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, MFT, Ph.D., SEP, is a psychotherapist (www.DrPayam.com), Somatic Experiencing Practitioner (www.SomaticAliveness.com), writer (https://www.drpayam.com/articles_and_book) ,and artist

(https://somaticalivenessart.etsy.com).

 
Licensed Marriage and Family Therapist online anywhere in CA & Florida.

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.

Payam Ghassemlou, MFT, Ph.D., SEP, is a psychotherapist (www.DrPayam.com), somatic experiencing practitioner (www.SomaticAliveness.com), and artist (https://somaticalivenessart.etsy.com).
 
Licensed Marriage and Family Therapist online anywhere in CA & Florida.

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