Developmental Shock Trauma
A Workshop With Raja Selvam, Ph.D.
Handout Prepared by Lori A. Parker, Ph.D.
Shock trauma can, of course, occur at any time in one’s life. Thus it might occur within developmental stages (pre-birth through adolescence). The focus in this workshop is on trauma that occurs within particular developmental stages — the attachment stages: Existence (2nd Trimester to 3 months): Need (1 month to 1.5 years of age); and Autonomy (8 months – 2.5 years). During these periods, most of the infant’s experience is in the sensory motor realm. Spoken language is barely available, and the limbic and cortical portions of the infant;s brain are not fully developed.
When a trauma occurs during these early developmental periods, there is often a great deal of nervous system dysregulation. What we will cover in this workshop are the behavioral themes that you may run into with your client when there is this type of nervous system dysregulation.
Suppose a child, for example, was conceived in the womb of an anxious mother in World War II. Or suppose a child had a surgery during these initial developmental periods. This child may develop PTSD symptoms early on. But the child of a depressed mother might also develop PTSD symptoms because, as an infant, the child didn’t get enough stimulation.
Clients, very often, have no idea. They will report what has happened after the time that they can remember. They assume that something they can remember must be the cause of their symptoms. They have no idea that their nervous system might have been compromised before they had the capacity for memory. For example, borderline personalities and eating disorders might be caused by something that occurred in the Need Stage.
Before beginning a discussion of what might go awry in these developmental periods — leading to various symptoms, let us distinguish between different types of trauma. These are not clear-cut categories. But it is important to understand that our concern here — is with a particular type of trauma — trauma that actually destabilizes the nervous system.
Developmental Trauma vs. Developmental Shock Trauma
Developmental Trauma: As a result of the repeated social interactions between the child and the caretakers, the developmental process of the child may go awry and lead to symptoms as the child matures. These symptoms might be of a physical nature, a psycho-emotional nature, a relational nature, or all of the above. They might be caused by inadequate mirroring, being repeatedly humiliated, or a lack of physical touching, to name just a few possibilities.
In such cases, there is mild or moderate nervous system activation over a period of time. Developmental trauma mostly involves the cortical and limbic areas of the brain. It leads to moderate psychological defensive responses (character structure patterns) but it does not lead to a “shock” response in the body and a dysregulation of the nervous system.
Shock Trauma As The Result of Developmental Trauma: As the result of the interaction between the child and caretaker, the developmental process of the child may go awry, leading to relationship problems and various other symptoms as the child matures. But in this case, it does lead to “shock” in the body (due to the accumulated stress). It does lead to an unstable physiology and a dysregulation of the nervous system. It engages the hypothalamus in orienting, fight, flight, freeze, and dissociation responses.
Shock Trauma As The Result of Overwhelming Event: The child may experience an overwhelming event during a particular developmental period (e.g., the child might have experienced a surgery, a bad fall, a bad accident, or a serious illness). In this case there is high nervous system activation. It does lead to “shock” in the body. It does destabilize the physiology (in the ways mentioned above). And it can, in and of itself, cause the developmental process to go awry. Character structures (formed as the result of developmental trauma) are reinforced by the shock trauma. The child may easily fragment or constrict in response to even small amounts of stress.
When we refer to shock trauma, we are talking about the effects it has on the physical body, not the energy body. What happens in shock trauma is that the physiology is met with a level of arousal it cannot cope with. It is like plugging an appliance into a socket that cannot hold the voltage. The younger one is, the less capacity one’s nervous system has, and thus the less able one is to handle the charge.
There are two basic responses the body has to the high arousal/overstimulation caused by shock trauma: fragmentation (parts of the body and/or experience are cut off from other parts without awareness) or constriction. Both fragmentation and constriction may lead to symptoms, and both may arrest the development of the child. So this is what we, as therapists, have to work with — the high arousal, the constriction and the fragmentation. The general therapeutic approach is to:
- Slowly lessen the constriction so that the energy can emerge to be discharged.
- Slowly discharge the arousal (allowing time for settling so that the body and brain can reorganize/readjust to the new state of less arousal.
- Slowly bring the fragmented pieces back in to be integrated (allowing time for settling so that the body and brain can reorganize/readjust to the new configuration).
THE TRIPOD MODEL
A Model of Shock Trauma Resolution
Based on the Somatic Experiencing Model
Dr. Peter Levine
- Titrate: In short, “small steps.” Whether you are lowering the arousal, lessening the constriction, or bringing the fragmented pieces back in, it needs to be done slowly — in small steps.
- Resource: One must learn to induce positive sensory-motor states in the body. You can do this using internal resources (e.g., grounding, centering, or calling forth character traits like inner strength and determination). You can also do so using external resources (e.g., pets, children, work, nature, friends). Resourcing serves to make the conditions right for pendulation to take place when trauma is contacted.
- Integrate: Spread/allow the benefits of successful pendulation throughout the body and throughout the brain. Do not let the client get stuck in unresolved constrictions or new constrictions. Help the client stay with the “silver lining in the clous.” Help the client to move into their awareness of the whole body (rather than just a constricted area that may be drawing their attention). Help the client to sense both themselves and the environment at the same time (again, rather than narrowly focusing on some small part of themselves that is drawing their attention).
- Pendulate: Helping the client to take a step toward disorganization, and then toward organization, and then back toward disorganization. In other words, this process is one of looping between disorganized states and organized states — looping between constriction and expansion — between experiences of fragmentation and experiences of wholeness.
- Organize: Allow the integration and the new reorganization plenty of time to settle. Remember that the body takes a lot longer to settle than the mind.
- Discharge: Lower the level of arousal by discharging the high charge from the nervous system. Lowering the arousal helps restores the self-regulation of the nervous system. One must track the shaking, heat, trembling, vibration, tingling, pulsing phenomena in the extremities in order to lower the arousal in the core, abdominal, thoracic, and head and neck areas.
Abdomen ↑ into legs,
Chest ↑ into arms or head and neck
Head and neck ↑ into arms or out the head and neck areas themselves
In general, use the body’s natural discharge pathways.
The Nature Of
Nervous System Dysregulation
Where does this dysregulation, high arousal, constriction and fragmentation take place? Does it take place in the cortical circuits (meaning, language, and storing of memory)? Does it take place in the limbic circuits (feelings)? Does it take place in the reptilian circuits (sensation)? If too much energy is introduced into a system that cannot handle it, the dysregulation will be primarily in the reptilian circuits. Sensation is the language of the reptilian brain. Thus, only through sensation, can we directly access the arousal, the constriction, and the fragmentation of shock trauma.
Developmental trauma that creates a shock response in the body (developmental shock trauma) leaves the reptilian brain disorganized and the individual prone to forming symptoms under normal stress. The reptilian brain must be coaxed back toward self-regulation. When clients have not healed using mainstream therapy, it may be because these involuntary circuits have not been dealt with. Therapists have not dealt with the “shock” component, but rather, have concentrated on the meanings and feelings surrounding the event or surrounding the interaction between the child and the caretaker.
To work with developmental shock, we need to be able to work with developmental issues and shock at the same time. To work with the shock aspect, we need to be able to work with the disorganization in the reptilian circuits and its impact on the rest of the brain and the body. We need to track and work with the sensory-motor experience — the interaction between the reptilian circuits and the body. There are four basic ways of doing this.
Traumatized individuals tend to pay excess attention to the gloomy aspects of their experience (to the symptom or to the constriction). They tend to withdraw their awareness from the environment and ignore nascent self-regulating tendencies that might be present (e.g., how the body might be settling — even if only in some small way; how the body might be expanding — even if only slightly; how the body might feel less afraid — even if only slightly).
The brain of the traumatized individual needs to be coaxed toward paying attention to the whole body and/or to the environment. It needs to be coaxed away from the fixation on the symptom or the constriction. The therapist must help the client look for self-regulating and emerging healing elements (even if they are small). This is a critical part of tracking and integrating the sensory-motor experience associated with shock.
Having said that, let us turn now to a discussion of each of the developmental periods mentioned above, and discuss what happens when things go well, as well as what might happen when something goes awry.
Autonomy Structure (8 months – 2.5 years)
The autonomy stage overlaps with the need stage (discussed next). The autonomy stage is the stage in which child starts to creep, crawl, and walk. The child begins to separate from the caretaker and create boundaries (by crawling away, walking away, and later running away). If things go well in this stage, the child can accomplish the tasks associated with this stage:
The Healthy Adult
- The individual has the ability to sense him/herself as a separate entity. They have a sense that they have unique experiences — unique sensations, etc. They are able to distinguish their own experience, in their own body. “These are my experiences.” “These are my sensations.” “These are my impulses.” “These are my feelings.” “These are my perceptions.” They are able to trust others to respect and support their reality.
- The individual has the ability to sense the other as a separate entity. They are able to sense that the other has its own experience, its own sensations, etc.
- The individual is able to sense the need for help. They wouldn’t, for example, hesitate to ask for help when they need it. So they won’t become overwhelmed, trying to do it all. They can also sense the degree to which they are of help to another. (So this person wouldn’t, for example, hesitate to ask for a raise in situations where that is warranted).
- The individual is able to sense both independence and interdependence. When the individual gets the help they need, they can sense that they are depending on the other.
- The individual has the ability to sense interpersonal impact. They can sense the impact that they have on another, and the impact that the other has on them. They can sense that their positive states, their negative states, their actions have an effect on you. And they can sense that the positive states, the negative states, and the actions of others have an effect on them. Although, as adults, they may continue to need mirroring, the healthy individual can hold onto their feelings, sensations, and impulses regardless if they are mirrored back by another.
NOTE: These are not mental notions. It is not enough that the individual “knows” (cognitively) that they are a separate entity or that they impact others. It is something the individual can physically sense.
The Developmental Process Gone Awry
Source of Disturbance: Neglect or intrusion dynamics
Self and Other: Let’s say the child has an experience that is fun and wants to share it with the caretaker. If the child is able to share the excitement without being overwhelmed by the caretaker, then the caretaker helps to modulate the child’s nervous system. But if the caretaker overdoes it, the child will turn away, and modulation of the child’s nervous system may not occur. On the other hand, if the mother is depressed and shows no interest, then the response of the child is one of deflation.
In either case, the modulation of the child’s nervous system may not take place. If the child’s nervous system is already unstable due to, for example, a traumatizing experience in the womb, then the situation is merely exacerbated by this later experience. The child’s nervous system is compromised even further.
The “sense of self” happens when the child comes to the caretaker and recognizes that the caretaker is in a different state than they are. Suppose, for example, the caretaker is concentrated on a difficult task and the child is having an experience that is fun. Suppose the caretaker stops what they are doing temporarily and resonates with the child’s experience. Then the caretaker goes back to their task and their more serious mindset. This is how the child’s brain begins to map self and other.
If the mother is always following the child around, there may be great mirroring but the child isn’t able to develop a sense of self. Its brain isn’t able to distinguish between self and other because there are no contrasting states. Thus too much mirroring is as detrimental to the child’s development as no mirroring.
Interpersonal Impact: The child needs to have a map of the “other” and a map of themselves (in their brain). They also need to be able to sense how the “other” is impacting them and how they are impacting the other. They need to sense this at the level of the body. If the mother is depressed and despondent, the child, for example, may have a sense in their body that they are not able to impact another. On the other hand, if the mother is destroyed every time the child turns away from her, then the child may have an inflated view of the extent to which they impact another.
The need for help: Whether the mother gives too much help or too little help, it is problematic for the developing child. If the mother gives too much help, the child cannot sense its own capacity and ends up relying too much on others. If, on the other hand, the mother gives too little help, the child ends up sensing that it doesn’t need help. To state this another way, the child will lack the ability to sense the need for help. As adults, they might therefore, tend to overwhelm themselves. They do not sense theirneed for help, so they don’t ask for help. They will try to do everything themselves.
If the child doesn’t have enough mirroring, they may have an inability to stay with a single experience. There is no strong sense of self in the body. In the therapeutic session, the client might rapidly move from one topic to the next. They might tell you one story after another (and each story may be wholly unrelated to the last). In Somatic Experiencing, the client may jump from one sensation to another. They try to hold onto their experience, but they cannot. So they will go desperately after another experience to “shore it up.” They often don’t remember one session to the next. There is no sense that they are able to stay with the story line.
This tendency to jump around can be verbal (linguistically jumping around) and/or nonverbal (jumping from experience to experience). You might find, for example, that in the context of their daily life, these individuals seem to constantly look for excitement — for some new stimulus. At the same time, they are constantly overwhelmed because their nervous system can take only so much stimulus. The movie, Eternal Sunshine of the Spotless Mind is a good movie to see if you want to get a sense of the “classic autonomy structure.”
When these individuals are in one state, they have one interpretation of the event. Then they are in a different state and they have a different interpretation. Then they wish they had thought the second way at the time the actual event occurred. So they just begin to act “as if” that was the case. For these reasons, these individuals are often accused of lying.
Any of the inabilities listed below suggests a disturbance in the autonomy stage. The source of the disturbance might be some form of neglect or intrusion dynamics. However, as mentioned above, a single “shocking” event (e.g., early surgery, accident, or fall) may throw the developmental process off, leading to similar inabilities.
- I can sense myself, but I cannot sense another.
- I cannot sense both myself and the other at same time.
- I cannot sustain the sense of the other when they leave.
- I lose the sense of you loving me the moment you walk out the door.
- I cannot sense myself when in the presence of someone with a very strong sense of self.
- I cannot sustain an ability to depend on another, or, conversely, I cannot sustain my independence.
- I cannot trust my dependence on another, or my interdependence with another.
- I cannot trust my reality.
- I cannot sense the need for help, and therefore tend to not ask for help.
- When I receive help, I cannot sense the dependence.
- I cannot sense the degree to which I am of help to others.
- I cannot sense how my positive states, my negative states, and my actions affect you.
- I cannot sense how your positive states, your negative states, and your actions affect me.
Remember. These patterns are imprinted physiologically — that is, in the body. Thus, clients must learn to sense these states physiologically.
Working With Autonomy Structures
You might have to educate the client, and help them to track their responses when they feel destroyed by something you did or said. Suppose, for example, that the client is telling you about a movie. You saw the same movie, and so you start to mirror back. You say something about the movie. Then the client begins to behave as if they have been destroyed. Your task is to help heighten the client’s awareness of how your response impacted them.
What was their response? Was there an immediate high arousal? Did they feel themselves constrict? If you witness them going away, you might simply inquire: What just happened? They may say, “I don’t know.” You might suggest what you think might have happened and then encourage them to begin to track what happens in their body when they feel “destroyed” by the words or deeds of others (either in session with you, or with others in their daily life).
These neglect or intrusion dynamics will tend to get played out in the primary transference with the therapist and/or in the secondary transference with individuals outside of therapy. Allowing these neglect and intrusion dynamics to play themselves out in the therapeutic process might not be pleasant work for either the client or the therapist, but it must be done. Otherwise the client can get stuck in demanding mirroring and/or avoiding invalidation in the context of their daily life.
It is important to also keep in mind that, for autonomy structures, the thought of “slowing down,” or the thought of boredom, is very scary. Feelings of emptiness may arise and they may feel compelled to find their own impulses (something they may not be able to do without guidance).
Working Directly With The Affect Components That Accompany Experiences
You may, for example, have to work with the shame surrounding the need for help, or the shame surrounding seeking help and not getting it. You might have to begin by determining whether the client can even sense the need for help in the first place. You might, for example, ask them when is the last time they remember needing or asking for help, and then see whether they can sense that need in their body. Once they are able to sense the need for help, you can then have them imagine asking for help. Then inquire: What happens in your body when you imagine yourself asking for help? Any number of affect states may arise. Shame may be one of them. Vulnerability might be another. They might even get angry in response to the vulnerability they feel. They might be more aware of the anger than the vulnerability.
Keep in mind that the client might not be able to identify the affect. They might appear ashamed, but be unable to sense the shame in themselves. In this case, you might have them sense their face. Then have them get an image of the face they are sensing and inquire of them: “What is being expressed by the face that you see?”
Another possibility is that when the client imagines themselves asking for help, they may simply be flooded with a myriad of sensations that they cannot make sense of. If you help them to track the sensations, you might find your way to the affect – in this example – the shame.
Working with shock trauma directly (i.e., completing/restoring the orienting, fight flight, defense responses).
If there is a trauma during this period (e.g., surgery or accident) that destabilizes the physiology, the traumatic event can, in and of itself, cause problems. There will be the problems caused by the malfunctioning of the brain itself. There can be visceral problems. But the trauma experience can also disrupt the developmental process. If there is trauma caused also by the interaction between the child and caretakers, then it’s a double whammy. In either case, you may have to work toward completing and restoring the orienting, fight, flight, and defense responses. This is what one learns to do in the Somatic Experiencing work of Dr. Peter Levine.
Need Structure ( 1 month to 1.5 years of age)
The basic skills learned during this period are the ability to: 1) express need; 2) take in nourishment and assimilate it; 3) differentiate needs and recognize satiation; and, 4) satisfy one’s needs by one’s own actions.
The Healthy Adult
- The individual is able to sense their needs in the body. They are able to sense what they need and what they don’t need. They are able to sense what they like (e.g., pleasure) and what they dislike (e.g., disgust).
- The individual is able to express their needs appropriately. Some people can sense their needs, but they won’t come forth with them. The healthy individual can do both. They have a sense that, through their own actions, by and large, they can get their needs met. They can make it happen, and they trust that. The also have a sense that when appropriate, they can get others to satisfy their needs.
- The individual is able to sense (viscerally) the dissatisfaction of not having their needs met, as well as the satisfaction that comes from getting their needs met.
- The individual has the ability to postpone certain needs (without dissociating or going into symptoms). They can delay gratification of their needs in the body. There is no urgency to getting their needs met. They don’t feel/act as if they will die in the next 5 minutes if their need is not met right away. For example, if they sense a need for contact – a longing for contact, they don’t have the sense that their life will end if they do not get it. They can tolerate the waiting period. They can withstand the frustration of their needs not being met.
- The individual understands that they will not always get their needs met by a particular individual in a particular way and they can tolerate their needs not being met. They are able to tolerate, in the body, the dissatisfaction, the disappointment, the distress of not having a particular need met, by a particular person, at a particular time. Since they are confident that their needs, in general, will be met, they are not attached to specific experiences. They can be flexible with regard to their own needs, and thus your needs.
- They have a sustained sense of satisfaction, of feeling nourished. They can take something in and retain it so that they can rely on it in “lean times”, so to speak.
Developmental Process Gone Awry
At times, the child must experience not having their needs met so that they learn to tolerate the frustration and disappointment inherent in not having their needs met. It is when the child’s needs are repeatedly unmet that it becomes problematic. When the child’s needs often go unmet, they become very frustrated, go into despair, and give up. They, in essence, “learn” that they cannot get their needs met. If, on the other hand, the caretakers are overly responsive, catering to the child’s every whim, so to speak, the child may never experience the frustration and disappointment of not having their needs met, and may not, as an adult, be able to tolerate the feelings accompanying unmet needs.
The trauma might not be from the interaction with the caretaker, but rather from something else entirely. The infant might, for example, be born with high arousal (perhaps from an anxious mother or from the cord having been caught around the neck of the infant during birth). Their physiology might, therefore, be compromised from the start, and this compromised physiology might, in and of itself, throw the developmental process off course.
It is important to note, though, that this will not necessarily be the case. A developmental process can be altered in a positive direction without therapeutic intervention. This might be the case, if, for example, there was a very loving grandmother, the father took good care of the infant, or the family pet always slept next to the child, helping to regulate the infant’s physiology. It is not necessarily the case that the developmental process might be thrown off course. But quite likely, it will be.
Any of the following suggests a disturbance in the need stage of development.
- I cannot sense what I need.
- I cannot express what I need.
- I assume my needs will not be met/I cannot trust you to meet my needs.
- When I get what I need, I cannot take it in. Or, I feel grateful at the time, but the sense of gratitude does not stay with me.
- When I don’t get what I need, I go into despair (or, conversely, become disgruntled, angry, nitpicky, critical).
- My sense of satisfaction is always temporary. I cannot sustain it.
- I am constantly distrusting my satisfaction. If I am feeling satisfied, it must be because I am in denial.
- I give up my needs a lot, and then go into despair.
- I am accommodating and sweet. I don’t let my neediness come out.
- I may agree to do anything the other person wants, but then I will attempt to make the other person feel bad about it. For example, “We can go there if you like; I will just take my allergy pills.”
- My needs can only be satisfied in a particular way.
- If my needs are not satisfied in a particular way, I go into despair, and have the sense that I cannot get my needs met.
- If my needs may at times be met, they are not met in the right way and not at the right time. “I want this, but I am getting that.” “I want it now, and I’m getting it later.”
- I have no sense that there might be an alternative way of getting my needs met (that might even be more satisfactory).
- I do not express that I want something in a particular way. I just expect people to figure it out.
- If people don’t figure out what I need, I get upset.
- If I have to ask for what I need, it’s not worth it. The other person should know.
- I am always trying to get attention. For example, in a class situation, I repeatedly ask questions but I am not really interested in the answer. I am just wanting the attention that asking the question brings me.
Working with Need Structure
You can begin by having the client think about what they need, and then see whether they can sense that need in their body. This might include the deeper longings for contact and nurturance. Then help them develop the ability to sense, in their bodies, the satisfaction of having their needs met. It is not enough to know cognitively that their needs have been met. The trick is to get them to sense the satisfaction in their body. Otherwise, they will continue to feel, at some level, that their needs are not being met. You can also help them to sense, in their body, the dissatisfaction of not getting their needs met. It is one thing to have the thought that their needs are not being met – quite another to be able to sense that in their body.
You can also help them to sense that the “other” (whoever that might be) can’t meet their needs. See whether they can sense that in their viscera – in their gut – in their chest. It is important to keep in mind that if there is traumatic stress, they might also sense the terror of not being able to get their needs met. Ultimately you want them to be able to tolerate the dissatisfaction in their body (and perhaps the terror in their body).
It might also be important to work on what meaning they might have made about themselves and the world. They may believe, for example, that there is only one thing that can satisfy them. This is quite restrictive. So have them sense what happens in their body when they think the thought, “Only he/she can satisfy my needs” or, when they think the thought, “I will only feel satisfied if we go to this particular restaurant for dinner. Going somewhere else will not satisfy me.” Another possibility is to have them sense what happens in their body when they think the thought, “No one can satisfy my needs.”
With the despairing states, when the client is not even feeling the impulse toward their needs, you might use voluntary muscles. Have them grab or grasp something, and then have them sense their body as they grasp or grab the object. Have them grasp the object and bring it close to them, and then have them sense what happens in their body as they execute this movement.
You might also have them to do the opposite. Have them push away. Have them sense the “I don’t want it” in their body. You could have them gesture spitting it out, or making sounds of disgust. Then again have them sense that in their body. You can have them express it through their eyes – the disgust or the “I don’t want it.”
As you work with these individuals over time, those who tend toward distrustful states might switch to despairing states and vice versa. But this will not necessarily be the case. Keep in mind that to the degree that you are working with developmental shock trauma, and not just developmental trauma, is the degree to which there is likely to be tremendous terror and rage. There might also be an inherent sense that something is wrong, or an extreme sense of emptiness, which feels unbearable to them.
If they are under-resourced, make sure that you titrate and work quickly. To titrate means to have them sense a little terror, a little rage, a little emptiness. Then help the client to attend to the rest of their body, or bring their awareness outside – into the environment. This is an example of where cathartic work — breath work — may be contraindicated.
A Special Case:
There are many reasons why people eat too much, too little, or get fanatical about special diets, etc. What we are concerned with hear is the individuals that are eating in order to settle their physiology. Eating gets the viscera to move. It brings the parasympathetic system on line. In short, it’s calming. From the psychoanalytic point of view, people are eating in order to manage intolerable affect states. So if the person has a visceral state that doesn’t feel good (e.g., emptiness) or if they are experiencing high arousal in the whole body, the person eats and feels better.
So what does one do with these intolerable feelings of emptiness, despair, hopelessness, helplessness, grief, or the longing for love? One tires to squelch the feeling — to calm it down — by smothering it with food. Or, ones tries to cleanse their system – as a way to “get it out” – as a way to get rid of the feeling altogether. Another possibility is that one purposefully causes themselves to vomit as way to “get it out.” They might do various things to force the physiology into some other state. So the therapeutic strategy would be to try to get the client to sense and tolerate these unbearable feelings in very small increments.
One way to do this is to suggest to the client that the next time they have the impulse to eat, or to force themselves to vomit, that they just sit for five minutes and notice what they feel. Repetitive movement/compulsive behaviors/addictions can also arise to deal with intolerable affect. Sexual and other addictions can, therefore, be approached in much the same manner. The next time they have the impulse to “act out,” their sexual addiction, for example, have them just sit for five minutes and notice what they feel.
Existence Structure (2nd Trimester to 3 months)
During this period, the infant is experiencing its basic sense of being, and how he or she is received – not only by the mother and family – but also by the world itself – the environment. This sense of either being welcomed or not welcomed is deeply imprinted, and it is this imprint that the personality develops.
The Healthy Adult
- This individual has a secure sense of existence (physically, psychologically, and emotionally).
- This individual experiences the environment around them as stable and reliable.
- This individual feels loved by others and welcomed in the world. They sense that they belong.
- They are able to sense “I am” in a very physical way.
Developmental Process Gone Awry
Either as the result of shock trauma or developmental trauma, the embryo, fetus, or the neonate has the experience that sensing its physical body in relation to the physical world around it (especially the mother and her womb, or the adopting parents), is too much to bear. This leads to constriction and/or fragmentation patterns in the physical body or, even worse, shock states of high arousal, constriction, and freeze/dissociation. Constriction or flaccidity in the skin, fascia, joints, ligaments, viscera, eyes, spine, and central nervous system itself are common responses to the distress.
The embryo needs to feel safe – secure — welcomed — wanted. If there is any sort of constant agitation in relationship to the mother’s body, it is not going to feel safe in relationship to the environment around it. It might feel threatened any time it senses another. The baby might be born sensing that that it is not wanted – that the world is not a welcoming place – that it does not belong in the physical realm.
What kinds of things might occur that leave the infant with the sense that it is not wanted, and/or that the world is a dangerous place? There are many possibilities. The father might beat or rape the mother while the baby is in the womb. The mother may smoke or drink. The mother might be living in a toxic environment without knowing it.
The mother herself might be highly stressed from her own trauma history. There might have been medical procedures performed while the fetus was in utero. The mother might have suffered from malnutrition due to, for example, living in wartime where food was sparse. And, of course, there might have been any number of possible birth traumas.
So let us just say, that for whatever reason, the baby is born highly stressed. The nature of the arousal will be Global High Intensity. This type of arousal spreads over the entire body, and does so very quickly. As is the case with any age, the physiological response will be to either constrict or fragment.
The infant must find some way to bind the intense arousal into discrete pockets. The infant is likely to constrict first, and then if that doesn’t work, these structures may go flaccid. So there might be constriction or flaccidity in the viscera, the fascia, the skin, the skull, the brain itself, the membranes, the joints (remember, the joints are autonomically enervated) the ligaments, and the eyes.
There are two presentations in the Bodynamic Model: Mental Existence (Early Existence/Schizoid) or Emotional Existence. In the Mental Existence Structure, the individual may be highly mental, but at the same time, confused mentally. That is, they may not necessarily be organized mentally. Their energy is withdrawn from the body (In Alexander Lowen’s model it is held in the bones). When this individual goes into the body, they will sense various degrees of constriction and flaccidity — in the skull, in the joints, etc. There might also be existential terror, existential rage, fear of annihilation, the desire to annihilate another, fear of fragmentation, and existential shame (they may feel as though there is something deeply wrong with them).
What distinguishes existential terror, existential rage, existential shame from your garden variety fears – from your garden variety anger – from social shame – is that it is in the physiology itself, and it is sensed physiologically by the individual (often times though, without their awareness).
Any of the following suggests a disturbance in the existence stage of development. Although there are “early” and “late” positions for each character structure, the early and late positions for the Existence Structure are the most diametrically opposed. So I will list the possible presentations separately.
- I tend to isolate myself – constantly moving away from contact with others and the world.
- Trusting others is extremely difficult for me.
- I have difficulty making deep contact with others.
- I don’t feel connected to anyone (even to those closest to me).
- I don’t feel welcomed/wanted (in the world at large, nor even in small groups of people).
- I cannot sense belonging in a physical way.
- I am at constant war with the environment.
- Just existing is a real struggle for me.
- My general attitude is one of resignation. “What’s the use?” I ask myself. Nothing will change.
- I have little desire to participate in the world as it is.
- Intense emotional experiences make me feel very unsafe (as they can activate the existential trauma).
- Interpersonal contact in general makes me feel very unsafe.
- Feeling really alive makes me feel very unsafe (as it can activate the existential trauma).
- I tend to “live in my head.” My energy feels constantly drawn upwards.
- My primary interest is in abstract ideas and concepts and in philosophical and spiritual matters.
NOTE: The body of these individuals is often split — side to side — front to back – or top and bottom — with the energy at times deep in the bones. They may for example be able to sense the back but not the front. Or their musculature might be flaccid on the bottom and constricted/rigid on the top. The presentation, in general, is more energetic, than physical. These individuals can, at times, seem quite ethereal in their presentation.
- I live with a constant feeling of having lost something that I cannot regain (and at the same time feeling desperate to regain it).
- I tend to fling myself toward intense social contact and intense emotional experiences.
- I find myself “clinging” in relationship, as if I am “hanging on for dear life.”
- I sometimes feel wanted, but always fear that it will not last.
- I find myself “clinging” to my involvement in the world, as if I am “hanging on for dear life.”
- My desire for contact with others is excessive. I have little or no desire to be alone.
- I cannot think clearly in response to stress occurring in the context of relationship.
- I live with a constant fear of abandonment.
Note: The “late existence” tends to be more embodied than the “early existence/mental existence.” They try to hold onto the world through their energy. They are highly energetic and emotional and can be misdiagnosed as a hysteric.
Working With Existence Structure
Whether you are working with the “early” or “late” existence structure, improving the client’s body awareness is of critical importance. This, in and of itself, can help the client to contain energy, feelings, and emotions.
If shock is involved, there may be a strong fear of fragmentation and annihilation. This is the case in both the “early” and “late” structures. There is also likely to be a global high intensity activation of the central nervous system. You must slowly lower the activation over a long period of time. Make sure that you take time to integrate after each attempt to lower the habituated high arousal state in the system. Very disorganized states (including spontaneous fragmenting movements) might come through as the terror, inhibitions and constrictions are worked through.
Early Existence (Mental Existence): Help them to sense their body through sensations first (perhaps giving them a list of sensations to help establish a vocabulary, as they may not have much of a vocabulary for sensation). Then begin to help them sense, in their body, their relationship to the physical world. Existential terror, shame, and rage will be there (with or without shock states of global high intensity arousal, constriction, fragmentation, freeze, and dissociated states). Keep in mind that the shame is a physical sense that something is amiss in the body. This sense might, in turn, be translated into a meaning: “There is something wrong with me, and therefore I am not wanted.”
With early existence, their primary fear in coming into the body is the deep fear of fragmentation. Because of this, they will tend to hold back strong emotions (including existential rage and fear) with their muscles. So one thing you can do is help them to sense the “holding back” in their bodies. You can even have them say things like: “Now,
I am holding back or holding on.”
A more direct way to go about this is to actually have them grab you around the wrist with one hand or both hands and squeeze as they say: “I am holding on.” “I am holding back.” This gives them a direct sense (in their bodies) of the defense. When they let go, have them sense that as well. You can even have them say, “I am letting go now.” In doing this, the muscles are taken to an extreme state of contraction. So when they let go, they can actually sense the release – thereby also heightening their awareness of what “letting go” feels like. This will help them to begin to track this “holding back” themselves.
Another possibility is to guide them through a visualization of fragmentation into a million pieces and then reassembling into a whole body. This has to be done very carefully and gradually while you track the activation level. (Carefully tracking the activation level and “titrating” the experience is a large part of what is taught in the Somatic Experiencing® Training Program (www.traumahealing.com).
When working with the early existence, one must help the client to gradually feel emotions and be in emotional contact (without fragmenting or constricting – without becoming symptomatic). Help them to contain the anxiety that may accompany being in an intimate relationship with another (again, without going into symptoms). Remember: they feel unsafe with high emotional charge and interpersonal contact.
Late Existence (Emotional Existence): The focus here is more on helping the client to contain the anxiety that might accompany separation. Pure cognitive understanding on the part of therapist will likely have little effect on the client. But “cognition” may very helpful for the client because emotions are big and uncontainable. These emotions would be akin to a child that closes its eyes and screams in terror of a monster in the closet.
The therapist can help ground the client through thinking because cognitive capacity is often lost in the high energetic charge and/or the emotional states. So the idea would be for the therapists to meet the strong emotions of the client in a way that the client feels seen. But the therapist must also help the client to contain these emotions.
When working with the late existence, you can also help the client manage the strong emotional effect that others have on them in general. Again, the concept of titration is important here – working with a small amount of emotional charge in the beginning, and gradually helping them to manage greater amounts, as time goes on and as their container develops.
NOTE: The developmental information is drawn from the Bodynamic Somatic Developmental Psychology Model as well as from my own clinical observations.
Reprinted with permission from: Copyright © Raja Selvam, Ph.D. 2004 All rights reserved