The process of separation/individuation can take place only when connection has been fully established on all levels of experience.
This chapter presents excerpts from the long-term treatment of a woman whose trauma and life struggles encapsulate the earliest issues of the Connection Survival Style. These excerpts illustrate how the specialized use of connection through NeuroAffective Touch, an aspect of the NARM approach, can be transformative when working with preverbal developmental/relational deficits.
Emma was referred to Aline by a colleague who, after eight months of therapy with her, had come to a therapeutic impasse. This colleague thought that Emma’s issues would benefit from an approach that specifically addressed early attachment and developmental deficits. As we have seen, because early trauma can interrupt the development of the capacity for affect regulation, it requires specific interventions that take into account the somatic dimension of the formation of self.
As Emma sat down in my office, she was nervous and uncomfortable. Choosing her words carefully, she avoided direct eye contact, keeping track of me with a periodic glance. She was almost forty years old and felt hopeless about her enduring, overwhelming fear of people, her need to withdraw and isolate herself, and the profound loneliness she experienced. Emma was, by her own account, extremely sensitive to people’s judgments of her and found them to be an ongoing source of pain and disappointment. She referred to people as “the humans,” a designation that conveyed the hopelessness of her feelings of disconnection and of not belonging.
Emma’s had difficulty with social interactions. She did not know how to read people’s behavior or what was expected of her. She experienced almost all interpersonal human contact as intrusive disruptions to her daily routine that readily escalated into intense, chaotic emotion. Living in a constant state of fear, Emma felt she had no choice but to disengage from her environment in order to attend to her confusing and exhausting internal states. The only way she knew to stabilize her internal sense of overwhelm was to limit contact with people, minimize stimulation, restrict her life, and retreat into the quasi-security of isolation. She could neither participate in life because she felt she did not belong, nor could she turn her back on it. Although she worried that she might be opening herself to another traumatic disappointment, her presence in my office showed that she still had some hope.
Emma experienced herself as trapped in a living hell. To hide her high level of internal activation, and in an attempt to meet social expectations, she had developed a smiling façade that thinly masked her extreme discomfort. Experience had taught her to expect rejection and she reacted painfully to any indication of misattunement. When opportunities for connection presented themselves, she vacillated between excitement and withdrawal into a heart-wrenching fear of disappointment. Afraid to express anger that could lead to rejection, not able to carry out a defiant “I don’t need you,” she felt condemned to feeling shame, self-hatred, helpless frustration, and despair. Nevertheless, Emma had not entirely lost the desire to actively participate in social life. In spite of her lifelong pain, she wanted to be loved and continued to yearn for connection. She began to cry as she described how she so often felt unseen and misunderstood.
I quickly became aware of Emma’s highly intuitive capacity to sense my emotional states. She carefully tracked my responses and reacted to any misattunement on my part with despair and shame. I was repeatedly reminded how, moment by moment, mother and infant co-regulate their emotional arousal, influencing and being influenced by each other’s changing behavior. Neurologically, signals between a mother and child pass back and forth at amazing speeds, as fast as 1/300th of a second, and it has been shown that mother and infant, in response to each other’s facial expressions, show sympathetic cardiac acceleration and parasympathetic deceleration. With Emma, who, like a baby, sensed every affective nuance of relational attunement or misattunement implicitly in her body, I had to be emotionally present and genuine. She needed a consistent demonstration of my trustworthiness and capacity for empathic attunement.
It took a few months for us to develop a common language. In the beginning, she frequently expressed how important it was to her that I “take her seriously,” meaning that I not pathologize her. She felt that a diagnosis would strip her of dignity and show “one-upmanship” on my part, proving that I discounted her experience on a fundamental level. She wanted to be seen as a person of value and was both terrified and infuriated by the possibility of being put in a diagnostic box. To connect with Emma, I initially needed to join her on her terms—I needed to enter her world with the utmost respect. She would accept nothing less.
EMMA: How do I know if you care about anything I say?
ALINE: When you talk about your pain, I sense it as a contraction in the pit of my stomach. What you say resonates inside me, right here … pointing to my solar plexus and heart. My gut responds to what you say and feels in ways similar to how you describe your body responding to me.
EMMA: You mean that what I say has an effect in your body? I never really thought about that before.…
Emma was surprised to hear that her words and internal states could impact mine. Because she had so often been told that she was too sensitive, she had foreclosed the possibility that another person could “get her.”
Tears came easily to Emma, and she often experienced herself falling into a void, a great bottomless emptiness—a marker of developmental trauma and neglect. Seen through the lens of early trauma, I could imagine her sensation of falling into the void as a primal disorganization rooted in the absence of attuned caregivers.
It is through attuned relationship that a mother co-regulates her infant’s developing nervous system and capacity for connection. A baby’s essential developmental task in the first year of life centers around developing a secure emotional bond with mother (or whoever is the primary caregiver). A mother’s essential job is to support her baby’s developing capacity to self-regulate by attuning to her own and her infant’s internal states. The communication between mother and baby is largely nonverbal, consisting of body-to-body signals moving through the nervous systems of both parties. The communications between mother and infant directly influence the maturation of the infant’s brain and nervous system, regulate social and emotional stimuli, generate the somatic aspects of emotion used to guide behavior, and allow the brain to adapt to changing environments and integrate new information and learning. It is through these communications that infants internalize the regulatory capacities that shape their capacity to cope with stress.
Emma’s moment-to-moment tracking of my internal fluctuations was as sensitive as that of a baby and required a reciprocal high level of emotional engagement, attunement, and resonance, fully calling upon my embodied intuitive capacities—she needed a regulatory parenting process. Emma lacked the experience of securely resting in the loving arms and under the watchful eye of a caring presence. She needed a supportive approach that provided highly attuned physical, emotional, and energetic presence from the bottom-up. Seen through the lens of early developmental trauma, it is easy to understand why a top-down cognitive therapeutic approach could be unbearably painful and had been re-traumatizing for her.
Emma’s gestation and birth had been traumatic. Her mother, an aspiring actress who was obsessed with maintaining the “perfection” of her 18-inch waist, had unsuccessfully tried to abort her. Labor had been difficult, and Emma had almost died. In addition, she was born prematurely and put in an incubator.
From birth, Emma had been the victim of neglect and emotional abuse. Emma’s mother immediately resumed her acting career, leaving her in the care of her sister who was unmarried and bitter about her own situation. Emma’s father showed little interest in his baby daughter and was almost never home. Her early memories were of a cold, uncaring aunt, of a mother who was obsessed with her own appearance and success, and of a father who flew into a rage if she disturbed him in any way. She had spent much of her childhood years in her bedroom, alone, seeking safety in imaginary games, all the while wondering if anyone would ever come to find her.
The long-term impact of neglect and emotional abuse includes chronic feelings of worthlessness, guilt, self-blame, self-hatred, vulnerability, generalized mistrust of others, and a pervasive sense of powerlessness, hopelessness, and despair. Emma suffered from all these symptoms. She was haunted by many of the deficits and much of the emotional suffering that result from developmental/relational trauma in the Connection phase.
Emma experienced a great deal of confusion about her sensations and feelings: mostly she was unclear about why they were so intense, and she was afraid of them. She found it difficult to share her internal experiences verbally; she often reminded me of a young child who is learning to speak.
EMMA: My parents never talked to me. They never talked to each other either. Our house was silent. They only paid attention to me to feed me and clean me.
Giving Emma the time and support to find words to express the neglected parts of herself—the child who had faced a self-absorbed mother, an absent, “rageaholic” father, and an uncaring, embittered aunt—was an ongoing learning experience. It is widely held in both somatic and psychoanalytic theory that without words to mentalize physical experience, unnamed, overwhelming emotions and sensations remain lodged in the body and its organs and are expressed as psychosomatic symptoms—a somatic encapsulation of unarticulated states. An attuned parent or caregiver begins the work of emotional and mental differentiation by naming aspects of experience in a way that modulates the unformed urgency of an infant’s emotional storms. Naming an experience brings sensations and emotions into consciousness. Since Emma lived in a largely nonverbal state, she felt great relief when I could accurately bring words to her internal experience. If Emma and I were to succeed in our therapeutic endeavor, the nonverbal communication moving at lightning speed between us would need to be slowed down and brought to awareness; we would need to describe in words and in the present moment what happened inside her and what passed energetically between us. She needed words to know and reflect upon her internal states.
Sensory-motor functions develop simultaneously with emotional, relational, and social capacities, and all build on each other. From this perspective, I believe it is important to view the body as having its own reality and its own struggle to come into being. When children miss their developmental markers at the sensory-motor level, the physiological foundation is not in place to support the emergence of their emotional and relational capacities, and they have no alternative but to compensate and work around the compromised capacities. Without the necessary sensory-motor skills, children have a diminished capacity to respond, the demands of the environment cause greater stress, and they cannot keep up with other children. More importantly, they often lack the key defensive reflexes that would allow them to adequately protect themselves, and they are therefore more vulnerable. As a result, other children who sense their vulnerability will scapegoat and attack them. In response, children who suffer from early developmental trauma avoid situations that demand capacities that are not developed in them, leading to a life strategy of withdrawal and isolation.
In my experience, when neurological development has been compromised, it is necessary to support the emergence of the body’s own impulses and movements. For Emma to feel secure and learn how to relate to another “human,” both of us had to openly communicate our internal reality in an interactive process. We made an agreement that, when appropriate, we would share our internal states: I would share my sensations and my emotional reactions with her, and she, in turn would express hers. She appreciated the structure and could relax when inner reality, mine and hers, was painted in clear, stark colors. It was reassuring for her to have a verbal interpersonal context for her experience. Emma’s fear abated whenever I expressed heartfelt feedback that made emotional sense to her. Slowing down and taking the time to break down key experiences into small present-moment increments, much like playing a movie in slow motion, frame by frame when necessary, helped her find words to describe her sensations and emotions and thus begin to make sense of her internal states. We were developing a first tier of language for her largely nonverbal experience. Finding words allowed her to share and match her internal reality and her external perceptions against my feedback. This meant that she was no longer alone in her struggle to know if her perception was accurate.
Emma was intellectually gifted and had in her twenties begun a medical degree but had abandoned the program because she found the social pressures unbearable. To engage the scholar part of her, I asked her if she would like to learn about the new theories of attachment, child development, affective neuroscience, and the impact of trauma on behavior. My intention was for us to develop a broader common reflective vocabulary. Her eyes lit up. She expressed great interest in the knowledge I shared with her about affect regulation, the effects of the mother-child relationship on the nervous system, the dysregulation caused by developmental trauma, and the fight-flight-freeze response that accompany threat and curtail an infant’s exploratory responses. She particularly resonated with the importance of dyadic attunement and its impact on attachment styles and began to do her own research on the subject.
Our psychoeducational conversations and her own readings had the effect of empowering her and normalizing her vulnerability and sensitivities. Emma was able to relate the information to her own childhood experiences. In essence, by identifying the developmental, neurological, and emotional bases of her difficulties, she created her own “diagnosis.” The understanding Emma gained about attachment and trauma gave her top-down descriptive concepts she could use to talk about the pain, fears, and social limitations she experienced. The knowledge she now had about the impact of developmental trauma initiated a process of disidentification from the experience of the helpless child and the deep shame she had felt about her social awkwardness and her dysregulated emotional states.
Having set a foundation for our work by establishing bottom-up sensory and emotional guidelines and attending to top-down cognitive understanding, I proposed an exercise used by somatic psychotherapists to engage a client’s capacity for attachment and help develop a felt sense of boundaries. The exercise is as follows:
1. The therapist leaves the room and stands just outside the door.
2. The client, now alone in the room, pays attention to her internal experience. If she feels activated by the therapist’s leaving the room, she takes the time to calm herself and only when stabilized does she invite the therapist to reenter the room. As the therapist reenters, the client notices any shifts in internal experience.
3. Having reentered the room and closed the door behind her, the therapist waits by the door for instructions from the client: for example, the client can tell the therapist to remain still, to face away from her, to slowly come closer step by step, to go back out, etc.
4. With each request, the client tracks and shares any change she notices in her internal experience and the therapist supports her to wait until any activation has abated before giving her next instruction.
This exercise often continues until the client can bring the therapist into her subjective field. It is intended to support the experience of agency through the implied message that clients are in charge, that the therapist will follow their lead and their pacing. It is also intended to give clients the experience of tracking and giving words to the sensory fluctuations that signal the state of their energetic boundary and relational capacity.
We began the exercise with Emma sitting on cushions at the farthest end of the room, some twenty feet from the door. I left the room and after approximately five minutes, she called me in. I came in, closed the door behind me, and stood facing her with my back to the door. Her response was immediate and intense.
EMMA: I couldn’t calm myself when I was alone in the room, so I decided to tell you to come in anyway. My anxiety started to rise as soon as I saw the door handle turn.… Now I can barely stand to be in the room with you.… I’m so embarrassed.… I feel like I shouldn’t be here … that I’m such a burden to you. I can’t take in that another person exists separate from me. I’m really numb right now.
As she described her anxiety and dissociation, I realized that this exercise required more resources than Emma had at her disposal.
ALINE: Emma, can I share with you what I’m experiencing right now?
EMMA: Nods.
ALINE: I’m finding it quite painful to see you struggle with this exercise that I set up. I didn’t realize that it would create such difficulty for you. Right now, you feel so alone and so far away over there across the room that I want to go and sit close to you and put my arm around you. But I’m conflicted because I also don’t want to impose more discomfort on you by invading your space.
EMMA: If you were closer, it would be easier.
ALINE: Is it all right then if I come to sit by you?
EMMA: Nods.
ALINE: I’ll come over slowly, and you can tell me if you need me to do anything differently.
As I crossed the room to sit next to her, I asked her to tell me where she wanted me to sit. She asked me to sit next to her, on her left side.
EMMA: Now I can feel myself calming down.
ALINE: Take as much time as you need … go at your own pace … there is no need to force anything to be other than the way it is. Pause for several minutes.… I notice that it seems to be an effort for you to sit up. Is that right?
EMMA: Yes. I like you here, but I just want to curl up into myself. My back hurts.
ALINE: I would like to support your back. Would it be all right if I put my hand on your back? You can tell me if it doesn’t feel right, and I’ll stop right away.
She agreed and I placed the flat of my right hand behind her diaphragm to support the apex of the collapse.
ALINE: How does that feel?
EMMA: It’s a relief. It’s calming me even more. Sighs.… It’s easier to have you touch me than to have you all the way across the room.
ALINE: That’s important for us to know. Pause for several minutes.… I would like to experiment a little with the position of my hand on your back and with the amount of pressure. Tell me what feels better for you.
EMMA: Nods.
ALINE: First, does my hand feel like it’s in the right place to give you the support you need?
EMMA: Could you move your hand down a little lower? Directs me to the area on her back, just below her diaphragm.… Right there. That feels better.
ALINE: Now, let’s experiment with the pressure.
EMMA: I think I’d like more pressure.
I gradually increased the pressure of my hand against her back until my pressure matched the internal pressure she was exerting in her own spine.
EMMA: Like that … that feels right.
ALINE: Remember, you can always tell me to stop if it no longer feels right. Or you can tell me to do something different.… Quiet for a few minutes.… What are you experiencing now?
EMMA: I don’t feel I have the right to be here. I must be such a burden to you, and I feel so embarrassed at my reaction … but I like you there too. Don’t stop.
We explored what she meant by “the right to be here.” Talking about not having the right to be gave words to the feeling that she was not wanted, that she had always been a burden and annoyance to her mother and particularly to her father. We explored how it felt to have me next to her, supporting her. The caring intention she could feel in my touch was a new experience. She giggled and squirmed and found it hard to believe. She had never felt that she had a right to exist, let alone that someone would actually want to be with her and respond to her need.
Some weeks later, she told me how pivotal this session had been in giving birth to her feeling of being wanted, seen, and understood.
EMMA: It started that day when you went out, then came back in the room, then came over and touched my spine, and I felt the support. I had spine hunger and didn’t know it.
Although the initial exercise was never completed, it served as an important catalyst. It opened our work to the use of touch and helped Emma realize that her despairing responses, when shared, could elicit empathy in a way that led to a positive response to her needs.
EMMA: No amount of talk about my problems seems to make much difference in the way I feel about myself. Mostly, just talking makes it worse. It’s hard to explain, but when you touch me I start to feel real. Like I exist.
From this session on, Emma wanted to be touched. Extensive training and experience in working with touch has taught me to allow touch interventions to evolve out of the client’s need. I approach the use of touch slowly, always asking for permission and direction, and inviting the client to give feedback, to guide or stop the interaction.
Being touched helped Emma feel the surface of her skin and literally locate herself in time and space—an antidote to her dissociation. We discovered that Emma had no integrated image of her body and its boundary—of where she stopped and another started. Consequently, she lived in symbiotic confusion. She reported feeling as though she did not inhabit her body and more often than not, felt herself spinning “somewhere above my head,” a common description of dissociated states.
Touch is a valuable tool with which to address breaches in the development of the relational matrix that cannot be reached by verbal means alone. There is now documented evidence for the critical role of touch in human psychology and biology. Basic research conducted by Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, shows that touch is at the foundation of relational experience. It is a fundamental mode of interaction in the infant-caregiver relationship. When we consider the somatic reality of an infant for whom language is not yet formed and the neuronal and biochemical processes that underlie verbal thought, we can understand how paying attention to the body and to the relationship between bodily experience and mental states is critical to support the developmental progression and integration of the capacity to relate to self and others.
EMMA: I can feel your hands, but I don’t have a sense of anyone attached to them. It’s enough to just feel your hands. It would be too much to have a person attached to them. This way, I can just feel myself as not alone.
Emma perceived my touch as a source of comfort even though she could not yet experience me as a separate person.
EMMA: I trust your touch. When I get a massage, I have to force myself to like it … but your touch comes right in. It’s as if you’re touching my emotions. Sometimes, during a massage, I actually feel something good, but it only lasts a second, then I shut down and I’m numb to the rest of it. It doesn’t happen with you. They [mother, father, aunt] all had an agenda for me. It was never about me. It was about me being a certain way to please them. That’s what humans do.
Typically, I began sessions by asking Emma to identify an area of her body that she perceived as wanting attention. Usually, she led me to her belly, mid-back behind the respiratory diaphragm, or to her right hip or jaw. My touch was quiet and consistent, my intent to nurture, and my movements deliberate and slow, trying to offer a quality of presence that her body could receive. After silently holding a chosen area for a while, I usually opened a verbal dialogue by describing my experience—the emotional valence, the density, the wave pattern I felt in her tissues.
ALINE: Today, I sense you suspended and sort of pulling in … my belly is getting tighter. I sense your belly as very still, a little frozen even, as if you’re holding your breath and waiting for something bad to happen.…
EMMA: Yes … there was a message from my aunt.… I haven’t called her back. I’m afraid she’s going to invite me to a family reunion, and I won’t know how to say no.
ALINE: I see … that makes sense then: your body isn’t sure if things are safe.
EMMA: Things aren’t safe. I know I’m going to lose myself. I always do when I talk to my family. Her belly visibly contracts.
ALINE: Emma, I’m going to place my hand over your belly. Take a moment to see if that feels right or not.
EMMA: After some time.… The more I think about my aunt, the tighter I get there. I had no idea until you touched me.
ALINE: Let’s take a moment to allow your belly to settle before continuing to talk about your family.
EMMA: Pause.… I’m really scared. No … actually, I’m scaring myself into that horrible state where I feel totally worthless and incapable.… I was building up to an anxiety attack.
ALINE: And now?
EMMA: No more words. I just want to be quiet and feel my body quiet down. I don’t have to go just because she invites me.
Touch helped Emma build a conscious connection to her felt sense and became an essential aspect of the dialogue evolving between us. Tracking sensation in my own body as well as in hers was an important source of relational information. While I made physical contact with her, I used words and metaphors to link sensations with feelings and thoughts in order to strengthen the feedback loops between her nervous system, viscera, and cortical functions. My touch was intended to awaken and support a sensory exploration of her internal states, and my words were an invitation for her to verbalize her experience. Knowing that I was sharing my own experience as an invitation for her to share hers, she in turn compared her experience to mine and we explored the similarities and differences—when we were in alignment and resonance and when we were not. Emma learned that when she paid attention and made connections between her sensations, feelings, and thoughts, her internal world became more manageable, and new insights and solutions could emerge.
The empathic and nurturing intention of my touch was deeply regulating for Emma’s nervous system, and the resulting direct and implicit connection to a caring other contrasted with her memories of childhood neglect and with the fear and disconnection she still experienced as an adult.
EMMA: I’m not fighting to get something that I wasn’t getting anymore. I can see that I’m getting something real, that I’m not making it up. It’s very sweet, and soft, and satisfying.… I didn’t know that before, but now I do. I can really feel the difference when I’m not getting anything and when I am. It’s such a relief. After every session I realize that my trust is growing, but when I go home I feel the emptiness. I got held and then I’m alone and I want more.
The contrast between the contact during our sessions and the contact hunger she experienced when alone at home brought up the grief of years of neglect and lonely yearning. She was realizing, on a conscious as well as on a visceral level, how painful the absence of connection had been and how much she had yearned for it even without knowing what it was she had been yearning for. Emma could now put words to her early experience. She described a frightening inner void, a painful emptiness that is one of the far-reaching effects of early developmental trauma, particularly neglect.
EMMA: It’s like there was a cold, dark, bottomless, never-ending void. It was always there, and it never stopped. Now I have moments when I feel that it’s good to be alive. And I can feel that it isn’t my fault. I’m not empty because I’m defective. It’s because I never got what I needed.
Without the comforting touch connection, Emma’s overwhelmingly painful emptiness had been unspeakable. We used our growing relational matrix to explore the adaptive survival strategies she had developed to insulate herself from the unbearable pain of neglect and isolation. Emma expressed the fear that if she opened herself to relationship, her pain would be even more unbearable.
EMMA: I feel really embarrassed that I might like you more than you like me. It feels dangerous that I’m letting myself need you. Isn’t that dependency? Isn’t that wrong? I’m afraid you’re going to “drop the baby,” and I don’t think I could survive that one more time.
She began to regularly use the expression “drop the baby” when she talked about past experiences of misattunement and neglect. She was terrified that I too would drop her if she let herself trust our connection. Emma wanted reassurance that it was safe to allow herself to become attached to me.
ALINE: Emma, let’s look at this together. We know that your body and nervous system are hungry to be touched … and that you experience relief when I attune to you and give you the attention you need and never had. And we also know how painful it was for you to grow up so isolated without anyone caring for you. I understand how vulnerable this must feel … there’s a lot riding on our relationship. So let’s see if we can create safeguards so that the baby is protected. The last thing I want is to drop the baby or for you to experience being let down or abandoned yet again.
We explored how to proceed in a titrated way that would allow her to manage the new experiences of expansion that come with feeling connected. Emma realized that the fear of being dropped was particularly strong on days when I touched areas close to her heart. We made a concerted effort to fine-tune our interactions; the more specifically my touch could meet her body’s needs and emotional yearning, the better she became at giving me directions and regulating her own affect. We identified areas where touch felt safe, calming, and brought comfort, and others that triggered emotional pain. We found that she did better when I changed my holding position often rather than when I held one position for a long time. We also explored the resources she had with which to comfort herself at home between sessions. She found that the longer she could be on the massage table and in contact during a session, the easier it was to hold onto what felt good when she went home. She realized that what was most resourcing was to remember, in her body, how it felt to be held during sessions.
EMMA: I know from the reading that being touched is bringing up my baby experience … the part that really needed a mother. They all dropped me … my mother, my aunt … and my father.
ALINE: And what happens when you connect with the part of you that knows?
EMMA: Well … I’m telling myself that you’re not them, and that it’s okay to remember how it feels when we’re together in a session. That it isn’t me being too needy but more that it’s about healing something I needed and didn’t get.
I took this to mean that she was developing some object constancy and capacity for self-soothing and self-regulation. After several sessions, during which I held one hand under her spine and very lightly massaged her belly with my other hand, creating a “sandwich” with her digestive track as its center, she had the following clarity:
EMMA: The touch puts me in touch with my pain … but in a good way. There’s something crying in me, crying as it lets go. The touch is filling me, and it’s going into the pain in a good way. I’m getting there, cell by cell. It’s like when I cut my finger. It takes time to heal, and there will be a time when I’ll be full. I need to be touched. I’m not feeling so guilty about needing to be touched anymore.
Emma was learning to receive. Slowly, she was learning to take in and integrate the experience of connection.
The work was moving forward smoothly, too smoothly perhaps, when an unfortunate scheduling confusion tested Emma’s developing trust.
EMMA: I was feeling so good, so open. I was trusting you … crying.… Now I’m closed and alone again. I know consciously that you haven’t done anything wrong, but my body doesn’t know it. It’s closed, and I’m afraid I’ve lost my only opportunity to heal.
She angrily wondered how she could have let herself open as much as she did, felt shame that she had allowed herself to care for me, and berated herself for being a burden.
EMMA: I must be a bad person because you haven’t done anything wrong. I’m the one fucking it up. I knew it! Nobody can ever be there for me. I’m a burden, and you don’t really want to see me anymore.
Dysregulation and fragmentation resurfaced. She reported that she was again crying at home, crying her feelings of intense loneliness and loss that were now back. She had had a few months of feeling hopeful, and now, after just a little taste of how good it felt, it was gone again. Perhaps forever. I was also concerned. What if the lost connection could not be repaired? I anchored myself in the process of mindful presence.
She huddled in the armchair, curled up, pulled in, and withdrawn. I then realized that she had had many experiences of loss, but none of finding again. Emma had never had the opportunity to move through an experience of reconnection once contact had been lost. The excerpts that follow detail the exploration and repair of her experience of broken connection.
ALINE: Do you know what happened in the past when you lost your sense of connection?
EMMA: People freaked out, and I ended up taking care of their upset.
ALINE: Do you know what was missing that didn’t allow you to find your way back?
EMMA: They said it was my fault and that I was too sensitive. They never listened to me.
When in the past Emma had tried to talk about her loss of connection, she had been attacked for being overly sensitive and demanding. Or she was berated for being wrong and for misperceiving the situation. I understood that she had not been received in a way that allowed her to express her feelings of disconnection and remain in contact with the other.
As she sat huddled in the corner of the armchair, knees up to her shoulders to cover her belly, arms wrapped tightly around her chest, eyes staring blankly, I suggested covering her with a shawl so that she did not have to protect herself using body tension. She made no motion to stop me as I lay a light shawl over her.
ALINE: Emma, I have a sense that there’s too much going on right now. Let’s see what happens if I put a protective cover over you.
ALINE: Addressing her need for boundary.… Feel the shawl act as a shield and see if your body can feel safer under its protection. See what happens if you close your eyes so that you don’t have too much stimulus coming in from the outside.
Her body slightly released its constricted and retracted position. She reported being numb from the waist down, with little awareness of her feet.
ALINE: Take your time.… I’m going to sit on the floor by the chair. I want to stay close to you, because in the past you’ve always been alone when you’ve been in this state. Several silent moments passed during which her breath slowed down.… I’d like to put my hand lightly on your foot. I put my fingers on the top of her foot, near her toes.… Tell me if that feels good, or if it feels intrusive. You don’t have to answer right away. Let your body pull away from my touch if the contact doesn’t feel right. She did not pull away. After a little while of silent contact, I offered to remove my hand.
EMMA: No. I like your hand there. Somehow, it’s helping me to slow down and come back.
We spent the next thirty minutes in quiet contact. Periodically, I would reassure her that there was no pressure to make anything happen, that we had no way of knowing what the outcome would be or if we would ever find our way back. We would just practice being in the moment with what was.
ALINE: All we can do is be quiet together and see what happens in its own time, like we have done many times in the past months.
I knew that Emma struggled with the intensity of her feelings. I reassured her that her feelings had their own course, their own rhythm, and that if there was an inkling of a chance to make it through, we both had to honor what was going on inside her, without any time pressure, without any judgment, without any preconceived idea of outcome. The contact of my hand on her foot allowed me to track the responses in her nervous system: I could feel the retraction in her legs softening, and concurrently, I could sense my own visceral turmoil calm down. As we neared the end of the session, I let her know that our time was coming to an end, that there was no pressure to have accomplished anything, because we had many more sessions to continue exploring this break.
ALINE: We don’t know what will happen, but I want you to know that I trust your sense of what you need. I trust that you know what is right for yourself, and that I am open to what you might need from me. I want to remind you that we have an agreement with each other to be truthful about our inner experience.
In the session that followed, she announced:
EMMA: I’m not back yet, but I do feel more hopeful. I lost it, and you didn’t freak out. You didn’t make me wrong.
She had “lost it,” and I did not punish her, berate her, blame her, get scared, or give up on her. I did not pull away, abandon her, or deem her hopeless. In her words, I did not “drop the baby.” She could retract and peek out of the corner of her eye to see that I was still there. I had urged her to stay with her feelings, even if those feelings were of mistrust and disconnection. She needed to feel them and not be rejected for having them. In these vulnerable moments of interactive repair, I was the representative of the “good-enough” mother, and my capacity for attunement was called upon to act as the external organizer of Emma’s internal dysregulation.
EMMA: I didn’t have to take care of you. I didn’t have to worry about hurting your feelings. You didn’t make it about you.
Though she was more present, I noticed that she was still retracted in the chair, holding her hands tightly closed in little fists.
ALINE: Emma, as we talk I notice that your body is still needing to protect itself and that your hands are tightly closed … it reminds me somehow of a frightened baby who has no one to hold on to.
EMMA: Yes. I just can’t let go. And I can’t trust you yet either.
ALINE: If you will allow it, I would like to spend some special time with the frightened one who is here today. I feel like making a cradle for her. How does that sound?
EMMA: Giggled as a little spark shot through her eyes.… A cradle?
ALINE: Are you wondering how a cradle could happen in this room?
EMMA: Well, yes!
I took the flat cushions from the two large armchairs, which when laid flat on the floor made a little bed. Then I gathered all the other pillows in the room and built them up around the flat cushions. And there it was—a cradle, just her size. She giggled even more as she crawled in to nestle in the middle of the pillows. I covered her with the shawl.
ALINE: Just as I did last week, I would like to stay in contact with you.
EMMA: Yes. The touch connection was the most important part of the session. I didn’t have to say anything, and I knew that you were there.
This time, I asked her to hold two of my fingers in one of her clutched fists. I chose this intervention based on the knowledge that babies are born with a grasp reflex that allows them to securely hold on to the mother should there be a need to flee danger. It seemed to me that her tightly squeezed hands were an indication of that early reflexive position. She decided to lie on her back and curled her right hand tightly around my fingers. She closed her eyes and after about ten minutes began to talk about how devastating it had been to lose the connection with her previous therapist and not find her way back. She cried as she continued to describe the pain of her mother not connecting to her. At the end of the session, she reported:
EMMA: I’m feeling better. I’m not all the way back … but some of the way.
In the following session, we went back to the cradle but found that it had mutated into a nest. She grabbed a heavy blanket and lay down in it. I sat by her head.
EMMA: The resistance to open to you is almost gone.
ALINE: I’m glad to hear that. Let’s see what happens today.
I sat silently beside her, with presence and intent. After about five minutes, she found words.
EMMA: I’m starting to feel now.… Tearful.… It’s the loneliness. There just is no one in my life I enjoy being with.… I don’t know what to do about it.
ALINE: Emma, I have an impulse to hold your head. Is that all right with you?
She nodded, and I moved to sit above her head. As soon as I touched her head, she began to cry harder. I intuitively followed an impulse to put very gentle pressure on the top of her head.
EMMA: There just isn’t anything to hold on to.…
Her hands were above her head with her fingers again curled tightly. As I had done before, I offered my index and middle fingers, and this time she grabbed on with her left hand and held on tightly.
EMMA: I have no idea how tightly I’m holding. Am I crushing you?
For the next hour, she alternated between tears and silence, while I internally cycled through anxiety, fear, heart pain, and confusion.
EMMA: I’ve gotten rid of everybody who upsets me in my life. I’m glad about it, but it leaves me so alone. Thank God for my animals. I don’t know what I would do without them.
I remained quiet as she naturally resourced herself with stories about her animals. When the session ended, she simply said:
EMMA: That helped.
We continued nesting for several sessions. Often during these sessions Emma could not tell me what she needed, and I had to trust my sense of attunement. During one of these sessions, I rested the flat of my fingers on her temples, imperceptibly contacting the temporal part of the masseter muscle, thus addressing the tightness of her jaw and the frozenness of her face.
EMMA: I feel a wall, and you are outside of me … clenching her fist to express her experience of the wall.
ALINE: I feel a wall too. As I came close, I felt myself coming up onto the surface of you, and it feels impenetrable.
EMMA: There’s no opening, and I can’t make one happen even if I want to.
ALINE: It’s fine to hang out here. It’s the way it is. There’s no need to make something happen. Energy moves in its own time. Let’s be curious about the wall.
My hands remained on her temples and slightly over her cheekbones. While I held her temples, our breath synchronized. Five minutes passed.
ALINE: I can feel little stirrings.
EMMA: Yes. It’s moving like that … makes little fluttery movements with her fingers.
ALINE: Yes, just like that. Like the density of the wall is breaking up, and I have the impulse to make those same little fluttery movements with my fingers.… I let my fingers move lightly and randomly over her temples.
EMMA: Yes, that feels good.
Within a few moments, the random flutters suddenly organized into a multidirectional pulsing pattern that radiated outwards from her temples. We had found a common rhythmic pulse and were able to allow that pulse to move both of us together—in somatic terms, we had entered a state of vibrational resonance.
EMMA: I felt that move!
ALINE: Yes! We both felt it at the same time. Now I feel drawn to put my hands on your upper chest, just below your collarbone. Tell me if that doesn’t feel right, because we know that your heart area is very sensitive.
EMMA: It’s good.… In a way, describing what is happening with words doesn’t allow me to go as deep, but it’s good to know how it works.
More silent holding followed. I applied a light pressure on the manubrium, mirroring and following the expansive and retractive pulls as I sensed them. The area of the manubrium seems particularly sensitive to issues of bonding. Feelings of sadness surfaced.
EMMA: I’m grieving again. I’m grieving the untouched, unseen baby. When you do that, it makes me realize that you’re giving me what I didn’t get.
A tightness in my throat suddenly released, and I felt myself dropping into my body, now able to breathe more deeply. I had not been aware that my breath had become tight and shallow until I felt it release. At that same moment, Emma sighed in relief.
EMMA: There, it opened!
An apt naming of the experience. What was the it that opened in both of us at the same time, I wondered. The it that cannot be forced, that cannot be made to open except in its own time, that knows when the right sequence of subtle movements has unfolded, when the progression has reached its culmination, and suddenly, as a key turns in a lock, opens a door, dissolves a wall, sends an impulse moving through what had been rigid and immovable.
ALINE: What just happened?
EMMA: It feels so good. If I follow the good feeling, it seems to open me. We had lost it, and now we are finding it again.
ALINE: I also felt it. A tension let go in my belly, and a sense of relief flooded my body.
She tracked the good feeling as it moved though her body, a feeling of letting go that connected her to herself and to me, and me to her. In attachment terms, I believe that the “it” that had opened was a result of the specifically fitted touch interaction that replicated the psychobiologically attuned attention a mother gives her baby. The fact that my frequency coincided with Emma’s own internal rhythms was key. This was not something we could have planned; it was pure grace.
Our nervous systems recognized and responded to the state of attuned synchrony we had found, and we discovered what appears to be a fundamental building block of nervous system regulation: a synchrony of attunement that brings with it soothing sensations and emotions—a positive state of implicit relational knowing that recognizes genuine connection.
Emma opened the following session in a joyful state.
EMMA: I’m almost back to normal with you. I’m not all the way back with trusting you, and I want a lot of time on the massage table today.
She was back in an adult state, able to reflect on the journey she had taken into the frozen and dissociated feelings of her infancy.
ALINE: Let’s listen to what your body needs today. Are there any sensations you would like to report, or areas you would like to bring to attention?
EMMA: Tension around my whole left eye and face.
Emma lay on the table, on her back, and I cupped my hand around her eye and eyebrow where she had indicated the tension. After a while, her left shoulder made a quick but strong spastic movement upward and inward toward her neck.
ALINE: Emma, did you notice that movement in your shoulder?
EMMA: Now that you mention it, yes.
ALINE: Do you remember it well enough to repeat it?
She repeated it exactly. I asked her to repeat it very slowly several times while I held different areas of the shoulder girdle. Finally, as my hand lay flat under her mid-back, a little above the insertion of the trapezius, she told me that it seemed to be the area from which the spastic movement was originating.
ALINE: If that movement had a message, what might it be?
EMMA: This might sound silly, but the first words that came to mind were “I don’t want to be born.” Right after that I thought “I know life hurts,” and I felt that I didn’t want to participate in life because of the pain that comes with it.
This statement triggered a flurry of spastic movement in her shoulder. The movement, which at first was incoherent with spastic repetition, organized into a retraction, and she curled her whole body into a tight ball. I was reminded of playing in tide pools, trying to touch an open sea anemone and witnessing its protective reflex to close. As she slowly relaxed back to a normal position, her left hand remained tightly closed.
ALINE: I notice that your left hand is closed in a tight fist.
EMMA: I know. It just won’t let go, and I can’t make it.
ALINE: I’d like to try something, if you will let me.
EMMA: Okay.
As I had in previous sessions, I put my left index and middle fingers into the palm of her tightly closed left hand. This time I sensed a different intent in the grip; it no longer felt like that of an infant needing to hold on, but I could not discern exactly what had changed. After a while, I found my fingers microscopically pushing against the palm of her hand and curled fingers with the implicit message to soften her grip. At first there was no force to my push; it was an intent flowing through, energy expressing through my fingers into her hand. She received the message, and her hand relaxed a little. We continued back and forth for some fifteen minutes, my fingers gradually pushing more strongly against the palm of her hand, her hand slowly letting go. No words were exchanged. At the end of the session she shared:
EMMA: I had new sensations that I’ve never had. I had to keep reminding myself that no harm was going to come to me. Your pressure was so subtle that I was able to override the reflex to close down and follow the new direction.
ALINE: I didn’t want to impose anything, but I had a clear desire to let your nervous system know that it could release the clutching.
EMMA: My experience with people has been so bad, no wonder I’m not willing to trust anyone. Images of my aunt came up. She was so rough with me. It’s important for me to be handled in a gentle way. My experience was that touch always hurt. It’s really good to be handled in a gentle way.
Emma was developing a felt sense understanding of the defensive measures her body had taken to protect itself against inexpressible intrusions and rough handling. I remembered the baby pictures with her aunt and mother in which she was twisting away. This tiny infant had never been embraced, her fearful grasp could never release into safe holding.
ALINE: Emma, what do you need now?
EMMA: Something in my upper chest and throat.
I slid my hand under her back, just above her heart, and placed the other on her chest, creating a line of energy between my two hands through the manubrium, esophagus, upper lobes of the lungs, and upper vertebrae. I could feel that the tissues in that area were energetically frozen: the bone lacked vibration, the muscles were rigid, and there was no breath in the upper lobes of her lungs. Moving my hand along her spine, I found a hard, knotted area between her shoulder blades. I supported that area, and it began to soften as she reported waves of fear coming up. She spontaneously began to breathe slowly and evenly as the waves of fear moved through.
EMMA: I never let down. I was born in fear. No one comforted me, and it has just continued ever since. I’ve never known anything but fear, until a few moments on this table.
In the following sessions Emma continued to release her fear. She could tolerate more concentrated holding as I steadily held, sandwiched between my hands, different areas of her torso and organs—her navel, solar plexus, stomach, liver, digestive track, and for increasingly longer periods, her heart. She allowed herself to enjoy the sensations of being cared for, essentially “feeding” her nervous system. In this process of psychobiological attunement, she felt understood. During one session, we focused our attention on her navel, bringing special attention to this fetal “mouth,” the original in utero feeding channel. The next time we met, she said:
EMMA: Well, the last session was really useful … the part when you held my navel with your hand underneath. It’s really hard to put into words, and I was looking for words to explain the feeling when I went home. I came up with the word entitled. Being held like that, sandwiched between your hands, was telling me exactly where I was and what my shape was. And I could feel myself inside, between your hands. Like I was, and I had a right to be. It reminded me of what you had talked about months ago about existing. Most of the time, I don’t feel like I exist, and I hate being around people because I feel like a big fake. But now I really get it, what it feels like to exist. I can’t tell you what a relief it is.
I now felt that we had enough common understanding and trust to directly focus on her tendency toward dissociation.
EMMA: … when I leave my body.…
ALINE: Leave your body … how do you do that?
EMMA: I pull in and up.… Points to an area about three feet above her head, to the right.
ALINE: If I follow where you are pointing, you go to a place above your head and to the right.
EMMA: Stops, looks surprised.… You’re right! I feel like I’m right there.… Points more specifically to the area above her head.… and when I’m there, my face freezes in a fake kind of expression … like I have to pretend to be happy. That’s why the touch is so important. It brings me back down into my body.
ALINE: Can you describe how you do that—how you come back down into your body?
EMMA: Typically, I come down into my body and then I pull right back out.… Points to her body and then above her head.… I do this over and over until finally, I drop in. It feels so good to be in. It’s such a relief. All those years that I felt so crazy, I didn’t know I wasn’t in my body. That’s why I was so upset when the break happened. I thought, here is my chance to find my way in, and I’ve lost it. I’ve lost it, and I’ll never find it again. After a session, I can hold it for a day or two, and I feel so great, then I lose it again. But it’s not so scary when I lose it because I know I can find it again.
Knowing that she left her body through the top right side of her head, I included some holding of her head during each session. Her craniosacral rhythm pulled to the right, and she described the right side of her head and face as “bigger” than the left. We experimented and found that putting my hands over her skull, with the slightest pressure downward on the right side, accelerated her “coming back in.” When she was back in, the cranial symmetry was restored.
Her confusion about attachment, which we had touched upon before the disconnection incident, came up for review.
EMMA: You know that whole thing I was beginning to feel before the phone incident … about attachment … about not knowing what’s right and what’s wrong. I’m really confused. When I try to attach, I get slammed. I get told I’m being needy. If I let myself feel attached to you, I think I’m doing something wrong. I don’t want to be needy, so I keep pulling myself back.
ALINE: So often, when you feel comfortable with me, I see joy bubbling up into your eyes, and something comes alive in you. It’s very strong.
EMMA: I feel a lot of sadness now. I was slammed so many times. My parents always used to say, “You’re too sensitive” and “Why do you care so much?” They were right, I do care too much. I wish I didn’t.
ALINE: I’ve noticed that when your feelings emerge, you feel deeply and passionately. That can be both a gift and a curse. Feeling deeply is a good thing, but managing all the energy that arises from feeling passionately is a challenge.
EMMA: Sometimes, I don’t know what to do when I come here. I’m excited to be coming, but I don’t know how to make contact with you, so lately, I’ve been talking … otherwise it gets too intense.
ALINE: Yes, I did notice that you’ve been reporting more on the events of your week. What are you experiencing right now as you tell me this?
Emma pulled up in a ball to show me how she felt, pulling her legs into her stomach and wrapping her arms around her torso. It was a familiar position, yet there was something different in its quality: Emma did not feel as “young” to me.
EMMA: It’s like I want to be in a cocoon. Protected.
A cocoon rather than a cradle or a nest. I offered her a heavy blanket, with which she covered herself. I sat on the floor in my usual place with my hand lightly on her foot. She closed her eyes and began to cry.
EMMA: I don’t know why, but here are the tears. I’m grieving again. All those years of isolation … it makes me cry.
Her tears were gentle, and I sensed a softening around her heart. Her urge to shut down was counterbalanced by the desire to stay open, even as she was experiencing sadness. We allowed the grief to be.
The therapeutic process described above covers a period of about twenty months of twice-a-week sessions. Emma continued to move through processes that alternated between excitement and despair, connection and distance, expansion and contraction, between stable states of regulated affect and unstable states of dysregulation. On an expansive day she might say:
EMMA: I feel it in my chest, under the breastbone: a warm, full feeling moving upward. There used to be only pain there. It’s really different.
On another day, she might be in contraction, again plunged in the fear of life and people:
EMMA: I lost it again. Yesterday I didn’t get out of bed … and I still don’t like people. The craving for contact is always there in spite of what I say about not liking people.
Emma often brought up the fact that our time-limited sessions were not enough to fill her deficits. She yearned for a haven where she could immerse herself in a nurturing environment—not a clinic, hospital, ashram, or retreat center, but a special place where nurturing resources were available whenever needed. I would remind her that since she could imagine it, this nurturing place existed in her as an internal resource.
Overall, through the ups and downs, Emma continued to grow.
EMMA: I’m not a baby anymore. I’m reading all kinds of books now, and I’m really enjoying them. The reading stimulates my brain in a completely new way. I’m making pictures in my mind as I’m reading, and I’ve never done that before.
ALINE: And since you are no longer a baby, how old are you?
EMMA: I’m about five years old.
Creating a narrative for Emma’s primarily nonverbal experience was a multi-leveled developmental journey. She needed to learn how to observe and be present to her internal experience and to develop a language to describe it. As she did, her capacity to contain negative emotions without fear and positive emotions without overstimulation, face disappointment without collapsing, and bring up memories without blurring past and present consistently improved.
Active and unfulfilled within Emma was a deep longing for connection, yet the idea of connection aroused terror about her very survival. Her ability to feel connected went through cycles of hope-expansion and despair-contraction. As she cycled through varying states and degrees of fragmentation to coherence, from numbness to vitality, from chaos to functional harmony, different elements of the Connection Survival Style could be clearly observed:
• Lifelong patterns of withdrawal and isolation
• Awkward social interactions
• Fear of life and people
• Narrowing and limiting her life to manage over-stimulation
• Feeling herself to be alien, nonhuman
• Longing for connection while expecting rejection
• Shame about her symptoms
• Exquisite but often painful sensitivity to others
• The after-effects of birth trauma, early neglect, and emotional abuse
• Sensory-motor disorganization
• Internal experience of a void
While NeuroAffective Touch was a particularly important factor in the work with Emma, all of NARM’s principles, tools, and techniques were brought into play. In order to facilitate new strategies for self-regulation and internal organization, I used the following NARM principles to engage Emma in a process that nurtured her positive sense of self, reduced hyper-activation, elicited undeveloped impulses, and encouraged new neurological connections:
• Emotional authenticity on the part of the therapist
• A non-pathologizing approach
• Therapist’s self-disclosure to normalize and resource the client’s experience
• Moment-by-moment mindfulness and sharing of emotional and physiological processes
• Working bottom-up as well as top-down
• Learning to track the felt sense
• Finding words for the body’s nonverbal experiences
• Tracking the cycles of connection and disconnection
• Psychoeducation
• Supporting adult consciousness and avoiding regression
• Working with the fixed beliefs about self, the world, and the therapeutic process
• Disidentification from shame-based identifications and pride-based counter-identifications
• Renegotiating the experience of shame
• Working with the undifferentiated sense of self to support separation/individuation
• Helping develop clear energetic boundaries
• Using NeuroAffective Touch to access the felt sense and support attachment
• Using NeuroAffective Touch as an antidote to dissociation
• Active repair of lost connection; working with the difficulties of reconnection
• Working with expansion and contraction cycles
• Supporting necessary grieving while avoiding regression
• Integrating aggression, self-expression, separation/individuation
• Integrating the therapeutic interactive regulation into the capacity for self-regulation
According to Eugene Gendlin, PhD, who coined the term, the felt sense emerges at the intersection of the psychological and the physiological and allows us to “form meaning from bodily experience.”* The felt sense becomes known at the intersection of top-down and bottom-up processes; felt sense perceptions bring together the awareness of our body’s reactions concurrently with emotional responses and thoughts, and the combined experiences, each belonging to a different order of being, allow us to make meaning of our internal world. The felt sense is not a mental experience, nor is it only a bodily awareness; it is the coming together of (1) the body’s direct sensory and emotional responses to internal and external events, (2) the mind’s attention to and synthesis of the information gathered by the senses, and (3) the level of congruence between these channels of experience and their integration to form the awareness of a particular state of being, a situation, or a problem. On the somatic level, to access the felt sense is to retrieve the knowledge and wisdom implicit in bodily experience. On the level of the mind, it is a process of developing a capacity for sustained, focused attention that supports relaxed, nonjudgmental awareness so that internal processes, both psychological and physiological, can truly be heard and tended to. The capacity to accurately assess whether the signals between body and mind are congruent or disjointed is critical to stabilizing internal chaos and making sense of one’s world.
The felt sense is usually not “just there”: it forms as we pay attention to our internal experience, moment to moment. When the felt sense is given time to emerge and form, we discover that our often-intangible bodily states progress from silent existence at the periphery of our awareness to a vivid presence on the map of our consciousness. The more we bring our focus to perceiving our sensations—skin sensitivity, body heat, involuntary and voluntary muscular contractions, organ vibrations, body positions, and so on—the more vivid the awareness of our internal visceral-affective experience becomes. Sensory qualities unfold according to the body’s flow, much as in free association, thoughts are noticed as they float to the surface of the mind. By finding words to describe the qualities of pulsation, movement, texture, color, or temperature that make up the information we receive from our senses, nonverbal experiences are brought into a verbal narrative. Sensory attributes can then be shared and processed and their implicit information translated into explicit personal meaning. In this way, new awareness is drawn from and given back to the biological realm, strengthening the links between body and mind.
Emma had never learned to notice and name the shifting rhythms and oscillations of the felt sense that are the language of the nervous system and that underlie the formation of self. Antonio Damasio, MD, PhD, has shown that developing an expanded vocabulary to increasingly differentiate the awareness of the bodily self is the foundation upon which the entire structure of consciousness is built.* When Emma found accurate descriptions for her sensate experience and when she was able to objectively describe it without regression, interpretation, or premature ascription of meaning, her bodily self felt mirrored, confirmed, and accepted on its own terms. As she mindfully refined her capacity for sensory attention, verbally connecting sensations and cognitions, her capacity for agency over her internal world increased.
Touch became an essential element in Emma’s healing process. There are important considerations to keep in mind when using touch as a therapeutic intervention. Not all clients respond positively to touch, nor is it appropriate to use with everyone. We must be aware that touch is a complex therapeutic intervention imbued with cultural conventions, gender-sensitive issues, and veiled power games. It can sometimes trigger deep-seated emotional experiences that can quickly become overly activating. It is therefore essential that a psychotherapist be trained in the use of touch before using it as a therapeutic intervention.
The ethical fears, prohibitions, and even taboos that surround the therapeutic use of touch reveal an overall lack of knowledge about its use as an important implicit healing language. In truth, few of us have been well touched. Our fear about the use of touch as a therapeutic modality speaks to the pervasive dysfunctions of touch that many have experienced. It speaks to the untold suffering that physical and sexual abuse, both dysfunctions of touch, have inflicted upon so many. Fear about touch also speaks to the deep yearnings and disappointments that the lack of loving touch leaves in our lives. For a client such as Emma, who requires a reparative experience to rework the effects of early trauma and neglect and the resulting dissociative responses, it could be argued that avoiding touch reenacts the initial missing connection she experienced as an infant. From this perspective, the use of touch can greatly expand our psychotherapeutic horizons and add effective, perhaps critical, forms of clinical reparative interventions, particularly with issues of early developmental and relational trauma.
NeuroAffective Touch is a sensory dialogue that engages the language of the body on its own terms, at the deepest biological level, and invites the mind as an active partner. By placing my attention on specific layers of Emma’s body—skin, connective tissue, muscle, nervous system—and by following existing rhythms and lines of force and suggesting new ones, I could attune to Emma and assist her in defining her felt sense experience. As Emma learned to be present to her visceral-affective experience, touch supported her in maintaining the focus inward on her interoceptive sensations—body heat, involuntary and voluntary muscular contractions, organ vibrations, skin sensitivity—and in bringing awareness to these invisible, usually unconscious, internal activities.
By specifically addressing the ways in which Emma had never been met or understood at the most fundamental level, my intention to nurture and support her initiated in her experiences of connection and trust. The unconditional acceptance inherent in a mindful, nurturing presence and touch reached through the traumatized layers of neglect, invisibility, unworthiness, and numbness and validated the foundation of self that is anchored in the body. My attuned attention to the rhythms of her breath, inner sensations, and movements enhanced her ability to stay connected to herself and to me, to attune to her own needs, and to regulate her strong emotions. In the direct containment of touch, Emma could increasingly feel and be present to her own body and mind and find relief in the congruence of her felt sense experience. Her growing capacity to be mindful gave her support to live in a world that had never welcomed her and to which she found it painful to relate.