Yesterday I finished Bessel van der Kolk’s monumental work, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. This book, the result of more than three decades of research, direct service, and tireless curiosity by this Dutch psychiatrist, tracks the development of the profession’s understanding (or more often, lack of understanding) of post-traumatic stress. The most important piece for me: that the effective treatment of trauma requires not just a top-down approach (i.e., the use of talk therapy or other language and mind-based techniques), but a bottom-up approach as well. In short, the traumatized person needs healing that addresses their bodies as well as their minds.
Van der Kolk covers many bottom-up approaches, including yoga, theater, body psychotherapies like Somatic Experiencing, and even massage, and delves into the neuroscience, clinical data, and long-term outcomes of how it all works. The book is a tremendous win for bodymind modalities like Rubenfeld Synergy, which works with gentle touch and movement to help clients reconnect with their bodies and access the memories, emotions, and stories that live there. But it’s also a validation for me of the practices I’ve been doing with my more traumatized clients.
For those who suffer from the common long-term effects of PTSD, getting into your body is no mean feat. Dissociation – the sense of “leaving your body,” even to the point of feeling like you’re observing it from the outside – can happen easily; I’ve seen a few clients who “zone out” or dissociate merely from being asked to pay attention to their feet. Numbing, another common symptom, means such clients often can’t feel their body much at all – nor the emotions connected to it. For people who have flashbacks and experience what happened to them not as a story that happened long ago, but as an immediate, present, and intensely terrifying series of sensory impressions, anything that gets them in touch with their bodies too quickly – such as touch – is out of the question.
Among the multitudinous pearls of wisdom I got from this book was a word for what I do when this is the case: pendulation. Taken from Peter Levine, Dr. van der Kolk’s friend and colleague who developed Somatic Experiencing, pendulation refers to helping a traumatized person dip a toe, as it were, in and out of the intensity of memory. By guiding the client toward the experience that needs integration, then backing away from it before their tolerance runs out, a practitioner can help a traumatized person gradually approach and come to befriend previously intolerable feelings.
So if you come to me with a trauma history, I might keep us in chairs for a while rather than going to the table right away. I might ask you to pay attention to your breath, but might back off even from that if I sense that you’re starting to feel anxious or “leaving the room.” It’s a delicate balance, but little by little, we get back in touch with ourselves, and regain the strength, as van der Kolk repeatedly says, “to know what we know and feel what we feel.”