Cher Hamilton-Tekautz, LCSW

Photo by Alex Green from Pexels

In May, I completed the Sensorimotor Psychotherapy for Trauma Themes Level One training program. I’ve been wanting to share some of the things I’ve learned so you may have a better understanding of what it means to work with a psychotherapist who incorporates Sensorimotor Psychotherapy, but I realized there’s so much information to share that this is going to be a multi-part blog series.

According to Pat Ogden, founder of Sensorimotor Psychotherapy, trauma occurs when a situation is perceived as threatening one’s safety and survival, which stimulates subcortical defensive responses and hyper or hypoarousal. This means when we experience something that is perceived to be life threatening, our nervous system gets activated and we go into a fight, flight, freeze, or collapse response (More on these responses to follow). I think this is changing, but when trauma or PTSD is discussed, many people think of war veterans or sexual assault/crime victim survivors. However, noting the distinction that a situation is considered traumatic when a person’s nervous system perceives an experience as life threatening, this expands the definition of trauma to include car accidents (even minor fender benders), medical procedures where consent wasn’t given, experiences of oppression such as racism, homophobia, sexism, transphobia, etc, experiences from a religious upbringing, and/or witnessing parents fighting in childhood, to name a few. And of course, experiencing a global pandemic is included in the list.

In my intakes with new clients I use the Adverse Childhood Experiences (ACE) questionnaire. This tool screens for experiences in childhood that are considered traumatic: parents separating or getting divorced, physical, emotional, or sexual abuse, neglect, the impact of poverty (not having enough to eat or clean clothes to wear), incarceration of a parent, parental substance abuse or alcoholism, mental illness of a family member, and domestic violence. These experiences add up to provide an ACE score. The study found correlations between higher ACE scores and health issues like heart disease and cancer later in life. And it was the first study of it’s kind to provide proof that childhood trauma is a public health issue that shouldn’t be ignored. Pediatrician, Dr. Nadine Burke Harris, discusses this in a 15 minute Ted Talk. If you’d like to find out your ACE score click here. I was completely blown away when I learned about the ACE study because it named experiences in my childhood and provided validation that what I had gone through shouldn’t be minimized. I also learned that minimizing experiences of childhood trauma is a pretty common survival strategy that inhibits recovery and healing after reading Pete Walker’s book, Complex PTSD: From Surviving to Thriving. I recommend this book for anyone who has experienced adverse childhood experiences. If you’d like to have a snippet of what Pete Walker’s book is like, I recommend reading his article Emotional Neglect and Complex PTSD.

Some of the clients that come to me for therapy are unaware they’ve experienced trauma in their childhoods. They may seek out therapy because their anxiety has become unmanageable (they’re having trouble sleeping, difficulty focusing, can’t relax, nothing seems to slow down the racing thoughts, irritability has increased) or they’re experiencing depressive symptoms such as trouble sleeping (too much or too little), an increase or decrease in appetite, low self-esteem or self-worth, feeling hopeless or suicidal, and/or not enjoying activities they used to enjoy. I’ve also worked with a number of clients who become overwhelmed by their work or relationships, struggle with guilt and people pleasing, or they experience emotions that feel out of control or out of context for the situation. From the perspective of Sensorimotor Psychotherapy, any of the above experiences/symptoms can be signs of trauma, whether or not someone has a specific memory of something traumatic that has happened.

It is important to note not all experiences of trauma cause post traumatic stress disorder (PTSD), Complex PTSD, or other mental health issues. “Psychological trauma is the unique individual experience of an event, a series of events, or a set of enduring conditions, in which the individual’s ability to integrate his/her/their emotional experiences is overwhelmed.” (Saakvitne et al) This means negative effects of trauma occur when a person’s emotions, body, and mind cannot make sense of the experience. This can lead to anxiety and panic, depression, or symptoms of PTSD: feeling on edge, being easily startled, scanning the environment for danger, experiencing nightmares, and overall intense distress when reminded of the trauma (whether you are aware that you are being reminded of the trauma or not).

According to Sensorimotor Psychotherapy, symptoms of trauma occur when we are unable to fully realize a mobilizing animal defense (fight or flight) in an experience of trauma. A fight or flight response involves activation of the sympathetic nervous system so that we can take action. Our heart rate and blood pressure increases, which means breathing becomes faster and shallower, blood flow is redirected so you may experience cool or clammy hands, stress hormones are released so you may feel tension or trembling in your muscles, and senses are heightened so you can be vigilant to your surroundings. In addition, digestion, tissue repair, and growth hormone production are halted because the body is focusing on what’s most necessary for survival. I think it’s important to note this activation can also be what someone experiences when they have anxiety, panic attacks, or PTSD (this is the body reliving the trauma that remains unprocessed). In life threatening situations where it is more dangerous to fight or run, or when all else fails, the parasympathetic nervous system takes over and the freeze or collapse response happens. The body shuts down to conserve energy, minimize injury, and be less of a target. In collapse the pain response is also inhibited. I’ve worked with a number of sexual assault survivors who experienced the freeze and collapse responses during an assault, which was often used against them by those who did not understand that freeze and collapse are automatic responses that helped them survive.

As mentioned before, in Sensorimotor Psychotherapy we work to find the mobilizing response (fight or flight) that wasn’t safe to utilize in the moment of the trauma. During sessions I will watch for movements that could indicate your body wanting to do something like your arm coming out to push someone away, or a movement in your leg that could indicate a kick, or you might report tension in your throat that could reveal a yell that was silenced. The idea is that once your body has completed the mobilizing animal defense (with mindful awareness during the process) you should no longer experience symptoms of trauma. I have personally experienced the effects of this when I worked with my Sensorimotor Psychotherapist on a near car accident that started to cause hypervigilance and fear while I was driving. While I was talking about the accident my arms came out (like to honk the horn, which I didn’t do during the near miss) so she had me press a pillow against the wall and I ended up yelling some swear words. At the time of the session I wasn’t convinced I had worked it all through (probably because I know too much about how the technique is supposed to work), but I did notice I felt much calmer when I drove after that. I should note that trauma processing is not one of the first things I do when I start working with someone. Sensorimotor Psychotherapy is broken into a three phase process where trauma processing does not occur until phase two (more on that to come in a future blog).

If you have any questions please reach out to me. I’d be happy to discuss this further.