The Body Keeps the Score – but we knew that

18693771Yesterday 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.”

 

 

Pay attention! Receive relaxation.

yoga
“I don’t need to describe what relaxation is like. I’m in it, right now.”
-A client, near the end of a session

The other day, a client I’ve been seeing for some months came in after a bit of an absence and, after lying on the table for a couple minutes, described the sensations of her body. She noted that her legs, in particular, felt very sunk into the table, and, she thought, “fairly relaxed.” The last phrase had some uncertainty to it, the ending going up, like a question.

Touching her feet and moving her legs a little in what we Synergists sometimes call the “windshield wiper” move, I noted that her legs hardly moved at all, and felt heavy and stiff to me. “Relaxed” wasn’t a word that came to my mind, and in a moment, the client herself withdrew it, noting that in fact her legs felt tired, resistant, and wary. As I moved to her knee and we brought some more attention to her feet and legs, she noticed tension starting to gather in her hips and upper legs. She felt as if her legs were reluctant to reveal more, that being vulnerable was too risky. Yet she longed to let go of whatever she was carrying, or at least, not to carry it alone.

The way we use language to talk about bodymind states is fascinating, and one of the thorniest paradoxes I’ve found is the apparent dichotomy of attention and relaxation. So often in sessions, when people bring attention to a place, they also bring tension. The body speaks its own, impressionistic language, and many bodies seem to respond to the fact that the words sound alike. It doesn’t help, either, that the word “attention” has so much baggage in our culture. Soldiers and servants are meant to stand at attention: that is, stiffly, formally, awaiting orders from some outside authority. Children are constantly being told to pay attention, and that idiom doesn’t end with childhood: as adults learn what it means to pay for things, attention becomes another form of rare currency, not to be spent lightly. When I was growing up in the ‘80s, we “the MTV generation” were forever being told that we had short attention spans; today, the subsequent rise in diagnoses of attention deficit disorder – and the attendant overprescription of medication – remind us again and again that attention is in short supply, and moreover, that paying attention is difficult, tedious, and anything but relaxing. Attention and tension become almost synonymous.

Relaxation, meanwhile, is a word that evokes a total lack of tension – and further, a lack of attention. Attention, we believe, takes a lot of work. Relaxation, therefore, is about lying inert on a beach, or sinking into a hot tub, or “vegging out” in front of the TV or a video game. We even use the word vacation when talking about taking time off of work, as if we were going to vacate our minds and bodies altogether in favor of some mysterious state where no tension – or attention – is required. (It is an interesting side note that these vacations often wind up being more stressful and non-renewing to our spirits than we expect.)

But a curious thing happened to during my session with this client – a thing I’ve seen happen with clients repeatedly. By the end of the session, as she kept bringing her attention – her awareness – to parts of herself she had been neglecting, she began to feel more relaxed. Her legs began to move much more freely, and her feet, rather than being splayed out to the sides, were much more upright – at attention – than they had been. Near the end of the session, she noted that her body – especially her lower body, where we had spent more time – felt much more alert and awake than it had at the beginning, and much more relaxed – genuinely relaxed – than it had been when we started. She felt relaxed, alert but not on guard, grounded, enlivened, and like the outside world wasn’t nearly so overwhelming as it had been.

I’m going encapsulate and boil down this idea, because it struck me and continues to strike me as very important: Attention and relaxation are not opposites. In fact, I might go so far as to say that true relaxation and attention require each other. Relaxation is not vacation. Relaxation is attention without tension.

One of the wonderful things Rubenfeld Synergy does for people is help them to pay close, loving attention to themselves, in a way that people often don’t have time, energy, or, frankly, inclincation to do. There are many things at play here, culturally: the separation of mind and body, the Judeo-Christian valuation of spirit over flesh, a Protestant urge to not be “self-indulgent,” a mass media culture that pushes us to punish ourselves in order to be the best. Whatever the web of causes, there isn’t a lot of space in this modern world for people to just sit or lie down and really pay attention to their bodies. But when they do, the surprising result is often a sense of enlivened peace, relaxed attention. A sense of being here, awake to the fact that we are, in fact, our bodies.

And this state, this grounded, relaxed alertness, is what true attention feels like. When it is available, it is much harder for anxiety and overwhelm to take over. Outside circumstances seem more manageable. One is allied with one’s body, instead of treating it as an ornery, unwelcome intrusion, a vehicle to get you from here to there, whose aches and pains you ignore and push through. And this alliance, this state of having body, mind, emotions and spirit all in one place, keeps us in touch with the resources we need to get through the struggles of our lives – and to fully appreciate the joys.

[Rerun] Self-care made simple

From Dr. Kathleen Young's blogOne of the most potent things I have found, both in my training and with my clients, is the utmost importance of self-care. For every acute problem, every chronic stress, every relationship explosion, cancer diagnosis, loathed job or existential crisis, self-care comes up again and again as not just the most important, but the very first thing that needs doing.

This is true not just for my clients, but for me, and other practitioners.  As they say, you’ve gotta make sure your own oxygen mask is secure before helping others.  And as the Rubenfeld principle goes, self care is the first step to client care.  And, lest we forget that other principle: each client is ultimately responsible for his or her own healing.

So it’s not all that surprising that when a client tells me something difficult, and I can feel my mirror neurons firing and my shoulders tightening, my breath growing shallow…the first thing I need to do, before I can even respond, is to check my own breath, my own body, return to my center, and respond from there.  If I do anything else, I put myself in it with them.  And, as anyone who has had someone so upset over something that happened to you that you ended up taking care of them knows, nothing good can come of that.

In my own continuing therapeutic journey, I’ve recently been introduced to Oasis in the Overwhelm, a little book by ex-Catholic nun, nightclub singer, type A go-getter, and Rubenfeld Synergist Millie Grenough.  Its essential core is four 60-second strategies for re-centering and calming yourself, basically at any time and place.

I already have a number of strategies that I use for this, and I pass them on to my clients when I feel they are needed. And of course there are more involved self-care pieces: working out more, eating better, getting enough sleep – all those things that your doctor is always telling you to do.

But for people who want solutions that they can learn quickly and use anywhere…I have to say that this is pretty fabulous.  Once I internalize them myself, I will definitely be incorporating them into my practice. Hint: they involve stretching, breathing, checking in with your body, and focusing on an object of comfort.

Go check it out.

 

The power of instinct

I feel good! Photo by emdees via Flickr

I feel good! Photo by emdees via Flickr.

Instinct. It’s a thing we tend to ignore a lot in our culture, preferring reasoned thought, logic, and thorough consideration. We “have a bad feeling” about someone we meet, but we give them a chance…and then another. We know what our gut is telling us about a situation, but we second-guess ourselves. We’ve been this way before and something is telling us that we should turn right here, but we follow Google maps instead and get lost.

Now granted, blind following of instinct or gut feeling is no better. Diving into unsafe situations without preparation because they seem like fun can get you injured or dead pretty quickly. Responding to physiological nervousness or fear even after it proves to be unfounded is classic anxiety. Following a hunch in spite of contrary evidence is what got us into the Iraq War.

But instinct is a valuable starting point for many investigations, experiences, and creative endeavors. The gut feeling is a literal thing, as it turns out, a sensation that comes from the complex nervous system of the gut. It is evolutionarily very old, and is our body’s way of telling us what seems good or bad, unsafe or comforting, exciting or frightening. We ignore such signals to our peril, and often, they can be powerful messengers.

I have found great value in following my instincts in Rubenfeld Synergy. But I had some practice long before, as part of theatrical training. Actors, when they are good, are often spoken of as having “good instincts” and making “strong choices.” These performers are open and flexible, taking what comes to them and making it into actions and characterizations that are compelling to watch.

In Rubenfeld Synergy, I have found that the most profound, helpful, and healing sessions and moments come about when I relax, get my feet under me, and follow my instincts. I’ll say what comes into my head (within reason), even if it doesn’t yet “make sense,” because I have already sensed it. Nine times out of ten, what comes to me ends up unlocking an “aha” for the client.

I worked recently with an actor in a Rubenfeld Synergy session, and I was having fun noticing the way her vocabulary and the way she experienced her body lined up with the way I worked. It was easy for her to feel and locate sensations, to access emotion through the body, and to feel subtle changes as they occurred.

After working on one side of her for a bit, I came to her opposite hip. For some reason, a silly German accent came into my head; I have been learning a bit of German recently and am planning a trip there soon. For no real reason other than that it was there, I said something like, “Und now ve come to dee right hip…vich for zome reason ist German…”

This moment of silliness opened up a whole line of inquiry for the client. “That’s my German side,” she said, after a little laugh. “The rule-follower.” And we were off and running on a thread about the division in herself, between the fun-loving, connected, relaxed and artistically free person, and the person with so many responsibilities that she sometimes feels like she’s holding on for dear life just to keep up the appearance of control.

This could have begun another way, but my choice to follow what seemed like a whimsical instinct to do a silly German accent was what helped that story emerge. And at the end of the session, the German – who developed a personality, a look, an entire image in her mind and body – was what she said she would take with her.

What might change for you if you paid attention to your gut feelings more often?

Working with love

Image by Candida Performa on Flickr

Image by Candida Performa on Flickr

Given that I work with individuals most of the time and my work tends to involve a massage table and touch, it’s probably hard to imagine how I work with couples or groups. But given that I also sometimes work with sexuality, I do sometimes have the occasion to work with couples who need help sorting out their relationships.

If there’s one thing I’ve observed about relationships, it’s the same thing I’ve learned about individuals: awareness heals. When a person becomes aware of one’s own habits – not just intellectually, in that “Yeah, I know I do that…” kind of way, but in a visceral, slowed-down, embodied way that allows them to notice it as it is happening, that is what can effect real change. When a person can feel a familiar emotion arising, and begins to ready the familiar reaction: the snipe in anger at your partner’s comment, the defensive posture, the eyeroll of contempt – and stop, feel the emotion move through, breathe, and make a different choice…that’s when true communication can occur.

Another thing I’ve learned from the training and used since: change happens in the relationship. What does this mean? Simply that what was wounded between two people, can only be healed in a relational context. Neither wounding nor healing happens in a vacuum. Sometimes, the wound has to be healed with a surrogate, like a therapist or other healer, or a friend, or another partner. If a relationship is abusive, for example, the abused partner will need to seek healing elsewhere than in that relationship. But it is still most likely that healing will occur with the help of another person, just as repeated wounding will often happen when an abused person enters another relationship. Those wounds happened in relationship, and express themselves again in relationship.

The best-case scenario is when the wounds incurred during a relationship can be healed within that same relationship, bringing wholeness and depth to that relationship’s story. When I work with couples, this is what I endeavor to do. As with all of my work, I help them tune in to their bodies: their posture, their breath, their physical sensations. I help them locate their feelings in their bodies, and often, this brings emotions to the surface, allowing them some release. I notice their gestural language, how they sit in the room, how they look or don’t look at each other. If and when it seems appropriate, I help them use touch to make contact with each other, to talk openly, to invite vulnerability. Most of all, I want to help them become aware of the patterns that have gotten to this place, find them in their bodies, and find a way to move out of them into something unfamiliar, unhabituated. To get in touch with each other in a new way, the way that is about what is true now, and what is possible, rather than about how they hurt each other in the past.

If traditional couples therapy hasn’t been working for you, please feel free to contact me, and dare to find a new relationship with someone you’ve known for years.

What was taken from you? Where do we get it back?

I went to the INARS conference this past week, and I’ve taken away so many learnings that I don’t know where to begin. But I was inspired today when I walked into a cafe for lunch and heard a song.

If you were conscious during the early ’90s, you undoubtedly know this song. It starts with the repeated words: “In the middle of the – I go walking in the – In the middle of the – I go walking in the – ”

Are we there? Yeah. The song is Billy Joel’s mega-hit from 1993, “River of Dreams.” Now, before I left for the conference, I hadn’t heard this song, or hadn’t paid attention to it, in years. But in a bar in Landsdowne Street with friends, having dinner before a They Might Be Giants concert with dear friends, I heard it, and my friend did too. We both started singing along together:

In the middle of the night (middle of the night)
I go walking in my sleep (walking in my sleep)
From the mountains of faith (mountains of faith)
To a river so deep (river so deep)…

We sang along and boogied from the bar to our tables and commented on how long it had been since we’d heard that song, and what a good song it was. I mumbled along to a lot of the faster lyrics, and we moved on to dinner.

Today, after therapy, after talking about everything I’d been through at the conference, I heard it again in the cafe: In the middle of the night…

And I stopped, because I was hearing words I’d never heard before.

And I’ve been searching for something
Taken out of my soul
Something I would never lose
Something somebody stole

This weekend, we focused on soul: what feeds us, where we feel at home, how we connect to passion, to center, to power, to connection itself. As part of that, we talked about the thwarts to passion: what does your passion call you to do, and what gets our way?

An important learning from this was that most of the time, the thing thwarting us is not of us. We may have internalized it, sure, but it was something done to us. “Something taken out of my soul. Something I would never lose. Something somebody stole.” Or, something somebody put there, something that doesn’t belong, that we should never have been forced to carry.

One fellow Synergist felt the sense of the thwart so deeply that she was convinced it was all her, and said it felt like a bunch of heavy locks. Gently but with laser clarity as always, one of the program heads, Noel Wight, told her: Very few people put locks inside themselves, just naturally, on purpose. It’s possible that this Synergist was the one who put them there. But what drove that action? What was the message she received that told her: lock yourself away. You are too much to take. Your passion burns too hot. Be quiet. Keep it to yourself.

What was stolen from her? What was put in its place?

And how do we get those things back? How do we return to ourselves, to a place where our passion, our will, can flow freely?

The answer differs for each person, but it starts with the body. What movement is restricted now, as a result of that thwarting, that theft, that abuse, that grasping, that constant imposition? Whatever it was, what movement can we use to restore ourselves to ourselves?

Here’s an example: for me, it was space. I got the message repeatedly that I took up too much space: I was too big, my laugh was too loud, I ate too much, and I needed to follow the rules, keep my legs together, and be a lady. So is is any surprise that now my hips are tight, I squeeze my shoulders into their sockets, my ribs get compressed, and I can’t take a full breath?

The restoration of my width, my length, my breath, my available space – this is the work that I need to do to restore my connection to passion, my soul, my source, and my sense of direction: where I am going in my life, and who gets to decide?

When we turn to the body and seek the source of our tensions, our aches, our habitual movements that hold us back, we begin to see other possibilities for movement, other ways that we can be, move, and live.

Contact me if you want some help doing this for your own life.

Rewiring your brain out of pain

When I was about 17 years old, I remember getting sunburned on my face. I particularly hurt on the skin around and under my eyes, but being out with family at the pool in the complex where my grandmother lived, I needed to hang out for a bit longer. I was reading a book – Toni Morrison’s Beloved, as I recall – and was having a hell of a time concentrating on it. But lying face down on a beach chair, I began a chant inside my head. It doesn’t hurt, I kept thinking. It doesn’t hurt, it doesn’t hurt, it doesn’t hurt.

I remember my astonishment when I realized, a few minutes later, that in fact it didn’t. I returned to my reading and, as I recall, the pain did not return.

People have been using the expression “mind over matter” for ages, but research is coming around more and more to the idea that this process is quite literal. A recent article in the Daily Mail sensationalizes it somewhat (it is, after all, in the Daily Mail), but the implications are clear: with practice, we can rewire our brains to ignore pain, so that it does not become or stay chronic.

One of the basic principles of neuroplasticity, as the ability of the brain to change and adapt is called, is that neurons that fire together, wire together. It is by this mechanism – the brain making associations, sometimes between seemingly unrelated things – that habits form, thought patterns become ingrained, some sexual proclivities develop, and trauma keeps hold of us over time.

With pain, the grooves in the brain can become very deep. “The role of acute pain is to alert us to injury or disease by sending a signal to the brain,” says Dr. Norman Doidge in the article. “But sometimes an injury affects the body and the nerve cells (neurons) in the brain. As acute pain continues, these neurons become hypersensitive, firing more easily with less stimulation.” Opioid drugs like morphine and oxycodone can increase this effect over time, driving the neurological grooves deeper until even a small stimulus can trigger pain, even in areas of the body that weren’t directly affected by the injury.

Another doctor who studied this phenomenon after his own severe injury, pain specialist Michael Moskowitz, “realised that many of the areas in the brain that fire in chronic pain also process thoughts, sensations, images, memories, movements, emotions, and beliefs – when they are not processing pain, that is.

This explains why, when we’re in pain, we can’t concentrate, tolerate certain sounds or light, or control our emotions well, because areas that regulate these activities have been hijacked to process the pain signal.

Working from the knowledge that two parts of the brain process both pain signals and visual signals, he developed a way of using visualization to overcome the pain when it arose. Focusing on an image of his own brain in pain, he then imagined the areas of pain getting smaller and smaller. By repeatedly telling the brain to process this visual image rather than focusing on the pain itself, he achieved a reduction of pain in 3 weeks, a major reduction in 6, and a near-pain-free existence after a year.

These findings, which he has begun putting into practice for patients for several years with surprising success, dovetail with the work that Synergists and other bodymind therapists have been doing for some time. Because awareness is the first key to change, getting clients to focus on different parts of their bodies, on their pain, on their emotion, or on whatever is happening inside them and describe it in detail can help the client regain some control over bodily responses to stimuli. By observing our state in detail, we can then take action to change that state.

I’m again remembering a certain demo session that Ilana Rubenfeld ran in our training, with a classmate who had been in a serious car accident more than 20 years ago, and sometimes still had pain from it. In that session, she helped him rewrite the memory: starting the process of rewiring the part of his brain that had built a groove around that event, a groove that kept saying remember, and helping him to remember it differently, to tell the brain that in fact it had been a near miss, to let those pain signals stop firing at last. It doesn’t hurt. It doesn’t hurt. It doesn’t hurt.

I’m looking forward to learning more.

Two great videos about Rubenfeld Synergy Method

Since the Fourth of July weekend is coming up, I figured I’d blog a little early and leave you all with something inspiring to take you into it.

In case you haven’t seen them yet, here are two great videos put together by the Rubenfeld Synergy Training Institute. The first, What Is RSM?, was filmed at the Omega Institute while I was in the training, and features my teachers Noël Wight and Joe Weldon, plus Ilana Rubenfeld herself, talking about the work and demonstrating a little of it. The second, Why Befriend Your Body?, was filmed last year, led by another great teacher of mine, Theresa Pettersen-Chu, and features a bunch of clients talking about what Rubenfeld Synergy has done for them.

Both are pretty fabulous, and give a simple idea of what this work is all about. Give them a look – each is less than five minutes long!

 

Some basic stuff you should know.

In the past little while, I’ve been tweaking and rearranging some of the content on this site, and ultimately, i hope to host my entire site here at WordPress, with the blog integrated in. For now, here are some of the new things you might take a look at!

Top Bar

I’ve revised my “Make an Appointment,” “Services,” and “About Kamela” pages somewhat. Go check them out if you want to know more about what I do, who I am, and how to get in touch with me. In time, I’ll be adding sub-pages to the Services section, to give a rounder idea of the types of help I provide.

Side Bar

I’ve added a Recommended Reading list near the top of the sidebar. Right now, this includes the 18 Principles of Rubenfeld Synergy series, the description of a typical first RSM session, and the GROUND series (Gentleness, Respect, Openness, Understanding, Noticing, and Discovery). More foundational posts will end up as pages soon, so that the foundational material is easily accessible by anyone who wants to check it out before coming to see me.

Anything else?

What would you like to see more front-and-center on this site?

Just breathe.

I had a great insight from a client this week, and as usual, it was something so simple, yet so hard to grasp for most people.  Ilana Rubenfeld used to talk about “a-ha moments,” and a wonderful classmate of mine in the Rubenfeld training talked about “duh-huh moments.” Coming to realizations like this can seem like the latter at times, but in my experience, that’s when you know they’re really important.

The realization was this: to go inward, the very first step is to breathe.

In this fast-paced world, it can be very easy for us to forget ourselves, to forget self-care, and to forget that in order to be effective in the world and helpful to others, we have to make sure we are clear. But some people don’t even know how to begin to go inward, rather than constantly reaching out for validation, for activity, for distraction, for love.

Here’s the answer: breathe, and pay attention to your breathing.

There is nothing so simple and effective as listening to your own breath to bring you into the moment, to connect you with yourself, and to begin to understand what is going on inside your own body and heart. You don’t need to believe in chakras or chi, you don’t have to hold crystals or light candles or believe in any gods or even take long walks in the woods (though I recommend that). You don’t even have to do anything as radical as talking to your body and seeing what it says back. Just take ten seconds, right now, to breathe out whatever is currently clogging up your mental works, then slowly let your lungs fill up again.  Then, do it again.  One more time.

Just breathe, as the song says. And see what happens to your mind, your body, your heart.

I dare you.