Frontiers in the Treatment of Trauma

Transcription

1 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 1 Frontiers in the Treatment of Trauma The Body's Critical Role in the Treatment of Trauma a TalkBack Session with Joan Borysenko, PhD; Ron Siegel, PsyD; and Ruth Buczynski, PhD

2 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 2 A TalkBack Session: The Body's Critical Role in the Treatment of Trauma with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Ron Siegel, PsyD Table of Contents (click to go to a page) What Stood Out Most... 3 Paying Attention to the Body When Treating Trauma... 5 How Therapists Can Use Body Work... 7 How to Keep Patients in The Now... 9 About the Speakers... 11

3 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 3 A TalkBack Session: The Body's Critical Role in the Treatment of Trauma with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Ron Siegel, PsyD What Stood Out Most Dr. Buczynski: After that session, I can see why Pat has such a following. Let s start again, as we always do, with what struck you when I talked to Pat? Let s start with you first, Ron. Dr. Siegel: I think what struck me most about Pat s presentation was this idea of finding the optimal middle space between the two difficulties that people who have suffered trauma experience the middle space between hyperarousal and hypoarousal. That threw me back to my early days of formal training as a therapist where I was trained by psychoanalysts who used to talk about titrating anxiety the idea was to get the level of anxiety so that it isn t too low that the person isn t challenged nor is it too high that they re overwhelmed. This is always our therapeutic task, but it becomes particularly poignant when we re dealing with folks who can go off the rails one way or the other that they become lost in hyperarousal or in hypoarousal. I also was very moved by her talking about allowing the body to speak. There are so many times in psychotherapy when we have a sense that, Something is going on here beneath the surface but I don't really know what it is. To get the level of anxiety so that it isn t too low that the person isn t challenged nor is it too high that they re overwhelmed is our therapeutic task. We re involved in this manifest content but, I can t I m somehow not touching the issue and I don't know what it is. This is the idea that Pat talks about and it shows up in so many other traditions: it shows up in Gestalt therapy; it shows up in Eugene Gendlin s focusing work; it shows up in Peter Levine s work that we spoke about earlier in the series. It s the idea that one can simply go inside, notice what is happening in the body and allow that to speak. It allows words, images, and associated thoughts to come out.

4 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 4 This will almost always be a royal road to the unconscious, if you will. It will almost always tell us what is happening now that s an enormously useful insight and approach. Finally, I d just like to say that she s honoring Wilhelm Reich. So much of our body-oriented therapies have to do with his insights and his advancements. Al Lowen s work on bioenergetics came out of it. Pat talked about her own experience with Ida Rolf Rolfing comes out of this. Reich was really quite a genius in pointing out that when people have been through difficult emotional One can simply go inside, notice what is happening in the body and allow that to speak. experiences, it shows up in the body. You can see it in the body, and you can work with it at the level of the body. This, of course, we know in our linguistic usage. If I say, I feel tense, am I describing a sense of nervousness and anxiety as a cognitive event, or am I describing tight muscles? I am obviously describing both because it is a unified phenomena. Reich fell out of favor after his orgone (energy) boxes and being imprisoned by the FDA for making some claims that were hard to substantiate, but the key is that Pat honors Reich s contribution, and that is really useful for all of us as therapists today. Dr. Buczynski: Right. How about you, Joan, what struck you? Dr. Borysenko: What struck me was the mindfulness required to really approach trauma in a body-oriented way. Trauma, as Pat spoke of so beautifully, is in the body indeed, that s where it is. I was sitting here myself just now thinking, Oh, we re going to discuss Pat Ogden and what struck me and what struck me was my own body posture. I m sitting here in a leather chair, scrunched up so that I can be seen in the monitor. But, what is happening for me, if I notice my own body and the way it s tipping over, is that this position makes me feel tired and a little disempowered. So, I m going to shift myself in the chair right now and align myself with gravity and think, Okay, right now I m not in the position of a therapist; I m in the position of a discussant. When people have been through difficult emotional experiences, it shows up in the body.

5 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 5 If I stop and I m aware mindfully of the feelings in my body, I ve a lot more energy. I feel a better sense of You have to be quite mindful yourself to track the little shifts that are happening in the body of a client. sureness in myself. This is really what I got from Pat. She was trained originally by Ida Rolf in many types of body work. Ida Rolf was a biochemist. If I recall, she was in fact a scientist. She imparted to her students really the science of mindfully observing what is going on in their own body and in the body of their clients. I was very impressed with the way that Pat talked about tracking how you have to be quite mindful yourself to track the little shifts that are happening in the body of a client. You have to be quite mindful to be able to experiment with these shifts in the same way that I just did an experiment with myself. I looked at my posture and was conscious of my posture related not only to my past but to how that shows up in the present moment. That is really useful for all therapists: to be aware of their own body posture and to track what is going on with their clients. It is very powerful. Paying Attention to the Body When Treating Trauma Dr. Buczynski: Ron, what sorts of things do we miss if we aren t paying attention to bodies in treating trauma? Dr. Siegel: I think we can miss a great deal. For one thing, as Pat and others have pointed out, very often the memory of the trauma is most accessible at the level of the body. We can feel the trauma in the posture in the tense muscles. We can have a royal road in as I was suggesting before. I sometimes step back and I talk to my patients about this, and ponder why yoga developed as a form of spiritual practice. Very often the memory of the trauma is most accessible at the level of the body. On the face of it, it seems crazy. What could stretching and paying attention to the sensations of putting the

6 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 6 body in different postures possibly have to do with psychological awakening? The answer to this lies in Reich s observation that Pat bases her work on. When we constrict, or when we close down in fact whenever we differentiate this from that This is good and That is bad there is a certain amount of body tension that is required to do that. There is a certain degree of defensiveness or constriction that is involved in coming up with different If we ignore the body, we ignore this fantastically useful road in for transformation. thoughts about this or that, particularly when those thoughts are negative thoughts anger, fear, and the like. The yogis discovered years ago that, Oh, well, if I stretch out these muscles, suddenly I have access to all of these thoughts and feelings that were present when these muscles contracted in the first place. When we breathe and do other things, it helps to enforce this process. If we ignore the body, we ignore this fantastically useful road in for transformation. It is no accident that Bessel was talking before about the use of yoga explicitly as an intervention simply holding this as a framework becomes very, very useful. It s useful to what Pat was talking about this idea of developing curiosity about what is happening in the body right now. Tracking, noticing what is happening, observing the body, as she Tracking, noticing, observing, and commenting can become enormously opening and liberating. talked about, and commenting on this Well, what might this be? can become enormously opening and liberating to people. That question of, What might this be? gives an object to attend to in this case a body event and that becomes an opening. Since many of the folks on the call are medical practitioners perhaps who see people coming in with somatic complaints, having this understanding that these somatic complaints are so often very tightly linked to behavioral and psychological events that have happened in a person s past can be very, very helpful in making a differential diagnosis. Is this some infectious process? Is this some other kind of disease? Or is this a manifestation of what we might call a Reichian process or not-yet-had-enough-yoga process of the body malfunctioning because of one

7 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 7 of these psychological processes? How Therapists Can Use Body Work Dr. Buczynski: Joan, a bit ago you talked about aligning your body with gravity, and Pat certainly talked about that tonight. Have you ever done anything with that with patients, or used any kind of body reading not so much reading but body work with patients? Dr. Borysenko: Most definitely, but I would like to just back up a little bit and say we all do that you don't have to be a therapist. As a parent, I want to go back to a story of growing up. Because I have a lot of the aspects of somebody who s a survivor of trauma, my total body posture when I was growing up was to hide behind my hair. My mother hated that she was always trying to tuck it back, Show your face. I would be bent over, and my mother was always saying, Stand up straight. Stand up straight. Your posture s terrible. Pull your hair As soon as we changed our body posture, not only did our mood change, but our thought process changed. back from your face. Of course, every parent knows this is not really helpful it just makes your kid mad at you! As the years passed, and in fact, as I took yoga and had other experiences one of them, by the way was very interesting. I went to a retreat with a very well-known Sufi master, and we danced the different planets. What is the posture of Mars? This was such power, this warlike person. What is the posture of Venus,, this open posture of love? We would march around being these planets and these archetypes, and it became so clear to me, as soon as we changed our body posture, not only did our mood change, but our thought process changed. Everything changed! I began to get very interested in all of this. Then, along came qigong, which is another extraordinary way to change your body for the better to become much more aware of the subtle ways in which you hold your body. I thought, I wish my mom had done this. If she had said something to me like, Imagine a string that attaches to the top of your head and it just aligns your body with gravity. Your shoulders naturally relax, and your spine naturally straightens.

8 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 8 You feel the body force, the chi, the aliveness actually start to move through you. There is an increased sense of confidence and all of this is absolutely true. That is why we should be teaching this to kids. If you re a parent, it s great to teach it to your kids. If you re a teacher, for one minute in the classroom in the morning, you can get your kids into a sense of confidence by affecting how their body will feel. At home you can do this with your spouse. Oftentimes, we are unaware. I have a tendency to dissociate, and obviously I m not mindful when I m dissociated I am somewhere else! My husband, Gordy, will say to me something like, Where are you, sweetie? You re all hunched over. And I will come to, and adjust my posture, and then suddenly my mind is back on-line as well. All of us not just therapists can come to be aware of our own posture, and help others to be aware of theirs. I liked how Pat always did that as an experiment to ask something like this to a child, Oh, sweetie, I notice you re all bent over and I m All of us not just therapists can come to be aware of our own posture, and help others to be aware of theirs. wondering if you could just imagine that string. How do you feel now? Is there some kind of difference? That is a way for all of us to become more mindful, more present, and more comfortable in our body. I learned a lot about this from being Rolfed you have to have feedback. When you come in for each session We re not normally aware of how we hold our body because it s an unconscious pattern. and the Rolfer puts you in front of the mirror (which is very unforgiving), you notice exactly how you are standing. You notice: Is my head sticking forward or are my shoulders up? Am I twisted one way or another? We re not normally aware of how we hold our body because it s an unconscious pattern. Anything we can do for ourselves and for the people in our life to notice How is our body? in a way that is so respectful and curiosity-making, is important. So, to read our bodies and to help read the bodies of others is a wonderful way to become more mindful.

9 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 9 How to Keep Patients in The Now Dr. Buczynski: Ron, Pat also talked about how important it is for us to work in the now, but that s not always easy. How can we help keep clients in the now? Dr. Siegel: For clients or patients who would be amenable to this and it wouldn t seem too weird to them, I will sometimes say, You know, I find that our work goes better if we both show up in the room. Why don't we take just a few minutes together to do a little bit of formal mindfulness practice, A huge factor is the practitioner: if our intention is to pay attention to what is happening in the moment, then that tends to set the tone and brings the other person into the moment. perhaps with the breath or listening meditation, or a body scan but something simply to deliberately announce that our intention is to be here with one another? We can certainly teach people informal practices mindful walking, or mindful eating, or tooth-brushing, or even a more formal practice that they can practice on their own. But, in addition to this, a huge factor is the practitioner whether you re coming at this as a mental health practitioner or anybody else working with human beings. It s really very simple: if our intention is to pay attention to what is happening in the moment, then that tends to set the tone and brings the other person into the moment. This is simply to be with somebody and say, What exactly are you noticing right now? What exactly are you experiencing in your body right now? It looked like something just happened: Did a thought come to mind? What was that? I learned this idea first from Fritz Perls in Gestalt therapy you re never going to be lost in doing Whenever you notice something has happened, bring the attention to that bring the person and the treatment into the present moment. psychotherapy because you can always bring your attention to what is happening here and now and ask the person to describe that. If you do that, there is always something happening and that will always lead to something else it will always unfold. This idea, which Pat calls body tracking, is a very important concept the idea that whenever you, as a therapist notice something has happened, bring the attention to that and by simply doing that, since the event is in the present, that sets

10 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 10 the stage and helps to bring the person and the treatment into the present moment. Dr. Buczynski: Lastly, Joan, Pat talked about managing transference of course, transference is something that every practitioner needs to think about and deal with. What did you think of Pat s specific view on it? Dr. Borysenko: I thought her view was really very interesting. When she talked about a client that she was The way we bounce up against each other is the ground out of which transformation grows. pushing and pushing and pushing and that was her stuff! The client finally got tired of being pushed, and that was very therapeutic because the client was somebody who normally had a lot of trouble setting boundaries. My sense is that the way we bounce up against each other like that is in fact the ground out of which transformation grows. That is true not only in therapy, but it s true in relationships. I don't think there is anyone there among us who doesn t have some sort of a place where they re projecting something from the past onto the present and they re not real clear in that moment. I know this happens in marriages just looking at my own marriage. You have to be willing to say, Isn t that interesting my stuff just bumped up against your stuff. I just realized that the way I was criticizing you / the way that I was not hearing you, (or whatever it Transference is one of the least appreciated way sin which human beings grow their hearts, spaciousness, understanding, and love. might have been) comes from the fact that what we were talking about has just brought up something for me that is unresolved. The kind of meeting of transference like that (I can t remember what she called it she had a particular word for it) is one of the least appreciated ways in which human beings grow their hearts, grow their spaciousness, grow their understanding, and grow their love. Dr. Buczynski: Thank you. Take good care.

11 The Body's Critical Role in the Treatment of Trauma Pat Ogden, PhD - TalkBack - pg. 11 About the speakers... Joan Borysenko, PhD has been described as a respected scientist, gifted therapist, and unabashed mystic. Trained at Harvard Medical School, she was an instructor in medicine until Currently the President of Mind/Body Health Sciences, Inc., she is an internationally known speaker and consultant in women s health and spirituality, integrative medicine and the mind/body connection. Joan also has a regular 2 to 3 page column she writes in Prevention every month. She is the author of nine books, including New York Times bestsellers. Ron Siegel, PsyD is an Assistant Clinical Professor of Psychology at Harvard Medical School, where he has taught for over 20 years. He is a long time student of mindfulness mediation and serves on the Board of Directors and faculty for the Institute for Medication and Therapy. Dr. Siegel teachers nationally about mindfulness and psychotherapy and mind/body treatment, while maintaining a private practice in Lincoln, MA. He is co-editor of Mindfulness and Psychotherapy and co-author of Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain.