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Sensorimotor Psychotherapy: Training for the Treatment of Trauma

An interview with Marilyn Marks, LICSW, Senior Clinician, Kermit Cole, MA, Team Leader, and Elise White, BA, Peer Counselor Interviewed by Jeff Bliss, MSW, Marketing & Development Director

Jeff: Tell us about why you decided to attend this training?

Marilyn: Before I came to Windhorse I met and worked with so many individuals that were struggling with serious mental distress that had trauma histories. I began to wonder to what degree that history affected the development of their delusions, hallucinations, and other symptoms that usually are medicated, but not healed? I wanted to know how to get to the root of the problem. Also I was very drawn to the very practical hands-on tools offered by the teacher (Janina Fisher,Ph.D.) who was using mindfulness practice, Body-Mind centering practices, and yoga techniques to immediately minimize hyper- and hypo-arousal due to trauma symptoms. I saw it as a way to augment and in some cases replace talk therapy. I had found talk therapy far too cerebral for many of these clients and that it actually exacerbated symptoms. It offers some a therapy that is not going to re-traumatize them. The root of this work is mindfulness and so it fits well with what we are doing here at Windhorse.

Elise: It was a confluence of events. A couple of years ago I read an article on trauma-informed peer support. Later, I heard Cailin Reiken (a Windhorse clinician) speak about trauma which resonated with me. I was drawn to a book on her desk titled Trauma and the Body and began to read it. It increased my curiosity to learn more about the role of the body in the work that we do. Also, I was spending many hours on basic attendance shifts with peers who had a history of trauma and who had experienced the mental health system as traumatizing. I really wanted to learn how to be more present and skillful in the ways in which I interacted with my peers around issues of trauma.

Kermit: I became interested in trauma when I was studying for my master’s, because it seemed to explain so many things in the academic, scientific, and ‘real’ worlds of mental illness. When I was involved in schizophrenia research at Harvard, the unacknowledged or underappreciated role of trauma in ‘mental illness’ became starkly clear to me. As I began working at Windhorse I knew I needed to understand more about the trauma perspective, so I took a course for nine months at Dr. Bessel van der Kolk’s Trauma Center in Boston. It was an overview of research, theory, and treatment that prepared me to take Sensorimotor Psychotherapy (SP), which is a practical training in trauma treatment.

Jeff: Please help me to understand sensorimotor work further? Marilyn: When I am using it, I am first interested in reframing the clients’ symptoms from a trauma perspective. One client, for many years before coming to Windhorse, was told she was scattered and crazy, but when she was able to reframe her experiences of her life as a response to trauma, a whole new understanding of herself opened up and she no longer judged herself so harshly and actually realized that her “scattered mind” was a coping mechanism for that time of trauma. Over time she shifted her orientation of herself from psychotic to dissociated, which was a huge step. After that shift we could begin to work with how her body could feel more “grounded” and her mind more present.

Kermit: As I understand it, SP defines trauma as the deep learning, in both the body and the mind, from things that have happened and, as importantly, things that ideally would have happened that did not. These experiences result in learning which plays out later in the environments in which we find ourselves, where the learning may or may not be as adaptive as it originally had been. SP does not “dig into the past” in the way traditional talk therapy does, trying to “understand” the trauma. One of the limitations of talk therapy is that, even if the person can effectively talk about the trauma, which is often not the case, new learning is not taking place within the same emotional/experiential context as the original events and therefore will not have the same impact as the original learning experience. Instead, SP recalls memories as a means to produce physical sensations and responses in the present moment and then to create new learning, safely, but within these analogous states. When all we are paying attention to is the story it is hard for change or healing to occur. The real change happens through bringing awareness to the body’s response to the story and discovering new body-centered responses as well.

Marilyn: Here is another example: A woman I worked with had been given a breast cancer diagnosis that was first misdiagnosed and then re-diagnosed as being malignant. In telling me this story of these events, her hands kept going up in front of her body. I went with that instinctual movement and explored how she related to it. As she moved and ‘listened’ to her hands, she created a boundary, a protective wall with her arms. She connected this movement with having felt deeply wronged by the surgeon. We were then able to work with ways for her to address that injury, by asserting herself with her doctor. So the lesson in this is essentially about not bypassing the body in exploring trauma.

Elise: Learning about the inherent wisdom of the body been powerful. So often in trauma, our bodies become a source of shame and fear. Yet our body also can truly help guide us through the dark places that have held us prisoner. This training has emphasized the importance of attunement and collaboration where “clients” can find their own answers by learning to stay present with what is happening in their own body. Discovering that there really is a “wisdom of the body’ which can be trusted can be wonderfully empowering.

Jeff: I am curious about how what you are learning is informing your work here with Windhorse clients, such as on basic attendance shifts or in intensive psychotherapy?

Marilyn: I actually start with myself first by noticing any signs of mild hyper-arousal. Then I breathe deeply, ground myself through my feet, and slow myself down. It feels wonderful and self-supporting. I am learning that in intensive psychotherapy this body-mind approach offers me a way to work with seemingly intractable situations. It may start with how clients perceive themselves as “the identified patient” or as “sick”. For example: One client continuously called herself sick or ill and with the sensorimotor work she was able to shift out of that identity. As we worked with her body posture she came to feel that it was the first time she ever felt like an empowered person that she could remember. We were able to do this because her body was showing her where her conflict was.

Elise: For me, it has been helpful to learn ways to “resource the body.” In part, this involves techniques to center and ground the body in order to work with one’s level of arousal. For example, I use the technique Marilyn mentioned earlier of pushing my feet into the ground. Immediately, I can feel a deepening of my breath and increased sense of relaxation. On shifts with my peers, I also find myself more easily tuning into the domain of breath and body. But just as importantly, I am learning to be mindful of my own sensations, movements and posture in order to better understand what my body is trying to communicate.

Jeff: Marilyn, I have heard you describe the importance of “feeling grounded” while on a basic attendance shift with someone. I was wondering if there was a time in the training with your own body in which you really connected with learning this new approach?

Marilyn: I had been experiencing a lot of stress in my life and so in an exercise I chose to explore that. There was a lot of rigidity in my body and shallowness in my breathing and the teachers asked me to stay with that rigidity and notice the fear there in my body. I began to rock back and forth and as I stayed with it my breathing deepened and my arms released and a playful feeling of letting go arose. As that happened, the stress I was experiencing actually eased. This was an example of my body informing my mind that I was okay and that I had options. This is considered a “bottom up” formulation where my body “informs” my mind. Traditionally I might use a “top down” approach where I sit and talk to my therapist and try to relieve the stress in my body by just talking about it.

Jeff: And for you Kermit or Elise?

Elise: This is so deeply personal for me. In one practice we had three people with one in the role of the therapist, one as the client, and one as the witness, and then we rotated the roles. In the client role I was asked to recall an experience from my life in which I wanted to say no and I did not. I was moved by how physical the effect of the event was in my body. This is why it is so personal, because after years of trying to understand the stories of my life, I had a direct experience of how profoundly the body holds and relays the story, even more richly than words can. Connecting with my body’s sensations moment by moment was the beginning of a healing process.

Jeff: What other experiential approaches are used in the training?

Kermit: We start everyday with a meditation. We explore in our bodies what we mean when we say “I feel traumatized,” or “I feel afraid,” or “I feel angry.” In the sensory motor formulation you say, for example “Where in your body do you feel this anger” or “How do you know right now that you are afraid?” and we might say “Well my heart is beating really fast” and we can take it from there. I was in the role of client during one of the practice sessions, for instance, and I was describing a frozen feeling in my chest that I get in certain situations. My partner kept asking me to describe it and explore it and as I did I found that I became unable to describe it, because simply paying attention to the feeling had melted it away. This is very different from saying “why are you frozen” or “why are you angry?” and then expecting that the reason the person comes up with is actually the most important one. It may be historically significant, but even so it’s not as important as learning to observe the physical reality of these feelings, relating to them mindfully and regaining a healthy, dynamic, fulfilling relationship with our bodies and our minds.

Jeff: May I ask you what motivates you to do this work?

Kermit: Learning something like this, which relates to the building blocks of how we become who we are and how we can change, is a reminder of why this is the most exciting kind of work to do. I have found that as I have been studying this and applying it I have become more adept at relating to my clients in regard to trauma and dissociation. It is so easy to ignore the things that are there blocking us in our lives — our stumbling blocks, those events that define us, that hold us back from being what we might become. But we are not more comfortable or happier for ignoring these things. The wisdom of what is in the sensorimotor training makes it possible to turn your attention to these very events. It is said that daylight is the best antiseptic. Once you start paying attention to something it starts to yield itself to becoming the next thing. It is this engagement with the moment that is in the end all that life offers us, and it is pretty good.

Marilyn: This work has completely re-invigorated and re-inspired my work as a therapist and also as a person in relationship with other people. In some ways I can not begin to describe how inspired I am to have this work get out into the world because of its healing potential, because of its potential to de-pathologize mental illness, and its potential to bring people home to themselves in a more complete way.

Jeff: Is this technique as applicable to those dealing with extreme mind states or “psychosis” as it is compared to someone who is not experiencing “psychosis” but is experiencing elevated anxiety for example?

Marilyn: I have learned that I have to be more cautious when working with someone experiencing psychosis as compared to someone who is struggling with a characterological disorder, such as a so-called “borderline disorder” or other axis II disorders (DSM-IV-TR). For the latter it is hugely helpful. I find I need to be very delicate in how I introduce this approach to people currently experiencing psychosis.

Kermit: I think the line between dissociation and psychosis is much blurrier than we consider it to be. In any case, our primary tools at Windhorse are pretty much the same. We engage with what is happening in the moment, using presence and mindfulness. So often, before clients come to Windhorse, they are told in various ways by people treating them, that they shouldn’t trust their minds and that they should surrender to being fixed. As a result of this training, “Trust your mind” is what I am saying to myself and silently to clients. That is what our “presence” says to the person we are attending to.

Marilyn: I think Kermit’s comment brings us right back to the beginning of all of this. Presence and mindfulness is the core of this approach and that is a way we are learning to heal trauma.