My Approach to Working with PTSD
Here’s a longer description of my approach to working with clients with symptoms of post-traumatic stress (PTSD):
When a new client walks through my door, I don’t see anything “wrong” with them. I assume that they are coming to me because there are some areas of their lives that aren’t working for them, and they want some help in changing how they feel/behave/react. I assume that some/many/most of the symptoms and difficulties they face in their lives are due to survival strategies that they have developed over the course of their life. These strategies may have been useful at a time, and may be useful in the future, so as we work together we’re not necessarily putting our energy into stopping a given behavior or extinguishing a symptom so much as helping them to develop new skills and techniques and ways of responding, and to find what works in those old survival strategies.
Here’s an example from my own life experience: As a child, I got really good at dissociating – “checking out”. When strong emotions would come up, I’d get very logical, very “rational”, and if that didn’t work then I’d really check out and be very disconnected from myself and others. This made romantic relationships extremely difficult to maintain (since I wasn’t connecting with my own emotions, much less my partner’s), and I could be great at problem solving. As I came into myself and learned to stay with my felt sense and my emotions, I can still be very logical *and* stay connected with myself and my loved ones, and I’m much less likely to go to those extreme states of dissociation.
I assume that for my clients to have made it this far in life, there’s a whole lot that has to be working, so let’s acknowledge, honor, and celebrate that even as we develop new skills and ways of being.
Another major part of my approach is that I don’t view myself as offering a cure, or even that I’m performing a healing. Instead, I’m facilitating my clients’ innate, inner healing capabilities, by deeply “listening” to my clients and offering education and occasional interventions to help you become more aware of your self, particularly those areas where you have more connection/strength/power/resource than you might consciously know. I won’t promise to “fix” them or make things better, because that is taking their power from them. At the end of our session, we go our separate ways and they are left with themselves, so I want them to have access to as much of their physical, mental, emotional, and spiritual resources as they can. Those resources are what they will carry forward in their lives, and what will carry them forward.
Summing up so far: I have as fundamental beliefs that we are each innately good, innately whole, and we each have an incredibly powerful innate drive and ability to grow and change and heal. We begin a therapeutic relationship because there are some things in your life that you want to change, which doesn’t make any of the ways that you currently *are* wrong or bad or broken, they just don’t work the way you want them to. You have adapted to the circumstances of your life in your own unique way and as we work together you will develop new adaptations that ideally will help you in the future.
In clients with body-related health issues, there are various pieces of the puzzle that need varying approaches to support their healing process. One piece is dealing with the present-moment symptoms the client is experiencing. Another piece is the fears of what kind of impact the health problems will have on the client’s future life. If there is a history of medical interventions, there can be secondary trauma(s) from those interventions that need to be worked through. Another piece is how the client’s close relationships are affected by the health issues, etc. What I’ve found is that as my clients work through the pieces that surround their particular issues, their relationship to those issues goes through profound changes. Even if the health issues aren’t entirely resolved, their lives are still transformed in ways that are extremely valuable to them. A common response towards the end of the healing process is something like “I still wish X hadn’t happened, and I’m glad for how things turned out.”
When working with clients with health issues, I use a both/and approach. Even as I’ll work with a client on the body/mind/emotions/thoughts/spiritual connections with their issues, I’m all for taking advantage of everything modern medicine can offer, and I encourage clients to get checked out by their physicians and other complimentary practitioners, because there are conditions that can be controlled and cured using other methods. Chest pain might be from old emotional wounds that have been somaticized (in other words, embedded in the body), and it might be walking pneumonia or a broken rib, so better to have a doctor check it out to be as sure as we can be of what is and isn’t happening.
My work is very present-centered, and a core question as we work is “Is this moment tolerable or not,” and a goal is to enable clients to have every moment be tolerable, and have the knowing that future moments will be tolerable as well. For example, if someone has lost a family member, then we’d like them to have the ability to handle their grief, no matter how deep it may be.
In the case that what is happening in this moment is not tolerable – whether too painful, too overwhelming, too out of control, too scary, etc. – then we work to find and create the resources necessary so this moment is tolerable. There’s much more I could write about how we do this, I’ll just pick one topic: Our own body is one of our greatest resources when dealing with stressful situations, for example when working with anxiety helping a client to have more awareness and connection with their legs is really helpful in restoring a sense of ability to respond to the anxiety-producing event/thought/feeling instead of being dominated by it.
However, when there are health problems then we tend to lose the body as a resource. In that case a part of the work is around getting in touch with those parts of the body that can still be a resource, even as other parts are acting up. When the digestive system isn’t working properly, there are typically some parts of the system stuck in the fight/flight response and/or some parts stuck in the freeze response. So, one key piece of the work is to have more connection to the limbs where the energies of the fight/flight response can be more effectively processed. In other words, the limbs become a resource so the digestive system doesn’t have to take so much on to itself.
One really key part of how I work is the importance I put on finding the places where clients are *not* overwhelmed, out of control, etc. In a very fundamental way, trauma is about overwhelm, and people who come to me for trauma work have had plenty of overwhelm already. So, what we do is find the places (in clients’ bodies/minds/spirits/lives) where they feel relatively more present/grounded/safe/in control/good/etc., where they can tolerate what is happening in this moment, and when they feel like we’ve got enough of themselves, then we start to dip our toes into the traumatic material, but always knowing that if things get intolerable they can return to the place of safety. Over time, clients build more and more capacity to handle the traumatic material, so they can go deeper, and as they do this the deeper material that seemed more difficult or even impossible to deal with at first becomes much, much easier. This is a different approach than some historical methods that would have clients tell their story from top to bottom and not pay attention to how overwhelmed and dissociated they would get along the way.
One question that comes up is how, exactly, do we do this? We might use one or more of the hands-on massage modalities, we might use movement exercises and experiments, we’ll use imagery and memories where they are helpful, and we’ll use the client’s own felt sense of their body/mind system.
Another question that comes up is how much work do we do together for how long? It depends on the specifics of the client. When the health issue is more neuromuscular in nature, sometimes only one or two sessions are needed, when other systems are involved and there’s a more complex history then more time may be needed, depending on the client’s goals. We (the client and I) typically see noticeable, helpful changes after the first or sometimes second session, and then additional changes in each succeeding session. Usually when a client wants to work something intensively then we have sessions once per week or once every couple of weeks. More often doesn’t necessarily help, because there needs to be time to integrate the results from each session. Sessions are typically an hour to an hour and a half in length, depending on what clients want.
What clients report for results include: less pain, less fear, more range of motion, better physical balance, better emotional balance, more of a sense of feeling sturdy and capable of dealing with whatever happens, more physical strength, more inner strength, fewer intrusive thoughts, less reactivity, and more ability to go for what they want in life.
