Sunday, January 21, 2024

Somatic Focused Trauma Therapy: You Have a Right to Heal by Payam Ghassemlou MFT, SEP, Ph.D.

For anyone who might be new to the body-inclusive psychotherapy method, below you will find a summary of a case that shows the effectiveness of this approach. This case also reveals how, as a licensed Marriage and Family therapist, my psychotherapy practice is inspired by my training in Somatic Experiencing® (SE), which was founded by Peter A. Levine, Ph.D. His curiosity about animals in the wild getting exposed to life-threating situations without getting PTSD while humans frequently succumb to this disorder was the start of SE’s development. SE is a body first approach that helps people discover where they are stuck in the fight, flight, or freeze responses, and how they can “resolve these fixated physiological states.”

SE is a powerful trauma healing medium that includes working with sensations, movements, postures, and gestures as a way of deepening resilience and to reset the nervous system. According to Dr. Levine, the autonomic nervous system (ANS) can become dysregulated due to “the thwarted responses of fight, flight, or freeze” in the aftermath of trauma. A body-oriented approach like SE can help stop trauma become “a life sentence” through “gently releasing thwarted survival energy bound in the body.” To do this, Dr. Levine developed SIBAM as a method to accurately track a client’s inner experiences. In his writings, he described SIBAM as an acronym for “Sensation (Internal-Interoceptive), Image, Behavior (both voluntary and involuntary), Affect (feelings and emotions) and Meaning (including old/traumatic beliefs and new perceptions). These five elements are the channels of experience that occur during a session.”

As you read this case, please note identifying information has been changed to protect confidentiality*. Xavier (pseudonym) is a 35-year-old cis gay man, and a person of color who started to see me to deal with anxiety and work-related stress. He has a history of trauma due to homophobic mistreatment, racial injustice, growing up poor in an impoverished neighborhood, and dealing with alcoholic parents.

After obtaining Xavier’s consent to offer body-inclusive psychotherapy and establishing therapeutic alliance, I started to educate him about the working of the nervous system, and the benefits of a bottom-up approach in therapy. Educating clients about a bottom-up approach, and the basic working of the nervous system can help enhance and clarify the somatic focused therapy process. Clients can benefit from knowing that relying on the thinking brain (a top-down process) as the only path to deal with the root cause of trauma symptoms is not enough to resolve trauma related symptoms. The parts of the brain that are responsible for reflexes, memories, and automatic survival responses are in its deeper regions, and trauma informed therapy needs to involve focusing on those areas.

I also encouraged Xavier to read Waking the Tiger by Dr. Levine, which was a helpful adjunct to his therapy process. It gave him a better understanding of the SE informed therapy process. In general, inviting clients to read books and articles on somatic focused therapy process can demystify the process and help with establishing trust.

My training in SE helped me notice Xavier’s nervous system is stuck on “low,” or hypo-arousal, and when faced with stress, he defaults to shutting down. For example, since he has been promoted to the lead designer at his industrial design job, he often feels overwhelmed dealing with “difficult” colleagues. SE stabilizing techniques have helped Xavier avoid staying stuck in a shutting down mode. One time during the practice of orienting to the environment, he noticed his dog sleeping in the corner of his home office. His dog is a helpful resource and brings him joy. I invited Xavier to track pleasant sensations in relation to noticing his beloved dog. He reported sensing openness in his chest, relaxation in his jaw, and clearer vision. This practice of orienting to the environment by pausing and noticing his surroundings through one or more senses became part of his somatic tool kit. This practice is one of the stabilizing techniques that I often use to support my clients’ nervous system regulation.

To explain it in more detail, orienting to the environment includes the exploratory act of pausing and gently taking in what’s around you. You can let your eyes go wherever they want to go while moving your head gently. You can let your eyes rest on an object for a few seconds, and, when you feel ready, continue with the exploratory practice until you are ready to stop. I often found it helpful to invite clients to notice what they sense as pleasant in their environments and stay with that experience as long as it feels right for them. Xavier, and many other queer trauma survivors, can benefit from introducing their nervous system to uplifting experiences which is contradictory to the experience of the trauma they had to endure. This can help stop letting one’s trauma become a life sentence.

Regarding his work stress, in particular the responsibility of being the lead designer, Xavier has found the concept of under-coupling very useful. By learning about coupling dynamics, in particular under-coupling, Xavier noticed he often underestimates the sense of accomplishment and pride that goes with his advancement of becoming the lead designer. The promotion increased his income, helped him learn more design skills, and freed him from doing many “boring” work related tasks. Up to this point, he did not make a positive association with it. He mainly focused on the burden of having to oversee more employees. When I invite him to identify what feels good about his promotion, he often reports feeling more relaxed and happier after describing it.

As I stated earlier, Xavier has a history of trauma. To avoid the risk of re-traumatizing Xavier by encouraging him to share in detail about his past traumatic events, I used the titration method. Titration is done very gradually to ensure that the trauma narrative does not retraumatize a client. Processing small bits of his painful story at the time and gently revisiting remembered sensations in his body helped Xavier avoid getting overwhelmed or re-traumatized. By holding a safe space and using the titration method, he has been able to uncover bodily sensations associated with his past traumatic experiences. By letting the sensations move through his body, he has been able to release stored trauma energy through crying, shakes, and trembling. This particular release of tension, stress, and trauma can happen during somatic focused therapy. Such an experience helped Xavier have a deeper awareness of his body-mind connection and improved his ability to release and regulate his emotions. Since our work together, he feels less bothered by his past negative circumstances.

Attending some of Dr. Levine’s seminars in Los Angeles, and online, I have learned, “Trauma originates in the nervous system, not the event.” For many queer trauma survivors like Xavier whose thinking brain gets hijacked by trauma memories and their bodies default to a freeze response, a body-centered approach or bottom-up processing is necessary to work with their arousal systems. Previous homophobic mistreatment can cause many queer people like Xavier to feel unsafe even where there is no real threat. What many trauma survivors hold inside in the aftermath of trauma can cause them to overreact in a safe environment or not react correctly in a dangerous situation. A body inclusive therapy can help heal such neuroceptive (a term coined by Dr. Stephen Porges) conditioning and support the ANS to move out of a dysregulated state into a biological state of safety and connection.

After Xavier accomplished his counseling goals, he stopped feeling anxious, his relationship to his job improved, and he was able to meet less frequently for therapy. He has benefited from occasional booster sessions to receive additional support to resolve his life and work-related challenges.

No matter what situation caused one’s trauma, everyone, including Xavier, has a right to heal from it. Life is meant to be an opportunity to grow, prosper, and experience love and joy. Not a constant re-living of one’s unhealed traumas. That is why somatic focused trauma therapy is so necessary to help not only LGBTQ+ people like Xavier but also anyone who is suffering from trauma to reach their full potential.

*Names and other details have been changed in respect for privacy and confidentiality.

© Payam Ghassemlou SEP, MFT, Ph.D., is a psychotherapist (marriage and family therapist) in private practice in West Hollywood, California.

Sunday, March 26, 2023

Earth, Love, Breath


Breathing with the awareness that we are connected to all living beings including the Earth is a fundamental practice in many spiritual traditions. For me, such awareness is an opportunity to connect with the soul of the world (Anima Mundi) on a deeper level. In one of the spiritual practices that I follow, I bring awareness to the space between the in-breath and the out-breath. Noticing and infusing this space with feelings of love and gratitude for life is how I can magnetize my inhalation and exhalation with an appreciation for the sacred nature of life. This practice can also impact the state of my autonomic nervous system (ANS). It provides a shift toward my parasympathetic system and invites a sense of serenity to my body and mind.

The ANS is the part of the nervous system that governs the fight, flight, or freeze instinct and is responsible for many unconscious bodily functions such as breathing, digesting food, and regulating the heart rate. It also plays an important role in supplying information from our organs to our brain. In addition, the ANS plays an enormous role in helping us experience safety. Once regulated, our ANS can help our body settle and make it easier to bring awareness to our breathing for meditative and healing purposes. There is magic in the breath that flows from a person with a regulated nervous system. When infused with love, it can offer the healing atmosphere needed to relate to the planet from a caring place.

Everyone has a nervous system. Embracing the oneness of our humanity can include awareness of our collective nervous system, and the need to regulate it. There are many breathing practices that can help regulate the ANS. Breathing from a regulated ANS can add harmony to the collective nervous system. It can also create the inner peace needed to breathe with the intention of loving the Earth.

When I breathe in the context of loving and connecting to my body and the Earth, I can create a relational field between my body and the planet. In this relational field, I can love the Earth. As Thich Nhat Hanh reminded us, we need to fall in love with the Earth. This love affair can happen through contextual breathing that involves mixing breath with love and offering it to the planet. During this practice the body can become a sacred vessel in the service of creation, a home to mystical experiences, and a container for love.

The Earth is a living being with a soul and in need of love. Our survival on the planet depends on how we treat the Earth and all its inhabitants. Those of us who hear the cry of the Earth cannot ignore the pain that has been inflicted on her by greed driven consumerism. As the ecosystem is being destroyed by greed and economic expansion, everyone has a responsibility to respond to the lament of the Earth. As the oceans get more polluted and the rainforests more devastated, we need to ask ourselves, “What are we doing for the Earth?”  

One way to help the planet is by loving it and relating to it as a living being with a soul. As I described earlier, this relationship can happen through our body, in particular the awareness of our breath. Not everyone finds meditative breathing helpful, and such practice should never be imposed on anyone. Those who can engage in slow and mindful breathing with the intention of caring for the world and inviting calmness to their nervous system can expand their meditative process beyond solely focusing on personal growth.

To turn the body into a container of love and a vessel in service to the Earth, one needs to claim the body first. Just like a garden that needs preparation and elimination of weeds before planting, the body needs preparation for deepening one’s relationship to life. This work needs to involve healing from one’s unresolved traumas. According to Peter Levine who developed the Somatic Experiencing® approach to healing trauma, “trauma is a fact of life,” and it can become embodied during a person's life. Since our ANS is shaped by our life experiences, having a history of unresolved trauma, or dealing with a current overwhelming situation can negatively influence our ANS’s ability to help us feel safe and cause it to dysregulate. Therefore, much of the healing from trauma needs to happen through the body. In particular, the nervous system needs to be regulated. For some, a traumatized body is less available for the type of breath work that has the potential to facilitate a kindhearted connection to the Earth. The sense of bliss that one can experience in relating to life from a place of gratitude is difficult to access in a body frozen by trauma.

After all these times that the Earth has been sustaining and holding us so generously, the least any one of us can do is to breathe with remembrance of the sacred nature of the Earth. Such breath carries a fragrance of love for the Earth and invites a sense of aliveness to the body. Also, such breath is needed to journey within and practice meditation with the soul of the planet in our hearts. Keeping the planet in our hearts during meditation can trigger healing energy that is needed to love the Earth back to health.


© Payam Ghassemlou SEP, MFT, Ph.D., is a psychotherapist (marriage and family therapist) in private practice in West Hollywood, California.




Saturday, August 27, 2022

Sleep Better (Part 1)

 Click  to watch this video on improving sleep

Sleep Better (Part 1)
Payam Ghassemlou Ph.D.

Having trouble sleeping is common. You are not alone. Let’s stay hopeful and overcome this challenge.

Your body is designed to welcome sleep. It needs sleep to rejuvenate and get you ready to have a productive day when you wake up in the morning. You can start by reminding yourself the simple fact that sleep is a natural part of life, and you deserve a restful sleep. Normalizing this process can reduce the anxiety you might have about sleep.

When you are trying to sleep, by focusing on not being able to sleep or reasons behind having trouble sleeping, you probably are not going to fall sleep. When you focus on problems with sleeping, or any upsetting thoughts , you won’t feel relaxed. Such thinking can activate your nervous system and make it harder for you to go to sleep.

Instead of worrying about sleep, let’s create a supportive bedtime ritual. I am going to describe an example of such a ritual that you might find helpful.

As a start, when lying in bed, take a minute and remind yourself of few things you feel grateful about the day you just had. It could be something simple like you feel grateful for having a pleasant lunch with a colleague or having fun playing with your pet. Just a simple reminder of good things you experienced today along with feeling of gratitude is good enough. By practicing gratitude, you are starting your sleep journey on a positive note.

In general, embracing gratitude can help your body and mind shift into a calming state. A daily gratitude practice is a simple way to invite positive emotions into all aspects of your life including sleep.

After practicing gratitude, take a minute or two and give yourself a loving hug. Fold your arms around your body, positioning them in a way that feels comfortable, and squeeze yourself with just enough pressure to feel a pleasant sensation. All you need is just a moment of feeling good because you deserve compassion.

You can try this self-hugging practice anytime you wish because loving yourself is a foundation for loving everything else.

After the gratitude and self-hugging practices, remind yourself you are making a conscious decision to sleep. Affirm the fact that sleep is good for you. Perhaps a part of you might not want to sleep. By telling yourself that you are making a choice to sleep, and you believe a good night sleep is essential for your health, you might be able remove all doubts about not sleeping.

Again, your body is designed to welcome sleep when you need it. Sleep is one of the gifts your body offers you toward good health. So, normalize the sleep process as much as you can.

When you are in bed, instead of focusing on negative self-talk or anything else that might be on your mind, try to connect to your body in a positive way. For example, focus on the support of the mattress that your body is receiving. Our bodies love to feel supported.

By taking a deep breath and bringing your awareness to comfort and the sense of support your body is receiving from the mattress that you are lying on, you can help your nervous system shift to a calmer state. Often the anxiety about not being able to sleep can activate your nervous system and keep you awake.

Your body and mind can work in complete harmony and support your sleep. Focusing on safety, and comfort that you experience in your body, can relax your mind. Give yourself permission to smile when you feel relaxed. The act of a gentle smile can also help you to feel safe and relax before falling sleep.

After practicing this bedtime ritual, just relax and surrender to the wisdom of your body. Again, your body knows how to go to sleep and your mind supports that process. No need to overthink it. Just let yourself drift into a peaceful sleep.

What I just described is one approach to a better sleep. I hope you find it helpful. There are so much more to be said about this topic which I plan to present in upcoming talks.

On a side note, always talk to your physician for any health-related concerns including trouble sleeping. In some cases, there may be underlying medical issues that might contribute to having challenges with sleep, and it is very important to treat those issues.  


© Dr. Payam Ghassemlou MFT, Ph.D. is a mental health counselor in private practice in West Hollywood, California.

Sleep Better  (Part 2)


Payam Ghassemlou Ph.D.

Click here to watch / listen to Sleep Better (Part Two)

Hello and welcome,

I hope you find my second talk on creating a ritual to sleep better helpful.

In the first segment, I mentioned your body is designed to welcome sleep. Please don’t over think it.

You can remind yourself the simple fact that sleep is a natural part of life, and you deserve to rest.

Normalizing this process can reduce the anxiety you might have about sleep.

I also encouraged you to create a supportive bedtime ritual.

Your bedtime ritual can include taking a minute and reminding yourself of a few things you feel grateful about the day you just had.

By practicing gratitude, you are starting your sleep journey on a positive note.

In general, embracing gratitude can help your body and mind shift into a calming state.

Your bedtime ritual can also include giving yourself a hug and really love and appreciate yourself.

This practice of loving yourself can help reinforce your attempt to help your body and mind shift into a relaxed state.

Finally, in the previous talk, I mentioned when you are in bed, instead of focusing on negative self-talk or anything else that might be on your mind, try to connect to your body in a positive way.

For example, by taking a deep breath and bringing your awareness to comfort and the sense of support your body is receiving from the mattress you can help your nervous system to relax.

This awareness of a sense of comfort might help you fall asleep faster.

I am now going to briefly talk about few more ideas that you can consider for your bedtime ritual.

Before I do that, I like to encourage you to talk to your doctor and make sure there aren’t any underlying medical issues that might contribute to having challenges with sleep.

I also encourage you to implement basic sleep hygiene.

For example, avoid large meals, caffeine, and alcohol before bedtime, make sure your bedroom is quiet and dark with the right temperature for your comfort level, and avoid using electronic devices close to your bedtime.

Now, let me discuss a few more ideas that might help you sleep better.

When it is time for your bedtime, let yourself become aware of feeling sleepy.

Allow yourself to welcome that feeling.

You probably had a busy day and naturally your body needs rest.

By noticing a feeling of being tired or sleepy, you are listening to your body’s need for sleep.

You might want to scan your body and identify specific areas of tiredness. For example, you might notice heaviness of muscles around the eyes.

Your eyes have been active most of your waking hours and now they are tired.

Most probably, your whole body has been busy working during your waking hours.

Naturally, your body can feel tired at the end of the day.

Focus on how good it feels to be in bed and resting.

By letting yourself sleep you are nurturing your body and mind.

You don’t need to fight your way to go to sleep.

You gently let your thinking brain step aside and let the wisdom of your body lead you to a pleasant dream state. The key is to relax and trust your body.

In case you wake up in the middle of the night, do not scare yourself by thinking you won’t go back to sleep.

Don’t overthink it.

Focus on how good it feels to be supported by the mattress or the pillow and letting your tired body rest.

Sleep is like a gentle river. It can drift you to a dream state.

It is a journey that can end with waking up and feeling refreshed.

Finally, if you wake up few hours early and still need more sleep, try to remain in your bed and rest.

Give yourself permission to relax and you might fall sleep again.

No need to get frustrated about waking up earlier than you wanted to.

Instead, let yourself focus on the quietness of the early morning.

Allow yourself to trust and have confidence in the wisdom of your body to help you go back to sleep.

In general, you cannot think yourself into sleep, but you can relax your body into falling asleep.

The key to a better sleep is to help your body and mind feel safe, relaxed, and deserving of sleep.

Make sure you consciously give yourself permission to have a good night’s sleep. It is important to affirm that. Your body listens to all your thoughts, so make sure you affirm the permission for a peaceful sleep.

I hope you find some or all these suggestions about creating a comforting sleep ritual helpful.

Please be patient and give yourself time to make progress in this area.

 Be Well!









Saturday, June 25, 2022

A Queer Perspective on Somatically Befriending Vulnerability

Since being vulnerable does not always come easily to many of us, it is important to have empathy for anyone who struggles with it. The internet is flooded with writings and talks on encouraging people to show vulnerability. Having trouble expressing it often gets associated with a lack of authenticity. Such judgmental interpretations can frequently trigger shame in people who don’t feel safe enough to be vulnerable due to certain socio-demographic factors. There is a misconception that expressing vulnerability is a matter of courage or just making a mental decision. By helping others reclaim it, I have realized the issue has little to do with bravery or honesty. It has more to do with the state of one’s nervous system. By having a somatic perspective on understanding vulnerability, we can open a new path toward befriending it.

There are many different paths toward befriending vulnerability which includes using the body to build a greater capacity to embrace it. Our response to many emotional experiences can be felt in our bodies. For example, Lucas, a 30-year-old cis gender gay man, disclosed having difficulty asking guys on dates. Doing so makes him feel very vulnerable. Among other bodily reactions, he reported tightness in his chest along with uncomfortable restricted breathing when faced with uncertainty to his invitation. Lucas has a history of growing up with the stress of homophobic mistreatment. He often felt unsafe at school due to the devastating experience of being bullied or called derogatory names. Fight or flight was not an option when he was feeling helpless and hopeless dealing with his traumatic school environment. Instead, his body resorted to numbing and shutting down. This response became his default whenever faced with overwhelming situations like entering a vulnerable state. Lucas’ reactions to becoming vulnerable had nothing to do with a choice or a lack of courage. It had more to do with his body’s threat alarm being frequently on.

In general, LGBTQ children are often at risk for being bullied, and they need protection. Lucas and many other queer youngsters growing up place their trust in individuals and institutions who were supposed to protect them from harm. Failure to receive such a protection at a critical developmental phase became a source of hurt and betrayal. The trauma of growing up gay in a world that did not embrace LGBTQ identity with kindness and acceptance led Lucas and many others to associate vulnerability with fear and betrayal. Given his traumatic history, Lucas needed help learning how to feel safe in his body when becoming vulnerable. Regulation of his psychophysiological arousal in response to vulnerability has been an important healing task for Lucas, especially when it came to making connections with other single gay men.

Taking a somatic approach toward working with vulnerability involves understanding the role of the autonomic nervous system (“ANS”). The ANS is the part of the nervous system that governs the fight, flight, or freeze instinct and is responsible for the unconscious bodily functions like breathing, digesting food, and regulating the heart rate. It also plays a vital role of supplying information from our organs to our brain. This system works automatically (autonomously), without a person’s conscious effort. The ANS is central to our experience of safety, connection with others, and our ability to bounce back from life’s overwhelming experiences. Relying on neuroception, a term coined by Dr. Stephen Porges, our ANS can differentiate between safety, danger, and a life threat. Neuroception, as Deb Dana (author of The Polyvagal Theory in Therapy) explains, is automatic, and it does not go through the thinking part of our brain. Everything from sound to smell to temperature in our environment, people’s tone of voice, and eye contact can influence our neuroception. It is like “internal surveillance” that looks for cues of safety and danger inside the body, in one’s environment, and in relationship with people. It helps us take immediate action in the face of danger or threat. The goal of neuroception is to keep us safe and alive. Based on my training in Somatic Experiencing®, Touch Skills Training for Trauma Therapists, Polyvagal Theory, and other body inclusive approaches, I have learned the autonomic nervous system is a relational system that has been shaped by experience. We now know previous negative life experiences and traumas can significantly affect how our neuroception accurately assesses safety, danger, or a life threat. This can explain why many people including Lucas with history of being judged, humiliated, and violated often avoid entering a vulnerable state. Their faulty neuroception causes them to feel unsafe in the absence of real danger.

Since “how we move through the world is guided by our ANS,” it is important to examine how growing up in a homophobic and transphobic environment negatively affected the working of the ANS. In my counseling work with gay, lesbian, bisexual, queer identified, and transgender people who have experienced homophobic or transphobic mistreatment, I have noticed their nervous systems are often shaped toward self-protection versus making connections. Repeated past humiliation and rejection by others have made it difficult for many of them to be open and willing to love and be loved. Given the important role that ANS can play in people’s ability to embrace vulnerable situations and form relationships, it is important to learn how to regulate it. When working in a regulated way, the ANS does not enact the response to the present moment situation based on one’s past conditioning.

Autonomic regulation has less to do with talking about our past trauma events and more to do with shifting our autonomic state that can be stuck on FFF (fight/flight/freeze) toward safety and relaxation. When Lucas was invited to share about his history, it was done for the purpose of having greater empathy for his suffering and learning how fear became associated with vulnerability. Lucas’ personal stories with homophobic mistreatment was handled with care and in a titrated manner to avoid re-traumatization. In general, encouraging people to get into their trauma stories all at once can become overwhelming for them because the nervous system cannot tell the difference between the original event and the telling of the event. Healing does not always need to involve re-telling the story. As Peter Levine, the founder of Somatic Experiencing International, stated, “Trauma is not in the event, but in the nervous system.” Based on my personal and clinical work, I also concur that trauma becomes embodied during a person's life and can affect the working of the ANS. Much of the healing from this trauma needs to happen through the body. In particular, the nervous system needs to be regulated.

The work of Stephen Porges’ Polyvagal Theory has brough to light the role of the vagus nerve in how we experience safety and connection. The vagus nerve which is divided into two pathways, the dorsal vagus and the ventral vagus, is the main component of the parasympathetic nervous system. The ventral vagal of parasympathetic system plays a crucial role in our experience of safety in our bodies. Activation of the ventral vagal force in the ANS includes but not limited to awareness and tracking of pleasant bodily sensations. For example, when I invited Lucas to notice his body being supported by the couch, he commented, “I can sense my body feels relaxed and comfortable.” By bringing awareness to comfortable sensations in his body, he began to breathe deeper and noticed a sense of expansion in his chest area along with his shoulders becoming more relaxed. For Lucas, tracking bodily sensations that were comfortable invited the flow of the ventral vagal of safety and connection.

Another useful somatic intervention involved identifying and embodying helpful resources that contributed to his healing journey. For example, attending LGBTQ Pride events and volunteering at the Los Angeles LGBT+ Community Center felt empowering for Lucas. By tracking his pleasant bodily sensations as he was sharing about these helpful resources, he was creating a physiological event in his body which contributed to regulating his nervous system. As the therapy session progressed, he found it easier to imagine and plan on asking a guy he met at his gym on a date without experiencing tension in his body. Repeated awareness of pleasant sensations in his body increased his ability to distinguish sensations of distress versus sensations of well-being. The more he focused on what felt good on the inside the more his autonomic dysregulation settled, and his window of tolerance expanded.

What makes each one of us feel vulnerable is unique and personal. What feels vulnerable to Lucas can feel quite different to another. Regardless of what activates it, the admission ticket to a more meaningful life for Lucas involved embracing vulnerability. It was important for him to liberate vulnerability from years of cumulative stress of dealing with homophobic bullying, and other fearful situations that he had to endure. By welcoming vulnerability and learning how to work with its transformative power, he was able to enrich his life. A “body-inclusive” therapeutic approach offered Lucas tools and practices to lower his activation and regulate his nervous system in response to his life stresses.

© Dr. Payam Ghassemlou MFT, Ph.D. is a mental health counselor in private practice in West Hollywood, California.

*Names and other details have been changed for privacy and confidentiality.











Sunday, May 15, 2022

Authoritarianism and the Harm to Psychotherapy by Payam Ghassemlou Ph.D.


My journey of becoming a psychotherapist with a passion for serving the LGBT community started over three decades ago. In those days, AIDS was devastating our community, and I wanted to make a difference. I started my counseling internship at the Los Angeles Gay and Lesbian center with a focus on helping people living with HIV/AIDS. As I look back on my journey of studying psychology and becoming a psychotherapist, I am realizing an obvious point. I learned how to practice psychotherapy in a democratic society. This is a crucial point because the kind of society where mental health services being offered makes a substantial difference.

Given my experience with living or visiting other parts of the world, especially in places ruled by authoritarian regimes, I have learned psychotherapy can be a transformative process when practiced in a free society. It is difficult to help individuals reach their true potential in a closed society where fear dictates people’s lives. In places where freedom of speech is protected, it is much easier to openly discuss all external events that can impact a client’s mental health including relevant sociopolitical issues. For example, in my Los Angeles based counseling practice, I have helped many people from all walks of life including lesbians, gays, bisexuals, transgenders, and queer or questioning people to become comfortable with their identity. Learning how to love themselves despite their homophobic and transphobic upbringing has been transformative. Practicing psychotherapy in a free society makes it possible to validate my client’s pain regarding homophobia, transphobia, sexism, racism, xenophobia, Islamophobia, anti-Semitism, classism, ableism, and other degrading situations. The safety to openly discuss and condemn such obstacles is necessary for many clients’ healings process. Those of us who are trained in somatic psychotherapy and have studied the impact of trauma on the autonomic nervous system, know how hateful acts can dysregulate the nervous system. In a free society, it is much easier to help the body and mind to heal from the impact of trauma.

Since the Trump Presidency and all the divisiveness and rampant polarization that came with it, I have noticed a troubling shift in American politics. For me, the notion that someday there would be a competition between democracy and autocracy in the United States of America was unthinkable. Especially as a foreign-born gay man who found America as a safe refuge. I cannot imagine the possibility of living under an authoritarian regime again. I know how precious democracy is because I have experienced how oppressive autocracy can be. Now, my nightmare about autocracy over democracy is beginning to feel real. The other day I found myself defending voting rights talking to another therapist who believed voting is a privilege and not a right. Moreover, I have spoken with many Fox News viewers who are willing to shift toward autocracy if such a regime would ban abortion, uphold conservative values, and keep non-White immigrants out. They do not realize what is it like living in autocratic countries like China, Russia, and Iran where people are miserably oppressed. Autocratic leaders do not care about issues like human rights, climate change, and the freedom of press. They lock up or execute anybody who challenges the way they govern. I understand the U.S. is considered a republic and not a democracy. However, no matter how I define it, America, unlike an autocratic country, makes it possible for a psychotherapist like me to provide a socially responsible way of practicing psychotherapy.

Despite of all the positive elements that make this country great, many of us are noticing disturbing situations that are jeopardizing our freedom. For example, some U.S. Supreme court judges were nominated by presidents who did not win the popular vote. These conservative judges, who do not represent the American majority, are making decisions that are negatively impacting our lives. Also, the continued use gerrymandering coupled with the voting restrictions in various states is paving the way toward totalitarianism. Many mental health therapists are concerned about the future of psychotherapy and its transformative potential as American democracy erodes. If the anti-democratic trend continues, and our freedoms keep getting chipped away, it would be only matter of time before they start policing our counseling profession. Some of us already are being restricted and controlled by some health insurance companies for greed and profit. Once a dictatorial system of government begins to dominate the U.S., it will have major impact on how we conduct psychotherapy. For one thing, I will not feel safe to freely explore how clients’ emotional pain might have something to do with the environment they live in. Also, since the mental health of the individual and sociopolitical factors are deeply intertwined, how a country is being run can impact people’s well-being. The stress of living under an authoritarian rule can lead to depression, anxiety, hopelessness, low self-esteem, and suicidal thoughts.

I hope I am wrong about U.S. democracy being replaced by an autocracy which could negatively impact the delivery of therapeutic services. Before the events of January 6, 2021, when a racist mob attacked the United States Capital, I would not have entertained the notion that U.S democracy is at risk. Now, I do. The events that led up to January 6, and the role that many far right politicians played to shape such assault on U.S. democracy has made many freedom lovers in this country alarmed. Many Americans do not feel safe knowing a major portion of the population are manipulated to believe a strong leader, who does not have to worry about oversight from Congress and elections, is good for them. Many of them believe a strong Caucasian leader can protect their European heritage, which is central to their identity, from cultural diversity. Moreover, some believe a forceful leader can protect their so-called Christian values. Some uneducated low information voters believe a Putin-like leader is necessary to stop homosexuals from turning their children gay and imprisoning doctors who provide abortion services. These individuals, who are brainwashed by right-wing media to believe in such absurdity, are part of our current problem with the rise of autocracy in the U.S.

When it comes to offering psychotherapy services, theoretical approaches are an integral part of the therapeutic process. Such theoretical approaches can provide a framework and guidance for therapists to help their clients. I believe, any psychological theories that teaches people to differentiate, and not remain a sheep in the flock is a threat to fascism or any type of dictatorial government. For example, a psychotherapist who utilizes feminist theory could have a tough time working under a fascist type of establishment since such theory focuses on gender inequality and discrimination among many other themes. Moreover, therapists who specialize in helping young people embrace their sense of curiosity, sexuality, and independence could become a threat to a system of government that thrives on repressive family structures, fear of authority, and sexual repression. Psychotherapy, as I know it, will change and therapists may no longer be allowed to help clients in cultivating a free mind. We could lose our freedom to choose our theoretical orientation when America becomes one of those autocratic countries, and any books including psychology books that are not ardent in its support of dictatorial government may be burnt.

As a cis gender gay man of color, I understand we currently have a lot of problems with racial injustice, sexism, homophobia, and transphobia in America, especially, for African Americans who have suffered so much from racial inequality. As of now, we are not a fascist state yet. I hope everyone including mental health professionals who care about freedom of speech and the right to free elections take the current push toward autocracy very seriously. Far-right hate groups in America have gotten stronger. Once we completely lose our precious American freedoms, everyone including psychotherapists may be required to adjust to the authoritarian order and submit to it. I hope that day never comes. There is still time to save American democracy.

© Dr. Payam Ghassemlou MFT, Ph.D. is a Licensed Marriage and Family Therapist (Psychotherapist), in private practice in West Hollywood, California.  ,







Wednesday, December 9, 2020

A Somatic Perspective on the Trauma of Growing up Gay by Payam Ghassemlou MFT, Ph.D.

For almost three decades, I have immersed myself in the life stories of many people of the LGBTQ community who had painful homophobic and transphobic upbringings. Many of the gay men’s personal narratives that I have heard are not very different from my own. Regardless of national origin, we are part of a tribe with similar stories of growing up in a homophobic and heterosexist world where our gayness was repeatedly assaulted. We are everywhere, and unfortunately so is homophobia.

Many gay men have shared with me that as long they could recall they always felt different. They were unable to articulate why they felt that way, and, at the same time, they did not feel safe to talk about it. Some knew this feeling of being different was related to something forbidden. “It felt like keeping an ugly secret that I could not even understand,” described one person. Other gay men have disclosed to me that this feeling revealed itself in the form of gender nonconformity, which could not be kept secret. Therefore, it made them more vulnerable to homophobic mistreatment at school and often at home. Gay men of color reported even worse experiences due to the additional stress of racism and racial bullying.

Many school-age children organize their school experiences around the notion of not coming across as different, in particular, queer. Any school-age child’s worst nightmare is being labeled faggot, which was commonly experienced by many gay individuals who did not flow with the mainstream. Educational institutions felt like a scary place for many of them who were scapegoated as queer growing up. Therefore, they had to cope with a daily assault of shame and humiliation without any support. This is a form of child abuse on a collective level, and it needs to stop.

So much has been written about the devastating impact of homophobia on gay people’s psychological functioning but not enough on the biological impact of it. It is important to understand how repeated hateful acts toward gay youngsters can impact the way their bodies and minds function, including the functioning of their nervous system. Unfortunately, this also applies to any child who is a target of hate and abuse. As Peter Levine, the founder of Somatic Experiencing, stated, “Trauma is not in the event, but in the nervous system.” Based on my personal and clinical work, I also concur that trauma becomes embodied during a person's life and can affect the working of the autonomic nervous system (“ANS”). Much of the healing from this trauma needs to happen through the body. In particular, the nervous system needs to be regulated.

The ANS is the part of the nervous system that governs the fight, flight, or freeze instinct and  is responsible for the unconscious bodily functions like breathing, digesting food, and regulating the heart rate. It also plays an important role of supplying information from our organs to our brain. The ANS can become dysregulated due to the thwarted responses of fight, flight, or freeze in the aftermath of trauma.

The ANS is central to our experience of safety, connection with others, and our ability to bounce back from life’s overwhelming experiences. This ability to recover defines resilience and requires the help of our ANS to keep us in our “window of tolerance”, which has been defined in the book Nurturing Resilience by trauma specialists Kathy Kain and Stephen Terrell “as the zone where we effectively process environmental signals without becoming too reactive or too withdrawn, given the circumstances.” The window of tolerance as a frame work is very helpful to understand where we feel safe, unsafe, and how to expand our optimal arousal zone.

Stephen Porges’, Bessel van der Kolk’s, and Peter Levine’s research and writings have significantly reworked my understanding of how the nervous system responds to threat and trauma. Drawing from their work and my decades of experience, it is my understanding the ongoing stress from homophobia can activate a youngster’s nervous system and “unresolved activation will be stored in the body as bound energy and manifest as trauma symptoms.” In other words, under a daily homophobic assault, a child’s sympathetic system (“stress response” or “fight or flight” response) gets overly activated. Often during such stressful situations, neither fighting nor fleeing can resolve the overwhelming situation, and the thwarted or incomplete fight and flight responses can become “trapped” within the body and dysregulate the nervous system. Such a dysregulated nervous system is more likely to get stuck on “high” or hyper-arousal. Anxiety, panic attacks, rage, hyperactivity, mania, hypervigilance, sleeplessness, exaggerated startle response, digestive problems, and many other symptoms are the result of a dysregulated nervous system that is stuck on “high” or hyper-arousal.

According to many studies, gay individuals who experienced homophobic related stress showed increased production of the stress hormone cortisol compared to peers in safer environments.  This experience of being stuck on “high” continuously activates a person’s stress response system, which leads to the release of stress hormones. Research in this area has shown overexposure to cortisol and other stress hormones leads to numerous health problem including headaches, oversensitivity to touch or sound, weight gain, heart disease, concentration impairment, and sleep disturbance.

On the other hand, there are gay men whose nervous systems are stuck on “low” or hypo-arousal, which can result from being terrorized growing up with no hope of protection. Faced with isolation, confusion, physical violence, not being valued, and carrying a secret that the youngster connects with something terrible and unthinkable is too stressful for any child to endure, especially when there is no empathic other to help him sort it out. Such experience is often beyond the youngster’s “window of tolerance.”  This is when the dorsal vagus can shut down the entire system, and the mistreated youngster can go into freeze. In other words, the youngster suffers in silence with numbness or dissociation as his only available survival mechanism.

Stephen Porges, the founder of Polyvagal Theory, has expanded our view of the vagus nerve, one of the largest nerves in the body and a major part of the Parasympathetic system. The word “vagus” means wandering in Latin. The dorsal vagus is a branch of the vagus nerve which is a much older part of the nervous system. Dorsal vagus regulates organs below the diaphragm. Dorsal vagus is instrumental in activating the “shutdown” of the body as discussed in cases of overwhelming fear which can result from homophobic mistreatment. This automatic survival mechanism can become a long-standing pattern of how individuals might cope with fear and stress in life. For example, people whose nervous system is stuck on “low” or hypo-arousal when faced with life stresses can default to shutting down, disassociation, chronic isolation, detachment, numbness, and suicidal thoughts.

In my counseling work, I have noticed when the nervous system gets stuck on freeze, when numbness and detachment become a gay man’s dominant state, he is more likely to engage in risky behaviors as a temporary relief from inner deadness. Thrill seeking behaviors such as sexual acting out, excessive gambling, and crystal meth (crystal methamphetamine) use are ways some gay men escape the emotional flatness that results from experiencing the hypo-arousal state. The same behaviors can also be used to cope with ongoing activation of the fight or flight response. One person might turn to substance abuse to escape his inner deadness and another person might use it to dampen his anxiety that often results from being stuck in a state of hyper-arousal.

As Peter Levine stated, “Trauma is a fact of life. It does not, however, have to be a life sentence.”  For those of us who have had painful struggles with homophobia, life after the closet needs to include dealing with memories of homophobic mistreatment that can lie dormant in our body. Recovery from it needs to start with resourcing and then progressing to completing the thwarted responses of fight, flight, or freeze. Such healing can reset the nervous system and restore inner balance. In Body Keeps the Score, Dr. Bessel van der Kolk writes about a body-centered approach to healing which allows “the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.”

How far the LGBTQ community has come in our struggle for equal rights reflects how brave we are as a community. Our bravery can continue by facing traumas we experienced growing up in oppressive environments that did not nurture our true essence. Not every LGBTQ person felt traumatized growing up, but those who did can benefit from the vitality and the sense of liberation that comes with incorporating somatic work as part of the healing process.

The Somatic Experiencing Trauma Institute offers trainings and seminars on the biology of traumatic stress reactions including tools on how to bring the body-mind-spirit back into balance. Participating in their trainings has enhanced my ability to help others who are interested to tap into the wisdom of their bodies for healing and growth.  There are many other institutes that offer body-centered approaches toward healing which reflect the increased popularity of such work.

For more articles by Dr. Payam, please click on the following link:

© Dr. Payam Ghassemlou MFT, Ph.D. is a Licensed Marriage and Family Therapist (Psychotherapist), in private practice in West Hollywood, California.

Sunday, April 26, 2020

A Somatic Approach on Working with Depression and Negative Self-Talk By Payam Ghassemlou MFT, Ph.D.

Depression is common and treatable. It can strike anyone at any age. Consulting with your physician or a licensed mental health provider is the best way to find out if you are suffering from depression and the type of depression you might be having.

A person with depression can experience a few or many of the following symptoms:

Feelings of sadness and emptiness

Feelings of anxiety

Experiencing restlessness or irritability

Losing interest in all or most activities

Problems with appetite that can lead to weight gain or weight loss

Sleeping problems

Loss of interest in sex

Low energy that can include feeling tired much of the time

Difficulty with concentration or making decisions

Feeling negative towards oneself including worthlessness or excessive guilt

Feeling hopeless or helplessness

Crying spells

Increased use of alcohol or drug use in order to cope with a depressed mood

Thoughts of death/suicidal ideation

Many people might not have the awareness that the underlying cause of the above-mentioned symptoms is depression; therefore, they cannot get the treatment they need. It is difficult to treat something that one has not identified yet. Over time, serious levels of depression that are not addressed get worse and can lead to other health-related issues. It can even lead to suicide.

There are different kinds of depression; hence, one person’s needs will differ from those of someone else. Psychotherapy is the most common treatment for depression. Psychotherapy can help on many different levels including integration of the clients’ body experiences in relation to their thoughts and emotions along with resolving or coping with issues that may contribute to their depression. Most mental health providers agree treatments for depression with suicidal ideation or other serious symptoms require a combination of antidepressants and psychotherapy. Some patients who might not show progress with standard treatments for depression might need additional resources.

In my counseling work with people who suffer from depression, I often notice that they have an inner critic which constantly makes them feel discouraged, inadequate and in many cases worthless. When the inner critic is the dominant voice inside a person, depression is likely to be present. Identifying the inner critic can be done by encouraging clients to pay attention to their body and their nervous system activation. For example, when Jack noticed his neck and shoulders curved forward, his head looking down, and unpleasant tension in his jaw, he was invited to become curious about this body language. The body language is a voice that does not use words and always tells the truth. He discovered an inner dialogue associated with this body posture, and it involved the following thought, “I am going to lose my job.” He realized how often he tells himself that his job is at jeopardy. When he was invited to examine all the reasons that he won’t lose his job, and all the resources that can help him to find another job in case he was let go, he noticed a shift in his body. He started sitting up straight with his shoulder pushing out, his jaw loosened, and he reported feeling more confident. He was encouraged to embody this new level of confidence by noticing all the positive shifts in his body including his deeper breath and feeling more relaxed in his shoulders. By tracking his pleasant bodily sensations that he was experiencing as result of identifying helpful resources, he was creating a physiological event in his body which led to regulating his nervous system. This can be a powerful approach to help someone suffering from negative self talk to use their body as a resource to modify such self-defeating dialogue.

There are many ways to work with negative inner dialogues and painful emotions that accompany them. It is helpful for clients and therapists to explore different treatment options as they work together. A collaborative therapeutic approach helps people to feel empowered and  in control of their recovery from depression.

Working with a mental health therapist to explore treatment options for depression is an important step toward healing. I hope anyone who is suffering from depression reaches out and gets the help they need. Everyone’s pain is unique, and no one deserves to suffer in silence. Reaching out and asking for help is a courageous act that people can do in response to suffering from depression.

© Dr. Payam Ghassemlou MFT, Ph.D., is  a marriage and family therapist in private practice in West Hollywood, California.