The good news is that human beings are generally flexible and resilient: we are ordinarily able to learn from and integrate a variety of life experiences. These experiences, whether uplifting or downbeat, flow easily through our body/mind stream of consciousness as long as we are not chronically over- or underaroused. The body/mind keeps flowing through new encounters with vitality, bouncing back into the stream of things unless there is a significant disruption. In this case, the person is knocked off that normal course—whether it is from a single episode, such as a disaster, an accident, surgery or rape, or from a chronic stressor, such as abuse or ongoing marital stress. When such disruptions fail to be fully integrated, the components of that experience become fragmented into isolated sensations, images and emotions. This kind of splitting apart occurs when the enormity, intensity, suddenness or duration of what happened cannot be defended against, coped with or digested. Personal vulnerability, such as age, genetics and gender also account for this psychic implosion. The result of this inability for the body/mind to integrate is trauma, or at the very minimum, disorientation, a loss of agency and/or a lack of direction.
Trapped between feeling too much (overwhelmed or flooded) or feeling too little (shut down and numb) and unable to trust their sensations, traumatized people can lose their way. They don’t “feel like themselves” anymore; loss of sensation equals a loss of a sense of self. As a substitute for genuine feelings, trauma sufferers may seek experiences that keep them out of touch—such as sexual titillation or succumbing to compulsions, addictions and miscellaneous distractions that prevent one from facing a now dark and threatening inner life. In this situation, one cannot discover the transitory nature of despair, terror, rage and helplessness and that the body is designed to cycle in and out of these extremes.*
Helping clients cultivate and regulate the capacity for tolerating extreme sensations, through reflective self-awareness, while supporting self-acceptance, allows them to modulate their uncomfortable sensations and feelings. They can now touch into intense sensations and emotions for longer periods of time as they learn how to control their arousal. Once a client has the experience of “going within and coming back out” without falling apart, his or her window of tolerance builds upon itself. This happens through achieving a subtle interplay between sensations, feelings, perceptions and thoughts. I believe that the people who are most resilient, and find the greatest peace in their lives, have learned to tolerate extreme sensations while gaining the capacity for reflective self-awareness. Although this capacity develops normally when we are very young, one can learn it at any time in life, thankfully.
Children gradually learn to interpret the messages their bodies give them. Indeed, it is by learning to coordinate movements (behaviors) and sensations into a coherent whole that a child learns who he or she is. By remembering actions that have proven to be effective, and discarding those that are not, children learn how to anticipate what the most appropriate response is and how to time its execution for maximum effect. In this way, they experience agency, satisfaction and pleasure. When a child is overwhelmed by trauma or thwarted by neglect, this developmental sequence is aborted or, if already developed, breaks down; and negative emotions come to dominate his or her existence.
After being traumatized, a child’s relationship with his or her body often becomes formless, chaotic and overwhelming; the child loses a sense of his internal structure and nuance. As the body freezes, the “shocked” mind and brain become stifled, disorganized and fragmented; they cannot take in the totality of experience and learn from it. These children, who have become “stuck” at some point along a once meaningful and purposeful course of action, engage in habitually ineffective and often compulsive patterns of behavior. These often play out in symptoms like those of attention deficit hyperactivity disorder or obsessive-compulsive disorder. The child’s uncoordinated fragmented efforts are not registered as normal, explicit, narrative memories but rather are encoded in the body as implicit, procedural memories including discomfort, constriction, distress, awkwardness, rigidity, flaccidity and lack of energy. Such memories are encoded not primarily in the neocortex but, instead, in the limbic system and brain stem. For this reason behaviors and memories cannot be changed by simply changing one’s thoughts. One must also work with sensation and feeling—really with the totality of experience.
The SIBAM Model
Human beings, in general, and therapists, in particular, make contact through a kind of “body resonance.” As described in Chapter 4, we humans are programmed to experience sensations similar to those of people with whom we are in close proximity.85 Imagine the scenario of being in a room filled with anxious conspiracy theorists as compared to one with blissful, meditating monks.
Resonance forms the basis for the empathic attunement needed to form intimate relationships.86 In treating traumatized individuals, a therapist first needs to cultivate a deep and enduring relationship with his or her own body. Only when a therapist’s embodiment skills are intact and engaged can he or she mentor and self-empower a client. Similarly, by refining their own capacity to observe the subtle behaviors of others, therapists can provide their clients feedback that helps them become aware of their sensations and feelings. Together, these two tools—somatic resonance and subtle observation—are of incalculable power and benefit. In the words of the analyst Leston Havens, “Perhaps the most striking evidence of successful empathy is the occurrence in our bodies of sensations that the patient has described in his or hers.”87
During the 1970s, I developed a model that allowed me to “track” the processes whereby my clients processed experiences. This model, which I call SIBAM, is based on the intimate relationship between our bodies and our minds. The model examines the following five channels, with the first letters of each element making up the acronym.
Sensation
Image
Behavior
Affect
Meaning
The SIBAM model stands in sharp contrast to the established hierarchical framework, codified as cogito ergo sum or “I think; therefore I am,” which has been the foundational premise of the standard, cognitive-behavioral therapies. In contrast, my five-element model is the essence of “bottom-up,” sensorimotor processing aimed at guiding the client through different “language” and brain systems, from the most primitive to the most complex; from physical sensations to feelings, perceptions and, finally, to thoughts. Sensation, Image, Affect and Meaning are tracked by the client, while Behavior is directly observed by the therapist. This approach allows for an intimate tracking of the multiple layers and textures of the totality of experience.
The Sensation Channel
In this channel, I refer to physical sensations that arise from within the body, from receptors lying in the interior of our organisms. These sensations are also known in the literature as interoceptive. They ascend via nerve impulses from the interior of the body to the thalamus in the upper brain stem, where they are transferred to many, if not most, regions of the brain. Four subsystems, or categories, make up the sensation channel in order of increasing depth: the kinesthetic, the proprioceptive, the vestibular and the visceral receptors.
The Kinesthetic Receptors
The first subsystem within the sensation channel is kinesthesia. The kinesthetic sense signals the state of tension of our muscles† and relays this information to the brain. When you feel “uptight,” it is because you are receiving excess nerve impulses coming from muscles in your shoulders and other areas—such as neck, jaw or pelvis—as well as from an overactive mind.
The Proprioceptive Receptors
The second subsystem, called proprioception, gives us positional information about our joints. Together, kinesthesia and proprioception tell us where we are in space, as well as the velocity of any body part. One could, for example, conduct a symphony with one’s eyes closed and then at the end place a finger precisely on the tip of one’s nose without looking—an extraordinary but possible
feat of sensation and coordination.
The Vestibular Receptors
The vestibular subsystem derives from microscopic hairs embedded within the semicircular canals of the inner ear. There are two of these canals positioned at right angles to each other. When we move (accelerate and decelerate in any direction), fluid in these canals “sloshes” over the hairs, bending them. Each hair is connected to a receptor, and these receptors then send afferent impulses to the brain stem. Information from this sense lets us know our position with respect both to gravity and to any change in velocity (i.e., acceleration and deceleration).
The Visceral Receptors
The fourth subsystem, which provides the deepest level of interoception, derives from our viscera and blood vessels. In Chapter 6 I described the vagus nerve, which connects the brain stem to most of our internal organs. This massive nerve is second only to the spinal cord in total number of neurons. Over 90% of these nerve fibers are afferent: that is, the vagus nerve’s main function is to relay information from our guts upward to our brains. Thus, the colloquialisms “gut instinct,” “gut feelings” and even “gut wisdom” have a robust anatomical and physiological basis. Visceral sensations also originate from receptors in the blood vessels—as sufferers from migraines know all too well, the abrupt dilation of blood vessels (after strong constriction) causing their excruciating pain. However, we are also receiving all sorts of other ambient information from our blood vessels. We feel relaxed and open when our blood vessels and viscera gently pulse like jellyfish, causing sensations of warmth and goodness to surge through our bodies. When the vessels and viscera are constricted, we feel cold and anxious.
The Image Channel
While image commonly refers to visual representation, I use it more generally to refer to all types of external sense impressions, which originally come from stimuli that arise from outside the body and that we have also incorporated into the brain as sense memory. These external (“special”) senses include sight, taste, smell, hearing and the tactile sense.‡ Counter to common parlance, I use the same word—Image—to categorize all of these external senses. Indeed, the I in the SIBAM model could refer, equally, to any of the externally generated Impressions (i.e., visual, auditory, tactile, olfactory, etc.). For example, if a person is physically touched by another person, he or she will experience both the external impression of being touched as well as the internal (interoceptive) sensation of his or her response to that touch. So if we have been touched inappropriately, it will be necessary to separate the actual tactile impression from our internal response to this stimulus in each new situation in order to free ourselves from reflexively reacting from past experience.
The visual impression, or Image, is the primary way modern humans access and store external sense information, unless they are visually impaired. The largest portion of our sensory brain is dedicated to vision. There are, however, other therapeutically oriented reasons for my including all of the external senses in the Image channel. At the moment a trauma takes place, all of a person’s senses automatically focus on the most salient aspect of the threat. This is usually a visual image, though it could also be sound, touch, taste or smell. Many times it is a combination of several or, even, all of the above sense impressions simultaneously. For example, a woman molested by an alcoholic uncle may panic on seeing a man who looks vaguely like him or whose breath smells of alcohol and who walks with a loud, lumbering gait. These fragmentary snapshots come to represent the trauma. They become, in other words, the intrusive image or Imprint. For me, the image of the shattered glass and the eyes of the teenage driver kept intruding on my consciousness and flooding me with fear and dread.
When reworking such embedded sensory images, a process of diffusing the adrenalin charge of the compressed “trauma snapshot” is necessary in order to uncouple associations that are symptomatic. An important therapeutic technique “expands and neutralizes” this fixation and helps the person recover the multisensory experience he or she may have had prior to the threat that caused the fragmentation. The following vignette illustrates this principle of expanding the “visual aperture.”
Imagine that early one summer morning, you are walking along a beautiful hillside. There is a babbling brook meandering beside the pathway. A gentle breeze makes the multicolored flowers look as if they are dancing on the meadow. You are touched by the sight of drops of morning dew sitting on a blade of grass. The sunshine warms your skin, and the scent of the flowers is nothing less than intoxicating. You are taking this all in. Then, unexpectedly, a large snake appears on the trail. You stop and hold your breath. All that you had perceived a moment ago is gone … or is it? Not really. What happens is that your perception has constricted to focus narrowly on the source of the threat. Most everything else retreats into the background, into the hidden crevices of your mind, so as not to distract you from what you must identify and do: to keep your attention solely focused on the snake and to slowly back away. After feeling safe again, you may return to the full sensory experience of the morning. When a traumatized individual is able to expand his or her sensorial impressions, associated hyperarousal begins to ease, allowing that widened perceptual field to return to its prethreat status, and thus enhances the capacity of self-regulation.
Before my accident, as detailed in Chapter 1, I was taking in the scene: the colors, sounds, scents and warmth of that perfect day. In the instant that I was struck, these pleasant images paled. Now my attention was riveted only on the image of the “predator”: the spiderweb cracks of the windshield, the beige grille of the car and the terrified face of the wide-eyed teenager. Luckily, in my self-administered first aid, I was able to return to the start of that perfect day, with the sensuous sights, sounds and smells of the precious moments before the impact.
The Behavior Channel
Behavior is the only channel that the therapist is able to observe directly; all others are reported by the client. Although the therapist is able to surmise much about a client’s inner life from a resonance with her own sensations and feelings, such inferences cannot take the place of the client also accessing and communicating his own sensations, feelings and images to the therapist.§ The therapist can infer a client’s inner states from reading his body’s language, the unspoken language of his actions/inactions or tension patterns. For example, the therapist, in noting a particular body behavior, may direct the client to focus on what he may be experiencing in his body (Sensation). If, say, the therapist observes a slight rising of the client’s left shoulder (Behavior), she can bring the latter’s attention to this postural adjustment and allow the client to contact the sensations of the asymmetrical tension pattern. Similarly, the client may be encouraged to access the other channels of experiencing (Image, Affect or Meaning) during the execution of this postural behavior. This will be clarified by the case examples in the next chapter.
Behavior occurs on different levels of awareness, ranging from the most conscious voluntary movements to the most unconscious involuntary patterns. These levels are similar to the gradations of consciousness I have examined in the sensation category. We will now briefly examine behaviors that occur in the following subsystems: gestures, emotion and posture, as well as autonomic, visceral and archetypal behaviors.
Gestures
The most conscious behaviors are the voluntary ones: that is, the overt gestures that people generally make with their hands and arms when they are trying to communicate. These movements are the most superficial level of behavior. People frequently use voluntary gestures to convey “pseudo-feeling” states to others. We have all seen politicians deliberately exaggerate their gestures for emphasis and effect. If you know the real thing, you can readily discern the fundamental disconnect or incongruity between one’s attempt to convey what one is trained to express (e.g., opening one’s arms to the audience or holding a hand to one’s heart) and what one is really feeling. At the same time, even volitional gestures can convey feelings, both to others and to ones
elf.
For example, one can interpret the nonverbal communication of the clenched fist as either a threat enhancing aggression or as the setting of clear boundaries and quelling fear. Here are some common gestures to experiment with: Rub your forehead with your hand and notice how that feels. Now stroke the back of your neck. What do these two gestures convey to you? Do they make you feel more or less secure? How about when you are wringing your hands versus when they are steepled, fingertip to fingertip? What differences do you notice?
Emotion
Facial expressions are at the next level of behavior and are generally considered to be largely involuntary. These micro-expressions are what the renowned Paul Ekman88 studied in his pioneering research spanning over four decades. With practice and patience, one can develop the skills necessary to observe these very brief changes of muscle tension (often in a fraction of a second) throughout parts of the face.‖ The specific patterns of these muscle contractions communicate the full range of emotional nuances to oneself and to others.a Giving clients feedback about their facial expressions can help them contact emotions of which they may be partially or fully unaware.
Posture
The third level of less conscious awareness in the behavior category is posture. Here I’m not referring to gross voluntary postural adjustments like those demanded by parents or teachers, such as “sit-up straight,” “don’t slump” or “shoulders back,” which refer to voluntary movements. These belong instead to the category of voluntary gestures. Sir Charles Sherrington, the grandfather of modern neurophysiology, alleges that “much of the reflex reaction expressed by the skeletal musculature is not motile, but postural, and has as its result not a movement but the steady maintenance of an attitude.”89 I would add that postures are the platforms from which intrinsic movement is initiated. In the words of A. E. Gisell, a student of Sherrington’s, “the requisite motor equipment for behavior is established well in advance of the behavior itself.” In underscoring how important posture is in the generation of new behaviors, sensations, feelings and meanings, Gisell added, “The embryogenesis of mind must be sought in the beginnings of postural behavior.”90
In an Unspoken Voice Page 16
