The Queer Body Remembers: Somatic-Focused Trauma Healing By Payam Ghassemlou MFT, Ph.D.

For many LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) people growing up was  distressing due to homophobia and transphobia. Schools felt like a scary place for those who were scapegoated as queer. LGBTQ people of color reported even worse experiences due to the additional stress of racism and racial bullying. Many of the gay men’s personal narratives that I have heard are not vastly different from my own. Regardless of national origin or skin color, we are part of a tribe with similar stories of growing up in a homophobic and transphobic world where our true essence was repeatedly assaulted. As LGBTQ people, we have connected around the theme of “love is stronger than hate” which raised awareness about our injustice and suffering. Addressing these issues have helped people to become more concerned about the mistreatment of not only LGBTQ kids, but also any youngsters who do not flow with the mainstream. More work needs to be done to make the world a safer place for marginalized people. Anyone dealing with oppression does not deserve to suffer in silence and needs encouragement to reach out and get support. Love and healing is more accessible than our painful moments want us to believe.

Injustice and trauma that were inflicted on LGBTQ people as result of growing up in an oppressive environment deserve empathy and healing. When it comes to healing, psychotherapy offers a variety of approaches to work with trauma, including the ordeal of growing up gay in a heterosexist world. Many mental health professionals who work with LGBTQ clients often rely on a “top-down” approach, which  focuses on the highest form of cognition that involves changing thoughts. Moreover, it challenges clients’ negative belief systems and their cognitive distortions. Many clients have benefited from cognitive restructuring in psychotherapy and developed skills in identifying and disputing irrational or maladaptive thoughts. In my clinical experience, when it comes to healing from years of assault on one’s core identity including feelings of shame and humiliation for same sex attraction, a cognitive approach is neither enough nor always possible. For many queer trauma survivors whose thinking brain gets hijacked by trauma memories and their bodies default to a fight-flight-freeze response, a body-centered approach or bottom-up processing is necessary to calm their arousal systems. Relying on the thinking brain as the only path to deal with the root cause of trauma symptoms is not effective. The brain parts that are responsible for reflexes, memories, and automatic survival responses are in the deeper regions of the brain, and trauma informed therapy needs to begin by focusing on those areas.

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. For many LGBTQ clients, trusting a professional or an authority figure might not be easy due to their history with a discriminatory health care system, religious bigotry, police violence, school trauma, and family betrayal. Establishing a therapeutic alliance with LGBTQ clients can be facilitated by explaining the therapeutic process including the key role the nervous system can play in trauma recovery and asking their permission to provide somatic-focused therapy.

Our body comes with an already built-in autonomic nervous system (ANS) that provides many vital functions. 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 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. Porges, our ANS is able 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 a “guardian angel” that helps us take immediate action in the face of danger or threat. The goal of neuroception is to keep us safe and alive.

Pat Ogden’s, Stephen Porges’, Bessel van der Kolk’s, and Peter Levine’s research and writings have expanded my understanding of the autonomic nervous system as a relational system that has been shaped by experience. We now know previous negative experiences and traumas can significantly affect how our nervous system accurately assesses safety, danger, or a life threat. This can explain why many LGBTQ people with history of being judged, humiliated, and violated often suffer from anxiety that stems from faulty neuroception.

Neuroceptive conditioning based on previous homophobic and transphobic mistreatment can cause many LGBTQ people to feel unsafe even where there is no real threat. What we hold inside in the aftermath of trauma can cause us to over-react in a safe environment or not react correctly in a dangerous situation. A body inclusive therapy can help to support the ANS to move out of a dysregulated state into a biological state of safety and connection.

There are many body-oriented methods for trauma healing including 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 the 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 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 to 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 experience. In his writing, 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.”

LGBTQ people who grow up with mistreatment can discover the tales of their abuse written in their nervous system. The queer body remembers the experience of growing up in a world with cruelty. Having over two decades of providing LGBTQ affirmative psychotherapy along with research and numerous trainings on body-mind therapy, I have learned cruelty and cumulative stress of mistreatment can become embodied during a person's life and affect the working of the ANS. For example, one gay high school student with symptoms of anxiety disclosed to me that he hears several homophobic remarks a day along with experiencing bullying and harassment. Such ongoing stress from homophobia can activate his sympathetic system (“stress response” or “fight or flight” response). Naturally as a target of hate and mistreatment, he wants to defend himself or escape the abusive situation. Often due to lack of protection for many LGBTQ youngsters, during such abusive situations neither fighting nor fleeing can resolve the overwhelming situation. As a result, the energy that gets locked inside him for not being able to fight or flee causes trauma symptoms. In other words, the thwarted or incomplete fight and flight responses can become “trapped” within the youngster’s body and dysregulate his nervous system. Such a dysregulated nervous system is 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.

On the other hand, there are those of us whose nervous systems can stuck on “low” or hypo-arousal, which can result from being terrorized growing up with no hope of protection or escape. For example, faced with isolation, confusion, bullying, physical attacks, and ongoing lack of safety is too stressful for any child to endure, especially when there is no empathic other to help the kid. Such experience is often beyond the youngster’s “window of tolerance” (a term coined by Dr. Daniel Siegel). This is when the dorsal vagal (dorsal branch of the vagus nerve as discussed by Dr. Porges’ Polyvagal Theory) can shut down the entire system, and the mistreated youngster can go into freeze. In other words, the child suffers in silence with numbness or dissociation as his only available survival mechanism. Dorsal vagal is instrumental in activating the “shutdown” of the body in cases of overwhelming fear which can result from trauma. This automatic survival mechanism can become a long-standing pattern of how individuals might cope with fear and stress in life. For instance, 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.

As stated, trauma symptoms are the trapped energy from the "incomplete defensive response" (fight, flight, or freeze) and healing involves helping the body to release such thwarted responses. Working with many members of LGBTQ community, 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, excessive gambling, hypersexuality, and crystal meth (crystal methamphetamine) use are few examples of  how 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 or other perilous behaviors to escape his inner deadness while another person might use it to dampen his anxiety that often results from being stuck in a state of hyper-arousal. It is important to note that the trauma is at the root cause of such a maladaptive way of coping.

As discussed earlier, as a “bottom-up” approach, SE focuses on the brain stem and its survival-based functions first rather than insight and emotions. Dr. Levine developed SIBAM to chart this “bottom-up” process, working from body to emotions and cognitions. The SE session involves teaching the client to track body sensation including the sensations related to the traumatic event. Experiencing  body sensations related to homophobic or transphobic events in a safe way allows the client to process the trauma. Often the client might experience discharge of the traumatic energy through heat, vibration, shaking, or tears. Such healing approach can reset the nervous system and restore inner balance. For example, Cyrus (names and other details have been changed in respect for privacy and confidentiality) a cisgender gay Iranian man who grew up suffering from homophobia and racism, came to therapy to work on his “coming out issues.” After he felt safe enough to address his traumas, our work progressed in helping him to develop awareness of “felt sense” of his internal states. We worked slowly and paused periodically to notice any sensations, movements, impulses, images, gesture, or feelings. Sometimes he experienced an uncomfortable heavy sensation in his chest and stayed with it short of getting overwhelmed. Other times he noticed spontaneous movement of his body rocking from side to side which felt soothing for him. We paid attention to any subtle movement or protective responses that was coming up. For example, one of the protective responses that was not available at the time of dealing with school bullies was emerging. I invited Cyrus to notice the movement of his hands and what might be coming up. He described sensing strength in his arms and an impulse to use his hands to push back. By slowing down the process, he was able to work with that impulse. By tracking his body sensations and movements, Cyrus was able to move through painful events and discharge the trauma energy by spontaneous trembling and shaking. In addition, alternating, or “pendulating,” between the sensations associated with the traumatic event and those that are a source of safety and strength was part of the process that supported his ability to self-regulate. Eventually, our work together led to the embodiment of his pride in being a gay person of color. It also helped Cyrus not letting his past traumas become a life sentence. He discovered love and a sense of safety is more accessible than his past wants him to believe.

On the path to recovering from trauma and living a passionate life, one needs resources. In Sensorimotor psychotherapy, Pat Ogden describes resources as, “anything that enhances the quality of our lives or provides what we need to meet life’s challenges.” She also discusses in details different categories of resources including internal resources and external resources. It is important to note, a resource needs to be tailored to the needs of the individual. For instance, some clients might find certain body movements like rocking or dancing helpful. Their body might respond positively to such an experience by releasing tension. Other clients might notice feeling lighter in their body after watching a comedy or playing with their pets. No one should feel judged for not finding certain resources helpful. One size does not fit all.

One of the resources that can benefit gay men is the discovery and the embodiment of the meaning of their gayness or queerness. In one of my articles, “Gays in Search of Meaning,” I discussed by embracing what is inherently purposeful about our gayness, we can start to live a more soulful life. Helping gay men to connect to their gay essence and find the numinous qualities inherent in being gay can be an enlightening process. Gay people have an advantage as far as enlightenment is concerned. Most gay people grow up feeling "different," and that differentness helps to not identify with the collective. As Eckhart Tolle, the author of The Power of Now, suggested,

"...realization that you are different from others may force you to disidentify from socially conditioned patterns of thought and behavior. This will automatically raise your level of consciousness above that of the unconscious majority, whose members unquestioningly take on board all inherited patterns. In that respect, being gay can be a help. Being an outsider to some extent, someone who does not fit in with others or is rejected by them for whatever reason, makes life difficult, but it also places you at advantage as far as enlightenment is concerned."

It is important to note concepts like soul, enlightenment, or spirituality can be triggering for many LGBTQ people who were harmed by homophobic religions. Throughout human history, many religious institutes have committed atrocities against LGBTQ people. In the name of their god, they have murdered queer people or denied them their human rights. For many LGBTQ people who were target of hate by homophobic institutions, knowing their right to a soulful life with depth and purpose can be a resource. Such awakening can become embodied when it is done within the context of somatic therapy. In my experience, many gay men have added meaning and a sense of aliveness to their lives by participating in body inclusive psychotherapy while working on discovering a deeper meaning of being gay. Such feeling of aliveness and its underlying bodily sensation is in contradiction to the fear and humiliation that many gay men had to endure growing up in a heterosexist world. In Body Keeps the Score, Dr. Bessel van der Kolk writes about a body-centered approach to healing allows “the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.”

Finally, how far the LGBTQ community has come in the 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 As Resmaa Menakem, the author of  My Grandmother’s Hands stated, “Healing does not happen in your head. It happens in your body.”

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

 

 

 

The Royal Road to Nervous System Regulation By Payam Ghassemlou MFT, Ph.D.

Many years ago, my husband and I worked on a small movie project that involved reshooting and editing some of the scenes. Inspired by that experience, I view life as a movie with the opportunity to reshoot and edit some of the upsetting or disappointing scenes. The editing tool is our imagination. Life experiences can consist of traumatic or tragic scenes, but we don't have to live in the shadow of our tragedies. As Peter Levine, the founder of Somatic Experiencing stated, "Trauma is a fact of life, but it doesn't have to be a life sentence."

With the help of our imagination, we can come up with an alternative to any unsettling life experience. Since these events impact the nervous system, the most important part of this work is noticing how the body responds to the new take along with the bodily sensations that can arise. Noticing how our body responds to a positive replica of an event can help embody a new relationship to the original experience. Many of us have heard how changing our thinking about a situation can impact the intensity of it. This is a similar concept except we work with the imagination along with the inner sensations and any unresolved excess energy within the nervous system. 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. As a result of studying their work, I have gained more respect for the body especially the autonomic nervous system (ANS). 

Since our life tragedies live in the body, they can be experienced as unpleasant sensations. For example, it is not uncommon for people with unhealed trauma to experience sensations such as tightness, freezing, heaviness, tension, shaking or others in their body. Some people that I have worked with have reported the bodily experience of “spacious” in the chest area or a sense of vitality after modifying the original unpleasant event in their imagination. Through my training in Somatic Experiencing, I have been learning about the importance of tracking bodily sensations that often come up during one’s healing journey. In general, this tracking involves paying attention to sensations within the nervous system and distinguishing between pleasant and unpleasant ones. In my experience, the more we bring pleasant sensations to our focus, the more regulated our nervous system can become. Using the imagination to take bad memories and form something new along with embracing pleasant sensations is the royal road to regulating our nervous system.

It is important to note that using our imagination for healing purposes needs to be done with the help of a professional who has training in healing trauma. We need to make sure that there is a trained person available in case we become overwhelmed by the imagination and can't cut it off. Different approaches work for different people, and there is no one size fits all when it comes to therapy. It is empowering when we offer people choices regarding interventions and healing modalities.

When we use our imagination to edit some of the painful scenes in our history, we can experience more mastery over situations that we felt powerless at the time. Imagination as the Sufi mystic Inayat Khan explained “is the stream that feeds the fountain of your mind."  Many people do not tap into the current of this stream and nourish their mind and body with its healing energy. By using our imagination to rewrite some of our life events, we can become an active player and connect with abilities and potencies that we may not have experienced previously. Our imagination can also be utilized in any current situation where we experience powerlessness. We can use it to create a solution or coping strategy for any life challenges we encounter. As Bessel van der Kolk stated, “Imagination gives us the opportunity to envision new possibilities—it is an essential launchpad for making our hopes come true.”

One way of editing our life story is by choosing an unhappy scene from our experience, and just like a movie director, use our imagination and reshoot the scene. Most of our life events have a beginning, middle, and end. We can choose a segment and change the scene to how we wished it had happened. For some, changing the beginning of an event makes more sense and for others modifying the middle or the end feels better. How and what to modify with the intention of creating an alternative scene is a very personal decision.

I once worked with an actor who felt devastated after learning his part in a popular television series was suddenly cut. The producer ended his role by having him killed in one of the episodes. He felt incredibly sad for not being in that show anymore. Sharing and receiving empathy along with grieving for the loss of his role was helpful but not enough. He still had difficulty feeling confident to pursue his acting career. At some point in our work, I invited him to imagine a different take from what had happened. A scene that was completely opposite to the original painful experience. Before starting the re-imagining, I encouraged him to find a comfortable position and notice how his back was touching the couch. Bringing his awareness to sensations that were comfortable in his body helped him be in the present moment in a relaxed way. It is important to be grounded in the present moment when doing this work. While he was imagining a more pleasant alternative to his original devastating experience, he noticed his body became infused with a pleasant warm sensation along with a change in his breathing and a delightful smile appeared on his face. As he was sharing how the exercise was helping him not to feel stuck, he was making a movement with his hands that seemed meaningful. By inviting him to notice the movement, he realized talking about letting go of defeat led to opening of his clinched fist. As he was noticing the movement and slowing it down, he started to sense some tingling in his hands. Something began to change for him in that moment that words could not describe. As Carl Jung stated, "Often the hands know how to solve a riddle with which the intellect has wrestled in vain." In our follow up meeting, he reported feeling less bothered by the loss of his acting job and more relaxed in his body. He also felt more confident showing up for auditions. 

Offering this approach to people has been very interesting. There is a level of unpredictability that makes the process adventurous. I never know how the person is going to re-imagine a scene or what the imagination is going to offer. For some people who are spiritually grounded, I have noticed they tend to receive an offering from their imagination in forms of helpful figures, guides or healing images. For example, one of the refugees from the Middle East who came to deal with his war trauma noticed the appearance of his beloved Sufi teacher who offered him a protective shield made of glowing light. Receiving the shield from his spiritual teacher gave him an “incredible sense of safety” that he had never experienced before. His body was mirroring his imaginal experience with a sense of calmness and relaxation. Having experienced war and other trauma, he often felt nervous in his body. His imagination became an important healing resource by offering him an experience that was in contradiction to the tension he often carried in his body. Every time he imagined the protective shield, he immediately felt safe.

Many people who talk about distressing life experiences in therapy are never given the opportunity to work with the experience in the arena of their imagination. The sky is the limit when it comes to using our imagination to work with any life scenarios. I recently met a gay man who felt traumatized growing up gay in a religious small town. All his past therapy consisted of sharing about his trauma and making the feelings associated with it more conscious. It was important and useful for him to address those feelings and have regard for them. He told me he was done addressing them. He wanted something different than talking about his trauma. Since he was very much into comic books growing up, he imagined one of his favorite comic book heroes rescuing him from this oppressive homophobic environment. The experience felt so real in his body. He had never experienced so much aliveness in a therapy session that involved dealing with his traumas of growing up gay in a homophobic and heterosexist world. For the first time in his life, he experienced the freedom to use his imagination for the purpose of changing what he could not change as a child. He was not in denial about the horror he experienced. For once in his life, he began to feel the opposite of the trauma. A safe therapeutic space can help people to imagine their painful history in a completely different way. Scenes can be added, deleted, modified with a different ending.

Our life traumas or tragedies are not just mental concepts. They are part of our bodily memories that can impact our nervous system. As Peter Levine stated, “Trauma is not in the event, but in the nervous system.” There are many paths toward healing those upsetting life experiences that has kept our nervous system dysregulated. By working with a licensed professional who has training in “body-inclusive therapy”, we can work on healing our nervous system from unresolved traumas. Our imagination can be a very powerful resource and an ally in this process. Trauma does not have to have the last word.  

For more articles by Dr. Payam, please click on the following link:  https://drpayam.com/articles_and_book

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