CAN THE BODY BE A BAROMETER OF SUCCESS IN TRAUMA WORK?

“It was the first time I felt alive in years. For once, the debilitating pain in my lower abdomen had gone away. I felt exuberant, strong, energized. Most of all I felt free.” As a sufferer of chronic pain and trauma, Nancy* had done what many sufferers of chronic pain and trauma do. She had become dissociated from both the trauma, and her physiological response to it. Not only was Nancy’s body bound in a frozen shock state, as a response to her trauma, but her emotional response to the trauma was bound to her overwhelming feelings at the time of the trauma.

As a victim of rape and assault, Nancy’s trauma is not unique. Although mostly women suffer from rape and assault, trauma can be any situation in which the victim’s defense mechanism’s become overwhelmed, and he/she is not able to escape. When a victim is attacked, as Nancy was, the first response is to flee, or fight the attacker. These primary defense mechanisms of fleeing or fighting, are called the active defenses. When the situation is too threatening and the victim is not able to flee the situation, or fight the attacker, the active defenses become overwhelmed, and give way to freezing, a secondary, passive defense. The freeze state is essentially the body’s last defense. When in this state, the victim is literally frozen and becomes very dissociated both physiologically and emotionally. The frozen state is a protection against both physical pain, and the overwhelming emotional response to the attack. For this reason, victims in the frozen state will have trouble remembering details of the attack. The victim becomes locked both physiologically and emotionally in the traumatized state. Because the victim’s active defenses were not able to overcome the attack, the victim’s body becomes fused with the bound energy not able to be expressed at the time of the attack. The victim also becomes overwhelmed emotionally, leaving him/her feeling helpless, terrified, and stuck.

Although the victim of an attack experiences many emotions at the time of the attack, he/she often holds one powerful image of the attack. For Nancy, this was her torn bloodied pants, as she laid there after the attack. Attached to this image, were her feelings of fear, and helplessness. Because she was not able to fight off her attacker, or flee the situation, Nancy had become struck emotionally to her feelings of fear and helplessness. When recalling an image of her bloodied pants, she was not able to feel active defenses of fleeing or fighting. This is often the case for trauma victims. They have become disconnected from their natural feelings of aggression, and self defense in response to the trauma. If we were in some way to test Nancy’s physical strength while holding this image of her bloodied pants in her mind we could guess that her strength would be compromised. However, because Nancy has become very dissociated from her body, she may be unaware of this. Could testing her physical strength be used as a barometer for Nancy to gauge her physiological and emotional states?

The field of muscle testing, has also been called kinesiology, or kinesiotherapy. Although the direct definition of kinesiology is the study of movement, the field of kinesiology has expanded to include muscle testing, nutrition, and somatic therapies. Muscle testing is essentially testing a person’s ability to resist pressure placed on her by the tester. The most common way this is done is with the person’s arm held outstretched, at shoulder height. The tester then applies pressure to the subject’s forearm, while the subject attempts to resist this pressure. The tester first establishes a baseline response from the subject to use as a reference guide. The tester may then choose to perform various muscle tests on the subject, using the baseline for comparison. Although various sights on the subject’s body can be used for muscle testing all muscle testing is performed on the right side of the body, and the same sight is used for comparison.

In healing trauma, several things must be accomplished, however, perhaps the most essential task of the trauma therapist is to help the client become aware of her dissociative tendencies. Dissociative tendencies leave the client feeling separated from her emotions as well as his/her body. Indeed, many clients have described this as feeling, “out of my body”, or “disconnected from my body”. When this occurs, the client is unable to capture her natural active defenses of fighting or fleeing, and remains stuck. A client that dissociates frequently may become so emotionally and physically cutoff that exercises designed to help her get more in touch with her body, may be extremely frustrating. Further, a client that continually repeats this cycle of dissociating and denying the expression of the active defenses, confirms her victim status, as she remains helpless to defend herself from her dissociations.

Targeting the client’s dissociations, and reduction of these tendencies would then be a primary goal of the trauma therapist. When the dissociative tendencies can be reduced, the space is opened for the client to begin to recapture her active defenses. Recapturing her active defenses will allow the client a means to express the energy that becomes bound in the body in trauma, as oppose to denying it. Expressing the natural response to trauma, and thereby engaging the active defenses, allows the client to move from the frozen shock state of passive defense to active defense, thereby stopping the cycle of re-traumatization that so often occurs when the client dissociates, denies expression of the active defenses, and remains feeling helpless and cut-off from her body. Expression of the client’s active defenses would therefore be a second goal of the trauma therapist.

Once the client has expressed her active defenses, she will need a way to reorient herself. This process of reorienting involves the client completing her active defenses and integrating them in a way that reorganizes her self concept. In order to reorganize her self concept, the client will need a symbol as a reminder of the feelings associated with her active defense. This symbol becomes a point of strength, most often a body part that the client recognizes as her most powerful fighting, or fleeing mechanism. She will also need an image that becomes a symbol for the completion of the active defenses. This symbol, most often an image that represents a successful escape of the attack, becomes a symbol of the client’s resolution of her trauma.

In trauma work, the muscle testing begins much in the same way, in that the right side of the body is always used, the same sight is used for comparison, and the process begins with the establishment of a baseline. From this point, the tester can then use muscle testing to identify positive associations and negative associations. Positive associations are memories that the subject holds that register as strong responses to the muscle testing. Positive associations are usually past memories that conjure up a sense of well being, comfort and security in the subject. A strong response is one in which the subject’s resistance is much stronger than the baseline resistance measure.

The tester can also use muscle testing to identify negative associations, also known as “triggers” for trauma victims. Negative associations are images of the trauma that the victim holds that measure much lower resistance than the baseline resistance measure. Negative associations are typically very frightening images, or flashbacks that invoke feelings of terror, rage, constriction, hypervigilance, and helplessness. Negative associations also precipitate the client’s dissociative process. Further, when the negative associations are overwhelming, the client’s dissociations become chronic.

The identification of positive and negative associations, and the resultant effects on the body can be very useful information for the client. Because trauma clients often have trouble identifying what they feel, much less the somatic effects these feelings have on them, this awareness can be groundbreaking for them. For Nancy, the knowledge that the image of her bloodied pants made her not only physically weaker, but also created an immediate pelvic pain, was incredibly useful. Further, by focusing her attention to the feelings of her legs, and the image of herself running from her attacker, Nancy was able to physically experience the effect of her positive association. This knowledge gave Nancy, and her therapist the tools to navigate Nancy’s story. Knowing that the image of her bloodied pants made her physically too weak to overcome the attack, Nancy, and her therapist were then able to focus Nancy’s attention to her legs, and restore Nancy’s active defenses, and the feeling of strength that coincides with them.

Because the goal of the trauma therapist is to help the client unravel her dissociative process, the therapist begins the trauma work by first using the muscle testing to identify the client’s negative associations. To do this, the therapist asks the client to recount the story of her trauma. While the client is doing this, the therapist is watching her very closely. When the therapist feels that the client is experiencing a strong physical response to an image or memory of her trauma, the therapist may choose to perform a muscle testing on her. The result of this testing will them be recorded by the therapist for later comparison. The therapist will continue testing the client as she recounts her trauma. The client’s factual memory of the trauma is insignificant at this point, as the therapist is watching the client’s physical response to her story. Each muscle testing measurement is recorded throughout this process, while the therapist is working to determine a hierarchy of negative associations in which the muscle testing responses can be categorized from most strong (resistance) to least strong (resistance). The strength of the client’s resistance indicates the amount of dissociation the client experiences with each image or memory. The weaker the client’s resistance, the less dissociation she is experiencing.

As the client is recounting her story, the therapist is also watching her very closely for initial active defenses. All people and animals will exhibit these initial active defenses in response to threatening situations, even when later dissociative states are in process. The active defenses are always the initial responses to threatening situations, until later dissociative freezing becomes the initial response. These initial active defenses include increased muscle tension, rigid posture, rapid, or loud voice, and readiness to fight or flee. However, due to the presence of the client’s dissociation, these initial active defenses will be very fleeting, and the therapist must watch the client very closely. The client’s statements can also sometimes be indicative of initial active defenses. Here the therapist is listening for any associations the client makes with any part of herself that represents strength. Some examples of these are, “My legs feel very light, like I’m ready to run”, “ I’m pushing him away with my arms, they feel very rigid and tight”, “My hands are gripping the door, they are very strong, like claws”. Similar to the way the therapist used muscle testing to identify the client’s dissociation, she will use muscle testing to identify the client’s initial active defenses. The measure of the client’s resistance to the therapist’s pressure represents the strength of the client’s active defense. The greater the client’s resistance, the greater the strength of her active defense. For example, her resistance may be very strong when asked to feel her legs at the point of her story where she identifies them, and her resistance may be much less when asked to do the same with her hands. This response would indicate that the client’s legs represent a much stronger active defense to her than do her hands. This would also mean that the client’s legs are a positive association with a point of strength for her. This is very important as the therapist is looking to build a hierarchy of active defenses for the client. This hierarchy will be used to help the client recapture her primary active defenses.

From this point, the therapist will then again ask the client to recount her trauma, watching for the first negative association of the client. Because the therapist has built a hierarchy of negative associations, she is well aware of the client’s first, or weakest negative association, and can guide the client back to this point at any moment. This is where the real work of trauma resolution begins. The therapist is asking the client to move through her hierarchy of negative associations, beginning with the first, or weakest associations. The therapist is then going to use the client’s hierarchy of active defenses to allow expression of these defenses at the appropriate times. Similar to releasing pressure from a steamer, the therapist is looking to release the energy of the client’s active defenses. Expression of the client’s active defenses may be a very intense experience for the client. She may experience very intense physical reactions including rigid muscle tension, sweating, racing heart rate, and elevated blood pressure. It is very important that the therapist not try to contain these physical reactions of the client. For the client, the containment is the expression of these active defenses and the release of the energy that is bound to them. It is only when the client expresses these defenses that she will experience relief from her dissociation and the symptoms resulting from it.

As the therapist moves the client through her hierarchy of negative associations, and uses her hierarchy of active defenses to systematically release the energy bound to the active defenses, it is imperative that the model of trauma resolution is followed accurately. The therapist must have a predetermined hierarchy of negative associations and active defenses, as well as both a symbol for the client’s greatest point of strength, and a symbol for the successful resolution of the trauma. Should these symbols not be in place, the therapist will leave the client feeling more victimized than before the work. In order for the client to express her active defenses, and release the energy attached to them, she must have a strong symbol as a point of strength. This is important as the therapist may need to bring the client back to this symbol should she begin to dissociate. The therapist can also use muscle testing at any point during this process to gauge the strength of the client’s point of strength. The therapist may also choose to stop the client at any point in the recounting of her trauma to retest the strength of her active defenses. Should these active defenses, or the client’s point of strength weaken, she may not be ready to continue this process. This is up to the therapist’s discretion. If at any point that client begins to dissociate and block the expression of her active defenses, she can be taken back to her point of strength to return her to her natural response to the trauma. When the therapist can move the client through the expression of her active defenses successfully, she will then need to reorient the client.

Reorienting the client involves the client creating an image or picture of the successful resolution of the trauma. This can be a picture of the attacker on the ground, and a safe spot, away from the attacker. For Nancy, this was the picture of her attacker on the ground, as seen from her rear view mirror, as she sped away from the scene of the attack. This image is essential for the client to solidify the resolution of the trauma, and to now adjust her self concept from one of victim to one of survivor. In order to truly see herself as safe, and feel safe, the client needs an image of safety to hold on to, as a resolution of the trauma. The therapist will also need to test the strength of this image through muscle testing. The client’s resistance at the point of resolution should be very strong in comparison to her baseline measure. If the client’s resistance is less than her baseline score, the resolution of the trauma is incomplete. When this is the case, it is an indication that either the client’s active defenses were not thoroughly expressed, her point of strength is incorrect, or dissociation has occurred during this treatment process. The therapist will then need to reestablish the client’s hierarchy of negative associations and active defenses, as well as her point of strength. Here again, muscle testing will be used to determine the accuracy of these hierarchies and point of strength. The therapist will then again move the client through the expression of her active defenses, until her resolution measure is much stronger than her baseline measure. A resolution measure that is much stronger than a baseline measure is the sign of a successful trauma resolution.

Can the body then be a barometer of success in trauma work? While kinesiology is a very new area in trauma work, several studies have proven the effectiveness of somatic therapies in trauma resolution. It has also now become widely accepted that trauma is both an emotional and a physical experience, affecting a client’s entire being. And although the trauma client may dissociative both emotionally and physically, we as trauma therapists can no longer deny the affect that trauma has on the body. Whether the body can be used to determine the success of our trauma work remains to be seen, but perhaps Bessel said it best in his groundbreaking article, “The body keeps the score.”