Sensorimotor Psychotherapy

by Grainne O’Connor

Many people who seek counselling for relief from their traumatic memories will find the more traditional approaches of talk therapy limited in their knowledge of the body’s role, but, no longer.

Founded in 1970’s by Pat Ogden, Sensorimotor Psychotherapy Institute (SPI) offered its first training in 1980 under the name ‘Hakomi Integrative Somatics’.  Influenced by leaders such as Bessel van der Kolk, Emilie Conrad, Peter Levine, Peter Melchior, Allan Schore, Ken Wilber, Onno van der Har, Ellert Nijenhuis, Kathy Steele, Stephen Porges and Martha Stark, Sensorimotor Psychotherapy draws from somatic therapies, neuroscience, attachment theory and cognitive approaches, as well as from the Hakomi method, a gentle psychotherapeutic approach pioneered by Ron Kurtz.  SPI conducts trainings throughout the world, and has gained international acclaim over the past twenty years.

I am delighted to say that Ireland was the first country in Europe to host this training.  I discovered that a Training for the healing of ‘Trauma in the Body’ was in the offering so I decided to run with this and bring this work to Ireland, hence Sensorimotor Psychotherapy (SP).  In this article I will try to explain some of the methods and how this approach differs from some of the more traditional psychotherapy approaches.

When I discovered Hakomi and took my first training in this method 12 years ago, my life changed.  That may sound a bit dramatic, but it’s the truth.  The gentleness of this work but also the powerfulness of this method is astounding. I finally found a way of living differently. It felt like coming home to me. I felt safe, in a world I could trust, sure that I would be understood and have the space to grow. People often ask me if this work has a Spiritual piece to it and my response is that, this work is a beautiful expression of a partnership model. It offers a way of healing that recognises not only the essential partnership between body and mind and soul, but the essential partnership between therapist and client. Sensorimotor Psychotherapy shows that inclusion, empowerment, and non violence make it possible for us to listen to ourselves and move to new levels of consciousness.

The foundation of Sensorimotor Psychotherapy is based on the five Principles of Hakomi and these Principles need to be in place within the therapeutic relationship for Healing to occur.

Organicity

The term organicity refers to the organism’s inherent capacity to grow and change, as well as to maintain its self-organizing integrity as a unique individual with its own preferences, desires and goals.

Non-Violence

Non-violence can be misinterpreted as meaning passivity, letting anything happen and not taking charge, rather than actively participating in the therapeutic process.  In Sensorimotor Psychotherapy non-violence refers to how one acts and not to whether one acts.

Unity

All parts of the universe are interconnected and interdependent.  Nothing exists outside the web of relations that constitute the “uni-verse”

Body/Mind/Spirit Holism

A human being is a unity of body and mind and spirit, the constantly interacting subsystems of the whole organism, a whole that is greater than the mere sum of its parts.

Mindfulness

To be mindful is to focus on internal states rather than external events and to attend to present experience rather than the past or future. Mindfulness is a passive state of consciousness in that its goal is to observe” what is” rather than attempting to manipulate or change it.

Psychotherapists who have been trained in psychodynamic, psychoanalytic or cognitive behavioural approaches are working predominantly within a framework of a ‘talking model’. Such practitioners are highly skilled at listening to the words and affects of clients and to attending to what is unconsciously being communicated; they track their clients associations, fantasies, and signs of psychic conflict, distress, and defences; they register the various narrative threads clients bring and bear in mind how and where the childhood story repeats itself in the present; they are trained in creating the therapeutic alliance, working within a therapeutic frame, and recognizing transference and counter transference nuances and enactments; they monitor physical symptoms, using psychopharmacological interventions when indicated; and they invariable take note of the physical presentation of their clients, such as mannerisms, subtle changes in weight or choice of clothing, the slumped posture of a depressed client or the agitated movements of an anxious client.

Yet while the vast majority of these therapists are thus trained to notice the appearance and movements of the client’s body, we would like to suggest that a thoughtful engagement with the client’s embodied experience is largely peripheral to these traditional therapeutic formulation, treatment plans and interventions. The body for a host of reasons has been left out of the ‘talking cure’. Sensorimotor psychotherapy is an approach that builds on the traditional psychotherapeutic understanding by not only including the body as central in the therapeutic field of awareness, but also employing a set of observational skills, theories, and interventions which are not unusually known or practiced in these aforementioned therapeutic approaches.

Another way to state this is that these approaches are based primarily on the idea that change occurs in a ‘top-down’ manner by talking about the client’s problems. The working premise is that a significant change in the cognitions of a client results in a ripple effect, or indirect trickle-down effect of change, so that the emotions, behaviours, and the physical or embodied experience of the client’s sense of self are all affected. The prime target of these approaches to psychotherapy is therefore the words of a client; that is, the words are the entry point into the therapeutic process. The client’s words reveal belief systems, cognitive distortions – the internal organizations of the self, often called the ‘internal working model’, an internalized relational template of self and other (Bowlby 1969). Through the client’s verbal representation, beliefs and affects are engaged, explored, and reworked through the therapeutic relationship.

Sensorimotor Psychotherapy incorporates many of the understandings of top-down approaches but adds the possibility that change can also be facilitated through a ‘bottom-up’ approach.  Such a bottom-up approach proposes that changes in the body will cause changes in the cognitions, emotions, belief systems, and capacity for relatedness in the client (Bakal, 199; Ogden & Minton 200; Fisher et al 1992).

We know that trauma profoundly affects the body and that many symptoms of traumatized individuals are somatically based. Clients suffering from unresolved trauma nearly always report unregulated body experience. For individuals who have experienced overwhelming events such as rape, assault, childhood abuse, or accident, their bodies may have been the very sites of the trauma. Others who have witnessed overwhelming events may have been spared direct physical involvement but nevertheless felt the compelling experience of the body’s reactions to threat; a desperate need to flee from danger, the readiness to flight for survival, or the paralyzed feeling of being frozen with terror. Whether the body was directly or indirectly involved in the trauma itself, the uncontrollable cascade of unmanageable strong emotions and physical experiences triggered by reminders of the traumatic event replays endlessly in the body. It is often this chronic somatic arousal that is at the root of the common recurring posttraumatic symptoms for which the client seeks therapy.

Although hypo arousal is equally as disabling and debilitating as hyper arousal, it is marked by deficits and thus can be easily overlooked or missed by the therapist.  It might manifest as numbing; dulling of inner body sensation; a loss of somatic capacities, such as impaired pain responses of intermittent motor inhibitions (Janet, 1898, Kardiner 1941, Van der Kolk & ven der Hart 1991) or a slowing of musculoskeletal response and diminished muscular tone, especially in the face (Porges, 1995).  In the therapy environment, hypoarousal may be subsumed under depression, lack of energy, or general debilitation and may not be recognized as a bodily response re-evoked by reminders of trauma.  In addition, chronically traumatized clients often develop a capacity to ‘hide in full sight’; their presentation does not always immediately reveal that they can be quite strongly affected by uncontrollable feelings and emotions. The client has learned to disguise and minimize his/her distress and continues to do so in therapy. For all of these reasons, it is easy for therapists to underestimate or to miss completely the distress of the still, inhibited, or hypoaroused client who could appear as bored, depressed or tired.

While psychodynamic, psychoanalytic and cognitive therapies depend primarily on clients’ verbal descriptions or inner states to guide the therapeutic process therapists cannot rely on clients to find the words to describe internal experience, especially early in treatment, if they have tuned out, numbed, minimized, or ignored their physical responses. Learning to describe somatic states is an outcome of successful treatment, a skill learned over time. Unless we have direct somatic methods of checking out and inquiring about such clients’ internal subjective experience and accompanying physical experience, it is therefore easy to misinterpret the unusually low arousal of such a client.

By dealing directly with the physical effects of trauma that may have become invisible to the therapist and client alike, the processing of unassimilated sensorimotor reaction (such as hyper and hypo arousal) is facilitated and the disorganized effects of these reactions on cognitive and emotional experience is moved toward resolution.  In this way, the practice of sensorimotor psychotherapy blends theory and technique from cognitive and dynamic therapy with straightforward physical interventions such as helping clients to become aware of their body, track bodily sensations and implement physical actions that promote empowerment and success.

Clients are taught to become aware of the relationship between their body’s organisation and their belief and emotions by noticing how a self-representation such as “I’m a bad person” affects physical organization, and how the words and content they describe in the hear-and-now of therapy affect their physical sensation and movements. Such interventions help to unify the body and mind in the treatment of trauma and provide clients with the additional means of using the body as an aid in overcoming past trauma.  Within the context of relationally attuned therapy, clinicians can help clients become curious and interested in the body’s sensations and feelings, especially in how their physical response to historical trauma continues in their present life. These somatic, bottom-up interventions can, in turn, provide a valuable additional approach to promoting the same goals as other psychotherapies.

By attending to physical responses rather than avoiding them, clients often find a reliable way out of their chronically overwhelmed and helpless states. Clients can be encouraged to tune into their physical responses as a support to finding a successful resolution to their physical distress. Clients who exhibit unresolved sensorimotor reactions to past trauma can learn to identify and experience the physical reactions themselves. In much the same way that clients who come to therapy with unresolved grief learn to identify and experience the grief, clients who exhibit unresolved sensorimotor reactions learn to identify and experience these reactions, physically. As clients become skilful at observing and tracking the sometimes-disturbing body experiences, these physical experiences, like the experience of grief, can often find their own expression and resolution. As their body’s sensations are recognized and followed mindfully by the client, it becomes possible for the body itself to lean the client into a necessary resolution and calming of the physical experience.

In sensorimotor psychotherapy, clients are taught to use their minds to be aware of the body’s sensations as they fluctuate in texture, quality, and intensity. The therapist teaches clients to differentiate between words that describe emotional states, such as panic and terror, and words for how their body feels, such as hot or frozen or churning.  In this way clients are encouraged to learn the language of their own movement and sensations, first via the therapeutic interaction as the therapist observes and names what they can see happening physically, and subsequently as clients themselves notice movements and sensations without prompting by the therapist.

Through cultivating the ability to form accurate verbal descriptions of their physical experiences, clients expand their perception and processing of physical feelings in much the same way that familiarity with a variety of words that describe emotion aids in the perception and processing of emotions. The capacity to use precise language helps to uncouple trauma-based emotions from body sensations and helps develop the client’s skill of tracking the sensations of the body that accompany arousal, such as trembling, as distinct from emotions, such as panic, until the sensations themselves settle down. This skill often serves to quiet the emotion as well.

Sensorimotor psychotherapy postulated that the failure of the body’s effort to defend itself successfully with active motor responses, such as fight and flight manoeuvres, contributes to the chronic re-experiencing of trauma when the person is triggered by reminiscent stress. The instinctual active defensive actions of flight and fight were not fully executed at the time of the trauma for various reasons. Perhaps these attempts at physical defence were executed in part but were not successful. In some situations, such actions would have made the trauma worse. In sensorimotor psychotherapy, we encourage clients to re-find these impulses to action – the feelings of wanting to push or run or scream or fight-through, tracking the movements and sensations in their own bodies that emerge during the therapy session. In one case, for example, a client who experienced a sense of submission to the sexual abuse as a child by her father discovered her forgotten, doormat impulse to push away, run away and protect herself. Witnessing and engaging her body’ responses to her traumatic past revealed these actions. She became aware of the previously aborted physical urge to push her father away and also run away. As she mindfully re-experienced how her body may have submitted and did not resist her father during the abuse, she also found that her body wanted to fight him and run. These physical impulses that she did not, could not, act upon at the time of the abuse appeared spontaneously as she became meticulously aware of her physical sensations and impulses to action while remembering the abuse. The lost impulses to resist had become encoded not only in praxis of submission, but also as beliefs or automatic assumptions of; “I deserve nothing” or “It is my fault” or “I am bad”.

The general concept of somatic work embraces a wide range of interventions, including body awareness and sensation; movement awareness and education; expressive movement; working with alignment, posture, and breath; and sometimes the judicious use of touch (Hunter & Struve 1997; Smith et al, 1997). These interventions directly treat the effects of trauma on the body by using current bodily experiences as a primary entry point in therapy, and by attending to the body’s organization and ‘processing’ of information throughout treatment.

While words are indispensable in the treatment of trauma, they cannot substitute for the meticulous observation of how clients attempted to defend themselves, and the exploration of how such physical defences were thwarted during the original traumatic event. Nor can words take the place of the thoughtful therapeutic facilitation of the client’s actual experience of empowering physical defensive action, impossible during the actual trauma of the past.  The sensorimotor psychotherapy model proposes that the satisfaction and pleasure of finally being able to know and perform the direct physical defensive actions that emerge spontaneously from recognizing the specifics of the traumatic past alter the somatic sense of self in a way that talking alone does not.

Knowing, feeling, and doing and thus experiencing – these physical actions helps to reorganize the way in which clients consciously and unconsciously hold and organize their understanding of past traumas. It changes the way they respond (cognitively, emotionally, and physically) in their current life and the way they envision the future.  Knowing the body and its reaction to trauma refines and adds to the cognitive building blocks of experience and adaptive action. This approach suggests that the judicious addition of bottom-up interventions assists in the resolution of unresolved trauma, and can help to resolve the chronic effects of hyper and hypo arousal states and their accompanying affect storms. By encouraging traditionally trained psychotherapists to incorporate some of the basic ideas, principles and techniques of sensorimotor psychotherapy the desire is to combine the best of both a top-down and a bottom-up approach thus allowing for chronically traumatized clients to find resolution and meaning in their lives.

The Training Programme in this work consists of three levels, each being a prerequisite for the next. A student may take only part I, part I and II, or all three.

Part I “Trauma Treatment”

Part II. Developmental, Attachment and Trauma.

Part III. Certification Training.

There is currently a training in Part I which is running until 2006 and there is a training in Part II starting in January 2006. Enquiries to gocon@indigo.ie Grainne O Connor, Ballykea, Skerries, Co Dublin. Telephone – 01 8490387

Grainne O Connor is a psychotherapist, facilitator and teacher in Sensorimotor Psychotherapy and is a fully accredited member of N.A.P.C.P and is certified in SP for the Healing of Trauma.Trained also in Spiritual Psychotherapy.