnie was politely interviewed by the police and then taken home by a friend. Surprisingly, she could not remember how she had escaped, but she was tearfully grateful to have been left unharmed. Afterward, her life appeared to return to normal, but when she felt stressed or in conflict, her body was still responding as it had when the knife was held to her throat.
Bonnie found herself helpless and passive or easily enraged under everyday stress, not realizing that this was a replay of the brief pretense at submissiveness that probably saved her life. Her “submission” successfully fooled the assailant, allowing a momentary opportunity for the instinctual energy of a wild animal to take over, propelling her arms and legs in a successful escape. However, it had all happened so fast that she had not had the chance to integrate the experience. At a primitive level, she still didn’t “know” that she had escaped, and remained identified with the “submissiveness” rather than with her complete two-phase strategy that had in fact saved her life. Motorically and emotionally, it was like part of her was still in the assailant’s clutches.
After processing and completing the rape-related actions, Bonnie now reported having an overall sense of capability and empowerment. She was “back to even more of her [old] self” in place of the previous submissive self-hatred. This new self came from being able to physically feel the motor response of elbowing her assailant, and then to sense the immense power in her legs that had, in fact, carried her to safety.
This is a case where symptoms did not emerge full-blown for twelve to eighteen months after the traumatic experience. Hence, it was not readily apparent that they were sequelae to a precipitating event. For reasons largely unknown, it is not uncommon for symptoms to be delayed by six months or even one and a half to two years. In addition, symptoms may only manifest after yet another traumatic encounter occurs—sometimes years later.
How many of our own habitual behaviors and feelings are outside of our conscious awareness or are long accepted as part of ourselves, of who we are, when in fact they are not? Rather, these behaviors are reactions to events long forgotten (or rationalized) by our minds but remembered accurately by our bodies. We can thank Freud for correctly surmising that both the imprints of horrible experiences, as well as the antidote, and latent catalyst for transformation, exist within our bodies.
The body has its reasons that reason cannot reason.
—Pascal
Just as she did every morning at work, Sharon was reading over her emails. It was a crisp, clear, New York autumn day—the kind of a day that makes one feel excited to be alive. Startled by a thunderous, deafening crash, she turned to witness the walls in her office moving twenty feet in her direction. Though Sharon was immediately mobilized, springing to her feet and readying to flee for her life, she was slowly and methodically led down eighty floors via stairwells filled with the suffocating, acrid smell of burning jet fuel and debris. After finally reaching the mezzanine in the north tower of the World Trade Center one hour and twenty minutes later, the south tower suddenly collapsed. The shock waves lifted Sharon into the air, violently throwing her on top of a crushed, bloody body. An off-duty police detective discovered her, dazed and disoriented, atop the dead man. He helped her find her way out of the wreckage and away from the site, through absolutely thick, pitch-blackness. She met a few other survivors sitting in front of a church, and together they gave thanks to be alive.
In the weeks following her miraculous survival, a dense yellow fog enveloped her in a deadening numbness. Sharon felt indifferent by day, merely going through the motions of living with little passion, direction or pleasure. Just a week before she had loved classical music; now it no longer interested her: she “couldn’t stand listening to it.” Numb most of the time, she was periodically assaulted by panic attacks. Sleep became her enemy; at night she was awakened by her own screaming and sobbing. For the first time in her life, this once highly motivated executive could not imagine a future for herself; terror had become the organizing principle of her life.§
Sharon’s terror was not focused on anything in particular; it appeared everywhere, projected “out there”—onto a world that felt threatening, even when everything was objectively safe and predictable. It kept her from flying, riding the subway or being in public places. She was constantly on guard, whether awake or asleep. Sharon saw me on a television interview, tracked me down through my institute and then traveled four days and nights, by train, to see me in Los Angeles, where I was teaching. On December 1, 2001, we did the session summarized below.
When she enters the room, dressed smartly in an orange business suit, Sharon walks straight to a chair and sits down without seeming even to notice me. It makes me eerily uncomfortable when, almost before I had introduced myself, she begins talking about the horrors of the event, blandly, as though it had happened to someone else.‖ Had I not comprehended her words, I might have thought she was talking about a boring office party rather than a personal confrontation with death and dismemberment. Listening to her emotionally disconnected narrative left me squirming, wanting to get up and leave the room. I am unsettled at what lies hidden underneath her blandness.
My introspection is interrupted, drawn to the intimation of a slight, expansive gesture made by Sharon’s arms and hands as she speaks; it’s as though she were reaching toward something to hold on to. Is Sharon’s body telling another story, a story that is hidden from her mind? I ask her to put her verbal narrative aside for the moment and to place her attention, instead, on the nascent message her hands are communicating to both of us. I encourage her to pursue this avenue by slowly repeating the movement and keeping her focus on its physical sensation.a
Moving slowly and focusing attention on a movement allows it to be felt in a special way. When clients do this, most often they will experience their arms (or other part of the body) moving as if on its own (“like my arm is moving me!”). People will often smile or laugh because the sensation of the arm moving itself seems so unusual.b
Perplexed at first, Sharon describes the gesture as though she is “holding something.” A noticeable shift occurs in her body; her face is visibly less strained and her shoulders less rigid. Unexpectedly, a fleeting image of the Hudson River appears in her mind’s eye, the daily view from the living room in her apartment across the river from Manhattan.
Jumping back to the narrative story, Sharon becomes agitated as she tells me how she is haunted, revisited, by the smoldering smoke plumes, which she now sees every day from this same window. They evoke the horribly acrid smells from that day; she feels a burning in her nostrils. Rather than letting her go on “reliving” the traumatic intrusion, I firmly contain and coax her to continue focusing on the sensations of her arm movements. A spontaneous image emerges, one of boats moving on the river. They convey to her a comforting sense of timelessness, movement and flow. “You can destroy the buildings, but you can’t drain the Hudson,” she pronounces softly. Then, rather than going on with the horrifying details of the event, she surprises herself by describing (and feeling) how beautiful it had been when she had set out for work on that “perfect autumn morning.”
This process is an example of expanding the “aperture” of an image to its pretraumatic state (as described in Chapter 7). Up to the moment before the impact of the jet, it had been a perfect day, infused with vibrant colors and gentle scents. These sense impressions still exist somewhere in the catacombs of consciousness, but they have been overridden by the traumatic fixation. Gradually restoring the full spectrum of the disparate parts of an image is an integral component of resolving trauma.c
Sharon’s body and images are beginning to tell a story that contrasts markedly with the one her words are relaying, almost as though narrated by two entirely different persons. As she holds the images of the Hudson River, along with the associated body sensations, she becomes aware of a tentative sense of relief. She now innocently recalls how she had been excited to come to work that day. Her gesture is stronger and more definite. Continued attention to the physical feeling of the gesture deepens her sense of relaxation, stimulating an almost playful curiosity. As she looks quizzically at her hands, first one then the other, I breathe a sigh of relief. Such a seemingly insignificant shift has profound implications—playful curiosity being one of the prima facie “antidotes” for trauma. Curious exploration, pleasure and trauma cannot coexist in the nervous system; neurologically, they contradict one another.d
This capacity to experience the positive bodily feelings (of interest and curiosity), while remaining in contact with her feelings of terror and helplessness, allows Sharon to do something she would not have been able to do a few minutes before. She can now begin to stand back and “simply” observe these difficult, uncomfortable, physical sensations and images without becoming overwhelmed by them.e They are, in other words, kept at bay. This dual consciousness induces a shift that allows sensations to be felt as they are: intrinsically energetic, vital and in present time, rather than as fragments, triggers and harbingers of fear and helplessness from the past. This felt distinction makes it possible for Sharon to review and assimilate many details of the horrific event without reliving it. This new “dexterity” for revisiting, without reliving, a traumatic experience is essential in the process of recovery and reengagement that I call renegotiation.
People need to disengage the emotional and mental associations from the raw physical sensations they have come to experience as precursors of disaster but that are, ultimately, sensations of vitality. Reestablishing these enlivening affects is a central core of effective trauma treatment. Interestingly, it is also found in ancient healing practices, such as meditation, shamanism and yoga.
When the first plane hit the building, only ten stories above her office, the explosion sent a shock wave of terror through her body. People’s immediate reaction to such terrifying events is to arrest, orient and then escape. This usually entails an intense urge to run. However, trapped eighty stories above ground with thousands of other people, Sharon needed to inhibit this primal reaction. Against the intense impulses to flee, she compelled herself to stay “calm” and walk in an orderly line down the stairs along with dozens of other terrified individuals; this was the case even though her body was “adrenaline-charged” to run at full throttle. Surely Sharon also felt the potential for any one of the other trapped office workers to suddenly panic and start a stampede that would further imperil them all. They, like her, also had to restrain their powerful primal urge to run. As Sharon slowly recounts the details of the escape, while feeling her bodily response, step-by-step, she recalls encountering yet another moment of stark terror when she found the door at the seventieth floor locked and impassable.
Because of the physical comfort she found in contacting the spontaneous, expansive gestures and the images of the Hudson River, I now trust that Sharon can more safely face some of this highly charged material without becoming overwhelmed and consequently retraumatized.f In following her “body story,” islands of safety (Steps 1 through 3 in Chapter 5) are beginning to form in Sharon’s stormy trauma sea. The safety experienced from these internal islands allows her to deal with increasing levels of arousal and to move through them without undue distress.
From this assessment, I guide her back to the moment of the explosion and then have her locate where and how that violent imprint feels in her body. As she attends to this “felt sense,” she becomes aware of an overall feeling of agitation in her legs and arms and tight “lumps” in her gut and throat. She says that she feels stuck. Here I introduce her to using the “voo” sound as a way to help her dissolve and transform the stuck sensations (see Chapter 6). As she focuses on those uncomfortable physical sensations (with the help of the vibratory sounds), the inclination to try to understand or explain them is reduced. With keenly focused attention, I guide her away from interpreting what she is feeling because I do not want the meaning to come from a mental place. The body needs to tell what’s on its “mind” first in order for new perceptions to arise in present time. (This warning about “premature cognition” was displayed on a bumper sticker I recently saw: “Reality: It’s not what you think!”)
Sharon quietly takes some moments to reflect. In suspending the compulsion for understanding, she experiences a sudden “burst of energy coming from deep inside my belly.” Does it have a color, I ask? “Yes, it’s red, bright red, like a fire.” Though visibly startled by its intensity, she does not recoil from its potency. Her experience shifts into (what she recognized as) a strong urge to run, concentrated in her legs and arms. However, with the very thought of running she again “freezes.” I sense that she is caught between the real and necessary desire to escape and her “unconscious” mind, which associates fleeing with being trapped. As on the stairwell, she had to restrain her powerful escape impulse and walk slowly—even though she was in mortal danger. This dilemma was compounded with the shock of finding the door locked on the seventieth floor. Then, when she eventually reached the mezzanine, the south tower collapsed and she was thrown violently into the air. Finally, there was the stark horror of finding herself lying semiconscious on a dead body.
Sharon was caught in a conflict between two very different centers in her brain: the raw, primitive self-preservation messages from the brain stem and limbic system were demanding that she run for her life, while her frontal cortex was sending messages of inhibition and restraint. It was telling her to be “reasonable” and walk calmly in an orderly line. In our session, it was crucial to separate the terrifying expectations of being trapped from her somatic biological impulses to act on and “metabolize” that survival energy. In order to uncouple the two, I ask if she can focus on the intense “electricity” she describes experiencing in her body and imagine taking it somewhere where she had previously enjoyed running. She stiffens in response to that invitation. She says, “It would make me feel too anxious.” I then surprise her by asking her where she feels the anxiety and what it feels like (see the Epilogue to this case). Disarmed, Sharon blurts out, “I don’t know. Oh, it’s my neck and shoulders and my chest feels like I can’t breathe … My legs are so tight that … I don’t know, they feel like they could …”
“Like what?” I ask.
“Like they want to run,” she responds. Then, with a little reassurance, she begins to feel the sensations of running along a path in her favorite park. After a few minutes, I observe a gentle trembling in her legs. I ask her what she is feeling, to which she responds, “I could really feel the running; it was full-out … and I don’t feel the anxiety anymore.”
“OK, Sharon,” I interject, “but what do you feel?”
“Well, actually I feel good, relieved … I feel tingly and relieved; and my breath feels really deep and easy; and my legs are warm and relaxed.” A tear gently streaks down her cheek. Her face and hands have an even pink color.
This was the beginning of Sharon’s separating the powerful biological urge to escape from her mental and emotional expectation that she would again be trapped and overwhelmed. By imagining—with full engagement in her bodily experience—the sense that she was running, unfettered, in a safe place, she was able to complete the frozen action locked in her body.g Just having Sharon imagine running would not have had much of an effect. However, first approaching the place where she was trapped, revisiting (touching into) that moment of terror and then experiencing the (new) possibility of completing that motor act was the therapeutic denouement.98
Having felt her highly charged physically sensations, just as they were, not as she feared or imagined they were, was the linchpin to uncoupling the catastrophic thoughts, as well as the emotions of terror and panic, from her actual physical experience. During this process, which lasted almost two hours, and which was punctuated with cycles of soft trembling and gentle sweating, she gradually developed the capacity to tolerate her sensations until they came to their natural completion. I believe evidence exists supporting the idea that this fulfilled and successful action “switched” certain critical brain circuits, allowing her to experience the possibility of meaningful, effective action rather than helpless anxiety.99 In this way her immobilizing anxiety transformed into a “flowing wave of warm energy.” The vast “life or death” energy of survival had metamorphosed, through cycles of trembling discharge, into feelings of aliveness and goodness.
After directly experiencing this relief as a sensation in her body (a sensation that directly contradicted her paralyzing terror) Sharon regained a sense of aliveness and the felt reality that she had, indeed, survived and that her life had a future with expanding possibilities. She no longer felt trapped in the horror of the event; it began to recede to the past where it belonged. And it was now possible to travel on the subway to hear her favorite music at Lincoln Center. A new and different meaning for her life arose out of a new and different experience at the instinctual bodily level.
This was the story Sharon’s body told. It is reminiscent of Antonio Damasio’s prose:
We use our minds not to discover facts but to hide them. One of the things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day.100
Our feelings and our bodies are like water flowing into water. We learn to swim within the energies of the [body] senses.
—Tarthang Tulku
To review, human beings have been designed over millennia, through natural selection and social evolution, to live with and to move through extreme events and loss, and to process feelings of helplessness and terror without becoming stuck or traumatized. When we experience difficult and particularly horrible sensations and feelings, our tendency, however, is to recoil and avoid them. Mentally, we split off or “dissociate” from these feelings. Physically, our bodies tighten and brace against them. Our minds go into overdrive trying to explain and make sense of these alien and “bad” sensations. So, we are driven to vigilantly attempt to locate their ominous source in the outside world. We believe that if we feel the sensations, they will overwhelm us forever. The fear of being consumed by these “terrible” feelings leads us to convince ourselves that avoiding them will make us feel better and, ultimately, safer. There are many examples of this in our lives: we may avoid a café or certain songs that remind us of a former loved one or avoid the intersection where we were rear-ended a year ago.
Unfortunately, the opposite is true. When we fight against and/or hide from unpleasant or painful sensations and feelings, we generally make things worse. The more we avoid them, the greater is the power they exert upon our behavior and sense of well-being. What is not felt remains the same or is intensified, generating a cascade of virulent and corrosive emotions. This forces us to fortify our methods of defense, avoidance and control. This is the vicious cycle created by trauma. Abandoned feelings, in the form of blocked physical sensations, create and propel the growing shadow of our existence. As we saw with Sharon, when we focus in a particular way on physical sensations, in a short period of time they shift and change; and so do we.
Sharon’s misdirected beliefs (though largely subconscious) are efforts to understand, to make sense of her experience and to help her justify why she feels so bad. These “explanations” will do nothing to help her move through her fright response and complete the inhibited actions that form the basis of her continued trauma response (the how). Mentation, at this stage, only interferes with resolution. For this reason I coach her to resist the seduction to understand and, instead, to fully engage with what she is now physically feeling in her body. The consequence of “premature cognition” is to take the person out of his or her sensate experience before it completes and has the opportunity to generate new perceptions and new meanings.
If you ask several anxious people what they are feeling, they may all say that they are feeling “anxiety.” However, you are likely to get several different responses if they are then queried with the epistemological question, “How do you know that you are feeling anxiety?” One may state, “I know because something bad will happen to me.” Another will say that he is feeling strangulated in his throat; another that her heart is leaping out of her chest; and yet another that he has butterflies or a knot in his gut. Still other people might report that their neck, shoulders, arms or legs are tight; yet others might feel ready for action; while still others might sense that their legs feel weak or that their chests are collapsed. All but the first reply are specific and varied physical sensations. And if the person who feared that “something bad will happen to me” was directed to do a scan of her body, she would have discovered some somatic/physical sensation driving and directing that thought. With a little practice we can actually start to separate out emotions, thoughts and beliefs from the underlying sensations. We are then astounded by our capacity to tolerate and pass through difficult emotional states, such as terror, rage and helplessness, without being swept away and drowned. If we go underneath the overwhelming emotions and touch into physical sensations, something quite profound occurs in our organism—there is a sense of flow, of “coming home.” This is a truth central to several ancient spiritual traditions, particularly certain traditions in Tibetan Buddhism.101
To understand the transforming power of direct sensate experience, it is necessary to “dissect” certain emotions such as terror, rage and helplessness (see Chapter 13). When we perceive (consciously or unconsciously) that we are in danger, specific defensive postures necessary to protect ourselves are mobilized in our bodies. Instinctively we duck, we dodge, we retract and stiffen, we prepare to fight or flee; and when escape seems impossible, we freeze or fold into helpless collapse. All of these are specific innate bodily responses, powerfully energized to meet extreme situations. They allow a woman weighing one hundred and twenty pounds to lift a car off her trapped child. It is the same primal force that propels a gazelle to sprint at seventy miles per hour in order to escape the pursuing cheetah.
These survival energies are organized in the brain and specifically expressed as patterned states of muscular tension in readiness for action. However, when we are activated to this level and, like Sharon, are prevented from completing that course of action—as in fighting or fleeing—then the system moves into freeze or collapse, and the energized tension actually remains stuck in the muscles. In turn, these unused, or partially used, muscular tensions set up a stream of nerve impulses ascending the spinal cord to the thalamus (a central relay station for sensations) and then to other parts of the brain (particularly the amygdala), signaling the continued presence of danger and threat. Said simply, if our muscles and guts are set to respond to danger, then our mind will tell us that we have something to fear. And if we cannot localize the cause of our distress, then we will continue to search for one; a good example of this was Sharon’s struggle to understand her experience. We see this in Vietnam vets who are terrified by the sounds of the 4th of July fireworks, even though they “know” rationally that they are not in any danger. Other examples are people who fear driving a car after they have been involved in an accident or people who fear even leaving the house because they do not know where these danger signals are originating from. In fact, if we cannot find an explanation for what we are feeling, we will surely manufacture one, or many. We’ll often blame our spouses, children, bosses, neighbors (be they next door or another nation) or just plain bad luck. Our minds will stay on overdrive, obsessively searching for causes in the past and dreading the future. We will stay tense and on guard, feeling fear, terror and helplessness because our bodies continue to signal danger to our brains. Our minds may or may not “agree,” but these red flags (coming from nonconscious parts of the brain) will not disappear until the body completes its course of action. This is how we are made—it is our biological nature, hardwired into brain and body.
These bodily reactions are not metaphors; they are literal postures that inform our emotional experience. For example, tightness in the neck, shoulders and chest and knots in the gut or throat are central to states of fear. Helplessness is signaled by a literal collapsing of the chest and shoulders, along with a folding at the diaphragm and weakness in the knees and legs. All of these “postural attitudes” represent action potentials. If they are allowed to complete their meaningful course of action, then all is well; if not, they live on in the theatre of the body.
If frightening sensations, such as the ones Sharon was experiencing, are not given the time and attention needed to move through the body and resolve/dissolve (as in trembling and shaking), the individual will continue to be gripped by fear and other negative emotions. The stage is set for a trajectory of mercurial symptoms. Tension in the neck, shoulders and back will likely evolve over time to the syndrome of fibromyalgia. Migraines are also common somatic expressions of unresolved stress. The knots in the gut may mutate to common conditions like irritable bowel syndrome, severe PMS or other gastrointestinal problems such as spastic colon. These conditions deplete the energy resources of the sufferer and may take the form of chronic fatigue syndrome. These sufferers are most often the patients with cascading symptoms who visit doctor after doctor in search of relief, and generally find little help for what ails them. Trauma is the great masquerader and participant in many maladies and “dis-eases” that afflict sufferers. It can perhaps be conjectured that unresolved trauma is responsible for a majority of the illnesses of modern mankind.
The concept of renegotiation is completely different from cathartic “traumatic reliving,” or flooding, a common form of trauma therapy still used after “critical events” like rapes, natural disasters and horror, like the World Trade Center attack that Sharon experienced on 9-11. Recent studies suggest that these therapies often do little to help and can actually be retraumatizing.102
One of the pitfalls of various trauma therapies has been their focus on the reliving of traumatic memories along with the intense abreaction of emotions. In these exposure-based treatments, patients are prodded into the dredging up of painful traumatic memories and abreacting emotions associated with these memories, specifically those of fear, terror, anger and grief. These cathartic approaches fall short as they often reinforce sensations of collapse and feelings of helplessness.
Adam was a financially successful businessman in his mid-sixties when I worked with him. He had a wife and family and was the owner of a multinational electronics company. As a quiet, kindly person, he was well liked by his employees and his acquaintances; yet Adam had no truly intimate friendships. Recently, his first grandchild was born. By all outward appearances, life has been good. It was the suicide of his son at the age of twenty-seven years that has broken this man of fierce, though subdued, determination. It has reduced him to obsessive self-blame and self-hatred.
“There was always something different about Paulo,” Adam stated matter-of-factly. “He was a sensitive child who was easily frightened. When he was around the age of four years old, for reasons unknown, he would awaken in the middle of the night screaming and crying.”
By late adolescence Paulo talked frequently of suicide. “Life is too hard,” he had repeated numerous times. Adam made sure that his son was never left alone during his darkest times. He had been fatigued by this decade-long ordeal, but he persisted in his committed vigil. Despite Adam’s exhaustive efforts to save his son, Paulo—no longer able to bear his pain—hanged himself in the bathroom. It was there that Adam found his limp, lifeless body. After the shock of Paulo’s suicide, Adam found that for the first time in his life he could not push ahead. Rather than feeling shattered by grief, Adam felt nothing … a state familiar to him even before losing his son. But this time, the numbness rendered him so fully shut down that he could not function. Life for him just stopped.
After several months of paralyzing inertia, Adam made an appointment to see a psychiatrist. He was prompted to do this by a family friend who advised him to get some medication for his despondent condition. After taking a personal history, the psychiatrist suggested that Adam’s past was preventing him from grieving his son’s death and gave him the diagnosis of “complicated bereavement.” Although the idea that his early life was “traumatic” or even implicated in his current malaise perplexed Adam, he agreed to talk to me.
Adam was born a motherless child. A massive heart attack during labor necessitated an emergency cesarean to save her only child. She died just as he was being born two months prematurely. Since his father had been conscripted into the Russian army, Adam was given to his father’s brother to be raised by his uncle and his wife. The aunt, who was supposed to care for him, was instead a cruel, likely psychotic, woman who repeatedly beat him.
Beyond the torment of this treacherous beginning, rife with abandonment and abuse, Adam’s life moved through a series of further trials and sorrows. At the age of four years, his uncle and two older stepsisters were deported and exterminated by the Nazis. He was then passed on to a series of Christian families who tried to hide his Jewish origins. During this time he would, according to these families, scream in the middle of the night—just as Paulo had done when he was the same age.
At the age of nine, Adam was given to a group of fugitives living in the forest. He “loved being there” because the people liked him and for the first time ever, he felt wanted. “That year was the best of my life,” he told me. Even though he loved and felt protected by his “forest family,” his night fits continued and grew in intensity. His crying and screaming would never subside, despite all attempts to soothe him. Since he could not even be awakened, the noise of his fits put his forest family in grave danger. So tragically, before his tenth birthday, Adam was sent back to the village, where he wandered aimlessly as an orphan.
One night, Adam was taken to the police station and interrogated. As he had been instructed, he gave the Nazis his Christian name. The police told him he would be punished if he lied. Next, they forced him to remove his pants in full view of everyone. To hide his shame, nine-year-old Adam stared at the wall, only to see a crucifix. This terrified him, causing him to believe that he would end up on a cross if he were caught lying. He was then taken to a concentration camp. “Being delivered alive to the concentration camp,” he said, “was a relief; at least I was with other Jews.”
Upon entering the camp, one of the prisoners from the village asked Adam his name. Now among his own people, Adam gave the name he had grown up with, and the names of those whom he believed to be his parents. The man then exclaimed, “No, no, that’s not your real family name.” And he told him the names of his biological parents and how they had both died. Adam remembered being unspeakably relieved to know that the cruel mother he had experienced was not his real mother.
While in the concentration camp, Adam witnessed people being brutally beaten, tortured and shot. Many others succumbed to suicide, often by hanging themselves. During his internment, Adam was without any real comfort or support to help him deal with such terror and horror. For most of us, Adam’s experience is unimaginable. If we were to honestly ponder the effect it would have had on us, we would be deeply disturbed by such terrible knowledge. Yet, to observe Adam in his life, he appeared, at least on the surface, little different from you or me, only more successful by modern-day standards.
As an orphan from birth and a survivor of the most unimaginable atrocities and human suffering, Adam had risen above this torment. He immigrated to South America at the age of nineteen, hoping “to escape his past.” There he settled and built his business, becoming a powerful, financially successful, international entrepreneur. Yet, when this extraordinary human being was referred to me, he had been reduced to a broken man. He was stooped over and shuffled as he entered the room. His posture and movements reminded me of patients I have seen in the back wards of psychiatric hospitals. His eyes looked blankly at the floor, and he seemed not to notice that I was even present. I had no idea where to begin. On the one hand, he was so shut down that it seemed like nothing I could say or do would reach him; but on the other hand, I feared that if I were able to bring up feelings, they might overwhelm him so completely that he would collapse into a bottomless catatonic despair. How could I reach this man without destroying him? I felt lost and intimidated by the scope and delicate challenge of my task.
By rote, Adam went on and on with the litany he had told the psychiatrist. There was not a trace of feeling in his narrative: “That all happened so long ago,” he added with a small tired sigh. I listened, finding myself quite uncomfortable at hearing such horror described without affect. In a strange way, though, I was relieved that he had no feeling; that way I wouldn’t have to feel either. Intellectually, I distanced myself from feeling and from Adam. I was able to do this by falling back on a clinical analysis, wondering what mechanism he had used to wall himself off from his horrific experiences and how he had kept himself from winding up wandering in the streets, like he had done as an orphan, or in the back ward of some mental institution.
As a way to try to initiate a little contact, I questioned Adam about his work, his family and friends—any topic where I thought there might be an entry point to even a tiny trace of positive feeling. Nothing came of this. I found myself, strangely, asking him to describe the last few hours of his day. Puzzled, he told me of missing his flight and frantically renting a car to drive the two hundred miles from Curitiba to São Paulo to meet with me. At the rental lot near the airport he recalled seeing children flying kites that they had made from things found at the garbage dump.h
I caught the first flicker on his otherwise expressionless face. But then, just as quickly, his face became flat again, and his body slumped forward in resignation. Not wanting him to collapse, I asked him to stand up with his knees slightly bent. Standing requires the activation and coordination of the proprioceptive and kinesthetic systems. This had the effect of keeping Adam’s awareness online by engaging the arousal branch of his nervous system. This intervention is the opposite of allowing a client to collapse, activating the shutdown response and thus perpetuating the mortifying feelings of shame and defeat. While he was standing erect with relaxed knees, I then directed Adam to “look inside” and find some place within his body where he could “find the picture of the children playing with their improvised kite.”i At first, he reported feeling more anxious (due to sympathetic hyperarousal), but with encouragement, Adam was able to locate a small circle of warmth in his belly. I asked him to “just get to know that sensation for a little while.”
He abruptly opened his eyes, surprising himself with his own words: “This could be dangerous.”
“Yes,” I agreed, “it could be; that’s why it’s important to learn about feeling, just a little bit at a time. Your body has been frozen for a long time; it will take some time to thaw,” I add. It was important that I validate his legitimate fear and offer him an image (thawing from freeze) that would help mitigate his fear, inviting him to explore his internal experience.
Adam then sat down and looked around the room. I asked him to describe what he saw.j
This provided the opportunity to connect the warmth in his belly with how he perceived the external world in the here and now. He looked perplexed. “Oh, I didn’t notice those flowers before—or the table they’re on.” Almost like the inquisitive expression of someone coming out of a coma, his face showed another minute flickering of awakening. He looked around noticing an oriental carpet and a painting. “They have colors, rich colors,” he said innocently.
“So as you look at those colors, I want you to find the place inside of your body that can feel—even, just the tiniest bit, those colors.”k
He looked back at me with a puzzled expression, perhaps awaiting further instructions. But then he closed his eyes and went inside. “It feels warmer in my belly, and the circle, it’s growing bigger in size.”
After a few moments I asked him to stand again: “Adam, I’m going to ask you to do something that might seem strange … I’m going to ask you to visualize the picture of the children with their kites … Feel your feet on the ground and how your legs support you. Now feel your arms as you hold the kite string … and imagine that you are there in the field with the children.”
Adam responded almost gleefully, “I can feel that in my arms and in my belly … It’s even warmer and bigger … I can see the colors; they are bright and warm … I see the kites dancing in the clouds.”
After a few quiet moments Adam sat down and looked around the room. “Take all the time you need, Adam … Just feel the rhythm of that … of the inside and the outside.”l
His eyes went back and forth between the table with the flowers and the painting. He focused on the table and started to describe the color and grain of the wood as warm … he paused … “like the warm feeling inside.” He closed his eyes again, without my instruction this time, rested for a bit and then opened them slowly and turned toward me, unabashedly looking into my eyes. This was the first time that Adam’s social engagement system (see Chapter 6) had awakened and come online.
Adam’s body showed some tentative aliveness; his drooping face assumed a colorful, almost vibrant, tone, and his stooped posture extended and straightened. Adam was like a tightly curled, newborn banana leaf turning and reaching toward the sun, confiding in its warmth as it slowly unfurls itself. He was in wonder of the room—as though seeing it for the first time. He looked at his hands and then gently held the fingers of one hand in the other. He then moved his hands to his upper arms and held his shoulders, arms crossed over his chest. It was as though he were holding and nurturing himself. He surprised us both by saying, “I’m alive.”
By learning that he could begin to feel, Adam became, in that moment, like the child, proud with the wondrous creation of his kite. That was the beginning of a gradual, rhythmical learning for Adam. Now, he could begin to feel his body-self without opening too widely the dark door of violence and horror in his soul. He was able to open up just enough to feel—to feel without being annihilated, without being swallowed up by the black hole of his horrific past or lost in the deep shadow of his immense grief and guilt about Paulo. Somehow, in this body-mindfulness, he was finding that there was a middle ground. He had uncovered a place between being completely overwhelmed and flooded, on one hand, and shut down into a deadening depression on the other.
Adam later wrote to me that his experience of a tender, yet durable, middle ground allowed him to experience a new sense of hopefulness. From this place, he was able to feel compassion for himself as the orphaned Holocaust child. “It was also the beginning,” he said, “of my being able to mourn for my beloved son and to find joyful pleasure with my family.”
I reflected on our session and on what might have brought Adam out of his immobilizing depression and into the stream of life. He was able to identify with the slum child’s exuberance—an exuberance that transcended the child’s deprived fate. Adam was able to feel, in his own body, the innocence, excitement and joy of a child flying a kite improvised from scraps of scavenged trash. In a similar way, Adam collected scraps from the trash heap of his devastating and dehumanizing past. This time, instead of collapsing under its weight, he marshaled a creative solution. By standing up (kinesthetically contradicting his habitual collapse) and physically grounding his pain, he mobilized his life force and joined with the transcendent flight of the kite. He could feel himself being drawn upward by the soaring image, and toward the possibility of authentic freedom and spontaneous play. Metaphorically, he reacquainted himself with the allegory of his namesake. Adam connected with the innocence of the biblical Adam—before the bitter fruit of terrible knowledge had singed his tongue with the bitter taste of man’s cruel and evil inhumanity. This formerly broken man now had touched into the grounded embodiment and resilient self-compassion enough to begin grieving and thus initiate a movement back into life. I did not want to expose (and most certainly flood) him with the shock of seeing his son hanging in the bathroom. My main consideration, at this point, was to coax his nervous system out of the shutdown caused by the shock and to begin establishing a base of resilience and self-regulation.
I’d like to invite you, the reader, to ponder the following considerations. Were Paulo’s inconsolable screaming episodes beginning at age four and his choice of hanging himself mere coincidences? (Remember, Adam’s wife reported that her husband would also scream and cry during the night, just as his son had done). Or were these incidents some deep transgenerational reenactment of his father’s unfelt experiences and unprocessed emotions? Such possibilities are among the mysteries of trauma and of the human spirit.
Certain authors discussing the Holocaust, such as Yael Danieli103 and Robert Lifton,104 have written groundbreaking analyses of the victims who lived through this horrific massacre. In working with Adam and a few other survivors of this kind of experience, I am personally confronted not only with the terrible knowledge of the cruelty that human beings are capable of, but also of the remarkable process by which the body is somehow able to compartmentalize the effects of this cruelty and go on with life. It maintains its tenuous hold, that is, until something is added to the unsustainable containment of their burden. Yet still, the smoldering flame of the deep self can miraculously reignite, given the right opportunity and carefully calibrated support.
After our session, Adam returned to the Polish town where he was born in search of any knowledge about his real mother, who had died during his birth. The Nazis had not destroyed the tombstone, and Adam replaced it with a new memorial stone because his heart “was so touched by knowing about her existence.”
The collision between the two contrary processes, one of excitation and the other of inhibition, which were difficult to accommodate simultaneously, or too unusual in duration or intensity, or both, causes a breakdown of equilibrium.
—Ivan Pavlov
It is not uncommon, particularly for a fireman, to be reluctant to see a psychotherapist—a “mind doctor.” This is especially true for a problem that is “obviously” physical. Vince was seeing a physical therapist for a frozen right shoulder. This disability was making it impossible for him to function in his job as a fireman. Treatment was not going well: after several sessions he was still barely able to move his arm from his trunk by more than a few inches. The consulting orthopedist had advised surgery: an operation in which the arm is “manipulated” (yanked violently) under general anesthesia in an attempt to free it. Such a surgery requires extensive and painful rehabilitation and often doesn’t improve the situation very much.
Since there was no apparent physical injury, the therapist, in the hope of avoiding the difficult procedure, referred him to me. The symptoms had begun a couple of months before our appointment. He was working in his garage and picked up a starter motor to put into his car. As he lifted it, he felt “a twinge of something” in his arm. The next day his shoulder felt tight and sore. Over time, the pain became more acute, and his range of motion progressively worsened, becoming chronic. Not surprisingly, Vince attributed his shoulder “strain” to working on his car. This is somewhat like the person who reaches down and picks up a piece of paper, only to have their back go into spasm. Common sense, and the clinical observation of most chiropractors and massage therapists dictates that this was already a back primed—“an accident waiting to happen.”
Vince is obviously confused about seeing a “mind doctor,” and he is reluctant to engage with me. Sensing this, I reassure him that I will not be asking him personal questions, but would just focus on helping him get rid of his symptoms. “Yeah,” he says, “my body sure is broke.” I ask him to show me how far he can move it before it starts to hurt. He moves it a few of inches and then looks up at me: “That’s about it.”
“OK, now I want you to move it the same way, but much slower, like this.” I show him with my arm.
“Huh,” he replies as he glances at his arm. He is clearly surprised that he could move it a few inches farther without the pain.
“Even slower, this time, Vince … Let’s see what happens this time … I want you to really give it your full attention; focus your mind into your arm now.” Moving slowly allows awareness to be brought to the arm. Just moving it quickly, without mindfulness, is likely to re-create the protective holding pattern.
His hand begins to tremble, and he looks to me for some reassurance. “Yes, Vince, just let that happen. It’s a good thing. It’s your muscles starting to let go. Try to keep your mind focused there, with your arm and with the trembling. Just let your arm move the way it wants to.” The trembling goes on for a while and then stops; Vince’s forehead breaks out in sweat.
As Vince moves to the edge of the bracing pattern, some of the “energy” held in his muscular-defense pattern begins to release. This includes the involuntary autonomic nervous system reactions, such as shaking, trembling sweating and temperature changes.m Because these are subcortically based actions, the person does not have a feeling of control over their reactions. This may be quite unsettling. My function here is that of a coach and midwife, helping Vince to befriend these “ego alien” sensations, especially since he is wholly unaccustomed to involuntary reactions that he can’t control.
“What is this, why is it happening?” Vince asks me in the voice of a frightened child.
“Vince, I’m going to ask you to just close your eyes for a minute now and go inside your body. I’ll be right here if you need me.” After some moments of silence his hands and arm begin to extend outward, his whole arm, shoulders and hands are now shaking more intensely. “It’s OK for that to happen,” I encourage; “just let it do what it needs to do and keep feeling your body.”
“It feels cold then hot,” he replies as he continues to reach out, moving now to about forty-five degrees. Then he halts abruptly. Amazed that he can reach out so far, his eyes open wide. At the same time, he seems agitated; his face suddenly turns pale. He complains of feeling sick.
Instead of backing off, I coach him to stay present with his physical sensations. He starts to breathe rapidly. “Oh my god, I know what this is.”
“Yes, good,” I interrupt, “but let’s just stay with the sensations for a little longer, then we’ll talk about it—is that OK?”n
Vince nods and moves his arm back and forth from his shoulder as thought he were sawing a piece of wood in slow motion. In this slow movement, Vince is beginning to explore the inner movement held in check and locked in a bracing pattern. He is now separating two conflicting impulses, one involving reaching out and the other, pulling away in revulsion. (I observe the revulsion as a particular pattern involving the retraction of his lip to one side and the hint of his head slightly turning away.) The trembling increases and decreases again, then settles. Tears flow freely from his eyes. He takes a deep spontaneous breath and then reaches out, fully, in front. “It doesn’t hurt at all!” This concurs with what I have found with chronic pain. There is generally an underlying bracing pattern, and when the bracing pattern resolves, the pain dissolves.
Vince opens his eyes and looks at me. Clearly complete with the bottom-up processing, he is now able to form new meanings. He tells me about the following event. About eight months earliero he had gone shopping for his wife. As he came out of the supermarket, he heard a loud crash. Across the street, a car had smashed into a light pole. He dropped his bag and ran to the accident. The driver, a woman, sat motionless in an apparent state of shock. The motor of the car was running, so he reached across her inert body to turn off the ignition, standard procedure to prevent fires or explosion. Just as he started to turn the key he saw a young child in the passenger seat, his head decapitated by an air bag. And then Vince told me why his shoulder got frozen: “I was fine before I saw the kid … I’m used to doing things like that, things that are dangerous … but when I saw the kid, part of me wanted to grab my arm back and turn away … I felt like puking … and the other part just stayed there and did what I had to do … Sometimes it’s really hard to do what you have to do.” “Yes,” I agreed, “it’s hard and you and your buddies keep doing it anyway … Thank you.”
“Hmm,” he added when he left, “I guess I have to learn to mind my body.” Vince had learned that mind and body are not separate entities—that he was a whole person. He said he wanted to learn more about himself and came in for three more sessions. He learned how to better handle stressful and conflicting situations and, needless to say, didn’t need the operation.
When we need to engage in life-saving actions, the amount of charge and adrenaline that floods our bodies is vast. When Vince attempted to save the passenger in the car wreck, there were two simultaneous, but opposing, survival actions: one to do whatever possible to save her life, and the other, to pull away from the horror. In this intense conflict, Vince’s nervous system and muscles locked up; his shoulder froze. In being able to “feel through” and separate out the conflicting impulses, first to reach forward and then to pull away in horror, the vast survival energy,p instead of both acting against itself, was discharged in the waves of shaking sweating and nausea.
Ivan Pavlov, who was awarded the Nobel Prize in Physiology or Medicine in 1904 for his prodigious work on the conditioned reflex, was thrust into a study of experimental (traumatic) breakdown by a chance event. The great Leningrad flood of 1924 caused the water to rise in his basement laboratory, precipitously close to the level of his caged experimental dogs. This terrified them but left them physically uninjured. When he resumed his experiments, he was startled to find that they had lost their previously acquired conditioned reflexes. While this was of obvious interest to Pavlov, another set of observations altered the future of his investigatory work. A significant proportion of the animals, though physically unscathed, broke down emotionally, behaviorally and physiologically. This included cowering and shaking in the corner of their cages, while other previously tame animals struck out viciously at their handlers. In addition, physiological changes such as elevated and depressed heart rates under mild stress and full startle reactions to mild stimuli (such as to tones or to the approach of the experimenter) were observed.
The flood evoked two conflicting tendencies, as suggested in Pavlov’s definition: “the collision between the two [intense] contrary processes, one of excitation and the other of inhibition.” In another example, the simultaneous impulse to eat and to suffer an intense electrical shock (when the shock is paired with eating) results in breakdown for hungry animals. With the existence of two opposing impulses, one to stay and eat and the other to escape a highly noxious event, there will likely be breakdown.
In summary, the motor expression of two intense instinctual responses creates a conflict and results in frozen states, such as the stasis in Vince’s shoulder. Normally, muscles that extend operate reciprocally with those that flex. In the traumatic state, however, agonist and antagonist operate against each other, creating frozen (immobility) states. This may lead to debilitating symptoms in almost any part of the body. The energy bound in inhibited (thwarted) responses is so powerful that it can cause an extreme bracing that often has profound effects. For example, when people jump from burning buildings to a trampoline net far below, the bones in their legs may actually fracture during the fall instead of on impact. This is because both the extensor and flexor muscles contract simultaneously, with inordinate intensity.
In times of war or natural disasters, the instinctual impulse for self-preservation often collides with those for the protection of one’s comrades. In World War I the prevalence of shell shock was tremendously high in the trenches. The foot soldiers were literally trapped and barraged with loud explosives for days to weeks on end. Instinctually, they were “urged” to run wildly to escape or to stay under fire and fight for the preservation of the group. In fact many soldiers were killed by unwisely running to escape (or were shot for supposed cowardice). In the few motion pictures taken of shell-shocked soldiers from World War I, one sees the tortured, twisted, convulsive consequences of such chronic thwarting. One wonders how many soldiers developed trauma and enduring guilt symptoms because they chose to protect themselves by leaving the wounded to fend for themselves. In any case, courage is a more complex phenomenon than is generally appreciated.
In a lifelong career of working with adults, I have occasionally been asked to see the children of my clients. I was frequently astonished by how, with the briefest of interventions, children rebounded from what would otherwise have been a devastating lifelong debilitation. These children, unshackled from the yoke of trauma, were free to develop with confidence, resilience and joy. I have cowritten two books on the prevention and somatic treatment of childhood trauma. One of them is geared to therapists, medical personnel and teachers,105 while the other is geared primarily toward teaching parents effective emotional first-aid tools.106
In this section, I offer the tender stories of three overwhelmed children: Anna, Alex and Sammy. Their vignettes illustrate the principle that less is more and speak to the innate resilience of the human spirit.
Eight-year-old Anna has enormous brown eyes. She could have been a model for one of the popular Keane paintings of almond-eyed children. The school nurse has just brought her in to see me. Pale, head hanging and barely breathing, she is like a fawn frozen by the bright lights of an oncoming car. Her frail face is expressionless, and her right arm hangs limply, as if it were on the verge of detaching itself from her shoulder.
Two days earlier, Anna went on a school outing to the beach. She and a dozen of her classmates were frolicking in the water when a sudden riptide swept them swiftly out to sea. Anna was rescued, but Mary (one of the mothers who volunteered for the outing) drowned after courageously saving several of the children. Mary had been a surrogate mom to many of the neighborhood kids, including Anna, and the entire community was in shock from her tragic death. I had asked the school nurse to be on the lookout for children who displayed a sudden onset of symptoms (e.g., pain, head and tummy aches and colds). Anna had already been to see the nurse three times that morning, reporting severe pain in her right arm and shoulder.
One of the mistakes often made by trauma responders is to try to get children to talk about their feelings immediately following an event. Although it is rarely healthy to suppress feelings, this practice can be traumatizing. In these vulnerable moments, children (and adults as well) can easily be overwhelmed. Previous traumas can resurface in the aftermath of an overwhelming event, creating a complex situation that may involve deep secrets, untold shame, guilt feelings and rage. For this reason, my team sought out, and learned, some of Anna’s history from several helpful elementary school teachers (and the nurse) prior to seeing the child. In this way, we could have information that either was consciously unknown to the child or might be dangerous to uncover given her fragile state.
We learned that at age two, Anna was present when her father shot her mother in the shoulder and then took his own life. An additional detail that compounded Anna’s symptoms was provoked by an experience she had prior to the picnic. She had been infuriated when Mary’s sixteen-year-old son Robert bullied her twelve-year-old brother. There was a strong possibility that Anna had been harboring ill will toward Robert before the drowning, and was seeking retribution at that time. This raised the likelihood that Anna might feel profound guilt about Mary’s death—perhaps even believing (through magical thinking) that she was responsible for it.
I ask the female nurse to gently cradle and support Anna’s injured arm. This could help Anna contain the frozen “shock energy” locked in her arm, as well as heighten the child’s inner awareness. With this support, Anna would be able to slowly (i.e., gradually) thaw and access the feelings and responses that could help her come back to life.
“How does it feel to be inside of your arm, Anna?” I ask her softly.
“It hurts so much,” she answers faintly.
Her eyes are downcast, and I say, “It hurts bad, huh?”
“Yeah.”
“Where does it hurt? Can you show me with your finger?” She points to a place on her upper arm and says, “Everywhere, too.” There’s a little shudder in her right shoulder followed by a slight sigh of breath. Momentarily, her drawn face takes on a rosier hue.
“That’s good, sweetheart. Does that feel a little better?” she nods, then takes another breath. After this slight relaxation, she immediately stiffens, pulling her arm protectively toward her body. I seize the moment.
“Where did your mommy get hurt?” She points to the same place on her arm and begins to tremble. I say nothing. The trembling intensifies, then moves down her arm and up into her neck. “Yes, Anna, just let that shaking happen, just like a bowl of Jell-O—would it be red, or green, or even bright yellow? Can you let it shake? Can you feel it tremble?”
“It’s yellow,” she says, “like the sun in the sky.” She takes a full breath, then looks at me for the first time. I smile and nod. Her eyes grasp mine for a moment, then turn away.
“How does your arm feel now?”
“The pain is moving down to my fingers.” Her fingers are trembling gently. I speak to her quietly, softly, rhythmically.
“You know, Anna, sweetheart … I don’t think there is anybody in this whole town that doesn’t feel that, in some way, it was their fault that Mary died.” She briefly glances at me. I continue, “Now, of course that’s not true … but that’s how everybody feels … and that’s because they all love her so much.” She turns now and looks at me. There is a sense of self-recognition in her demeanor. With her eyes now glued on me, I continue, “Sometimes, the more we love someone, the more we think it was our fault.” Two tears spill from the outside corners of each eye before she slowly turns her head away from me.
“And sometimes if we’re really angry at someone, then when something bad happens to them, then we also think that it happened because we wanted it to happen.” Anna looks me straight in the eye. I continue, “And you know, when a bad thing happens to someone we love or hate, it doesn’t happen because of our feelings. Sometimes bad things just happen … and feelings, no matter how big they are, are only feelings.” Anna’s gaze is penetrating and grateful. I feel myself welling with tears. I ask her if she wants to go back to her class now. She nods, looks once more at the three of us, and then walks out the door, her arms swinging freely—in rhythm with her stride.
Alex, like several of the children who witnessed the tragedy from the beach, was having trouble sleeping and eating. His father brought him to us because the youngster had barely eaten in the last two days.
As we sit together, I ask him if he can feel the inside of his tummy. He places the hand gently on his belly and, with a sniffle, says, “Yes.”
“What does it feel like in there?”
“It’s all tight like a knot.”
“Is there anything inside that knot?”
“Yeah. It’s black … and red … I don’t like it.”
“It hurts, huh?”
“Yeah.”
“You know, Alex, it’s supposed to hurt because you love her … but it won’t hurt forever.”
Tears cascade down the boy’s cheeks, and color returns to his face and fingers. That evening, Alex eats a full meal. At Mary’s funeral Alex weeps openly, smiles warmly and hugs his friends.
You can discover more about a person in an hour of play
than in a year of conversation.
—Plato
Just as neither Vince nor his medical practitioners were able to associate his persistent frozen shoulder with a horrific event, often, children’s symptoms or changes in their behavior can present puzzling questions that baffle parents and pediatric professionals alike. This is especially true when the child has “good enough” parents that provide a stable and nurturing home environment. Sometimes the child’s new actions, although anything but subtle, are a mystery. The bewildered family might not connect the child’s conduct or other symptoms with the source of his terror.
Rather than expressing themselves in easily comprehensible ways, kids frequently show us that they are suffering inside in the most frustrating ways. They do this through their bodies. They may act bratty, clinging to parents or throwing tantrums. Or they might struggle with agitation, hyperactivity, nightmares or sleeplessness. Even, more troubling, they may act out their worries and hurts by steamrolling over a pet or a younger, weaker child. For other children, their distress may show up as head and tummy aches or bedwetting, or they may avoid people and things they used to enjoy in order to manage their unbearable anxiety. Parents ask where in the world these childhood symptoms can possibly come from?
The very emblem of youth—“ordinary” events, such as falls, accidents and medical procedures—when unresolved are suspects as hidden culprits that underlie a child’s angst. This was certainly the case with the toddler Sammy.
Since children by their nature enjoy play, therapists and parents can help them to rebound, moving beyond their fears to gain mastery over their scariest moments through the vehicle of guided play. As children express their inner world through play, their bodies are directly communicating with us.
Here is the story of Sammy, a two-and-a-half-year-old boy, where setting up a play session led to a reparative experience with a victorious outcome. There are suggestions provided after this case story for therapists, medical professionals and parents. The following is an example of what can happen when an ordinary fall, requiring a visit to the emergency room for stitches, goes awry. It also shows how several months later, Sammy’s terrifying experience was transformed through play into a renewed sense of confidence and joy.
Sammy has been spending the weekend with his grandparents, where I am their houseguest. He is being an impossible tyrant, aggressively and relentlessly trying to control his new environment. Nothing pleases him; he displays a foul temper every waking moment. When he is asleep, he tosses and turns as if wrestling with his bedclothes. This behavior is not entirely unexpected from a two-and-a-half-year-old whose parents have gone away for the weekend—children with separation anxiety often act it out. Sammy, however, has always enjoyed visiting his grandparents, and this behavior seemed extreme to them.
They confided to me that six months earlier, Sammy fell off his high chair and split his chin open. Bleeding heavily, he was taken to the local emergency room. When the nurse came to take his temperature and blood pressure, he was so frightened that she was unable to record his vital signs. This vulnerable little boy was then strapped down in a “pediatric papoose” (a board with flaps and Velcro straps). With his torso and legs immobilized, the only parts of his body he could move were his head and neck—which, naturally, he did, as energetically as he could. The doctors responded by tightening the restraint and immobilizing his head with their hands in order to suture his chin.
After this upsetting experience, mom and dad took Sammy out for a hamburger and then to the playground. His mother was very attentive and carefully validated his experience of being scared and hurt. Soon, all seemed forgotten. However, the boy’s overbearing attitude began shortly after this event. Could Sammy’s tantrums and controlling behavior be related to his perceived helplessness from this trauma?
When his parents returned, we agreed to explore whether there might be a traumatic charge still associated with this recent experience. We all gathered in the cabin where I was staying. With parents, grandparents and Sammy watching, I placed his stuffed Pooh Bear on the edge of a chair in such a way that it fell to the floor. Sammy shrieked, bolted for the door and ran across a footbridge and down a narrow path to the creek. Our suspicions were confirmed. His most recent visit to the hospital was neither harmless nor forgotten. Sammy’s behavior told us that this game was potentially overwhelming for him.
Sammy’s parents brought him back from the creek. He clung dearly to his mother as we prepared for another game. We reassured him that we would all be there to help protect Pooh Bear. Again he ran—but this time only into the next room. We followed him in there and waited to see what would happen next. Sammy ran to the bed and hit it with both arms while looking at me expectantly.
“Mad, huh?” I said. He gave me a look that confirmed my question. Interpreting his expression as a go-ahead sign, I put Pooh Bear under a blanket and placed Sammy on the bed next to him.
“Sammy, let’s all help Pooh Bear.”
I held Pooh Bear under the blanket and asked everyone to help. Sammy watched with interest but soon got up and ran to his mother. With his arms held tightly around her legs, he said, “Mommy, I’m scared.”q Without pressuring him, we waited until Sammy was ready and willing to play the game again. The next time, grandma and Pooh Bear were held down together, and Sammy actively participated in their rescue. When Pooh Bear was freed, Sammy ran to his mother, clinging even more tightly than before. He began to tremble and shake in fear, and then, dramatically, his chest expanded in a growing sense of excitement and pride.
Here we see the transition between traumatic reenactment and healing play. The next time he held on to his mommy, there was less clinging and more excited jumping. We waited until Sammy was ready to play again. Everyone except Sammy took a turn being rescued with Pooh Bear. Each time, Sammy became more vigorous as he pulled off the blanket and escaped into the safety of his mother’s arms.
When it was Sammy’s turn to be held under the blanket with Pooh Bear, he became quite agitated and fearful. He ran back to his mother’s arms several times before he was able to accept the ultimate challenge. Bravely, he climbed under the blankets with Pooh Bear while I held the blanket gently down. I watched his eyes grow wide with fear, but only for a moment. Then he grabbed Pooh Bear, shoved the blanket away, and flung himself into his mother’s arms. Sobbing and trembling, he screamed, “Mommy, get me out of here! Mommy, get this off of me!” His startled father told me that these were the same words Sammy screamed while imprisoned in the papoose at the hospital. He remembered this clearly because he had been quite surprised by his son’s ability to make such a direct, well-spoken demand at just over two and a half years of age.
We went through the escape several more times. Each time, Sammy exhibited more power and more triumph. Instead of running fearfully to his mother, he jumped excitedly up and down. With every successful escape, we all clapped and danced together, cheering, “Yeah for Sammy, yeah! Yeah, Sammy saved Pooh Bear!” Two-and-a-half-year-old Sammy had achieved mastery over the experience that had shattered him a few months earlier. The trauma-driven aggressive, foul-tempered behavior used in an attempt to control his environment disappeared, while his “hyperactivity” and avoidance (which occurred during the reworking of his medical trauma) was transformed into triumphant play.
The following analysis of Sammy’s experience will help clarify and apply the following principles for working using pediatric therapeutic play.
Healing takes place in a moment-by-moment slowing down of time. In order to help the child you are working with feel safe, follow her pace and rhythm. If you put yourself in the child’s shoes (through careful observation of her behavior), you will learn quickly how to resonate with her. Let’s return to the story to see exactly how we did that with Sammy:
By running out of the room when Pooh Bear fell off the chair, Sammy indicated loud and clear that he was not ready to engage in this new activating game. Sammy had to be rescued by his parents, comforted, and brought back to the scene before continuing. In order to make him feel safe, we all assured him that we would be there to protect Pooh Bear. By offering this support and reassurance, we help Sammy move closer to playing the game—in his own time at his own pace.
After this reassurance, Sammy ran into the bedroom instead of out the door. This was a clear signal that he felt less threatened and more confident of our support. Children may not state verbally whether they want to continue, so take cues from their behavior and responses. Respect their wishes in whatever way they choose to communicate them. Children should never be rushed to move through an episode too fast or forced to do more than they are willing and able to do. Just like with Sammy, it is important to slow down the process if you notice signs of fear, constricted breathing, stiffening or a dazed (dissociated) demeanor. These reactions will dissipate if you simply wait, quietly and patiently, while reassuring the child that you are still by his side and on his side. Usually, the youngster’s eyes and breathing pattern will indicate when it’s time to continue.
Experiencing fear or terror for more than a brief moment during traumatic play will not help the child move through the trauma. Most children will take action to avoid it. Let them! At the same time, try and discern whether it is avoidance or escape. The following is a clear-cut example to help in developing the skill of “reading” when a break is needed and when it’s time to guide the momentum forward.
When Sammy ran down to the creek, he was demonstrating avoidance behavior. In order to resolve his traumatic reaction, Sammy had to feel that he was in control of his actions rather than driven to act by his emotions. Avoidance behavior occurs when fear and terror threaten to overwhelm both children and adults. With kids this behavior is usually accompanied by some sign of emotional distress (crying, frightened eyes, screaming). Active escape, on the other hand, is exhilarating. Children become excited by their small triumphs and often show pleasure by glowing with smiles, clapping their hands or laughing heartily. Overall, the response is much different from avoidance behavior. Excitement is evidence of the child’s successful discharge of emotions that accompanied the original experience. This is positive, desirable and necessary.
Trauma is transformed by changing intolerable feelings and sensations into desirable ones. This can only happen at a level of activation that is similar to the activation that led to the traumatic reaction in the first place.
If the child appears excited, it is OK to offer encouragement and continue as we did when we clapped and danced with Sammy.
However, if the child appears frightened or cowed, give reassurance, but don’t encourage any further movement. Instead, be present with your full attention and support, waiting patiently until a substantial amount of the fear subsides. If the child shows signs of fatigue, take a rest break.
You can never move too slowly in renegotiating a traumatic event with anyone; this is especially true with a young child. Traumatic play is repetitious almost by definition. Make use of this cyclical characteristic. The key difference between renegotiation and traumatic play (reenactment) is that in renegotiation there are incremental differences in the child’s responses and behaviors in moving toward mastery and resolution. The following illustrates how I noticed these small changes with Sammy.
When Sammy ran into the bedroom instead of out the door, he was responding with a different behavior, indicative that progress had been made. No matter how many repetitions it takes, if the child you are helping is responding differently—such as with a slight increase in excitement, with more speech or with more spontaneous movements—he is moving through the trauma. If the child’s responses appear to be moving in the direction of constriction or compulsive repetition instead of expansion and variety, you may be attempting to renegotiate the event with scenarios that involve too much arousal for the child to make progress. If you notice that your attempts at playful renegotiation are backfiring, ground yourself and pay attention to your sensations until your breathing brings a sense of calm, confidence and spontaneity. Then, slow down the rate of change by breaking the play into smaller increments. This may seem contradictory to what was stated earlier about following the child’s pace. However, attuning to children’s needs sometimes means setting limits to prevent them from getting wound up and collapsing in overwhelm. If the child appears tense or frightened, it’s OK to invite some healing steps. For example, when renegotiating a medical trauma, you might say, “Let’s see, I wonder what we can do so that Pooh Bear (Dolly, GI Joe, etc.) doesn’t get so scared before you [the pretend doctor/nurse] give him the shot?” Often children will come up with creative solutions showing you exactly what they needed—the missing ingredient that would have helped them settle more during their experience.
Don’t be concerned about how many times you have to go through what seems to be the “same old thing.” (We engaged Sammy in playing the game with Pooh Bear at least ten times.) Sammy was able to renegotiate his traumatic responses fairly quickly. Another child in your care might require more time. You don’t need to do it all in one day! Resting and time are needed to help internally reorganize the child’s experience at subtle levels. Be assured that if the resolution is not complete, the child will return to a similar phase when given the opportunity to play during the next session.
Remember that biology is on your side. Perhaps the most difficult and important aspect of renegotiating a traumatic event with a child is maintaining your own belief that things will turn out OK. This feeling comes from inside you and is projected out to the child. It becomes a container that surrounds the child with a feeling of confidence. This may be particularly difficult if the child resists your attempts to renegotiate the trauma.
If the child resists, be patient and reassuring. The instinctive part of your child wants to rework this experience. All you have to do is wait for that part to feel confident and safe enough to assert itself. If you are excessively worried about whether the child’s traumatic reaction can be transformed, you may inadvertently send a conflicting message. Adults with their own unresolved childhood trauma may be particularly susceptible to falling into this trap.
In Too Scared to Cry, Lenore Terr,107 the brilliant and esteemed child psychologist, warns clinicians about allowing children to engage in traumatic play “therapy” that reenacts the original horror. She describes the responses of three-and-a-half-year-old Lauren as she plays with toy cars. “The cars are going on the people,” Lauren says as she zooms two racing cars toward some finger puppets. “They’re pointing their pointy parts into the people. The people are scared. A pointy part will come on their tummies, and in their mouths, and on their … [she points to her skirt]. My tummy hurts. I don’t want to play anymore.” Lauren stops herself as her bodily sensation of fear abruptly surfaces. This is a typical reaction. She may return over and over to the same play, each time stopping when the fearful sensations in her tummy become uncomfortable. Some therapists would say that Lauren is using her play as an attempt to gain some control over the situation that traumatized her. Her play does resemble “exposure” treatments used routinely to help adults overcome phobias. But Terr cautions that such play ordinarily doesn’t yield much success. Even if it does serve to reduce a child’s distress, this process is quite slow in producing results. Most often, the play is compulsively repeated without resolution. Unresolved, repetitious, traumatic play can reinforce the traumatic impact in the same way that reenactment and cathartic reliving of traumatic experiences can reinforce trauma in adults.
The reworking or renegotiation of a traumatic experience, as we saw with Sammy, represents a process that is fundamentally different from traumatic play or reenactment. Left to their own devices, most children, not unlike Lauren in the above example, will attempt to avoid the traumatic feelings that their play evokes. But with guided play, Sammy was able to “live his feelings through” by gradually and sequentially mastering his fear. Using this stepwise renegotiation of the traumatic event and Pooh Bear’s companionship, Sammy was able to emerge as the victor and hero. A sense of triumph and heroism almost always signals the successful conclusion of a renegotiated traumatic event. By following Sammy’s lead after setting up a potentially activating scene, joining in his play and making the game up as we went along, Sammy got to let go of his fear. It took minimal direction (30–45 minutes) and support to achieve the unspoken goal of aiding him to experience a corrective outcome.
* Recall the discussion in Chapter 4 of Beatrice Gelder’s work demonstrating how attuned we humans are to the survival-based postures of others. These findings also relate to research on mirror neurons. A mirror neuron is a neuron that fires both when an animal acts and when it observes the same action performed by another animal. Thus, the neuron mirrors the behavior of the other, as though the observer herself were performing the very same act. Such neurons have been directly observed in primates and are found in the premotor cortex and in the insula and cingulate, suggesting their importance in communicating internal bodily states and emotions. The neuroscientist Stephanie Preston, the Dutch primatologist Frans de Waal and other neuroscientists have independently posited that the mirror neuron system is centrally involved in empathy and that since it is the body that is being mirrored, intimate moments are nonverbal in nature. In humans, brain activity consistent with that of mirror neurons has been found in the premotor cortex and the inferior parietal cortex. See Chapter 4 for specific references to this research.
† I do this to help her keep connected with me as she goes inside, as well as to feel more grounded.
‡ This is an important difference between “talk therapy” and body-oriented therapy. Rather than trying to help patients make new meanings or understand their problems, body therapy creates a space for the “body story” to unfold and complete. When this occurs, new meanings and insights emerge spontaneously, generated by the patients themselves, as an integral part of this process.
§ The sense of a foreshortened life, of wordless despair, is a central characteristic of severe trauma. The person is in a fundamental way stuck in the horrific imprint of the past and thus cannot imagine a future different from the past.
‖ This is an effect of dissociation. It is as though Sharon is describing what happened to another person; it is as though she is outside of her body, observing, but not really being present. She lives back at the moment of shock where dissociation is what allowed her to survive the unimaginable horror and terror. In the Hollywood, Hitchcock version of trauma, the sufferer is barraged by flashbacks. In real life, though, the numbing or shutting-down phase is often more significant and is generally characteristic of severe and/or chronic trauma. These are the people who become the “walking dead.”
a Frequently, people will make exaggerated gestures as a way of avoiding feeling the underlying sensations.
b I believe that this is because these very slow (“intrinsic”) movements, when done mindfully, operate through the gamma efferent system. This system is intimately connected to the brain stem–autonomic nervous system and involves the extra pyramidal motor system. Voluntary movement, on the other hand, is controlled by the alpha motor system and is independent of the autonomic nervous system. Gamma-mediated movements tend to “re-set” the nervous system away from extremes of activation.
c Returning to these positive, expansive sights is not an avoidance, but rather an integral part of trauma resolution.
d This is similar to the widely accepted principle of reciprocal inhibition discovered by the Nobel Prize–winning physiologist Sir Charles Sherrington.
e This is the inherent capacity to pendulate (to rhythmically shift between states of distress/contraction and pleasure/expansion; see Step 3 in Chapter 5). Pendulation is an essential ingredient in the alchemy of transformation—it is what brings people into present time.
f To the nervous system, being overwhelmed by an event is really little different than being overwhelmed by similar sensations and emotions that are internally generated.
g Until this was done, Sharon still experienced herself as being stuck in the stairwell. All of her thoughts had revolved around this deeply imprinted belief. By having the (new) physical sensation of running at a heightened level of arousal, Sharon contradicts her previous, bodily, experience of helpless freezing.
h The exuberance of ghetto kids joyfully flying such improvised kites is portrayed in the classic film Black Orpheus (Orfeu Negro), a reworking of the Greek myth set in Rio de Janeiro.
i At this point I did not want to ask Adam to try to feel something (this would only lead to frustration and failure), but rather to interest him in initiating exploration (in “finding the picture inside”).
j This is done to amplify figure ground perception and presence.
k It is important to take a little piece of new internal experience like this and connect it to external perceiving. This is the “figure ground” that gives rise to the “experience of now.”
l Figure-ground shifting is often a general movement to fluidity and flow.
m I believe that slow, mindful movements evoke the involuntary functions of the nervous system, particularly the extrapyramidal/gamma-efferent system.
n I am interrupting the urge to seek temporary relief by finding an explanation for a sensation, rather than completing the frozen action and welcoming the formation of new meanings.
o Often there is a significant delay between a traumatizing event and when the symptoms present.
p In a different situation the urge might be to save one’s own life, or to stay pinned down in a foxhole, as in the “fog of war.”
q This trust of safety would not happen without a solid attachment. Where healthy bonding is not the case, or where there is abuse, therapy is, of course much more complex and also generally involves therapy for the parents or caregivers.