Day One

Becoming Trauma Informed

As an indigenous woman I appreciate the complexities and dynamics in health policy and research. Given the complexity of the impact of intergenerational trauma on the lives and wellness of Indigenous peoples, future treatment interventions must be holistic and multifaceted with the inclusion of cultural safety models in policy and legislation, with research being key to making those strides and changes and elevating the health of a nation who have suffered due to the exclusion of these concepts in the past (Czyzewski, 2011; Duran, 2006a; Gone, 2013; Marsh, Cote-Meek, et al., 2016).

Agenda - Day One

8:30 – 9:00

Registration

9:00 – 10:00

Introductions, Expectations & Experiential Exercise

Background, Literature & Rates Of PTSD

10:00 – 11:00

Introduction to Trauma

Definitions, Epidemiology, History

11:00 – 11:15

Break

11:15 – 12:15 PM

 Sequelae of Trauma / Trauma and the DSM V

Somatic Experiencing Trauma Therapy

12:15 – 1:00

Lunch

1:00 – 3:00

 Meditation/Breathing/Grounding/ focussing

A brief overview of Groups & Sharing Circles rules and guidelines

Experiential Seeking Safety Sharing Circle / Seeking Safety

3:00 – 3:15

Break

3:15 – 4:00

 Individual check-in

Feedback and a Brief Evaluation of the Day

 

What are Trauma-Informed Practices?

 “A trauma-informed approach emphasizes understanding the individual … Rather than asking ‘How do I understand this problem or this symptom?’ the service provider now asks ‘How do I understand this [person]?’ ... This approach shifts the focus to the individual and away from some particular and limited aspect of functioning.

It also gives the message that life is understandable and that behaviours make sense when they are understood as part of a whole picture (Courtois, 2012).

Trauma-informed practices provide a lens that should guide clinical responses, interventions, and other interactions with clients.

Why Is an Understanding of Trauma Important for the Addiction Workforce?

Trauma is pervasive. It can be life changing, especially for those who have faced multiple traumatic events, repeated experiences of abuse or prolonged exposure to abuse. Even the experience of one traumatic event can have devastating consequences for the individual involved.

It is very common for people accessing substance use treatment and mental health services to report overwhelming experiences of trauma and violence. Often people who have experienced trauma view their use of substances as beneficial in that it helps them to cope with trauma-related stress. Unfortunately, this seemingly adaptive coping mechanism can make people more vulnerable to substance use problems.

To meaningfully facilitate change and healing, substance use treatment providers must help people make the connections between their experience of trauma and their problematic substance use or mental health concerns.

What Are Trauma-informed Approaches?

Trauma-informed services take into account an understanding of trauma in all aspects of service delivery and place priority on trauma survivors’ safety, choice and control. They create a treatment culture of nonviolence, learning and collaboration. Working in a trauma-informed way does not necessarily require disclosure of trauma. Rather, services are provided in ways that recognize needs for physical and emotional safety, as well as choice and control in decisions affecting one’s treatment.

In trauma-informed services, there is attention in policies, practices and staff relational approaches to safety and empowerment for the service user. Safety is created in every interaction and confrontational approaches are avoided. Trauma-specific services more directly address the need for healing from traumatic life experiences and facilitate trauma recovery through counselling and other clinical interventions. Advocates for trauma-informed approaches in the substance use treatment field do not ask substance use treatment professionals to treat trauma, but rather to approach their work with the understanding of how common trauma is among those served, and how it is manifested in peoples’ lives. It could be said that trauma-informed approaches are similar to harm-reduction-oriented approaches in that they focus on safety and engagement. In trauma-informed contexts, building trust and confidence pave the way for people to consider taking further steps toward healing and recovery while not experiencing further traumatization.

 

Key Principles of Trauma-informed Approaches

 Researchers and clinicians have identified key principles of trauma-informed practice, which have parallels with principles underlying evidence-based practices in the mental health and substance use field.

  1. Trauma awareness: All services taking a trauma-informed approach begin with building awareness among staff and clients of: how common trauma is; how its impact can be central to one’s development; the wide range of adaptations people make to cope and survive; and the relationship of trauma with substance use, physical health and mental health concerns. This knowledge is the foundation of an organizational culture of trauma-informed care.
  2. Emphasis on safety and trustworthiness: Physical and emotional safety for clients is key to trauma-informed practice because trauma survivors often feel unsafe, are likely to have experienced boundary violations and abuse of power, and may be in unsafe relationships. Safety and trustworthiness are established through activities such as: welcoming intake procedures; exploring and adapting the physical space; providing clear information about the programming; ensuring informed consent; creating crisis plans; demonstrating predictable expectations; and scheduling appointments consistently.

    The needs of service providers are also considered within a trauma-informed service approach. Education and support related to vicarious trauma experienced by service providers themselves is a key component.

  3. Opportunity for choice, collaboration and connection: Trauma-informed services create safe environments that foster a client’s sense of efficacy, self-determination, dignity and personal control. Service providers try to communicate openly, equalize power imbalances in relationships, allow the expression of feelings without fear of judgment, provide choices as to treatment preferences, and work collaboratively. In addition, having the opportunity to establish safe connections— with treatment providers, peers and the wider community—is reparative for those with early/ongoing experiences of trauma. This experience of choice, collaboration and connection is often extended to client involvement in evaluating the treatment services, and forming consumer representation councils that provide advice on service design, consumer rights and grievances.
  4. Strengths-based and skill building: Clients in trauma-informed services are assisted to identify their strengths and to further develop their resiliency and coping skills. Emphasis is placed on teaching and modelling skills for recognizing triggers, calming, centering and staying present. In her Sanctuary Model of trauma-informed organizational change, Sandra Bloom described this as having an organizational culture characterized by ‘emotional intelligence’ and ‘social learning.’ Again, parallel attention to staff competencies and learning these skills and values characterizes trauma-informed services.

Canadian Centre on Substance Abuse

From Teresa ‘s book:  Enlightenment Is Letting Go! Healing from Trauma, Addiction, and Multiple Loss

Chapter One
Trauma and Addiction

Introduction

This chapter offers a framework for the exploration of the complex connections between people with substance use disorders and trauma. Taking into account the distinct differences between the needs of men and women, with gender sensitivity, the chapter will cover the sequelae of trauma and addiction and unique innovative, integrative approaches to care.

Trauma and Addiction: The Connection

The relationship between trauma and substance use disorders has been well documented. Studies have found that 25 percent to 40 percent of patients receiving treatment for addiction report a history of trauma and present with clinically significant posttraumatic stress disorder (PTSD) symptomatology (Brief, Weathers, Krinsley, Young, and Kelly 1992; Brown and Wolfe 1994; Kovack 1986; Miller, Downs, and Testa 1993; Triffleman, Marmar, Delucci, and Ronfeldt 1995). Dual diagnosis of PTSD and a substance use disorder is surprisingly common. The rate of PTSD among patients in addiction treatment is 12 to 34 percent; for women it is 30 to 59 percent. Rates of lifetime trauma are even more common (Kessler, Sonnega, Bromet, Hughes, and Nelson 1995; Langeland and Hartgers 1998; Najavits, Weiss, and Shaw 1997; Steward 1996; Stewart, Conrod, Pihl, and Dongier 1999; Triffleman 1998).

Epidemiological studies in the United States have reported prevalence rates for substance abuse and dependence (including alcohol) of 20 percent in the general community. A systematic study reveals the high frequency of trauma history in addicted populations (Bernstein 1994;  Boyd, Blow, and Orgain 1993; Cottler et al. 1990; Schnitt and Nocks 1984). Efforts are increasing to understand the complex relationships and devise effective interventions.

Other studies show that an individual with a past or current psychiatric disorder has a substantially increased risk for a substance use disorder. The risk is at least double for those with affective and anxiety disorders and is often higher for other psychiatric disorders.

Becoming abstinent from substances does not resolve PTSD; indeed, some PTSD symptoms become worse with abstinence (Brady, Killeen, Saladin, Dansky, and Becker 1994; Kofoed, Friedman, and Peck 1993; Root 1989).

People with PTSD and substance abuse or dependence are vulnerable to repeated traumas and more so than with substance use alone (Fullilove et al 1993; Herman 1992; Dansky, Byrne, and Brady 1999; Najavits et al 1998).

Perpetrators of violent assaults use substances at the time of assault in a high percentage of domestic abuse (50 percent) and rape (39 percent) cases (Bureau of Justice Statistics 1992).

Trauma Defined

People are traumatized either directly or indirectly, according to the DSM-1V diagnosis of PTSD. People can be traumatized without actually being physically harmed or threatened by harm. Simply learning about traumatic events carries traumatic potential.

What Is Posttraumatic Stress Disorder (PTSD)?

PTSD is the result of exposure to a traumatic or extremely emotionally and psychologically distressing event or events. Such an experience can have severe effects on a person’s behavior, thinking, and feelings even long after the event or events have occurred. This can last for many years.

Many clients, as you will read in the following chapters, believe or feel that the traumas were not that severe, and they really downplay them when they come for help. This denial of the seriousness of the events is part and parcel of the coping that comes into place during these events.

There Are Different Kinds of PTSD

Simple PTSD

This results from a one-time terrible event such as a rape or a car accident. This type is different from complex posttraumatic stress, which is described below.

Complex PTSD

This tends to occur when the abuse suffered was prolonged or repeated and/or if it was caused by a family member, loved one, or caregiver. It is also more prevalent if the abuse happened early in life. It can also happen as a result of chronic trauma or abuse in adult life, for example in a man or women involved in an abusive relationship for many years. In order to carry the diagnosis of PTSD, the following four things must be present:

  • Experiencing an event that was life-threatening or that actually resulted in harm, intense fear, helplessness, or horror;
  • Continuing to experience the traumatic event after it is over;
  •  Seeking to avoid reminders of the event; and
  • Exhibiting signs of persistent arousal.
Sequelae of Trauma

Complex Posttraumatic Stress Response: DESNOS/Disorder of Extreme Stress, Not Otherwise Specified

Dr. Judith Herman and others state that severely traumatized individuals (for example, victims of severe childhood abuse, political torture, or concentration camps) have a more complex symptom picture (Herman 1992).

Responses to complex posttraumatic stress may include:

1.     Affect dysregulation

·      Chronic preoccupation with suicide

·      Self-injury

·      Overreaction to minor stresses

·      Becoming emotionally and cognitively overwhelmed easily

·      Difficulty in calming or soothing self

·      Alcohol and other substance use

·      Problems with eating

·      Compulsive sexual activity

2.     Dissociation and changes in consciousness

·      Amnesia

·      Transient dissociative episodes and depersonalization

·      Derealization

·      Reliving the experience

3.     Changes in self-perception

·      Ineffectiveness

·      Guilt and responsibility

·      Shame

·      Helplessness

·      Self-blame

·      Feeling that nobody else understands

·      Minimizing the experience

4.     Alterations in relations with others

·      Inability to trust

·      Revictimization

·      Victimizing others

·      Failures of self-protection

5.     Somatization

·      Digestive system problems

·      Chronic pain

·      Cardiopulmonary symptoms

·      Conversion symptoms

·      Sexual symptoms

6.     Alterations in systems of meaning

·      Despair and hopelessness

·      Loss of previously sustaining beliefs

·      Loss of hope

Addiction Defined

Drug addiction is the chronic or habitual use of any chemical substance to alter states of body or mind for purposes that are not medically warranted.

Traditional definitions of addiction, with their criteria of physical dependence and withdrawal have been modified with increased understanding and research; with the introduction of new drugs, such as cocaine, that are psychologically or neuropsychologically addicting; and with the realization that its stereotypical application to opiate-drug users was invalid because many of them remain occasional users with no physical dependence.

Addiction is now more often defined by the continuing, compulsive nature of the drug use despite physical and/or psychological harm to the user and society and includes both licit and illicit drugs. The term “substance dependence” is now frequently used because of the broad range of substances (including alcohol and inhalants) that can fit the addictive profile.

Psychological dependence is the subjective feeling that the user needs the drug to maintain a feeling of well-being. Physical dependence is characterized by tolerance (the need for increasingly larger doses in order to achieve the initial effect) and withdrawal symptoms when the user is abstinent.

The United States has the highest substance use rate of any industrialized nation. Government statistics show that 47 percent of the United States population has tried marijuana, cocaine, or some other illicit drug. By comparison, 65 percent of the population has smoked cigarettes, and 82 percent have tried alcoholic beverages. Marijuana is the most commonly used illicit drug (Substance Abuse and Mental Health Services Administration 2009).

Why Do People Use Drugs?

People take drugs for many reasons: peer pressure, stress relief, increased energy, relaxation, pain relief, escape from reality, greater feelings of self-esteem, and recreation. They may take stimulants to keep alert or cocaine for the feeling of excitement it produces.

Effects of Substance Use

The effects of substance use can be felt on many levels: on the individual, on friends and family, and on society. People who use drugs experience a wide array of physical effects other than those expected. The excitement of a cocaine high, for instance, is followed by a “crash”: a period of anxiety, fatigue, depression, and an acute desire for more cocaine to alleviate the feelings of the crash. Cannabis and alcohol interfere with motor control and are factors in many automobile accidents. Users of marijuana and hallucinogenic drugs may experience flashbacks, unwanted recurrences of the drug’s effects weeks or months after use. Sudden abstinence from certain drugs results in withdrawal symptoms. Heroin withdrawal can cause vomiting, muscle cramps, convulsions, and anxiety. With the continued use of a physically addictive drug, tolerance develops, that is, constantly increasing amounts of the drug are needed to duplicate the initial effect.

Sharing hypodermic needles used to inject some drugs dramatically increases the risk of contracting HIV infection and viral hepatitis. In addition, both prostitution and the disinhibiting effect of some drugs put users at higher risk of acquiring HIV and other sexually transmitted diseases. Because the purity and dosage of illegal drugs are uncontrolled, drug overdose is a constant risk. There are over ten thousand deaths directly attributable to drug use in the United States every year; the substances most frequently involved are cocaine, heroin, and morphine, often combined with alcohol, tobacco, or other drugs. Many drug users engage in criminal activity, such as burglary and prostitution, to raise the money to buy drugs; and some drugs, especially alcohol, are associated with violent behavior.

Treatment

The Therapeutic Alliance or Relationship

This is the most crucial aspect in therapy; it is the positive connection that must be established before anything else can happen. This relationship is the key that will open the door to the work that has to be done. The healing lies within that therapeutic relationship. The issues of safety and trust must be considered at all times. People bring with them their suffering, hurt, pain, guilt, shame, helplessness, hopelessness; and in these symptoms they tell us how bad it was and still is. A compassionate, caring, and giving professional with deep knowledge and skills can support and assist people on their healing journey.

Stages of Addiction Treatment

Stage One: Engagement, Stabilization, Detoxification, and Contracting

All of the above entail the building of trust in the relationship, coupled with empathy, understanding and respect. Looking at issues such as housing, transportation, and welfare, the involvement of significant others is key to the healing journey. Psychoeducational sessions are crucial as we educate and talk about the substances and effects on the person’s life. Reflective listening and the exploration of the fears of quitting are mandatory in this first phase of treatment.

Stage Two: Persuasion, Empathy, Support, and Psychoeducation

Here we focus on motivational interviewing, acknowledgement of the struggles and pain, and exploration of the benefits of quitting. The therapist’s understanding and empathy at this stage is crucial. Education follows all the stages and moves through the treatment of both trauma and addiction as a golden thread. The education must focus on all the dimensions of the human being: mind, body, and spirit. We also explore the need for pharmacotherapy at this stage and implement that as soon as possible.

Stage Three: Active Treatment

In this stage we focus on all the skills and interventions that could help and enhance recovery. Clients may need to go into residential treatment or attend AA, NA, or other therapy groups that focus on addiction and trauma. Pharmacological support remains an important part of the treatment. The teaching of new skills to deal with all the challenges cannot be emphasized enough.

Stage Four

Here we solidify all the gains of the previous stages through continual exposure to the triggers and challenges that come on a day-to-day basis. Addiction treatment is a process, as is trauma treatment. We walk with people all the way and collaboratively figure out what is working for them. Each and every individual will present with their own particulars and idiosyncrasies and working hand in hand with people can empower them to become stronger and more motivated.

In chapter thirteen, which covers group psychotherapy for trauma and addiction, the interventions and treatment strategies useful in dealing with both disorders are discussed in more detail.

Stages of Trauma Treatment

Stage One (Early Stage): Stabilizing and Managing Trauma

SAFER

S: Safety and Self-Care. The first step to any form of trauma treatment is safety and self-care. Here we teach clients to manage the symptoms and to gain the knowledge to be empowered or to get stronger in the process. Safety includes ensuring safe housing and checking and talking about suicidal ideation. It is also important to schedule a physical examination and make sure that no signs or symptoms are missed. This also includes the use and implementation of pharmacotherapy.

A: Affect. Many clients are stunned when they hear for the first time that all their symptoms and behaviors have names. When they grasp this and realize that they are not crazy or imagining things, they begin to heal. Those symptoms persist, as I explain in many of the chapters, as a language, that is, being able to speak about the unspeakable.

F: Function. This is about recognizing the old ways of hurting self, by self-harm or by using drugs and alcohol and then moving toward making changes to function at a higher level of being.

E: Education. This tool is woven through both trauma and addiction like a golden thread. When clients begin to understand the why of their feelings, thoughts, and behaviors, they can begin to make informed decisions to change.

R: Relationships. In all the chapters on trauma and addiction, the areas of relationships are discussed in detail. Life is about relationships: the relationships with self, partners, family, friends, and the world. Both disorders involve and affect all of the above, hence my inspiration to write this book after the brutal experience of 9/11.

Stage Two (Middle Stage): Processing and Grieving Traumatic Memories

During this stage the exploration of the past and painful memories is initiated. We explore how the trauma affected the past and also how it affects the individual in the here and now.

Various approaches may be used in this stage, including exposure, cognitive process therapy, desensitization, and eye movement desensitization reprocessing (EMDR). I have written in many of the chapters about the importance of alternative therapies such as yoga, meditation, thought tracking, and group therapy. (There are more explanations in chapter thirteen, which discusses group psychotherapy for trauma and addiction).

Stage Three: Restructuring, Reconnecting, Rebuilding, and Reintegrating

During this stage the focus is on the above-mentioned four Rs. This is the ongoing work, and the goal here is to encourage people to let go. Letting go of all dysfunctional ways in order to build new healthy lives and ways of living. This stage is beautifully written about by people in this book who took the risk of telling their stories. Giving back to humanity and society as they did is a clear indication of the extent of their healing and transformation.

Conclusion

As we move into the new era of multiple technological advancements, we continue to encounter the vulnerability and suffering of humans whose childhood abuse histories led to the development of complex posttraumatic stress disorder and addiction. These disorders brings with them challenging, complicated, and painful consequences. These challenges must be addressed at all levels—mind, body, and spirit—in other words, in the context of the biological, psychological, spiritual, and social dimensions.

Treatment should be client-centered, gender-sensitive, and specific to the needs of people being aware of the complexity of needs. Treatment must be integrative, inclusive, diverse, effective, collaborative, and consistent with new research and best practices.

Health care professionals are challenged daily working in this field and need sound knowledge, skills, and gentle openness, coupled with deep compassion and understanding of the human spirit and suffering. Self-care is mandatory for the professional in this field. The healing and deep work only happen in the therapeutic relationship. Professionals should treat themselves in the same way they advocate Books, 1994.

Somatic Experiencing Trauma Therapy

Trauma Healing offers a framework to assess where a person is “stuck” in the fight, flight, freeze, or collapse responses and provides clinical tools to resolve these fixated physiological states. It provides effective skills appropriate to a variety of healing professions including: mental health, medicine, physical and occupational therapies, bodywork, addiction treatment, first response, education, and others.

Healing Trauma: hint: It’s not about reliving the trauma

Trauma Healing offers a framework to assess where a person is “stuck” in the fight, flight, freeze, or collapse responses and provides clinical tools to resolve these fixated physiological states. It provides effective skills appropriate to a variety of healing professions including: mental health, medicine, physical and occupational therapies, bodywork, addiction treatment, first response, education, and others.

Why Heal Old Trauma? Shouldn’t I leave well enough alone?

When the nervous system is freed from accumulated stress and trauma, the benefits are pronounced.

  • Improve relationships
  • Eliminate chronic pain
  • Enjoy more physical energy
  • Become less accident prone and forgetful (become more present)
  • Increase ability to focus
  • Reconnect to your ability to trust
  • Calm the nervous system
  • Live more of your potential

What is Somatic Experiencing (SE)?

Somatic Experiencing is a body-awareness approach to trauma being taught throughout the world. It is the result of over forty years of observation, research, and hands-on development by Dr. Peter Levine. Based upon the realization that human beings have an innate ability to overcome the effects of trauma, Somatic Experiencing has touched the lives of many thousands. SE restores self-regulation, and returns a sense of aliveness, relaxation and wholeness to traumatized individuals who have had these precious gifts taken away. This work has been applied to combat veterans, rape survivors, Holocaust survivors, auto accident and post surgical trauma, chronic pain sufferers, and even to infants after suffering traumatic births.

Symptoms of Overwhelm or Traumatic Stress

Traumatic symptoms are not caused by the “triggering” event itself. Symptoms stem from the leftover survival energy that has not been resolved and discharged due to a disturbance in the self-regulatory capacity of our autonomic nervous system and physiology.

Each time we are not able to return to a relaxed ‘normal’ state our nervous system becomes more hypersensitive or unresponsive and we are more likely to be affected by events, actions or experiences that previously may not have had an impact. Over time, after months or years, symptoms of the following types may arise:

  • Heart palpitations, breathing problems, dizziness
  • Hyper vigilance, being on guard or over alert
  • Extreme startle response
  • Hyperactivity
  • Extreme sensitivity to light, sound or touch
  • Involuntary behavior: tics, jerking limbs
  • Anxiety, including chronic low level anxiety
  • Panic attacks and phobias
  • Fears and terrors
  • Flashbacks and intrusive memories or images
  • Overwhelming emotional responses such as shame, anger, depression
  • Insomnia, poor sleep, nightmares, night terrors
  • Psychosomatic illnesses, particularly some headaches, migraines, neck and back problems
  • Muscle weakness, muscle pain e.g. fibromyalgia, myofacial pain
  • Digestive problems, e.g. irritable bowel syndrome, spastic colon
  • Immune system disorders
  • Skin reactions
  • Environmental sensitivities
  • Physical, mental or emotional exhaustion
  • Mood swings, shame, depression, rage, aggression, lack of self worth, easily irritated
  • Feelings of helplessness and powerlessness
  • Mental ‘blankness’ or feeling spaced-out
  • Amnesia, forgetfulness
  • Indecisiveness and feelings of overwhelm
  • Attraction to dangerous situations or people
  • Addictive behavior: smoking, alcohol dependency, drug abuse
  • Avoidance behavior: avoiding places, activities, memories, situations or people
  • Attachment difficulties in nurturing, bonding or committing to others or receiving from others

As SE works directly with the neurophysiology of the body to help regulate the nervous system and its effects on the endocrine and immune systems, these symptoms can gradually be reduced.

Trauma Healing

Traumatic symptoms are not caused by the “triggering” event itself. They stem from the frozen residue of energy that has not been resolved and discharged; this residue remains trapped in the nervous system where it can wreak havoc on our bodies and spirits. The long-term, alarming, debilitating, and often bizarre symptoms of post traumatic stress disorder (PTSD) develop when we cannot complete the process of moving in, through and out of the “immobility” or “freezing” state.

Somatic Experiencing is a gentle and profound way of working with trauma stored in the body.

Trauma can be of two types: shock trauma and developmental trauma. Shock trauma results from distressing incidents such as a fall, surgery, a car accident, or being the victim of a crime or a natural disaster. Developmental trauma refers to having had a childhood history fraught with family dysfunction, neglect and/or abuse.

Somatic Experiencing (SE) facilitates the completion of self-protective motor responses and the release of thwarted survival energy bound in the body, thus addressing the root cause of trauma symptoms. This is approached by gently guiding clients to develop increasing tolerance for difficult bodily sensations and suppressed emotions.

SE does not require the traumatized person to re-tell or re-live the traumatic event. Instead, it offers the opportunity to engage, complete and resolve, in a slow and supported way, the body’s instinctual fight, flight, freeze, and collapse responses. Individuals locked in anxiety or rage then relax into a growing sense of peace and safety. Those stuck in depression gradually find their feelings of hopelessness and numbness transformed into empowerment, triumph, and mastery. SE catalyzes corrective bodily experiences that contradict those of fear and helplessness. This resets the nervous system, restores inner balance, enhances resilience to stress, and increases people’s vitality, equanimity, and capacity to actively engage in life.

Traumatic symptoms are not caused by the “triggering” event itself. They stem from the frozen residue of energy that has not been resolved and discharged; this residue remains trapped in the nervous system where it can wreak havoc on our bodies and spirits. The long-term, alarming, debilitating, and often bizarre symptoms of post traumatic stress disorder (PTSD) develop when we cannot complete the process of moving in, through and out of the “immobility” or “freezing” state.

How Does SE Differ From Other Therapeutic Modalities? 

Traditional cognitive and emotional based ‘talk’ therapies can be considered as being “top-down” approaches. They focus on insight and emotions first and secondarily may focus on the bodily responses to trauma. Talking about the trauma can have an adverse effect as the person can be re-traumatised with the flooding of reactions and overwhelm that rises during the process if their nervous system is not able to regulate itself. Sometimes, this is when people leave good therapy feeling that they are feeling worse.

In contrast Somatic Experiencing is a “bottom-up” approach. SE focuses on the brain stem – the reptilian brain and its survival-based functions that are not under conscious or emotional control. Access to these instinctual action and arousal systems is through the mode of physical bodily sensations, imagery and motor patterns. In the process of working with the ‘felt sense’ of the body other elements of the trauma experience may arise such as meaning and emotions. Thus cognitions and emotions are included in SE practice but they are secondary or derivative from physical sensations through the bottom-up processing.

SE uses techniques and interventions that work directly and gently with the neurophysiology of the body. SE avoids some of the issues that catharsis, re-enactment or talking about the story may create such a re-traumatisation or re-arousal of intense emotional states that can be frightening or too confronting to clients and may discourage them from continuing on their healing journey.