27 year old Sonia enters the office and slides into her chair, facing her therapist. She starts to talk about her week, her difficult triggers happening in relationship with her female partner.
“I can’t seem to tolerate any touch lately. I know I’m turning Maria off!”
Her therapist, Esther, and she have been meeting for 4 weeks. Esther had started with a typical initial evaluation and gathered that her client was there to work on problems with intimacy in her relationship. Sonia also noted that she had been sexually abused as a child by her brother and later on, at 14, by her male softball coach.
Esther says, “Notice what you feel in your body as you describe your triggers.”
Sonia starts to tense up, folding her arms across her chest, crossing her legs.
“I don’t know that I notice much of anything…”
Esther suggests that she close her eyes and notice her breathing, asking her to describe it’s qualities. “Is it long or short, deep or shallow, irregular?”
“I feel like it’s shallow.”
Esther continues, “When you think about not wanting to be touched, what do you notice in your body. Move your awareness to your chest, your solar plexus, and down to your stomach.”
Sonia describes feeling tight, constricted, and feeling her heart rate increase.
“What do you feel in your hands and your feet?”
“I feel a slight pulsating in my hands, numbness in my feet.”
“Noticing the pulsations in your hands. Notice any slight change in temperature, strength of the pulse, shift in numbness in your feet.”
Sonia rearranges herself on the chair, taking a deeper breath. She sighs and opens her eyes, feeling discomfort in this exercise.
Esther had already explained about the use of Somatic Experiencing in their initial two sessions. She had explained that this work involves slowing down, that slow is better, more productive.
She responds to Sonia’s discomfort, encouraging her to continue, despite the vulnerability she feels. She then says, “Let’s work with a resource.” She explains what a resource is, being an image that makes her feel safe, something that provides comfort for her.
Sonia takes a while and then comes up with an image of her dog sitting on her lap. She is encouraged to imagine feeling her dog’s fur, wrapping her arms around her dog, and staying with the image for a while.
Esther then encourages Sonia to return to focusing on the pulsing she was feeling in her hands. They continue to work in this way, eventually getting to an earlier memory when Sonia didn’t want to be touched. She had no control when she was being touched inappropriately by her brother. She went back to the earliest memory of this occurrence at 7 years old. Her brother was 5 years older than her.
The above vinete of a therapy session illustrates using a form of mindfulness-based therapy. Somatic Experiencing, or SE, was developed by Peter Levine. He observed the fight/flight/or freeze reactions to Trauma Therapy Toronto out in nature. It is natural to see animals who have been engaged in a fight for their lives go off and shake the energy out of their bodies. Typically, humans who have been traumatized experience freeze. Their body’s innate response to trauma or victimization would be to fight or flee. The freeze usually occurs when children have experienced trauma, feeling helpless and powerless over more powerful perpetrators.
SE is one of many body-oriented psychotherapy modalities. It can be woven nicely into psycho dynamic relational therapy. Bringing mindfulness to a session allows for more present moment experiences. This helps to sensitize traumatized individuals to frozen energy in their nervous systems. Movement and release becomes more possible when they experience safety within their bodies. It slows down the narrative part of therapy and brings out more of the internal experience.
John Briere, PhD has developed a workshop for professionals that integrates Buddhist philosophy and empirically-based mindfulness approaches with effective trauma treatment. He has integrated Eastern models of suffering, attachment, and mindfulness. He describes mindfulness as being the opposite of avoidance. Traumatized people have learned to go to extremes to avoid pain. Typical numbing behaviors, such as addictions, keep them safely numb. Briere’s work with complex trauma, including dissociative disorders, involves breath training and grounding through “somatosensory feedback.” He teaches clinicians to work with a deep diaphragmatic breathing. In his mindfulness-based model, he teaches nonjudgmental self-observation. Working with affect regulation and equanimity (nonreactivity to internal states), creates more ease and stability for traumatized people.
Jon Kabat-Zinn developed mindfulness-based stress-reduction, which has assisted many traumatized people in recovering from somatic reactions to trauma. He teaches people to slow down and experience “being”, rather than “doing.” Working largely with illness, he created a center for people to attend classes in mindfulness.
Another empirically- based mindfulness related therapy is Marsha Linehan’s Dialectical Behavioral Therapy. This highly structured class teaches clients daily mindfulness practice,which is woven into the 3 modules. These modules are life skills: emotion regulation skills, distress tolerance skills, and interpersonal effectiveness skills. This model works effectively at changing self-abusive and addictive behaviors, which have been used historically as coping mechanisms in dealing with PTSD. Clients are given hands on skills to practice, work sheets to fill out, and diary cards, in which they practice the “observe and describe” skill. This mindfulness practice involves rating difficult emotions and urges from 0-5 on a daily basis.
