Recently I had the opportunity to attend a session at the 24th Annual International Trauma Conference here in Boston; this year’s focus was on Neuroscience, Attachment and Therapeutic Interventions. It was my pleasure to attend the session “Safety, Risk and Transformation: Attachment-Focused Therapy at the Regulatory Boundaries of the Window of Tolerance.” A pioneer in the field of body-based pyschotherapy, Pat Ogden, and skilled therapist, Anne Westcott, led this session on Sensorimotor Therapy and The Window of Tolerance. Being a board-certified dance/movement therapist, I share the same value of body-based interventions in psychotherapy. Ms. Ogden and Ms. Westcott provided well-researched descriptions and case examples of Sensorimotor Therapy in this framework. As a therapist who references and teaches my clients about the Window of Tolerance, I was happy to have additional resources and case examples on how it affects the treatment of trauma, attachment and developmental issues.
Inherent in good psychotherapeutic treatment are components of safety and risk. Using the Window of Tolerance as a framework is helpful for both clinician and client. Take a look at the basic diagram of The Window of Tolerance above for a visual. Daniel Siegel describes this as an area of arousal in which we each can function; it pertains to any particular moment given that we have more tolerance for some emotions and situations than others (2010). Being outside of the window is chaos; one end of the window is hyperarousal and the other end is hypoarousal. So, what does all that mean? It means that each of us has limits to what we can handle at any moment in any situation. For example, if a person experiences stress regarding their workplace, there is limit to how much stress they can experience and continue to effectively function. Too much stress can push a person into a state in which they experience anxiety, intrusive images, and strong emotions. It could also push a person to shut down, be numb, or passive. Therapy is the exploration of working within the window edges “safe but not too safe;” so the therapeutic experience is fruitful (Siegel 2010). If one is aiming to address this stress of the workplace in therapy, only talking about what’s good in the job may be too safe, but exploring how this person interacts with challenging coworkers could push the windows of tolerance and lead to growth and meaning.
I find this framework gives my own clients language and understanding to reference in identifying where they feel safe, unsafe, and how they are growing. It is also being attuned to a patient’s window that provides the therapist the framework to make choices of safety and risk (Ogden et. al. 2006).
This training session was rich with examples and explanations of how therapists can guide healing and growth, and that a body-based approach, in the case of this training Sensorimotor Psychotherapy, provides layers of information and intervention for therapeutic work. One example Ms. Ogden referenced was of the simple action of holding up the hands. If this gesture was expressed in anyway by a client, or themes of boundaries expressed it could be explored in a variety of ways based on the client’s needs, “Where do the hands feel best?”, “Do you feel a change when you put your hands up?”; and continue with the gesture in real time, perhaps, “it almost looks like you’re pushing.” I’ve used such interventions with my own clients to increase understanding of feelings and patterns.
Much of a person’s tolerance is expressed nonverbally, and exploring boundaries is also enhanced by attuning to the patient’s gestures, preparatory movements, habitual responses, and new actions. Learning from the client’s habits and safety allow for new ways to be introduced. This training session highlighted the skill of a therapist who can read and be attuned to body language. In my own sessions, I work with a number of clients who enter in the therapy room very emotional, worried, lethargic or disengaged. My goal as a therapist is to use their verbal and nonverbal cues to bring them into a level of engagement with themselves and me before we explore the triggers and underlying causes of the deregulation.
Ms. Ogden served as a compassionate and supportive instructor, reminding the therapists in the room that each therapeutic intervention is a judgment call on the part of the therapist, even highlighting some of her own examples of pushing a client too far into the risk zone, owning up to her own trigger points. It takes a skilled and trained therapist to be attuned in this way, but also to use all therapeutic material in the best interest of the patient.
The more therapists can attune to what the client is presenting in front of us, the more we can make an educated intervention that leads to empowerment and growth. Therapists can strive for this growth. Living more fully with more options is certainly my wish for my clients.
To scheduled a session with Kimberly S. Bevans, please call 617-651-0996 or email firstname.lastname@example.org
Siegel, Daniel J. (2010). The mindful therapist. A clinician’s guide to mindsight and neural integration. New York: W.W. Norton & Company, Inc.
Odgen,, P., Minton, K., Pain, C. (2006). Trauma and the body. A sensorimotor approach to psychotherapy. New York: W.W. Norton & Company, Inc.
A skyline and tree view from Brookline taken April 17th.
In the past few weeks, we’ve seen horror, heroism, struggle, strength, terror and heart. The Boston Marathon Bombing, city and surrounding area lockdown and manhunt may grow distant in our experience, but not necessarily from our minds and bodies.
As we get further from the days of the events, our relationship to the events may change. Some may feel like they’re getting back to normal; others may be feel like their symptoms are increasing. Both are normal and completely depend on the person. I want to take this opportunity to discuss a few symptoms and effects of trauma. I want to highlight that trauma affects everyone differently. The various effects of trauma have come up often in my sessions; not just how this trauma is affecting my clients, but those around them. In the wake of these events, we need support, and we yearn to make sense of what has happened. Here I provide some education on what trauma can look like and how we can support others and ourselves.
Everyone handles events differently. An event or experience labeled as “traumatic” depends as much on the individual as it depends on the event itself. Each individual's past experience, coping skills, and support in their lives is a factor in their reaction and ability to handle advantageous experiences.
No symptom is too small. Any event can bring about a mental, physical/sensational, and spiritual change that may or may not require some attention. Perhaps your sleep is a little more disrupted than usual, or perhaps you notice your friend is more vigilant than usual on public transportation. Symptoms of posttraumatic stress can vary in their degree and include: worry, anxiety, avoidance, nightmares, sleeplessness, fear, emotional distress and feeling things you simply don’t usually feel.
Getting “back to normal” also depends on the individual. I have a client who experienced the bombings just a couple blocks away from the finish line which triggered an immense amount of anxiety for this person, also fear, distress, worry, difficulty sleeping as well as tightness and discomfort in her body. This client was urged to go back to work two days after the bombing, and encouraged to get back to her old routine. Problems surfaced from this (well-meaning) advice. This client’s workplace was still a crime scene two days after the event. The workplace was not enough “normal” for her to be able to return to a routine. She was not able to stay at work and was in fact re-traumatized. That said, getting back to normalcy is immensely helpful, but we must be sensitive to what “normal” actually looks and feels like.
Getting help must be the person’s choice. The client I reference above was encouraged to seek mental health counseling at a large local hospital. The intentions were good but did not fit what this person needed. She needed to be somewhere that was less threatening to her and she needed someone by her side whom she trusted. She was more than willing to get help but was being pushed in a direction that inspired further dread and distress. Receiving therapy in a quieter area of the city in a quiet office a few days later accompanied by a loved one proved much more helpful.
“Recovery” varies in length. Resolve is different for everyone; recovery is different. Often people also have the chance to grow in their recovery process. Respect your own process and the process of others. Many people may feel effects of a traumatic event even many years after.
Empathy. Empathy goes a long way for both yourself and those you know who have been affected by a traumatic event. Whether this means reaching out to help those also affected by the event or engaging in a practice such as “Metta” or “Loving Kindness” (of Buddhist origin) that sense of connecting and offering is immensely powerful.
We are resilient. Most people will return to a sense of normal.
Anger is normal... but acting on it is unproductive.
Optimize your thankfulness. Events like this can remind us of what we have by the way of family, friends, loved ones, pets, jobs, health and homes. Even if what we normally interpret what we have as small or insignificant, a traumatic event can help us appreciate and be grateful for what is in our lives.
When I work with groups and individuals suffering from trauma, the themes I always see as most healing are honoring what you and others feel. Be kind to yourself and others. Only by recognizing how we have been affected can we make choices to heal, grow, and keep moving forward.
Kimberly Schmidt Bevans
Kim is a body/mind therapist based in Brookline Massachusetts. She specializes in the use of the body-mind connection to address stress, anxiety, mood disorders, relationship issues, as well life transitions and creating change.
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