I have paid close attention to the insights of Peter Levine ever since his book “Waking the Tiger: Healing Trauma” was published. He pointed out that while animals face being hunt down almost on a daily basis, they are virtually immune to traumatic symptoms. With that observation in mind, we have to take a fresh look at trauma healing in human survivors.
Healing involves understanding the role in healing played by bodily sensations, especially in the kinesthetic sensation. Through heightened awareness of these sensations, trauma can be healed. Levine’s approach does not fall into the prevailing practice of over-emphasis on pharmaceuticals even though he considers the problem to be a physical and neurological one.
These are my thoughts concerning his ideas. If there is any confusion or accidental misrepresentation of his work in what I have written, the fault is entirely mine.
The task of the therapist is to help clients by offering them an “island of safety.” It doesn’t have to be a big island, even a very small one is beneficial so long as it is safe. Then, give them a tool so that they can get to that island of safety by themselves. This is accomplished by teaching them self-soothing techniques.
The “island of safety” refers to a palpable, kinesthetic sense of comfort and security; an experience of safety and of being firmly anchored. This must be clearly communicated and demonstrated to the client in therapy so that the therapist conveys the experience, not just the idea.
As survivors of past trauma know, the consequence of the trauma is something that is deeply locked in the body. It is quite different from a conventional understanding of memory, which is narrative. It is unlike the memory of recalling what happened at the ball game yesterday. It is more like a computer that is stuck in a loop and must be re-booted.
“The body keeps the score,” is a phrase emphasized and coined by another trauma specialist, Dr. Bessel van der Kolk. Basically, the body has lost the ability to feel safe. The patient has lost even the memory of what “safe” feels like. This is something that comes up often in therapy.
Therefore, the task in therapy is to help the client to “reset” his or her hyper-alert response. Post trauma, patients are “jumpy” with easily triggered nervous system reactions. With therapy, the patient can realize that it is possible to re-learn and experience safety.
How is this possible? The path to healing is to teach the client that although terrible things did happen in the past, it is possible to experience feelings of safety and joy by living in the present. To a frightened or hurt child, pain and insecurity is felt in the body without narrative memory. The best remedy is to experience the mother (usually but not always) to “physically cradle the child in her loving embrace.”
The cradling by any genuinely protective adult has power. This is how healing is possible. But, as therapists we cannot cradle a patient for reasons that, although obvious, bear repeating:
(1) It is prone to leading to transgressions of the therapeutic boundary.
(2) Our client is not a child, even though the emotional feeling they may express is that of a helpless child.
(3) The therapist, ideally, is teaching the client “to fish” rather than being given a fish as a temporary measure. One aims to teach the client self-healing rather than dependency on the therapist or a pill.
The procedure is teaching the client to generate a sense of self-reliance, of learning what constitutes comfort, security and physical stability. The most immediate goal is to bring the client to the relatively comfortable and secure environment of the here and now through actual experience rather than through words or pharmaceutical intervention.
Words do not create bodily sensations and often run the risk of unknowing retraumatization. I have had patients whose abusers repeatedly used the word “relax” as a prelude to the abuse. For such patients, to suggest that they relax is one of the worst possible thing to say. While retraumatizing words have immediate bodily sensations for the patient, they are the opposite of what you need to convey. They remember the feeling of trauma, they do not remember the feeling of safety. Therefore, mere words are often empty of meaning for patients.
There are medications that can temporarily quell emotional distress. However, there is a clear difference between the actual experience of safety and the experience of suppressing distress through medication. The actual experience is tangible safety. It nourishes the patient and undermines the power of the traumatic events. Quelling the emotional upheaval through medication that suppresses the distress is not the experience of safety. It is simply the apparent absence of upheaval. These are quite different things. I use the term “absence of upheaval” because the distress will re-appear the moment the medication’s suppressive effect weakens.
We must be careful to ensure that our work will not be re-traumatizing, so pre-therapy contracting work is important here. The therapeutic alliance is basic and fundamental to the process. It needs to be cultivated and sustained through empathy, positive regard and congruence.
