Somatic Trauma Therapy: Afterthoughts

This is a review of a twelve day workshop on Somatic Trauma Therapy by Babette Rothschild, originally published in the Journal of the Association of Chiron Therapists in 1997

 

I completed Babette's Somatic Trauma Therapy course eight months ago. [1] I want to reflect here on specific aspects of the theory and practice which have affected me and influenced my thinking and work. In particular I shall explore: the  nature of the containment it offers; definitions of trauma; the usefulness of calibrating autonomic activity and mapping its function and symbolic meaning; and building ego through muscle tensing.

  My experience as a client

Babette did two pieces of work with me in the group as demonstrations of technique, one near the beginning of the training, and another a year later during the final section of the course. They made a lasting impact on me, as significant as a range of other therapeutic encounters I have experience in ten years of individual therapy and training groups, at Chiron and elsewhere.

 I can remember them clearly - this it itself is important because my memory of events in the past, even quite recent past, is often not very vivid. The two pieces of work both centred on my experience of giving birth, which I chose because it was a recent event and had traumatic elements to it, but also because of its overwhelming importance in my life.

  I told the story of my experience of sixteen hours in labour. During this narrative, Babette stopped me frequently to gather further information, to help me pay attention to my body, to slow me down, and to encourage and support grounding and containment. Being interrupted so often was quite challenging for me as a client, but it is crucial to the external regulation that the trauma therapist provides. The acceleration of process - thinking quickly, being flooded with  images - is symptomatic of sympathetic nervous system (SNS) activity. From a biodynamic point of view it makes sense to slow down the headlong pace so that the story itself can be 'digested'. This braking cuts through the self-enclosure - also characteristic of narcissism - which re-enacts the sense of profound isolation that is a mark of traumatisation. [i]

 What I like about Babette's technique is the exact calibration of autonomic activity.

She focussed on my autonomic signals, and selected the wetness/dryness of my tongue as a marker to gauge my shifts in and out of sympathetic and parasympathetic. [ii] [iii] When my autonomic signals showed that both sympathetic and parasympathetic systems were becoming strongly activated - the defining criteria of  a 'traumatic' state - she would work to ground me and lessen the anxiety before continuing. As a therapist I have found this mapping of autonomic activity the single most useful tool from the course. [iv] There are of course all kinds of ways of assessing a client's state - behaviour, language, countertransference, and undoubtedly we are subliminally aware of autonomic signals anyway as body psychotherapists - but the framework of the theory of autonomic functioning made it very concrete, particularly in precisely defining the 'edge' of a process.

  To help contain my process and integrate autonomically, Babette would slow me down, and sometimes asked me to talk about Melissa in the present. The fact that the outcome of the birth was good  - I had a beautiful healthy little girl - made it the perfect anchor to ground me as the anxiety level rose. This was extremely effective - the moment I thought of Melissa, I would start smiling and relaxing. This technique of choosing an anchor - a safe subject with strong positive associations - is one that most conflicts with our training at Chiron. Rather than following a process, it is a strategic deflection designed to reduce the charge. I found this highly structured, cognitive style of working quite alien to my intuitions and impulses as a therapist. Despite experiencing its effectiveness, I have not used it with clients. Where there is a need for strong containment, I am much more likely to use a here and now interpretation.

 Babette also paid close attention to muscle tonus, and distribution of body awareness. She frequently asked me about my perception of my body. In my case, a key marker was the relaxation and contraction of the muscles in my belly, specifically the rectus abdominus. Another technique used to help me brake was muscle tensing. This is a deliberate contracting of specific muscles which helps build a physical, muscular sense of containment. I was very struck by the effectiveness and simplicity of this. It has had a significant influence on my thinking about muscle and its relation to ego and I have integrated muscle tensing into my work as a massage therapist.

 The other major tool of trauma work is the use of the SIBAM model (Sensation, Image, Behaviour, Affect, Meaning). This is used to chart the degree of fragmentation in the client - a traumatised client will have major aspects missing, such as affect, or sensation or image. Often there is a lot of 'meaning' - ie. beliefs or decisions made during or after the trauma which can dominate and restrict the person's life. Babette picked up on the beliefs implicit in my narrative - particularly around success/failure, abandonment, and aggression - and challenged these on a cognitive level.

  A particular kind of containment

One remarkable effect of Babette's technique was that I began to remember more details of the whole experience - especially sensory details like colours and smells, sounds, as well as conversations and aspects of my internal process. This was significant because usually when I retrieve memories they are fairly global, feeling-centred, with perhaps one or two clear  pictorial details, but I have never experienced remembering specific sensory detail so precisely. At the end I felt a sense of containment that was also subtley distinct from other experiences I have had of feeling contained. I felt slightly toned in my muscle, with an overall evenness in my awareness of my body. I felt in my head - in my mind - an almost physical sense of integration, as if my corpus callosum  (a thick connection of nerve fibres connecting left and right hemispheres of the brain) were a muscle that had been worked a bit. I had a fantasy that my left and right brain had become more integrated.

  I want to compare this experience of feeling contained  with two other kinds of experience of containment.  Obviously the kinds of containment I describe overlap but I am attempting to distinguish them by emphasising their bodily nature here. Most familiar to me is the sense of being held, of having let go of something, of feeling a bit lighter, of being able to breathe more easily, of feeling relaxed. Another version is a post-vegetative-upheaval state, where there has been either a strong discharge, or an intense barely bearable experience of internal conflict, which I have somehow survived. This experience carries with it a sense of huge internal re-organisation on a vegetative and muscular level. I associate the former state more with my individual therapy, where my therapist works mainly through interpretation. The second state I associate with other therapeutic experiences I have had at Chiron on some occasions, although not that often, and certainly less often than the first kind of just feeling held. It characterizes one aspect of body psychotherapy, where the emotional charge is allowed to intensify  and structuring or interpreting may be secondary.


[1]   Babette Rothschild developed her Somatic Trauma Therapy from her training at the Bodynamic Institute in Denmark, and from the work of Perter Levine. An outline and discussion of the course contents by Paddie Smith  was published in editions 4&7 of the AChP newsletter.



[i] In the second part of this article, I discuss the definition of trauma at length, including reflections on the relationship between trauma and narcissism.

[iii] The essence of the theory is this: in stressful situations the sympathetic nervous system is activated and the parasympathetic is lowered (as we learn in the training at Chiron); in trauma, both systems are activated, with the parasympathetic system often masking the sympathetic. At its climax this results in tonic immobility, or freezing - the whole system is paralysed. The clue to a remaining post-traumatic state is that the autonomic nervous system remains out of balance:  in terms of body temperature, sleep, in relation to pain, visual disturbance, heart irregularities etc. Early signs that a trauma is being reactivated - such as in a therapeutic process - are combined symptoms from both sides of the autonomic nervous system, such as one part of the body being hot (PNS) while the other is cold (SNS), or sweating (SNS) with a normal heart rate (PNS), or a dry tongue (SNS) and constricted pupils (PNS).

[iv] I believe that calibration of autonomic activity can give us information about the clients level of internal conflict - the trauma signals may be an indicator of  the intensity of the transference relationship itself . They give us an embodied reference for psychological defences such as denial, rationalisation, reaction formation etc. In the second part of this article I discuss the symbolic function of autonomic symptoms.

Psychotherapy, Supervision, Consultation and Training

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