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.

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: http://www.focusingonborden.com/

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.

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.

 

Conclusion

 

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.

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. ...like 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. 

Summary: 

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 

nanwecan@comcast.net 

410-730-8780

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

4 Bateau Landing 

Grasonville, MD 21638 

linda.healingbridges@gmail.com  

www.healing-bridges.com 

410-827-8324

Find Out More:

www.ac-ts.com 

www.healing-bridges@gmail.com 

References 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Schwartz, M., Galperin, L., & Gleiser, K. A. (2009, March 13). Attachment as a mediator of eating disorder: Implications for treatment. Retrieved from Castlewood Treatment Center for Eating Disorders: http://www.castlewoodtc.com/wp-content/uploads/2011/07/attachment_as_a_mediator.pdf 

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

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

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

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ACKNOWLEDGMENTS 

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. 

A new section by Sheila Rubin, LMFT, RDT/BCT

Role Development

Role development p 396 In a chapter about Psychodrama by Antonia Garcia and Dale Richard Buchanan in Current Approaches in Drama Therapy by David Johnson and Renee Emunah, “Moreno believed that the self emerges from the roles we play. He postulated that when people learn a new role, they follow a particular pattern of role development. The arc of the learning curve begins with role taking and proceeds to role playing and role creating.” “Dysfunction occurs when a person has a lack of either social roles or pschodramatic roles and function is seen as having a balance of both.” First a person can’t imagine a certain role, so I tell them a story about someone who had that role. Then I may suggest a conversation that that person may have. P, 43- Moreno wrote that “In orer to develop functionally moreno believed that each of us must first be doubled as newborns.” So much of the work I do in the therapy session is about mirroring the client.(p. 43)

From my chapter “Self In Performance” I write:

“Each story in our lives is like a pebble splashing into the pond of our inner worlds and the water that ripples naturally outward. When there has been trauma, the stories that would naturally flow outward can get truncated, withheld, or lost.”

This list is from my chapter “Almost Magic…” I wrote a series of therapeutic processes to work with shame. This can happen over the internet as well, as I describe in the case that follows,

Working with shame

• Counter-shaming- Help the client experience a series of successes. Focus on strengths.

• Grounding

• Some personal sharing to join and show humanity, join in imperfection

• Provide psycho-education about shame

• Mindfulness or observing ego

• Use objects or symbols to externalize shame and process current shame

• Separate shame from other emotions- objects or scarves or pillows can provide symbols

• Use projective or embodied to explore where the shame came from

• Introduce a protector

• Find aesthetic distance for the client to work with the shame

• Using projective or expressive processes to work with the shame

• Find a person’s true voice

• Give back the shame to where it came from- giving the shame back

• Witness the powerful healing taking place

• Embody the new role the new voice- try a posture or movement

A teen aged client complained of feeling “a presence watching me sometimes”. As we worked, I wanted to understand about the presence she felt sometimes while undressing an also when she got home from school. I wondered if it was perhaps an externalized voice of her inner critic, so I asked general questions about how she felt at school, at home, and listened for something that said she might feel judged or criticized. I asked when she felt the presence most strongly. She felt it most strongly in school when even though she knew the answer, she felt shy to raise her hand because the other person would be thinking that she would give the wrong answer that maybe wasn’t smart. She had fears of letting herself down and letting down her family. Over time I would normalize her concerns by telling her some of the developmental jobs of this particular time in her life is about comparison and finding her way socially as well as academically. I shared briefly about my shyness in highschool and ways that I over came it. This helped to normalize what she was going through and model that it is possible to get through, I helped her begin to feel inside her body by grounding exercises and stomping her feet.

At some point she could feel inside her body near the end of the session and she began to feel lighter and more hopeful. The presence was on a trip and she was able to use coping skills to put her attention on other things. During one skpe session we used symbolic imagery symbols to represent the part of her that was afraid that if she showed up as her real self in school, and people still didn’t like her then, she would feel destroyed. The imagery to protect this tender part of herself that she was maybe protecting by listening to the presence. I had empathy for this part that needed protection.

A session I asked her to imagine a movie or play with similar characters, say a waitress and a customer. Let’s say the waitress made a mistake with the order. And in the first seen, let’s say the customer is a mom who used to work as a waitress. How would the girl who was a waitress feel- terrible, just terrible. And if the customer left a big tip then the girl would realize that she must have gone through the whole dinner remembering her mistake and thinking about it the whole time. I asked. Would she have compassion for the young waitress because she know how that is a hard job and just learning. Yes, she said, but you know, if she gave a big tip it is because she probably thought she is a looser. Wow, I said, pretty critical. And let’s change the seen, same seen, different movie. Let’s say it’s the same waitress and the customer is someone her same age. Let’s say he’s a guy this time, let’s say a cute guy. So how would the waitress feel if she made a mistake at his table? Even worse, she said. So much worse, because he’s someone she wants to impress. That would be horrible!!! She probably would just feel like she’s wrong for even thinking he was cute if she made a mistake. And what about the tip? What if he left a big tip? That would be the worst, she said. Why I asked? She sighed and said, if it was someone her own age and she made a mistake that would be horrible. Why, I asked. Because he would know how awful she really was. As we discussed feelings of being embarrassment getting more and less depending on the situation.

So is there something you could tell the waitress about each of those scenes? I said something about it being a new job and a high leaning process. I asked her what she would tell the waitress if she could, to reassure her? And I asked to replay the scene one more time and said if you could go back and change one thing after the mistake, what would it be? In the first scene she had the waitress tell the female customer how sorry she was, and that she was just learning this new waitress job. And imagine how she would respond? She might laugh in a kind way and say that she remembers that. How does it feel? She paused and said – not so bad when we talk about it. I had her go back into the other scene with the cute guy and she imagined telling him later that it was her first day so of course the job was new. She imagined the waitress then joking with the guy and both of them laughing! How does that feel? So much better, she said. So how does your body feel? Lighter…A little more space. Where is the space? She points to her chest.

As we unpack the scene in our talking she admits surprise at how easy it was to imagine the waitress talking about her mistake and saying what was happening for her instead of keeping it all inside! I asked about the feelings of embarrassment. Much less. She said she couldn’t wait to practice this next week.

I explained that we were working on several levels. One level was giving her tools to cope with the experience of the presence and the shyness. On another level we were working with symbols to understand the role that the presence has for her and other ways to relate to it. Another level we are working developmentally about what it is to be female in high school and all the issues of dating, finding her place with the other kids socially and intellectually. She began to understand that the presence was something she could gain more control over, by shifting her focus away from it by talking to family, friends, getting busy with schoolwork. Eventually she realized gained a different relationship to it and it bothered her less and less. As she became more comfortable with saying what was going on with her instead of hiding behind her shyness, friends started to reach out to her more and she didn’t feel as alone.

The power of somatic imagery helped. Role plays that we did over skype helped. The eye contact we had over skype helped her feel normal and part of her life journey.

She reported learning to begin to laugh at herself, something that had been very hard, in a way that was countershaming for herself and the other person. She reported that it took the pressure off of herself and the other person when in an uncomfortable moment. She said that sometimes she wasn’t worried what the other person was thinking anymore.

Along the way we found things to say in her new role of power taking her locus of control back , “ I’m commited, I’m ready, I’m in control” In sessions she would feel a calmness in her body and a relaxedness. That’s how I would track.

Imagination Activated via Drama Therapy and Expressive Arts Therapy

From our workshops and from an unpublished paper on “Healing Shame in the Imaginal

Realm” Bret Lyon, Ph.D., and I present that:

When a person gets stuck in shame, the most powerful way to get unstuck may be to activate his or her imagination. In the imaginal realm, logic and time are fluid and flexible. What actually happened can be explored and changed. What was stuck can be reexamined and shifted. Shaming situations from the past can be revisited, excavated through writing and expressive exercises, and thereby shifted.

There are ways to give back the shame to where it belongs—through drawing, writing, and imagining past shaming experiences and saying now what you wish you had said then. Structured writing and expressive processes can symbolically give back the shame. This is where to find resilience. This work can be done with extra care when the session is over the internet because the person can quietly slip into the shame vortex. I develop exercises to help them have something to hold on to during and after the session.”

Renee Emunah in her book Acting For Real (1992) writes about “Drama Therapy as the intentional and systematic use of drama and theater processes to achieve psychological growth and change” (p.3). Drama therapy can include play, role play, psychodrama, dramatic ritual, and psychotherapy. We are helping the client to develop an observing self, an inner director that can reflect on our life (p.32). “A dramatic enactment can include both reality and fantasy (p.27). Eva Leveton from A Clinician’s Guide to Psychodrama wrote about the therapist becoming the client’s double, and talking for the client as an emotional double or a counselor double, or an exaggerated double. Adam Blatner expounded that psychodrama offers a place for replaying scenes of the past, expressing feelings now that have not been expressed, and for opening new possibilities for the future. “Individuals are invited to engage more authentically in activities that increase their sense of being alive” (Blatner, 1988, p. 85).

Working with Counter-shaming Metaphors

There is much to be explored in this new world of online therapy. As I was writing this chapter I received an email and was invited to possibly set up some online groups for an eating disorder program. That would be an interesting population to work with online because when I work with them in person, many tended to dissociate. There is much to be discovered. There is much to be explored. There is much to be created. I am excited about being able to reach people who don’t live near me and do work online. I am excited about developing ways to work through shyness and awkwardness and shame that many clients present using combination of drama therapy, expressive arts and attachment work/psychotherapy.

Adam Blattner writes in Foundations of Psychodrama, p. 79

Activity in Psychotherapy

Blatner writes “The process of psychotherapy should not be thought of as a passive treatment in the sense of the medical model typified by receiving penicillin shots for pneumonia. Rather, it is a form of experiential learning, requiring a significant degree of courage and active partipation on the part of the patient” As a way to move beyond the typical tendency to lapse into passivity he suggested including elements of imagination, emotion, plysical, movement, and cognition and including play in therapy sessions. P.79

Metaphore

Blatner writes about the value of metaphore in psychotherapy (p.155)

Surplus Reality

Blatner writes in Foundations of Psychodrama. That one can enact not only scenes that involve real events in a person’s life, but also scenes that have never happened. The scenes can represent hopes and fears or other psychological concerns.(p178)

Homework I often suggest after online sessions dealing with shame: Draw or write in your journal, play music that is soothing or exciting, move dance, meditate, get it all out to writing and writing, and then close the book! Now begin your life!

ABOUT THE AUTHOR

Sheila Rubin, LMFT, RDT/BCT is a leading authority on Healing Shame. She co-created the Healing Shame Lyon-Rubin therapy method and has delivered talks, presentations and

workshops across the country and around the world at conferences from Canada to Romania for over 20 years. Sheila is a registered drama therapist and a board certified trainer through NADTA, adjunct faculty at John F. Kennedy University’s Somatic Psychology Department. She is an alumnus and has taught for California Institute of Integral Studies’ Drama Therapy Program.

Her expertise, teaching and writing contributions have been featured in numerous publications, including six books. Sheila is a president emeritus of San Francisco CAMFT and the Northern

California chapter of NADTA. For more information on Healing Shame workshops, certification and private therapist consultations visit www.HealingShame.com or www.SheilaRubin.com. She

integrates somatic, expressive and attachment modalities in her work with couples, families, and children who have shame and trauma. Her private practice is in San Francisco and Berkeley, CA. Sheila has trained with attachment theorists Diana Fosha and Sue Johnson, and Hakomi somatic pioneer Ron Kurtz.

Sheila and her husband, Bret Lyon, have created and co-lead "Healing Shame Workshops” for therapists in Berkeley, CA and throughout the U.S. and Canada. Sheila has written about her work in several publications. She authored the chapter "Women, Food and Feelings" in The Creative Therapies and Eating Disorders, edited by Stephanie Brooke, addressing her work incorporating drama therapy modalities into a hospital-based eating disorders program she developed. She wrote the chapter “Myth, Mask and Movement: Ritual Theater in a Community Setting” in Ritual Theater, edited by Claire Schrader. She authored a chapter on “Self-Revelatory Performance” in Interactive and Improvisational Drama; Varieties of Applied Theatre and Performance, edited by Adam Blatner. And she wrote the chapters “Almost Magic: Working with the Shame that Underlies Depression” in The Use of the Creative Therapies in Treating

Depression, edited by Charles Meyers and Stephanie Brooke, and “Embodied Life-Stories: Directing Self-Revelatory Performance to Transform Shame” in The Self in Performance, edited by Susana Pendzik, Renée Emunah and David Read Johnson, to be published in 2016.

Sheila can be reached at www.SheilaRubin.com and www.HealingShame.com.

References

Amadeo, J. (2001) The Authentic Heart; An Eightfold Path to Midlife Love,Canada, John Wiley and Sons

Blatner, A. (1988). Foundations of psychodrama: History, theory, and practice. New York, NY: Springer Publishing.

Emunah, R. (1994). Acting for real: Drama therapy process, technique, and performance. New York, NY: Brunner/Mazel.

Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York, NY: Basic Books.

Garcia, A. and Buchanan, R. (2009) Psychodrama in Johnson, D and Emunah, R. (2009), Springfield, IL: Charles Thomas Publishers.

Graham, Linda. (2013). Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-being. Novato, Ca.: New World Library.

Hughes, D. A. (2007). Attachment-focused family therapy. New York, NY: Norton & Company.

Johnson, S. (2005). Emotionally Focused Couple Therapy with Trauma Survivors; Strengthening Attachment Bonds, NY, NY. The Guilford Press.

Kaufman, G. (1974). On shame, identity and the dynamic of change. Paper presented at the annual meeting of the American Psychological Association, New Orleans,

LA. Retrieved from http://files.eric.ed.gov/fulltext/ED097605.pdf

Kaufman, G. (1992). Shame: The power of caring (3rd ed.). Rochester, NY: Schenkman

Books.

Nathanson, D. L. (1992). Shame and pride; Affect, sex, and the birth of the self. New York, NY: W. W. Norton & Company.

Rubin, S. (2007) Self revelatory performance in Intercalative and Improvisational

Drama; Varieties of applied theatre and performance, ed. Blatner, A. Universe

Schore, Allen N. Affect Regulation and the Origin of the Self: the Neurobiology of

Emotional Development. 1994 New Jersey, Laqrence Eribaum Assoc. Publishers.

By Marjorie L. Rand Ph.D.

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

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

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

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

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

• Breathing
• Containment
• Grounding
• Presence
• Breathing

Breathing

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

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

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

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

Containment

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

Grounding

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

Presence

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

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

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

About Marjorie L Rand, PhD

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

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

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

By Sheila Rubin, LMFT, RDT/BCT
Get Sheila's bio in part 2 of this article.

I begin this chapter about the internet with the fact that my clients think I’m a Luddite. I grew up with a wall phone telephone that, by definition, was attached to the wall. At most, we could stand a few feet from the wall, with a few inches of cord linking us to the phone. This was in a time even before answering machines. I came of age and went to study radio and television in college during the time of the black-and-white Portapak video machine that was heavy, where we actually spliced tape using our fingers—just before electronic newsgathering. Response time to a letter was a couple of days to a couple of weeks. I’m fully aware that the words I’m writing here will likely be outdated due to technology changes before the book is out in the world. I have accepted the use of a smartphone into my private practice, along with doing therapy over the phone or Skype if I have met the client at least once in person. I have come a long way!

Who Wants Therapy over the Internet?

People who live far away, people who don’t have time to drive to a therapist’s office, and people who are shy comprise the population of those who request therapy via the internet. I use the word shy to describe people who may feel uncomfortable or even ashamed about what they want to talk about “in private.” This is a great place. The internet provides a safe venue in which shy people may feel safer about seeking help. In working with shy people, I use extra care to welcome them, help them feel safe, and am aware that they may, at some point, reveal their shameful feelings

Therapy on the Phone or Internet

On both phone and Internet, with individuals or couples. I find that I check more often for

feelings that I might be able to sense when working face-to-face. I slow things down and tend to do more somatic work, asking clients to ground and to sense somatically for part of the session. I always ask at the end, “What are you taking from this session? What was helpful?” I also give homework after each session; for example, make a list of the coping skills from the session and put them on your calendar day by day, or take the powerful symbolic objects from this session and put them out in your room at home with a note by each to remind you what each part said to you today. Or, find an object to represent the shy part of you that is afraid to speak and take the card we wrote today and put it next to it. Practice it in the mirror before you talk to your boss.

Concerns about Technology

What about when technology fails, when a person just revealed something that has been hidden and Skype freezes? In the middle of a session, a husband was telling his wife why he had trouble when she touched him. Suddenly the screen froze and this tender moment was interrupted. I was frantically trying to call them on Skype, which would not reconnect. I had to call them on my cell phone; the tender moment had passed and they were fighting again. There was a rupture that had been caused by failed technology that mirrored the rupture in their relationship. I had to slow things down and gently find the words to meet them and name the negative cycle that occurred when communication came to a standstill. I used this as a symbol of what they were both dealing with within the relationship and helped them build a bridge toward each other.

Shame is the rupture of the interpersonal bridge, says Kaufman (1974, 1992). Any disruption in connection with a significant other can disconnect the person from him- or herself, or the therapist, and activate the feeling of shame.

What I realized was I had to let them know ahead of time the constraints and the benefits of using the phone for therapy or skype for therapy. It will save them time coming to my office when they are in a difficult place in the relationship, but it may not be as contained as an in-person session. One couple who was struggling with the husband having an online affair and the wife needing to see his phone to be reassured that he wasn’t meeting the woman. I spoke slowly and carefully to them to get an agreement before we began to talk. “Because we are not face-to-face, I can’t just put up my hand to interrupt you if there is shouting. I am going to do the session slowly and have you repeat what you hear the other person saying so that I can know you heard them and they can know that you heard them. We are going to take turns. Are you both in agreement? And because the phone is not a predictable medium, each of us is on a cell-phone, if one of us gets disconnected for any reason we need to have a plan. Is each of you near a home or office line? If someone’s line dies, we will momentarily stop the session and I will wait for the call of the person who was disconnected. Call me back on your office phone and I will use my phone to accept both calls.

Shame

In my chapter in Self in Performance coming out in 2016 or 2017, I write that “Shame can be right there in the shadows. It is easy for misunderstanding.” When I can’t see the emotion on clients’ faces, because we are on the phone or they are looking away from the skype screen, I don’t know what they are experiencing. In the book Shame and Pride, Nathanson (1992) explained that throughout life we are balancing between pride when we are seen in a good light and shame when we make a mistake of being seen in a less than favorable light. Diana Fosha (1992) later wrote that we would call this our “self at best” and our “self at worst.” We strive to be seen as smart or clever or helpful, but when a mistake is made and something is unclear, suddenly the person is risking being exposed and seen as self at worst. This concept is helpful to remember as a client is sharing vulnerable revelations. I know from my own vulnerability how scary it can be to be exposed at the wrong time or without kindness and support.

Skype Therapy

I have done consultation for colleagues as well as therapy sessions on Skype. The good news is that Skype can serve as a bridge between family members who do not live within driving distance of one another. It can also get in the way of direct eye contact and physical contact those family members long for. It proved very therapeutic for an elder client to see her grandchild over Skype, even though she believed it would not “do the trick.” She had been hurting because her son didn’t call her as often after the baby came and that the other grandparent was invited and she was not. We role-played her talking to her son, but nothing shifted. She still felt left out, like something was wrong with her for not being chosen to spend time with the new family. We unpacked under all the feelings of anger toward her son for not insisting that his wife invite her at the same time as the other grandparents and under that was the feeling of shame. She felt ashamed to not be invited and fought with him on the phone when they did talk. I asked her to role-play talking to her son in a way that invited a solution instead of blaming him for her

frustration. I invited her to role-play the visit with the grandchild. She rocked back and forth.

Finally, I suggested that she use Skype as a way to visit her grandchild. She told me that I didn’t understand. She wanted to pick her up and rock her in her lap in the rocking chair. I invited her to try just one phone visit on Skype with her son and grandbaby. She sat in the rocking chair at her home and rocked during the skype session with her son and his Babby. She was delighted to see her grandchild recognize Grammy over Skype. This experience fulfilled her longing to visit with her grandchild. There were many Skype visits thereafter. Her feelings of shame about being left out decreased and invite to visit increased.

Containment

Please note that I only do sessions remotely if I have met with the client in my office and we have developed a solid therapeutic container first. When the client is in my office, I can observe a range of nonverbal cues and get a sense of his or her energy. Over the phone, there are subtle cues I may miss. Here are ways I work with the absence of the visual modality. Because I am not seeing them, there are things I need to do to contain the energy of the session and the pace of the session. Because the client isn’t seeing me, there are ways I want to structure things to help them feel me where they are sitting.

Case Example of Phone Session

This client was feeling dark; her boyfriend was spending time with his ex-lover again instead of going on the date they had planned.

Client: “He’s still in the role of letting his ex rely on him. I couldn’t stop crying for hours.

My emotions got all wacky or something. I see his side when he’s helping his kids. But

every act of his kindness is an act of affection toward his ex. One day its good between

us, and the next day I feel ignored, neglected.”

Therapist: “How about if you choose something in your room to represent your feeling

neglected and ignored.”

Client: “OK, this plant.”

Therapist: “Can you move it near you and look closer at it? And as you are looking at it,

what does it say to you? What does it symbolize?”

Client: “You have to pay attention to a flower. You have to water it or it dies!”

Therapist: “So that’s a very powerful symbol of needing to be tended and cared for.”

(I wanted to pause and have her reflect on the importance of her attachment needs. She really wanted to just rush past them in the session. Choosing an object helped me direct the session to make space for that subject. The act of choosing something took her into another part of her brain where creativity was more open to her. Having a symbol can be a very powerful metaphor. Having it in front of her helped her to focus on it during the whole session).

Client: “Yes! I want to be cared for. But when I feel this way, I don’t feel like myself. It

feels like I don’t exist. It’s too painful when he says he’s coming over and then he cancels

because he’s with his ex-lover. Why am I punishing myself? I could go out and be in

another relationship!”

Therapist: “So there’s another part of you that doesn’t want to be punished anymore, that

wants to find another relationship, one where the guy is choosing you instead of choosing

his ex. Can you look around the room and find an object that represents this part of you?”

(This is another place I want to pause the session and give her time to feel the

power of what she just said. I want a symbol for that part so we can talk to that

part as well, maybe have a conversation with both of them.)

Client: “This candle!”

Therapist: “Can you put the candle in front of you and look at it. What does it represent?”

Client: (Surprised) “There’s a light in it! I can attract things…people! But I’m not ready to move on.”

Therapist: “Can you give each a voice? What does the flower say and what does the

candle say to you?”

(The candle told her that she is bright inside when she’s not so depressed

worrying what is going on with this guy she’s dating. It gives her inspiration to

grow herself and step out of the relationship to a real relationship where someone

could really be available for her. As she was expressing this, another feeling

showed up.

Client: “I feel deep anxiety.”

Therapist: “Where is the anxiety in your body?”

Client: “My diaphragm.”

Therapist: “Can you put some space around it and take some slow deep breaths?”

Client: “I’m not being logical. I should just leave him. But I don’t want to leave him. He

says kind things to me, offers to work it out. I really care about him. He’s clear about his

intention that he wants to be with me!”

Therapist: “There are a lot of conflicting feelings.”

(Because we are on the phone, I want to keep the connection and let her know that

I am here and that I hear her.)

Client: “I’m scared. Lonely.”

Therapist: Yes, there’s a part that’s scared and lonely.”

(I want to support this part.)

Client: “It’s like a pouting child!”

(And it feels like she is putting down that part. It is like some part of her is

shaming that part of her for wanting what she is wanting.)

Therapist: “I wonder, I’m curious if there is some shame around that part?”

Client: “Yes.”

Therapist: “Can you look around and find an object to represent the part that comes out

and shames you when you talk about your attachment needs?”

Client: (Apparently looking around her room for a few moments) “A hat.”

Therapist: “How does a hat represent shame?”

Client: “I put it on myself!!! I have a hard time asking him to meet my needs and I’m scared that they won’t get met again. That he’ll cancel plans with me again!”

Therapist: “Maybe the shame comes out to put you down for feeling what you’re feeling?”

Client: “Yes. If I’d recognize those things, logically I would leave.”

Therapist: “That inner conflict is so painful. So one part of you shames you for having normal wants and needs from him and when you think he lies again or cancels plans, then that part shames you again for not leaving.”

Client: “He told me he couldn’t have me over because he didn’t want his neighbors to think I was a homewrecker because his ex just moved out. So now I feel shame for wanting to come to his house. It’s been over six months we’ve been dating. So when is he going to tell people?”

Therapist: “How did you feel when he said that?

Client: “Insecure! Nerves all over my body. On edge!”

Therapist: “What did the nerves say?”

Client: “Run!”

Therapist: “And what did you do when you felt that strong urge to run?”

Client: “I’m feeling shame about my feelings. He’s good with his words, but his actions don’t match. Then I feel shame for wanting to leave.”

Therapist: “I wonder if this current feeling of shame reminds you of anything that happened before in your life.”

Client: “I feel so much shame in this relationship. It reminds me of my last relationship.”

Therapist: “The one where the guy was hiding his porn addiction and hiding his other lovers?”

Client: “Yes. That was terrible. But I want to give this guy more opportunity, more time to show me that he can make the life for us he is always promising. I want to give him the benefit of my doubts. I want this relationship to work.”

Therapist: “Of course you want this relationship to work. Can you turn to the plant that represents your needs? What does the plant say?”

Client: “The plant says, ‘You’re making yourself suffer!’”

Therapist: “What does the hat say?”

Client: “It says that I’m ashamed of my feelings. I’m embarrassed that I want him to visit me instead of his kids. That’s terrible.”

Therapist: “What does the candle say?”

Client: “It says that I don’t need to shame myself for my feelings. I have a light inside me. I need to remember.”

(I’m wanting her to stop here and reflect and to work to understand if maybe there

is something here for her to be shameful for. That would be a form of healthy

shame.)

Therapist: “Sometimes shame can pull a person out of her deep knowing by cutting off the life force or the light. Sometimes there is healthy shame that tells a person that there is something he or she doing or another person is doing that is actually shameful, that should be shameful. And there might be helpful information here if this is healthy shame. Healthy shame can help a person make new decisions or understand things differently. Here is some homework to do before our next session. Get out your journal at the end of the session and ask yourself, “What did I get from this session?” Please write it down. And please write down some of these questions. Please do some journal writing to answer these questions:

• What does the plant say?

• What does the candle say?

• What does the hat say about how you shame yourself?

• Listen to the shame and feel if there is something of value here or if it is just putting you down.

• Is there part of it that is valid?

• Is there something to listen to that is actually shaming in the situation for a reason?

• Is there something here from a past relationship or situation where you felt shamed?

• Is there something you feel shy about?

• Is there something for you to learn about shame here?

Understanding Shame

Shame is a primary emotion. The role of shame is to warn us and protect us. Our nervous

system shuts down and we actually lose cognitive ability when we are feeling ashamed.

Two indicators of shame are confusion and stuckness. Shame can freeze both mind and body. Shame is so difficult to see and cope with because it often hides behind other emotions. Shame, like of its functions is to protect us by lowering our emotional intensity and capacity to act. It is important to differentiate healthy shame, which can help us pause and rethink, from toxic shame, which can produce paralysis and leave a person so frozen that he or she is incapable of action and clear thinking. Healthy shame can lead a person to take responsibility for his or her actions, reassess, and make changes.

Healthy Shame

John Amadeo in The Authentic Heart writes that shame can be instructive and that “properly acknowledged shame and guilt can open a doorway to understanding how you’ve hurt someone.” (p. 64)

While excessive or toxic shame can keep a person in denial, “shame overload paralyzes

your capacity for clear introspection.” He says that “No growth is possible without some

small amount of shame.” (p.65)

In my chapter “Embodied Life-Stories: Directing Self-Revelatory Performance to

Transform Shame” in the book The Self in Performance by Emunah, Johnson and

Pendzic, I wrote:

“When we become significant to another person, as happens when we are therapist,

supervisor, friend, spouse, or parent, then we can induce shame in him or her unconsciously, unintentionally, even without knowing it has happened. Failure to fully hear and understand the other’s need and to communicate its validity—a look in the other direction, a frown, a disappointing facial expression—whether or not we choose to gratify that need, can sever the bridge and induce shame.

Developmental needs that are not met over time can also lead to internalized shame. The child learns to feel shame that his or her needs don’t matter; the rupture is from outside, from the parent who fails to validate the child’s needs.”

I would add that it then is on the inside and the person learns unconsciously to shame themselves. “I am creating attachment through my witnessing, which starts from the first moment: being seen in a positive way, which is counter-shaming.” Daniel Hughes in Attachment-Focused Family Therapy writes about why shame may be a central factor in the development of pathology and a deterrent to getting help: “First, shame places one in a fog, hidden from potentially significant others, actively avoiding the exposure to another who could provide—through intersubjective experiences of acceptance, understanding, and empathy—a pathway toward both effective regulation as well as self-awareness. Second, shame prevents the development of the ability to reflect on and make sense of one’s behaviors and subjective experiences” (p. 184).

In the Eight Keys to Safe Trauma Recovery (2000), Babette Rothschild notes that “shame, quite simply, tells us that something is amiss” (p. 87) and that “Rather than discharge, as an example in yelling or crying, shame dissipates, when it is understood or acknowledged by a supportive other. More than any other feeling, I find that shame needs contact to diminish” (p. 92). Rothschild describes a process for deciding when to address shame, understanding the value of shame, apportioning shame fairly, and sharing shame (pp. 98–100).

by Tina Stromsted, Ph.D.

Nature as Witness

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

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

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

The body as transformative vessel 

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

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

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

Discovering Authentic Movement

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

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

Application of Authentic Movement 

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

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

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

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

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

AMI & Soul's Body 

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

DreamDancing® 

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

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

BodySoul Rhythms®

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

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

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

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

Conclusion

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

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

References:

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

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

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

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

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

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

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

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

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

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

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

Wilkinson, Margaret. (2006).  The dreaming mind-brain: a Jungian perspective. Journal of Analytical Psychology (51), 43–59

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

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

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

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

   

 Published: Tina Stromsted. (July, 2018). Embracing the Body, Healing the Soul, C.G. Jung Society   of Atlanta Newsletter.  http://jungatlanta.com/articles.html 

By Dr. Leslie Ellis

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

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

A theory of personality change (1964)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The experiential response (1968)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Alex Diaz, PhD

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

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

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

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

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

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

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

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