Trauma is a fact of life but it doesn’t have to be a life sentence

by Bríd Keenan

The context
I became aware of Somatic Experiencing (SE), as developed by Peter Levine, when I was invited to a Bert Hellinger Political Constellations conference in Würzburg in 2004. Peter Levine showed a video of his work with a man who, as a child, had spent years in a prisoner of war camp.

In witnessing this, I experienced a profound shift in my knowledge and practice as a Gestalt psychotherapist. Nothing was to be the same again. Since then I have integrated this approach, which has strengthened and deepened my original Gestalt practice. I completed my SE foundation training in 2005 and have continued with advanced trainings in SE as well as various clinical developments arising out of SE.

What became clear to me was that unfinished business of the traumatic experience, the incomplete self-protective responses of fight/flight, need to be completed in order to live well in the present. Recent discoveries in traumatology illustrate the central role of physiology in trauma integration.

I knew from both my personal work and my client work that even where there is full understanding of the traumatic event, the physiological remnants of trauma can persist – often in the form of medical and psychological conditions which can leave clients feeling isolated, fearful and dependent on medication for many, many years and with all the attendant social and relational impacts. Clients would often say to me ‘I have told this story a hundred times and nothing really changes’. This was usually accompanied by some physical manifestation of distress or description of a persistent, puzzling medical condition. At these times I experienced the limitation of my training and knowledge.

I have always been wary of another ‘new cure’, particularly coming as I do from the North of Ireland. There have been various government-funded approaches to trauma introduced over the last 30 years. Predominantly, this has applied a trauma approach focused on the individual experience which has pathologised and medicalised the impact of trauma. In addition, these were often applied within political, religious and legal structures and discourses, which have influenced the context and effectiveness of trauma support. This Western model of trauma support has been questioned in other countries emerging from conflict (Fassin & Rechtman, 2009; PRADET, 2007).

I had never heard of Somatic Experiencing. I was both cautious and excited by the possibilities of this approach in relation to my own work as a Gestalt psychotherapist in the post-ceasefire era in the North of Ireland.

There were a number of elements that fascinated me in Peter Levine’s approach that day. Of course, with hindsight and training I have learned to identify and apply these elements of the work. At the time, however, what struck me immediately was the minimum use of story.

A traumatic experience is a shaming experience arising out of vulnerability and lack of control. Retelling the story can often evoke that shame and in an isolated and dissociated way (Gibbons, Lichtenberg & van Beusekom, 1994; Levine, 2010; van der Kolk, 2015). The narrative in SE is used to track nervous system activation, rather than to search for memories. I thought about the people in my practice who, for various reasons, could not speak about what had happened to them or were caught in the repetitive story of traumatic events.

Furthermore, I was intrigued and excited by:

• The emphasis on the client’s capacity for survival as the starting point of the work. This was very different from identifying and clarifying the problem first.
• The quality of attending to the client.
• The simplicity of language and phenomenological observation which established safety in the therapeutic relationship.
• How Peter Levine was tracking changes in the nervous system by observing changes on the surface of the body and his curiosity about that. It was without interpretation, assumption or reading body language.
• The significant shift in the client’s experience which he described as being alive.

My personal experience of this occurred a few years later, after my three-year training in SE. A client with a very traumatic past provided a perfect description of trauma integration (Seigel, 2008) when, reviewing his time in therapy, he said I don’t feel like a ghost in my own life anymore. Now I can see people and they can see me. I knew I had survived but I didn’t feel alive.

Somatic experiencing

When seemingly disparate symptoms, the broken shards and fragments, the signs of syndromes that traumatised people exhibit are followed, they reveal clues that can be used to activate the process of healing.

(Levine, 2015: 169)

The SE approach, one of the best-known psychobiological approaches to trauma resolution, was pioneered over forty years ago by American author and clinician Dr. Peter Levine.

Throughout these years, developments in neuroscience have illustrated clearly the importance of physiology in how we experience the world. In the absence of a single word apart from ‘organism’ in Western thought to describe this whole human entity and experience of the environment, the term psychoneuroendocrinoimmunology (PNEI) is being used to describe this complexity. PNEI is the study of the interaction between psychological processes and the nervous and immune systems of the human body. There is a growing awareness of the importance of physiology and the nervous system for the work of psychotherapists and counsellors (e.g., Macnaughton, 2004; Scaer, 2001; Cosolino, 2002; van der Kolk, 2014; Porges, 2007; Heller & Lapierre, 2012; Maté, 2003).

To support clients experiencing the impact of trauma, we need to understand and work with their physiology (Levine, 2010). We need to gauge how the incomplete instinctive fight/ flight and freeze responses to overwhelming events are held in the nervous system, and how these embodied remnants from the past are present in the form of overwhelm, fear,

anger, dissociation or stress, affecting a person’s ability to live well (Levine, 2010). SE offers a framework for working directly with nervous system dysregulation resulting from these effects (The Foundation for Human Enrichment, 2012).

Equally importantly, the SE framework relates to how the client processes the whole experience. It does so by tracking the client’s process, working from a ‘bottom-up model’. This model, using the acronym SIBAM – Sensation, Image, Behaviors, Affect, and Meaning, guides the client “from the most primitive physical sensations to feelings, perceptions and finally to thoughts” (Levine, 2010: 139).

SE work draws on Eugene Gendlin’s “felt sense” (Levine, 1997: 66) in order to direct awareness of the whole experience and in particular to develop a cognitive awareness of the senses. It is not about finding memories or changing how we think about how we feel (Levine, 2015).

Trauma impairs thinking processes and rational problem-solving abilities, which means that “the whole cognitive part of the brain shuts down when people are traumatized, triggering the primitive survival part of the brain” (van der Kolk, 2017: 3). Traumatic experiences cause the neo-cortex to lose its capacity to discriminate or inhibit activity from the other parts of the brain. The neo-cortex has to reconnect to these other parts for trauma to become re- integrated (Levine, 2015).

The cognitive re-connection does not happen by trying to understand before the traumatic charge has been addressed. SE uses conscious awareness in the here-and-now (neo- cortical-level brain activity) to focus on our own body’s internal sensations (limbic circuits and reptilian brain level). This helps to facilitate the re-integration of the three ‘parts’ of the brain (Levine, 2010).

The “Triune Brain” (Siegel, 1999: 10-18) is the model of the brain used by SE – the neocortex, the limbic or mammalian brain, and the reptilian or lower brain – to illustrate the physiological response to trauma (Levine, 2010). In evolutionary terms, the neocortex is the newest part of the brain and the reptilian, the oldest.

Expanding a person’s tolerance of their bodily sensations helps them to trust their sensations and to begin to separate the fear and immobility which is the core of trauma (Levine, 2010). Ultimately, the focus of the work is on the embodied completion of the incomplete self- protective responses (fight and flight). Completing fight/flight alters the experience of freeze/dissociation and supports change to emerge at all levels of SIBAM.

Understanding trauma and survival:

Trauma may result from a wide variety of stressors such as accidents, invasive medical procedures, sexual or physical assault, emotional abuse, neglect, war, natural disasters, loss, birth trauma, or the corrosive stressors of ongoing fear and conflict.

Foundation for Human Enrichment (2015)

Judith Lewis Herman (Herman, 1992) itemised the features of ‘Complex Post Traumatic Stress Disorder’ (CPTSD). Since then, early childhood trauma, including poverty and inequality, is being recognised and understood as a result of complex trauma. This is described recently in the research into Adverse Childhood Experiences (Karr-Morse & Wiley, 2012). Gostin’s conditions for good mental health (published by the World Health Organisation in 2004) identified: “A climate that respects and protects basic civil, political, economic, social, and cultural rights is fundamental…” (Gostin, 2001: 264-274). More recently, research at the University of Chester (Buxton & Turnball, 2018) illustrates the importance of the ICD-11 proposed diagnostic classification of complex post-traumatic stress.

The good news
We possess a natural ability and capacity to overcome overwhelming experiences, and generally, we do – with timely, appropriate and relevant support. As human beings we all experience the physiological impacts of trauma and it is through these events that each of us learns how to survive. We develop resilience: “our survival strategies are life saving responses and represent successful adaptations, not pathology” (Heller & La Pierre, 2012: 33). Left unsupported and unintegrated, however, the impact of trauma can result in a range of psychological and physical conditions (The Foundation for Human Enrichment, 2015: B1.8).

Whilst all humans experience the physiological impact of trauma, how we survive – our survival style and strategy – is determined by our unique personal history and our political, sociocultural contexts. SE works directly with the bound-up trauma energy in the nervous system, exploring how that survival response has become and remains uniquely part of each person’s life and how this impacts the capacity for social engagement and self- determination, that is, to experience connectedness to life. The loss of connectedness is a major cause of many physical and psychological conditions (Levine, 2010).

We remain in this ‘frozen state’ as if the event was still happening. The behaviour related to this experience is typically referred to as PTSD. Levine refers to this state as “functional immobility” – emphasising that along with the freeze, people still have the capacity to continue with ostensibly ordinary lives – rather than unchanging pathology, understood by the word “disorder” (Levine, 2010: 49). In fact, he prefers the word “injury” (Levine, 2010: 33-5) rather than disorder to compare recovery from post-traumatic responses to a recovery from a broken bone.

At the moment of a traumatic event
Trauma is experienced “directly or indirectly, e.g. via hearing” (Leitch, Vanslyke & Allen, 2009: 1) and pushes us beyond the normal capacity to cope. The first impact is isolation: we feel that we will never be ourselves again nor like anyone else. (Burrows & Keenan, 2004). We are frozen in the past but continuing to survive in the present.

Surviving trauma requires a huge charge of energy and a huge instinctive effort to keep going afterwards. When this energy charge cannot be used up at the time of the trauma, for the instinctive self-protection or the protection of loved ones, people can suffer great distress through this experience of overwhelm. The whole human system becomes fundamentally dysregulated or out of balance as a result.

The instinctive response to self-protect is as natural and instinctive as breathing. We cannot stop these responses nor choose one over the other. When neither fight or flight is possible, for example, you are too small/young, feel frightened/cornered/captured/weak/injured/alone, the autonomic nervous system (ANS) responds by working at the most effective use of energy to maintain life. We are scared stiff, frozen with fear (Levine, 2015), like an animal ‘playing dead’. This is a physiological capacity that ensures survival: ‘We live to fight another day’.

The nervous system
To complete an action, for example, go to the shops, make a meal, move a muscle, requires an energetic charge in the nervous system. When the action is completed the charge leaves the system and the system rests. This is nervous system regulation (charge and discharge). The Autonomic Nervous System governs the parts of physiology that operate without involving intention, such as breathing, heartbeat. Action relies on the Sympathetic Nervous System (SNS) and rest following completion is enabled by the action of the Parasympathetic Nervous System (PNS). This SNS/PNS rhythm enables us to operate within our range of resilience (Foundation for Human Enrichment 2015: B1.6). In other words, we manage our lives.

When trauma has been successfully integrated at a physiological level, our capacity to feel alive re-emerges. Healthy nervous system regulation is indicated by the return of a natural curiosity and a sense of being alive. The interplay in the nervous system between the SNS and the PNS allows us to be curious, as curiosity requires the ability to take risks. Hypervigilance gives way to curiosity.

However, trauma affects this rhythmic interaction and pushes us beyond our normal capacity to cope. Surviving trauma requires a huge energetic change (SNS) and when this cannot then be discharged (PNS), the system continues to behave as if the traumatic experience was still happening. This unintegrated energy in the SNS can result in ‘hyper’ responses such as anxiety, panic, hyperactivity, hypervigilance, chronic pain, rage. The hypo state (PNS) includes depression, lethargy, exhaustion, chronic fatigue, poor digestion, disconnection and low blood pressure amongst others (Levine, 2010).

Evolution and trauma response
Recent research by Dr. Stephen Porges (Dykema, 2006) expands our understanding about what happens when the self-protective responses are not completed. His research shows that rather than trying to balance the SNS and PNS, we have a hierarchical response as a result of evolution. In short, we respond to danger by using the newest system available and if that does not work we then move backwards to earlier tried and tested systems.

The vagus nerve is the major nerve of the parasympathetic system and has two systems, an older one and a newer one in phylogenic terms, hence the name ‘polyvagal theory’ (Dykema, 2015). The newer ventral vagal system, unique to mammals, is linked to the cranial nerves and controls facial expression and vocalisation, arms and the upper triangle of the body. This newer system, the system of social engagement (our need to connect with others) can operate only when it detects that the environment is safe. It enables connection. We need other people to help us to regulate our mental and emotional states. However, traumatic experiences take us out of interpersonal relationships rather than into them.

The older dorsal vagal complex is related to the gut and to the “play dead” (Levine, 2010: 121) capability, that is, the dorsal freeze. When social engagement does not produce safety, and ‘fight or flight’ is not possible, then when life is threatened the dorsal system engages, enabling the ‘freeze response’ – the life conserving strategy (Porges, 2018). Of course, these are not choices. These are instinctive self-protective systems designed to preserve life (Levine, 2015: 100).

So how does SE work with this theory of the physiology of trauma?

The key to resolving trauma is in uncoupling the fear from the paralytic immobility, allowing the intense energies bound in the immobility state to be accessed, freed, and ultimately to be transformed.

(Foundation for Human Enrichment, 2015: B1.14)

It is in the completion of the self-protective responses that self-regulation returns. Based on this, SE has developed a coherent approach which prioritises the body narrative rather than the verbal narrative. SE is not a set of techniques but an integrated approach to working with trauma. Every element of this approach is based in the understanding that trauma resolution is not found in the memory of the event. It lies in working with the nervous system, that is with the somatic experience of traumatic events.

SE maintains that human beings have the capacity to overcome and integrate these experiences. The capacity for survival has been demonstrated by the client’s life to date and exploration of this is vital before moving to any work with traumatic material.

What the practitioner does
SE practitioners relate to clients through:

• The use of simple language and quiet tone to connect to limbic and lower parts of the brain; complex language engages the cortex.
• Resonance: the presence of the therapist is the most important factor.
• Observation: focusing on and tracking the client’s sensory responses.
• Self-report: Supporting the client to report on their inner experience.
• Education: Assisting the client to recognize normal signals of dysregulation and re- regulation, etc. (Foundation for Human Enrichment, 2015: B1.21).

When working with traumatic reactions initially the therapist must attend to the following:

1. Safety
2. “Initial exploration and acceptance of sensation” (Levine, 2010: 74). Clients are encouraged to orientate to the felt sense to support what is new in the experience. This supports the client’s
   sense of safety and capacity. SE works peripherally with the activation. This means that the work may begin away from the area of greatest injury in order to build enough stability to tolerate the strong sensations and emotions contained in the apex of the event.
3. Establish ‘pendulation’, which is the natural rhythm of contraction and expansion. Facilitating the re-regulation of the ANS “by restoring gentle cycles of sympathetic and parasympathetic interplay” (Levine 2015: 55). This supports the client “to experience this rhythm and to know that no matter how bad we feel in the contraction phase, expansion will inevitably follow, bringing with it a sense of relief” (Levine & Kline, 2008: 33).
4. Use titration, that is, working with “the smallest ‘drop’” of survival-based arousal to support integration (Levine, 2015: 75). SE respects the slow, titrated pace of the work and discourages fast, intense cathartic responses (Levine, 2015: 82-3).
5. Pay attention to opportunities to complete the fight/flight responses
6. Support the separation of fear and immobility.
7. Freeing and guiding the redistribution of survival energy so that it becomes available for living in the present
8. Orientating to the here and now and supporting “the re-engagement of the system of social engagement” (Levine 2010: 75). For example, the language used in SE is the language of process and relational engagement in the present tense, e.g., ‘What are you noticing now?’ rather than past tense, e.g., ‘What did you notice?’ (van der Kolk, 2015, as cited in Levine, 2017).

A final word
Integrating traumatic experiences is not completed in isolation. What may be a personal experience occurs within social relationships. We are affected by the condition of others and they by us. In this way, integration must take place at all levels of human existence (Danielli, 1998).