Three Phase Treatment of Trauma
Trauma treatment in the sensorimotor approach is broken up into three phases. The first phase is devoted to symptom reduction and stabilization; the second phase to treatment of traumatic memory and the third to personality integration and rehabilitation. The phases are not strictly sequential but proceed organically, often in a spiral fashion in therapy. For example, after stabilization in phase1, one can get destabilized while working with traumatic memory in phase 2 which would necessitate some phase1 interventions to bring arousal back within the tolerance window.
The body is engaged in different ways in the three phases of treatment. In phase 1, clients learn to keep arousal within a window of tolerance by recognizing triggers, changing orienting tendencies, and limiting their access to overstimulating situations. The unnecessary activation of defensive responses that usurps the functioning of other action systems is mitigated through the use of somatic resources. Awareness of the body is emphasized so that clients can learn to recognize the beginning somatic signs of hyper-and hypoarousal and use somatic resources to return arousal to the window of tolerance. Clients learn about the core and periphery of the body and utilize autoregulatory resources that pertain chiefly to the core of the body, and interactive– regulatory resources that concern primarily the periphery of the body, to change the movement and sensation of their bodies to facilitate optimal arousal. Self-care skills that stabilize the energy regulation system, such as regular sleep and eating habits, are also established in phase 1.
In phase 2, unintegrated memory fragments— the physical sensations, sensory intrusions, emotions, and actions— are addressed. Clients identify and embody the resources that helped them cope with traumatic events and learn to use the body to discover actions that provide a sense of mastery even when remembering those past traumatic events. Through awareness of the physical impulses that emerge when the memory is evoked, clients find and complete the innate “acts of triumph,” the mobilizing defenses that were ineffective at the time of the original trauma. Practicing these empowering defensive actions diminishes feelings of helplessness and shame. As mobilizing actions are exchanged for the immobilizing defenses and newly associated with the traumatic memory, a sense of mastery over the traumatic past ensues.
In phase 3, with the somatic skills to maintain arousal at a tolerable level, the embodied experience of empowering actions in relationship to traumatic memories, and a developing awareness of, and confidence in, the body as an ally instead of an enemy, clients are psychologically equipped and somatically reinforced to turn their attention to enriching their everyday lives. The resources learned in previous phases of treatment are used again in phase 3 to support healthy risk taking and more active engagement in the world. Clients learn about the dynamic relationship between the core and periphery of the body and discover how the integration of core and periphery supports adaptive action and new meaning. Cognitive distortions— and the ways in which the body sustains them— are explored to help clients change negative beliefs and engage in the action systems of daily life with increasing satisfaction.
The major goals of phase 3 are :
(1) identify reflexive beliefs,
(2) explore how they interface with physical tendencies,
(3) endure the associated affects,
(4) consider the inaccuracies of the beliefs, and
(5) further develop their integrative capacity to challenge and restructure these beliefs and their somatic counterparts. Traumatic Memory
Memory is not a unitary process but a network of interconnecting systems that contributes to the storage and retrieval of information (Cordon, Pipe, Mayfan, Melinder, & Goodman, 2004). A careful clinical recognition of, and ability to distinguish between and work with, memory that is declarative or explicitly held in a conscious, narrative verbal format and nonverbal, implicit memory that is evoked by traumatic reminders is vital to the work of sensorimotor psychotherapy.Core and the Periphery of the Body
When we recall a past experience with a subjective sense that we are remembering something, we are retrieving explicit memory. This type of memory is verbally accessible and “supports ordinary autobiographical memories that can be retrieved either automatically or using deliberate, strategic processes (Brewin). Explicit memory retrieval is often a kind of “memory modification” rather than an exact recall of events (Siegel, 2003). Thus recall is not necessarily “factually” accurate; rather, it is an “active and constructive” process, subject to distortions and revisions based on the emotional state of the person at the time of recall and associations with both previous and subsequent experiences (Van der Kolk, 1996b). Schachtel explained that explicit memory “can be understood as a capacity for the organization and reconstruction of past experiences and impressions in the service of present needs, fears, and interests”. Like all narratives, explicit memories become elaborated in the service of “telling the story”: Those details essential to the story’s main points are elaborated, whereas other details may be discarded or become part of the subtext (Janet, 1928; Van der Kolk & Van der Hart, 1989). The elements of traumatic memory that are verbally accessible can be revised, edited, and placed in relationship to the individual’s autobiographical knowledge so that the trauma is “represented within a complete personal context comprising past, present, and future” (Brewin).
In contrast, implicit memory is memory for the nonverbal aspects of experience: the smell of your grandmother’s attic, the tensing of your body at the sound of a siren, an opening in your chest when you remember seeing the dawn break over the ocean, and so on. Implicit memories are best thought of as somatic and affective memory states that are not accompanied by an internal sense that something from the past is being remembered (Siegel, 1999, 2001). The implicit memories are often “situationally accessible,” activated in the client’s present life by both internal and external stimuli reminiscent of the trauma: They “[ contain] information that has been obtained from more extensive, lower level perceptual processing of the traumatic scene( e.g. visuospatial information that has received little conscious processing) and of the person’s bodily (e.g. autonomic, motor) response to it” (Brewin) This form of memory includes the reactivated sensorimotor components of memory that emerge in response to traumatic reminders and are not usually integrated with verbally accessible, explicit components.
When memories cannot be organized through language, they are organized on a more primitive level of information processing (Piaget, 1962) that comprise three forms of implicit memory: procedural, perceptual, and emotional (Siegel, 2003). The traumatized person “remembers” via all three avenues: through somatic action tendencies (procedural), sensory intrusions and sensations (perceptual), and emotional storms (emotional).
Of particular importance in a sensorimotor approach to traumatic memory is procedural memory, which is “expressed in behavioral acts independent of cognitive representational storage” (Sokolov et al.,). The unconscious nature of procedural memory is efficient. It enables us to automatically perform many tasks, and accounts for many of the behavioral tendencies that help us cope with trauma as well as defensive tendencies that persevere long after the danger is past.
Disrupting Procedural Memory
Grigsby and Stevens suggested that disrupting what has been implicitly, procedurally learned is more effective in changing dysfunctional patterns than talking about what initially happened to cause them: “Talking about old events (i.e., episodic memories), or discussing ideas and information with a patient (the semantic memory system), may at best be indirect means of perturbing those behaviors in which people routinely engage”. For change to occur, the procedural learning— especially the body’s tendencies— must be “disrupted.” It may not be enough to gain insight: the tendency to enact the old pattern somatically must be changed. New actions must replace the old. (Here, cognitions are useful in motivating engagement in new actions.)
Grigsby and Stevens described two ways that procedural learning can be addressed in therapy: “The first is… to observe, rather than interpret, what takes place, and repeatedly call attention to it. This in itself tends to disrupt the automaticity with which procedural learning ordinarily is expressed. The second therapeutic tactic is to engage in activities that directly disrupt what has been procedurally learned”.
For the purpose of mapping somatic resources, an oversimplified distinction is made between the core of the body and its periphery. The physical core of the body comprises of the pelvis, spine and ribcage. The physical periphery of the body is comprised of the arms and legs. The core provides support and stability to the structure and is grounded through the inside of the legs. The periphery provides mobility and interaction with the environment.
Generally speaking, somatic resources that involve awareness and movement of the core of the body (centering, grounding, breath, alignment) provide a sense of internal physical and psychological stability and therefore support autoregulation. Somatic resources that develop awareness and movement of the periphery (pushing away, reaching, locomotion) tend to facilitate social skills and interactions with the world at large and support the capacity for interactive regulation. In this oversimplified schema, the core is a “supporting pillar” for the movement of the extremities in turn, positive interactions with the environment support and develop the core and provide a sense of “having a core.”
As a consequence of childhood neglect or abuse, the trauma survivor “may [either] seek to surround herself with people at all times, or she may isolate herself completely”. The interactive regulatory pattern suggests a reliance more on the periphery for regulation and a lack of connection with the core of the body and the self. The autoregulatory strategy relies more on the core and is accompanied by corresponding deficits in the ability to use the arms effectively in reaching out to, and setting personal boundaries with, others; or the legs in moving toward and away from objects or people in the environment.
Physical tendencies are “a statement of… psychobiological history and current psychobiological functioning” (Smith). When trauma has induced a negative belief about oneself, others, or the world, the harmonious interaction between core and peripheral areas of the body is typically sacrificed. A belief such as “I’m bad” may set off physical tendencies of constriction, hunched shoulders, held breath, shortened neck muscles, and restricted movement. The corresponding emotions of shame, anxiety, or hopelessness further exacerbate the physical tendencies. These physical tendencies support cognitive distortions and trauma-based emotions, and, in turn, cognitive distortions and concomitant emotions manifest in physical tendencies that hinder the integration of core stability and peripheral movement.
This is what Gurdjieff had to say about this interconnection between physical tendencies, thoughts and emotions.
"If a man were able to work on himself everything would be very simple and schools would be unnecessary. But he cannot, and the reasons for this lie very deep in his nature. I will leave for the moment his insincerity with himself, the perpetual lies he tells himself, and so on, and take only the division of the centers. This alone makes independent work on himself impossible for a man. You must understand that the three principal centers, the thinking, the emotional, and the moving, are connected together and, In a normal man, they are always working in unison. This unison is what presents the chief difficulty in work on oneself. What is meant by this unison? It means that a definite work of the thinking center is connected with a definite work of the emotional and moving centers—that is to say, that a certain kind of thought is inevitably connected with a certain kind of emotion (or mental state) and with a certain kind of movement (or posture); and one evokes the other, that is, a certain kind of emotion (or mental state) evokes certain movements or postures and certain thoughts, and a certain kind of movement or posture evokes certain emotions or mental states, and so forth. Everything is connected and one thing cannot exist without another thing.