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Member driven blogs to spotlight solutions, share opinions, raise public awareness, and contribute to shaping our national mental health policy.  Stay current and up-to-date in the world of somatic psychology and practices.

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  • 12 Sep 2019 2:39 PM | Anonymous

    By Sonya Denise Ullrich, MS, AMFT, SEP, ABMP


    Here’s a thought experiment: Think of someone you know well who has struggled with addiction; it could be a client, a family member, a friend, or, perhaps, yourself. If you view this person’s addictive behavior as a way of setting boundaries, which relationships come in to focus? Which socioeconomic, structural realities? What need for change? Does the nature and focus of your support change also?


    This -- addictive behavior as boundary-setting behavior -- is an overlooked but clinically useful concept for treating addiction. Centering the boundary-setting function of addictive behavior can be an important aspect of building psychosocial skills, distress tolerance, self-knowledge, interactive regulation, and, because of all of these things, sustainable recovery. It goes further than the concept of “coping strategies” and puts relationship at the center of addiction; if addiction does not start out as a relationship surrogate, it certainly ends as one. Addiction as a surrogate relationship and barrier from interpersonal stressors is costly, but it often feels more reliable than other people in the wake of relational trauma. In the words of a high ACE-scoring combat veteran friend choosing a life of alcohol use over his second wife during their divorce, “I like you some of the time. I like alcohol all of the time.” The more general example I share with clients is, “I’m so high that you can’t hurt me in here.”


    The well-known ACEs study by Fellitti et al. (1998) produced one of the most compelling statistics related to addiction. Patients with an ACE score of four or more are 4000% more likely to become an intravenous drug user than someone who scores lower on the scale of childhood adversity. Four thousand percent! That makes a strong case for the argument that compulsive behaviors replace the function of social relationships in nervous system regulation when early relationships are themselves dysregulating. Furthermore, the Harm Reduction Coalition (2019) demonstrates the importance of restoring healthy relationships in reducing the harmfulness of addictive behavior with one of its central tenets. It “establishes quality of individual and community life and well-being -- not necessarily cessation of all drug use -- as the criteria for successful interventions and policies.” The decriminalization of substance use, likewise, addresses social relationships by reducing related stigma and poverty and re-engaging drug users in community participation on a larger social scale.


    Clinical Application


    As a specialist in trauma, attachment, and touch skills in treatment programs for both chemical dependency and process addictions, I have introduced the idea of addictive behavior as boundary setting behavior to a diverse range of clients. The usual response is a pause of momentary consideration, then a nod of agreement. Whether you can deconstruct this conceptualization through more widely discussed principles of addiction medicine is one thing. The clinical utility of these ideas is quite another. Centering the relational aspects of addictive behavior in the therapeutic frame begets reliable client endorsement and insight. This, in turn, prepares clients for the therapeutic endeavor in a threefold way: to look to the past to resolve the developmental trauma underlying so much addictive behavior, to the present to enrich and reciprocate social support, and to the future to evaluate relapse risks and take ownership of any skill-building necessary for nurturing satisfying relationships. 


    Practically speaking, this is a very simple clinical intervention when you understand the reasoning behind it.

    Therapist: “Do you feel like you use your addictive behavior to set boundaries in relationships? Where words and less harmful actions don’t work well enough? Maybe something like, ‘I’m so high, you can’t hurt me in here?’”


    Client Response: “Yeah . . . totally.”


    Therapist: “Really? With whom? In what way?”


    Done. And you’ve sparked a self-affirming exploration that will generate effective treatment objectives. 


    Let’s dig a bit deeper into the rationale behind this approach. The motivational factors most commonly emphasized in addiction treatment include: the mood-altering effects of addictive substances and behaviors; pleasure-seeking; self-medication of underlying disorders; the neurobiology of diminishing returns; social influences that normalize or incentivize addictive behaviors; and somewhat more recently and mercifully, the roles of socio-economic marginalization, traumatization and the need for external regulation of the autonomic nervous system. All of these factors are important and central to the addictive process; communicating boundaries is generally regarded as one of many subsets of skills required for successful recovery. 


    However, prioritizing relational skills and stressors throughout addiction treatment contributes to compassionate, effective care that is congruent with contemporary neuroscience and trauma-informed care. For someone to engage routinely in the legal, financial, and health risks associated with addiction, they tend to have relational trauma histories or current circumstances that make high-risk pleasure-seeking through altered states a necessity for relief of pain. Whether through the direct anesthetization of opiates or ketamine, the depression-staving dopamine rush of stimulants or action gambling, or the safely distant simulation of social contact that comes with sex addiction, any compulsive consequential behavior becomes a surrogate relationship. For lives deficient in attunement and empathy, the relational impact of addiction can feel like a justified protest/withdrawal or simply the only alternative. The impact of addiction on others invariably takes a backseat to the need to alleviate one’s own pain during the addictive process. Articulating relational boundaries in therapeutic recovery re-engages clients in their relationships; it empowers clients by emphasizing their own unmet needs through actionable goals and offsetting the usual waves of shame and self-recrimination.


    Personal Insight and Observations


    It was a sunny weekday afternoon, several decades ago. I was sixteen and my brother was eight. I was babysitting, as I often was. I loved my brother deeply, helped deliver him at birth, and I managed to share with him my values related to environmental sustainability and community. I could hear him playing outside my window soon after we arrived home. I wanted to be a loving older sister, however much I resented my parents for forcing me to provide the care for their two other children while giving so little emotional support in return. So, I inhaled a modest amount of crystal methamphetamine to offset my depression and balance the scales with my parents, and then gladly joined my brother in the yard.


    As with so many who turn early and hard toward compulsive self-soothing, I was a depressed, anxious adolescent with an insidious trauma history. However, while the etiology of addiction is always multi-factorial, I was using my addictive behavior to establish very private and costly relational boundaries in a family system where many previous attempts to signal my distress, express my needs, and set reasonable boundaries essential to the task of individuation had failed. I had gotten perfect grades and been the perfect baby sitter, but nobody noticed. I spent years on the edge between ortho-and anorexia, but nobody seemed to care. I used tactics borrowed from political protests to register complaints in my home, but they fell on deaf ears. With the agency of a new driver’s license, I acted out my angst, fumbled for nervous system regulation, and fought to complete the developmental tasks of adolescence via my first stimulant addiction. 


    My polysubstance relapse pattern bore out this boundary-setting relational dynamic. My major relapses occurred when I lacked the psychosocial skills and the responsive social environment to establish boundaries, express needs, and say “no” in any healthier way. As a client with little resilience and an extensive trauma history, I had also been pushed over the edge of relapse by therapy I found emotionally and physiologically overwhelming. I became a practitioner of gentle somatic and attachment-based interventions because they allowed me to understand the nature of my fraught internal wilderness through developing internal tracking skills. They also let me know I was not alone through connecting me to a broader evolutionary framework of my own biology and behavior and gave me enough understanding and perspective to tolerate the risk of communicating my needs.


    Case Examples from Colleagues 


    I have treated hundreds of clients struggling with addiction and have employed this concept to good effect. To honor their confidentiality while providing real-life case information, I introduced the concept of addictive behavior as boundary setting behavior to a range of colleagues who also share addiction histories. As an added bonus, some interviewees volunteered the progress they made through somatic psychotherapy. The case examples that follow are from colleagues, names changed, whom I have interviewed expressly for this article. As much as possible, I have left their stories in their own words.


    Brian, a career paraprofessional in abstinence-based addiction treatment and golf enthusiast, used to “drink, drug, gamble and act out sexually” to escape impossible internalized perceived expectations within his family of origin. In his words, “I just needed to blow it all up because I couldn’t deal with the pressure.” In romantic relationships, he describes keeping partners away through keeping relationships superficial and engaging in infidelity, fearing commitment and anticipating not being good enough, as with his family, “even once I was in recovery.” He also describes feeling burned out as an employee in the addiction treatment industry and engaging in “resentful retaliation” by staying out all night engaging in his addictive behaviors while he was on the clock. He described addiction as a surrogate relationship as “a nice, tolerable place to go to escape the pain of isolation.”


    Grant, a healthcare administrator, abstinent gambling addict/substance user, and devoted adventure athlete, has a history of sexual abuse, “I had coping mechanisms even then, acting out all the time. I thought I was unlovable and then got into drugs and alcohol in high school. Discovering gambling when I was older gave me the same escape and felt much healthier than when I was getting high. It wasn’t, of course. In relationships, I have a hard time trusting anybody. Because of my molestation history with my brother, I would push women away. Even though I still struggle with trust, I recognize these lifelong patterns. I’m able to and want to stay present after sex. Somatic psychotherapy allowed me to fully connect my adult addictive behavior to my childhood trauma history and fully process my emotions and cry that hard for the first time. It opened my eyes to how profound an impact that made on me. I don’t feel unworthy or unlovable anymore.”


    Aimee, a rural crisis behavioral health clinician and motorcycle enthusiast, reflected on where she is at now, psychosocially speaking, as she celebrates a year of abstinence after her one major relapse with methamphetamine. “I just bought a new motorcycle. I realize I have these expensive hobbies that function to push my partner away. They are the hard boundaries that give me autonomy and independence. I still use alcohol as a lubricant. Those are my ‘lubricating boundaries’.” She described her current partner as “like sitting on a still lake” after a long, volatile relationship in which she began using again “to prevent abandonment, to form a bridge, and then to deal with the abandonment once she left.” She described that relationship as “a lot like my mother. She was incredibly violent. I used to peek around the corner and only come out if she, my mother, was in a good mood. I was hiding beer in my cowboy boots by the time I was twelve. She could yell and yell at me and I didn’t care. That was also the year I started getting sexually abused by a neighbor.” She described having, “a long fuse. When I get to a point, before I explode, I jump into addictive behavior to prevent the explosion. Or when my partners or my family demand I show up a certain way.” She described her ability to navigate reduced cravings and negotiate healthy boundaries with her current partner. “There’s no abandonment threat because she doesn’t generate the same highs and lows. She can talk about boundaries.” She added that her somatic therapist has her focus on her breath during moments of sexual intimacy to alleviate panic and to be present with her partner for a few moments.


    Brandon, a harm reduction activist, health provider in a rural indigenous community, and musician, assumed his addictive behavior was pathological and needing to be gotten rid of rather than understanding it as a response to something. “Instead of ‘I just use drugs because I’m broken’, I began to understand that it helped me survive. It provided comfort, joy, a sense of belonging and basic human social needs that we are culturally, systemically deprived of in a capitalist culture. Family is one of the social structures is key to systemic control. I don’t blame the abusive mother and negligent father because they’re a product of the economic system that created their behavior. I don’t blame the abnormal child, either.” He described the tension between wanting to reduce the social stigma, legal consequences, and shame for his clients who use drugs while also relating to their desire to stop using heroin because that was something he needed to do to restore relationships and appropriate boundaries in his own life, as well.




    Regardless of their philosophical approach to their own recovery or the time and perspective they have from their own compulsive self-soothing, the colleagues I interviewed were able to respond autobiographically to the concept of addictive behavior as boundary setting behavior. They did so in ways that were novel, insightful, and self-affirming. For myself, this concept has helped evaluate risk, identify skill deficits, and hold my own history with compassion. I have had hundreds of clients in addiction treatment who have found it useful, too. With vulnerability and humility, I offer it to you.

     About Author Sonya Denise Ullrich, MS, SEP, ABMP.

    Sonya Denise Ullrich, APCC, SEP is a practitioner with twelve years of experience in somatic trauma resolution and twenty years in manual therapies. She has a background in Somatic Experiencing, Feldenkrais, PACT couple therapy, and human ecology. She currently practices somatic psychotherapy throughout San Diego county, assists trainings in touch skills for trauma resolution, coordinates regional events for the California Association for Professional Clinical Counselors, and teaches workshops on touch skills for couples.

    She worked in a range of addiction treatment settings in California and Arizona and has developed addiction treatment programming based on somatic trauma resolution and attachment theory. She is passionate about interdisciplinary social science and global health. She is pursuing opportunities to research the use of touch cross-culturally and use participatory methods to develop culturally appropriate programming for trauma resolution.

    Learn more about her work online.

  • 2 Aug 2019 5:59 PM | Anonymous

    By Nancy Alexander, MSW, LCSW-C
    By Linda Ciotola, M.Ed., CHES (ret), TEP 

    Trauma survivors are among the most challenging, frustrating and heart-wrenching populations in any treatment setting. Treating them has been associated with vicarious traumatization of the clinician (Neumann & Gamble, 1995). Diagnosed with everything from Borderline Personality Disorder to Dissociative Identity Disorder, their often intractable, unmanageable repertoires of ‘acting out’, self-destructive and demanding behaviors, causes many a well-intended clinician to refer these clients elsewhere. However we recognize they have developed a vast array of creative survival skills, making them well suited to psychodrama and the creative arts. As helpers, we feel overwhelmed (Figley, 1995) by their lack of insight, their regressions, chronic hopelessness, neediness, rage, their re-victimization and by their complicated, ambivalent transferences, which vacillate between love and hate, trust and paranoia, idealization and devaluation. Many of us wonder if we are ‘cut out’ to work with this emotionally demanding population. Should we do as many of our colleagues have done and refuse to treat them? Perhaps the better question here is “Am I cut out to work with this population alone?” 

    A team approach integrating psychotherapy and psychodrama brings an enhanced array of skills, knowledge and creativity to the treatment process (Lev-Wiesel, 2008). It provides the client with innumerable corrective emotional experiences, opportunities to concretize and integrate both horrendous life experiences and fractured ego-states in a safe consistent holding environment that is adaptive, pro-active and supportive. Our collaboration grew from a mutual interest in trauma work. One of us, rooted in psychodrama, using the Therapeutic Spiral Model (Hudgins, 2002), to help trauma survivors and the other, a psychotherapist specializing in trauma. Neurons fired and we embarked on our journey of collaboration. We are co-authoring this article in an effort to let creative dedicated clinicians know about this unique treatment approach, some of its fundamentals and its many benefits, for the client and for the clinician as well. 

    The Role of Trauma in the Trauma Spectrum Disorders 

    Trauma can be induced by many situations including war, crime, domestic violence, natural disasters and child abuse. It results from being personally exposed to terrifying experiences that involve actual or threatened death or serious injury, or witnessing an event that involves death, injury or threat to another person. The individual’s response to the event involves intense fear, helplessness or horror. Most of the individuals in treatment with us are adult survivors of severe, complex and prolonged childhood trauma and carry diagnoses of Dissociative Identity Disorder and Posttraumatic Stress Disorder. Many have co-occurring diagnoses of Eating Disorders, Anxiety Disorders, Addictions and various personality disorders including Borderline Personality Disorder. All the clients we worked with have been in therapy for many years, many have had numerous psychiatric hospitalizations, many have had a history of suicide attempts and all of them present with high risk behaviors of some sort, whether by overt self-destructive actions like overdosing or cutting or slightly more subtle behaviors like gross violation of a diabetic diet or picking up strangers through internet sites. 

    The symptoms they report include recurrent, intrusive flashbacks, hallucinations, disorientation to time and place, inappropriate affect, memory loss, addictive behaviors, depression, anxiety, emotional detachment, misperception or distortion of reality, self-destructive behaviors and rituals, somatic disorders/body memories, distressing dreams, dissociative states, intense physiological distress and reactivity, feeling estranged from others, diminished ability to feel emotions, difficulty falling asleep or staying asleep, hyper-vigilance, exaggerated startle response, irritability or angry outbursts, difficulty concentrating or completing tasks, suicidal or homicidal ideation or behaviors. In short all of them have difficulty living their lives in a functional way and are distressed beyond what their current circumstances would warrant. As  Eugene O’Neill said in A Moon for the Misbegotten, “There is no present or future, only the past, happening over and over again, now.” (O'Neill, 1970)  

    A central construct to consider when discussing trauma is the role of the brain. The brain is also central to understanding why psychodrama is so effective with trauma-induced disorders. When a person faces overwhelming trauma the brain absorbs information about the trauma and stores it in the limbic system (Van der Kolk, McFarlane, & Weisaeth, 1996). The limbic system is where sensations, emotions and non-verbal information are automatically stored. The body is then flooded with stress hormones, the fight, flight or freeze response takes over and when that happens cognition is blocked. The result is that the trauma experience stays stuck in the limbic system and because cognition is blocked the individual is unable to accurately process the traumatic events and make clear present-based sense of them. As long as the information is stuck in the limbic system body memories, flashbacks and dissociated affect, impulses and behaviors continue. Because psychodrama can address issues non-verbally if done properly it can provide a safe vehicle for accessing the trauma information stored in a non-verbal part of the brain and move it to the cognitive processing part of the brain where the information can be verbalized, accurately labeled and processed from a current day perspective. 

    The Fundamentals of Trauma-based Psychotherapy 

    The core of reconstructive psychotherapy begins with the therapeutic relationship; it is the core of trauma recovery work (Greenberg, 1998). Without a strong positive psychotherapeutic bond nothing transformational can occur. Reparative work requires trust and empathy be established and maintained, it’s a prerequisite before the client can internalize what body-psychotherapists call ‘a body of trust’ within the self (Ridge R. M., 1998). Cognitive-behavioral work and insight-oriented work are both important components of trauma recovery but need to occur within a strong reparative relationship. The transference–counter-transference is that dynamic intersection that generates the energy for change. The client’s emotional wounds occurred within some type of emotional bond that was violated and the individual cannot be fully restored unless healing occurs within the context of a reparative bond. J. L. Moreno asserted “we are wounded within relationship and we heal within relationship.” (Moreno Z. T., 2010) Safety and consistency are essential and maintaining strong therapeutic boundaries is critical toward that end. Clients who have experienced abuse from an early age develop adaptive skills which disintegrate into dysfunction the result of which challenges the therapist’s rules, boundaries and limitations. Clients may become preoccupied with ways to violate those boundaries and engage the therapist in non-therapeutic ways (Van der Kolk, Perry, & Herman, Childhood origins of self-destructive behavior, 1991). It is essential that the client recognize the repetitive emotional and behavioral patterns that regularly occur in their lives. By identifying their patterns and what triggers them the client takes a necessary first step toward symptom management. Guided imagery, music, relaxation or dissociative reduction techniques can be helpful in managing body memories or panic attacks (Blake & Bishop, 1994). 

    Beyond support and validation, beyond trust and understanding is the client’s story. Every client has a unique story which has led to deeply ingrained patterns of behavior. Some patterns are overt and clearly identifiable but intra-psychic patterns are harder to identify. Because trauma memories are ‘stuck’ in the non-verbal part of the brain, psychotherapy alone may be inadequate because psychotherapy is word-based and trauma experiences are not (Van der Kolk, 1997). If the client cannot access the information or use words to describe what they are feeling, then what can be accomplished within the confines of that approach may be limited. The client may be acting out but unable to explain why or produce enough information to describe their internal experience. It is in those swirling moments of instability that these clients become most difficult to manage and the therapist may begin to feel frustrated. At those times the therapist may resort to setting limits sometimes veiled threats, ‘if you cut yourself I’ll terminate with you’ and the client’s fear of abandonment rises along with their distrust; yet they have no better skills to manage their feelings or behavior than they did before. It is times like these that a creative team approach can move the stuck client and therapist to a higher level of competence (De Zulueta, 2006). 

    The Role of Psychodrama in Trauma Treatment

    Psychodrama is action based, expressive and creative. It allows the client to view past events from a here and now perspective and provides support while accurately labeling and processing trauma material. Because it is action based it is uniquely able, like other expressive therapies such as art and movement therapy, to access the non-verbal part of the brain and to transfer non-verbal material from that part of the brain to the cognitive processing part of the brain (Carey, 2006). It provides an opportunity for the client’s inner world to be externalized and enacted, to be emotionally perceived, identified and understood, then to be remembered, repaired and re-internalized. When that happens the trauma memory can be stored in the cognitive part of the brain and sequentially organized along with other life events. This neutralizes its impact on the identity, perception and functioning of the trauma survivor. 

    One of the essential values of psychodrama is its emphasis on movement. In psychodrama it’s not just tell me it’s also show me, so the individual moves from sitting in a chair struggling for words to being able to communicate through often simple movements. Trauma memories are contained in the brain and in the body. Through mindful breathing, (Springer & Rubin, 2009) movement and specific grounding techniques flashbacks can be controlled and the frozen dissociated client can find a way toward self-expression. 

    Psychotherapy and psychodrama are each rich and meaningful interventions but when used appropriately together they can provide a powerful forum for trauma recovery. 

    Essential Psychodrama Techniques Used in Collaboration

    The double is a special auxiliary role used in psychodrama. The double’s function is to support the protagonist, client or the individual whose story is being enacted. While the double originated as a classical psychodramatic role, the art of doubling can enhance the therapeutic alliance to a greater degree than empathic, reflective or supportive listening (Hudgins, 2002). The clinician assuming the double role first explains the process and then asks permission to sit beside the client. The double always works towards establishing empathic attunement by doubling the client’s breathing, posture, facial expression, gestures, verbalizations, and voice tone. The double forms a united front with the client to support the client in expressing unspoken inner feelings. The double speaks in the “I” as this inner voice of the client. Client is asked to repeat the statement if it is accurate or to correct it if it is not. So, even if doubling statement is inaccurate, it clarifies and furthers self-expression. This kind of doubling is called classical doubling. It is particularly helpful with clients who have alexithymia (Hudgins, 2002). There are two other types of doubling that are helpful in working with trauma survivors, the body double and the containing double. The body double, developed by the Therapeutic Spiral Model is used to decrease dissociation, and help people experience their bodies in a healthy state (Hudgins, 2002). The containing double also taken from the Therapeutic Spiral Model, balances cognition and affect in an effort to help clients stay oriented to the present while working on trauma material (Hudgins, 2002). Types of doubling can be used by themselves, alternatingly or in combination with each other. Linda, co-author of this article, created the triple double, which interweaves all three types of doubling techniques from moment to moment depending on the client’s needs. (Burden & Ciotola, 2002) (Ciotola & Hudgins, 2003) 

    Dr. Kate Hudgins who created Therapeutic Spiral Model tm defines the observing ego role as,"...a role in which people can neutrally observe and narratively label their behaviors." To make the term more user friendly for clients we call this the witness role, and teach the client its function, to allow them to give themselves neutral factual information about their thoughts, feelings, impulses and behaviors, without judgment. Once the witness role is internalized, it can be used at any time, enabling clients to step back from the trauma, view it a distance and then accurately label what occurred, something that did not happen at the time of the trauma. During a psychodrama the client can be role reversed into the witness role, as needed. role reversal occurs when participants exchange roles either interpersonally or intra-psychically. 

    De-roling occurs at the end of each drama to clear auxiliaries and props of any energy, feelings, projections or issues that were assumed during the drama. Each psychodrama ends with sharing; this unique event follows each drama wherein all participants share how the drama related to them. The personal information shared, relates to the work that just occurred and helps the client feel understood and empathically connected with the psychodrama team. 

    Following each drama the protagonist or client is asked to create a project of integration. These projects concretely express and record the drama’s meaning. Linda describes it this way "…trauma has hard-wired the brain and body to hold on to a particular belief system, to ways of reacting, to ways of being with self and others. a mosaic whose pieces have been arranged in a particular pattern, psychodrama takes the old configuration apart and reorganizes traumatic experiences in a new way. But for a little while, those newly configured pieces are sort of up in the air and not glued together. The project of integration glues the transformed pieces together.” A project of integration can be as simple as a one page collage or as complex as a power point presentation, it must include words and images in order to integrate right and left brain functions. Psychodrama integrates feelings and visual images contained in the limbic system with cognitive processing of the cerebral cortex; this allows the client to combine both types of memory and move forward. We encourage clients to complete their project of integration within 48 hours of the drama. This is because the brain tends to revert to old patterns before the new one gets glued in. The project is then shared with the therapist and psychodramatist the following week to further anchor in the crucial learning. Many of the projects we’ve seen reflect the depth, beauty and creativity of these trauma survivors as they make meaning of their psychodramatic experience. 

    We find follow up email is especially helpful. From shortly after the drama until it is clear that the client has successfully journeyed through the process, email messages are exchanged between the psychodramatist, the psychotherapist and the client. These may answer questions about the client’s experience, provide specific suggestions or information. Most importantly they maintain emotional connection and safe containment. 

    Three Ways to Combine Psychodrama and Psychotherapy

    Out of our collaboration we formulated three different approaches that unite psychodrama and psychotherapy. 

    Collaborative approach – the psychodramatist and the psychotherapist are both in session with the client at the same time. These sessions are uniquely structured so that each clinician has a distinct role. When the psychodramatist assumes The doubling role during an individual therapy session it helps the client to remain grounded, express feelings, deal with dissociated aspects of self and work more effectively with the therapist while remaining within what Bessel van der Kolk calls, the window of tolerance. (Van der Kolk, 2003) This means that there is enough stimulation of the limbic system to access the trauma material, balanced with enough containment to keep the client from being re-traumatized. 

    During collaborative sessions, the therapist remains in her "therapist role", interacting with the client as she would normally do, while the psychodramatist assumes the doubling role. The therapist and psychodramatist do not talk directly with one another at that time and the therapist refers to the psychodramatist as the client’s double. Both the therapist and the double focus attention on the client. The process takes some getting used to but once mastered it works perfectly. The psychodramatist sits next to client, in the double position, both face the therapist and a usual therapy session takes place while the psychodramatist uses what we call the triple double, a composite of classical doubling to help clients access and express feelings, the TSM containing double to help balance affect with cognition and the TSM body double to help the clients decrease dissociation and remain in their bodies in a more grounded state. The moment to moment flow of the three kinds of doubling takes place according to the client's needs. 

    When working collaboratively, clarity about role, boundary and function is essential. With a client population where boundaries have been violated and roles were confused, it is essential that the role of the psychotherapist as primary and the role of the psychodramatist as auxiliary be clearly and consistently maintained. Through the years of working together not one single client ever seemed unclear about which of us was doing what. We each played meaningful roles in the client’s recovery process and emotional life, but they were distinctive roles, complimentary and valuable but distinct. 

    Clients with histories of severe trauma disorder need to demonstrate grounding and containment skills and have basic trust in the therapeutic relationship before being introduced to psychodrama. They have to be able to abstract well enough to grasp the concepts necessary to engage in psychodrama and demonstrate a commitment to the recovery process which includes preventing re-traumatization, controlling regression, learning to identify and avoid shifts in ego-states, being able to differentiate and utilize both psychotherapy and psychodrama. 

    Case Example

    Janice is a 55 year old married professional woman who was sexually abused by her father until the age of 13 and was emotionally abandoned by her mother. She had numerous therapists and a long history of depression, suicidal preoccupation and several inpatient psychiatric hospitalizations for treatment of DID and PTSD; in addition she had alcohol and nicotine dependence. Janice exemplified Tian Dayton’s observation that ‘trauma and addiction go hand in hand.’ (Dayton T. , 2000, p. xvii) Trapped in the painful cycle of trauma and addictions, being frozen and mute, she was unable to access her strengths, name the traumas and begin healing. As Tian states, “giving words to trauma begins to heal it.” (Dayton T. , 2000, p. xvi)  Janice was introduced to psychodrama because during therapy sessions she was mute for long periods of time and when she spoke it was in whispers; she displayed abrupt shifts in ego states, evidenced by changes in cognition, point of view, manner of speech, body movements and facial expression; these varied dramatically from alter to alter, also called personalities or parts. 

    After introducing the double role to the client, explaining its function, and how she could accept or change any doubling statement, and could request an end to doubling at any time, the psychodramatist assumed the double role and began tuning in to the client's breath, posture, facial expression, and what the client was communicating energetically if not verbally. 

    Double: ‘I feel frozen’ 

    Janice: (no response) 

    Double: ‘I cannot move’ 

    Janice: (blinks and gives small head nod, but says nothing) 

    Double: ‘I cannot speak’ (double is also 'leading' the client at this point with a Body Double technique of long slow audible breaths to help give the parasympathetic nervous system the 'ok' to calm down) 

    Janice: (presses lips together) 

    Double: ‘My lips are sealed. I cannot talk about what happened to me’ 

    Janice: (begins to cry) 

    Double: (using her own body to 'lead ' the client,) says ‘I can feel all four corners of my feet on the floor and look at Nancy and just let my tears be.’ 

    Janice: (still crying, looks at feet and places soles of feet firmly on ground, says nothing) 

    Double: Says, (while raising eyelids to look at Nancy), ‘I can raise my eyelids and glance at Nancy and know I am ok here in this moment.’ 

    Janice: (raises eyelids to look at Nancy, is breathing more deeply in sync with double) 

    Double: ‘I know I am ok in this moment’ (if that's right repeat it, if not correct it.) 

    Janice: nods head and says, ‘Am ok’ 

    Double: ‘I can choose when to speak’ (if that's right repeat, if not, correct it) 

    Janice: nodding (double nods with her), ‘I can choose’ 

    Double: ‘I have choice here’ 

    Janice: ‘I have choice here’ 

    The client then started to tell her story while remaining grounded and present. At times, vignettes, defined as short psychodramas that can be very brief or expand as indicated (Dayton, T 2005), evolve during these sessions so that specific therapeutic issues or trauma components can be addressed. The psychodramatist may also be in the director’s role and can use the triple double from the director's role to help pace the work in a safe way. Collaborative sessions are scheduled between regular ongoing individual psychotherapy sessions. i.e., client and therapist meet 3x a week and one of those sessions is collaborative and involves the psychodramatist. 

    Alternating approach – full length psychodramas are scheduled as needed in order to work on more complicated emotional issues. Individual therapy sessions are ongoing and used to help prepare the client for and develop goals for the dramas. The psychotherapist attends the dramas taking either a strength role e.g. courage or the witness role. In a psychodrama all participants are fully engaged serving to validate and support the client, broadening and strengthening the emotional safety net to include the entire psychodrama team who see, hear and feel the client’s story. A psychodramatic experience “…allows clients to feel deeply seen, deeply felt by another, guided safely through feared internal landscape, and also fosters a sense of mastery and authenticity…. Having an emotional experience that is shared, safe, and when processed to completion, results in clients feeling open, at peace, having a sense of clarity, self-compassion and wisdom, further strengthens the bond to the therapist which allows emotional processing to proceed to a yet deeper level.” (Schwartz, Galperin, & Gleiser, 2009, p. 19) 

    In our collaboration the psychodramatist adapted and modified her experience from the Therapeutic Spiral Model tm to guide the process. Our team consisted of the psychodramatist, the psychotherapist and two highly trained psychodrama auxiliaries. On average, the time frame of about 6 hours was scheduled in a private setting to do the work. Before the protagonist/client arrived the team set up the room and held a team meeting which addressed issues to be cleared so that team members could be fully present. Following the drama, de-roling and sharing occurred and the client was assigned a project of integration. Following the protagonist’s departure the team remained to process, close and cleanup. 

    During dramas, the witness role held by the therapist, who had largely been holding this role psychologically for the client all along, and often took notes while in role that were useful in the project of integration and in follow up therapy sessions. Those sessions were more effective since the therapist learned first-hand about the client’s psychodramatic experience. 

    The psychodramatist joins the therapy sessions before every drama to determine needs and goals and returns after the psychodrama to review the client’s experience, see their project of integration and formulate further goals to be accomplished. 

    Clarissa – is a 50 year old unmarried professional woman with a history of child abuse. She is the youngest of 8 children abused and intimidated by her alcoholic father and neglected by her frightened mother. Cast in the role of family protector from an early age she was taught to stand up to her father and take care of her mother. A bright child she did well in school, left home and worked her way through college becoming an executive at an early age. She entered therapy with complaints of forgotten sexual encounters and worried that she hurt people in her sleep. Once diagnosed with DID, we found that she had a complex system of alters, she worked actively in therapy, journaling and following assignments perfectly. After three years she integrated her system. It turned out that she had sealed over many of her symptoms because she didn’t want to admit she was still having difficulties. Once psychodrama became a part of her trauma treatment regimen, she found a place of freedom and self-expression. The approach we used with her was the alternating method. Individual therapy sessions were alternated with periodic full length psychodramas. 

    The contract for Clarissa’s first private psychodrama was to eliminate the ‘wall of pain.’ This is something that occurred when one of her alters, ‘Tom’, felt the need to protect her by creating pain in the form of excruciating headaches and body pain. One auxiliary was asked to hold the role of the ‘wall of pain’ while the other held the role of ‘Tom’ with Nancy in the witness role and Linda using the triple double from her director’s role. And as the drama unfolded Clarissa and her alter realized that the ‘wall of pain’ was no longer necessary in the present and the alter in fact was a child part suffering role fatigue and Clarissa was an adult who could choose to handle her feelings and situations differently. This freed her alter from that role and allowed Clarissa to access her spontaneity and creativity. As a result the physical pain created by this part ended and a sense of safety within the system was established. “For over 40 years I have tried to break through the chains of the…‘wall of pain’ and now… it is gone” 

    Combined approach – an adequately trained clinician can assume both roles simultaneously during one session. Props concretize roles for both the therapist/director and the client and expand role options when no auxiliaries are present. Once the client is familiar with these processes role changes can occur seamlessly. 

    Case Example

    Suzie – a 46 year old single professional woman with a history of emotionally vacant relationships, presented with low self-esteem, anxiety, obsessive compulsive disorder and a sleep disorder. She sought therapy primarily because of a pronounced decrease in her ability to function at work and because she had become entangled in a dysfunctional romantic relationship and was unable to integrate her perception of it. She idealized ‘Mike’ and focused on every tiny exchange they had and yet had amassed a mountain of evidence that he was dishonest about his interest in her and activities with other women. Her internal battle about his truth and her hope was all consuming. Every incident intensified her focus and diminished her ability to think clearly and perceive accurately. 

    Therapy sessions had been reduced to yes buts and compulsive reiterations of each miniscule exchange. Though she could see and hear what the therapist reflected back to her she couldn’t let go of him and her behavior was continuing to disintegrate. 

    Our first psychodrama à deux, psychodrama in which only the director and protagonist are present, began by asking Suzie to write her strengths on yellow sticky notes posted around the office. Strengths were integrated in action with the help of doubling done from the director’s role. Then Mike’s positive and negative qualities were concretized in two scarf piles allowing the protagonist to identify each quality and its impact on her. When she chose a dark splotchy scarf to represent his lies and she wrapped that scarf around her head and over her face and said ‘his lies are all around my head.’ The doubling statement was ‘his lies blur my vision and cloud my judgment. I just can’t see through them.” She repeated “yes, his lies are blinding me.” Once his negative qualities were addressed, doubled and deepened, a photo was taken with her cell phone to help her remember what it was like to be wrapped up in ‘Mike’s’ negative qualities. She was then directed to dispose of the scarves in whatever way seemed right to her, making a clear statement about the quality the scarf represented and how she planned to address that quality. Some were thrown in the trash, i.e. “I’m tossing your lies in the trash” and some were stomped on. Following the drama she experienced a shift in her feelings about him and was eventually able to disengage from the relationship. 

    Warming Up to Collaboration 

    The first stage of the collaborative warm up is an interest in working differently and beyond one’s usual scope starting with the therapist’s willingness to expand into the world of psychodrama. The psychotherapist has to see the value in both approaches. Psychodramatists are more inclined toward thinking about collaboration since that modality is more group oriented by definition. Once the therapist learns about psychodrama and sees its value, there is a learning stage. Psychodrama is not just psychotherapy with movement, art or music. Psychodrama is an independently recognized field; created by J L Moreno during the 1920’s (Moreno J. L., 1977), it was designed to have many applications including recovery from trauma. It has a well-developed theory, techniques and credentialing process. Once the therapist has become sufficiently familiar with psychodrama, the next step is the decision to share the client with another professional, to encourage the client to engage in psychodrama, to become familiar with those techniques and experiences. 

    One of the most powerful side effects of working in tandem is that the client is provided with an opportunity to experience the relationship between the psychotherapist and the psychodramatist (De Zulueta, 2006). For individuals who have spent their lives in a world where people are in conflict, experiencing their treatment team demonstrate cooperation and good communication, show mutual support and have honest exchanges even if there are disagreements is often an amazing experience for clients. Often before or during a psychodrama ideas are openly brain stormed, even differences of opinion are valued and explored openly and without conflict. 


    In summary, the collaborative work between psychotherapist and psychodramatist is beneficial because roles are mutually reinforced and clinicians feel supported in working with this complex and stressful population. We have received consistent feedback from protagonists about the safety and connection they have felt from having the exact same psychodrama team for each of their psychodramas. They felt that the team sharing and constancy of their dedication provided a unique opportunity to trust and be validated for the first time in their lives. These deeply personal experiences allow them to reformat their early attachment experiences (De Zulueta, 2006). One client affirms the process by saying “Now I am authentic…spending more time with people and less time alone and isolated… I am grateful and so very happy for being able to have these experiences. I didn’t even know people could feel like this.” And another client says [through psychodrama]... “I found my voice and was honest in a way I have not been before. I can’t express in words what a transformation it is. What you do is miraculous!” 

    Author Contact Information:

    Nancy Alexander, MSW, LCSW-C 

    5658 Thicket Lane 

    Columbia, MD 21044 


    Linda Ciotola, M.Ed., CHES (ret), TEP 

    4 Bateau Landing 

    Grasonville, MD 21638 


    Find Out More: 


    Bien, T. (2006). Mindful therapy: A guide for therapists and helping professionals. Somerville, MA: Wisdom Publications, Inc. 

    Blake, R. L., & Bishop, S. R. (1994). The bonny method of guided imagery and music (gim) in the treatment of post-traumatic stress disorder (ptsd) with adults in a psychiatric setting. Music Therapy Perspectives, 12(2), 125-129. 

    Blatner, A. (2000). Foundations of psychodrama: History, theory, and practice (4 ed.). New York, NY: Springer Publishing Company, Inc. 

    Block, S. H., & Bryant Block, C. (2010). Mind-Body workbook for ptsd: A 10-week program for healing after trauma. Oakland, CA: New Harbinger Publications, Inc. 

    Burden, K., & Ciotola, L. (2002). The Body Double: An Advanced Clinical Action Intervention Module in the Therapeutic Spiral Model tm to Treat Trauma. 

    Carey, L. J. (2006). Expressive and creative arts methods for trauma survivors. Philadelphia, PA: Jessica Kingsley Publishers. 

    Ciotola, L., & Hudgins, K. (2003). The Body Double an Experiential Model for Eating Disorders. 

    Dayton, T. (2000). Trauma and Addiction. Deerfield Beach, Florida: Health Communications, Inc. 

    Dayton, T. (2005). The Living Stage. Deerfield Beech, Fla: Health Communications. 

    De Zulueta, F. (2006). The treatment of psychological trauma from the perspective of attachment research. Journal of Family Therapy, 28(4), 334-351. doi:10.1111/j.1467-6427.2006.00356.x 

    Greenberg, L. S. (1998). Handbook of experiential psychotherapy. New York, NY: The Guilford Press. 

    Hudgins, M. K. (2002). Experimental treatment for ptsd: The therapeutic sprial model. New York, NY: Springer Publishing Company, Inc. 

    Kellermann, P. F., & Hudgins, M. K. (2000). Psychodrama with trauma survivors: Acting out your pain. Philadelphia, PA: Jessica Kingsley Publishers. 

    Lev-Wiesel, R. (2008). Child sexual abuse: A critical review of intervention and treatment modalities. Children and Youth Services Review, 30(6), 665-673. doi:10.1016/j.childyouth.2008.01.008 

    Moreno, J. L. (1977). Psychodrama. Beacon, NY: Beacon House, Inc. 

    Moreno, Z. (2012, May 12). Wife of J L Moreno and co-developer of MOrenian Arts and Sciences. (L. Ciotola, Interviewer) 

    Neumann, D. A., & Gamble, S. J. (1995). Issues in the professional development of psychotherapists: Countertransference and vicarious traumatization in the new trauma therapist. Psychotherapy: Theory, Research, Practice, Training, 341-347. 

    O'Neill, E. (1970). A Moon for the Misbegotten. In E. Rinehart and Winston, A Treasury of Theater from Isben to Lowell (p. 690). New York : Rinehart and Winston. 

    Ridge, R. M. (1998). Rebuilding the body of trust. The Center for Experiential Learning (Charlottesville, VA), Newsletter(Winter). 

    Schwartz, M., Galperin, L., & Gleiser, K. A. (2009, March 13). Attachment as a mediator of eating disorder: Implications for treatment. Retrieved from Castlewood Treatment Center for Eating Disorders: 

    Springer, D. W., & Rubin, A. (2009). Treatment of traumatized adults and children: Clinician's guide to evidence-based practice. Hoboken, NJ: John Wiley & Sons, Inc. 

    Van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harford Review of Psychiatry, 1(5), 253-265. doi:10.3109/10673229409017088 

    Van der Kolk, B. A. (1997). The psychobiology of post-traumatic stress disorder. Journal of Clinical Psychiatry, 58, Suppl. 9. 

    Van der Kolk, B. A. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatric Clinics, 12, 293-317. 

    Van der Kolk, B. A., McFarlane, A. C., & Weisaeth, L. (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York, NY: The Guilford Press. 

    Van der Kolk, B. A., Perry, J. C., & Herman, J. L. (1991). Childhood origins of self-destructive behavior. The American Journal of Psychiatry, 148(12), 1665-1671. 


    We would like to offer our profound thanks to our dedicated auxiliaries, Connie Newton and Lisa Miller, both TSM Certified Trained Auxiliary Egos for their tireless devotion to this work and for their brilliance, creativity, warmth and loving support of our protagonists and our psychodrama team. Without them this work could not have been accomplished. 

    We would also like to offer our admiration and appreciation to all of our protagonists for their courage and their trust. It is because of you that we do what we do. 

  • 31 Jul 2019 7:05 PM | Anonymous

    By Marjorie L. Rand Ph.D.

    If I could offer you a cure for your depression and anxiety that did not cost any money, required no special clothing nor equipment and is something you are already doing, would you want to know what it is? Or would you rather take expensive pills which have multiple side effects? There is even a hidden extra benefit which comes along with the secret cure, of which I will inform you later.

    Before I tell you the secret, I also need to give you a few facts. There are various forms of depression from dysthymia (mild) to clinical (severe) with many variations in between these extremes. With extreme cases, medication in combination with psychotherapy, yoga, meditation, and exercise is the most effective treatment. But most people along the mild to moderate portion of the scale who are functioning, living a productive life, but who feel numb or just do not feel fully alive are not in need of medication. Maybe they are OK at work because it provides structure, a place to go, something to do every day. But on weekends they may isolate and hang around the house watching TV or sleeping all day, never even getting dressed all weekend. They do not shop or cook for themselves, so they tend to eat fast food or junk food, mindlessly. Does this apply, even a little bit, to you?

    So part of the secret cure that most people are not aware of is that they can control their own nervous system. Many of us spend our lives trying to control other people and our environment (which is not possible), instead of trying to modulate or regulate our own states of arousal or moods. We have it completely backward. The only thing we can control is ourselves. But since our nervous systems and emotions reside in our bodies, (Pert,, we cannot control or regulate our emotions from our minds.

    Are you getting any closer to guessing the cure? What do meditation, yoga, and exercise have in common? You may guess breathing and you would be correct. Let me explain how the Autonomic Nervous System (ANS) works and how you can use breathing to modulate and change it. The ANS is often thought of as “automatic” because it controls functions which are usually unconscious, such as heart rate, blood pressure, digestion, circulation to name just a few. However, many of these autonomic or unconscious functions can come into conscious control through one system. By now, I think you have guessed it. Breathing is the one function in our body-mind that can be done unconsciously or consciously. Breathing is the most basic support system of living. You can live long periods of time without food and shorter periods of time without water, but only minutes without breathing.

    Here are 4 basic ingredients of the secret cure for depression:

    • Breathing
    • Containment
    • Grounding
    • Presence
    • Breathing


    When we are hyper-aroused (sympathetic or fight or flight) we are stuck in a response which floods us with stress hormones. We can regulate our ANS down to parasympathetic (relaxation). How? Through breathing!

    First, we want to relax and expand the body by parasympathetic breathing, and creating space for energy to flow. We focus the breath down in the lower abdomen (navel center) and focus on a long sighing exhale (exhaling more than we inhale).

    Once the body is expanded (which I will explain in containment) we can move on to sympathetic breathing techniques. In states of hypo arousal (depression), there are different breathing techniques for heightening arousal or aliveness and energy. Sympathetic breathing techniques involve breathing into the upper chest all the way up to the upper ribs and collar bones. In this type of breathing the inhale is emphasized-almost like a runner who is panting and calling up energy to the muscles.

    Optimally, we want balanced breathing equally distributed between chest and belly, but that would require a moving, flexible diaphragm muscle.


    If you pour liquid into a rigid container (a glass vase, for example), there is a limit to how much liquid the container can hold before it spills over (discharges) or breaks (fragments). Your body is the container for your life energy which is generated by breathing. Your body needs to expand like a balloon which stretches and holds more air with each breath. On the exhale, tension is released from the muscles. Something like letting the air out of the balloon. So the inhale is “opening up” and the exhale is “letting go”. With each and every breath you are expanding your container and building more energy, which is the antithesis of depression. In depression, the body is closed down, the exhale is retained and there is little energy. So the secret cure for depression really is breathing!


    What is grounding? It means being (living) inside your body and not only in your head. So grounding has something to do with the feet. If you are standing your feet are on the ground. Can you imagine putting your brain in the soles of your feet? How different might your reality seem? If you are sitting, then your sitting bones, as well as your feet, are in contact with the ground. And if you are lying down, you are most grounded of all, as your whole body is being supported by the floor or bed. It is extremely important to be grounded if you intend to use your breath to lift you out of your depression.


    Remember in elementary school, when the teacher would call roll and you would answer “present” if you were not absent? How many of us are really “absent” in our lives, living in a world we have created through our belief systems, instead of in the here-and-now present moment. Depression is primarily living in the past, and getting present in the moment usually results in feeling OK (right here, right now). So the mindfulness techniques help us to keep watching ourselves slide into the past and snatch ourselves back up to the present (where we are OK).

    So now you have the ingredients for the secret cure to depression. If you are on medication for depression prescribed by a physician or psychiatrist, do not stop taking your meds unless you consult with that prescribing physician. It is perfectly safe to do the breathing techniques along with your meds.

    You can see examples of my breathing techniques on my Marjorie Rand You Tube channel or my website under Yoga Therapy.

    About Marjorie L Rand, PhD

    I have been a psychotherapist for 39 years, licensed in three states: California, Colorado and New Mexico, and have trained psychotherapists world-wide since 1986. My training Institutes are located in Switzerland, Canada, Germany, Israel. The IBP institutes in the US (as well as other countries mentioned) also use somatic psychotherapy, and supported yoga therapy.

    The focus of my work is body/mind/spirit, using somatic psychotherapy and meditation. As a Developmental psychologist, I believe that we are influenced by events starting at conception and through the first three years of life (based on Object Relations theory).

    In addition to my practice as a Marriage and Family Therapist, I am also a somatic psychotherapist, meditation teacher, supportive yoga therapy teacher and pre- and peri-natal psychologist.

  • 19 May 2019 5:17 PM | Tina Stromsted, Ph.D., LMFT

    by Tina Stromsted, Ph.D.

    Nature as Witness

    Dance was medicine, and nature my deepest container and first witness.  As a child, when painful feelings arose around our family dinner table, I’d clear the table, load the dishwasher, and then dart across the street into the alfalfa field. I’d find the clearing at the center of the field and begin to spin and turn, holding the horizon line steady with my eyes as my body whirled. Blue sky, clouds, green leafy corn stalks, sweet alfalfa and the ground under my feet brought freedom, as family tension drained from my body into the soft, receptive earth. There, I’d dance, turning countless circles, my arms outspread. I felt full of abandon. Little did I know at the time that I was treating my wounded soul with core elements of Authentic Movement, which would become a cornerstone in my life and work.  

    A ‘shimmer’ ran through me; a life force that pulsed with spirit. Time stood still; there was a sense of oneness with the natural world all around and within me. In the natural way of childhood, I had stumbled on the whirling dance practiced by the early Sufis. Feeling free and whole, my soul restored, I’d return to the house for more chores and homework. Nature was my primary witness. 

    Years later, while studying and performing dance and theatre, I realized that my heart was not in ‘performing’. What really interested me was transformation, and how the body/psyche/spirit was involved in that. I sought the feeling of connection I’d experienced in my childhood fields. While teaching dance in my 20s, I began to focus not so much on the exactness of the students’ technique, but on the ‘shimmer’ that came and went in their soul expression, the movement of light in the body. As I sought ways to support them – letting their vitality come through in the dance and reflecting those moments back to them at the end of class – many began to tell me their life stories. Wanting to better hold and understand their experiences, I did volunteer work in mental health clinics and returned to graduate school to study clinical psychology and dance/movement therapy along with ongoing studies in somatic practices, creative arts therapies, Zen meditation, personal analysis, and eventually post-doctoral studies and analytic training at the C.G. Jung Institute of San Francisco. (Stromsted, 2015, pp. 341-2)

    The body as transformative vessel 

    The journey through life is not simply metaphorical, psychological or spiritual, but also concretely experienced in the body. Together with our dreams and intuition, the body can act as a compass to guide our life’s course. When you enter into the realm of the body, you encounter your history and all that may be dwelling there. With movement signatures that express us as uniquely as our fingerprints, our bodies serve as sculptured intermediaries between our inner and outer worlds. Our physical make-up reflects not only our genetic inheritance, but also the compromises and choices we’ve made in defining a lifestyle for ourselves, first as family members and then as individuals. Our experience, if embodied, also offers us a way to connect with all of humanity. The body is not only personal, but cross-cultural and universal. Our thoughts and feelings express themselves as gestures, often striking chords of emotional and spirited recognition within people everywhere. 

    The body should be thought of as a major initial text. It pulses with the oldest language,

    containing a deeper historical memory, which we strive to recognize through newer mediums such as neuroscience, genetics, somatic psychology, dance/movement therapy, trauma work, quantum physics, affect and attachment theories and others. ‘The body does not lie,’ said the late modern dancer and choreographer, Martha Graham. The body remembers why it is here: for healing, for embodiment, for incarnation (Stromsted, 1994/5, p. 17).

    Discovering Authentic Movement

    In 1982, I was introduced to Authentic Movement by Jungian analyst and dance/movement therapist Joan Chodorow, and soon engaged in many years of study with her, and with dance/therapist and scholar of mysticism Janet Adler.  I felt a deep resonance with the practice, as it took me back to my spontaneous dances in nature.  However, there was an essential difference: here I had a human witness.  How wonderful is that? To carry the knowing of nature into the realm of human relationship. Wounding often occurs within relationship, so it is within relationship that the healing process needs to occur. Authentic Movement deepens connections with the self, with the other, and with the generative life force.  The practice enables us to explore and acknowledge deeper feelings, images, relational dynamics and a more authentic

    sense of self as we re-inhabit our body in the context of a living, human community; the vital web of life.  This is the foundation of healing and growth.

    Application of Authentic Movement 

     “Movement to be experienced has to be found in the body, not put on like a dress or a coat. There is that in us which has moved from the very beginning; it is that which can liberate us.”                    - Mary Starks Whitehouse 

    Authentic Movement is one of the most potent avenues I have found for recovering the body/psyche/soul connection.  A Jungian form of dance therapy also known as ‘movement in depth’ or ‘active imagination in movement’, the practice provides a powerful avenue to engage the unconscious. Bodily expression brings clarity and healing to our woundedness, allowing the exploration and emergence of a new life energy.

    Tina Keller-Jenny (Swan, 2011) and others explored including the body in their analysis with C. G. Jung and with Toni Wolff. Then, in the 1950s, pioneering dance/movement therapist Mary Whitehouse (1911-1979) further developed Jung’s active imagination method by engaging the body more fully in ‘movement as active imagination.’  Since then, Authentic Movement (as it came to be called) is increasingly practiced by therapists, artists, spiritual and healing practitioners, clients, educators and social activists. I believe its widespread use comes as a response to a growing need to embrace the wisdom of the body and its essential role in the process of integrative healing, development, and transformation. The ‘talking cure’ is not enough, particularly where repressed, preverbal, and/or dissociated material and traumatized affects are concerned. These take up residence in the body, until circumstances are safe enough to allow them to be felt, mirrored, brought to consciousness, and healed. 

    The attuned, containing presence of the witness/therapist in Authentic Movement allows the mover/client safer access to early, primary-process-oriented parts of the self.  In the process, exploration of areas where development halted, together with transpersonal experience often emerge. Through this engagement, new neuropathways in the brain may be established, supporting further integration and embodiment. 

    This method has evolved with three major applications: as a form of psychotherapy, as a resource for artistic expression, and/or as meditation/sacred dance. Telling the story, developing healthy boundaries, engaging alternative healing modalities, creative arts practices and nurturing self-care rituals can all assist in the process of re-inhabiting the body. Illness, too, though painful, can offer a pathway to transformation and an enhanced appreciation for life, if attended to and explored consciously. As Jungian analyst Arnold Mindell puts it, “Body symptoms are dreams trying to happen in the body.” (Mindell, 1985)

    AMI & Soul's Body 

    In 1992 dance/movement therapist Neala Haze and I established the Authentic Movement Institute (AMI) in Berkeley, California (1992–2004). Other founding faculty members, Joan Chodorow and Janet Adler, together with Joan’s husband, Jungian analyst Louis Stewart contributed their areas of expertise to the teaching and curriculum development.  Elements included Jungian and developmental psychology, active imagination, somatics, dreamwork, play, arts practices, choreography, theory development, clinical applications, and mystical studies. (Stromsted and Haze, 2007).  Over time, additional faculty and guest teachers joined us in offering a variety of applications such as: treatment of cancer and other diseases; deepening our connection to nature; applied anatomy and neuroscience; poetry and storytelling; and non-violent community action.


    From childhood, myths, fairytales, and dreams guided my understanding of life’s challenges by showing that natural cycles of death and rebirth illuminate the path. Jung called this “individuation;” the journey toward wholeness. In the early 1980s I developed DreamDancing® as an approach that engages the energies, feelings and action of a dream, helping to further embody qualities that can guide and enhance one’s life. Exploring dreams through the body helps us ‘incarnate’ the inner life energies that are being out-pictured through the dream, seeking insight and integration into daily life. (Stromsted, 1984; 2010).

    One way to work with dreams in the body is to identify key gestures which can be strung together like beads on a necklace in a dance that speaks directly from the nonverbal, emotional midbrain where the images are formed (Stromsted 1984, 2010; Wilkinson 2006). Clients can also deepen a connection by stepping into a dream character and continuing the dream through an active imagination process. When practiced within group settings, themes and stories often emerge from the ‘collective body’ (Jung 1927, par. 342; Adler, 1994/1999) bringing insight to both individuals and the group, enhancing community.

    BodySoul Rhythms®

    Jungian analyst Marion Woodman made a significant contribution to engaging the body in healing the body/psyche/spirit split with BodySoul Rhythms® (BSR), which she co-created with dancer Mary Hamilton and voice teacher Ann Skinner. After completing their Leadership Training Program, I was invited by the Marion Woodman Foundation to co-facilitate training programs with Meg Wilbur (a Jungian analyst, voice teacher and playwright), and Dorothy Anderson (an artist and communications specialist). Our trio furthered the evolution of the work by leading ‘Wellsprings of Feminine Renewal’ intensives, adapting myths and fairytales into plays that illuminated the feminine individuation journey, integrated with other BSR elements such as movement, voice, dreamwork, art, mask work and ritual.

    The Dance of Three, an application of Authentic Movement, is a vital component of BSR. It involves a primary mover, an engaged responder, and a reflective witness who take turns moving to music, witnessing, and containing. Their reflections on their own and each other’s experience bring it to further consciousness.  Inner listening combined with outer engagement enhances our ability to be present with ourselves and others in increasingly conscious relationship, inviting a level of perception that can evoke deep respect and empathy. 

    In both Authentic Movement and BodySoul Rhythms®, the presence of a containing, compassionate witness contributes to healing, as the client opens to his or her senses to natural movement, and to the unfinished business and unlived potentials within. The witness/therapist, in turn, is often touched by the places her mover ventures to go; in this way, both people can open to their deeper natures and to the divine, the third space that they share.

    At my Soul’s Body® Center, I continue to engage and develop elements from Authentic Movement, BodySoul® work, DreamDancing®, Embodied Alchemy® and other creative, embodied healing methods. Soul’s Body® work focuses on attending to natural movement; supporting the development of a conscious, embodied container; engaging the sacred feminine and masculine; and working with the imagination, metaphor and dream images in the body. We also investigate the somatic foundations of the transmission process of multigenerational family patterns, explore body symptoms, cultural elements, and incorporate the use of non-judgmental/non-interpretive language in creative and healing work.


    Over the years, I have come to see Authentic Movement as a ‘safe enough’ container, a kind of uterus from which the client/mover may be reborn, in the presence of an outer witness or ‘good enough’ mother figure, from the ‘symbolic mother’ of his or her own unconscious. This in turn roots him or her in the instinctual ground of nature, the Great Mother. My practice has made it clear to me that containment – psychic, physical, emotional and spiritual – is necessary in order for deep transformation to unfold. In this ‘cocoon’ the melting of old defenses, including the body-stiffening that reflected them and held them in place, can begin to soften (Stromsted, 2014, p. 50).

    A more evolved awareness of self makes possible a more sensitive and nuanced relationship with your environment – interpersonally, politically and ecologically. The body plays a central role in this; for with a more vital, felt sense of our own embodied experience, we cannot help but resonate with the life force that animates all living beings. Instead of dissociating, projecting, becoming combative, and/or fleeing to spirit when feelings in the body are too uncomfortable to bear – thus passing them from generation to generation through unconscious trauma patterns – we can find a spiritual home in the body (Stromsted, 2014, p. 55). ‘Shimmer’ extends, and the seeds from my dances in the fields continue to grow.  


    Adler, Janet. (1994). The Collective Body. In P. Pallaro (Ed.), Authentic Movement: Essays by Mary Starks Whitehouse, Janet Adler, and Joan Chodorow (pp. 190-204). Philadelphia: Jessica Kingsley Publishers, 1999.

    Jung, C. G. (1927), ‘The structure of the psyche’, in Collected Works (trans R.F.C.

    Hull), vol. 8, Princeton: Princeton University Press.

    Mindell, Arnold.  (1985).  Working with the dreaming body Abingdon-on-Thames, UK: Routledge and Kegan Paul, Ltd.

    Stromsted, Tina. (1984). Dreamdancing: The use of dance/movement therapy in dreamwork.Ó Unpublished master’s thesis. John F. Kennedy University, Orinda, CA.

    Stromsted, Tina. (Autumn/Winter ’94-’95). Re-Inhabiting the female body. Somatics: Journal of the Bodily Arts & Sciences X (1), 18-27.

    Stromsted, Tina. & Haze, N. (2007). The road in: Elements of the study and practice of authentic movement. In P. Pallaro (Ed.), Authentic Movement: Moving the body, moving the self, being moved: A collection of essays (pp. 56-68). Volume II. Philadelphia: Jessica Kingsley Publishers.

    Stromsted, Tina. (2010). ‘DreamDancing®’ In P. Bennett (Ed.), Facing Multiplicity – Psyche, Nature, Culture, Proceedings of the 18th International IAAP Congress for Analytical Psychology. Montreal, Canada. Einsiedeln, Switzerland: Daimon Verlag.

    Stromsted, Tina. (2014). The alchemy of Authentic Movement: Awakening spirit in the body. In Williamson, A., Whatley, S., Batson, G., & Weber R. (Eds.), Dance, somatics and spiritualities: Contemporary sacred narratives, leading edge voices in the field: sensory experiences of the divine (pp. 35-60). Bristol, United Kingdom: Intellect Books.

    Stromsted, Tina.  (2015).  Authentic Movement & The Evolution of Soul’s Body® Work. Journal of Dance and Somatic Practices: Authentic Movement: Defining the Field, Intellect, vol. 7 (2), 339-357.  

    Swan, Wendy. (Ed.) (2011). The Memoir of Tina Keller-Jenny: A Lifelong Confrontation with the Psychology of C.G. Jung. New Orleans, LA: Spring Journal Books.

    Wilkinson, Margaret. (2006).  The dreaming mind-brain: a Jungian perspective. Journal of Analytical Psychology (51), 4359

    Tina Stromsted (2019). Witnessing Practice: In the Eyes of the Beholder. The Routledge International Handbook: Embodied Perspectives in Psychotherapy: Approaches from Dance Movement and Body Psychotherapies. London, UK: Routledge.

    Tina Stromsted & Daniela Seiff (2015). Dances of psyche and soma: Re-Inhabiting the body in the wake of emotional trauma. In D. F. Sieff (Ed.), Understanding and healing emotional trauma: Conversations with pioneering clinicians and researchers. London, UK: Routledge.

    Tina Stromsted, Ph.D. LMFT, LPCC, BC-DMT, RSME/T is a Jungian Psychoanalyst, Board Certified Dance/Movement therapist, and Somatic psychotherapist with 40 years of experience as a clinician, trainer, and educator. With a background in theatre and dance, she was co-founder and faculty member of the Authentic Movement Institute in Berkeley (1992-2004).  Currently she teaches at the C.G. Jung Institute of San Francisco, in the Depth Psychology/Somatics Doctoral program at Pacifica Graduate Institute, and is a core faculty member for the Marion Woodman Foundation.

    Founder of Soul’s Body® Center her numerous articles and book chapters explore the integration of body, brain, psyche and soul in healing and transformation. She teaches internationally and has a private practice is in San Francisco.


     Published: Tina Stromsted. (July, 2018). Embracing the Body, Healing the Soul, C.G. Jung Society   of Atlanta Newsletter. 

  • 8 May 2019 6:23 PM | Anonymous

    By Dr. Leslie Ellis

                Back in 2011, Eugene Gendlin, the founder of focusing-oriented therapy, received his third major award from the American Psychological Association, this one for his distinguished theoretical and philosophical contributions to psychology. In 2016, the year before he died at the age of 90, Gendlin received lifetime achievement awards from both the World Association for Person Centered and Experiential Psychotherapy and the US Association for Body Psychotherapy. His work has made a significant impact on how somatic and experiential therapies are practiced around the world. However, many of Gendlin’s ideas were ahead of his time, and some of the potential impact from his ‘philosophy of the implicit’ has not yet made its way into mainstream thinking about the practice of psychotherapy. This article brings some of Gendlin’s radical ideas to light, summarizing his three most important papers on the theory of psychotherapy.

    There are three articles that focusing teachers from around the world agree are Gendlin’s most important contributions to psychotherapy theory, and although they are decades old, the ideas expressed in them continue to have a ‘radical impact’ (Ikemi, 2017) on psychotherapy theory. Many of Gendlin’s ideas have filtered into the common parlance of psychotherapy in various ways: proponents of immediacy and mindfulness in therapy, and those who encourage clients to follow their ‘felt sense’ or embodied understanding of an issue are taking their lead from Gendlin’s theories. It has been incorporated into methods like Emotion-Focusing Therapy and Somatic Experiencing. However, there are some concepts which underlie the process of psychotherapy that have not shifted appreciably since the days of Freud. One such concept, repression, is challenged and advanced by Gendlin’s philosophy.

    A theory of personality change (1964)

    In this ground-breaking article, Gendlin (1964) makes note of how the therapy endeavour is often a conversation between the client and therapist about what has gone wrong in their past (their experiences, development, family of origin, etc.) that has made them feel or act the way they now do. Therapy brings new awareness to the client about their past situation, and a realization that they must have felt all of this all along but kept it out of awareness because it was unacceptable or overwhelming. The concept of repression originated with Freud and has not changed much in the past 100 years.

    Part of the problem with this conceptualization, said Gendlin, is that it can only explain the personality as it is, and does not in theory allow for the possibility of change. It also operates on a ‘content paradigm,’ a sense that in their unconscious, people are holding a vast storehouse of fully-formed but forgotten experiences that must be unearthed so the client can understand how they came to be the way they are. There is the inherent assumption that this insight will bring change. What has been repeatedly observed, however, is that “knowing is not the process of changing.” Gendlin (1964) and many others have observed that in fact, personality change happens in the context of an emotional process, and in relationship.

    Gendlin (1964) developed a theory for this change process that updates the concept of repression with something that seems more plausible. He would say that the past experiences that still plague our clients were not experienced and then forgotten, but rather avoided or stopped before they happened. These pieces of unfinished process are tangible in the body as a felt sense that carries rich, complex and implicit meaning. When we pay direct attention in the present moment to the sense we still hold in our bodies about these unfinished aspects of our stories, it will unfold and be fully felt. Often, attending to a process that has been stopped leads to painful realizations, likely the reason the process was stopped in the first place. But even when a person comes to realize just how hard this experience is to fully feel, the process of turning toward it and allowing it to unfold most often brings a sense of relief, an easing of the anxiety surrounding it. This is surprising. Gendlin wrote, “One would have expected the opposite.”

    Another surprising thing happens as a result of attending directly to the felt sense of even the most intractable issue: “Even when the solution seems further away than ever, still the physiological tension reduction occurs, and a genuine change takes place. I believe that change is really more basic than the resolution of specific problems,” (Gendlin, 1964). What changes in this process is not the external situation, but the entire way the person holds the problem. What often follows such a shift is a flood of realizations, memories and new ways of making sense of old patterns. Gendlin said this dawning of insight is often mistakenly seen as the source of change when it is actually the by-product.

    How is it that such a transformative process is facilitated by the presence of another person? Gendlin said that it changes our manner of experiencing immediately when we are with someone else rather than alone. Of course, the nature of the person we are with makes a difference. With a self-oriented, impatient listener, we are apt to close off to our experience more than we normally would. However, with a listener that allows us to “feel more intensely and freely whatever we feel, we think of more things, we have the patience and the ability to go more deeply into the details, we bear better our own inward strain… If we have showered disgust and annoyance on ourselves to the point of becoming silent and deadened inside, then with this person we ‘come alive’ again.” This quality of presence that Gendlin describes is one that we as therapists endeavour to maintain. It is this quality of listening can move our clients forward in the places where their process has stopped, and the movement forward in these frozen places is what brings genuine change.

    The client’s client: The edge of awareness (1984)

    In this article, Gendlin (1984) differentiates feeling from the ‘felt sense’ and explains why following the felt sense, which is not as clear or intense as a feeling, is what leads to change. “People often have the same feelings over and over, quite intensely, without change-steps coming,” Gendlin wrote. Feeling things repeatedly does not discharge them as was previously thought, but actually reinforces them. On the other hand, the vague, murky felt sense leads to feelings and ideas that have not ever been consciously expressed, and this novelty is what leads to change.

    Gendlin stressed that it is the immediacy of the felt sense unfolding now that gives it the power to transform, not a reworking of the past, which is so often the paradigm for therapy. “Therapeutic steps are not a re-emergence of denied experience. What matters most for change-steps is precisely the new implicit complexity of the bodily living.” The past is always contained in the present experience, but the important difference in focusing is that it asks a person to attend freshly to what the felt sense brings now, rather than speaking from a hackneyed, familiar script about one’s life experience.

    Client-centered therapy encourages the therapist to follow the client’s lead, to come with no agenda and preconceived notions, but to allow the other’s process to unfold. And for a focusing client, Gendlin’s advice is to treat their felt sense the way the client-centered therapist ideally treats them. The felt sense is the ‘client’s client,’ (hence the article’s name). So as a therapist in this context, our job is the support our client to be gentle, open-minded, curious and respectful to the inner felt sense that is unfolding, to offer gentle reminders whenever they assume they already know what it’s about. (The same holds true in working with the dreams; people often make assumptions about their dream’s meaning.)

    This way of approaching therapy changes the manner of the conversation in some striking ways. Clients will typically begin their session by describing all they know about their problems, while a focusing approach is more concerned with what they don’t know. As a focusing therapist, our job is to continually bring the client back to the inwardly-sensed ‘unclear edge,’ a place they may be reluctant to stay with. To encourage focusing, the therapist can inquire into the felt sense in such a way that the client has to stop and check inside.

    Gendlin said, “There is a great difference between talking about and pointing.” An example he offers of pointing: when a client says something like, “I must not want to do this (get a job, meet new people, write an assignment) since when the time comes, I don’t do it.” The phrase ‘must not want to’ is speculation, an indication that the not-wanting is not directly sensed. Rather than simply reflect the not-wanting, the therapist can invite the client to stop and sense the not-wanting directly, to set aside what they think about it and see what is really there. This kind of redirection to the current sense of something can be done whenever you notice such speculation in a session. The result of pointing to something that can be directly sensed is often surprising, and moves a previously stuck process forward.

    From this kind of activity, Gendlin observed that “process-steps have an intricacy and power to change us,” and that, “we have to rethink our basic concepts about the body, feeling, action, language and cognition” to explain this. In the remainder of the article, Gendlin offers ten theoretical propositions in support of this major revision in thought.

    In the first few theoretical propositions, Gendlin writes about the process of finding words to convey the complexity of ‘feelings-and-situations’ in which we human beings find ourselves. The words come first in our bodies, and point to implicit in feelings-and-situations. Like feelings, “must come or we don’t have them. We can remember them and believe they ought to be there. But to have them they must come. And this is always a bodily coming.”

    Gendlin views feelings, thinking, actions and words all primarily as lived experience in the body, and each bodily event as implying what comes next. He calls this ‘carrying forward’ and said, “In therapy we change not into something else, but into more truly ourselves. Therapeutic change is into what that person really ‘was’ all along… it is a second past, read retroactively from now. It is a new ‘was’ made from now.”

    From this new was, steps come that change one’s conception of the past entirely. For example, in my therapy practice, I often work with early-childhood trauma, and uncover felt-senses of traumatic situations that the person, as a child, could not assimilate. Their story of childhood, when they first enter therapy, is often that it was fine and normal, but there is a lack of depth and detail which tells me they are not truly in touch with their inwardly-sensed experience. When, as an adult and with a supportive other, they do attend to the felt sense they carry of this early time, it can open up what has been termed ‘repressed memory.’

    Gendlin’s formulation feels more accurate, as those with a history of repeated trauma often dissociate from their experience. The trauma is not recorded, then forgotten, but rather, not fully experienced in the first place. When, through focusing, the client’s sense of what really happened comes into their body, there is a sense of knowing, a dawning of understanding why they were so withdrawn, anxious or angry as a child. This new ‘was’ makes sense of both how they experienced their childhood and of many of their puzzling reactions in the present. It is a carrying-forward that leads to a radical re-conceptualization of their life situation, and it often precipitates a flood of feeling, insight and re-evaluation.

    Gendlin carefully differentiates feeling from a felt sense. Feelings are often less complex, more recognizable and can be repetitive if nothing surrounding the feeling changes. A felt sense contains the emotion and the whole implicit complexity of a situation. It is “a much larger whole. The implicit situation as a felt sense is a single mesh from which endless detail can be differentiated: what happened to us, what someone did, why that troubled us or made us glad, what was just the also going on… and on.” If a situation feels familiar, repetitive and stuck, Gendlin said “the stuckness is a finely organized sense of why usual ways won’t do, and of what would.” So even our internally-sensed knowledge that something is wrong and feels like it can’t be fixed contains within it an implicit sense of what would carry the situation forward. When something entirely new is called for, the felt sense can lead to highly creative next steps.

    There are many situations that call for novel responses to carry them forward, and the felt sense of this can be quite specific. “An odd situation’s implying is more organized than the usual routines and contains them. The novel implicit is not unrelated to familiar concepts, phrases, and actions. It includes these and exactly why they will not suffice” (Gendlin, 1984). We can’t speculate but must allow the process to unfold, “like an unfinished poem that very finely and exactly requires its next line.”

    The experiential response (1968)

    This article provides clear guidance for therapists in how to help our clients find the equivalent of that precise next line of their unfinished poem. We need to learn to listen in an unobtrusive way that allows them to carry their own experience forward. This process is not a simple reflection of feelings expressed by the client, but rather a reflection of the intricate felt sense; it involves not just about picking up on emotional valence, but more gathering a sense of the whole of what the client is ‘up against’ (Gendlin, 1968), including the history of the issue, thoughts about it, all its complexity. If you, as the therapist, want to support the client in focusing, you need to respond not only to the words as expressed, but to the larger felt sense that underlies the words, and in a way that allows the client to inquire further into what they are sensing. You may try many responses that appear to lead nowhere. What is more important than being right about what might lead to an experiential response is to simply keep responding to how the client reacts next. Saying something like, “That didn’t seem quite right for you… can you sense into what would feel more right?” can help move the process forward as effectively as saying something exactly right, which we can never do all of the time. Saying the wrong thing can even make the felt sense more clear to the client, because they get a clear reaction from their body that says, ‘No, it’s definitely not like that,’ which then brings a sense of what is right.

    The goal in this process is not deeper understanding or a clearer definition of the issue, but a sense of the experience moving forward toward an internal release that changes how the uncomfortable sense is held in the body. When this happens, Gendlin (1968) said there is “a very distinct and unmistakeable feel of ‘give,’ easing, enlivening, releasing.” He called this referent movement but the more current term is felt shift. This is the only reliable sign of progress, and it always feels good, even when what is discovered in the process is not so good.

    After a felt shift, it may be easy to go back and make sense of the progress, but before the felt shift, this would not have been possible. The experiential process itself cannot be predicted and moves forward on non-logical steps. In fact, it is not usual for someone who is focusing to contradict something they said earlier in the process and feel both were right at the time. Focusing can transform the felt sense of a situation so completely what was initially seen as a problem no longer seems to be one.

    Gendlin believed that the most powerful engine for experiencing is interaction, which is why focusing works so much better with another person (although it is possible to have an interaction between oneself and one’s felt sense). Our job as the therapist is to offer our authentic reactions to the client, not our theories or even our wisdom:

    What matters is that the therapist is another human person who responds, and every therapist can be confident that he can always be that. To be that, however, the therapist must be a person whose actual reactions are visible so that the client’s experiencing can be carried further by them…. Only a responsive and real human can provide that. No mere verbal wisdom can.

    This does not mean the therapist’s reactions become the centre of attention; it is only the reactions to what the client is feeling, perceiving and implying that are expressed. At times, when a client has trouble sensing inside or articulating their felt sense, the therapist’s reaction can be the key element in moving the process forward. These responses to our clients don’t always feel clear or good. Gendlin (1968) said, “The therapist cannot expect always to be comfortably in the know. He must be willing to bear being confused and pained, to feel thrown off his stride, to be put in a spot and not find a good, wise, or competent way out.”

    Gendlin felt that the therapist must be more open in their interaction than the focuser would typically experience, and give voice to anything that helps the client “see more clearly what he is up against.” For example, if a client’s responses typically result in rejection by many of those she encounters, the therapist must find a way for the client to succeed where she usually does not. For this to happen, Gendlin believed reassurance or “whitewashing” would not help. “What is bad must be expressed as just as bad as it then is or seems.” However, this honesty must be paired with a response by the therapist to the inherent ‘positive tendency’ Gendlin believed underlies every action.

    Gendlin offered the example of how one might respond to being pressured by a client: “I am feeling pressured by you, and that makes me feel like pushing you away, but that isn’t how I usually feel or want to feel with you. So, we’ll do something to clarify it, resolve it, since that isn’t really how you and I are.” The point is not only to be honest about a challenging reaction, but also to then be willing to carry the interaction further “to a positive, life-maintaining experiential completion which was only implicit and had been stopped and troubled until then.”

    Taken together, these three articles articulate some essential ways that therapists can engender an experiential response in their clients that helps them move forward in areas of their lives that were stuck or causing trouble. In addition, they go beyond mere articulation of method to explain the key aspects of the underlying philosophy that is Gendlin’s major contribution to the theory of psychotherapy.

    Dr. Leslie Ellis is an author, speaker and teacher of focusing for use in therapy, with a special focusing on dreams and trauma. She is vice president and coordinator of The International Focusing Institute. She welcomes feedback and discussion and can be reached at

    Three articles that the world’s top focusing teachers agree are essential:

    Gendlin, E.T. (1984). The client's client: The edge of awareness. In R.L. Levant & J.M. Shlien (Eds.), Client-centered therapy and the person-centered approach. New directions in theory, research and practice, pp. 76-107. New York: Praeger.

    Gendlin, E.T. (1968). The experiential response. In E. Hammer (Ed.), Use of interpretation in treatment, pp. 208-227. New York: Grune & Stratton.

    Gendlin, E.T. (1964). A theory of personality change. In P. Worchel & D. Byrne (eds.), Personality change, pp. 100-148. New York: John Wiley & Sons.

  • 14 Apr 2019 3:38 PM | Anonymous

    By Alex Diaz, PhD

    In any team sport, creating a robust team dynamic is always the greatest challenge for any coach. Team members differ in personality styles, attitudes, motivation, and behaviors. A coach fixated in believing that his message will equally resonate with each player will fail to create a cohesive team approach as individual’s differences are not being considered. To achieve an effective teamwork atmosphere, leaders shine in their ability to unite individuals by seeking a common goal while supporting their emotional behavioral differences.

    An individual’s emotional behavior results from the combination of personal genes and life experiences, both supportive and upsetting. Such experiences mold a neurological imprint in our brains leading to the development of behaviors whose roots lie in implicit, subconscious, emotional memories. These memories cannot be intentionally brought up. According to psychologist Peter Levine, emotional memories are “felt-sense emotions such as surprise, fear, anger, disgust, sadness, and joy.” These memories lie just below the neo-cortex. Giving an oral presentation before a large audience may bring an array of felt-sense emotions, such as calmness or nervousness, which are derived from implicit memories based on prior experiences.

    Hierarchically, our brain develops implicit memories first and explicit ones later. We feel butterflies in the belly and later verbalize them as anxiety. A tennis player, who is serving to win a grand slam match, will feel rapid heartbeats and shallow breathing. If the player is from Australian, such felt sense awareness will be verbalized in English; if the player is from Japan, the same felt sense sensations will be spoken in Japanese. Both players feel implicit memories based on past experiences. Human beings experience non-verbal awareness before sensations turn into a verbal language.

    To be coherent between what we sense and what we express is the result of how emotionally regulated we are. When athletes are asked about the experience of losing a very close game, they rationalize their feelings by either minimizing its emotional content or expressing a rationalization aimed at, subconsciously, diverting the attention from that of feeling upset. An emotionally regulated athlete not only feels the upsetting emotion by embodying a faster heart palpitation, but also by verbalizing it. When leaders attune to the emotional needs of self and others, an implicit level relationship takes place. It is at this implicit human connection that meaningful interactions are forged, bringing trust, safety, healthy relationships.

    Being emotionally met allows for channels of communication to open up between leaders and team members. A team member will be more cooperative if he/she feels an inner sense of trust. In a survey presented at the 2015 World Class Performance Conference, the first leading factor for top Olympic performances rested on the coach-athlete relationship over other factors such as athlete self-awareness and having optimal training environment. In a 2008 Coach Survey Summary Results: Evolution of Athlete Conference, it indicated that focusing on the athlete as a whole person was more valuable than seeking techniques to improve performance.

    On the other hand, when leaders seek inter-connectivity by using explicit language, it leaves a sense of emotional disconnection. Hence, a perceived lack of emotional safety is felt. More importantly, it leads members to having second thoughts about their own self-worth or thinking they have done something wrong. On the other hand, connecting with team members by supporting their hard work or frustration, praising when sincere effort is performed rather than taking such a behavior for granted, and encouraging when mistakes are made lead to promoting a higher sense of understanding and appreciation.

    Holistic approaches aim at self-regulating emotions by eliciting implicit language attunement. Yoga, mindfulness, breathing relaxation, visualization of positive experiences, and somatic psychology embrace connecting at a non-verbal language. These practices help to develop a greater sense of tuning in to our felt-sense awareness and, as such, enhance our capacity to regulate emotions and maintain meaningful relationships.

    At the core of who we are as humans, the emotional connection is what has kept us alive and able to survive for so many years. Whether we are part of a sports or corporate team, we owe it to ourselves to enhance our capacity to regulate emotions at an implicit level as such experiences will only bring a greater sense of human connection and an enhanced present moment awareness.

  • 14 Apr 2019 1:50 PM | Anonymous

    By Jan M. Bergstrom, LMHC, SEP, DaRTT

    It never fails to surprise me that I receive many calls from my clients that are completely stressed out. In my 24 years of practice, I see my clients in a constant state of rev in their nervous system. Rev is when the sympathetic branch of the nervous system gets into a chronic state of hyperarousal. The sympathetic branch regulates arousal and gets us ready for action. So, when you are in a chronic state of sympathetic arousal or rev, the experience of your life feels like “always having the gas pedal on”. Here are some great interventions from my new book called Traveling the Journey Home, coming out this June 2019 for your use during these challenging times. Enjoy!

    Grounding and Centering Practice in Action

    Grounding and Centering are two other practices that reconnect you directly with the resources that are naturally available in your own body. It is important to reestablish your relationship to both the ground and to your body’s center, the place where action and feeling originate. These functions are compromised during trauma reactions. In trauma, you lose your ground, so an important part of healing is learning how to find your ground and center again. As you ground and center yourself before each exercise below, it will help you create a feeling of safety, and a sense that you are in charge. Here is how you do it.

    Grounding Technique

    1. Sitting in a chair, gently push the heels of your feet into the ground. Notice the sensations in your legs when you engage the muscles and release the muscles. Experiment with finding just the right amount of pressure in your feet. 
    2. Bring your awareness to what your feet feel like in your shoes as they are resting on the floor. Wiggle your toes and name the sensations that arise. Become aware of your feet on the ground.
    3. Begin Deep slow breathing – explore pace breathing by Marsha Linehan (Linehan, DBT Skills Training, Handouts and Worksheets, Guilford Press, 2014), where you slowly inhale to a count of five, completely expanding the rib cage and belly, then slowly exhale to a count of seven until your rib cage has contracted and your shoulders have dropped. Do this at least five times. 
    4. Gain physical support from a comfortable chair. Bring your awareness to your buttocks as it sinks into the chair and your back as it is being supported. Name the sensations that arise. Experiment with slumping over and then sitting up straight, lengthening the spine as you do so. Imagine having a string pulling you up straight. Notice any and all sensations as they arise. Does your back hurt? Your vertebrae creak? Can you feel the blood leaving your head? Do you feel taller? More in control? Become aware of each sensation, whether physical or cognitive. Don’t judge these sensations, just greet them.
    5. Focus nonjudgmentally on the sensations you can feel throughout your whole body. Start scanning your feet and slowly move up through your legs, abdomen, torso, into your arms and hands, finishing off at your neck and head. Just allowing whatever shows up to be there.
    6. Tense, then relax your muscles. Try using an exercise ball if you have or can get one. If you don’t have one, try a beanbag, a roll of socks, a crumpled towel—anything that you can hold in your arms or between your legs and squeeze tight, hold for five seconds, then relax for five seconds. Notice the sensations and the difference between the engaging muscles and releasing muscles.  

    This same practice can be done with movement, such as Tai Chi, Qi Gong or Yoga. Take a class and see if you can focus on what is happening in your body moment by moment rather than thinking about your day or what is in the future. If you start thinking about the past or future, don’t worry. Just gently bring yourself back to your body awareness and breathing.

    As with the Mindfulness practice, this Grounding Technique will help you to calm yourself, control your thoughts and triggers, and enable you to bring yourself to the present at will—whenever you find your thoughts and anxieties spiraling into the past or worries of the future.

    The Grounding Technique becomes even more powerful when it is combined with the Centering Technique. This technique is a bit more unique, but every bit as transformative.

    Centering Techniques

    1. Place one hand on your heart and notice what happens in your body when all thoughts are dropped, and you focus on just your hand. Observe the weight of the hand, its temperature, the sensation of the hand itself and the sensation of it resting over your heart. Notice any changes in your breathing, your heartbeat, even the energy you feel in your hand. Visualize in your mind’s eye a warm ball of golden energy swirling around in your hand as it rests upon your heart. 
    2. Keeping your hand on your heart, gently place the other hand on top of your head. Apply a slight pressure on the top of your head to create a sensation of being grounded to the earth. With the hand on your heart, focus on channeling warmth and empathy throughout your body through this hand.

    With practice, you will find these techniques are effective in helping you to gain and remain calm and detaching yourself from the thoughts and memories that haunt you. By learning how to become aware of your thoughts and the sensations they awaken in your body, you will gain mastery over them. 

    Techniques to Help Stay Grounded and Centered

    There always comes a time when you find it hard to stay present with an emotion or body feeling. This is totally normal, and you may find yourself wanting to stop your investigation of the material that is coming up. No problem! In fact, it is important to know when to stop and what to do. I recommend healthy alternatives rather than medicating your feelings by eating, drinking, taking drugs or engaging in self-abusive behaviors. Here are some healthy techniques for staying grounded and centered. You may have heard these suggestions a thousand times and, like anything we hear a thousand times, they may go in one ear and out the other. But this time, try something different., Try at least three of these exercises, just once. Afterwards, reflect on how your body feels, and how your mind feels. Then do them again, another day. You’ll be surprised with the difference such simple activities can have on both your body and your mind.

    1. Go outside and take a walk in your favorite place. If you find your thoughts spinning off into worries as your feet carry you along the pathway, bring your mind back to the moment. Observe the sky above you, the earth below you, the flora and fauna. How many birds can you see? Smile at the people you pass. When you get home, see how many things you can recall from your walk. The more alert you are to the world that surrounds you, the less space there is in your mind for worries.
    2. If you have a dog, take your dog for a walk or go to a dog park. Use the time to truly enjoy your pet’s own joy for the outdoors.
    3. If you have a cat, pet and play with it. There is a reason we call our pets “pets.” Just petting the fur of a dog or cat can have a comforting effect on both the pet and ourselves, as our endorphins are stimulated.
    4. Call a close friend and reach out for support. If you are in recovery, call a fellow member or your sponsor. Be sure to listen and be there for your friend, as much as your friend is there for you. If your friend is unavailable for such an emotional call, don’t judge your friend. They might be in the middle of taking care of their own needs. Ask them to call when they have more time, and call someone else. Remember, we are all struggling. The more thoughtful you are of your friends’ time and needs, the more thoughtful they will be of yours.
    5. Work out moderately at the gym or at home. If you haven’t worked out for some time, start small. If you find yourself watching TV, use the commercial breaks for short spurts of exercise. Try finding a five- or ten-minute YouTube video you can work out with. If you go to the gym, start with twenty minutes, work up to half an hour, and make a fifty-minute workout three times a week your goal. Don’t push yourself too hard. Be gentle with yourself. You’ll get there.
    6. Dance to your favorite music, journal your feelings, draw or use some medium for an artistic expression of what you are feeling. Indulge in your playful side. You never lost it—you just learned to ignore it as you matured. Let it out!
    7. Move your body and open your arms and spread them out to create a circle. Experiment with expanding the size of this ‘container’ until it is “big enough” to hold all the feelings and sensations or “all of the parts” of your pain. 
    8. Use your body to put one palm on the side of each knee: push arms against the outer part of the knees while simultaneously pushing out with the legs. Or use the arms to push against the side of the body. This creates resistance and engages your muscles to fight back, which can give you a feeling of empowerment.
    9. If you have a flashback or start to dissociate or “fade out,” become aware or what is called “orienting” to the external environment (or room). This technique can be a helpful way to “come back” into the room. To do it, just choose and describe three things in the room that you like and reflect on why like them.
    10. You can also turn your head and neck and slowly as you focus on objects in the window, the wall, the door, the lamp, the bookcase. Or focus on objects that might be comforting such as your most favorite object, or cues that tell you where you are.

    Mind’s Eye Imagery

    Mind’s eye imagery is a technique that draws on images to calm and ground the body. Remember all these resources I’m referring to are those internal or external cues that help you to find a safe place to return to when you become triggered as you navigate through your childhood trauma. 

    I usually ask my clients to think of a time in their life when they traveled somewhere, had a favorite animal they loved, connected with someone special and experienced a felt sense of calm, acceptance, grounding, centeredness, and safety. Once they find this experience (or several experiences), I ask them to write them down. These visual image resources will be used throughout the rest of the book for any of the processes that we journey through. They will act as anchors. An anchor is like a ballast. It gives stability in times of need. And that is just what you are seeking.

    Mind’s Eye Imagery Practice in Action

    While in this grounded and embodied state, sit somewhere where you are comfortable, and close your eyes to contemplate these scenes below. Allow yourself at least a minute for each scene. Notice your felt sense or bodily sensations. See if you can put words to them. Some examples might be: calm, relaxed, soft, warm, centered, tight, airy, spinning, or whatever words describe the sensations. Remember, don’t judge the sensations—just find a word that best describes the sensations you feel as you contemplate the scenes that follow.

    1. Sitting on your favorite beach listening to the ocean waves
    2. Hiking up your favorite mountain, reaching the top overlooking a beautiful valley
    3. Looking across the Grand Canyon and the river that flows through it
    4. Being on a tropical island 
    5. Sitting in a cozy cottage with a warm fire burning in the fireplace, the snow gently falling outside

    Did these scenes calm you? Excite you? What changed in your internal state as you contemplated these scenes? Did you find one that brought you instant calm? If you didn’t, think of a time when you were traveling or in nature and you loved what you were seeing and feeling. If so, you have created a room in your mind where you can find instant comfort. When stressed, anxious or triggered, go to this place and relax. There’s no admission to be paid, no taxes or mortgages you must come up with, no applications to fill out. This place is yours, available to you whenever and wherever you find yourself. Welcome!

  • 12 Apr 2019 6:11 PM | Anonymous

    By Dr. Cedar Barstow,  M.Ed., C.H.T., D.P.I.

    Power, simply the ability to have an effect or to have influence, is a magnetic, addictive, and corrupting force. Research shows that taking on higher role power or having higher rank power inevitably changes you. You are given gifts, actually privileges, from the outside world that change how you see yourself, how you see and relate to others, and how they see and relate to you. The greater the power difference the greater the effect. These privileges change you whether your intentions are for service or for selfish gain.

    What is it about power that is corrupting? Why are we so corruptible?

    These are questions that Julie Diamond asks in Power, A User’s Guide (Diamond, 2016. It gets right down to the bottom of things. Power is the ability to have an effect or to have influence. We all have power. Even a baby has power. Think about the effect of a baby's cry or a baby's laugh. This is personal power. It is personal and unique. It is part of part of our identity. We may use it wisely and well. We, or the people around us, may inflate it or diminish our awareness or access to it, but as long as we are alive we have the ability to have an effect.

    It is another kind of power that is corrupting—role power. Role power is the increased power that is embedded in a role or position you are given. Your role power is not your identity. Your role power is like a scarf or mantle of extra power that is added on to your personal power. It is attached to the role and should come off and on with the role. Teachers, Clergy, Therapists, Presidents, CEOs, Policemen, Politicians are roles that come with increased power. The power that comes with higher rank also changes people and how others experience them. Rank power can also be corrupting. Wealth, higher education, experience, celebrity, white, male and even parenting are examples of higher rank. In summary, personal power is immutable, role power is earned, won, or assigned, and rank power is mutable by culture and is sometimes earned. In this article the primary focus is on the privileges of role power and how to mediate the perils. (Barstow, 2015, p. 303-307) Some of the greatest perils of power come from the tendency to blend personal, role, and rank powers instead of seeing role and rank as add-ons to personal power.

    Here's a taste of research that describes some of the changes power brings. Studies show that once people assume positions of power, they’re likely to act more selfishly, impulsively, and aggressively, and they have a harder time seeing the world from other people’s points of view. Dacher Keltner calls this the paradox of power: "The skills most important to obtaining power and leading effectively are the very skills that deteriorate once we have power” (Keltner, 2007). These skills (what most people want from leaders) are characteristics of what could be called social intelligence: modesty, empathy, engagement with the needs of others, and skill in negotiating conflict, enforcing norms, and allocating resources fairly. (Barstow, 2015, p. 316-318).

    [In another study,] when researchers give people power in scientific experiments, those people are more likely to physically touch others in potentially inappropriate ways, to flirt in more direct fashion, to make risky choices and gambles, to make first offers in negotiations, to speak their mind, and to eat cookies like the Cookie Monster, with crumbs all over their chins and chests (as quoted in Keltner, 2008, Barstow, 317-318).

    Research shows that power leads people to act in impulsive fashion, both good and bad, and to fail to understand other people’s feelings and desires. . . . 

    For instance, studies have found that people given power in experiments are more likely to rely on stereotypes when judging others, and they pay less attention to the characteristics that define those other people as individuals. Predisposed to stereotype, they also judge others’ attitudes, interests, and needs less accurately. . . . Power encourages individuals to act on their own whims, desires, and impulses. . . . Perhaps more unsettling is the wealth of evidence that having power makes people more likely to . . . interrupt others, to speak out of turn, and to fail to look at others who are speaking. . . . Surveys of organizations find that most rude behaviors—shouting, profanities, bald critiques—emanate from the offices . . . of individuals in positions of power (Keltner, 2008, Barstow, p. 318).

    Some additional research does indicate that people with a moral center made up of attitudes and values such as kindness, humility, honesty, respect and fairness, are less affected by the corrupting effects of elevated power (Lammer, Stapel, 2009, pp 279-289).

    I find this information both unsettling and liberating. I have long wrestled with how to understand what is called evil. With an infusion of empathy and compassion, I see, through the lens power, that, not only do we all have the capacity to misuse power, but we are all subject to the addictive trance of elevated power that reduces our empathy and inhibitions and pulls us toward prioritizing our own needs and interests because our higher role or rank allows us to. It takes a mighty commitment to self-awareness and the well-being of all to be able to mitigate these effects. This is a life-long engagement with understanding and refining your impact on others.

    We have all, mostly inadvertently, caused harm in minor and sometimes major ways, and we have all been hurt by misuses and abuses of power. This is human. I'm thinking of the teacher who says she was open to feedback but gets defensive and angry when she hears critical words; the therapist who has an emotional affair with his client; the CEO who begins to think of her employees as simply cogs in a wheel; the doctor who offers choices without medically evaluating the options; the banker who makes money from giving a bad loan; the policeman who privileges people with rank; the parent who offers authority with no love, or love with no authority; the Priest who mixes up love relationships with congregant relationships; or the politician who thinks only of re-election strategies rather than what is best for her constituents.

    I wonder how many of these could have been reduced or prevented if this information about the corrupting nature of power were part of everyone's basic education.

    Why are we so corruptible

    This is the second part of Julie Diamond's question (Diamond, 2016, p. 49 ff.). She goes on to say that "Something happens to us like being under the influence of drugs. . . . This creates a deadly cocktail of opportunity and immunity." Since everyone is affected, we need to take a moment to feel compassion for ourselves as human beings. We are all vulnerable to the deteriorating effects of elevated power. The greater the power difference, the stronger the effects, and the more tempting the perils. 

    I'd like to take you on a journey to help you understand more about how the changes that come with power feel and the impact they have on you. Disneyland has a ride called Thunder Mountain. Now, please imagine that, with a group of other leaders, you are climbing not Thunder Mountain but Power Mountain. You are excited. You've just been given a role with increased power. You want to use it for the good of all. The higher you walk, the further away the village and the villagers look. The higher you climb, the greater your role power and the greater the power difference 

    between you and the people you are responsible for. You climb up the path, for example, from student to graduate student to teacher to assistant professor to dean to college president. The higher you get the greater the view and the rarer the air.* 

    Along the way you will receive four gifts or privileges that will support you in doing your job and fulfilling the responsibilities of your role. These are the four gifts that power gives to everyone, no matter what their intention. These are the gifts that will impact and change you, inevitably. You have not earned these gifts of power, although you may have earned the power role. They are not given because you are good or bad. Each weaves its own spell. 

    Receive now your first gift, symbolized by a coin: Access to resources and opportunities, including money, people, information, supplies, and control. The functional leadership purpose of this gift is to provide you with the support you need to fulfill the responsibilities of your role. As you take in this gift, notice how this alters your inner experience and how you see others. What perils can you feel or imagine? 

    Receive now your second gift, symbolized by a scarf that you put around your neck: You become bigger than yourself. You are bigger because, to others, you are now a role--an add-on to your personhood. The needed leadership purpose of this gift is to provide you with the increased ability to have an effect and to have the influence that you will need to fulfill your role. As you embody a role in addition to being a person, notice your inner experience and how others may see you. What perils can you feel or imagine? 

    Receive now your third gift, a piece of paper with slits cut in it to symbolize changes in your vision and how you are seen: You gain social distance and prerogative to enable you to see the big picture and not get too caught up in the details or with individuals. As you take on more distance, notice your inner experience and how it changes your perceptions of others. What perils can you feel or imagine? 

    Receive now your fourth gift, symbolized by a wand: Freedom to act with limited interference, and significant immunity from the impacts. This will allow you to make decisions in a timely and direct way. As you feel this freedom and immunity, notice your inner experience and how you approach making decisions and taking action. What perils can you feel or imagine? 

    Now you have reached the top of the mountain. You hold your gifts. You are at the summit. You have a great deal of role power. The gifts enable you to do your job. They are privileges and they are empowering. Take a minute to notice what they allow and help you to do. They also change you in corrupting ways. Take a minute to get a sense of the perils that come with the advantages. Notice the magnetic pull toward being self-serving, toward less empathy, toward impulsiveness and control. 

    Here at the top of Power Mountain you must choose how you will use these gifts. The gifts pull like a magnet toward being self-serving. When you have so much intoxicating power, why would you choose to use it in service to others? As in Star Wars where the dark and the light are of the same genetic pool, you must choose. 

    Here's where you get to decide whether or not you will fully embrace and say "yes" to your role and rank power. This is a humbling and sacred moment. You can decide that your good intentions will be enough ensure your right uses of power. You can take a "wait and see" attitude and let bumpy experiences be your teacher. You can decide to pretend these negative aspects don't exist or don't apply to you. You can make power itself the enemy and deny that you have greater power. You can choose to use your power in the service of your own wealth, fame, and ego-gratification. Or you can let the impact of the drug of power pull you to use your 

    powers for wealth, fame, control, or self- aggrandizement. Or you can make the most challenging and ultimately rewarding choice: owning and using your role power in service of others and for the good of all. 

    Here's an interesting thing: only if you choose socially responsible power, do you need to understand both the gifts and perils and how they are affecting you. (To misuse your power, you do not need to know the intentions and strategies for right use of power.) If you don't choose to monitor and mediate your own shadow tendencies and vulnerabilities, you will blindly and inevitably misuse your power. Power is a strong teacher. You will have many opportunities to look again at this choice. 

    If you are paying attention, you will be able to take advantage of the great teachings power has to offer you through mistakes, self-reflection, and self-correction. Your relationship with power is a life-long engagement with your impact, vulnerabilities, limitations, and mistakes. This relationship with power, in itself, will prove to be an extra gift. What do you choose? 

    Next we descend and return to the village where you can find out more about how you are changed and how differently you are responded to. One more thing. Choosing to understand both the privileges and perils of increased power is surely and deeply humbling. Humility is an under- acknowledged value for leaders, and yet, honored and appreciated by those they serve. "If you don't have a way to incorporate the humbling experiences that come with elevated power, you will have to depend on your role alone to carry through or to legitimize your behavior" (Rosenholtz, private conversation, 2016). 

    Here is a chart that describes, in the left column, the perils that come with the four gifts and privileges. The right column lists some activities that can help empower you and also mediate the changes, temptations, habits, and tendencies. This is a big light to shine on territory that has not been much named or explored. Be compassionate and curious as you look over this chart. In the perils side of the chart, think about harm caused by over-uses, under-uses or unconscious uses of power from your own life experience or that you have heard of or read about. Thoughtfully notice several perils that you may be particularly vulnerable to in your work in the world. Then look at the mediating activities and make a commitment to be self-aware and pro-active. 

    A few reminders as you look at this chart. First of all, since power has a neutral meaning of the ability to have an effect or to have influence, it is not power itself that is corrupting. It is role power that changes us. As Julie Diamond puts it, "Something happens to us when we step into roles of power: its like being under the influence of drugs or alcohol or having someone cast a magic spell that alters our perceptions and emotions. As though slipping on Sauron's Ring of Power, when we step into a position of power, we think, feel, and behave differently. The role itself allows for its own corruption. It is a magic that must be carefully 

    managed" (Diamond, 2016, p. 31). 

    The second reminder is that your personal power is the foundation that you need to stand on, rest in, and be nourished by. Personal power is what we all need to do things, to accomplish our goals, and to engage well with other people, and to make the world a better place. Role power "is based on the external, [while] personal power is self-sourced. . . .Your personal power can thus be independent of the validation of others. In fact, it is the only power that can transfer from context to context" (Diamond, 2016, p. 63). "Cultivating personal power starts with knowing and valuing who you are. Growing our personal power is our greatest asset for good and strongest weapon against the corrupting influence of power" (Diamond, 2016, p. 67). 

    The third reminder is compassion: compassion for ourselves, compassion for others. We are all affected by the magic spell of role or rank power. We all feel its pull toward being self- serving and less empathetic. The news is overloaded with horrific examples and images of abuses of power. And yet, most people care about the well-being of those close to them and have good intentions at heart. Again, drawing on Julie Diamond's wisdom, although "corruption implies an illegal act, it also refers to non-conscious, unintended, unpremeditated acts that break or stretch social and relational bonds, and in so doing, inflict harm. . . .By and large these are unconscious actions carried out by someone with high rank, good intentions, and benign neglect" (Diamond, 2016, p. 51). 

    Understanding the spell of role and rank power is one of the primary reasons for working with this chart. 

    Each bullet point ( • ) on this chart is a nugget to which numerous stories and examples could be added. 


    About the Author
    Cedar Barstow, member of the USABP, is the Founder and Director of the Right Use of Power Institute
    she has been designing, developing, and teaching this approach since 1994. Two books explore these ideas in depth. Right Use of Power:  The Heart of Ethics is a resource for people in the helping professionals. Living in the Power Zone: How Right Use of Power Can Transform Your Relationships, written with her husband, Reynold Ruslan Feldman is right use of power for everyone. Internationally,  she  offers Right Use of Power (RUP) workshops and trains' others to present their own RUP programs, and develop e-courses and other materials.  She also serves as a consultant in ethics and power issues for individuals, groups, and organizations.  

  • 12 Apr 2019 4:33 PM | Anonymous

    By Sharon P. Austin, PsyD

    Currently, tick-borne diseases (TBDs) are the fastest growing vector-borne diseases in the US. Statistics on Lyme Disease, the most prevalent TBD, estimate over 300,000 new cases of Lyme every year in the US alone, with some estimates up to one million/year, 40% of these are children.  This is not including all the possible coinfections (e.g., Anaplasmosis, Ehrlichiosis, Babesiosis and Bartonella), which are also transmitted by ticks. The Lyme pathogen has been reported in all 50 states.

    We must therefore anticipate many of our clients who have either moved from high endemic areas with TBDs, or have traveled to such areas have a greater likelihood of having contracted a tick-borne disease unknowingly.  Without early detection TBDs can evolve into multi-staged and multi-systemic illnesses that mimic and/or coincide with many medical and psychological conditions.  Two of the primary symptoms are chronic pain and fatigue. “Chronic” TBDs wreak havoc on couples, families and individuals.  Mental health practitioners can play a critical role in helping clients and their families navigate the complexity of these diseases.

     The challenges faced by clients with TBDs are daunting.  Some examples include:

    1)     Chronic TBDs are often not considered a common or legitimate medical condition.  This can mean clients often do not receive adequate support from their practitioners, friends, family or employers.
    2)     Thus far there is no reliable test for the various strains of the Lyme pathogen and the co-infections.
    3)     Outdated beliefs have a negative effect on treatment.  These include: 
    a)     Lyme disease testing is seen as reliable
    b)    Lyme disease is hard to catch
    c)     Lyme disease is easily treated
    d)    One can feel a tick bite
    e)    Lyme disease always presents with a bull’s eye rash
    4)     TBD symptoms may not be apparent for weeks, months or years. The early symptoms may appear flu-like, therefore dismissed.  Undetected pathogens can then spread throughout the body.
    5)     Because of the complexity of the symptom profile from one individual to another and no standard treatment protocol, treatment at various stages of the disease can have mixed results.  Recovery is often complicated and confusing.
    6)     Financially TBDs can be devastating from loss of employment, denial of insurance and disability and cost of treatments. One estimate of the financial burden is $1.3 billion/year in medical costs but could be as high as $50-100 billion annual drain on the US economy. Chronic TBDs can cause a wide range of symptoms with relapsing/remitting patterns.  These can include:

                Joint and muscle pain         Extreme fatigue

                Facial nerve palsy                  Meningitis

                Carditis                                      Recurrent fevers, chills, night sweats

                Headaches                                Sensory sensitivities

                Sleep disturbances                 Dizziness, low blood pressure

                Visual impairments                 Gastrointestinal disorders

                Neuropathic pain syndromes

                Susceptibility to autoimmune conditions


    “Neurological Lyme” is particularly problematic for children and adults alike.  Symptoms under this category can include any of the above symptoms concurrent with reduced functioning in the following areas: 

                Speech and language skills     “Brain fog”

                Memory & concentration       Information processing

                Multi-tasking abilities             Comprehension


                Irritability                                Depression

                New onset ADHD                    Mood swings

                Anxiety, Panic & OCD             Suicidal ideation

                Oppositional Defiant              Declining school performance           


    Clinical studies suspect possibly one third of psychiatric clients show signs of past infection with the Lyme pathogen.  As psychotherapists we can provide a vital role for these clients as we may be the first to detect the possibility of TBDs as a cause of psychiatric conditions. 

    Given the likely epidemic of TBDS, we could ask additional questions when there are confusing, numerous and waxing and waning symptoms.  These include:

    -       Have you lived in or traveled to high endemic areas?
    -       Have you ever been bitten by a tick?
    -       Did you have a rash? Treatment?
    -       Do you have a positive family history of TBDs?

    For clients with chronic TBDs, we must be aware of dual diagnoses between psychological and medical conditions.  Their presentation may be more than their trauma histories driving the physical symptoms.  It may be more than “schoolitis” or problematic parenting.  We have been trained to recognize how trauma resides in our bodies and how critical attachment experiences are.  Yet we must be willing to look at an even bigger picture that includes the role of infections such as those transmitted by ticks. 

    Although we cannot advise on medical or nutritional treatment we can counsel clients on factors that may be exacerbating their physical and emotional conditions.  We help clients be accountable to many wellness factors such as regular medical check-ups, good nutrition, exercise & sleep hygiene, challenging negative thoughts and maintaining healthy relationships.  All of these factors are critical for clients with chronic TBDs. We can also facilitate communication amongst providers. Most of all, as Terry Tempest Williams says so beautifully:

    The unexpected action of deep listening

    can create a space of transformation

    capable of shattering complacency and despair”

    We are trained to listen, be a witness, stay attuned and be patient for our client’s story to unfold.  In a time of numerous doctors, multiple assessments resulting in inconclusive diagnoses, uncertain medical treatment and outcomes clients of all ages with chronic TBDs need our comforting presence and our message, “I believe you and I’m with you!”

    These are a few helpful resources:,,,,

    About the Author
    Dr Sharon Austin is a Clinical Psychologist in Fort Collins, CO specializing in Somatic psychotherapy for couples, trauma and chronic medical conditions.  In addition she practices Gestalt Equine Assisted Therapy.  She is a volunteer for the CO Tick-Borne Diseases Awareness Association (COTBDAA) and she is an Ambassador for the Global Lyme Alliance.  She is a Mom of two college students and co-hobby farm owner with her husband, tending to their horses, sheep, dogs and chickens.  Dr. Austin can be reached at or 970-493-4093.



  • 4 Feb 2019 5:21 PM | Anonymous

    From the NARM Training Institute.

    In June 2018, nearly 40 years after the APA controversially yet officially recognized Post-Traumatic Stress Disorder (PTSD)as a mental disorder that required clinical treatment, the World Health Organization released the ICD-11 including a new diagnosis: Complex Post-Traumatic Stress Disorder (C-PTSD).

    This diagnosis has the potential to completely revolutionize the world of mental health.

    Understanding the long-term impact of unresolved early trauma is indeed a world health issue.  Attachment, relational and developmental trauma – which crosses all cultures, religions and communities – impacts the neurobiological development of children and creates life-long patterns of disorganization within the body, mind and relationships.  Perhaps a greater understanding of Complex Trauma can help us understand the underlying causes of the disorders our clients are struggling with, in addition to the increasing social challenges like substance abuse, systemic injustice and violence.  A trauma-responsive perspective brings great hope.

    While PTSD evolved the field of psychology in a major way nearly 40 years ago, those of us that have worked in this field know that there are limitations to the diagnosis and the treatments addressing it.  C-PTSD helps us evolve our understanding of trauma.  Now that C-PSTD has been officially recognized, the next step is to finding treatments that are specifically geared to addressing Complex Trauma. 

    Many of us have experienced frustration with clients dealing with complex trauma due to their lack of progress in therapy, as well as those clients who make good progress only to regress back to old, stuck patterns of self-sabotage, hopelessness and despair.  These are usually the clients that therapists bring to consultation. 

    The question we as NARM consultants get asked repeatedly – how can I most effectively help my client?

    To answer this, let’s revisit The ACEs Study (Adverse Childhood Experiences).  The ACEs Study has a fascinating origin.  Originally, it was designed as a weight-loss program until the head of the program, Dr. Vincent Felitti, observed that despite making successful gains toward their weight-loss goals, nearly 50% of the participants were dropping out.  This did not make sense to Dr. Felitti at the time: why participants would leave the program as they were losing weight and coming close to meeting their weight-loss goals.  He created a questionnaire to understand this phenomenon and discovered that a majority of those that dropped-out had experienced childhood trauma.  Thus began the monumental research project we now refer to as the ACEs Study.

    One fascinating aspect here is the underlying mechanism of self-sabotage.  One would think that the closer a participant got to their goals the more motivated they would be to complete their program.  But whether it’s weight loss, or a student dropping out their senior year of college just a few credits shy of graduating, or someone who has been sober and returns to their substance use, we see so many examples of people getting closer to health, wellness and success turn to behaviors that are self-sabotaging and self-destructive.

    We are now unwinding this puzzle through recognizing the “survival” function of shame and self-hatred.  As young children, everything revolves around staying connected to our caregivers via attachment – this is essential for our basic survival and well-being.  When there has been failure, whether from our caregivers or from the environment, our basic survival is threatened.  A child is unable to experience themselves as being a good person in a bad situation.  Therefore, unconsciously, psychobiological mechanisms turn on to assure our basic survival.  A main survival strategy is what we might refer to as shame and self-hatred; that children experience themselves as bad as a way to protect themselves from their failures of their caregivers and/or environment.

    One of the things we have observed in consulting many somatic-oriented therapists internationally is that despite very effective and powerful somatic work, therapeutic process still gets thwarted without recognizing and working directly with the survival-based developmental strategies.  Clients begin to get better and then repeatedly have set-backs or sabotage it in a number of ways.  Going back to the original weight-loss program, something is threatening about moving forward in life toward greater health and well-being.  That something is the way we learned to protect our early caregivers and environment through foreclosing fundamental aspects of ourselves, even if those fundamental aspects are positive like growth, healing and aliveness.

    So what does this have to do with somatic therapy?  What happens when a client is moving toward greater embodiment, self-regulation and empowerment (“bottom-up”), but we fail to recognize the underlying shame-based wounds that have led to the dysfunctional strategies, behaviors and symptoms?  Or for traditional, talk-based therapists, what happens when we work with the psychodynamics of shame, self-hatred and self-sabotage (“top-down”) without shifting the physiological and emotional patterns that are fueling the self-limiting beliefs and behaviors?  And, what happens when we are working with early attachment wounds and don’t recognize our own countertransference (our own unresolved trauma patterns and triggers) and how this impacts the therapeutic process?  

    The NeuroAffective Relational Model (NARM) is a therapeutic approach designed to work with the unresolved wounds and patterns leftover from early trauma.  This integrated “top-down” (psychodynamic-based) and “bottom-up” (somatic-based) approach works with the psychobiological patterns of shame and self-hatred within a deeply mindful, relational context.  With a framework that identifies the developmental wounds from early trauma, our clients have a possibility of moving forward unencumbered by these unconscious survival strategies that have come to dominate their lives.  Freedom from childhood trauma is possible 

    While research on this is still in its infancy, we at the NARM Training Institute are buoyed by clinical reports and early research demonstrating how effective the NeuroAffective Relational Model (NARM) is in resolving attachment, relational and developmental trauma.  We have trained thousands of mental health clinicians throughout North America and Europe, and are rapidly expanding our NARM training programs throughout the world and online.

    If you have clients that are struggling from unresolved early trauma and would like more information on how to provide more effective therapeutic support for your clients, we invite you to learn more about the NeuroAffective Relational Model in our online or live training formats.  

    To learn more about this revolutionary method to treat this paradigm-shifting diagnosis:

    Visit NARM

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