Month: April 2013

What happens during the first appointment?

Sometimes people wonder what it would be like to visit a therapist for the first time. I have found that people often feel more at ease when they have a little information.  Here’s a basic outline of what is likely to happen if you schedule a consultation with me:

You are welcome to contact me via phone or email to schedule our first appointment.  I will let you know whether or not I am able to accept new clients at that time. If I can’t, I can help you find another therapist to work with.  

To save time on our meeting day, I will ask whether or not it’s okay to email my intake documents, for you to print and fill out at home.  If not, then I’ll ask you to show up about 15 minutes early for our appointment, so that you can fill them out in my office.

My intake documents ask for information like your name, address, phone number, etc. I also ask you to provide basic information about your family, life history and physical/mental health history.  All of the information you provide to me is confidential and can only be disclosed under certain circumstances (which are outlined in the privacy documents I will also provide to you). Some examples of those circumstances include: Child abuse (of a child who is currently under age 18), elder abuse, abuse of a disabled person, danger to yourself or others, subpoena or court order, and/or a release of information signed by you.

Here are a few pictures of my office:

2015-05-02 13-52-51 -0700     2015-05-02 13-51-56 -0700

 

A few important things about my office: It is on the second floor, and my building only has stairs, no elevator. If you have any physical limitation that prevents you from walking up one flight of stairs, please let me know so that I can make arrangements to see you in an accessible office nearby. Also, my office does not have a waiting room, so if you arrive more than a few minutes early, I may not be able to let you in until our appointed time.

When you come in for the first time, I do my best to help you feel comfortable and at ease.  We talk about your life circumstances and what brought you to see me.  I do take notes during the first session, to help me form a framework in my head about what’s going on in your life. We talk about what is and isn’t working, and your goals for therapy.  I start to provide you with information about the body and nervous system, and how they might be contributing to your symptoms.  If you haven’t tried somatically based therapy before, I might gently start to introduce you to the method, so that you can try it and see whether or not you feel it’s for you.

By the end of the appointment, we should both have a reasonably clear hypothesis or idea as to what’s going on, and I can outline how I would suggest addressing it. I will let you know whether or not I feel I am able to help you; and if not, I can help you find someone else to work with.  You would also let me know whether you feel comfortable in working with me and whether or not you wish to proceed.  If we both agree to proceed, we would then schedule our next appointment.

Of course, this is only a general outline. My work is flexible moment to moment according to the client’s needs.

Here is where you can find my contact information, if you’d like to schedule an appointment.

 

Caught In The Vortex

We all know what it’s like to be caught in the vortex.

trama_vortex

In the parlance of Somatic Experiencing (R), the “trauma vortex” refers to that internal state of being stuck in the trauma, or its effects:

*  An anxiety (or panic) attack.

*  Repetitive or obsessive thoughts.

*  Feelings of despair or hopelessness.

*  Seething anger or explosive rage. 

*  Deep depression you just can’t shake.

These are just a few examples; I think everyone has their own version of it. The key word is “stuck.” When someone’s in it, it can be very difficult if not impossible to get themselves out.

The trauma vortex is an unpleasant state within that’s unmanageable. It takes over; or else it lurks beneath the surface, threatening to rise up whenever the person encounters a trigger. The vortex consists of the internalized aftereffects of traumatic experience(s). Some people live within their vortex all the time. Others are relatively okay in between periods of being triggered.  Many people sense it’s there, but they don’t quite have the words to distinguish or describe it.

Somatic Experiencing (R) practitioners help people learn to recognize when their vortex is trying to rise up and swallow them.   We help clients learn how to step outside of it, manage it, and then gradually diminish it. That is, we help our clients get unstuck.  Trauma means being stuck and not finding (good) options, whereas healing means flow, and choices opening up.

For every vortex, there is a countervortex of goodness and strength.  We help our clients discover, access and strengthen those.  No trauma vortex is quite as terrible when one has a good hold on a countervortex.

counter_vortex

Do you remember “Pac-Man”?  When Pac-Man gobbles up the big pill, he’s empowered, and can defeat the ghosts that were chasing him.  He draws his strength from that pill, which is like the countervortex.  The goal is to help the client internalize that strength as a baseline, rather than just for a few moments like Pac-Man. Then, that strength can be used to deconstruct the trauma vortex.

EmpoweredPacMan

(The ghosts are running scared now!)

So if you’re considering coming in for therapy, please know that it’s not all about working in the vortex! In my view, therapy has to be manageable, often gentle–even fun, at least some of the time.  Generally, the first step is figuring out what’s going on. Then we learn how to stabilize and start to experience goodness (countervortex) again.  To do this, we use the body’s own self-regulatory, or homeostatic, mechanisms. Only then is it safe or effective to go after those vortexes, the aftereffects of trauma in the nervous system.

In my experience, freedom from trauma creates ease in one’s body, mind and spirit.  It means being able to be present in the moment and fully embodied.  Some people can get there quickly; others encounter harder work over a longer period of time.  Personally, I think it’s a lifelong journey rather than a static destination.  I don’t think anyone’s ever really “finished” finding and defeating all of the tough stuff inside.  But the skills one learns in dismantling a vortex become lifelong strength, to help the person with each new challenge.

Somatic therapy is NOT….

As I’ve stated previously, I am happy and proud to be a somatically oriented therapist, that is, a therapist whose theory and interventions include awareness of the patterns in the physical body.  To date, Somatic Experiencing (R) is the most effective modality I personally have practiced or experienced. Of course, that’s why I do it, and I continue to study safe and effective ways to help clients learn to intervene in their stuck patterns.

I want to be clear, though. Somatic therapy….

*  Is NOT a magic bullet.  You still have to attend regularly, do the work, and especially, feel your feelings. In my experience, many if not most symptoms are related to the person not knowing how to experience their emotions, or not having the capacity to tolerate them. That is, the feeling seems too big, too much, or too overwhelming.  They either shut the feeling down and become disconnected from it, or become flooded by it, or they may alternate between these two conditions. Just like in any therapy, you have to learn to look within, and learn how to manage your own emotions.  Fortunately, I have a lot of training in how to help people develop this capacity.

*  Is NOT substitute for medications.  Let me repeat this: Somatically based therapy is not a substitute for competent psychiatric assessment and treatment.  As with any kind of therapy, some people will get along fine without meds, and some people will need meds, either on a short- or long-term basis.  I am licensed as a psychotherapist, not an MD, so I can’t prescribe medications or give medical advice. In some cases, my initial or ongoing assessment tells me that treatment is not likely to be safe or effective without a psychiatrist monitoring the client and prescribing medication as needed. In those cases, I am not able to provide treatment to the client unless they are complying with their medication regimen.

*  Is NOT completely distinct from traditional psychotherapy.  For the most part, we still use the same forms, procedures and format. Psychotherapy works because of the two people sitting in the room together, both working towards the goal of the client functioning and feeling better.  (For a discussion of the importance of the therapeutic relationship, see my earlier blog entry.)  However, in somatic therapy, we might be standing up or moving around the room. We might be in silence for several minutes as the client monitors (“tracks”) some of their physical and/or emotional experience. There might be some movements specific to the client’s situation that may help them return to homeostasis.  So in some cases it looks different, but somatic therapy incorporates the same assessment, treatment planning, relationship development and interventions used in standard psychotherapy, while offering additional options.

*  Is neither “conventional” nor “alternative”, is neither “Eastern” nor “Western”.  In my experience and opinion, it’s all of the above.  Theories and practices of somatic psychotherapy include cutting edge neuroscience and plenty of scientific study.  They also include an awareness of Eastern philosophy and intervention styles.  For example, SE(R) uses its own form of mindfulness, which it labels “dual awareness”: The client maintains awareness of being safe in the present moment as they work with their experiences from the past.  Mindfulness is a concept borrowed from Eastern cultures; it’s increasingly becoming incorporated into standard Western psychotherapy.  I refer the reader to the references section of Dr. Levine’s latest book, In An Unspoken Voice.  I’m flipping through his references as I write this; there are many citations of modern scientific and clinical journals.  (This makes sense, as he holds doctorates in both medical biophysics and psychology.) The text of the book also contains references to and explorations of philosophy, Greek mythology and shamanistic practices. I’m glad to be part of a tradition that merges various healing modalities, drawing from the best of all of them instead of putting them at odds with each other.

To sum up, I study and practice this therapeutic orientation because it’s the best and most effective I’m aware of; but it isn’t a magic bullet, and it won’t help those who aren’t invested in helping themselves.

More on working with the body

fI’ve been a helping professional since 1988, and a licensed therapist since 2003.  That’s a reasonably long history of working with people; but my whole world really shifted in January of 2009, when I began studying Somatic Experiencing (R) with my mentor, Maggie Kline.

In learning to read and work with the client’s physical body, I feel as though I were given a whole new pair of super-sharp glasses.  Sometimes my colleagues and I joke that we’ve stumbled upon the owner’s manual for life and the human condition.

Well, okay, not really. But it sure feels like it!   Here’s why:

While the “smart brain” thinks it’s the most important thing around, much of our experience actually comes from our bodies. Even though our conscious brain doesn’t know this.

Humans are distinguished from most other animal species by our neocortex.  This is the most recently evolved part of the brain, the wrinkly part on the surface.  It’s responsible for “higher” and more abstract functions like mathematics, industrialization, and bureaucracy. Okay, it also does more fun things like language, art, design, organized pillow fights, etc.

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The neocortex is really fond of overestimating itself. It thinks it’s the be-all and end-all, and that it’s responsible for the bulk of our conscious life experience. However, research is increasingly demonstrating the role of the body in creating thoughts, emotions and experiences.

Have you ever jumped a few seconds before you consciously know what startled you? That’s your body acting before your “higher brain” has the chance to come online.

In fact, that’s the very same “fight or flight” energy that we work with in Somatic Experiencing (R).  Your body is constantly, constantly monitoring your environment in an effort to protect you, and most of the time, you’re not even aware of it.

Unfortunately for survivors of stress and trauma, the unconscious automatically compares current circumstances to previous situations that were overwhelming in some way.  It tends to get stuck: it always thinks a new version of the same old thing is going to come back and haunt you again! The more overwhelmed your body was when the trauma happened, the more hypersensitive to these old patterns it becomes. Even old patterns you’re not conscious of.

This can lead to all sorts of symptoms that the “smart brain” can’t understand–or cope with.  In fact, our “smart brain” usually gets in the way of symptom resolution. This is why “lower” animals don’t usually suffer from anxiety, depression,  or other “mental health” symptoms! They instinctively follow their body’s needs instead of questioning them, getting embarrassed, or worrying about what their friends will think.  In fact, animals only show signs of traumatic stress when they are somehow blocked from following their healing instincts.

On the other hand, the human neocortex can sometimes repress the symptoms for a while (“think about something else!”). A person can also try to eat, drug, rationalize, or otherwise beat their symptoms into submission. But it’s all still under there somewhere, just waiting  to pop out at an inopportune moment.

Somatic therapists help you learn to safely communicate with your body. When you learn to recognize what it’s “saying”, you and it learn to work together instead of at odds with each other.  Generally, the end goal is a well-regulated nervous system: Developing a state of relaxed ease, but alert, fully present, and able to engage with others.

http://www.dreamstime.com/royalty-free-stock-photos-happy-woman-dog-image5151498

(Like this!)

Even though we’re just big fancy animals, it’s vital to include the neocortex, socialization and the human condition in therapy. At the same time, someone can talk and talk, but until they experience a different state of being in their physical body, the changes are too often fragile or superficial.  I’ve seen clients have mood states they’ve struggled with for years, start to shift immediately as we follow the body’s suggestions.  The time it takes varies greatly, usually in direct proportion to the trauma the person has experienced.

So no…I don’t actually have the owners’ manual to life. In any case, I’m sure it’s constantly being revised. I was surprised, though, how much of the human experience clarifies itself when our physical selves are fully included.

 

 

Why somatic therapy?

OK, I’ll say it outright. I’ll  even trumpet it to the heavens (or at least into the interwebs):

I am delighted and proud to be a somatic therapist.

I am thrilled to be at the crest of this benevolent and very useful wave that’s slowly rising, gaining momentum as it sweeps over the healing professions. I love having the tools to provide a more holistic approach to my clients, helping them learn to work with their minds, bodies and, it often seems, their souls.

“So yeah,” you might say, “Somatic psychology.  Mind-body therapy. What is all this, anyway? We’ve been sitting on couches and talking for about a hundred years now; and that’s worked pretty well. But now you want to interrupt my story. You want me to stop talking and pay attention to my ‘felt sense’, my ‘movement impulses’. Why do I care what my leg is doing? And those sensations in my stomach–I’d really rather just forget about them, anyway, ’cause they’re not comfortable. What is going on here?”

I’ll give you a hint:

It’s not  “just in your head.”

If you were to stick your neck into an MRI tube, I would bet that the imaging would show thousands, maybe millions of connections between your head and your body.  Veins, arteries, fascia, muscles, bones, nerves, an esophagus and windpipe…

http://www.dreamstime.com/royalty-free-stock-photo-anatomy-head-image29068925

 

(Look, Ma, it’s all connected!)

OK, OK, you say. But that’s just anatomical.  There’s a big functional division between the brain and the body.  The body is just the walking-around package; we really exist in the control center, the brain. Right?

Well, no. Not really.  Consider the following points:

*  Your digestive tract contains plenty of neurons and neurotransmitters, yes, the same kinds that are in your skull. This is known as the enteric nervous system or enteric brain.  I’ve heard it said that volume-wise, it’s about the same size as a cat’s brain. Sooo….your gut is processing more than just food! No wonder people have always talked about getting gut feelings about things, as in “I knew in my gut he was cheating on me,” etc.

http://www.dreamstime.com/royalty-free-stock-images-parasympathetic-system-image25474169

*  There is a very big and important nerve that travels from your brainstem, winding its way through your body and down to your abdominal cavity. It’s called the vagus nerve, and there is cutting-edge research about its involvement in depression and all kinds of mood states. It seems there’s truth to the popular saying about someone who’s depressed having “a heavy heart.”

And here’s the thing: Over 80% of the vagus nerve is afferent.   In anatomical terms, that means the nerve impulses are traveling from the body to the brain. So, your brain isn’t just telling your body what to do! Your body is doing a lot of talking to your brain. In fact, the lower, more primitive portion of this nerve is strongly implicated in the freeze response, which actually shuts down the higher thinking functions of the brain.  Here are some articles from the website of Dr. Stephen Porges, the primary researcher developing the connection between the vagus nerve and mood and social functioning.

* It’s well-known that young children develop their brains through the use of their bodies: by touching, tasting, smelling, running around, falling down, learning to use their hands, their limbs, to solve problems; by interacting with something (or someone) and then watching to see what happens. Infants start this process by making faces at other people and then reacting to what the other people do. Why would all this stop in adulthood?

*  I haven’t bothered to do a particularly thorough search for this post, but over the years, I have read about many studies demonstrating the positive effects of physical exercise in alleviating depression.  Just Google it–a lot of results come up.  This is backed up by my clinical experience. So if the mind and body were so separate, how could running around or doing an aerobics class, help cure the blues? And why do so many report such joy in movement?

http://www.dreamstime.com/royalty-free-stock-photography-running-dog-image3770607

*  There is some speculation that Descartes was fulfilling a religious agenda with his famous theory of mind-body dualism: that is, by declaring that body was separate from mind/soul, ” irreligious people will be forced to believe in the prospect of an afterlife.” I’ve also heard that his proposed dualism made it politically easier for early anatomical scientists to dissect bodies, since corpses were  no longer in the purview of the church. In any case, the belief isn’t global; Eastern philosophy and medicinal practice doesn’t support mind-body dualism.

Does this mean the brain isn’t important? No! Not at all.  But solely working with cognition may not be sufficient for the treatment of trauma and mood disorders. Drs. Larry Heller and Aline LaPierre, in their new book, Healing Developmental Trauma, propose that nervous system dysregulation travels in loops between brain and body. So, we need to address both top-down (cognitive) and bottom-up (somatic) processing. That is, deal with both the thoughts and with the body.

For me, the bottom line is that by working with mind and body, I get to help my clients move towards becoming truly alive.  Somatic therapists (among many other people) have discovered that you can’t really be alive, in the deepest sense of the word, if you’re not fully inhabiting your body. People usually become alienated from their bodies because they have experienced physical and/or emotional pain.  (I recall someone in my Somatic Experiencing class saying on the first day, “I’m really a loft person. I live from the eyebrows up!” She didn’t “go downstairs” much, preferring to stay in the realm of her thoughts.)

The good news is, humans are very resilient, and retain mechanisms to heal. A somatic therapist doesn’t “heal you”. He or she helps you learn to reclaim your birthright in discovering and activating your body’s own homeostatic (balance) mechanisms.  Many people happily discover the sheer joy of being in their bodies, of being truly alive.  Now, this may take quite some time and a lot of work, to approach this joyful state of being.  And therapy, like the rest of life, has no guarantees.

But you don’t get anywhere if you don’t even try, right?

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