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.