I hope this blog post is finding you enjoying the last few days of summer, absorbing the fresh air and vitamin D that this season has to offer as we’re starting to feel the transition to Autumn. I’ve been busy in the office, as well as out, finding time to enjoy the sunshine and unplug, as well as navigating an exciting transition in my practice that I will share more about in my next post, so stay tuned! First, I have been itching to share my experiences and insights from my most recent 20-hour training on incorporating Trauma Sensitive Yoga into my clinical practice.
Trauma Center Trauma-Sensitive Yoga (TCTSY) is an empirically validated, adjunctive clinical treatment for complex trauma or chronic, treatment-resistant PTSD. Developed at the Trauma Center in Brookline, Massachusetts, TCTSY has foundations in Trauma Theory, Attachment Theory, and Neuroscience as well as deep roots in Yoga (http://www.traumasensitiveyoga.com). Here are some words from David Emerson, the Founder and Director of yoga services for The Trauma Center at the Justice Resource Institute that inspired me to add Trauma Sensitive Yoga as a modality offered at liv wellness from his interview on the Trauma Therapist Project Podcast:
“In trauma sensitive yoga we call it shared authentic experience. The facilitator has to have an understanding of themselves as not separate. We have to be available and present. When I invite people to make choices about their bodies, I am actually doing it, too. That is a little bit different from what we learn in a psychodynamic-focused school. There, you are really taught to remove yourself. There is a patient and a client. One is more sick, one is more whole. And the whole treatment perspective comes from that understanding. Here, it is more about two people coming together and having a shared authentic experience. I trust that.
You have to have clear boundaries and each of us are responsible for our own self and own experience. But we have to be willing to show up with people in a way that’s authentic and we can’t hide behind ideas of us and them. Of wellness and brokenness. What is comes down to with trauma is I don’t see trauma as a pathology. I see it as a response to overwhelming experiences. And it really makes me less inclined to pathologize people. I have something to offer. But it’s not as an expert who’s going to tell you what to do. I was trying to conform to a medicalized mental health approach or even a top down yoga teaching approach. There’s a lot of schools of thought out there, but I think many are taught to approach as the expert. The fact is- no one knows your body like you do. So if a yoga teacher or therapist comes on and says they know your body better than you do yourself, it’s not useful. Especially in the context of trauma.”
This non-pathologizing, joining approach to trauma work really resonated with me. It feels a lot more comfortable, authentic and human to the somewhat contradictory training programs where counsellors are encouraged to be a blank slate, and to avoid “bringing yourself” into the therapy room. However, the reality is we do, inevitably, bring ourselves into the therapy room. Our responses are dictated of course by our training, but they are also influenced by what we bring to the room as complex people. We can’t help that, so best be mindful and attuned at all times, do our own work, use it as a tool in the healing process, and acknowledge how it interplays with what the client is bringing, without trying to shove what we bring into the desk drawer.
In this TSY approach, the therapist comes to the therapy room equipped with their own self-attunement, trauma information, an empirically validated treatment modality, and the skills to hold safe, non-judgmental space. The client comes equipped with their own skills that have enabled them to survive and cope, the experience and knowledge of inhabiting their bodies for the length of their lifetime, and the desire to make change. This coming together is in my experience, a powerful force in healing. As I approached the training with this partnering in mind, it energized me and my practice in many ways.
So without further ado, allow me to distill some of my favourite nuggets for you as I outline my personal and professional journey to TSY, what TSY is all about, as well as what to expect when we incorporate TSY into a therapy session.
What I bring to the therapy room… my personal journey to incorporating TSY:
Yoga has played a role in my life since I was about 14 years old. I’ve written in previous articles about my background in competitive figure skating. The sport of figure skating allowed me to develop many invaluable skills, including the ability to attune with my body. Simultaneously, a lot of my on and off ice physical training during my competitive years were not under my control. Training regimens were for the most part created for me, and off-ice conditioning were prescribed by the coaching team. When I attended my first yoga class outside of my training, I remember sensing a feeling that I now talk about often as a therapist: empowerment.
For that hour or 90 minute class on a rectangle of mat, I was making my own decisions about my body based on the wants and needs of my own internal world. On the ice as well as in off-ice conditioning, it was typically encouraged to push to my physical limits each time. On the yoga mat, how much I pushed on any particular day might look different. Some days my body wanted me to push my muscles and try every advanced posture. Some days my body said it needed to be in a resting posture, or solely listening to my breath. The important aspect that I learned was that all this counted as yoga: being in tune and responding to my body, whether I was in the instructor’s prescribed posture or a resting posture.
During this time, I was even in awe of how my body naturally adapted. Seated in a cross legged position in a heated room, I could feel the discomfort within my body as the heat rose. I noticed it, and continued to breath. I observed as my body produced sweat to adapt and accommodate my environment, all without me consciously taking any action at all. Wow, a built in misting system that required no work or intelligence on my part! It brought a new level of respect and gratitude for the gift of dwelling within my body. It brought a relationship between me and the things I cannot control, working in harmony, with an element of trust. It became clear that all my body’s automatic adaptive capabilities were just as impressive, if not more so, than what it could do when I “pushed it to its limit.”
The lessons I learned at this early time in my life transitioned into my counselling career in a few main ways…
1. Movement and yoga became one part of my out-of-office self-care practice. My ability to counsel is limited by my own self-knowledge, so this self-care practice allowed a time to pause and check in with what was coming up for me.
2. The empowerment in decision making I found on my mat became the type of experience I would strive to provide for my clients when they’d enter my office for a session. This was their session, their space, and they could explore feeling safe to share, respond to, and make decisions based on their own internal wants and needs in that moment.
3. When I learned EMDR therapy, those experiences of mindfully noticing without judgment, and being present with what arose (from my aforementioned heated yoga example- discomfort, sweat) allowed me to truly comprehend the state we want to be in when reprocessing trauma.
These three components have been paramount for me as a therapist in general, especially in the arena of trauma healing, and inform my day-to-day work. With that background, it was only natural that yoga would sneak its way more formally into my clinical practice.
Enter: Trauma Center Trauma-Sensitive Yoga…
Yoga literally means “to yoke,” that is, to join oneself to the infinite. Therefore the essence of yoga, similarly to therapy, is about relationship. Trauma, especially in complex-PTSD, is typically an injury of relationship. Whether that injury is between another person, people, the self, or the world in general, it creates associations (in a physical, neurobiological sense) of pain/fear when faced with relationship with others and/or the world around us as we move forward afterwards. When relationships are harmful, inconsistent, abusive, unsafe, sources of betrayal and pain, especially in the critical time of early development, the idea of relating to others and/or the world around us can feel threatening and overwhelming. You can imagine how conflicting and confusing it would be to both feel a deep human need for love, belonging and connection, while simultaneously fearing it in a life-or-death kind of way. Even relating to the self, whether it be to raw or avoided feelings, thoughts and physical sensations, or relating to the part of the self that you perceive to have betrayed you, can feel like too much. The process of healing is a process of gently and at your own choice, pace, and time, finding safety within the relationship with the self, the other, the world. Therapy can provide a most promising environment in which to take those first steps of exploring safety in the relationship with the self, as well as with a safe other (trained therapist).
As an EMDR therapist, it has been such a privilege to find a modality that provides that space for exploring and establishing internal safety, while also providing efficiency in making change. It isn’t uncommon for a client with a presenting concern of a single-incident trauma to see their symptoms resolve 1-2 reprocessing sessions. With more complex trauma, there were two main sticky spots that were arising here and there during trauma work with clients:
1. When a client presents without specific incidents, no memory of traumatic incidents due to dissociation, or the traumatic incidents are hard to pinpoint. For example, if emotional abuse was pervasive during early development and there was a general sense of rejection or abandonment. Tacked onto this is the added challenge of a client having little basis of healthy attachment to stand on. With very few experiences of what healthy attachment is, it is more challenging to create them from scratch.
2. When a client is quite numbed out/dissociated from their bodies, and therefore we must build embodiment skills during preparation phase before the question of “where do you notice that in your body?” could be answered in reprocessing phase.
I find Trauma Sensitive Yoga quite useful during preparation phase to help with these sticky points.
What to expect in Trauma Center Trauma Sensitive Yoga
There is always choice for the participant in the movement of TSY. We may sound like broken records, constantly reminding the participant of the invitation rather than instruction, but it is important to at all times ensure the participant is aware they can say no, or make any other choice that feels supportive in that moment.
This is the participant’s enactment of their choice of how they would prefer to move their body (or not!) in that present moment. This action in movement is key in the process of healing complex trauma or chronic, treatment-resistant PTSD. Kurtz, Ogden, and Levine all suggest that traumatic memory is primarily encoded as emotion and that these emotions are mediated by the body, “Treatment is mostly about using your body to change your relationship to emotions: I do something with my body in order to express or relieve emotional content.” This differs from EMDR, in which attention is paid to not only the body experience, but also emotions, thoughts, and images. With TSY as an adjunct therapy to EMDR, especially when used in preparation phase, it can help titrate the work so that attention to all these different aspects during reprocessing phase don’t become overwhelming. In TSY, “the object of mindfulness is always the same: the body experience. We are not interested in any other objects: not thoughts, feelings, emotions, sights, sounds, or smells. With TSY, any time the facilitator invites the direction of attention, it is toward what is felt in the body.” This focus on the body is helpful to build embodiment skills for someone who is quite dissociated from their body. It is also especially helpful if there are not clear memories of the initial trauma, as we are focused on what is coming up in the body now, in the present moment. Those words and audio-visual memories are not needed to heal.
A major tenant of TSY and any effective trauma treatment is that the client’s subjective experience is more important than any external idea of how the practice is or “should be.” This can be viewed as a difference from many types of non-trauma sensitive yoga classes, where there is a proper form. In TSY, “by valuing the internal perspective over the external in everything we do and say, we send a clear message about power dynamics: with TSY, power resides within the subjective purview of each individual and is not externalized or centralized in the teacher.” I’ve been told by many survivors of trauma that they would love to be able to experience the benefits of yoga, but find non-trauma sensitive yoga classes too activating. It feels important that this aspect of choice in TSY can help survivors access yoga as part of their healing practice.
Interoception is a fancy word defined as, “an attentional praxis that centers on our ability to feel the activity of our interior self, that is, the self contained within our skin.” In TSY and in therapy, a space is created for a client to have their own experiences without anything being imposed from the outside, “The facilitator supports their clients as they learn to trust what they feel, make their own choices about what to do based on what they feel, and take action based on what they choose to do.” In the research on the effectiveness of TSY using fMRI scans, after 20 weeks all eight participants that received TSY had more activity in parts of the interoceptive pathways (left insula, right thalamus, and right dorsomedial prefrontal cortex) than their counterparts. Our ability as humans to use the skill of interception is crucial. It is literally the way we interact with ourselves and our world. It is how we can feel safe in our bodies and in the world. It is how we can feel comfortable and empowered to make decisions about our bodies and our lives in our world. It is the basis for all action.
I’ve been enjoying incorporating this new skill of TSY with clients, and we do so flexibly. A session may look like re-evaluation phase of EMDR for the first 10-15 minutes, TSY for 15 minutes, then using the remainder of the session to process the experience. We can also use what comes up in the TSY work during reprocessing phase of EMDR. Although the modality is developed for complex trauma or chronic, treatment-resistant PTSD, I find it to be beneficial to any person with a body! Especially in our modern world with so much stimulation and a norm for over-working oneself, this gentle practice is a beautiful natural soother of our nervous systems.
Helen Thomas MC, RCC, LPC
References and more information:
Trauma Sensitive Yoga in Therapy: Bringing the Body into Treatment by David Emerson
Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror by Judith Herman