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How Deep Tissue Work can assist the Release of Post-Traumatic Stress Tension

bernhard schlage, 2018.

nachdem der wissenschaftliche nachweis der wirksamkeit für körperpsychotherapie für die verbreiteten krankheitsbilder dieser welt erbracht worden ist, geht es dem europäischen verband nun darum, die behandlungsweisen im einzelnen einen größeren öffentlichkeit darzustellen. dazu ist ein erster band erschienen, in dem auch 3 beispiele aus meiner praxis aufgenommen worden sind: bernhard schlage (2018), 3 case studies about body psychotherapy; in: courtney young (editor); the body psychotherapy case studys; Body Psychotherapy Publications, 60 Earlston Road, Stow, Scottish Borders, Scotland UK, TD1 2QT pp. 89 – 114

Abstract

This case study shows how elements of deep tissue work from Body Psychotherapy allow the release of post-traumatic stress tension in the upper chest. It introduces the so-called ‘affect cycle’ and shows how the complete understanding of this model offers a therapeutic framework for the use of different Body Psychotherapy techniques, especially during deep tissue work in the body. In this way, the therapist can help the client to achieve the release of traumatic reactions in ways not usually open to discussion therapy.

A Body Psychotherapie Case Study

Introduction

While attending a regular session in a type of talking therapy, this client became aware that she was feeling a lack of emotional freedom in her body: she thought that this might be caused by some post-traumatic stress, or chronic tension in her torso (upper body).

Case Presentation

The client was 36 years old, married, and the mother of 2 children. The relationship with her husband had been dominated by negative communication patterns. In her work, she was also searching for a new professional perspective. She had been participating in a training program entitled: “Dreaming-up Processes” about shamanic dream-work (Schlage, 2010) when some traumatic memories came into her consciousness. Then, in the context of another (different) therapy session, she had remembered situations of sexual abuse in her childhood; and she realised that she was still holding on to a number of bodily tensions originating from that abuse.

At the beginning of the course of Body Psychotherapy sessions, in the initial ‘adult attachment interview’ (Brisch, 1999; Bowlby & Fry, 1953), she ‘presented’ her non-verbal behaviour as evoked shyness, i.e. her face downcast, looking at the floor when entering the therapy room. She had also displayed the typical mannerisms of a person with an “oral” character structure (Johnson, 1985; Keleman, 1983), with a depressed or collapsed ‘hole’ in her upper chest around the sternum / the area of the heart, and the (so-called) „angels-wings“ showing in the back, caused by the protruding proximal parts of the shoulder blades. Her breathing pattern had been focused on the exhalation part of the breathing cycle, so she tended to feel as if she had lost all her energy, and she said that she did not really feel properly ‘grounded’. Her unconscious movements were small, sometimes seeming centred, though the force of the movements was weak, and their direction did not give any clear orientation, neither for those she was in contact with, nor for herself. Some of her feelings were predominant, especially her feelings of anxiety and sadness, but ultimately her ‘affect cycle’ was not very strong; it lacked energy and petered out, and she did not seem to experience any emotional climax or release, and thus she gave the impression that she had tried, rather ineffectually, to evoke a reaction in people that she normally related to, than to fulfil any full release of her emotions. (Erken, Painter & Schlage, 2012)

Diagnosis

If a psychiatric diagnosis were to be considered relevant, it might be something like: “Asthenic, inadequate or passive personality disorder or neurosis; ICD-10: F60.7” 35; or possibly “F.43.1 Post-traumatic stress disorder”.

Management and Outcome

This client had a total of 42 Body Psychotherapy sessions over a period of 3 years. She had come into contact with me because she participated in a training session (of mine) in shamanic dream-work. Whilst working with her dreams, several memories from her childhood came up, which, at first, we handled with some ‘dream-work’ techniques, until suspicion arose of sexual abuse actually happening in her early childhood.
From that time onwards, she entered in to Gestalt Therapy with a colleague of mine, and the „tracking of the original scenario“ (Rosenberg, Rand & Asay, 1985) had been done within this setting; in addition, there was also some work on transference had been done in that therapy setting (Greenson, 1967). Yet, after a while, she found that several muscular tensions in her torso were persisting (and these pains seemed to be related to the trauma in her past). She also sensed symptoms typical for trauma, like feeling cold and starting to tremble, especially in emotional situations (Reich, 1967; Levine, 1997). So, she had the desire to utilise some Body Psychotherapy techniques in order to find some greater release from her suffering: thus, she came back into therapy with me.

At the beginning of the Body Psychotherapy work, we had tried to develop a deeper level of trust and contact. Even with her Gestalt therapist – a woman – and now, in contact with me again, her need for safety was primary and thus there had to be a clear contract concerning the obligation to maintain secrecy, and secondly, she emphasised that she also needed safety (very clear boundaries) concerning the contact between her (as a woman and a client) and me (as a male therapist).

We usually started the sessions by talking, and then I often guided the therapeutic dynamic into a form of ‘role play’ that allowed her to express her need for separation and distance: for instance, one ‘role play’ setting was where she had to mark out her ‘personal space’ with a rope on the floor, and then I encouraged her to allow herself to feel different emotions at different places within the marked-out circle. I was interested in what she felt, especially when she was more in the centre, or more at the periphery, and this was accompanied by my questions about what she felt when the therapist (me) came closer to the demarcation of her rope circle, or when the therapist kept more of a distance from her in the ‘safe circle’. This role-playing gave her time to discover that she was able to regulate (moderate) her own feelings, and also to discover the distance that she might need in order to feel ‘safe’ when involved in any interactions, especially with me.

After helping her to learn how to stabilize herself and regulate herself; and having integrated different strategies in order to regulate an appropriate working- distance between us; we went on and tried to explore her reactions to touch in different areas of her body. We began with areas that the client chose for herself, and later on this changed to various other parts of the body, that were chosen by me, her therapist (all within the normal bounds of propriety, of course). We took time to explore her inner reactions to the different types of touch – such as experiencing warmth or coldness, or tension or relaxation; and we would then engage in a dialogue about the quality of touch and her experiences of that touch.

But also, she allowed herself to sense the actual touch itself: does the skin of the therapist’s hand feel separate from her skin; or does it feel like a fusion between both? What was the quality of temperature at the place of touch, and does something from the sensation of the therapist’s hand “flow” into her body, or vice versa: can the tension or pain in this area be felt only by the touch of the therapist’s hand, or by the therapist through his hand? And does this happen by itself, or is the client able to regulate the direction or amount of any sensation? We also ‘tracked’ her reactions (Ogden et al., 2006: pp. 262-264) that she felt in the core of her body, depending on the place of touch: either, closer to the periphery, or on more distant parts of the body, in order to find out the different (or maybe even paradoxical) body reactions, in response to the different types of touch and the different places of touch.

Later on, we practised (for about 5 sessions) some of the various “freeing” or “anti-blocking” techniques used in Body Psychotherapy: making the use of breath, movements and sounds, in order to deepen contact with the chosen body parts (Rothschild, 2000): and in changing her awareness in the area of touch, by focusing her breathing into this area (use of breath); following any small or tiny movements that might then be felt in that area (tracking), and trying to increase or reduce these; giving her expression of movement a wider radius, and more strength, or more speed (use of movement expression); making sounds to support her expression, if needed.  All this detailed work was designed to support her so that she could develop and deepen her trust in her own abilities of self-regulation and self-encouragement (Schoenaker, 2011). She not only practiced these when in contact with (me) the therapist; but also, with some members of her family. These steps prepared the way for the next phase of our work (which took about another 5 sessions).

So, we then focused on some of her deeper muscular tensions: particularly those that she felt in her upper torso. After a period, during which she felt she needed to re-discover her personal boundaries, especially those with regards to the degree of her nakedness that she could tolerate in this area (exposure of her upper chest area; but not including her breasts), we managed to find ways of me being able directly to touch her ribcage.

As described in another article (Schlage, 2016), we were now using fairly deep and strong physical touch, working together with her breathing, and exploring any internal awareness or movements, to help to reactivate the frozen feelings in this part of her body. As Peter Levine describes (1997) the „counter-pulsation“ (which is what he called ‘tension’ in certain areas) has a tendency to increase initially; so, at first, the client found herself with a strong ‘muscular’ resistance towards ‘something’: her inhalation became fixed; her posture defensive; pressing her wrists to the front of her chest; making fists; and sensing an unknown scream in her throat.

Using the techniques that we had used before, she was more and more able to transform this ‘frozen’ gesture into some form of movement, and finally even to try different kinds of voice-work (even screaming) to get relief from tension in this area. This is the so-called “emotional climax” (Erken et al., 2012: p. 209) that we had to approach several times, until she developed some trust in this process. We then could focus similarly on the somatic memories that ran parallel to, or were involved in, this process.

While following this path of contact, movement and sound – probably for the first time in her adult life – the client was able to gradually re-connect with her traumatic memories (those that she had only spoken about in her Gestalt therapy); and connect these with her bodily experience; and, in this way, she found herself experiencing a deep state of relaxation after these sessions. Of course, it was not just one singular session that brought about her ‘liberation’ from these long- established (chronic) tensions. It was a step-by-step-process of her re-connecting with her body, her movements and emotions; of her growing in confidence through these experiences; and occasionally passing through phases of … deep shame, as well as – paradoxically – deep laughter, which emerged several times when repeating this body-oriented process. In the end, she felt much more relaxed, especially in her trunk and upper chest, and her ability to breathe and the capacity for movement in her shoulders had increased significantly. For the subsequent phase of her therapy work (which involved the integration of her new emotional abilities into her family relationships), she decided to return to work with her Gestalt therapist, and so we decided to terminate the Body Psychotherapy part of her therapeutic process.

Discussion

In the beginning, this case study opened up difficult questions about interdisciplinary cooperation with other colleagues. Uexküll & Adler (1990) postulate that this is the optimum way of working with psychosomatic or post- traumatic cases in individual therapy: yet, in reality, it rarely happens. Therefore, there is still some research that needs to be done as to how this collaboration could possibly be managed better, in order to improve this ‘inter-collegial co-operation’ for the benefit of our clients.

Another difficulty that was obvious, was in relation to the different genders of the client and therapist. Body Psychotherapy practice – because of the physical (or even intimate) contact – can present more of a challenge than in most of the talking therapies, since we do not only experience transferential themes in our emotional contact, but we are also going to touch the clients directly, so they will be interacting with us, and we will be in actual contact with them and their fears and needs for safety, and – at the same time – they will also need our support in exploring and, particularly, in regulating the amount and quality of contact. This case study is an example of demonstrating the great importance of giving sufficient time and space for this process, and the actual techniques used are related to those that Greenson (1967) describes.

A third difficulty that this case study presented was the aspect of, or the degree of, traumatization as a result of the early sexual abuse that happened to the client. This difficulty demonstrates how a ‘talking therapy’ can be helpful for clients to become aware of their memories, and of the abuse that they may have experienced. However, with some clients, this is not sufficient for the somatisation to be released, because of the limitations that the traumatic experience has left in their emotional reactions and body awareness. With some clients, like in this case study, there is a need to help them to reduce or release some of the physical and structural limitations, caused by the ‘frozen’ emotional wave in their bodily experience.

Here, some of the special techniques of touch that are employed in (for example) Postural Integration Psychotherapy (Painter, 1987), were used to reconnect the client’s mental life with her physical contact that helps to restore the unity of body, emotion and memories again (Juhan, 1992). These techniques can also put the person back in touch with the suppressed ‘frozen’ fight-or-flight reactions, that would have been triggered by the abuse, but were not able to be acted on: hence some of the ambivalence and aggression also present in her reactions.

In this work, I (as the therapist) was deeply touched by the client’s courage to confront the reality of her childhood sexual abuse (from a close male relative), and also by her will to understand what had really happened: – this was not in order to see herself as a victim of her past, but also to acknowledge that, in fact, she is a survivor, and that she had re-discovered her natural or healthy strengths and resources, for instance, in her healing (shamanic) practice, and also in her new professional orientation as a volunteer in the hospice movement, caring for people on their pathway towards death (Papadopulos, 2007).

In this case, thankfully, it was possible for the client to confront her traumatic experience, even though this meant a lot of hard work. But, the question comes up: does “healing the trauma” mean: either removing the symptoms of trauma; or deleting traumatic experiences from the memories of the victims? Actually, there are many other ways of opening up insights that can be used by a client, so that the traumatic experience begins to hold some new possibilities to develop self- authorization and repair self-esteem.

But, there seems little we can do if a client does not have enough personal strength; or if the memories cannot become clear enough; or if they cannot be accessed because of massive repression; or if the former perpetrators are still living together with the client (which is often a problem with sexual abuse in the marriage).

It is therefore helpful to keep in mind that all unconscious memories have a tendency to become re-experienced, or to be re-lived in the transference situation, during any form of therapeutic work. This has been very well-established in psychoanalytic settings (Stern, 1986), and it is also clear for many types of Body Psychotherapy work (see: Levine, 1997; Rothschild, 2000; Ogden et al., 2006). The sensorial basis of this type of embodied transference phenomenon has been clearly established in ‘mirror neurone’ research (Rizzolati, et al., 1996).

However, in daily Body Psychotherapy practice, it appears like something a miracle, that happens again and again to the therapist during their work, to feel (or resonate to) sensations in his/her body that are related to the sub-conscious processes happening within the client’s body. The therapist then just has to decide when it is the right moment (and if it is appropriate) to mention their own sense of awareness to the client.

Summary

In this particular case study, the client was fully aware of her trauma and abuse before entering into this particular Body Psychotherapy process: therefore, the goal (that she wanted) was to make her more somatically aware of how she ‘stored’ the symptoms of her trauma, and how to help her to reduce the tensions in her torso, without triggering her defence mechanisms. Pat Ogden (2006) talks about staying well within the client’s “comfort zone” or “window of tolerance”, and the delicate preliminary work with her boundaries and the different experiences of touch demonstrated something of this approach. It was obviously very important for her to re-establish a sense of control; and it would have been very different (and it might have been a bit easier) with a female therapist, but the therapeutic relationship had already been started through the shamanic training work and the client chose to continue with this: the therapy setting had become a relatively ‘safe’ place, where these memories could now emerge.

 

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