Titration vs. Catharsis: How Fast Should We Heal?

The Somatic Experiencing method of healing is committed to working in a titrated fashion. This means getting to the core little by little by deactivating each physiological charge met along the way.  Titration is a term derived from chemistry, that when two opposing chemicals are put together quickly there is an explosion.  If chemicals can be slowly mixed together by adding one drop at a time an explosion is avoided.

Along those same line, in Somatic Experiencing therapy it’s helpful to break down the big charges in small manageable bits that are easily integrated and moved through successively.  This gradual pendulation back and forth between the inner resources and edges of the activation caused by trauma is what allows for the renegotiation.

This graceful and sensitive movement is what distinguishes Somatic Experiencing in the field of trauma recovery. Conventional systems of healing that are purely cognitive focused unknowingly are reinforcing the downward spiraling patterns of the dysregulated physiology without first establishing physiological support.  This cathartic approach may lead a person’s physiology deeper into dysregualtion.

My teacher Steve Hoskinson, who is on the faculty of the Foundation for Human Enrichment, shared with us the danger of opening up a conversation with a client who has been severely traumatized by saying “so tell me about your traumas”. He explained that a direct question into the core of the trauma for a person’s physiology, is like lighting a match in their room full of dry grass, and upon hearing that question, inside them they’ll be screaming “please put that match out right now or the whole room will catch on fire!!!” It will ignite their nervous system’s reactions so quickly that there won’t be any time to set the initial conditions so their bodies can find their inherent rhythm within their system of activation and deactivation, and solid resources that act as a counter balance to the activation.  As practitioners we’re trying to help them find this natural rhythm within, so they physiologically can experience that “what goes up must come down”.  A traumatized person’s nervous systems are stuck on the “up”, and they can’t see that coming down is even a possibility.  What Somatic Experiencing is trying to get at is supporting a person toward uncoupling their fear (which caused the immobilization) with the arousal of sensations. Peter Levine brings attention to this idea in his book “Waking the Tiger”, stating, “Because of fear, the traumatized person will prevent or avoid completion of the arousal cycle, and remain stuck in the cycle of fear”. How do we help a person move through toward completing these cycles so they can return to homeostasis once again?

Slowing Down and Setting The Story Aside

The traumatic event has such a strong pull into its vortex that people tend to dive head first into the story, and the world around tends to reinforce that pattern, “so tell me what happened”?   Unlike more traditional schools of cognitive therapy that encourage a cathartic re-telling of the story to “get it all out”, Somatic Experiencing approaches things in a different way.  There is an understanding that the re-telling of the traumatic story will bring out the dysregulated physiology of the client, and can in fact cause re-injury, if not handled with awareness.

In Somatic Experiencing, they would argue the importance of addressing the physiological phases that the person is expressing while re-counting their story. By encouraging a slowing down in the pace of the story telling, this inner awareness can more thoroughly be accessed.  This slowing down process allows for a renegotiation to take place within their nervous system around the physiological memories and charges.  In using this biologically based system of healing, it’s become evident that trauma is not held in “the event” but rather in the nervous system, which holds the key to it’s unwinding.

This invitation to track the sensations inside their body and slow down, interrupts their body’s traumatic patterns that are contributing to their symptoms, and opens new pathways.  My teacher Steve Hoskinson used to refer to this traumatic pattern as the well worn “rabbits trails through the grass”.  These traumatic habitual pathways inside our nervous system are used involuntarily, and lead us quickly and predictably straight to the center of our anger, fear, and emotional pain where we feel stuck. This approach of slowing a person down and the frequent invitation to “set the story aside for a moment” to track sensations is helpful in the unlocking of the stuck patterns, and ending the cycle of reenactment. Steve Hoskinson would often mirror this idea to his clients with a gesture of his arms moving to the side, as if placing something to the side, saying “let’s put that story over here.”   This lets their physiology know “we’re not going into this head on”, and the interest in the cognitive story telling becomes secondary to the interest in the physiological deactivation of the nervous system at each step careful step.  This is one of the main goals of Somatic Experiencing.

The sensation tracking helps them connect to the part of their brain where the trauma is wound up, and provides a way out of the neo-cortical story telling mechanism, that can become hauntingly repetitive in the minds of those who suffer from trauma.  People often try to “think their way out” of their uncomfortable feelings.  Their mind tells the horrific story over and over, leaving them in a rut.  In the Somatic Experiencing approach a supportive and attuned space is held for an organic discovery of new pathway of awareness through their bodies and beings. This provides new possibilities of how these high-energy states process through their bodies, hopefully leading them to a more balanced, relaxed, and trauma free life.

Completion of Self-Protective Responses

In this next section I’d like to talk about the benefits of completing thwarted self-protection response in terms of trauma healing, and the restoration of a sense of safety that comes as a result. As mentioned earlier in this essay, when someone has trauma it over activates the limbic brain and continues to trigger the defensive responses, of fight, flight, or freeze.42  A person will feel threatened when they have undischarged arousal and this will become a perpetuating cycle.43  This continual “up”, with no composite “down”, is caused by the over activation of the limbic brain, and is what chemically taxes a persons over so much so that over time that they eventually develop Post Traumatic Stress Disorder.

In Somatic Experiencing there is a established understanding that an interruption in an organism attempt to protect themselves will cause these defensive responses to stay on, even if the environment around is safe. Unfortunately, this high charge in their physiology is like having the “ON” button pressed all the time.  This internal state can be very tiring and can create tremendous disturbances for a person, mentally, physically and emotionally.44  Peter Levine describes the effects of trauma, “ When arousal continues (because discharging is too threatening), we find ourselves in a no win situation. We feel compelled to find the source of threat, but the compulsion is internally generated and even if external sources of threat is identified, the compulsive, hypervigilant stance will continue because the internal arousal is still present.”45

In the context of Somatic healing, a person is able to contact their thwarted protective responses and have a completely different and successful experience with them than they’re used to having with them in their lives.  People living with PTSD are constantly trying to manage the activations that have build up inside them, which after a while is exhausting.  It is the safe and supportive container held by the therapist that allows for this completion to happen.  The Somatic Experiencing practitioner is looking out for these phases and is encouraging and subtly “routing them on” to be expressed and have a voice, until they find completion.  Until these impulses are complete, unfortunately a person will feel constantly on the defensive and not trusting of the environment around them, which you could imagine is a terribly confusing and disorienting existence.

As one of the leading experts in traumatology Bessel Van der Kolk said,  “trauma causes an inability to assess relative stimuli.”46  This skewed reality makes living life and survival in this world very difficult.  For example with a war veteran, when they hear a loud sound of a car backfiring they jump with the same shock as if it’s a grenade detonating.  On that same note, trauma poses severe challenges to relationships, as you never know who’s out to get you.  Unless treated, sadly people will walk through life feeling inadequate at self-protection, leaving these traumatized individuals in a state of perpetual fear.

In traumatic cases that involved physical violation, therapeutically it can be very healing to lend support toward a person restoring their sense of boundaries.  This may be achieved through the completion of our natural impulses. The Somatic Experience Practitioner has to be keen in their observations to notice these small physical impulses that their client is exhibiting.  It might be as subtle as a small gesture of their hand coming up.  This small gesture, that was seemingly random in the conversation, could be the beginnings of a larger self-protective movement that is attempting to complete in that phase.47  When you lend interest toward these gestures that are surfacing, the person’s attention is also brought more inward.  Usually they’re invited to explore the sensation inside the micro movements, and more times than not, the instinctual and organic process takes over and from underneath a greater self-protective movement arises out and finds completion.48  The invitational language of Somatic Experiencing can sound something like these questions: “ What are you noticing now?”, “Where in your body do you feel that?”, and “Tell me what it’s like, how would describe it?”48

When conscious awareness is used to focus on the inner experience of the felt sense, it will aid the completion of these responses as well as support the “gentle energetic discharge” to happen.  Peter Levine relates this tracking of sensation back to the process that animal access through action as seen in the polar bear.50  Somatic Experiencing uses this technique to go underneath the radar of the neo-cortex that governs thinking, reasoning, and higher cognitive functions, and goes straight to roots where the disruption is within the body, in the limbic and reptilian brain, and aids these various phases toward their completion and integration. 51

In Somatic Experiencing there is an interest in supporting a client find a sense of safety, so they’re not constantly feeling on edge.  Even after returning to a safe environment, a human’s nervous system will feel on high levels of threat.49  Their brain will constantly signal their body that the environment is not safe, and in that there is a repetitive and unsuccessful attempt at self-protection that never quite finds completion.  This people with trauma often do not feel safe, and thus cannot let down their defenses.   What has been discovered is that through experiencing success in their self-protective response, and a subsequent discharged of the extra survival energy, their nervous system would send a different message through their body and mind that “things are ok”, and then they would return to equilibrium.52

I’d like to use an example of a woman has been a survivor of severe domestic violence.  During her experience of being physically hit, her self-protective responses were thwarted, meaning her attempt to protect herself was unsuccessful. Once her neuroception read “threat” in her environment her self-protective responses should have come on line to perform. Her body probably had an automatic motor action plan in place (to strike back or block the hit), but then collapsed at the harsh interruption of a blow to her body by her perpetrator.

“ There is often a survival dilemma between the need to fight and the possibly greater potential for survival by submitting. Apparently mutually exclusive survival impulses are at odds with each other.”53

The way to support a person, who feels helpless and defenseless toward their resolution, would be to invite them to imagine what they would have liked to have done during their attack, how would they have liked to protect themselves?  They’re invited to visualize that action, what ever it might be, i.e. making a quicker get away, or fighting back.  As they visualize that plan of defensive action, they’re invited to track inside their bodies the associated sensations, to feel into their eyes, skin, hands, feet, musculature, bones, organs, their relationship the ground, the positioning of their body.54   Imagining is very powerful.  By imagining, and writing the script over of their experience, they’re invoking the physiology of “I can”, instead of “I can’t”.  Usually what people report after imagining blocking the blow of their attacker, is a tremendous surge of energy inside them.  There is usually an increase in their heart rate increases, they feel enlivened with emotions that have been bottled up. These unfinished emotions, like the self-protective responses, that have been dormant underneath the ice of their immobility states are able to rise to the surface to their completion.55  It’s common at this point for people to experience a discharged of the remaining survival energy as a type of electricity out their arms and legs, as exhibited by the polar bear shaking and twitching.56

Peter Levine believes that the “trauma symptoms are a result of a highly activated incomplete biological response to threat, frozen in time”.54  So as these impulses find completion over time symptoms tend to dissipate.  As a practitioner, seeing a person return back to health after the completion of these unresolved survival instincts is a real powerful thing to witness.  You can instantly notice a return to vitality, aliveness, and health where seemingly there was none.

It is the safety that the practitioner provides that is in part what allows their bodies neuroception to feel safe enough that they can begin to unwind and contact these places within them.  Just like the animals in the wild, we are able to sense when things are safe, and only then will our natural defenses systems let down.  If a practitioner is providing a contained environment where the client can feels safe or at least safer, their body will begin it’s instinctual process toward self-regulation, and eventually find a more relaxed and stress free state of being.

 



42 Somatic Experience Training Manual. Beginning 1. Pg. 14.

43 Levine, Peter A. Waking the Tiger Healing Trauma. Berkeley: North Atlantic, 1997. Print. Pg. 150.

44 Levine, Peter A. Waking the Tiger Healing Trauma. Berkeley: North Atlantic, 1997. Print. Pg. 157.

45 Levine, Peter A. Waking the Tiger Healing Trauma. Berkeley: North Atlantic, 1997. Print. Pg. 156.

 

 

 

 

 

 

 

46 Bessel van der Kolk, MD, is a clinical psychiatrist whose work attempts to integrate mind, brain, body, and social connections to understand and treat trauma.

47 Somatic Experience Training Manual. Beginning 2. Pg. 12.

48 Somatic Experience Training Manual. Beginning 1. Pg. 18.

49 Somatic Experience Training Manual. Beginning 1. Pg. 14.

50 Levine, Peter A. Waking the Tiger Healing Trauma. Berkeley: North Atlantic, 1997. Print. Pg. 187.

51 Levine, Peter A. Waking the Tiger Healing Trauma. Berkeley: North Atlantic, 1997. Print. Pg. 86-87.

 

 

 

 

 

52 Somatic Experience Training Manual. Beginning 2. Pg. 25.

53 Levine, Peter A. Waking the Tiger Healing Trauma. Berkeley: North Atlantic, 1997. Print. Pg. 26.

 

54 Somatic Experience Training Manual. Beginning 2. Pg. 9.

55 Levine, Peter A. Waking the Tiger Healing Trauma. Berkeley: North Atlantic, 1997. Print. Pg. 110.

56 Somatic Experience Training Manual. Beginning 2. Pg.3.