Sensorimotor Psychotherapy for the Treatment of Trauma
By Pat Ogden, Ph.D. and Kekuni Minton, Ph.D.
Traditional psychotherapy addresses the cognitive and emotional elements of trauma, but lacks techniques that work directly with the sensorimotor elements, despite the fact that trauma profoundly affects the body and many symptoms of traumatized individuals are somatically based.
Trauma calls forth physical defenses such as lifting an arm to avoid a blow, slamming on the brakes in the face of an accident, fighting or running away from an assailant, etc. When such active defenses are impossible or ill advised, they may be replaced by other defenses such as submission, automatic obedience, numbing and freezing (Nijenhuis & van der Hart, 1999; Nijenhuis, 1999). Such less physically active defenses may be the best option in some instances, such as when a victim is unable to fight or outrun an assailant.
Frequently, the complete execution of effective physical defensive movements does not take place during the trauma itself. A victim may instantaneously freeze rather than act, a driver may not have time to execute the impulse to turn the car to avoid impact, or a person may be overpowered when attempting to fight off an assailant. We believe that over time, such interrupted or ineffective physical defensive movement sequences contribute to trauma symptoms. Herman (1992) states:
Failed defensive responses along with the inability to modulate arousal appear to contribute to distressing symptoms, such as intrusive images, sounds, smells, body sensations, physical pain, numbing and constriction. Helping client experience the physical actions of defense might help alleviate such symptoms, as illustrated in the following description of a first therapy session with Mary, a client who had been repeatedly raped as a child by a family member.
At first, it was difficult for Mary to be aware of her bodily sensations because when she tried to do so, the hyperarousal, shaking, panic and terror became overwhelming. The therapist believed that if Mary could fully experience a physical defensive action, these symptoms might subside considerably. To accomplish this, the therapist asked Mary if she would be willing to push with her hands against a pillow held by the therapist. The therapist asked Mary to temporarily disregard all memories and simply focus on her body to find a way of pushing that felt comfortable. Mary's sense of control was increased as she was encouraged to guide this physical exploration by telling the therapist how much pressure to use in resisting with the pillow, what position to be in, and so on. Mary eventually experienced a full execution of physical defensive response: lifting her arms, pushing tentatively at first with just her arms, then increasing the pressure and involving the muscles of her back, pelvis, and legs. After experiencing the defensive sequence, which Mary described as a strong "NO!", she was able to be self-aware without becoming overwhelmed.
Following this session, Mary stated that she felt more peaceful and that she was able to sleep through the night for the first time in weeks.
Sensorimotor Psychotherapy was developed entirely from clinical practice, and interfaces easily with traditional clinical skills. Although there has been no formal empirical research at this time, there are many anecdotal reports from both clients and therapists that attest to the efficacy of the technique. Professionals using Sensorimotor Psychotherapy report that it often reduces PTSD symptoms, and that the ability to track body sensation helps clients experience present reality rather than reacting as if the trauma were still occurring. However, if a client is not as available for or interested in body processing as was Mary, Sensorimotor Psychotherapy may be contraindicated and the therapist must use other techniques. Sensoimotor Psychotherapy integrates cognitive and somatic interventions to foster integration of three levels of information processing: cognitive, emotional, and sensorimotor.
Herman, J. (1992). Trauma and recovery. New York: Basic Books.
Nijenhuis, E.R.S., van der Hart, O. (1999). Forgetting and re-experiencing trauma: from anesthesia to pain. In Goodwin, J. and Attias, R. Splintered reflections: images of the body in trauma. Basic Books.
Nijenhuis, E.R.S. (1999). Somatoform dissociation: phenomena, measurement, and theoretical issues. The Netherlands: Van Gorcum and Comp. B. V.
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