Dr. Peter Levine gives us a bigger context for the healing of PTSD. Emotional transformation, or catharsis, as I prefer to call it, is not an isolated event, but part of a complete cycle of emotional response to danger. And this applies to other kinds of emotional healing as well. Here is what I learned at a recent training. (Photo: Stig Nygaard, Flickr)
I recently attended an introduction to SE, Somatic Experiencing, an approach to treatment for trauma pioneered by Dr. Levine. I had been intrigued by his presentation at a Daniel Siegel conference, but this time I had a chance to learn more and then to discover his extensive writings on mechanisms of healing.
Idea One: The Interrupted Stress Response Cycle
Many clinicians, myself included, have thought of trauma as a response to overwhelming emotion where an automatic circuit breaker in the mind has disconnected the emotion and sometimes the whole experience from consciousness. Healing by what I call catharsis is seen as allowing the experience back into consciousness where the emotion can be transformed to a point where it no longer elicits the painful visceral responses that PTSD sufferers so dread. This isn’t wrong, but there is more to it.
In the last post, I emphasized that healing, in addition to requiring that emotion be conscious, also demands a context of safety and empathic connection. What Peter Levine and his followers have added is that this transformation is but one component of a natural response cycle that has been interrupted in mid-stream.
Levine uses the example of a herd of grazing animals in the wild. At the approach of a lion, the herd becomes aroused. They are on alert, vigilant, with heightened senses and stress hormones rising. When the lion attacks, the herd goes into full flight (other possible reactions depending on species and circumstances are to fight or to freeze). When the lion has found it’s prey or given up the chase, the herd stops running, but is overflowing with nervous energy. They move about actively, then gradually settle down and begin grazing again. That is the full cycle.
We humans have a similar cycle. Think of people, excitedly waiting to ride the Dragon Coaster. The cars slowly clank up the hill, then in a brief moment, muscles tighten and terror takes hold. Almost instantly the fear abates and is replaced with joyful screams and laughter. The riders emerge, full of energy and movement, then settle down to eat some cotton candy. The happy release of energy is the natural version of the moment of transformation in therapy. Bodily movement and emotions soon give way to calm.
In trauma, Levine points out that the danger and emotion are so overwhelming that the organism can’t process what is happening and the cycle is halted. The physical movement of flight, fight, or going limp is arrested with the cycle at the point of greatest arousal. The survivor remains physiologically, neurologically, locked in an emergency response. Stress hormones, muscle tension and frozen emotion can remain out of awareness but at high levels indefinitely. Release comes when the individual is able to resume the cycle and finish processing as would have happened had the system not been overwhelmed.
So the amazing transformation of therapy, the one I call catharsis and Levine calls “biological completion,” where movement and emotions come to consciousness and are processed, is simply a component of a stress response cycle that has been interrupted in mid-stream. This way of thinking about healing places it in a more natural context. I wont’ think of resolution of traumatic experiences in quite the same way again.
Idea 2: Trauma is Embodied
Dr. Levine, reminds us that trauma is embodied, that is held in the body including its nervous system. His unique contribution is to show that emotions are not the only thing that can be held in suspension. The physical impulses and movements associated with fight, flight and going limp are just as much part of the stress response cycle. They, too, can be stopped indefinitely. Muscles that have been inhibited may await release. Even when muscle movement has actually happened, an overwhelmed brain may be unable to experience completion of an intended self-protective gesture. Careful, modulated attention to bodily sensations is what can lead to release and return to contact with consciousness, where the response cycle can resume its processing with an outpouring of nervous movement and energy, then gradual return to a new and lasting calm.
Trauma treatment should not forget the role of the body and physical sensation. Somatic Experiencing (SE) consists of a trove of attitudes and methods, sometimes using words and sometimes not, for tuning in to the body through the senses and facilitating biological completion. It is too easy for talk therapists like myself to neglect the physical and miss a world of bodily symptoms as well as a major pathway to the emotions. SE is a resource not to miss.
Idea 3: Intensity Must Be Modulated
Dr. Levine is not the only one to emphasize the importance of a deeper, more visceral processing of trauma that leaves the survivor permanently changed. Van der Kolk and even Freud have made the same observation. What has made this subject confusing is that proponents of various therapies, in their eagerness to claim that theirs is deep and curative, sometimes accuse other treatments of being either re-traumatizing or too superficial for lasting cure. The key is not as much in the choice of therapy as how the level of arousal is regulated.
Somatic Experiencing incorporates some excellent ideas for regulating the intensity of therapy. One is “titration,” meaning that the therapist works to slow down or intensify the treatment to keep the level of arousal in a workable range, not too high or too low. Another principle is “pendulation,” that is, alternating between arousal and calming (think of the natural rhythm of peek-a-boo) to help create an atmosphere of safety.
Most therapies incorporate some means for regulating arousal, but not all recognize how important this is. Exposure therapy was invented to increase arousal because the older technique of desensitization tended to allow the patient to distance too easily from feelings. Unfortunately, exposure, when taken too literally, can be interpreted as encouraging excess arousal without paying attention to empathic connection. At the other end of the spectrum, talk therapy and cognitive restructuring therapy make it easy for therapist and client to avoid emotion. Unless arousal is heightened, they can leave frozen trauma untouched.
When authors discourage overdramatic forms of treatment, what they really mean is that arousal for its own sake, or if it is not paced and kept within bounds, can be overwhelming and can lead to re-traumatization. On the other hand, when they criticize overly intellectual treatments, they mean that bodily sensations and emotions may be neglected. A simple way to say both is that transformative therapy requires conscious, visceral experiencing in a context of safety and empathic connection. What Peter Levine would add is that bodily sensations need to be attended to, along with emotions and that moment by moment pacing and attention to the rhythm of arousal are crucial components in creating a context of safety.
I hope this tiny taste of SE is of interest. You will find more on the SE website [http://www.traumahealing.org]. I can also strongly recommend Peter’s books.[link to book page].