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advancing our field

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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  • 1 Jul 2020 10:14 PM | Anonymous member (Administrator)

    This series was created to empower people in challenging times and everyday life. We are bringing to the public short resourcing exercises to regulate body and mind.

    In challenging times, when stress and anxiety run high, nurturing your body-brain and mind is more important than ever.

    Maintaining presence and equanimity depends on your capacity to mindfully align sensations, emotions, and thoughts. 

    These short somatic exercises, generously offered by our members, teach you how to use your energy, emotions, and awareness so that you can face challenges with confidence, and step into your life feeling connected and empowered. 

    Use them for yourself and with your clients.

    View this series in its entirety on Youtube. 

    Visit the Channel

    Episode 1:
    Simple Movement to Ease Your Anxiety - Dave Berger


  • 20 Jun 2020 7:50 PM | Anonymous member (Administrator)

    Below you will find resources for addressing this topic. There are links and people that have been referenced in USABP circles. You can also reach out to our member organizations as well. Please email us with any of your suggestions. The list and site presence will build out over time. Thank you all for your contributions.

    USABP Training organizations

    Member Organizations often include webinars, workshops or specialize in training activity to address social justice, anti-racism, diversity, systemic racism, implicit bias, polarization and more.

    See a list of our organizations and the ways in which they assist in this issue through Somatic Psychology, Body Psychotherapy and other Somatic-based Therapy Practices


    Radical Aliveness Institute is a USABP Official Training School addressing somatic and systemic issues world wide from US to Central and South America to Africa and the Middle East.


    A List of Member Organizations' Helpful Resources

    NARM & Cultural Misattunement Webinar: Addressing the Impact of Cultural Trauma from Systemic Oppression with NARM Therapist Claude Cayemitte, MSW, CCTP hosted by NARM Training Director and Senior Faculty Brad Kammer, LMFT, LPCC


    Two podcasts brought to you by the NARM® Training Institute

    Transforming Trauma, Episode 013:
    Addressing Systemic, Cultural, Racial, and Complex Trauma with Claude Cayemitte


    Transforming Trauma Episode 015:
    Post-Traumatic Growth in Communities of Color and NARM in the Classroom with Giancarlo Simpson


    USABP Continuing Education Training webinars: 

    > To view one has to be a member and logged in to there account. 

    Working with Polarization and Trauma in Groups:  how to work cross-culturally and cross-nationally

    Presented by Ann Bradney, CCEP, CPRA 
    Founder of the Radical Aliveness Institute 


    Embodied Activism: Getting a Grip on Social Justice and Moral Courage in Somatic Psychotherapy
    Presented by Rae Johnson, PhD, RSW, RSMT, BCC 


    A Thousand Paper Cuts - Grasping and Transforming the Trauma of Embodied Micro-aggressions
    Presented by Rae Johnson, PhD, RSW, RSMT, BCC 


    USABP viewpoints ARTICLES

    Privileges and Perils of Power

    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.



    USABP Somatic Practitioners


    Somatic Experiencing Practitioners specializing in matters related to the Criminal System


    Directory, Organizations, Books, Trainings, and more

    Dr. Rae Johnson
    Embodied Social Justice introduces a body-centered approach to working with oppression, designed for social workers, counselors, educators, and other human service professionals. Grounded in current research, this integrative approach to social justice works directly with the implicit knowledge of our bodies to address imbalances in social power.

    USABP Member Nola Butler-Byrd
    Nola Butler Byrd, Ph.D., LPCC is a Certified Radix Practitioner and a Licensed Professional Clinical Counselor. She is also an Associate Professor and Director of the Community-Based Block Multicultural Counseling and Social Justice Education Program

    USABP Member Zeshan Mustafa, CCEP, JD, RYT
    Specialties with Somatic Support:
    BIPOC, Anti-Racist Activists, and Codependents.

    Author of:
    "When Helping Is Not Helping: a Somatic Approach to Working with Clients of Color."

     Read More & Buy

    Additional Non-USABP RESOURCES

    Right Use of Power Institute

    White Supremacy and Me by Layla F Saad

    National Association of Social Workers Anti-Racism Resources

    Blindspot by Mahzarin Banaji and Anthony Greenwald

    Center for Partnership Studies, founded by Dr. Riane Eisler

    Take the Implicit Association Test (IAT) to Measure Your Bias:

    Test me

    The IAT

    At the heart of the book Blindspot: Hidden Biases of Good People is a method called the Implicit Association Test (IAT) which was designed by Tony Greenwald to detect the hidden contents of the mind. Its original application was to explore the group-based preferences, stereotype, and identities that may not be accessible to conscious awareness. Since then, it has been used widely to study preferences, beliefs, and identity, and found applications in domains of health, education, business, government, the law and law enforcement. The test is currently available at 39 country sites, in 25 languages.

    Free Racialized Trauma Course

    Google Drive link to comprehensive educational reading, tools, exercises and organizations to help explore this topic from many sources.

    Take me to these links

    Engaged Citizenry

    Andrew Goodman Foundation


    BU Center for Anti-racism Research

    Featured Body Psychotherapists, Speakers, Authors and Trainers

    Resmaa Menakem
    Coins the phrase White "Body" Supremacy and has exercises for one to work through to embodying trauma and work with issues around race and trauma.

    We can't help ourselves to heal racialized trauma if we don't acknowledge that it even exists 


    Resmaa Menakem, MSW, LICSW, SEP, has appeared on both The Oprah Winfrey Show and Dr. Phil as an expert on conflict and violence.

    He has served as director of counseling services for the Tubman Family Alliance; as behavioral health director for African American Family Services in Minneapolis; as a domestic violence counselor for Wilder Foundation; as a certified Military and Family Life Consultant for the U.S. Armed Forces; as a trauma consultant for the Minneapolis Public Schools; and as a Cultural Somatics consultant for the Minneapolis Police Department.

  • 15 Apr 2020 5:54 PM | Anonymous member (Administrator)

    Recently the USABP and Bodynamics Institute presented a webinar that included demonstrations on how to "Use one's body to contain anxiety under times of uncertainty." 

    Anne Isaacs went over that in her full webinar presentation,  Creating New Psychophysical Resources That Heal Developmental Disruptions:   Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns.

    Following that webinar attendee and USABP member Karen Kirsch stepped in to action to provide other USABP members and the larger community with some of the tools presented in the above webinar.

    These tools can be useful in Teletherapy.

    Use them for self care too. 

    This demo is also found on youtube too

  • 15 Apr 2020 4:04 PM | Anonymous member (Administrator)

    Instructional Guide to Somatic Resourcing Strategies for Containment and Orienting

    Prepared by Sarah Schlote
    An Excerpt from the Anne Isaacs', Bodynamic Institute presentation, Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns

The following selected illustrated practices derived from Bodynamics support resilience and self-regulation through containment and present-time orientation in times that are activating or unsettling.

    I have added in additional commentary drawing from Somatic Experiencing® and the polyvagal theory to elaborate and support integration of some of these ideas.

    A file with visual cues is available in two formats. Download to get them:

    Get the PDF Download 

    Get the A4 Download

    Iliotibial Tract Hold

    The iliotibial tract (also known as the IT band) is a thick band of connective tissue that extends from the pelvis and hip area to the tibia and knee, along the outside of the leg. It provides a sense of social balance, in terms of pulling oneself together and also letting go, and allows us to manage our emotional energy through self- containment. Bringing intentional attention to the outer edges of our physical container can provide a settling effect when we are feeling panic, have lost a sense of our own boundaries, or are hyperventilating. This particular practice shifts anxious energy from the head and upper body and provides an embodied felt sense of our body as a container, which helps us to feel centered in our core (the abdominal cavity is a much larger space and offers more “breathing room” to be with difficult emotions than when they are up in the head). It also allows the rest of the body, in particular the limbs, to become a conduit for stuck activation, allowing that energy to move down towards the feet.

    Version 1:

    • Place your hands on the outsides of your lower thighs or knees, and have your feet and knees shoulder-width apart. Lean forward on your legs as you are doing this.

    • Keeping your knees in place, press outwards into your hands, as your hands provide resistance against the pressure from your legs (while keeping the hands in place). This will create a sense of dynamic tension.

    • Hold this position for a little while.

    • The most important part of the practice: Relax slowly to a count of 10 (“one locomotive, two locomotive, three locomotive…”), gradually releasing the tension/resistance from your hands, arms and legs. If you like, lengthen your exhalations as well as you let go.

    • When finished, sit upright and notice what is different.

    Version 2:

    • Follow the same instructions as above, only without crossing your arms.

    Other Options:

    • Place your feet on the inside of each chair leg, and press out with your knees. The chair legs will provide the resistance that your hands did in the other versions. This frees up your hands for other things, and can be done more discreetly (like when in a meeting or another social setting).

    • When standing, with your feet flat on the floor, push outwards from your knees to your hips.

    • When lying down, cross your ankles and then push outwards from your knees to your hips.

    Lower Side Ribcage Expansion

    At times, when we feel a surge of emotion rising up, we might sense a knot in our chest and a tightening in our throat as our body contracts around our feelings. Emotions like anxiety feel like they “get stuck” in the upper chest, and there can be a sense that things are too painful or overwhelming. This can especially be the case if we tend to become submerged in or blend with our internal experience, and lose a sense of having a grounded adult witness or access to our core Self in the present moment. Unconsciously, we might forget that we now have a much larger, grown-up body that can hold our internal experience, and instinctually respond as though our physical container was much smaller when feelings  were much more overwhelming to our less developed nervous system. Our container contracts to hold things in, which gives the impression that the pain or discomfort will never end, or that we won’t be able to handle it: a somatic re-enactment of what we may have felt when we were younger. As a result, emotions and sensations become blocked and don’t move through our system as they were meant to. This exercise provides a felt sense of having a larger container, which can have a calming effect and provide a more spacious conduit for emotions to pass through and settle.


    • Take a deep breath in, breathing into your lower side ribs so that they expand outward. Then, use your muscles to keep your ribcage open. You can continue to breathe if you like (or if you are able) while holding your ribcage in this wider position.

    • After a few moments of holding your ribcage open, slowly allow your ribcage to relax as you exhale. Take all the time you need to do this.

    • Allow your breath to come in normally and notice what shifts as you pay attention.

    • If you like, at the same time, isometrically activate the adductor muscles (inside the thighs), and then very slowly let those go as well.

    • Track what happens inside. What is different in terms of your sensations or feelings? Or, what is different about how you are experiencing them?

    Serratus Anterior Superior Hold

    The serratus anterior superior is a muscle located beneath the armpits on both sides of the body, starting under the shoulder blade and stretching forward along the sides of the ribcage. As babies and young children, this is the area where grownups place their hands as they pick us up in response to our need for social engagement, co- regulation, reassurance, and play. The serratus muscle is involved in connectedness, a sense of the heart opening and the physical action of reaching out towards others or nourishment.

    This muscle is also connected to our desire to be wanted and loved for who we are (including our curiosity and impulses), and provides us with a felt sense of our ability to contain our sensations and emotions while also getting our needs met. Finally, it is linked to having the space to enjoy ourselves, the freedom to explore the world, and the ability to express our emotions without losing contact with ourselves and others.

    From the standpoint of the polyvagal theory, early face-to-face interactions are the first step to experiencing co- regulation, since as infants we rely on the social engagement system of our caregivers to help us develop our own. The face-to-face moments we experience in the safety of our relationship with our caregivers supports the face-to- heart connection. In other words, these interactions stimulate the

    ventral branch of the vagus nerve, which links the musculature of the face, neck, larynx and pharynx with the heart and lungs. When we feel safe and held, the ventral vagus acts as a pacemaker on the heart, which modulates our arousal.

    This particular self-hold can help provide a sense of containment and settling when we are feeling anxious or lonely.


    • Place your hands under your armpits and then allow your arms to come down over top of your hands.

    • Press in or squeeze into that muscle on both sides, holding yourself in that place.

    • If you like, lengthen your exhalations as you breathe.

    • What do you notice when you hold yourself there?


    Orienting is a deceptively simple practice, the purpose of which is to support us to become more present. As we become more present to ourselves and our current conditions, and if these conditions are perceived by the nervous system to be safe(r), our organism can begin to settle out of whatever panic, urgent energy, or spiralling thoughts we are experiencing while in a state of hyper-vigilance.

    The suboccipital muscles at the base of the skull are involved in orienting efforts, and are psychologically connected with the instinctual sense of having the right to have strength or power. Defensive orienting involves turning towards perceived dangers or threats, or looking for escape routes or objects for self-protection. Exploratory orienting involves turning towards novelty in the environment (curiosity) or seeking out resources, such as social connection, nourishment, play, comfort, delight, etc. (sucking reflexes to take in this goodness are connected to the exploratory seeking impulse). Defensive orienting can be in or out of proportion to the current conditions. For instance, when we are anxious or in a state of panic, we can experience a startle response where we pull back and hold our breath, freezing in place. Our bodies can become tight or rigid, we hold our breath, and our gaze can become fixed or our eyes can dart around frantically without really taking in our surroundings. This is another way our bodies, emotions and thoughts become stuck. Our minds begin to fixate on the future, getting caught in worry about what might happen again. Orienting can help us to recognize relative safety now.

    From a polyvagal perspective, orienting allows us to engage the same parts of the face and neck involved in the social engagement system, which stimulates the ventral vagus nerve. When the ventral vagus is back online, it provides a face-heart connection that acts as a pacemaker on the heart (or a set of brakes), slowing us down and allowing us to reconnect with the here-and-now and with relationships.


    • Taking a deep breath, slowly exhale as you let your eyes look around and take in your surroundings. Allow your eyes to slowly look where they want to look, as opposed to where you think they should look. What draws their curiosity?

    • Using your occipital and neck muscles, let your head turn slowly to check out all directions, leading by your ears and exhaling slowly as you do. If you like, also see what happens if you allow your head to look up and down as well. Take all the time you need.

    • Notice if there is anything dangerous or threatening in the present moment.

    • What happens as you taken in your surroundings? What is different inside?

    Note: in Somatic Experiencing®, the goal of orienting isn’t necessarily to become more grounded; rather, we want to develop more accurate neuroception in the present. That is, we are looking to develop a more accurate sense of safety, danger, or life threat in the here-and-now. If our organism accurately detects safety and becomes more grounded as a result, then this practice can indeed support settling and deactivation of anxiety. However, for others who have difficulty trusting themselves to accurately detect signs of danger or life threat because of a tendency to be under-attentive, this practice can also be used for the opposite purpose, especially if an individual’s orienting response was thwarted, resulting in hypo-vigilance.



    Bodynamics is a developmental somatic psychology approach developed in Denmark, that proposes that somatic and psychological development occur simultaneously. This means that the voluntary use of specific muscles not only has a physical function but also a psychological one as well, and that psychological difficulties can be addressed by working with the muscular system and the various character structures that occur at different developmental stages.

    • Bodynamics theory:

    • Seven developmental stages and their associated character structures:


    Foundation for Human Enrichment (2007).Somatic Experiencing® – Healing Trauma[training manual]. Boulder, CO: Somatic Experiencing® Trauma Institute.

    Isaacs, A. (2020, March 26).Creating New Psychophysiological Resources that Heal Developmental Disruptions: Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns[webinar]. Hosted by the United States Association for Body Psychotherapy.

    Isaacs, A. & Isaacs, J. (2016, March 24).Healing Developmental Disruptions: Using the Body to Focus Verbal Therapy

    [webinar]. Hosted by the United States Association for Body Psychotherapy.

    Porges, S.W. (2018, November 3). Trauma and intimacy through the lens of the polyvagal theory: Understanding the transformative power of feeling safe [conference lecture].The Science of Connection: Honoring Our Somatic Intelligence.Santa Barbara, CA: United States Association for Body Psychotherapy Conference.

    Suggested Citation

    Schlote, S. (2020). Somatic Resourcing Strategies[handout]. Guelph, ON: The Refuge.

    Thanks to Anne Isaacs for granting permission to develop this handout.


  • 3 Mar 2020 4:10 PM | Anonymous member (Administrator)

    Presented by Stacy Reuille-Dupont, PhD, LPC, CPFT

    In this interactive presentation, I would like to review the concept that mind lives in every cell of our body and movement patterns are expressions of mind. By looking at the physiological sciences of hormones, neurotransmitters, brain/locomotor development, anatomy, and physiology we can concretely evaluate postural dysfunction, misalignment, and tension patterns set up by physical or psychological states.

    Watch Now


    Note from Dr. Stacy Reuille-Dupont

    Jumping off from my first career as an exercise scientist, I found somatic psychology as a way to bridge and treat physical health symptoms at the level of being. Drawing on my dissertation research regarding perception and participation in physical exercise within a clinical mental health population, I found blending Hakomi’s character analysis with locomotor developmental stages unlocked psychological core wounding and allowed for corrective experiences in the “forced mindfulness” of difficult physical challenge.

    Beyond traditional therapy, these interventions also treated physical health problems of obesity, chronic pain, chronic disease management, addiction patterns, and others that often have roots in the psyche and are impeding if not distracting from deeper work. The nervous system directs it all. When the nervous system becomes dysregulated as a result of wounding (psychological or physical) the body systems adapt.

    These adaptations are brilliant options for the body at the time of pain, however if left unchecked create systemic problems that may lead to chronic disease states, both physical (e.g. diabetes, obesity, pain) and/or psychological (e.g. low self-worth, addiction, stunted personal growth, rigidity in life participation). In our current culture, these adaptations become targets for interventions as independent factions rather than utilizing the intelligence of the whole system. Physical health care often separates itself from mental health due to its cause and effect, tangible nature, however taking a broader approach that includes psychology we treat the problem, not just the symptom. One finds mind present in all forms of body dysfunction from basic building blocks of cellular activity, immune dysfunction, and inflammation patterns to postural deviations as a result of psychological or physical wounding. By honoring the embodiment of personal experiences the body psychotherapist can engage in larger and often discounted conversations about what health is and is not.

    In this interactive presentation, I would like to review the concept that mind lives in every cell of our body and movement patterns are expressions of mind. By looking at the physiological sciences of hormones, neurotransmitters, brain/locomotor development, anatomy, and physiology we can concretely evaluate postural dysfunction, misalignment, and tension patterns set up by physical or psychological states. These states often continue psychological distress and influence overall health. Corrective exercise patterns can be used to free not only the physical system, but the emotional body as well creating whole person health.

    See the companion article for this video presentation.

  • 3 Mar 2020 2:34 PM | Anonymous member (Administrator)

    This article will help in understanding and incorporating physical movement systems into psychological treatment. It is presented by Stacy Reuille-Dupont, PhD, LPC, CPFT

    Movement facilitates the physical wiring and structure of being. Movement creates concrete manifestation of the abstract. The embodied experience becomes tangible. Even a thought or emotional experience is movement at the cellular level.

    - Stacy Reuille-Dupont, PhD, LAC, USABP presentation, 2018

             Many struggle to own the power of physical experience. In fact, on average people with mental health illness die younger and use more health care services. Medical staff struggle to treat and diagnose accurately, and they engage in costly medical treatment more often than those with mental wellness. They often present to physical health care providers with 5 or more unrelated symptom presentations. This is because addiction, trauma, and experience live in the tissues. These experiences create “knots” in the system. These knots embed in layers of muscle and facia that evolve to create adaptive ways of dealing with the world, however many are powerless in their somatic experience of life. They are disembodied and look outside themselves to be fixed. As they become less connected to self they also become less connected to others, community, society, etc. The looking for external solutions to internal problems becomes a distraction. The body has everything it needs to address a problem, but many are so disembodied and scared of somatic sensation they let go of this power and become more disconnected. This is where movement helps. Movement returns focus to the body, it returns focus to deeply knowing one’s truth, and it returns focus to personal power. This article will review areas of the body and psychology impacted by movement and discuss how different movements allow for change in the whole system.

    Endocrine System

                Starting with subtle levels of movement we cannot underestimate the endocrine system. The area I have studied most links the endocrine system to psychological trauma disruptions (Reuille-Dupont, 2014). Whether a trauma is physical (broken bone) or psychological (emotional neglect) the Hypothalamus - Pituitary - Adrenal (HPA) Axis gets involved. As a result chemistry shifts. When chemistry shifts the perception of the situation changes. Shifts can be positive or negative, however if stress hormones are not metabolized they wreck havoc on other tissues and may contribute to increases in chronic pain, inflammation, digestive, and immune disorders (Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002).  Physical movement can also target the HPA axis, however does so in a way that metabolizes the bio-chemicals and dysfunctional muscle patterns (Droste, Gesing, Ulbricht, Müller, Linthorst, & Reul, 2003). The endocrine system is often dubbed the “little central nervous system” for its control and care of the body’s experience. When looking at how the endocrine system influences the perception of experience by changing how the body feels in any given state, the endocrine system becomes a tangible system influenced through thoughts, emotional states, ingestion (food, news, media, social influence, environmental items, etc), and movement. Thus as movement is introduced the body becomes an active vehicle to change perception of experiences.

    Nervous System

                The body is a great antenna, but the brain does not have its own direct inputs, inputs are the senses. Sense experiences all come through the body. The body collects the information, sends findings through nervous system channels and reports to the brain. The brain works tirelessly to categorize and direct responses to stimuli for survival. If one is constantly living in reaction to past events rather than response to current experience the system becomes rigid in response options. To be a responder to present moment experiences one must learn to slow down reaction. This happens by increasing capacity for physical sensation. Therefore the brain judges the situation differently based on present moment reality and not past experience reactions when the body is able to experience the situation with capacity. Movement becomes the vehicle to slow or speed the nervous system response.

                The movement of the nervous system is subtle. For instance, movement can be used to shift posture.  As movement increases, heart rate rises, as heart rate rises the nervous system reports to the brain which determines if this is a good situation or not. In my office (within a large community mental health and integrated care center), I found many examples of people who needed to exercise yet could not. Their brains kept registering rising heart rate, quickening breath, and sweat response as panic and would shut down the system. The physical sensations of exercise were tipping them outside the window of tolerance. Helping people understand the responses in the body is important. It gives space to pause, decide desired outcomes, and options for reaction. It can be as simple as using a pressure point. For many familiar with communication lines within the body, location points for contact are important and we know putting pressure on them influences other systems, such as the endocrine, facia, or muscular systems. An easy one I often teach my clients is the 3rd eye point. By putting pressure on this point (between the eyebrows) we have a direct way to lower heart rate and slow breathing. Depending on the client I have them get into different positions allowing pressure to be exerted on this point and notice what happens. It could look as simple as having them press on it with their hand, I can press on it for them, or have them put their head on a desk, counter, the wall, or other hard surface. There are many points we can use to shift the communication of the nervous system to the brain, and most clients can learn and discretely perform on their own at home, school, or work when needed.

    Heart Rate and the Circulatory System

                Slowing the heart and breath bring us to the circulatory system. All changes, mental or physical, are transmitted through the central nervous system, which controls heart rate via the sympathetic and parasympathetic responses (Appelhans & Luecken, 2006). These responses signal to the brain to expand or contract from experience. Taking a slightly wider gaze on this connection, it is the heart that influences how we respond, it is the piece of us that is in control of everything else. It is often thought the brain directs it all, and make no mistake the brain is very very very important, but it is the heart that tells the brain what to categorize. The heart is the conductor of the orchestra that is the brain. It communicates our experience through heart rate variability. Heart rate variability changes with each breath directing the brain in its categorization of experience. Safe or not? Connect or not?

                The heart has its own electrical system. Looking at electrical theory one can see that electrical systems either repel or collapse into each other. If my experience of you is safe, I will expand my electrical system to meet your’s. We may become one electrical field, and we can see and feel these connections between people. As a result of connecting to you, I will mirror you, viscerally respond to you, and will “know” things about your experience. When people get stuck this system gets rigid. People become stuck in old patterns, orient from fear, or struggle to effectively manage limbic resonance experiences. Some people lack an ability to connect to the somatic experience of another (bound), some people are overly connected (unbounded). Both experiences create problems for social engagement of the nervous system. Due to respiratory sinus arrhythmia, the connection between the breath and heart rate, one influences the other (Porges, 2007). If I want someone to be more active, say to treat depression which is lethargic, heavy, slow, and often stuck energy, I can match the current heart rate with movement and raise it slightly (the next section will discuss movement as treatment).

                A simple way to influence this system in your office is to slow down your breathing. By slowing your breath rate, you will slow your heart rate, by slowing your heart rate your electrical pattern changes in the field. As this happens your client (if they trust you) will match you. Thus processing difficult pieces of psychological work feels more supported and builds capacity to experience themselves and others with less reactivity.

    Musculature and Facia System

                If I can get connected to my client using my subtle breath, imagine what big movement systems can do. The trick to using the bigger systems is to know how to influence them. Posture impacts our psychology and our psychology impacts our posture. For example, if I am stressed I may internally rotate my shoulder joint collapsing my chest, making it more difficult to breathe. The change in my breath rate changes my heart rate and influences my sympathetic and parasympathetic systems. Over time my upper back and neck shift into what is known as forward head. This creates stress on the muscle and joint configurations. The muscles respond by tightening, eventually becoming “knotted”. These knots are deposits of different  pro-inflammatory and biochemicals (Shah, Thaker, Heimur, Aredo, Sikdar, & Gerber, 2015). The muscles begin to shift movement patterns around the trigger points. The adaptation eventually results in dysfunctional movement patterns and stress on the system. This process could start as a physical injury or an emotional one. Remember the body is the vehicle through which all experience is processed.   

                Eliminating the adhesions in the physical structures can help eliminate them in the mind as well (many modalities exist to do this: massage, exercise, dance, yoga, tai chi, chi gong, acupressure/acupuncture, dry needling, rolfing, physical therapy, chiropractic, etc.). The trick is often in practitioner and modality connection. If the client becomes connected to the practitioner and the modality fits the client’s personality it is likely they will find relief from it. In our offices we can use the gross motor systems to program movement to access psychological healing.

    Movement to Heal

                As an exercise scientist and personal trainer/group exercise instructor for over 20 years, I am pretty confident at figuring out how to program someone’s physical strength and endurance. As a clinician for over a decade, I feel like I am pretty good at figuring out how to help shift behavior and belief. However, in my office many of my clients would not participate with me. I couldn’t figure it out. I was starting small, meeting them where they were, and the math of physiological change was solid. I looked deeper and did research around what was getting in the way of actually participating in physical exercise. I thought it was psychological trauma experiences, as many described symptoms while exercising that overlapped window of tolerance literature. For the population I studied, it was not trauma, it was panic that mitigated the ability to participate no matter how strong the belief in exercise as a modality to help address a variety of issues. In addition, exposure to exercise created an expanded range (larger window of tolerance to physical sensations). As a result, I learned that offering movement experiences modulated by psychological theory to address stress disorders, especially panic, helped people adhere to a movement program that addressed physical and psychological disorders (Reuille-Dupont, 2014). With these findings I was able to create a variety of movement programs and experiences clients could use to heal mental health presentations.

                When choosing appropriate movement interventions one must consider the client’s current state. You cannot ask a person with deep depression to engage in high intensity “bouncy” exercise. The energy of depression is heavy, slow, lethargic, stuck. We have to start with movements that match and then increase the upward energy in small increments. For someone with ADHD or high anxiety with racing thoughts yin/yang yoga is miserable. They may even struggle with power vinyasa due to lack of ability to focus well. By programming movement to shift quickly and often, sometimes in a chaotic pattern then increasing the rhythmic content slowly we help them meet the racing mind and teach clients to direct it. In addition, we must consider physical limitations, physical health conditions, physiological understanding of heart rate, sweating, breath rate as they link to panic (findings in my research), disorganized body presentations, and psychosis. Someone having a psychotic or manic episode may be able to work with you but be ready to adapt quickly and often. Below are some ways I use movement in my office.

    Walking is a big focus in my practice. I take them outside and have a treadmill in my office to help people understand heart rate training zones and teach them about the physiology of fear. This allows them to have an experience while walking in a safe environment and learn to modulate their own breath and heart rate. It also helps them get comfortable with tension in the muscles and sweat rates, both can signal danger to the brain and exacerbate psychological symptomology.

    Posture. I often use posture to help determine the psychological structure of a person’s belief patterns: where are they hiding, projecting, collapsing, etc. By watching planes of movement, postural deviations, and simple movements you can see where the body is blocked, armored, or adapting. By using theory around body and psychological wounding presentations I can then choose exercise patterns that match locomotor and psychological development phases.

    Here are 3 examples of movements I use in my office to engage clients in corrective experiences:

    Feet are very interesting places to start. By having the client walk we can see what is happening in the pelvis, spine, chest, and head. All movement should come from the core and should be somewhat equal in gait. You should be able to see rotations throughout the foot, leg, and hip structures. This gives a lot of information about armoring and world view. When working with sexual trauma or eating disorders the feet are a great place to start because they give access to the inner thigh, perineum, and pelvic floor areas of the body that are often hyper/hypo active. By manipulating which part of the foot the client is paying attention to (different toes, heel, arches, etc) we can create sensation in the leg and pelvis. This allows for safe processing and reconnecting with these physical structures and allows healing of psychological wounding and physical issues that may also be present. In addition, it allows discussion around items like safety, security, strength, stability, etc that are often early life psychological wounds. Sometimes I do this work in my office, other times it is homework.

    Tabatta. For this I would suggest you have advanced training, however, I think the example can help you conceptualize how you might adapt movement in your office. Tabatta style training is intense structured work lasting 4 minutes. It is cardiovascular in nature (see about for information on Heart Rate Variability), but can incorporate strength as well. There are a number of similar modifications/training modalities that can be adapted for use with a variety of clients. For these exercises I work with the client to determine core wounding patterns and corrective belief statements. Then I choose an exercise to represent the locomotor development at the stage of core wounding and we run intervals. During the intervals I act in ways that can be corrective - offering help and support, checking for safety, and repeating corrective statements. Often by the end of the 4 minute cycle clients have “wired” in a new pattern. Although I am still doing research on this method, so far the results are positive for corrective change, depth oriented work, and mindfulness ability.

    HITT Training Exercises. I often use these for cravings. These are a variety of movements that include power training (strength and speed together). By asking clients to do a difficult movement for a short period of time we “short-circuit” the craving. Many of my clients have addictive patterns and this “gets them out of their heads”. It changes the physiology and helps get around negative thinking and habitual behavior patterns. Good examples are burpees, jumping lunges/squats, or pushups. A note of caution, make sure you understand the clients true ability and risk for injury before prescribing, and when working with eating disorders assess for ability to maintain the prescribed time limits, some folks will over use and perpetuate exercise addiction behaviors.

                As said in the beginning, movement is what anchors the experience. By choosing the right movement for the right disorder, matching the person’s personality, psychological presentation, and intended corrective experience interventions, movement lends itself to effective mental health treatments and can help heal physical health problems as well. By helping people learn to move effectively, they are also taught about personal power, inspiration, personal space, boundaries, strength, healthy eating patterns (think food/mood/microbiome), and decision making skills. There are many options and ideas, some very simple to start or send the client home to explore between sessions. As you consider adding movement into your practice, where do you think you will start?

    To get the full video lecture on this with more insights and ways to work with clients click here


    Appelhans, B. M., and Luecken, L. J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10(3), 229-240. DOI: 10.1037/1089-2680.10.3.229

    Droste, S. K., Gesing, A., Ulbricht, S., Müller, M. B., Linthorst, C, E., & Reul, J. M. H. M. (2003). Effects of long-term voluntary exercise on the mouse hypothalamic-pituitary-adrenocortical axis. Endocrinology 144(7). 3012-3023. DOI: 10.1210/en.2003.0097

    Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Psychoneuroimmuology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology 70(3). 537-547. DOI: 10.1037///0022-006X.70.3.537

    Porges, S. W. (2007). A phylogenetic journey through the vague and ambiguous Xth cranial nerve: A commentary on contemporary heart rate variability research. Biological Psychology 74(2). 301-307.

    Reuille-Dupont, S. (2014). Impact Psychological symptom severity on leisure time exercise behavior and perceived benefits and barriers to physical exercise. (Doctoral dissertation). Retrieved from ProQuest. (UMI Number 3686498)

    Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial trigger points then and now: A historical and scientific perspective. PM&R The Journal of Injury, Function, and Rehabilitation 746-761. DOI: 10.1016/j.pmrj.2015.01.024



    Stacy Reuille-Dupont, PhD, LPC, CPFT holds a PhD in Clinical Psychology/Somatic Psychology from The Chicago School of Professional Psychology. She is a licensed clinical psychologist and licensed addiction counselor. Her psychology practice looks at the impacts of physical exercise on mental health symptoms. More at her psychology practice website: or blog: where she blogs about psychology, movement, and health from the inside out.

  • 2 Dec 2019 5:16 PM | Anonymous member (Administrator)

    Boundary exercises:

    1. Toward and Away
    2. Like it / Don’t like it
    3. Boundary-Setting Script Rehearsal

    “Toward and Away” is a well-known physical proximity exercise that can be done with groups, couples, and individual clients.

    One person stands still and their partner, facing them from a few yards away, moves slowly toward the still person until the still one detects some sensation of alarm or hesitation and then tells the person coming toward them to stop. Clients usually need a few attempts at this to become sensitized to the somatic cues of their own boundaries, and it tends to be a satisfying process of self-discovery. Variations can include approaching from the sides, from the back, or with varying speeds.

    In groups, two lines of participants face each other and practice with the person facing them, taking turns. Couples do this with each other. Therapists can also practice this with their individual clients, volunteering as the "still" person if the client needs a demonstration of tracking somatic cues related to boundaries, threat, and safety.

    Like it/ Don’t like it

    One of the ways to introduce different aspects of relational dynamics is to designate one side of the room (or piece of paper if constrained) as “like it most” and the opposite side as “don’t like it at all”. Call out likes and dislikes at intervals, especially in regard to interpersonal dynamics, and have clients organize themselves along the spectrum for each statement, evaluating and expressing how much they (and their neighbors) like or don’t like something. This exercise has endless room for creativity, but examples relevant to the setting of interpersonal boundaries include statements such as:

    1) I like being alone when I’m angry;

    2) I like to resolve conflict immediately;

    3) I respond well to a thoughtful or expensive peace offering; and

    4) I really like being held by someone safe when I’m upset.

    This can be adapted to work with groups, families, couples, and individuals. It creates a safe space to playfully and honestly self-assess, understand each other, and express our individual preferences and shared neuroses.

    Boundary-Setting Script Rehearsal

    A fan of action methods, I have rarely been disappointed by combining somatic tracking with empty chair work to create a powerful therapeutic intervention. Using trauma physiology and affect tolerance to inform the practice of communicating interpersonal boundaries is a satisfying iterative process. The integration of somatic practice and action methods makes space for organic expressions of healthy aggression, dissociative adaptations, attachment behaviors and other coping strategies that make up the meat of therapeutic insight. This increased self-knowledge leads to a greater sense of choice and capacity for effective communication once attended to and worked through.

    The process is this: A client (with moderate affect tolerance) imagines someone they need, or needed, to establish a boundary with in the empty chair. As they attempt to articulate their boundary setting, the therapist helps them identify and process the feelings and instincts that arise and inhibit their honest expression of needs in their actual relationships.

    This exercise is ideal for individual sessions and group therapy. It can be useful in couple and family therapy, although it’s worth noting that the tension of the exercise increases dramatically when the invisible subject in the empty chair also happens to be visible, present and observing the exercise from the same room.

    Provided by By Sonya Denise Ullrich, MS, AMFT, 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.

  • 31 Oct 2019 5:00 PM | Anonymous member (Administrator)

    Addiction From The Bottom Up: A Felt Sense/ Polyvagal Model of Addiction

    Many of us working in the healing arts are exploring alternative ways of experiencing and conceptualizing the body, recognizing that the western, post Descartes view of mind/body duality is distorted and harmful. Our current way of understanding and treating addiction reflects this disembodied view. Addiction is seen as a malfunctioning of our computer-like brains.

    Shifting into a bottom up approach allows us to experience the wisdom of the body, and the wisdom of addictive responses. From an embodied place of experiencing, and through the lens of Polyvagal Theory, we understand addictive behaviors as the bodies attempt to keep us  alive when being present is too overwhelming.

    It’s time to look at addiction with a fresh pair of eyes. I have created a new model in the conceptualizing and treatment of addiction. The current brain disease model is failing us, rates are soaring, and people are dying in the streets. We can and must do better than this!

    Over forty years of keeping my client's company I have developed a model that understands addiction as an adaptive attempt to regulate emotional states. Addictive behaviors are self-soothing/self harmful ways to survive when we aren’t able to calm ourselves. These behaviors do not come from sickness: they come from a bodily response to threat and a wired in mechanism of survival. The Felt Sense/ Polyvagal Model (FSPM) addresses addiction where it lives, in the body.

    Download the Felt Sense - Polyvagal Model (FSPM) Model

    This graphic model draws from the work of: Stephen Porges - Polyvagal Theory, a new understanding of the autonomic nervous system, Eugene Gendlin - Felt Sense embodied psychotherapy practice, and Marc Lewis - learning model of addiction. This work is a first in bringing addiction into the exciting world of Polyvagal Theory.

    The objective is to provide a graphic model of addiction that integrates new neurobiological findings in brain research, an alternative learning model of addiction (Lewis, 2015), and subsequent clinical approaches that address embodied trauma therapies. Therapists will be able to understand addiction using a sophisticated theoretical framework and treatment strategies that challenge old, pathologizing approaches. The model is adaptable to any school of psychotherapy or healing practice.

    As I began to learn about Polyvagal Theory, I realized that it enhanced my understanding of what I knew intuitively: Clients were using addictive behaviors to propel themselves from a state of sympathetic arousal to a dorsal vagal response of numbing, and vice versa. Through the lens of the Autonomic Nervous System (ANS), we see these behaviors as adaptive.

    The Felt Sense/Polyvagal Model

    Looking at the graphic depiction of the FSPM Clinician version we can see a number of important theories overlapping.

    Focusing and the Felt Sense

    The term Felt Sense, named by Eugene Gendlin, PhD. (Focusing, 1978) comes from a contemplative practice called Focusing.

    Focusing is a six step process that helps us to find our implicit, embodied knowing about an issue in our life. A knowing that is at first vague. Turning attention inwards and listening with compassion allows a felt sense, a whole sense of the situation, to form. See example below.

    Notice on the Felt Sense Polyvagal Model that each circular state has the words thoughts, feelings, physical sensations, and memories. Each of these different aspects of experience are a pathway into the Felt Sense. In asking questions about these aspects we help the client to deepen their embodied knowing of the issue. As the felt sense forms we pause and stay with the fullness of experiencing. Sometimes a Felt Shift, a physical release happens as the client integrates a new knowing. This shift is the bodies’ knowing and pointing in the direction of growth and healing. The client feels a relief, a settling. Focusing is a natural process that happens all the time. Gendlin didn’t invent it. He found that clients who were doing well in therapy were connected to their bodies. They had access to a Felt Sense. However, because we live in such a disembodied culture, many clients need help to connect, so Gendlin created the steps.

    The following is an example: A client comes in with anxious feelings and a tightening in her  throat. She says that she doesn’t know why she feels this way. We begin the process of quietly turning attention inwards, down into the centre of the body. Tears come as she connects the physical sensations with the feelings of sadness and anger. A beginning of the Felt Sense starts to form. I ask “Can you welcome both feelings?’ she pauses and explores where there are no words. She puts a hand on her throat.

     “ I don’t know how to be with anger”, she says. More sensing into the body.

     More tears flow as she feels the physical sensations of the Felt Sense flooding into her throat  and now down into her chest. A whole Felt Sense of her situation forms; thoughts, feelings, physical sensations, and memories.

    “This goes way back for me. Little girl afraid to be angry, so I cry instead. This needs to stop. I need my anger.”

    Her whole body moves and relaxes with a Felt Shift. She feels her throat loosening, a new piece has come for her. An explicit knowing that has great meaning for her. A need to connect with her anger. Her Felt Sense carries this meaning forward into her life as she welcomes what came in her Focusing practice session.

    Now we can map the felt sense onto the Felt Sense Polyvagal Model to integrate the autonomic nervous system states. This gives us more information about the client’s journey. In the Clinician version she has moved from chaos/sympathetic meme, down to Integrated/Ventral meme in her Focusing Oriented Psychotherapy session. Together we look at the Client Version of the model as she maps her journey from Flight/Fight to Flock.

    Polyvagal Theory

    Looking at the graphic depiction of the FSPM Clinician version, we can see:

    Three circuits of the ANS—Depicted in the solid line triangle at the bottom right legend

    A)    Ventral in yellow at the bottom of the page,

    B)    Sympathetic in red on the right, and

    C)    Dorsal in grey on the left.

    Intertwining States---Depicted in the dotted line triangle at the bottom right legend.

    Intertwining states are states in the system that utilize two pathways. The Autonomic Nervous System has the capacity to blend states creating a greater range of experiences.

    Intertwining states are represented in the model in mixed colors.

    Play is on the bottom right in yellow/red.

    Stillness is bottom left yellow/ grey.

    The FSPM proposes a third intertwining state of Addiction

    Addiction is at the top of the model, red/grey

    This state is a blending of sympathetic and dorsal. Without the presence of the ventral vagus, the Social Engagement System is offline. When trauma and other states of emotional dis-regulation occur, the capacity to regulate through the ventral vagus are compromised. The ANS shifts into survival mode. We can then employ addictive behaviors in an effort to seek relief from suffering.

    Applying The Model

    In addition to providing a new map for teaching the model, I have created a simple version for clients that uses 6 F’s to define the states of the Autonomic Nervous System. Flight/Fight, Freeze, Fixate, Flow, Fun, Flock. With time our clients learn how to identify and track the state that they are in, and to use the tools that we teach them to move more and more into the ventral vagal state.

    A Call to Action

    “Addiction is our teacher” says Bruce Alexander. In his new documentary, Rat Park, he shows us how we have lost connection with each other and with the natural world. He sees addiction not just as a psychological problem, but a global, political problem.

    Addiction is a political problem!

    I invite you to join me in standing up, and speaking up about a new way of understanding and treating addiction. I am currently writing a book about the model. For more information and questions please go to my website.

    Download Felt Sense Polyvagal Model to Share with Clients 

    A Call to Action

    “Addiction is our teacher” says Bruce Alexander. In his new documentary, Rat Park, he shows us how we have lost connection with each other and with the natural world. He sees addiction not just as a psychological problem, but a global, political problem.

    Addiction is a political problem!

    I invite you to join me in standing up, and speaking up about a new way of understanding and treating addiction. 

    I am currently writing a book about the model. For more detailed information and questions please go to my website

    Jan Winhall, M.S.W. R.S.W. F.O.T.T.  Toronto, Canada. Jan is a psychotherapist in private practice and Director of Focusing On Borden, a centre for teaching Focusing and Focusing-Oriented Therapy. Jan is the author of “Understanding and Treating Addiction with the Felt Sense Experience Model” In Emerging Practice in FOT. Jan teaches internationally and is a lecturer in the Faculty of Social Work at the University of Toronto. She is currently writing a book about her new Felt Sense/Polyvagal Model for treating addiction.

  • 12 Sep 2019 2:39 PM | Anonymous member (Administrator)

    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 member (Administrator)

    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 


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    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. 

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