worked through a lot of issues of childhood abuse, he was just beginning to think he MIGHT want to entertain the idea of a relationship with a woman for the first time since his health crisis began. A few months ago I began working with him carefully applying Somatic Experiencing© principles of resourcing, titrating, pendulating, etc. The results have been quite astonishing to both of us. He has begun dating and discovered a sexuality far deeper and more exciting than anything he remembers feeling when he was younger and hormones were raging. And concomitantly, the urge to do his creative work has become unsquelchable. Each session leads to deep relaxation which he cannot ignore (he is a workaholic), followed shortly by creative and sexual openings. He now openly admits that he feels my deep caring for him, can allow me to touch him without inwardly flinching, and pats the hand I place on his abdomen. A portion of a session with him is in the vignette below. The following concepts and procedures have been gleaned mostly from two modalities of body psychotherapy, Somatic Experiencing© and Sensorimotor Processing©, both of which are based on neuroscience and trauma research. I will briefly survey five of their many ways to facilitate the process: pendulation and titration, resourcing, utilizing all components of experience, the use of mindful language and discharge (state change). Pendulation and titration are concepts easy to apply to even purely psychodynamic sessions. Many of us were trained to allow the patient to complete a horrific narrative in the hope that the neocortex would make sense of it and thereby lessen its ramifications in the person’s present life. The autonomic nervous system, however, is hard-wired, in its optimal, resilient state, to pendulate between sympathetic and parasympathetic modes. Extrapolating, we have learned that the energy locked into the system by trauma is most effectively released in small increments. Therefore, pausing in the account (which we call titration), to allow the nervous system to “recycle” avoids iatrogenic retraumatization. This can be done in a number of ways: by resourcing at the beginning and as it unfolds, by asking the patient to focus in the present and on bodily sensation, and by any one of a number of grounding and stabilizing exercises. It is also important to work within range of resilience: don’t push through resistance or promote catharsis. In this approach, the narrative is used to track nervous system activation, not search for memories. Resources are whatever is positive in patient’s life or imagination: they can be any element of experience: sensation, image, behavior, affect or meaning. It is important to locate and list them with patients at the outset of the therapeutic process. They are reparative in themselves and can also be periodically introduced to allow the autonomic nervous system to pendulate and avoid retraumatization. Titration keeps the nervous system activation within the “window of tolerance.” It is important to allow lots of time as the autonomic nervous system processes more slowly than the motor system or cognition. Traumatic material must be introduced slowly and in small bits, allowing or fostering re-regulation of the nervous system continuously. Utilizing multiple components of experience enlarges the experience, makes it wider and deeper and thereby increases the healing capacity of the intervention. The five components are: • Sensation, which involves any of the 5 senses • Images, which can be internal or external (red ball in chest vs. sunset) • Behavior can be verbal/nonverbal, voluntary/ involuntary, conscious/unconscious. • Affects, or feelings, are actually patterns of sensations • Meaning refers to an explicit linguistic concept or statement (Adapted from Somatic Experiencing Training Manual, 2007, p.B1.27) Language must be mindful, invitational, including open-ended questions such as “How would it be to…”1 Discharge (state change) can take place through awareness of any aspect of experience: sensation, images, behavior or movements, affects, or through meaning (cognition). Our exploration of this phenomenon has been led by Peter Levine’s ethological observations. Why don’t animals have PTSD? They shake after a traumatic event, pick themselves up and walk away. This led to Levine’s exploration of what human beings can and often manage to do. Trauma lies in the nervous system, he concluded, not in the event. If a person’s nervous system cannot manage an event on its own, it must be helped to process the activation which lies outside its range of resilience, ultimately increasing that range. This usually happens most efficiently when we work bottom up (concentrating on sensations), rather than top down energy & character vol.37 may 2009 31
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