Positive Health Online

Introduction

Car accident trauma is one of the most misunderstood, most under-treated and even most incorrectly treated of all traumas. Car accidents are increasing, affecting more than ten million people worldwide each year.

A study reported in the American Journal of Psychiatry (April, 1999) revealed that most car accident victims showed symptoms of post-traumatic stress disorder (PTSD) and that symptoms remain high more nine months after the accident. Of course, not everyone who is in an auto accident suffers from post-traumatic stress.

As practitioners, you are likely to have experienced two different types of clients that are troubled with PTSD symptoms related to car accidents. The first group is comprised of those people who have been in an accident and suffer from a variety of cognitive, physical and emotional symptoms including confusion, chronic pain, anxiety, angry outbursts, weight gain, insomnia, as well as driving-related fears, and who realize that these symptoms are related to their auto accident.

There is a second group of people who have many of these same symptoms but have no idea that these symptoms have anything to do with an auto accident that may have taken place even years earlier. Also, because most people cannot avoid driving, they are continually exposed to their trauma triggers in a way that people suffering from other types of traumas don't necessarily have to face on an everyday basis.

Somatic Experiencing and the Heller Resiliency Model

As teachers of Somatic Experiencing(r) (SE), developed by Dr Peter Levine, we find SE to be invaluable in the treatment of a variety of traumas. We have adapted SE and designed the Heller Resiliency model(c) specifically for working with car accidents. We will begin with a general clinical example illustrating how Somatic Experiencing and the Heller Resiliency model(c) differ from other modalities in the treatment of trauma (PTSD).

Clinical Example – Female Auto Accident Client

When a client comes in for treatment of car accident trauma, normally practitioners will ask the client to tell them what happened, to go through the accident as it actually happened. This usually fits with the client's natural tendency to want to tell the story. They have probably already gone through the trauma event with many people including other practitioners. The client has come to see you because they are still experiencing a variety of symptoms – anything from anxiety while driving to flashbacks or persistent physical pain.

Our first intervention is to encourage the client gently not to repeat their story. We let her know that we do want to hear the whole story eventually, but to begin with we have another focus. The question we ask, a key to how our work differs from other modalities is, "Can you tell me the first time you remember feeling safe after the accident?" It may be that she will respond, "I felt such relief when I saw my husband's face when I awoke in the Emergency Room". As she relates that memory, the therapist will usually see marked signs of relief, from the muscles relaxing to the breathing becoming fuller and deeper. Then we use specific languaging to help the client more fully feel this sense of relief and safety in her body. Helping the person ground their experience in sensation is what Somatic Experiencing calls working in the 'felt sense'. "Felt sense is a term coined by Eugene Gendlin in his book

Focusing.[1]

We ask the client to pay attention to the physiological shift that is taking place. We ask her where in her body she feels this shift and to describe the sensation physically. She may reply, "I feel a loosening and warmth in my chest and arms", and we respond, "And when you feel this loosening and warmth in your chest and arms, what else do you notice or what happens next?" We will continue in this manner, helping the client to track her physiological responses until she feels relatively stable.
We want to help the client to build an awareness of what we call an 'oasis of safety' before beginning to work with the traumatic material.

There are two reasons why we want to start this way:

1. When the client is telling her story in the order it originally happened, the retelling activates the client's physiology as if she were actually reliving the accident and she may respond by feeling flooded or by dissociating. Symptoms may worsen or intensify. A well-meaning therapist may unintentionally retraumatize the client by having her go through the traumatic event too quickly, in the order it happened, and with insufficient support. It is easy to safeguard against these difficulties, which we will explain shortly;

2. The image of the husband coming into Accident and Emergency and the subsequent physiological discharge of traumatic energy become the first resource that we may return to again and again in the course of actually dealing with the traumatic event itself.

Personal resources include any memory or fantasy of people, places, skills or experiences that trigger relaxation in the body, a sense of well-being or comfort, as well as autonomic nervous system discharge.

We recommend building an inventory of resources that originates out of the client's own experience related to the specific traumatic event that she is currently processing. We do not suggest or insert resources for her. She accesses her own. As she discovers resources co-emergent in her experience with the symptoms related to the trauma, the client feels increasingly empowered, dispelling the overwhelming helplessness that accompanies the traumatic event. This way of working enhances her sense of self-efficacy and rebuilds her trust in the innate healing wisdom of the body.

If the client does not have an experience of feeling safe that she can call on since the accident, we may have to find another situation from before the accident that brings a feeling of safety to start this process. It is always essential to begin working both from an oasis of safety and a sense of stability, with resources in place that will help to neutralize the traumatic energies. It is very important that those resources come from the client's own experience and not from the therapist's suggestions. Many trauma survivors feel particularly betrayed by symptoms in their body, so to rediscover the body's innate capacity for healing lays a foundation for the client to begin trusting her own body again and eventually to come home to it. It is of crucial importance that the work on the trauma progresses slowly, and that the client has resources in place. Another key concept of Somatic Experiencing(r) is called 'pendulation' or 'looping'. Looping is a technique where the therapist helps the client move back and forth between small pieces of the traumatic material to one of the client's resources. This looping back and forth helps to discharge the activation in the nervous system that emerges as the person slowly works through the traumatic event. In contrast to how EMDR(r) is usually practised, for example, we always begin at the least charged aspects of the accident first and wait to deal with the most difficult aspects of the trauma last.

The Structure of Trauma

Basic to the understanding of Somatic Experiencing(r) is the concept that trauma is in the nervous system, not in the event. In the face of threat, all organisms enter into survival mode, and when these defensive reactions are not able to be completed due to the suddenness or the overwhelming quality of the event, these energies remain bound in the body in the form of symptoms. Survival mode is a highly aroused state to enable short-term defensive reactions of running away, fighting or freezing. Very powerful energies of fight, flight and freeze become mobilized. If these defensive mechanisms get overwhelmed and we are unable to use them to defend ourselves successfully, those highly charged energies get bound in the body and, if left undischarged, begin to form the symptoms of trauma.

"The very structure of trauma, including hyperarousal, dissociation, and freezing, is based on the evolution of predator versus prey survival behaviors. The symptoms of trauma are the result of a highly activated, incomplete biological response to threat, frozen in time. By enabling this frozen response to thaw, then complete itself, trauma can be healed." (Peter Levine, founder of Soamtic Experiencing(r))[2]

Freeze Frame

Because in most car accidents drivers have very little or no warning and they often occur at high speed with great force, we often use a strategy called 'freeze frame'. Once the client identifies the moment she got the first glimpse of the car that hit her, we ask her to stop and freeze the image, and then ask her to move the car back mentally as far as she needs to in order to regain a relative sense of safety so that she can feel how her body would have initiated a survival response if she had had more time and space. Completing the instinctive defensive survival responses of fight and/or flight in fantasy, as well as slowly completing the actual sensorimotor patterns that accompany them, creates a corrective experience that releases thwarted impulses and frees bound energy. This strategy of facilitating biological completion is central to our work.

Explaining this process in depth exceeds the scope of this paper, but there are specific examples in Diane and Laurence Heller's Crash Course: A Self-Healing Guide to Auto Accident Trauma and Recovery,[3] as well as in Waking the Tiger by Peter Levine.[2]

Moving from Fragmentation to Integration

For those practitioners who have never seen Somatic Experiencing(r) work, the amount of discharge and physiological release that is effected by using this gentle technique is always surprising.

People have the perception that time and space collapse at the moment of impact. Due to the velocity and force of the impact, it is particularly important to tease the intensely activating material apart, one moment at a time, and to work before and after the accident.

We start by establishing the previously described oasis of safety that a client can continually build on and touch back into. And we make sure to focus her attention on establishing a sense of 'after'. Most clients, early on in the treatment, are unconsciously stuck in the time of the accident and are expecting it to happen again – what we call a 'futuristic memory'. Also, the reptilian brain takes a 'snapshot of the scene' anytime it feels threatened. Because of this reaction, clients often fear anything that reminds them of the original circumstances of their accident. Triggers for fear and anger may be activated by re-exposure to particular intersections or highways, tailgating drivers, or even cars of a certain colour, if those were elements relevant in the client's particular accident event.

For most people, the moment of impact is the most overwhelming and is the most highly charged part of the accident. Usually people dissociate or disconnect, experience a discontinuity of self, and often a gap in memory, related to the impact.

Only by going slowly, directing attention to events before and after the impact and working gradually towards the centre, is it possible to begin closing the gap in awareness to regain a continuity of self. By looping between resources and the triggers of high activation, there is an experience of moving from fragmentation towards integration. Clients find that they can gradually slow down and maintain an integrated awareness from start to finish throughout the accident, including impact. Then, perceptually, the accident can move from seeming to be ever present, or fixated in the future, into the past where it belongs. Symptoms diminish and triggers of fear, panic and anger are extinguished as continuity of self is re-established and the accident is experienced as truly over.

References

1. Gendlin Eugene. Focusing. Bantam Books. New York. 1998.
2. Levine Peter. Waking the Tiger. North Atlantic Books. California. 1998.
3. Heller Diane and Heller Laurence. Crash Course: A Self-Healing Guide to Auto Accident Trauma and Recovery. North Atlantic Books. California. 2001.