Mark Lewis

Finding The Balance – Somatic and Cognitive Strategies in Resolving Trauma

Tom looks haunted as he describes his feelings of guilt and shame that he did not do more to protect himself and his wife from the men who mugged them. He keeps repeating the ‘if only’ themes: if only he had done more, seen them coming, taken charge. He berates himself for ‘letting’ the assault happen. He describes the repeated flashbacks of the men’s’ faces looming in and their aggression.

The therapist looks at Tom sympathetically and gently challenges his beliefs: “how could you have done some thing? There was a group of them and you were outnumbered. Also you didn’t want to make something worse for your wife either.” But somehow the challenges don’t seem to sink in. Tom flinches away from taking a more forgiving attitude towards him self and the situation.

The therapist changes tack, moving to psycho-education about trauma responses. “Its natural you froze, it was impossible to run as you wouldn’t desert your wife. You couldn’t fight as there was a group of them. It triggered the freeze response in your nervous system, immobility as the best way to survive.”

Tom understands the logic and trusts his therapist even, but just can’t accept what is being said. If this was about someone else then he might accept it but for him self? No, the feeling of shame is just too persuasive. He can’t get away from the feeling, the knowledge that he had failed.

The therapist shifts focus again, seeing that the cognitive challenge, the appeal to Tom’s rational thinking isn’t getting through. Even the trauma psycho-education and the nudge towards self compassion isn’t working.

The therapist suggests they really break down what happened, slowing the whole thing down, stretching out time and seeing it all in slow motion. The therapist guides Tom to really pay attention and be mindful of his bodily reactions, his sensations and movement impulses as well as perceptions as they very carefully go through the incident.

Tom starts to become aware of the sequence of what happened and elements that he had forgotten or been ignoring: the feeling of sudden shock, his head and neck twisting to orient towards the danger and the noise, the sense of it being too late and too close thus making action impossible, the way his body and mind felt unable to organise itself in to an effective response.

With the therapist’s help in the session, Tom follows the impulse to act that had been thwarted, starting from the feeling of energy in his right shoulder and the subtle instinctive clenching of his fist. But then Tom experiences a powerful sense of stasis, feeling his energy as though stuck, both ready for action and yet unable to move. As he recalls the experience, Tom has the acute feeling of being torn between impulses to run and get away and impulses to protect his wife or even to confront the attackers. He feels the rigidity in his muscles that are still primed for action and yet unable to allow themselves to release. As his therapist helps him track his experience, he becomes aware of a point at which his energy seems to suddenly drain away replaced by a feeling of weakness, his muscles limp and his mind strangely disconnected. Even his vision seems to become narrowed and lacklustre.

In the session the therapist helps Tom to stay present to this experience, staying in touch with his changing internal process. After a while the drained collapsed feeling starts to change and Tom reports more energy coming in to his right arm and shoulder as well as the side of his torso. The therapist encourages Tom to follow his impulse and allow any movement that emerges. Tom looks surprised as his shoulder comes forward and his jaw tightens strongly. Suddenly he has the realisation: “I just wanted to barge them out of the way, to put my body between them and my wife.”

The therapist makes an invitation to Tom, to imagine that it was possible to do the barge movement and to feel the impact on the men with as much force as he wants. With Tom’s agreement, the therapist gives some physical resistance to Tom’s shoulder push, allowing Tom to really feel the strength of it and have some feeling of impact. Tom pushes suddenly with real strength and then gasps and breathes deeply. As his breathing settles a bit, Tom becomes tearful and starts to sob. It is as though the held in tension, emotion and breath has released at last.

He looks up, taking in his surroundings as if for the first time. Tom looks surprised, saying, “Wow things seem kind of clearer now.” And then, “You know, now I realise, I just didn’t have time to react. They came out of nowhere. And I was so caught between the urge to act and fearing I would make it worse. It was like my body took over. It just froze.”

At last a sense of sympathy for himself is creeping in. Tom looks tearful but also starts to smile. There is a look of relief. “It was impossible, I did what I could.”

Now it becomes possible for the therapist and Tom to talk deeply about what happened, the impossible dilemma he felt thrust in to and the reason the freeze immobility response was his nervous system’s only solution. There is also a feeling that Tom has reclaimed some sense of his own power and esteem: the determined muscular barge movement was there but just made impossible by other equally valid protective concerns. Tom’s posture has straightened, his back feels stronger and his breathing fuller.

After a while the therapist mentions Ross’ ‘locus of control’ concept: in order to avoid the feeling of actual powerlessness in a traumatic event, you persuade yourself that actually you could have done something different and taken control of the situation. Thus self blame is unconsciously taken as a more palatable option than the realisation of your powerlessness.

Now Tom is able to take in the idea, to understand its implications for him and how his mind has been trying to deal with the traumatic event he and his wife went through. It is hard for him to admit that he experienced powerlessness but he can see that this was what happened temporarily, with him caught in a situation completely outside of his choosing.

Tom leaves the session feeling more in touch with his own wisdom and more integrated with his actual experience. He has both regained a sense of his own power while also grieving the reality of its loss. Tom feels more objective and less inclined to berate or blame himself. He perceives the world as having regained colour and depth and a certain sense of safety.

The therapist had tried ‘top down’ or ‘head first’ strategies such as cognitive challenge and psycho-education but quickly realised that Tom could not make use of this in his current state. The therapist changed to a ‘bottom up’ or ‘body first’ strategy, accessing the memory and wisdom held in his body sensations and impulses. As they mindfully worked with this, gradually his feelings, perceptions and ultimately his thinking were able to transform. Once this reorganisation of his body and mind had taken place, he was then open to more cognitive information and able to make use of it and be changed by it.

This story shows the importance of flexibility of approach, moving between top down and bottom up strategies, to promote psychological healing. We all have layers: from the bottom layer of body sensation, through movement impulses, emotional feelings, perceptions and finally cognitions (including meanings and beliefs). Sometimes changing the top layer by challenging faulty beliefs and providing new information is enough for a change of feelings with a new way of seeing the world and a relaxation in the body. But, rather like watering a plant that does not have strong receptive roots, the cognitive intervention can just ‘run off’ leaving the felt experience in emotions and body unchanged. It is then that we need to get our ‘hands in the soil’ and work with the level of bodily experience to enable growth and change so that new meaning can emerge and be absorbed.

NB: This a fictional story that nevertheless represents the common experiences of people going through their trauma healing process in somatically informed therapy.

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