Owning yourself fully: Bessel van der Kolk and healing trauma through the body

Image by Run Jane Fox on Flickr

Image by Run Jane Fox on Flickr

The big issue for traumatized people is that they don’t own themselves anymore. Any loud sound, anybody insulting them, hurting them, saying bad things, can hijack them away from themselves. And so what we have learned is that what makes you resilient to trauma is to own yourself fully.

-Bessel van der Kolk

In the course of thinking about Rubenfeld Synergy Method in the context of trauma, I’ve been looking at the marvelous Bessel van der Kolk, known by many in the area as the head of the Trauma Center at the Justice Resource Institute in Brookline, MA. Krista Tippett interviewed him for On Being late last year, and the result is a remarkable look into the man’s life, work, and personality. He has been working with trauma since his time with Vietnam veterans at a VA hospital during his training as a psychiatrist. It was there that he first became fascinated with the idea what trauma is and what it does for us: a soldier refused to take the drugs prescribed for nightmares, because to him, the nightmares were a way of keeping the memory of his friends alive.

His recent book, The Body Keeps the Score, is being cited more and more in the healing circles I travel in. It is an exploration of a lifetime working with people who have become living memorials in some way: their bodies unchanging testaments of traumatic events. Trauma, he says, happens when the mind is unable to synthesize a narrative about what has happened, and the events get “stuck” in the body, replaying themselves. Even Darwin, as early as 1872, wrote “how emotions are expressed in things like heartbreak and gut-wrenching experience. So you feel things in your body. And then it became obvious that, if people are in a constant state of heartbreak and gut-wrench, they do everything to shut down those feelings to their body.”

I have seen this phenomenon in my practice, where clients often cannot feel what is happening in their bodies, or are unaware of what their bodies are doing, or they “leave the room,” in essence, dissociating whenever their awareness is called to their bodies. The experiences that they have had there are too intense to be repeatedly endured, and they have found ways to disconnect from their somatic experience. And so the process of addressing trauma somatically starts with helping people reconnect with their bodies in ways that can begin to feel safe.

van der Kolk has worked with yoga, eye movement therapy, and other somatic practices to help people return to their bodies. “It was very striking in our yoga study,” he says, “even during the most blissful part of the yoga practice called Shavasana, what a hard time traumatized people had at that moment to just feel relaxed and safe and feel totally enveloped with goodness, how the sense of goodness and safety disappears out of your body basically.” In his work, as in Rubenfeld Synergy, van der Kolk has found that “something that engages your body in a very mindful and purposeful way — with a lot of attention to breathing in particular — resets some critical brain areas that get very disturbed by trauma.” It can take a while to help someone reconnect with their own breath, to have a sense of their skin and bones and muscles, to have a relationship to their own sensations and emotions that is not simply another way of triggering the trauma. But the research is clearer and clearer that returning people to their bodies is a clear route out of the cycle.

One of my favorite bits of the interview was about stress hormones and their value, and how what really prevents overwhelming experiences from becoming trauma is movement:

“The stress hormones are good for you. You secrete stress hormones in order to give you the energy to cope under extreme situations…What goes wrong is, if you’re kept from using your stress hormones, if somebody ties you down, if somebody holds you down, if somebody keeps you imprisoned, the stress hormones keep going up, but you cannot discharge it with action. Then the stress hormones really start wreaking havoc with your own internal system.

But as long as you move, you are going to be fine. As we know, after these hurricanes and these terrible things, people get very active and they like to help and they like to do things and they enjoy doing it because it discharges their energy.”

This links back to a post I wrote years ago that continues to be popular, about trauma and streaming. When action is possible in a moment of crisis, it is less likely to become “stuck.” But when trauma is repeated, or when movement or action isn’t safe, then the event or events can become “frozen” in the body, stuck in a repeat loop until we can return a sense of safety to the body, and a sense of consciousness to the ongoing experience of being embodied.

Except for a small number of practitioners, the connection between trauma and the body is a minority voice in psychology. Luckily, it is expanding, but it has taken some time. I am hoping to connect with Dr. van der Kolk and the Trauma Center soon to talk about how Rubenfeld Synergy can contribute to this process of healing from trauma. For now, I recommend listening to the whole interview here , or reading the transcript here.

Working with sexuality

It doesn’t take a bodyworker to tell you that sexuality is a touchy topic in modern life.  Sex is one of the driving forces of our human existence, and its prominence in what drives us is evident equally in the suggestive images and messages that bombard us daily, and in the repressive messages we still receive from family, church, and politics.  Sigmund Freud – perhaps a bit too obsessed with sex – based his entire theory of psychology on what he called the “sexual model.”  But whether he was obsessed or not, it is undeniable that sex and sexuality are major issues for many people seeking therapy of one kind or another.  Sex is powerful, and society’s mad efforts to control it, promote it, discourage it, regulate it, sell it, and use it to sell us other stuff we don’t need can seriously screw up our relationship to it.

The therapy world has a problematic history with clients and sexuality, starting with Freud and continuing to this day.  Therapists have taken advantage of patients who, in their vulnerability and trust, have expressed sexual or romantic interest in them.  Bodyworkers – particularly massage therapists – often have to navigate sexual responses in clients, inappropriate requests, and even assault; some also assault their clients.  Our professions are rife with potential issues because so much is in the room: emotional difficulty, sexual difficulty, deep connective trust, and in some cases, touch.

In Rubenfeld Synergy, the focus on the body and the touch – though explicitly clothed and non-sexualized – can easily evoke sexual response, remind a client of a sexual experience, put the client in touch with his or her emotions and fantasies, or trigger a traumatic response associated with a sexual assault.   I explicitly deal with clients who have issues around sexuality, and I’ve encountered a number of different questions around how to deal with sexuality in sessions.  I want to explore them individually, in an effort to bring light to something that is too infrequently discussed.

In future posts, I will discuss clients who come in for other issues but then reveal sexual difficulties; clients who become aroused during sessions; clients who attempt to take advantage of the therapeutic relationship to indulge their fantasies, and clients who need grounding around touch and sexual trauma.  There are strategies for walking the fine line that can thread itself through these sessions, and I hope to explore them in detail in the coming weeks.  Stay tuned…

 

People into BDSM no longer considered mentally ill. Well it’s about time.

As reported by The National Coalition for Sexual Freedom, the makers of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM, has released its new edition (DSM-5).  In previous editions, paraphilias – a catch-all term for “unusual” sexual desires falling under the umbrella of fetishes, BDSM, or kink – were basically considered mental illnesses.

In the new edition, the Manual is making a distinction “between atypical human behavior and behavior that causes mental distress to a person or makes the person a serious threat to the psychological and physical well-being of other individuals.”

This strikes me as quite a step forward, and I’m pleased with the psychological community for finally starting to look at the wide panoply of sexual and gender expression among human beings and seeing that sometimes – perhaps even most of the time – it’s simply not a problem.

Now, in order for these types of desires to be classified as mental disorders, they have to meet several criteria.  Besides having desires that are considered out of the ordinary, these desires must cause the person to:

feel personal distress about their interest, not merely distress resulting from society’s disapproval; [emphasis mine] or

have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.

What this means for my own clients as well as for kinky people everywhere – especially kinky parents who, historically, have been involved in custody disputes resulting in their children being taken from them – is spectacular.

The DSM-5 also distinguishes between sexual interests and sexual disorders.  The disorders currently defined under the DSM-5 are: exhibitionistic disorder, fetishistic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder, transvestic disorder, and voyeuristic disorder. However, any of these may be an interest in a healthy person, rather than a mental illness.

For example, a person may be an exhibitionist, but not have exhibitionistic disorder: a condition that causes her significant shame, guilt, anxiety, personal distress and adverse effects on her life, or causes harm to others.  A person may have masochistic sexual interests: i.e., he might get sexual arousal out of being hurt.  But that doesn’t mean he has sexual masochism disorder, which might mean he desires pain that causes him significant permanent injury, or that he seeks it out in ways that violate the desires and consent of others.

The one exception is pedophiliac disorder, whose clinical definition remains essentially the same as that in the DSM-4.  Having such desires, even if they are not acted upon, is still considered a mental illness, as it falls under the category of “desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.”  They have simply changed the name from “pedophilia” to “pedophiliac disorder” in order to maintain consistency.

I have complicated opinions about this last point, but I will save it for another post.  For today, I just want to express my happiness that what are simply unusual sexual desires and practices (and honestly, I think our culture is showing more and more that they’re not as unusual as we think…) have been officially de-pathologized.

 

 

People into BDSM no longer considered mentally ill. Well it's about time.

As reported by The National Coalition for Sexual Freedom, the makers of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM, has released its new edition (DSM-5).  In previous editions, paraphilias – a catch-all term for “unusual” sexual desires falling under the umbrella of fetishes, BDSM, or kink – were basically considered mental illnesses.

In the new edition, the Manual is making a distinction “between atypical human behavior and behavior that causes mental distress to a person or makes the person a serious threat to the psychological and physical well-being of other individuals.”

This strikes me as quite a step forward, and I’m pleased with the psychological community for finally starting to look at the wide panoply of sexual and gender expression among human beings and seeing that sometimes – perhaps even most of the time – it’s simply not a problem.

Now, in order for these types of desires to be classified as mental disorders, they have to meet several criteria.  Besides having desires that are considered out of the ordinary, these desires must cause the person to:

feel personal distress about their interest, not merely distress resulting from society’s disapproval; [emphasis mine] or

have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.

What this means for my own clients as well as for kinky people everywhere – especially kinky parents who, historically, have been involved in custody disputes resulting in their children being taken from them – is spectacular.

The DSM-5 also distinguishes between sexual interests and sexual disorders.  The disorders currently defined under the DSM-5 are: exhibitionistic disorder, fetishistic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder, transvestic disorder, and voyeuristic disorder. However, any of these may be an interest in a healthy person, rather than a mental illness.

For example, a person may be an exhibitionist, but not have exhibitionistic disorder: a condition that causes her significant shame, guilt, anxiety, personal distress and adverse effects on her life, or causes harm to others.  A person may have masochistic sexual interests: i.e., he might get sexual arousal out of being hurt.  But that doesn’t mean he has sexual masochism disorder, which might mean he desires pain that causes him significant permanent injury, or that he seeks it out in ways that violate the desires and consent of others.

The one exception is pedophiliac disorder, whose clinical definition remains essentially the same as that in the DSM-4.  Having such desires, even if they are not acted upon, is still considered a mental illness, as it falls under the category of “desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.”  They have simply changed the name from “pedophilia” to “pedophiliac disorder” in order to maintain consistency.

I have complicated opinions about this last point, but I will save it for another post.  For today, I just want to express my happiness that what are simply unusual sexual desires and practices (and honestly, I think our culture is showing more and more that they’re not as unusual as we think…) have been officially de-pathologized.

 

 

A safe space to speak your truth: how do we cultivate safety?

Many of my readers will likely have heard the term “safe space.”  This phrase is sometimes used as a term of art in therapeutic circles, referring to a place where people can speak freely and honestly without fear of judgment or ridicule, but it is also often used in communities organized around oppression – i.e., feminists, people of color, LGBTQI, and so on – for a place that contains only people of the oppressed group, whose members can speak without concern over the thoughts and opinions of the oppressor.

To me, and in my work, a safe space can also be highly personal: a place, whether real or virtual, where I can speak my mind and heart without worrying that I will do collateral damage by doing so, or have to censor my feelings for fear of hurting someone else’s.  For many people, such spaces are few and far between, and some people don’t have any safe space at all.

A counselor’s office may be the only space someone has that is “safe.”  Someone who is living under hostile parents, or with an abusive partner, or in a housing situation with unstable friends or strangers, may feel they have nowhere that is safe.  Someone who lives alone and is isolated from friends and community may similarly feel that there’s nobody who will understand or even listen to their problems.  And that’s where therapy, counseling, Rubenfeld Synergy or any number of other emotional health practitioners come in.

The trouble, of course, is that a therapist of any kind is always a stranger, at least at first.  There is some safety in a stranger, though.  I am remembering when I first started journaling online: it was before Facebook, and before such things began to be called “blogs.”  I was in my mid-twenties, and pouring out my soul to a group of total strangers on the Internet.  It was freeing and thrilling, to share my story with people who couldn’t see me, under an assumed name; to write in a way I had only previously written to myself, in my paper journals.  The people I connected with, based on shared interests, liked my writing, laughed in the right places, made supportive comments.  It helped enormously, at a time in my life when I needed help to grow and change.

Over time, though, that space changed purpose, radically.  I began to meet people in real life who lived near me, and form friendships.  Soon I began to add people I met in real life to my online friends list, and before I knew it, instead of an audience of strangers, I had an audience of people I knew, whose lives intersected with mine.  Ironically, it wasn’t long before that was no longer a safe space for sharing my deepest feelings and life experiences: there were too many people, and the story was no longer only mine.

With a counselor, confessor, therapist, or whathaveyou, the stranger relationship can be a double-edged sword: the person doesn’t know you, and is specifically trained not to judge you.  But unlike online, you can see them and they can see you.  The confession is one-sided, and they know your real name.  You’re sitting with them face-to-face, without the protection of a keyboard and screen.

So how, as healers, do we create safe space for our clients?

In RSM, as with all things, we begin with the body.  For some clients, getting on the table right away is too much: they may need to sit and talk for a while, get their thoughts out to a compassionate listener, and not worry about the intimacy of being touched just yet.  Often I will talk with a new client, and begin to introduce the concept of tuning in to their bodies.  I may have them touch their own bellies or hearts or knees.  I may have them put their feet on the floor and feel how the ground supports them.  I may have them notice what they’re feeling, physically, as they talk about a particular topic, then attempt to locate that feeling in their bodies.

Grounding emotion in physical solidity can be incredibly helpful for increasing safety, and making a client feel that what they are experiencing is real and normal.  It also begins to cultivate a relationship of trust between the client and his or her own body: a relationship that often has been broken in people who seek help.  The more a client knows he can trust his body to tell the truth, the more resources he will have to support him in difficult times, and to make the changes he wants in his life.

As the person who is facilitating the client’s increased sense of safety, I feel that listening without judgment, bringing open compassion, and not pushing the client too far, too soon are probably the most important skills for cultivating a relationship of safety.

What do you feel is most important?  Your comments, as always, are welcome.

 

The four powers of the Synergist

A colleague responded recently to my post on finding my ideal clients by talking about the four needs of attachment theory.  In short, a client needs the same things from a therapist or Synergist that a child needs from a caregiver – or an adult from a loving relationship.  I’ll simply quote my friend here: “To be open and trusting for a healing experience, we need to feel like: I Exist (I am seen and heard), I am Safe, I am Loved (accepted) and I Belong.”

Since I just returned from a big fat Pagan conference, I couldn’t help looking at these four really excellent pillars of attachment and linking them to the Four Powers of the Witch/Magician, as they relate to the four elements in many Pagan traditions: To Know, To Will, To Dare, and To Keep Silence.  These correspond to the elements/directions of Air/East; Fire/South, Water/West, and Earth/North.

What many people come to various kinds of therapy, counseling, body or energy work looking for is to feel empowered and in control of their lives.  There’s a reason I decided to call my business Power In Your Hands; besides the reference to the work being hands-on, I wanted to give the feeling that coming to see me will help you claim your own power.  The Four Powers are the ways a magical worker – or anyone, really – have of getting anything done.  To achieve a desire, first you have to Know what it is, and gain as much knowledge as you can about how to go about it.  Next, you have to Will – to take definitive action toward your goal.  In the course of your action, you also must Dare: open your heart to vulnerability, to the possibility of failure or success, to the various surprising paths that might open as you take the leap.  And finally, to Keep Silence: to digest what has happened, to rest from your efforts, to germinate new ideas as a seed rests in the soil until spring.  (This last step is the one our culture tends to encourage us to skip: it’s all Know! Will! Dare! Know! Will! Dare! None of this is sustainable without rest, recovery, and reflection.)

In counseling or therapy, the client is seeking help in tapping into these powers, and as my friend pointed out, four pieces need to be present in order for the healing to occur.  To feel the sense of “I Exist” or “I Am Seen” is what precedes “To Know”: one must have the clarity of Air, which brings definition, acknowledgment, and curiosity – not to mention breath! – for both.  To Will something into being – to take action – one must first feel Safe; the power of Fire needs a strong container in order to be harnessed, and the feeling of safety provides that container. Water is associated with emotions, love, fluidity and openness: one must feel that they are loved and accepted before being willing to open to vulnerability: To Dare.  And finally, Earth brings the sense of grounding, home and hearth, stillness and being with what is.  The feeling of “I Belong” corresponds well to this, and a person who feels like they belong has an easier time Keeping Silence and being still with what is while the next course of action gestates.

I hope that even those readers who have no knowledge of or interest in paganism can relate to these ideas.  I’d love to hear your thoughts on this.

 

Not Actually A Psychotherapist

Earlier this month, I made a post about finding my ideal clients in which I implied, near the end, that I’m a body psychotherapist.  (The exact quotation was, “If you were looking for help from a body psychotherapist, what would you hope they could do for you?”  Which admittedly was more about finding out what people want out of body/mind workers in general – of which there are countless flavors – but did imply that I’m a body psychotherapist.)  At the beginning of the article I did talk about the need, especially early in Rubenfeld Synergy’s development, for it to be called something else – a Method, to use the actual name; a “modality,” to use a term that people outside of the bodywork world don’t generally know; a “technique,” as Alexander adopted.  Associating bodywork with psychotherapy is still taboo, and as I learned a few days ago, actually against the Standards and Practices document I signed when I was certified as a Rubenfeld Synergist.  Oops.

So it falls to me to state clearly, here and now: I am not a psychotherapist.  While the roots of the Method include Gestalt therapy, I am not a Gestalt therapist, either.  I am, in fact, not any kind of therapist.  🙂

I do practice a Method that is included under the umbrella of The United States Association for Body Psychotherapy, but I am not permitted to call myself a  psychotherapist, body or otherwise.  Bad things could happen.  (Someone was sued some years back.)

While the Standards and Practices of my certification of course trump anything else for me, there is a weird thing in Massachusetts that potentially puts things in a gray area: in Massachusetts, one is permitted to hang out one’s shingle as a psychotherapist without having a license.  I’m not entirely sure why this is the case, although the extensive and arguably unreasonable hoop-jumping required to get any kind of licensure in Massachusetts might be part of the cause.  More likely it’s a weird loophole that hasn’t yet been closed.

A 2006 Boston Magazine article on sexual abuse in psychiatry notes:

Like many states, Massachusetts regulates specific types of mental-health workers, but there are gaps. In addition to psychiatrists, it requires licenses for people holding themselves out as psychologists, mental-health counselors, social workers, and marriage and family therapists. Not covered is the term psychotherapist. That means anyone from an unemployed construction worker to a psychiatrist who’s been punished for abusing a patient can call himself a psychotherapist. One Boston-area phone book has 432 listings under the heading ‘Psychotherapists,’ and it’s possible that not one of them is actually a licensed therapist. (Insurance companies will not pay for treatment by unlicensed therapists, but many people don’t have mental-health coverage anyway.)

This is troubling to say the least, and I find it sadly ironic that it seems the population most likely to abuse this lexical loophole is not necessarily people who study for years to learn alternative modalities, but people who used to have licenses but now don’t because they are unethical jerks.

Given this exceedingly ugly company, I will no longer be tempted to refer to myself as a body psychotherapist, or a psychotherapist of any kind.  While I may do further studies one day and obtain some kind of official state licensure, at the moment, Rubenfeld Synergy Method is enough for me.

Still, though: it’d be nice to have something to call what I do besides “Synergist,” since nobody knows what that is.  “Bodyworker” isn’t quite accurate; “Counselor” is close but runs into the same legal gray area.  Apparently RSM has been legally defined as a “holistic bodymind healing modality.”  Just rolls off the tongue, donnit?

But, we do what we must.  My certification, code of ethics, liability insurance and professional organization membership are all covered, and handy labels must wait for some stroke of marketing genius to touch down.  Until then – my listing in Psychology Today notwithstanding – I’ll stay away from the gray.

Finding my ideal clients

Cognitive Therapy | Fox Valley Institute, Naperville IL (630) 718-0717
I’m currently taking a course with my mentor, Joan Brooks, on marketing.  It was something of a struggle for me to begin it, I’ll admit, and I’m finding myself dragging my feet, too, in getting the homework assignments done.  Let’s face it: marketing just isn’t all that sexy.  It’s not the thing that we go into business for when we’re trying to help people.  And if you’re a bleeding-heart like me, you probably find most things to do with advertising and marketing highly suspicious – maybe even evil.

So yeah, it’s a hurdle.

Yet I’m highly aware that this work that I do, as subtle, as beautiful, as healing as it is, isn’t known by a lot of people.  Because the use of touch in psychotherapy has been taboo for so long, Rubenfeld Synergy Method has been kept largely underground: a small community, its knowledge spread by oral tradition.  Ilana joked repeatedly, when she was visiting our training, about her lawyers telling her to “call it a Method,” rather than a “therapy” or anything that could potentially get her into trouble.  The long and storied history of therapists taking advantage of their patients – a problem that continues to this day – has made the entire profession skittish about using touch at all in relationships where mental and emotional health are involved.  It is only now, and slowly, that touch is being re-examined as a crucial tool for healing trauma.

Even as RSM is being built up as a brand, though – as we’re getting the word out and making it better known – it’s still a tough sell.  Part of the reason for this is because when people are seeking help, they basically want to know one thing: How can you help me?

Many of us have gotten so caught up in describing what we do that we’ve forgotten to tell people – specific people – how it can help them.  And the answer to that question is different, depending on who the practitioner is, and whom the practitioner is talking to.

As part of this course, I’m in the midst of identifying the clients I’ve enjoyed working with most and feel that I’ve helped the most, seeing the things that they have in common, and shaping my message so that the clients I like best – and the ones who will benefit most by seeing me – can find me.  It’s a process, but I’m beginning to see patterns emerge.

Namely, the people I seem most suited to working with are – shocker, here, I know – performing artists (singers, actors, dancers, etc.) and what I’m currently referring to as sexual outlaws: queer folk, kinksters, polyamorous people, and others who are dealing with gender and sexuality issues.  Based on this, new marketing language is slowly emerging.

How about you?  If you were looking for help from a body psychotherapist*, what would you hope they could do for you?  What are the problems that keep you up at night?

(*Not actually a psychotherapist.)