An essential characteristic of the therapeutic method is the work with the somatic sensations and with the memory systems (episodic, procedural, semantic memory). Based on the somatic traces of trauma the work with the episodic memory integrates the traumatic experience. The procedural memory gives access to trauma-dependent patterns of behavior, and the learning of abilities represents an important resource. The semantic memory supports the client in his autonomy and in managing the sequels stress and trauma.
Research progress in neuropsychology and biosciences together with modern models of trauma therapy illustrate ways of a “somatically oriented” solution of trauma. The methodical basis of TraumaSomatics® uses the fact, that we dispose of a memory system that can be differentiated into semantic, episodic and procedural memory (see also readings from Allan Schore, John Grigsby and David Stevens, Bessel van der Kolk, and Eric Wolterstorff). The therapeutic objective is the separation of these memory systems in order to work individually with each of them. In this context it is a valuable tool that the therapeutic procedure addresses the somatic level. Practical work shows that the symptoms of a traumatic experience can be resolved by reorganization of the somatic memory system. The development of the capability to recognize the traumatic experience as past gives access to the present moment.
The somatic side of trauma Trauma and the nervous system
Traumatic experiences generally are accompanied by enormous stress and by complex patterns of sensory input that are threatening and painful in an extreme way. The traumatic situation mostly appears like an unexpected attack leading to a state of shock. It gets out of conscious control because the processing and storage of incoming traumatic information becomes uncoupled from higher brain functions. The reactions of the threatened human, which are fight, flight or freeze, are now driven exclusively by the autonomous nerve system. A trauma is connected with the experience that there is no opportunity to solve the situation and a deep sensation of being overwhelmed. The first natural reactions to such an event are intensive somatic sensations, emotions such as anxiety and pain, and extreme arousal of the nervous system. The physiological state of arousal of the nervous system can continue unchanged, however, even if the traumatic challenge has passed. This means that the self-defensive system of the traumatized person is in a persistent state of alarm expecting that the dangerous situation could return each moment. This chronically increased stimulation of the autonomous nervous system persists both during sleep and awake states, so that the persons concerned suffer from massively disturbed sleep, generalized panic symptoms, increased startle response and sensitivity to noise. This demonstrates that the nervous system is affected by traumatic events in a long-lasting manner. Consequently, parts of the nervous system are still occupied with managing the past although there is actually no threat of the organism at the present moment. Additionally, the switch from higher brain functions to the autonomous nervous system leaves no opportunity for cognitive integration of the traumatic experience at the timepoint of the event. With his method “Somatic experiencing” Peter Levine was the first to introduce a somatic level into the trauma therapeutic process. With his model of activation of stress and trauma he turned the focus to processes in the nervous system. He describes trauma symptoms as an aftermath of activation of energy that could not be released during the overpowering traumatic experience and is therefore still captured within the nervous system.
Traumatic memory in therapy
Living in continuous fear of physical punishment by its violent parents, a child learns a plenty of somatic reactions which are adopted as a somatic habit. It learns to recoil, to turn its head to the side and to use its hands for protecting its head. When this threat continues for longer time, certain muscular and connective tissue structures are permanently activated in the body and certain somatic patterns are trained unconsciously. The child is permanently alert and fears the repetition of punishment. As unconscious reactions its organism shows chronically lifted shoulders, a distorted neck, and a tight and nervous stomach. Wilhelm Reich described this pattern of locally fixed and degenerated posture as a protecting armour. These rigid patterns of unconscious muscular tension are found in the head, jaw, neck, shoulder, thorax, diaphragm, pelvis, legs, arms, hands and feet. The inability to solve a threatening situation is “freezed” in the soma and its structures, and in this way forms an aspect of the somatic memory. This represents a deep memory of the triggering traumatic situations which is accessible by the release of such somatic patterns during the therapeutic process. A striking feature is the obvious somatic involvement of the client in the past event as it is reexperienced. During the TraumaSomatics® session the client isn’t still or passive, but a multitude of symptoms and movements appear in the soma representing a fundamental difference to therapeutic strategies which rather aim at a cognitive understanding and neglect the somatic level. Focussing on the information provided by the SomaNet enables integration of the traumatic memory as the previously unconscious information becomes accessible to consciousness and to the semantic memory (see below), and thus to cognitive processing. An inclusion of the “somatic memory field” is also emphasized by the sensational research on trauma therapy of the psychiatric working group of the Harvard University, including Bessel van der Kolk and Judith Herman. They point out that the limbic system of the brain and its sensorimotor pathways are responsible for the storage of traumatic memories, and not the verbal region of the cortex as it is the case for normal memories. Accordingly the publication of their model is entitled “The body keeps the score” making the following implications for trauma therapy obvious: The somatic level has to be involved to enable effective recollection of the past and to release the traumatic residues. The importance of focussing on somatic memories is also emphasized in sensorimotor psychotherapy. In her recently published book “Trauma and the body: A sensorimotor approach to psychotherapy”, Ogden points out the necessity to include the somatic level in trauma therapy. Her method works with a close observation of somatic signs of the clients, such as spontaneous muscular tensions, trembling, changes of the respiration and the pulse, and of body movements. A special repertoire of techniques are necessary to accompany these somatic processes, in order to attain an “unfreezing” of the somatic memory and to bridge defensive barriers, which obstruct the access to the traumatic memory. Furthermore, her therapeutic work emphasizes the interface between Top-Down and Bottom-Up Processing. Top-Down and Bottom-Up Processing represents two directions of flow of information. This hierarchical information processing describes the evolutionary and functional hierarchy between three levels of organizing experience: the cognitive, the emotional and the somatic level. It represents the concept and architecture of a triune brain. The reptilian brain, which developed first in evolution, represents the somatic level controlling arousal, homeostasis of the organism, sensation, and programmed movement impulses. Concerning emotional processing, the limbic brain, which surrounds the reptilian brain, mediates emotion, social behavior and learning. The last developed region of the neocortex enables cognitive information processing, such as self awareness and conscious thought. In her clinical practice Ogden developed a three-step procedure to work with these levels of organizing experience.
(1) She observes the client`s information-processing tendencies on each of these levels.
(2) She identifies which level of processing will most successfully support the integration of traumatic experience at any particular moment of therapy.
(3) She applies specific techniques that facilitate the processing of traumatic experience at that particular level.
The therapeutic technique of TraumaSomatics®
In the following two central aspects of the practical work with TraumaSomatics® are described in more detail: the work with the level of somatic sensations, and the work with the memory systems. Besides, there are other specific therapeutic tools that will be the subject of further publications. The therapeutic work with somatic sensationsIt requires a special training of the TraumaSomatics® therapists to be able to use the somatic information systems of the SomaNet during the therapeutic process, in particular the “symptoms” of the “excited nervous system” and the level of sensations in the body tissue. Often we find a dynamic course of the processes, resulting from energetic over- or undercoupling phenomena in the nervous system which are detectable with difficulty only. However, studying the body sensations decelerates the processes and important reorganization phases of the somatic memory can be recognized. Another aspect is the direct link between emotions and the perception of somatic sensations. Experiences of early life phases are dominated by somatic sensations, and it needs a time of learning processes to assign emotions to these sensations. A close coupling between emotions and somatic sensations results also from the research of Candace Pert on neuropeptides as the physiological substrates of emotions (for details see: The subunit of the chemical net). The episodic memory system The episodic or biographic memory system stores important experiences, that are frequently associated with an emotional load, as e.g. traumatising experiences. A characteristic of episodic memories is that they can be described in words. Memories of traumatic events are linked with external “triggers”. Post-traumatic symptoms, in particular so-called “flash backs”, develop by confrontation with an individual trigger. This trigger initiates, that the traumatic situation that took place in the past, is experienced again both on somatic and psychological levels as if it would actually take place at the present moment. For example, if I experience a car accident, I see a car coming towards me, then I step on the brake and smell the burning rubber of the tires, I sense the pain, when my head hits the window, and I hear the glass splintering. If a later experience is similar to the original event even only in a small detail, e.g. if I am at home and I hear a glass breaking, memories of the old event can return at that moment. Then, the nervous system is in the same state of arousal as in the moment of the car accident, the experience, sensations and thoughts repeat themselves in such a way, as if the accident would take place at the moment. The reorganization of the episodic memory occurs via the access to the somatic memory. Here we use the fact that the psychological healing system is also a somatic system, a living and dynamic system, which disposes of the capacity to generate transitions from dysfunctional to functional states via self-organizing patterns. A possible therapeutic approach in this memory system is the technique of “temporary containment” of somatic sensations, emotions and thoughts. By creating a therapeutic space of somatic awareness the trained TraumaSomatics® therapist observes and supports the fine somatic sensations as well as possible somatic movements of orientation and protection, occurring both on a visible and a microscopic level. Thereby, the process changes from pure abreacting (catharsis) to release and integration, both on the level of the nervous system and in the somatic structures as well as on the cognitive level. The procedural memory system Acquired habits originate from the procedural or habit memory system. They are also called “non-explainable” habits. For example, we are able to ride a bicycle, but we aren’t able to express in words the procedure of riding a bicycle. Procedural memories are memories of actions and not of descriptions or thoughts. One develops procedural habits by precise repetitions, like for example learning a sport or a foreign language. These habits and abilities are learned slowly, but if they are trained, we never forget them or at least never completely. Remembered habits show up as, e.g. mental attitudes and behaviors, or certain abilities to get in relationship with others. Habit memories store also deep psychological habits: patterns of behavior, of thinking and of emotions, which were learned by repeating them again and again in a completely unconscious manner. What the child learns to adopt unconsciously, appears later as the character of the adult. Humans with traumatic experiences either could not develop a number of abilities in their early life, or later certain abilities got lost through the traumatic experience. These abilities include for example the ability to say “no”, to set limits, to take responsibility for oneself, and to have confidence. In the therapeutic context we speak of abilities which are weak, damaged or underdeveloped. The traumatherapeutic work with the habit memory reorganizes and/or establishes abilities, in order to use them as important resources. As therapists we need these abilities in order to work with our clients effectively. Traumatised clients depend on these abilities everywhere in their life, e.g. with the family, friends, on the job. Also in the relationship with the therapist the availability of these abilities is important, particularly if stress or trauma symptoms emerge. Prerequisites to achieve healing processes are a good contact to resources and the recovery of abilities. The semantic memory system Finally, it is important to lead the clients into their own autonomy. One aspect is to create in them the understanding for the therapeutic procedure and the different stages of the therapeutic process so that the client can take on an active role which is supported by the therapist. Another aspect is to dismiss the client from the victim role and lead him into independence via the cognitive understanding of the past traumatic experience. The therapeutic techniques of TraumaSomatics® transfer traumatic memories from a somatic level to levels that are accessible for higher brain functions so that the processing of the past can be finally done on a mental and cognitive level, and by verbal expression. Pierre Janet pointed out that the verbalising of memories is important: “It is not enough to be aware of a memory that occurs automatically in response to particular current events: it is also necessary that the personal perception knows this image and attaches it to other memories”. To create conditions that support the healing of trauma it is very important to develop and establish the ability to live in the present moment in the client. When a memory of a past event reappears, we may be slightly surprised to realize that the entire experience of remembering and of restoring somatic memories is happening now. We may be experiencing something again, but this experiencing is going on now. Intuitively we feel that we are not back at the time the event happened. The nature of the present moment poses a challenge to the neurosciences. How do we know that something took place in the past? How do we recognize the present now? As Daniel Stern writes, the presence of mind and body is comparable to an “existential affect” . Pathological states of dissociation can influence the sense of being in the here-and-now. Dealing with traumatic memories requires a sense of self to be aware of the moment. But where can we experience the presence better than through our body, our tissue and cells?
Résumé
A manifold knowledge originating from neuropsychology, from psychotherapeutic and somatic therapeutic methods, as well as from medicine and biosciences, combines with the experience of somatically oriented trauma therapy to make evident that the somatic level plays an essential role for development, fixation, and resolution of trauma.
The efficacy of TraumaSomatics® grounds in the reorganisation of the somatic memory and the increasing resolution of the somatic traces of the traumatic experience. Both, the calming down of the nervous system and the changes in the structural and chemical net, contribute to these processes. An essential characteristic of the therapeutic method is the work with the somatic sensations and with the memory systems (episodic, procedural, semantic memory). Based on the somatic traces of trauma the work with the episodic memory integrates the traumatic experience. The procedural memory gives access to trauma-dependent patterns of behavior, and the learning of abilities represents an important resource. The semantic memory supports the client in his autonomy and in managing the sequels stress and trauma.
