There is so much talk about identity politics in the political world—this is nothing new in the world of psychotherapy. The distinguished silos of understanding and practice, the dismissal of psychotherapeutic traditions, the identification and alignment with ‘one way’ is beyond a doubt, problematic. We can see this rigidity and problematic ideology in our political worlds, why is it so difficult to see that in our clinical worlds? In our clinical trainings?
The idea of somatics and working in and with the body is not new, and is making inroads through multiple previously isolated silos of clinical practice. The idea of working in and with the body has become romanticized in many clinical minds and worlds, and in those worlds has often assumed a superlative position to talk therapy. In other words, it remains misunderstood and misaligned. These polarizing positions speak to this problem of silo mentality, setting people up to defend their positions, and missing the necessity of working with both the story and the body, with the relational dynamics that are wired neurophysiologically and operate behaviorally, or relationally, often firing out of awareness.
Coming from a somatic or body-centred origin as a therapist, and having moved my orientation to bridge it with attachment theory in practice, and psychodynamic psychotherapy has made all of the difference in how I see and understand clinical work with people, people with trauma, particularly relational trauma.
In twenty years of clinical practice and teaching hundreds of therapists, I haven’t found there to be easy answers to what it takes to sit with, and heal human suffering. Clinically, I have needed a bigger and bigger canvas, read, an ever-expanding tapestry of theory and practice not only to hold the unbearable, but to understand and traverse the depth and vastness of the abyss, to meet and companion people back from the outskirts of the void that trauma creates.
From my perspective, one that I teach in the Somatic Attachment Psychotherapy two-year online training, not only is the body necessary for processing trauma, but so is the story, the narrative, the content. People need to be witnessed. With relational injuries (insecure attachment), typically passed down through generations, we are working with elements of mystification and distortion of one’s understanding of self, other and how relationships work, we are working with an autonomic nervous system that has difficulty with regulation, we are working with a system that defends against integration, we are working with folks that have trouble mentalizing, and some folks with insecure attachment may have a lack of emotional literacy and capacity. That’s a good amount of injury to work with on both sides of the clinical chair.
There is no one way to practice, and there is no one way to heal. That is clear. Nor, can only one silo of psychotherapy respond to histories rife with anguish, unbearable, distorted and mystified experience. To bear witness and hold someone with a history of relational trauma requires the therapist to enter into the clinical space ready and able to work with the whole of the self—the body and psyche, the relational dynamics that are present and replicated from early relational experience, and work beyond silos with an ever-expanding clinical canvas that allows for diversity, nuance, and integrated thought and practice. My invitation here is to reach across the aisle (I know this sounds political, but isn’t everything political), to invite curiosity and integration, to expand your canvas—your particular understanding and brand of psychotherapy.
I’m in the process of closing my clinical practice—after 21 years—to make more space for my teaching practice, but also to explore new frontiers that have been calling for my attention for a while. It took my clients by surprise, and truth be told, it surprised and continues to surprise me. I love my work. I have profound and meaningful connections with the people in my practice, all of them, and some of them I have known and worked with for 17 years. That’s a long time.
As I find myself in transition, I have been reflecting on where it all started, this love that I have for therapy, for working in and with the bodyself. I have been tracking the unfolding of my evolution and understanding of how to work with and support the healing of trauma, trauma of all kinds, but specifically, the heart of my clinical and teaching practice has always been the reparation of early attachment injuries.
If we go back to the beginning, to the fall of 2001, I saw a demonstration of Somatic Experiencing. I was in my first semester of grad school. I entered grad school knowing I was interested in trauma work but had assumed I would learn and use EMDR (I never did), but I was captivated by somatic work. I don’t know that I could grasp the profundity of what I was seeing, but my body knew. I remember as I witnessed the demonstration, I had an involuntary vocalization—not a gasp, not a laugh, but some sort of bubbling forth of a knowing—this is it I thought, I need to know more. Two months later as I started my second semester of my Master’s, I started training in Dr. Peter Levine’s Somatic Experiencing.
For the next 12 years I was deeply immersed in the somatic world—in 2006 I began working with Dr. Sharon Stanley as she built her Somatic Transformation training program. This immersion served me well—Sharon is a gifted and generous clinician and educator, and I was fortunate to be mentored by her until the end of 2014. I had found my clinical home in the somatic world.
Homes change 😊. I began studying with Dr. Allan Schore sometime around 2010 and I stretched my clinical mind and practice: I continue to appreciate Allan’s brilliance and the vast disciplines his work traverses. During this time, I was departing more and more from my somatic roots and teachings. In 2015, I studied with Dr. Mary Main and Dr. Erik Hesse in the Adult Attachment Interview Training (AAI)—that training was significant in putting into words the relational dynamics I was working with in my practice that were replications of early relational injuries and also embedded in the body. In retrospect, it was the AAI that helped me articulate my knowing and continues to serve as foundational to my understanding of relational trauma, which is the heart of my clinical work. This created yet another home.
Fast forward to 2016 and I started my own Somatic Attachment Psychotherapy 2-year training for therapists. I had been teaching workshops for the previous twelve years but this was different. I was able to have a bigger canvas to explore and expand upon my understanding of how to work with folks that have an insecure attachment from a somatic lens. It started out as a good program, but I’m excited to say that my thinking and knowing from there has significantly shifted again and again as I leaned into relational and interpersonal psychoanalytic psychotherapy training beginning in 2019. This too feels like another clinical home.
I think that what’s true for me is that over my clinical career I have found many clinical homes that continue to be foundational in my clinical thinking, practice and teaching. Somatic Attachment Psychotherapy (SAP), as it stands today, is an embodied way of practicing psychotherapy oriented toward working with relational injuries (insecure attachment).
Now, SAP has evolved into an outstanding training program and community. That’s not even hard to say—I have been supported by incredible teachers, some of the most brilliant hearts and minds in the field, and I have taught hundreds of amazing therapists that continue to invite me to expand my thinking and practice. Perhaps most significantly, I have walked with incredible people in my practice over time as they, and we processed, their early wounds and they found healing. This is where the work really happens, in clinical spaces, where theory meets practice, and emergent process happens and builds new practice and theory. Kind of a spiral situation.
While there’s lots more to my story, I find myself at the next opening of the spiral. I’ve found my next teacher, it’s in a different discipline, related but outside of psychotherapy. Sometimes, when I listen to him speak, I weep…and that tells me, like that involuntary vocalization 24 years ago, follow this—see what doors open, bring your curiosity—I think there’s another home here.
“The greatness of a nation and its moral progress can be judged by how its animals are treated.” Mahatma Gandhi
Last week we spent an afternoon meeting with some staff and volunteers from the BC SPCA Wild ARC (Wild Animal Rehabilitation Centre) in Metchosin. It was incredible to hear about the exquisite care the team offers to injured and orphaned wild animals, and overwhelming to put together just how many hands and hearts it takes to run the animal hospital. WOW.
Wild ARC cared for 2,043 wild animals last year from all over the region, helping them recover and return to the wild. This incredible program provides much needed care to injured, sick, orphaned and distressed wildlife (more than 80 percent related to human impact) with the goal to release recovered animals back into the wild.
In the BBP Somatic Attachment Psychotherapy 2 year training we talk about love being medicine—and throughout the clinics we talk about what does that really mean? In essence, we come to know that love means holding a frame and framework to allow for the most possible healing for our patients. In a reflection of this principle, the humans that work and volunteer at the BC SPCA’s Wild ARC offer a similar holding environment, offering interaction and care that is most beneficial for the wild animal to heal and return to life.
The thing that struck me most was the dedication of the team—volunteer and staff—to care for the animals. There is no snuggling Bambi, befriending the owls, or petting the rabbits—the team members take exquisite care NOT to familiarize the animals with people so voices are low in the hallways and protocols are taken to ensure wildness is maintained so they can return successfully and not be habituated to humans. We were inspired by the people we met that work and volunteer at Wild ARC and got an inside scoop on their dedication, what it takes to nurse some of the animals back to health, or to save their lives – baby hummingbirds need to be fed every 15 minutes! Some volunteers come in and just do laundry, like for their whole shift! WOW, just wonderfully dedicated folks.
While from the outside it looks like a wildlife education centre nestled among tall trees, once inside the centre, it is a hospital and infirmary. Wild ARC is not open to the public for tours as it’s patients need a dedicated environment to heal and recover in. We were able to learn that spread out on the hospital campus are a variety of enclosures to house and rehabilitate the animals—from deer enclosures, to a raptor shed where large birds of prey can spread their wings and fly, or learn to fly, to the raccoon rooms – specific for babies, juveniles or adults. They also have water enclosures for animals that are water based like seabirds, water fowl, river otters, etc. The enclosures are enriched with materials from the animal’s natural habitat like cedar boughs, water pools, and things to climb. Each species of animal has specific dietary requirements and meals are carefully prepared, including Wild ARC growing their own mealworms!
This quality of diverse care is an incredible feat – to be able to treat over 2,000 injured or orphaned animals per year, most of them (70%) in the spring and summer months, to coordinate over 150 volunteers, to fundraise the money needed to run the hospital (nevermind the whole of the BC SPCA—they don’t receive government funding), is monumental.
Thank you, from the bottom of our hearts, to the BC SPCA, the dedicated staff and volunteers of the Wild ARC, and to everyone who opens their hearts and wallets to care and support wild animals.
If you are interested, one of the enclosures that we sponsor has a web camera – the deer enclosure – (there are currently no deer in care so the enclosure is empty though check back often during the busy spring and summer season) – WATCH
I’ve been having lots of conversations with therapists looking to enroll in our Somatic Attachment Psychotherapy Training about working with the body in therapy. Lots of therapists identify that they in fact already do use the body in their clinical practices, by asking,
what’s happening in your body?
where do you notice that?
is there a sensation that tells you that?
and then what they share with me is that they often feel uncertain about what to do with that information, or how to take it beyond their initial question/intervention – of course, this is what we teach in SAP over the two years! These conversations inevitably beg the question, is that enough? Is it enough to have people identify what is happening in their body and then notice it, stay with it, watch it? My response is, enough for what? What is the purpose of drawing the client’s attention to their internal sensation or felt sense? What is the working theory, not only about why the therapist is inquiring about the body, but also inviting clients to stay with it? That’s the guiding question here, what is the purpose?
If the intention is to merely have people increase their capacity to be present, be with what is, and increase capacity to tolerate discomfort, then yes, the status quo of how people often use the body might be a worthwhile intervention, though perhaps not the best intervention, as most therapists, prior to somatic training, choose to include the body at a time when there is distress, intense emotion, or disconnection/disembodiment. (More on this later).
If the intention to help process and metabolize material in the system (relational and incident traumatic material), then no, just dropping in and noticing the sensation, and staying with it, particularly difficult or uncomfortable sensations, is not likely going to further the processing of the neurophysiological material or psyche reorganization, and if it does, it will be short-lived. What is likely though, is that simply focusing on the body during these times of arousal will move the system out of the processing window into high/hyper or low/hypo arousal as the dysregulation in the system creates more and more dysregulation. Alternatively, the client may continue to feel the sensation but not really garner further process or understanding from it – for example, the tightness remains tightness, so the intervention fizzles without any further clinical or embodied process unfolding.
In order to process (trauma, grief, loss, etc.), the work is to up and down regulate the autonomic nervous system along side the story. This is where BBP/SAP differs from other somatic dominant trainings – one of our guiding principles is that people need to tell their story, and be witnessed relationally, rather than just experience and process what is happening in their body, so working to re-organize the psyche and body in concert. When we invite the body into the clinical dialogue and process, we want to be able to work to help people to not only be present to what is happening within, but to the nuanced truths of the story that also help anchor and facilitate processing and internal re-organization, both of which are key to change.
Change is key to therapy. We know the body and psyche are wired together, and that trauma is held in the right (versus the left), so we understand as therapists how bringing the body into practice offers an effective way to attend to and process traumatic material (of all kinds) in order to regulate and process the physiological body and reorganize the psyche and internal working models, and ultimately bring forth a new narrative understanding of self and story.
For clinicians, working adeptly with the body necessitates a solid understanding of the Polyvagal Theory (Porges) (read, the Polyvagal made simple) and the Window of Tolerance (Siegal). These conceptual frameworks offer therapists a theoretical framework to guide the use of somatic interventions, rather than simply inserting them into the therapy. Further, I would suggest that correlating sensations and felt sense into this framework is necessary for therapists to have a sophisticated capacity to work with, and in the body.
If we circle back to these conversations I’m having about bringing the body into practice, it seems to me that what we are differentiating here is mindfulness and somatic processing. While there is overlap, they ultimately have different purposes. Mindfulness is a practice oriented towards increasing one’s capacity to be with what is. Somatic process has the intention to shift the internal state and process material. These are significant differences when thinking about the purpose of inviting the body into the clinical conversation. In this way, I want to underscore not only the difference between mindfulness and somatic therapy, but the difference in intention. Somatic therapy is used to process material. It may use mindful presence to attune and be with experience, but it at its core, it’s about shifting and processing—making it different, not learning to be with what is.
This fall I’ve been thinking a lot about the capacity to witness. I have been thinking about what supports it, what threatens it, what builds it, and for therapists, how we are called to witness the unbearable, the unspeakable, and at times, that which has not, and perhaps cannot, or cannot, at this time, be metabolized through the body and psyche of the people we sit with. This is the work we do in the clinical space. As therapists, we serve as witness, and in doing so, material that has been rendered unbearable, becomes tolerable enough to metabolize. Mucci (2018) speaks to this, “by taking in the pain of the other, and bearing witness to it, the other is enabled to retrieve those parts of his or her existence that seemed erased, dissociated, split and disconnected. This retrieval enables a transformation in the social connection, a sign of renewal, reconstitution, collective reparation, and rebirth” (Mucci, 2013 cited in Mucci, 2018, p. 176 – 177). Mucci speaks of this as rebirth as there is a return of vitality as the psyche integrates and the autonomic nervous system processes the life-threatening states held in the body, moving from hypo arousal or dorsal vagal into a stronger, dominant ventral vagal state.
But what happens when we as therapists are also called to witness horror and terror in the larger world, the one outside of our clinical space, and in response to it, we feel fear, despair or helplessness? How do we continue to do the work that we do, and what is called for, when we are taken to our knees by world events, when our clinical spaces are infiltrated with the happenings of the larger world? As an educator in Somatic Attachment Psychotherapy, I’m always thinking about, how do we become more and more robust, where do we lean, what do we lean into, what holds us, how do we maintain our witness when we stumble, and as we stand as witness for and with others, what do we need?
In this time and place in history, where we are inundated by geo-political chaos and disconcerting movements, both in our own small communities and around the world, I am aware of the toll it takes. I know that it taxes each of us as clinicians, even if we are able to shut out some of the bombardment of difficult news, it comes in through our practices, and of course impacts us energetically. I’ve been thinking about that in my own life, and in a broader way, the lives of the therapists I know.
I think about the work that we do. I am awash with memories, scraps of competing truths vying for primary remembering, primary knowing:
I remember that the body is “our primary text and starting point for knowledge” (Rountree, 2006, p. 98). This quiets me. I land.
I remember, “When we remain connected to our body knowledge, it will make it more difficult for the powers that be to control our minds” (Crawford, 1998, p. 57). I nod.
I remember, “A brain disconnected from the stomach, intestines, throat, heart, and other parts of our body isn’t only seriously impaired, it can be as deadly as the proverbial loose cannon” (Todd, 2001, p. 28). I nod.
I remember, “People who can’t trust their own body knowledge feel out of touch, have less tolerance for ambiguity, seek clearcut simple rules to determine their actions, tend to consider complex situations in simplistic terms, and are thus more likely to be swayed by “experts” and by naïve either/or arguments” (Todd, 2001, p. 24). I feel worry.
I remember, “reading the body as one would read a text, we used our lived experience as another valid and valued source of information and knowledge…” (Gustafson 1998, 52). I nod.
I return to remembering that the body is “our primary text and starting point for knowledge” (Rountree, 2006, p. 98). This quiets me. I land.
I come back to the truth that nothing remains static. Embodiment is an ever-shifting evolution. Paired with the body is the capacity to witness, to be present, to hear the testimony of the people we sit with, and to use my body and my regulation in the process, for the process. For me, this has been an ever evolving and expanding quest, and I hope that is for you too.
This past week has called me to dig deeper and steady myself as my perception of reality shifted, as did many peoples’, with the outcome of the US election. By happenstance, my weekly supervision group was the first clinical space I entered into after the US election. I am one of the two Canadians in the group, the others are American. We put aside our cases and we sat, we processed, we made sense, and most importantly we connected and stood as witness for one another.
Since then, I have needed to take time, to be with myself, and come back to what I know beyond this moment. I had to take a bird’s eye view of history, of humanity, and lean into the vastness of time, to remember that Rome wasn’t built in a day, nor did it fall in a day, and I had to find commonality of values with those that understand a way forward that is different from my own perspective. Remembering the goodness of people beyond their political leanings helped me remember how to connect across differences, even when the chasm feels vast. This was imperative, not finding it as a philosophical endeavor, but for myself, so I could find my ground again and stand, until the next time I stumble.
References:
Crawford, L. 1998. “Including the Body in Learning Processes.” In Proceedings of the 17thAnnual Conference of the Canadian Association for the Study of Adult Education, edited by Maurice Taylor, 57-60. Ottawa: University of Ottawa.
Gustafson, D. L. 1998. “Embodied Learning about Health and Healing. Canadian Women Studies 17 (4): 52-55.
Rountree, K. 2006. “Performing the Divine: Neo-pagan Pilgrimages and Embodiment at Sacred Sites. Body & Society 12 (4): 95-114.
Mucci, C. (2018). Psychoanalysis for a new humanism; Embodied testimony, connectedness, memory and forgiveness for a “persistence of the human”. International Forum of Psychoanalysis. 27:3, 176 – 187.
Todd, J. 2001. “Body Knowledge, Empathy and the Body Politic.” The Humanist (March/April): 23-28.
Recently, I’ve been thinking about early experiences with caregivers that lead to insecure attachment and the formation of chronic shame. We know experiences of overt shaming, neglect, chronic misattunement, or a lack of relational repair, are reflections of the caregivers own relational injuries and likely reflect their own early experiences with their caregivers, and their own insecure attachment and chronic shame. Another, possibly less obvious avenue of chronic shame creation, than say, overt shaming or neglect in early life, is through objectification. Hooten (2019) writes, “A child that is objectified, whether adored or criticized, who is evaluated instead of being joined in their energetic and emotional state, produces a state of disconnection and shame” (p. 33). I see the evidence of this clearly in the many folks I sit with in my clinical practice which focuses on the healing of trauma, specifically relational trauma.
As I consider the effect of these early experiences, I am reminded of a quote from O.B. Epstein (2022) that for the child, these interactions form “…micro-moments of accumulated grief which never seem to go away, quite the opposite; they will continue to generate a sense of insecurity and shame in the growing child and be present during adulthood” (p. 48-49). This linking of shame and grief has real clinical relevance in the healing of chronic shame, because at some point in the treatment, as the client comes to see and better understand the multitude of ways that the unseen hand of chronic shame has formed, guided, and limited their life, both past and present, a real grief and sadness will emerge. In this expanding understanding of their life and the ongoing impact of chronic shame in it, there will be a grieving and reconciling of missed opportunities, possibilities, relationships, and how compromised their sense of feeling free and creative and solid in what Bromberg (2017) calls the “…unique pleasure of oneness…” (p. 19) has been due to chronic shame. Although this part of the healing can feel overwhelming and unending for clients, clinically, I see it as an indicator of their increased capacity, and progress in their healing, which brings the promise of not just decreased chronic shame symptoms, but an increased stability and comfort in themselves, which has been largely elusive.
References:
Epstein, O. B. (Ed.). (2022). Shame Matters: Attachment and Relational Perspectives for Psychotherapists. Routledge.
Hooten, J. (2019). Shame: An Existential Wound. The Knowing Field. (10), p.29-44.
Solomon, M. F., & Siegel, D. J. (2017). How People Change: Relationships and Neuroplasticity in Psychotherapy (Norton Series on Interpersonal Neurobiology). WW Norton & Company.
Wild ARC cared for 2,043 wild animals last year from all over the region, helping them recover and return to the wild. This incredible program provides much needed care to injured, sick, orphaned and distressed wildlife (more than 80 percent related to human impact) with the goal to release recovered animals back into the wild.
