The Clinical Heart of Bringing the Body into Practice
The Clinical Heart of Bringing the Body into Practice
by Lisa Mortimore, PhD, RCC
In reflecting on what it means to be an attachment oriented, relationally focused, somatic psychotherapist and educator, I come to three questions that speak to the heart of the matter: What does it take to regulate a nervous system dysregulated by trauma, whether that be relational, incident or a complex blend? What does it take to offer reparative therapeutic experiences for development and maturation of the right brain and to shift attachment patterning? And, what does it take to venture into the abyss of the underworld and accompany the client as they reclaim their vital life force?
Early primary relationships build the growing self and wire the brain to anticipate and expect (Siegal, 2010) for better or for worse. Insecure attachment, created through inconsistent and unpredictable affect regulation and repair whereby the infant is left for long periods in high/hyper arousal states (abuse) and/or low/hypo arousal states (neglect), affectively imprints neurophysiological patterns in the body (Schore, 2014). Caregiver failure to recognise or respond to a genuine aspect of the child forces dissociation/disavowal of that part(s) (Bromberg, 2011), infusing chronic shame into the insecure internal working model (IWM) of the self. Thus, we find with insecure attachment the IWM has a distorted sense of self and impaired knowing of healthy relationships, scaffolded upon a dysregulated autonomic nervous system (ANS), impaired processing of the right brain, and patterns of relating and affect management strategies that lack flexibility.
Trauma wounds the neurophysiological body, fragments the psyche, and forces the soul into the abyss. Wounds of this nature call for therapists to jointly descend into the abyss of the underworld to accompany, witness and support the return to life (Wirtz, 2014), to facilitate regulation of the ANS and offer reparative relational experiences. In addressing both the psyche’s response and the bodily based impact of trauma, I believe the trinity of attachment-oriented relational psychotherapy, somatic work and an embodied regulated clinician are essential for the restoration of the integrity of the self.
What does it take to regulate a nervous system dysregulated by trauma, whether that be relational, incident or a complex blend of both?
The ability of clinicians to make interventions to help the ANS process the bound or chaotic material of the right brain/body calls for a strong understanding of neuroscience including The Polyvagal Theory (Porges), the window of tolerance (Siegal), and Regulation Theory (Schore) to work safely and effectively with hyper/hypo arousal states. Additionally, a deep understanding of the complexity of the ANS and adroit use of specific somatic interventions and right brain processes to: foster embodiment; create movement and integration of energy bound and dispersed; restore thwarted or impaired impulses for connection and protection; embody, sense and process dissociated emotional and physiological content; and create a regulated ANS that can integrate the horror and terror inherent in trauma. While somatic processing is critical for the regulation of the ANS and integration of traumatic material, it is insufficient to repair the depth of psychic fragmentation and soul descent of individuals with histories of early trauma.
What does it take to offer reparative therapeutic experiences for development and maturation of the right brain and shifts in attachment patterning?
It is well documented that the therapeutic relationship can offer reparative experiences (Pearlman, & Courtois, 2005; Siegal, 2012; Wirtz, 2014) and such opportunities require clinicians to engage in relational practice that goes beyond alliance building, attunement, and empathy to include establishment of the regulated, witness self to help integrate non-recognised dissociated parts and to reorganize the distorted IWM in the reparation of early trauma. Additionally, authenticity and emotional processing of the relationship completes “the cycle of affective communication that was insufficiently developed in childhood” and provides “an emotional re-education” that “remediates a developmental void” (Maroda, 2010, p. 20). To build a safe enough haven for exploration and connection, therapist awareness of their own attachment patterning is paramount. The safety of the therapeutic relationship offers clients opportunities to: experience a secure base from which to relate, explore and assess their own system of relating and IWM; attempt and process new ways of relating to pave new relational and neural pathways; and explore rupture and repair dynamics that reveal dissociative relational material, that when addressed, heal past wounds.
And, what does it take to venture into the abyss of the underworld and accompany the client as they reclaim their vital life force?
The embodied regulation of the clinician is essential to bear “witness” (Prince, 2009), “to behold” (van Loben Sels, 2005), to stay present, embodied and regulated in the face of unspeakable, undigested, extreme suffering of the other. Holding steady as the client’s dissociative material emerges asks us to reach within and beyond into our depths of connection to the sentient archetypal world, to hold our ground and avail ourselves as the regulated anchor in the dysregulated realm of trauma.
Bromberg, P. M. (2011). The shadow of the tsunami and the growth of the relational mind. New York: Routledge.
Maroda, K. J. (2010). Less is More: An argument for the judicious use of self-disclosure. In, Bloomgarden and Mennuti, R. (Eds.) Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy. New York: Routledge, p. 17 – 30.
Pearlman, L.A., & Courtois, C. A. (2005). Clinical application of the attachment framework: Relational treatment of complex trauma. International Society for Traumatic Stress Studies. p. 449 – 459.
Prince, R. (2009). The Self in Pain: The Paradox of Memory. The Paradox of Testimony. The American Journal of Psychoanalysis. 69, p. 279-290.
Schore, A.N. (2014). The right brain is dominant in psychotherapy. Psychotherapy, 51, 3, p. 388 – 397.
Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are. 2nd ed. The Guilford Press: New York.
Siegal, D. J. (2010). UCLA Adult Attachment in a Clinical Context Conference DVD with Main and Hesse.
van Lobel Sels, R. (2005). When a body meets a body. Spring 72, p. 219 – 250.
Wirtz, U. (2014). Trauma and beyond: The mystery of transformation. New Orleans: Spring Journal Books.
Lisa Mortimore, PhD is a psychotherapist and educator in Victoria, BC. In her Bringing the Body into Practice trainings and workshops, Lisa weaves somatic psychotherapy, embodied relational and attachment oriented practice, and connection to the sentient, archetypal world. www.lisamortimore.com
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