Dreams are the body’s built-in imagery system, and most come in symbolic and image-laden form. They may contain trauma- specific imagery in the form of posttraumatic nightmares and memories of buried trauma as well as keys for renewing safety and directions for healing. One approach, based on Carl Jung’s method of active imagination (Jung, 1963), is called the guided active imagination approach (Schiller, 2008). This method attends carefully to preliminary and concurrent issues of client safety when doing deep dreamwork, using a form of guided imagery. Understanding and using the concept of felt sense can help clients to reorient themselves in their own bodies. The concept of felt sense is based on ideas put forward in Eugene Gendlin’s (1982) book Focusing. It implies a perceived bodily experience that is visceral and cognitive at the same time. Gendlin describes felt sense as “a bodily awareness, a non-linear experience . . . the medium through which we experience the totality of sensation” (Gendlin, 1982, p. 32). Ann Weiser Cornell (2005, p. 89) describes felt sense as “a freshly forming holistic sense that has a more-than-words-can-say quality to it.” It is the ability to tune into one’s body sensation and to describe it in relation to the cognitive context and the emotions being generated. (For example, if a client says, “I feel so ashamed when I think about what happened,” the clinician can respond with the questions “Where do you feel that sense of shame in your body?” and “How would you describe the sensation?”) Many practitioners have begun integrating mindfulness as a component of their treatment or as a separate, adjunctive treatment for PTSD. Mindfulness is an umbrella term that can encompass a number of mind–body interventions, and there is increasing empirical support for its utility for individuals with PTSD (Williston et al., 2021). One meta-analysis of recent studies showed that mindfulness-based approaches led to a reduction of PTSD symptoms with low rates of dropout from treatment (Boyd et al., 2018). Stress Inoculation Training Some trauma survivors are either uninterested in or unable to remember their traumas and therefore are incapable of engaging in trauma processing or narrative work. Stress inoculation training (SIT) represents an evidence-based “here- and-now” approach that aims to minimize hyperarousal symptoms without requiring deeper trauma processing (Jackson et al., 2019). SIT focuses on teaching and practicing coping skills to improve clients’ confidence in their ability to cope with, manage, and reduce stress. Clients work through three primary stages of SIT: Education, skill introduction, and skill practice (Jackson et al., 2019). During the education stage, clients receive psychoeducation about their trauma symptoms and collaboratively identify their sources, levels of stress, and current coping mechanisms (Meichenbaum, 2017). In the second stage of treatment, clients learn new coping skills—relaxation training, cognitive coping, assertiveness skills, guided self-dialogue, and mindfulness—that can replace or supplement their existing tools. Finally, in the third stage, clients practice the newly learned skills either in in-vivo sessions or during stressful conditions outside of the sessions (Meichenbaum, 2017). In addition to practicing skills, clients can create plans for handling future stressful situations or work to change or remove aspects of their lives contributing to stress (Meichenbaum, 2017). SIT is often used in conjunction with other therapies (Meichenbaum, 2017; Society for Clinical Psychology, 2016). Sensorimotor Psychotherapy One of the most useful systems for body-oriented work is sensorimotor psychotherapy. Building on the work of Ron Kurtz, who pioneered a therapeutic system called Hakomi (which emphasizes mindfulness), Pat Ogden and her colleagues (2006) designed a system of therapeutic work that approaches the body itself as central to the therapy and includes a variety of observational skills, theoretical perspectives, and interventions that are different from those employed in traditional models of psychotherapy. This system incorporates somatic (body-based)
interventions within therapy, with the goal of unifying body and mind in the treatment of trauma. It is based on the premise that in order to overcome the sense of being trapped in and by the past, traumatized persons must be able to (Ogden & Fisher, 2015): 1. Recognize old physical patterns and what sensory motor schools call “action tendencies,” 2. Learn to inhibit initial trauma reactive impulses, 3. Bring to completion the incomplete or frozen responses to the trauma that the body has become stuck in, and then 4. Learn and execute more effective and adaptive responses. Skills of tracking psychoemotional responses in the body (a process also known as interoception ) and calming, soothing, and grounding the body are taught with attention to a phase- oriented trauma treatment protocol that focuses first on safety and stabilization and later on processing traumatic memory and integration. One example of the use of this protocol could be recognition of a recoil response in the face of danger. Although the recoil response may have been adaptive at the time of initial threat, it no longer serves a useful purpose in current daily life. Now a trigger event causes danger to be perceived, even though there is no danger. The first step of a sensorimotor intervention would be recognizing the instinctual physical response of recoiling, or backing up, as a current response to an old problem, and then inhibiting that response. (This process is somewhat reminiscent of certain CBT skills.) Next, while attending to the original fear, a new, more empowering physical response in the present can be tried, such as saying no, pushing back, calling for help, or running. When the clinician has learned about and is comfortable with these types of interventions, these options can be role-played during a session so that the client is able to get a physical sense in their body of the differentiated response. Any sort of physical movement can help the body to complete and work through old, unfinished responses. Simply getting up and changing position can help clients to get out of the trauma trance they can fall into when traumatic sensations or memories surface. For clinicians or clients solely interested in practicing and promoting client interoception, rather than also addressing trauma processing and integration, Peter A. Levine’s (2015) “somatic experiencing” is a logical fit. In a way similar to sensorimotor therapy, somatic experiencing cues clients to track their physical sensations and ultimately regulate their physiological reactions to future trauma reminders. In this case, A useful tool for the assessment of a session or of an intervention that utilizes body-oriented techniques is the Subjective Units of Distress, or SUD, scale (Wolpe, 1969), previously mentioned in Chapter 5. This self-scaling method is based on cognitive- behavioral protocols and is also used as a pre- and posttest in EMDR and most energy medicine techniques. The client identifies the emotions connected with the distress and then rates them on a scale of 0 to 10, from “I am calm and relaxed when I think about this issue” to “This is the worst distress (fear, anger, anxiety, sadness, etc.) I can imagine.” Body-oriented and energy work takes this rating system one step further by asking, “Where do you feel this emotion in your body?” and “What are the sensations that you experience there?” For example, a client may name anxiety as the emotion and feel it in their belly as a churning sensation and in the hands as sweaty palms. Someone else may experience the same emotion of anxiety as a racing heart and shortness of breath. After the emotion has been named, rated, and located, the interventions are carried out. The SUD scale rating is then taken again, in the hope of providing a concrete subjective indicator for the effectiveness of the actions in reducing the initial distress. If the SUD scale rating has remained the same, or gone up, then a different approach is clearly indicated. the interoception is the primary goal. The Subjective Units of Distress Scale
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