Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (Norton Series on Interpersonal Neurobiology Book 0)

by Pat Ogden

Schore (2011) asserts that it is the brain’s right hemisphere, responsible for implicit emotional and body processing, that dominates human behavior.

The most critical purpose of this comparison is to predict the next moment with sufficient accuracy so that we can make an adaptive physical action (Llinas, 2001).

Making meaning and predicting the immediate future of a relational interaction begin long before the acquisition of language and are evident in the behavior of infants. Beebe (2006)

Early experiences are remembered “as a series of unconscious expectations” (Cortina & Liotti, 2007, p. 205). These expectations are all the more potent and influential precisely because the experiences that shaped them are not available for reflection and revision. When we do not remember what happened, the memories

Form is determined by function;

The movement, posture, and physiology of the body adapt automatically, without our conscious intent, to assure survival and maximize available resources.

Attachment issues arise from experiences with others, especially early attachment figures (the person[s] who looked after us as children, to whom we were emotionally bonded) that cause emotional distress but do not evoke extreme autonomic dysregulation.

Relational trauma involves interactions with others that are experienced as threatening and do stimulate dysregulated arousal and animal defense.

The “social engagement system,” mediated by the ventral parasympathetic branch of the vagus nerve, fosters interaction with the environment (Porges, 1995, 2001, 2004, 2005, 2008, 2009, 2011).

The social engagement system is further developed throughout childhood in face-to-face, brain-to-brain, body-to-body nonverbal communications with others who effectively regulate the child’s autonomic and emotional arousal.

Porges (2004, 2011) coined the word neuroception to describe a neural process, outside the realm of awareness, that is neurobiologically programmed to detect features in the environment, including behavioral cues from others, that indicate degrees of safety, danger, and threat.

The animal defenses—subcortical survival instincts that organize around the neuroception of danger and life threat—include the cry for help, designed to elicit help and protection; mobilizing defenses of fight or flight that organize overt action; and immobilizing defenses of freeze and feigned death that engender a lack of physical action.

The goals of the defensive system—to defend and protect—conflict with the goals of daily life systems—to engage with other people and the environment.

Responding to the arousal of daily life systems—such as the needs of one’s children, the demands of work, or the sexual needs of one’s partner—requires neurocepting safety and keeping the emotions, thoughts, and defensive responses associated with past trauma at bay.

Kurtz (2010) recommended that psychotherapists be on the lookout for particular nonverbal cues, or “indicators,” that are “a piece of behavior or an element of style or anything that suggests . . . a connection to character, early memories, or particular [unconscious] emotions.

Especially important are indicators that reflect and sustain predictions that are “protective, over-generalized and outmoded

Verbal and nonverbal communications might contradict each other and conceal aspects of internal experience as well as reveal them.

Indicators reflecting unresolved trauma include hyperarousal (e.g.: tension, rapid heart rate, trembling, wide eyes) and hypoarousal (e.g.: vacant expression, flaccid muscles, collapse of posture), terror, panic, or rage, impulsive or dulled reactions, and other signs of faulty neuroception and animal defenses.

Mindfulness helps facilitate this task by teaching clients to orient and focus awareness on the effects of past events as they emerge in the present moment (Kurtz 1990; Ogden et al 2006).

To support therapeutic goals, mindfulness is directed by the therapist, who carefully and firmly guides the patient’s mindful attention toward particular elements of internal experience thought to support therapeutic goals (Ogden 2007; 2009).

Experiments include simple verbal actions (e.g., saying “no”) and physical actions (e.g., reaching out, making eye contact, pushing away) that challenge conditioned responses, or engaging a habitual response in order to discover more about it (e.g., exaggerating

tension pattern, or purposely avoiding eye contact).

When explored in mindfulness, these experiments yield discoveries that are “unforced, ...

Experimenting with habits of movement, posture, and gesture can change the implicit communication to others and also to the self.

In Sensorimotor Psychotherapy, body awareness is only the beginning. The point is to help clients address and change procedural learning—how information is processed on a bodily level—which requires that the movements, gestures, and postures that reflect and sustain one’s history are addressed in such a way that they start to change spontaneously.

Schore (2009a) writes: “At the most fundamental level, the work of psychotherapy is not defined by what the therapist explicitly, objectively does for the patient, or says to the patient. Rather the key mechanism is how to implicitly and subjectively be with the patient” (p. 41).

Safety is created primarily through implicit body-to-body affective communication, rather than through words.

Bromberg (2006) points out that the atmosphere of the therapeutic relationship must be “safe but not too safe.

If your clients insist, “I don’t like my body,” you have an opportunity to explore how their dislike of the body came about, often as a learned, adaptive response to trauma, adverse experience, familial expectations or cultural pressures.

Psychoeducation helps clients become informed collaborators so that the material in this book will be more easily and successfully integrated into their treatment.

When verbal psychoeducation is accompanied by demonstration, visual representations, or modeling, clients can more easily comprehend, retain and use what we offer.

Therefore, how you introduce attending to the body is critical. Tuning into the body requires a quiet spaciousness and a sense that this is a perfectly natural activity for both of you to be doing.

you direct attention to them by naming what you track.

After you track, contact, and frame, you can use mindfulness questions to specifically guide your client’s awareness. At

Emotional biases are accompanied and sustained by procedural habits in the body that limit the range of emotions we experience.

To reclaim the variety of core emotions that have been previously inaccessible because of our childhood relational defenses, we will need the support of a trusted other person.

window of tolerance and a repertoire of resources

Since our patterned emotions developed in our early relationships, they can be transformed, rather than simply vented,

This transformation is supported by dual awareness,

here in present time as resourced adults and ourselves in past time in the state we were in as young children seeking...

reexperience the old pain and emotions that we could

To explore how you experience different emotions in your body.

To further identify familiar and unfamiliar emotions,

To identify the high and low arousal emotions that were common or accepted in your family,

To describe a negative feedback loop of emotions, thoughts, movements, and sensations that intensify your negative emotions,

To select an emotion that you avoid, push away, detach from, or that is unfamiliar to you, and to explore a sliver of memory in which that emotion was not welcomed.

Many of us take walking for granted, but the bipedal walk is a complex function shaped not only by anatomy but by development and psychological context.

heighten clients’ awareness of how habitual patterns of walking reflect personal history and can unconsciously reinforce trauma-related dysregulation, attachment-related beliefs and habitual emotions.

reviewing the patterns of walking

You can educate yourself by observing various walking styles in a public place and imitating them yourself.