Pain and Pastures: By Nancy Scott
HA note: Nancy Scott (LMFT PC) is a therapist who works with individuals with an emphasis on helping the body recover from the physical effects of post-traumatic stress, anxiety, depression, grief and loss. You can follow her blog at http://infirm-delight.blogspot.com and learn more about her professional practice at http://nancyscottcounseling.com. This post was originally published on her blog on October 13, 2013 and is reprinted with her permission.
Flora* walked into my office with an air of confidence.
Her light brown hair and fair complexion gave her a youthful look, even as her saucer blue eyes gave away a deep sadness within. A tattoo circled her wrist like a bracelet, a delicate design of leaves and letters. She began to tell me how she had been diagnosed with bipolar disorder several years earlier and that she had been quite depressed for a while now. The medication she had been taking had seemed to help at first, but not so much anymore. She began to tell me about her rigid religious upbringing and her history of physical abuse, but I interrupted her. I asked if I could talk for a moment about how I work before she went much further. Because while telling her story is of great importance, how she tells it may be even more significant.
I asked her to take a moment and look around the room, to gaze out the window at the blue sky outside.
I waited in silence as her eyes surveyed the room, then moved to the tree outside my upstairs office window. At last, her eyes came back to meet mine, and I noticed a slight shift in her breathing. I said I’d like to explain some things about the somatic therapy that I offer, and asked if we could do an experiment.
“For just a moment, see if you can tune in to the sensation of your body in contact with the sofa, behind you and beneath you. Can you tell me what you notice about your sense of your weightedness?” I spoke softly, working to meet her gaze with my care.
“I feel some weight coming back into my legs. I hadn’t been aware of them a minute ago.”
I reflected her response and noticed with her that her awareness of having legs was returning. “What’s your temperature like? Is it warm or cool, or neutral?”
“I feel a little cooler. I was pretty warm there at first.” The color in her face was evening out as we spoke.
“How about your breathing? What’s your breathing like?”
“Pretty shallow. But it’s getting deeper.”
“See if you can tune in to that for a moment, breathe into it a bit?”
She paused, and I noticed with her that her body took a full, deep breath. Her shoulders moved just slightly downward.
By the end of our session, we talked easily, and I invited Flora to compare how she was feeling now with how she was feeling when she first came in.
“I feel a lot more relaxed, at ease.” She stretched her long arms out in front of her and yawned. “My breathing is deeper; I can feel it. This is really different. I’ve been to a lot of counselors and every time I’ve started therapy I’ve always had to start by spilling out all the details of my history. It’s a relief to not have to go into all that right away.”
Trauma as I define it is anything that overwhelms the body’s ability to regulate itself.
Our flight/flight/freeze response is located in the sympathetic nervous system, marked by elevated heart rate, shallow breathing, narrowed peripheral vision, and tightened muscles that are ready to run or fight at a moment’s notice. It can be triggered by any threat, real or imagined. Flora was clearly in a state of sympathetic arousal or “activation” as she entered my office and began to tell me her story.
If you’ve ever been in a near car-crash and swerved suddenly to avoid it, it was this physiological response, your survival instinct, that was triggered to help you escape the danger. Cortisol and adrenaline flood your body, and you swerve to avoid a collision. You might pull over to collect yourself and notice that your whole body is shaking. This is the way it re-regulates itself, discharging the sympathetic activation that surged into your bloodstream a moment earlier. We tend to want to shut it down, to move on, because it can be uncomfortable, but it turns out it’s important to let it finish. It’s our body’s way of dispelling the experience and recovering its innate regulation.
The body knows how to recover.
This normal response to threat is built in at the most primitive level of our brain function. It is meant to be activated quickly and then discharged or released quickly.
However, if the danger persists, for example if we are trapped in a stressful circumstance, or for whatever reason we are unable to fight or flee, the body’s next best approach is to “freeze.” People sometimes call this immobilized feeling “depressed” or “stuck” or “numb.” If this response goes on for a while, it can become more chronic, without release, and the body can become disregulated, resulting in a variety of symptoms including anxiety or panic, depression, insomnia.
If it goes on longer, still louder symptoms can emerge, perhaps even those of bipolar disorder or dissociation.
With our experiment, I invited Flora to notice her body’s response in order to help it regulate itself before we went further. Sometimes people can do this, and sometimes they can’t, depending on the kind of trauma they have experienced and how their body has responded to it. If they can’t, then I take other more indirect approaches, still openly working to find some regulation in the body. I might work with someone for several sessions before moving toward their story, simply helping to “resource” the body, finding sources of comfort in daily life, or places in the past that brought them a feeling of wholeness, of “being themselves,” grounded in the experience of the present moment.
For Flora, we discovered that there was a place where she grew up, largely in isolation, a field near where some cows grazed. She could walk far into the pasture and lie down under the shade of some trees. She would stare up at the sky and notice how blue it was. Whenever we began to slowly move toward talking about the physical abuse she suffered at the hands of her fundamentalist Christian parents, we could change gears and put her back, in her mind’s eye, into that pasture. Her body would begin to shift, to release, as she recalled the vibrant color of the sky, the sound of the breeze moving the leaves, the fragrance of the blossoms nearby, and the warmth of the sun on her skin. It was a source of deep regulation for her body.
Over time, Flora’s body began to discharge the physical elements of the trauma stored deep inside her.
She worked hard to integrate the emotional and spiritual components of her life’s narrative as well, and to cease being a victim of her past. With the oversight of her physician, she was able to wean off of her medications. As the symptoms of her bipolar disorder resolved, she came to see them as pointers to her trauma rather than lifelong mental illness. By the time we finished our work, the flashbacks were fewer, and if they did arrive, she was able to separate the past from the present. She had tools on board that she could employ to process her feelings, thoughts, and sensations.
Flora and I worked together for two or three years, moving back and forth in each session between body “resources” like the pasture near her home, or her love of the ocean, or the feel of her dog curled up next to her, and the deeply painful memories of the abuse. We explored the sensations in her body of activation and regulation, and moved toward the careful expression of the dark memories, which had been so overwhelming in her previous therapies. We worked to balance it with things that brought her life, groundedness, hope. The memories became less intense over time, more integrated, physically and emotionally, as we paid close attention to her body’s ability to move back and forth between a certain level of activation and the deep regulation she was beginning to experience.
I’ve worked as a therapist for about fifteen years now, “somatically” with people like Flora for about ten.
I have found that working with the body is essential for resolving traumatic memory.
I have been helped tremendously by the work of Christine Barber, Peter Levine, Maggie Phillips, Dan Siegel and Bonnie Badenoch, to name a few. I have come to believe that the complexity and variety of mental illnesses described in the DSM-5 (my profession’s diagnostic manual) reflects how individual bodies respond to their respective traumas. I have seen the symptoms of these various diagnoses largely eliminated by working with sensations in the body and moving toward integration of implicit and explicit memory, sensation, emotion, mind and spirit.
I have worked with a number of people who were diagnosed bipolar, like Flora, and who were able to move beyond their symptoms toward substantial healing.
They are the real heroes.
* “Flora” is a composite of people from my work in private practice as a Marriage & Family Therapist. I have made her unrecognizable in order to protect confidentiality.