Positive Health Online

This sample chapter of a book is intended for bodywork therapists of any discipline to give insights into the manifestation of physical and emotional trauma. The aim of this book is to add a new dimension of understanding and a skill set, to support and treat the traumatised body-mind complex. The skills developed on reading this book should complement an already existing practice.

In recent years trauma has become a household word, a word that is perhaps overused and at times inaccurately used. “I was so traumatised when I got to the shop, and they had sold out of avocados!” Yet what is also true is that trauma is ubiquitous in our society. We (almost) all have a trauma past, whether this is apparent to us or not: one that manifests in our body-mind. The first realization of a trauma history may be a chronic unexplained illness, fatigue, chronic pain, a life of chaos or perhaps the breakdown of a relationship. This is often the impetus to seek help, and this may begin the journey to unpick and explore our complex, colourful, often challenging past; it may perhaps be the opportunity to explore our family history and even transgenerational trauma. 

The manifestation of trauma explored in this book, is seen through the lens of bodywork. Trauma is a bodymind response to one deeply distressing experience or a series of smaller distressing experiences. A trauma experience whether real or perceived (consciously or unconsciously) affects the individual in the same way by dysregulating the nervous system and causing symptoms. A trauma is a threat that overwhelms the individual. Overwhelm occurs when we lack capacity to adequately respond to the experience (whether real or perceived), which is why what is perceived as a threat to a relatively powerless child or vulnerable person is completely different to what is perceived as a threat to a healthy, resourced adult. During a trauma incident, one’s sense of safety is destroyed, and there is a real or perceived threat to the integrity of self. 

Exposure to traumatic events pushes the nervous system outside of its ability to self-regulate. This dysregulated state of the nervous system manifests in different ways, most commonly explained as a fight, flight response (always on edge) or freeze response (feelings of helplessness, inability to move, or make decisions). These states can be witnessed and palpated in the system. Traumatic events interfere with the brain circuits that involve focusing and being able to stay in emotional control. A constant sense of danger and therefore hypervigilance promotes the continuous secretion of stress hormones, which create symptoms affecting every system in the body. 

When a client with a trauma history feels safe enough to come home to their body (or a part of their body where the trauma imprint lies), to begin the journey of inhabiting their body, healing will begin. As they continue the journey of noticing the ever-changing landscape of body sensation and begin to tolerate and then befriend the sensations within their own body, this will lead to lasting change and healing. This is where we as bodywork therapists can support this fundamental and powerful change, reducing symptoms and improving quality of life. 

What I have witnessed in 30 years of clinical work is that the untold story of trauma manifests in the body, presenting as symptoms, unexplained illness, chronic pain, fatigue, overwhelm or chaos. The adapted neurophysiological response creates changes in our physiology – it is this that leads to symptoms held deep within the system. The trauma imprint is held within the cells, fluids, tissues, and energy of our body, affecting function. If we, as trauma informed bodywork therapists, create the correct conditions of safety, neutrality, and compassion; this, alongside permissive touch, and appropriate techniques, allows the imprint of a trauma history to begin to unfold, and express itself safely, without overwhelm. Presentations of chronic unexplained illness,[i] fatigue, or chronic pain - which are on the rise[ii, iii]- are frequently what clients present with in clinic, often with the words “I have tried everything”. When clients present with chronic pain pathologies and other unexplained symptoms, I hold an awareness of, and space for, a trauma history. A space for the story that precedes the presentation of said pain or pathology.

The power of this work lies in the truth, that the body can access trauma that can’t be verbalised. 

1. Those with a trauma history, will often explain that they have often been failed by words, they may have asked for help from caregivers, expressed their needs or fears in words, yet their needs have not been met. They have been failed by words and therefore stop expressing themselves in words.
2. Words are often inadequate when we attempt to share our story. When it comes to trauma, memory is hijacked, our neocortex where higher cognitive function originates, is at least temporarily impaired in those with a trauma history. Survival mode kicks in, to keep us safe. Our bodies when triggered by events re-experience the impulse to fight or flee, feel overwhelmed or helpless, yet these feelings are almost impossible to articulate.  
3. We are often conditioned to believe that our unique set of circumstances are “normal”. Human nature often justifies past behaviours. For example, the following statements have been shared with me during my time as a therapist: “My parents never reassured or cuddled me, but that was normal in the 60’s: no-one showed their kids affection.” “I was caned at school, but so was everyone, it was no big deal.” “I was unconscious, when I lost my virginity, but that ok, I needed to lose it sometime.” All of the above are trauma stories that have been normalised by the client.
4. Some memories are constrained by the social mores that influence us as we develop.
5. Finally some of our memories are pre-verbal, from an embryonic time or in the first few years of life before we can clearly articulate our needs, feeling or desires.

In summary, our mind and intellectual memory may not be able to access our truth in words, or we may have adapted the story.

Trauma Informed Bodywork

The beauty of Trauma Informed Bodywork is that we do not need to know our client’s story in words, by working with the body, we have the opportunity to bypass the intellect, and societal conditioning, giving the body the opportunity to express its truth from its core – its biology.  All that is held within the system can then begin its journey of self-expression and resolve. Expression of all emotions, deep vulnerability, pain, sadness, loneliness, fear, joy – can be expressed safely via sensations, from deep within the body. Resolve integration, and discharge of the manifestation of physical and emotional trauma, occurs, without the use of the conditioned story to explain the trauma experience.

The Body Keeps the Score

 https://www.amazon.com/gp/product/0143127748

Our body physiology is our living biography, and when the correct conditions are created the body physiology can begin the journey of integrating and processing the trauma imprint.   

Specialists in the trauma resolution field all point to the same truth – that trauma is stored in the body-mind. Therefore, as bodywork therapists with sophisticated touch and relational skills, we are in the ideal position to support the body to process these disturbing tissue memories and move towards healthy function of both body and mind. In her book The Body Remembers, Babette Rothschild clearly illustrates how somatic memory[1] becomes our personal history and recognises the importance of integration of body mind in the treatment of trauma. In his bestselling book The Body Keeps the Score, Bessel van der Kolk explores how traumatic experiences leave traces on our minds, emotions, biology, and immune system. Peter Levine tells us that the treatment of trauma is rooted in an understanding of the bidirectional communication between our thoughts, and our physiology, if we listen to the voices of our body this will lead to healing from trauma. Gabor Mate states that the good news is that trauma is not what happens to you it’s what happens inside of you as a result of what happens to you.  All these statements point to the same truth – that trauma alters body state and function. The involuntary neural circuits, which drive trauma physiology also control instinctual, emotionally led behaviours.  These range from anger, to aggression, to withdrawal, fear, and dissociation. Our body physiology and our instinctual, emotionally led behaviours can all be changed by creating the correct conditions of safety, neutrality, and compassion; as well as applying trauma informed bodywork techniques. 

To illustrate this, I will use a case study: “It’s in my Body.”  I first became aware of a trauma story held within the system in the early 2010s.

A client walked into my treatment room and explained to me that she had done many years of talk therapy, it had helped – but – she explained – I know “it’s” in my body. She did not explain what “it” was. However, what is clear to me now, is that “it” was the physical manifestation of trauma, from her lived experiences.  Her body was carrying the story of her life, her biography from her embryological beginnings, difficult childhood and adulthood was being expressed as symptoms. 

She talked a little about her difficult childhood, and explained to me that as a teenager, she had been coerced into an abusive relationship, and subsequent marriage, where she suffered, sexual, physical, and psychological abuse for many years. She talked about high stress levels, internal anxiety, pain in her heart, poor digestion, muscular tension in her whole body especially shoulders. As well as seeking my support, she had support from social services, regular counselling sessions, a supportive GP, a good homeopath, and a skilful tai chi teacher. It was encouraging to me that she was resourced enough to have gathered support around her and she was embodied enough to be able to feel and describe her body tension. 

The abuse she had endured had changed her neurophysiology and physiology.  She was visibly hypervigilant, which led to exhaustion, her memory and concentration were poor. Her ability to stay present and respond appropriately to current situations was inhibited. Her ability to sleep or rest was greatly reduced, her interpretation of the world around her and the safety she felt within the world, was adversely altered. She constantly expected her ex-husband to jump out of the bushes. She had a court injunction to prevent her ex-husband from coming into contact – so although in theory she should have begun feel safer – she did not - the trauma of her past had changed her neurophysiology - the information from the nervous system, was that she was in danger continued to cycle. An example of her hypervigilance.

What was also apparent was how her physiology was affected. She had a visibly protective posture with both contraction and collapse of anterior chest, her breath was shallow. Her eyes were on-stalks, expressing hypervigilance. Her chin was tipped slightly upwards, with contraction of the sub-occipitals – she was holding her head in a startle response [2].  There was a rigidity to her movements, hypertonic musculature, and tissue density. Pain, impaired function, restricted movement, and reduced fluid flow through the tissues were all apparent. 

What was clear through consultation and informal observation, was how her history was being expressed both in her neurophysiology and physiology. I observed that she moved between a hypo-aroused[3]  and hyperaroused[4] states, in her daily life. During this first consultation she was in a hyper-aroused sate. 

The Power of Positive, Nurturing Touch

Acknowledgement: previously in author’s article Issue 278
Re-integrate Patterns of Overwhelm, Trauma and Emotional Holding

Understandably before the hands-on session commenced, my client needed a very clear explanation of exactly where to lie, what to wear, and where was I going to place my hands. Once she felt safe enough to receive treatment, I invited her to lie supine on the couch. The supine position is important, as this enabled me to see her face and track facial expressions throughout the treatment. I commenced the session with an exploration of her embodiment, I asked if she could feel the contact of the couch beneath her. The sense of contact was slightly available to her, but she felt rigid and light on the couch. We took some time together for a simplified body scan[5]  she was able to rest a little bit deeper into the support provided by the couch. I could witness as she did this, that she was able to settle further. She loved how the body scan helped her to settle deeper, it became an integral part of treatment sessions. We then explored an external resource[6]  she had a cat that she loved and cuddled, she visualised being with and stroking the cat, heard and felt the cats purr and smelt the fur. All of this supported my client to settle deeper. She began to access her parasympathetic nervous system and she felt safe enough to stay there. I initially witnessed the change in her breath and her voice as she settled, her body softened and then a stilling in the room was palpable, as she dropped further into a parasympathetic state. 

The skill of accessing the parasympathetic nervous system, and the ability to stay there – rather than rebounding back into a fight flight or sink into a dissociative state – is a skill that needs to be taught to those with a trauma history. Part of this re-education of the nervous system, can be done and in clinic, it can then be taught as home care. 

I settled myself at her head end, rested into the support of my seat. I remained aware of my own presence and mindful movements around the couch to build safety. With a broad awareness of the whole of her physical body and the energy field just beyond, I made light, flat hand contact at both of her shoulders, my soft responsive hands contoured her shoulders. There was on initial contact a palpable vibration and nervous system activation[7]. I felt deeply into my own internal resource[8]  and used my presence and my own Nervous System to support her into co-regulation.[9]. The client’s nervous system began almost immediately to clear the neural activation and discharge cortisol and adrenalin trapped within. It is this charge contained within the system which causes the vibration as well as symptoms. As the discharge was processed, different sensations and movements came through her body.

I gave space for the vibration. The vibration became a soft tremble[10] and then the tremble began to build. I gave her permission to allow the tremble through her system. The tremble built to a systemic tremble. There were a few flicks which expressed through the legs and arms. Throughout this process I was aware of her breath and her face, this – along with my felt sense, supported me to track the process, ensuring she was not feeling overwhelmed. 

To give verbal permission to the client to allow these movements, and to listen to these sensations of the body is essential, as this facilitates safe change. It is common for a client to try to shut down the movements, as it does not feel “normal”. If a tremble or vibration arises, I quietly inform them, that is a discharge from the nervous system, and is to be encouraged. Explaining it is a self-correcting mechanism from the wisdom of the body, which is seeking a return to greater health.

Simultaneously an intense heat came through her chest and throat, which reddened deeply. Her chest felt slightly compressed, and throat constricted, I ensured that the sensations were tolerable. I broadened my awareness and lightened my touch, with the aim of turning down the intensity of the sensation. My client was OK with the sensations that arose. Compression is often a sign of emotions which have been pushed down into the system. Constriction in the throat is often the result of unspoken words. Heat sometimes signifies the emotions of anger and frustration being processed directly from the body, these expressions of unresolved history arise and move through. 

At times, when there is evidence of energy trapped around the chest or throat. I ask if there are any sounds or words to accompany the sensations, I may use my own voice in a gentle drone or hum to encourage my client (social norms dictate we don’t make strange sounds in a clinical session). Making a noise, may support the process and help move energy through the system. An alternative is to lightly tap the area of constriction and trapped energy. If you use this approach, always check in, as this may feel too intense. 

Whatever sensations our client feels, acknowledge these, and ask if they are familiar: they may be sensations that have been trying to express themselves for some time. Be mindful that emotions can also arise during this process and move though. By resourcing ourselves, and our client; holding a neutral, safe space and giving permission for the change to take place, the client can really allow the process of reintegrating patterns of overwhelm and a return to greater health of body and mind. Ensure that the client is still able to access their resource and at the same time to stay present with the felt sense. Part of the client’s attention should be on their resource – to ensure feelings of safety; and part of their attention on the layers of sensations being expressed from within the body physiology. There is a need to dip in and out resource (to continue with feelings of safety) and the felt sense (to stay embodied with the process): this facilitates safe, fundamental, and lasting change. This is a skill that can be taught to clients during session work. 

As well as allowing the discharge in the form of full body trembling during session work, my client was also able to access this state alone, thus facilitating further change. After 4 sessions of treatment my client reported “feeling really good considering the last 8 years, I am really grateful that I can respond at a deeper level.” We continued with regular (2 hour) session work, and her trauma history continued to be safely and effectively expressed from her body. She moved from a state of contraction and freeze to a sense of physical freedom and “much more emotional control”. Her awareness of her felt sense deepened with time. Initially her awareness was of pain and contraction of musculature, especially shoulders. As this resolved her awareness moved to her jaw and throat, then her digestive organs. Over time chapter by chapter, the embodied story of her life was safely expressed, and the physical holding patterns were given the opportunity of resolve. As her body physiology changed, so did her words; “I am feeling less vulnerable;” “I feel more relaxed and empowered”, “I have a sense of freedom.”

It is clear that embodied listening to the subtle language of the sensations from the body, plus titrating[11] intense emotion and sensation, is the key to healing trauma. Engaging the client in the process, facilitates a return to an embodied presence and empowerment. When a client uses descriptors to explain the sensations as they arise and, in the body, this engages and enhances the felt sense and increases embodiment. As the nervous system processes the contained charge, there is simultaneously a tissue and fluid response throughout the system. Resolve takes place, emotions arise and move through, the embodied reality our biography, of our lived experience is expressed safely, through and from the system. Resolve from chronic unexplained illness, fatigue and chronic pain takes place. The nervous system come back into regulation, facilitating a return to harmony and health of body-mind complex.

In the quiet depths of treatment, when we have created safety, and moved into a neutral state, we can rest into the universal support provided for us. When we witness with compassion from deep within our hearts, and there is no expectation of an outcome.  Only then, a deep calm appears, a timeless, magical quality arises to support the process of change. In the words of TS Elliot it feels as though “…the still point of the turning world”[iv] is accessed. Change takes place in the physical body (nervous system, tissue, and fluid field) and from the energetic body. This magical, timeless quality arises and facilitates the dissipation of trapped energy from deep within the system, back to the universe. When this magic occurs, large chapters of the trauma story seem to move on and never need to be revisited. The body is always seeking balance and a return to greater health, when the correct circumstances are created this occurs. Trauma Informed Bodywork is a powerful tool at facilitating change and trauma resolution. 

Notes

1. Somatic Memory: Body memory
2. The startle response is a set of musculoskeletal contractions viewed as a behavioural interrupt, that prepares the organism for action.
3. Hypo-aroused – feeling numbed by the stress (disconnected, exhausted, withdrawn, socially, isolated difficulty with decision-making & concentration)
4. Hyper aroused – feeling overwhelmed by the stress (agitation, frustration, irritability, anger, aggressive behaviour, hypervigilance)
5. Body Scan – an invitation for her to bring her attention to parts of the body and bodily sensations in a gradual sequence from feet to head
6. External resource – explore something that supports and resources, a memory of a favourite place, a pet. Use the senses to engage the client in the process. Ask them to describe what they see, smell, hear, textures that they feel. This engages the parasympathetic nervous system as the positive memory is brought to the fore and they settle into the memory.
7. Nervous system activation: autonomic nervous system as one of the major neural pathways activated by stress. In situations that are associated with chronic stress or trauma, the sympathetic nervous system can be continuously activated without the normal counter action of the parasympathetic nervous system. Palpable as vibration.
8. Internal resource – a sense of wellness, ease and conform within my own physical system. That supports me to stay present and neutral.
9. Co-regulation: we can support our clients to regulate their nervous system by regulating our own nervous system. We can use our breath, our voice, our own resources to drop deeply into parasympathetic state, which will support our clients to access an otherwise inaccessible parasympathetic state. This is how we share our calm with someone with a trauma history.
10. Tremble: takes place as the Nervous system discharges cortisol and adrenalin, which has been trapped within the system, causing symptoms. As these discharges a tremble passes through, the limbs or whole system.
11. Titration: A word borrowed from Peter Levine. Slowing the process, by experiencing small amounts of distress with the goal of relieving pain and preventing overwhelm.

References 

1. https://pubmed.ncbi.nlm.nih.gov/21565598/#:~:text=Results%3A%20Medically%20unexplained%20symptoms%20made,anxiety%20di%20sorders%20it%20was%2011.4%25
2. https://www.versusarthritis.org/about-arthritis/data-and-statistics/chronic-pain-in-england/#:~:text=Around%2015.5%20million%20people%20in,take%20part%20in%20daily%20activities.
3. https://www.bu.edu/sph/news/articles/2017/chronic-pain-and-the-health-of-populations/#:~:text=Globally%2C%20it%20is%20estimated%20that,with%20prevalence%20increasing%20with%20age  
4. Elliot T.S; 1941. Burnt Norton. London. Faber & Faber