Psychophysical Approaches to working with PTSD and the Ego
by: Ditte Marcher & Lene Wisbom
Since the mid-80s, the Bodynamic System has developed new ways to work with trauma and stress-related conditions by incorporating the body in a very concrete, physical manner. In this article we describe how we work with the Ego split that is caused by shock.
For the past four decades, Bodynamic International has accumulated knowledge and collaborated with other renowned trauma specialists in order to develop a cognitive physical psychotherapeutic method. Like other psychophysical trauma approaches, our work focuses on the responses and reflexes of the nervous system.
The fundamental philosophy of Bodynamic is that we all have a unique balance of dignity and mutual connection, which is challenged by events in the course of our lives. It is the restoration of this balance that we seek to achieve.
By working on healthy reflexes, we restore the body’s ability to shift between a state of readiness for action and activity (the sympathetic nervous system) and its predisposition for repose and tranquillity (the parasympathetic nervous system). One of the symptoms of PTSD is that the balance between the two nervous systems is now working sub-optimally or very badly, with serious physiological consequences for the person in question.
Our aim is to remedy the effects of a shock trauma/PTSD while at the same time develop new cognitive, emotional and physical resources as well as psychosocial skills, so that the client can become better at being focused, in contact with him or herself and optimise his or her options also in times of distress. This can be achieved on the one hand through concrete training in cognitive, emotional and physical skills, so that the Ego’s capacity may be restored, while on the other hand through expanding one’s ability to act in new ways while focusing on the resources made available through the person’s shock reactions.
This article will focus on the theory and principles underpinning the specific psychophysical working methods that Bodynamic therapists use in a variety of ways in order to realign the Ego following a traumatic experience.
THE FUNDAMENTAL PRINCIPLES OF BODYNAMIC
We define mutual connection as the close intimacy that surfaces between two or more people, and which presupposes that each person maintains his or her individuality.
Mutual connection exists also on a global level; it is the profound innate knowledge that every living being on this planet is interdependent. Despite differences (as for example between a gnat and an elephant), all forms of life depend on this coexistence that gives us an experience of universal interaction with everything.
The spiritual element of mutual connection includes what we have just outlined, but also incorporates an interaction with the collective unconscious, as well as with what we call each person’s life- and soul- energy.
We use the word Dignity to describe a person’s inner sense and feeling that she is able to own her inner values and deep ethics, respecting them and living in accordance with them. Dignity also involves an authentic acceptance of certain commitments, actions and rights.
The Ego consists of a combination of character-structures (defence structures) and Ego-functions (Ego-skills), which are the two pillars of the Bodynamic psychophysical concept. The psychomotor development of children is integrated with many years of empirical research in emotional responses to form the unified whole that is the Bodynamic Character Theory and the 11 Ego-functions.
Based on our experience, we maintain that the muscles in our bodies perform the social, emotional, cognitive and physical functions of the Ego. By training our muscles and reflex movements we broaden the Ego’s skills and capacity to maintain a high energy level. When subjected to shock events, the Ego is exposed to a very high intensity of energy and, more often than not, to much more than the Ego can cope with, given its available resources, skills and defense strategies.
The Me is something bigger than the Ego and serves other functions. It is the part of the personality that, amongst other things, takes over in life and death situations, when we are forced to act more rapidly than the Ego can handle in order to stay alive and be able to manage a ‘high intensity of energy’.
The Me is all about instincts, reflex systems, genetic knowledge and automatic skills, as well as the knowledge that stems from the collective unconscious. By working with the Me’s strategies, we tap into our deep, essential powers as human beings and the fundamental skill to act directly from our core until a sense of balance is restored.
When intensity becomes too much for the Ego, a shift takes place, and control passes on to Me, while the Ego’s experience of integrity splinters.
The Ego splinters – An Image
You are looking at a large sheet of paper that describes your Ego and all its skills, defense patterns and forgotten potential. It is an Ego that functions fairly well from day to day and which you have learnt to live with. This sheet of paper is familiar, but when something happens that puts pressure on you, you are cast off your Ego and into your Me and its 5 sub-elements: instincts, ancestral knowledge, collective unconscious, automatic skills and spiritual components. The paper is metaphorically shred to pieces that scatter to the winds; some closer by, some far away.
When you later come back to your Ego, you find it splintered, in pieces. It may have got torn into several or just a few pieces/elements. So you try to put it back together again with adhesive tape, but that takes a long time, and the paper is never the same again.
As a result, a lot of people feel that their lives are different following traumatic events and say that the trauma has ruined their lives; others, however, say that it has been a gift.
Our thesis and experience is that a person will invariably experience a trauma as a major change. The crucial task in therapy is to put the paper back together again in a new way.
The 5 Ego Aspects
The following illustration is an image of a personality:
- The Me has been there since conception, and the consciousness that envelops it can expand throughout our entire lives. The Me has faster unconscious strategies, that go beyond the Ego’s skills.
- The Body Ego develops since birth, but in reality we perceive it through our physical senses and psychomotor sense perception.
- The Individual Ego is formed after two years of age through the individuation and separation process and is that point in time when we become conscious of the fact that we are individuals, different and separate from others.
- The Role Ego is formed after three years of age and is that point in time when we become able to take on roles in life and sustain them in our social interactions.
- The Observing Ego functions in conjunction to all three previous Ego-aspects and refers to our ability to observe what we do while we do it.
- The Integrating Ego starts in adolescence and is that part of us that assimilates the four Egos into an adult awareness.
THE BRIDGE BETWEEN THE EGO AND THE SELF
In the late 1990s, researchers and authors started analysing various phenomena observed in brain research that have had profound significance for Bodynamic’s further development and shock trauma therapy.
In his book Sense The World, Tor Nørretranders notes that Benjamin Libet was the first to describe and research the ‘0.55 seconds’ delay between an impulse to act and a conscious action, meaning that our consciousness is half a second late in reacting. Libet says, ‘consciousness cannot start an action, but it can decide whether an action will be executed or not’.
Other scientific research has shown that when people have their bodies touched, activity is triggered in the brain without that half-second delay, i.e. before their subconscious becomes aware of it. In other words, we experience things consciously with a half-second delay, but in life-threatening situations we react before we think, and that response is actuated from a higher authority – the Me.
Shock impacts on our fundamental ability to remain intact as a personality, thus incapacitating skills such centering, grounding, boundaries, and energy management.
By working with consciousness and the body on the connection between the body’s impulses and delayed conscious thoughts, we build a bridge between the Me’s unconscious rapid strategies and the Ego’s conscious skills. That way we create a new realignment and the possibility to find a new way of being in the world, with an Ego that has become stronger.
”In therapy I gradually got closer to the situation– step by step – and every time that I had reactions that my therapist could see, I was stopped, and I allowed myself to feel my heart throbbing and me shivering; I talked about a safe place and felt the impulse to run away, but bit by bit I started feeling how my body ‘survived’ – by practicing rolling falls, a technique I had learnt at judo when I was 11. Every time I got knocked over, my body let go and rolled in the same direction; I fell down and did a somersault with my head bent and my arm raised for protection before coming back up on my feet again. For the few seconds that this ingenious physical response vibrated in my body, I was so happy and proud. Over the next few days I could feel my body strutting in a new way, and my head felt much clearer.”
Here we have a description of a client who responded ingeniously during a shock situation thanks to the Me’s automatic learning capacity. The client managed to recall this response in the safe therapeutic space, by gradually getting closer to the various elements of the traumatic story, remembering the body’s responses and re-establishing the connection between the Me and the Body Ego and thus between memory and consciousness.
The resource-oriented training of muscles and reflexes builds on the fundamental knowledge that the body is equipped with inner resources.
It is a capacity that helps us handle both extreme situations and ordinary everyday circumstances.
BODYNAMIC MODEL FOR WORKING WITH PAST SHOCK TRAUMA
- Present symptoms and how they affect our day-to-day lives. Understanding the trauma, locating the various body management strategies, building networks, developing resources in the present, developing safe spaces / finding safe people in the present, and recognising the peak-experience of management strategies.
- Exploring the critical element of the shock. How life carried on and how the client worked through elements of the crisis.
- Processing the shock. The peak experience of the shock trauma; processing the core of the shock trauma.
- Strategies for achieving closure with the shock. Network and cultural strategies, e.g. propose rituals.
HEALING OF PTSD AND ENSUING HEALING OF THE EGO
We can get through certain shocks and traumas with our mutual connection and dignity left intact, which means that we don’t develop PTSD, even though our lives have changed.
However, when we are unable to cope with certain events while maintaining our dignity and mutual connection with ourselves and others we may suffer from PTSD. What happens is that the defense patterns that we know and are used until a traumatic event strikes are shattered because of the shock, so that when we gradually come back to our Ego, some of our familiar defense mechanisms have become ‘useless’ in the character-structures and the Ego-functions.
The aim is to get our Ego to grasp, understand and integrate the shock so that it is no longer a splintered fragment of ourselves, but it becomes assimilated in all the skills of how we experience ourselves in the world, thereby integrating this new knowledge.
It is important to teach the Ego to find comfort in the knowledge that there is something greater in ourselves, a space where we can allow ourselves to simply be and experience the world. This needs to be understood cognitively but also synthesised with our feelings and bodies.
The brain can be compared to a computer. The faster it runs, the more stress it accumulates. The more programmes are running, the more memory gets used, and the slower the computer functions, until it stops working altogether. It takes time before we can gain access to it again, and some of the programmes may have got damaged, there may be a virus infection, or some of our files may have got lost.
The brain is quite similar. The more things we busy ourselves with, the slower our brain works. In threatening situations, cognitive structures function too slowly, and the brain begins to automatically shut down certain parts, while other parts take over (brain-stem, instincts, the Me) and do everything while we (the Ego) have no access to what’s going on.
When the danger has passed, and we begin to come back to reality, it is rather like turning the computer back on again. For a while the computer seems to be working properly, but we have lost access to certain parts of it due to a virus or damages on the hard disk.
The Ego slowly begins to start functioning again, but there are parts of our skills that remain hidden, even though we cannot see or understand this. Six months or a year may pass, even two years – actually, several years may pass, even up to 13 years, as we have witnessed in soldiers – before the virus causes the computer / soldier to break down.
So if we compare PTSD cases to virus infections in computers, our work is to locate the virus before the entire computer shuts down.
June 20, 2014 10.39 pm, DR-home page
One in ten people on early retirement suffers from PTSD
Since 2007, 8652 Danes have been afflicted by stressful traumas so severely that they have been deemed unfit to work. This means that roughly one in ten people who go on early pension suffer from PTSD. Compared to PTSD, schizophrenia causes only half as many people to retire early. This is a problem, says the Danish Mental Health Fund, adding that the health system falls short in dealing with this mental illness, given that the striking majority of patients are never offered the right treatment. As a result, we end up seeing so many people suffering from a condition that leaves them disabled in their working lives and social contacts, says Mental Health Fund chairperson, Anne Lindhardt, to Politiken newspaper.
1: PRESENT SYMPTOMS
A: UNDERSTANDING TRAUMA AND RECEIVING ACCEPTANCE
If the traumatic event has taken place in the past 3 months or so, the client still needs to tell the story in detail, voicing all the feelings, and having both the story and the feelings received with acceptance. If the traumatic event took place more than 3 months ago, it is more expedient for the client to stick to the facts. This is based on our experience that a longer period of time has passed during which the client has been functioning relatively well and has come to grips with the event, but is now seeking help because something is not working as well as he wishes or as before. In such a situation, retelling the story complete with feelings and details will oblige the client to relive the trauma, with all the concomitant physical and emotional reactions. We thus run the risk of re-traumatising the client, so keeping to the bare facts keeps the client on a more cognitive undramatic plain.
In the beginning, I would tell my story all the time, even though I couldn’t really remember all that much. It was as if I were narrating an exciting dramatic story and I got lots of attention.
Bit by bit I realised that the attention was directed at the story itself and at what it evoked in the person I was telling it to and with no genuine attention towards myself. As a matter of fact, several people distanced themselves. I began to discover that after I had told the story I would get even sadder, suffer from sleep problems and flash backs that would isolate me even more. So at some point I no longer felt like telling the story anymore. It had become too much for me!
B: MANAGEMENT STRATEGIES AND BUILDING NETWORKS
We teach the client certain basic skills, such as grounding, centring, energy management, and boundaries – 4 of the 11 Ego-functions. Thanks to concrete body exercises that relate to specific psychological themes, all these skills partly restore the connection between the head, the body and the dissociative state.
In addition, this training in basic skills offers a possibility to bolster forgotten resources or discover new ones.
When working with shock, networks are important. It is imperative that we have safe people to contact or be with. In this part of the process we also work on the Ego-function of Connectedness.
C: SAFE SPACE AND SAFE PEOPLE
A vital element of our working method is to find our safe space and safe people – both in the present and perhaps also in the past.
When the Ego splinters and our integrity shatters, we feel alone and insecure, because the world has become an unsafe place to be in. Working on re-establishing our connection to the world, other people and ourselves fosters a sense of security, and new learning can begin.
In the therapy room we utilise the person’s unique ability to visualise, so that when her heart begins to hammer, her hands go clammy and the head goes blank, we ask her to remember her safe space and safe people and ‘run there’. This often works. The client’s heart calms down, and we can begin to talk about what has just happened, what it felt like, what she is experiencing and so on and so forth.
D: RECOGNISING THE PEAK EXPERIENCE OF THE MANAGEMENT STRATEGIES
In Bodynamics, Peak/Culminating Experiences are defined as highly intense experiences with heightened senses, altered sense of time, spiritual openness and a strong feeling of happiness.
In some of the survival strategies there is a peak that is involuntarily linked to the shock event. The peak of the shock can be the point in time when we become aware that we just got through it, that we didn’t die, or that we expanded spiritually. In this part of the process, we become consciously aware of the power and energy of this peak moment, bringing it into the here and now.
As we return to our bodies from the peak moment, we take a decision that is highly spiritually charged. First we perceive and acknowledge the peak moment and in the next phase we work on the decision.
2: EXPLORING THE CRISIS ELEMENT OF THE SHOCK
Every traumatic event unleashes a period of crisis, during which re-alignment takes place. During the second part of our work, we talk about the physical traumas and the problems the trauma has caused in the family and work spheres. We look at ‘how we moved on with our lives’ and which issues we still haven’t worked with.
3: PROCESSING THE CORE OF THE SHOCK
PEAK-EXPERIENCE OF THE SHOCK TRAUMA, PROCESSING THE CORE OF THE SHOCK TRAUMA
A shock may consist of several attendant shocks, which means there may be several shocks and peaks. At the core of each shock we find survival strategies, a peak, and decisions.
When we come out of the shock, there is a period of time when we cannot use the Me and we haven’t activated the Ego yet, so we find ourselves in a no man’s land for a while. It is during this time that we make decisions – core decisions, such as ‘I’d rather die than…’ ‘I will never ever…’ These decisions are so crystal clear and precise about everything or nothing that they seem almost inviolable. ‘I will never go out there again’ ‘I will never again get close to…’ ‘I’d rather die than get intimate again’. We can’t just change decisions such as these. Instead we have to attend to them and investigate what the client gets out of sticking to these decisions.
Occasionally certain skills freeze up, so we end up behaving in the same pattern or repeating the same experience over and over again. Only by reinforcing the Ego and getting new automatic skills from the Ego – skills that can be incorporated in the Me – can the PTSD reaction patterns begin to change.
Given that core decisions are basically decisions piled on top of more decisions, our work doesn’t revolve on changing decisions but only on investigating them and becoming aware of them. Becoming conscious of our decisions obviously also brings about changes, but if we say to people that they will change, they immediately build up new defences to avoid the change.
When we work on blocked areas, and people express that they want to change them, we need to stop them and let them know that we are merely going to help them investigate, find explanations and be there with them, without trying to prove them right or wrong. We will simply be there with them, so that they may take ownership of what has happened.
As soon as we discover our blockages and become conscious of them, both at a cognitive and physical level, the unconscious need for them disappears, and they stop being automatic. They have become conscious, and thus we can choose to use them or simply drop them.
WORKING WITH ENGRAMS
Given that the Ego was not present at the event, it cannot remember what happened, but with the help of somebody else who can offer support and think rationally, traces of the memory may surface up in the Ego, parts of the event may be suddenly recalled, and then the entire explanation / logic behind the event may come back.
It is not important to remember the entire story, but just to remember the things that provide a sense of meaning and wholeness in the client, that help him gain insight into the bits that cause guilt or shame, the parts when he did something that was not okay for the Ego. This integration work will help point out that it was okay, because it was exactly that thing that got the client through and kept him alive.
Memories get stored in several places. We need physical memories and cognitive explanations – we need many layers of memories in order to become integral again. Some people are extremely clear about details and can talk easily about them, but lack the physical memories and need to be helped restore them. Others need help with intellectual understanding. Lots of people don’t remember all that much, but have an unbelievable number of physical reactions, e.g. tics or physical symptoms that they can’t connect to what they remember.
In our experience, it all boils down to which defense mechanisms surfaced from the Ego and how we stored them. All new automatic skills can be created only through the Ego, and that is why it is important to work with physical skills and consciousness in the psychological themes (Character-structures).
WORKING WITH THE FEELINGS THAT TAKE OVER
All emotions elicit a physical response in us, which has an impact on any group’s interaction and survival. Joy opens us up, anger freezes us and shuts us off, sadness lowers our energy levels and makes us vulnerable, disgust causes nausea and an urge to push things away, fear increases our urge to be alert and look around, sensuality/sexuality increases our desire to touch, become attached and get close to someone, shame can either increase energy levels –we blush and look away– or lower energy –we go pale, our hands go cold, we lower our heads and want to crawl away and hide.
Throughout the entire course of therapy we will be working with both the quicker more irrational emotional and sensory input and the more conscious emotional experiences.
STRATEGIES TO CONCLUDE THE SHOCK WORK
Realigning ourselves into a new way of being, integrating new skills and finding new ways of coming back to ourselves takes time and can be boosted through rituals, such as writing a note and sticking it on the fridge, e.g. ‘Remember to say stop!’, ‘Remember to breathe’, go for walks along the water, ask a friend to call you every week in order to maintain stable contact, etc.
Every time we do something that we know is good for us, the body remembers, our sense of security increases and realignment is consolidated.
Working with PTSD means working with several layers in a person. If PTSD has really got hold of someone, something has died in the life that that person used to life. She can never get that life back again, and she always feels a sense of loss of innocence. She must create a new life, and that requires a lot of new elements.
Lene Wisbom, 1955, is a psychotherapist, member of the Danish Psychotherapists’ Association and the European Association for Body Psychotherapy. She is a Bodynamic analyst, senior trainer, supervisor and trauma specialist, as well as head of systemic group processes. She has clinic in Copenhagen. She is a member of the coordinator team of Bodynamic.
Ditte Marcher, 1959, is a senior trainer and CEO of Bodynamic International Ltd. She works as a teacher, management consultant, therapist and supervisor. She is a specialist in working with shock and PTSD. She also works with veterans and youth. She sits on the Forum Executive Committee of the European Association for Body Psychotherapy.
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