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Resolving Trauma inPsychotherapy: A SomaticApproachby Peter Levine

PTSD and Veterans: AConversation with Dr. FrankOchbergby Frank Ochberg

Explaining PTSD & The CountingMethod (2-DVD Set)by Frank Ochberg, MD, and AngiePanos

Healing Trauma Through theBody: The Way In is the Way Out

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by Victor Yalom and Marie-Helene Yalom

Master somatic therapist Peter Levine discusses thephysiological origins of trauma, and how his SomaticExperiencing approach provides effective treatment.

Sections in this Interview:An Unconscious Image

The Polyvagal Theory

Releasing Trauma from the Body

Working with an Iraq Vet

Emotional Processing with Trauma Survivors

Experiencing the Body

A Personal Experience of Trauma

PTSD & Medication

Comparison to EMDR

Current Work

VictorYalom:

So Peter, you've spent most of your life working with trauma and traumatized patients, and have

developed an approach called Somatic Experiencing® that focuses on including, and putting emphasis, on

the physiological aspects of trauma. You believe that working with the trauma through the body is

necessary to any trauma resolution and a required step before addressing emotional and cognitive issues.

We'll get into this in more detail, but let's first start with: What got you there? How did you get interested in

trauma in the first place?

PeterLevine:

My career began somewhat accidentally. In the 1960s I started a practice in the fledgling field of mind-body healing. Around that time it was completely in its infancy. I had been developing a protocol to usebody awareness as a tool for stress reduction. I would teach people how to relax different parts of theirbody and they would have a very deep relaxation that was much deeper than I had expected. And so Iwas referred a patient—I'll use the name Nancy—by a psychiatrist, and she had been suffering from a hostof physical symptoms including migraines, severe PMS, what would now be called fibromyalgia andchronic fatigue, pain in most of her body. And the psychiatrist reasoned that if I could help her with someof my relaxation techniques, it could help with her anxiety or at least with her pain.

VY: Now, were you a psychologist at that point, Peter?

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at that moment of stress, Ikind of was prompted byan unconscious image, avision of a tiger crouchingat the other side of theroom and getting ready tospring.

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PL: At that time I was finishing a degree in medical biophysics. And again, there was not a field of bodywork atthat time, but I had met some influential people including Ida Rolf and Fritz Perls, and I was hanging out atEsalen—I took a leave of absence—and that's where I really got exposed to these different mind-bodyapproaches.

VY: And this was a heyday where all sorts of things and discoveries were happening?

PL: Crazy stuff. Yeah, exactly. It was both exciting and a chaotic free-for-all in some ways. So anyhow, thispsychiatrist sent this woman, Nancy, to see me, and she was extremely anxious. And she was with herhusband because she couldn't go out of the house alone. She had, again what would be called now,severe agoraphobia. So anyhow, she came into my office and I noticed her heart rate was really quite high—it was probably about 90, 100 beats per minute. So I did some work with her breathing and then with thetension in her neck. And her heart rate started to go down. And I thought, "Oh, okay, this is great." And itwent down and then all of a sudden, it shot up to, I don't know, 140-150 beats per minute. I could see thisfrom her carotid pulse.

VY: Not what you were going after.

PL: Not exactly. I had gone from success to abject failure and, really, fear of putting her into extreme panicattack. So I said something, probably the most stupid thing anybody could say. I said something like,"Nancy, just relax. You need to relax." And her heart rate started going down. And it went down and downand down. And it went to a very low level, probably in the mid-50s. And she looked at me. She turnedwhite, and she looked at me, and she said, "I'm dying, I'm dying. Doctor, don't let me die. Help me, helpme, help me." And at that moment of stress, I kind of wasprompted by an unconscious image, a vision of a tigercrouching at the other side of the room and getting ready tospring. And I said, "Nancy, Nancy, there's a tiger, a tiger'schasing you. Run, climb those rocks, and escape."

VY: And this was just a spontaneous kind of image that came from your imagination or unconscious?

PL: This was a spontaneous image. My unconscious. Yeah, because I had really, truly no idea what to do. Iwas in a state of, well, near panic myself. So to my amazement, to both of our amazement, her legsstarted moving as though she were running. And her whole body started to shake and to tremble. And thisoccurred in waves. And she went from being very very hot to extremely cold. Her fingers turned almostblue. And the shaking and the trembling and the waves of coldness and heat went on for almost 30-40minutes, maybe. And after that, her breathing was free and spontaneous. She opened her eyes and shelooked at me and she said, "Do you want to know what happened, Doctor? Do you want to know whathappened to me?" And I said, "Yes, please."

This was one of the first patients. This was certainly the first one where something like this had happened.I worked with a lot of people in getting them to relax, and there were some kinds of things like that, butnever anything nearly as dramatic. So anyhow, she reported how during the session she remembered along forgotten event: as a four year old child, she was given ether for a tonsillectomy—at that time, etherwas routinely used for tonsillectomies—and she remembered feeling suffocated and completelyoverpowered by the doctors and nurses who were holding her down to put on the ether mask while shewas trying to scream and get away. As I discovered later, many people who had anxiety disorders hadalso had tonsillectomies as children with ether. So anyhow, that was the last panic attack that she had.And many of her symptoms abated. Others disappeared completely. We did a few sessions after thatwhere I was actually able to do different relaxation procedures with different muscles and different parts ofher body. So of course I was curious about the image—where did that come from?

Marie-HeleneYalom:

The tiger image?

PeterLevine:

Yes, the tiger image. At that time, I was taking a graduate seminar, and some brief mention was made ofa phenomenon called tonic immobility. If animals were physically restrained and frightened, they would gointo a profoundly altered state of consciousness where they were frozen and immobilized, unable to move.And it turns out that this is one of the key survival features that animals use to protect themselves fromthreat—in this case from extreme threat. Actually there are three basic neural energy subsystems. Thesethree systems underpin the overall state of the nervous system as well as the correlative behaviors andemotions, leading to three defensive strategies to threat.

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MY: That's the polyvagal theory developed by Stephen Porges?

PL: Yes. These systems are orchestrated by the primitive structures in our brainstem—the upper part of thebrainstem. They're instinctive and they're almost reflexive. The tonic immobility is the most primitivesystem, and it spans probably over 500 million years. It is a combination of freezing and collapsing—themuscles go limp, the person is left without any energy. The next in evolutionary development is thesympathetic nervous system, the fight-or-flight response. And this system evolved from the reptilian periodwhich was about 300 million years ago. And its function is enhanced action, and, as I said, fight-or-flight.Finally the third and most recent system is the social engagement system, and this occurs only inmammals. Its purpose is to drive social engagement—making friends—in order to defuse the aggressionor tension.

VY: So this is when we're feeling threatened or stressed we want to talk to our friends and family?

PL: Yeah, exactly. Or if somebody's really angry at us, we want to explain what happened so they don't strikeout at us. Obviously most people won't strike out, but we're still hardwired for those kinds of expectations.

VY: Most people have a general sense of the fight-or-flight, but would you just say a few words on it?

PL: Basically, in the fight-or-flight response, the objective is to get away from the source of threat. All of ourmuscles prepare for this escape by increasing their tension level, our heart rate and respiration increase,and our whole basic metabolic system is flooded with adrenaline. Blood is diverted to the muscles, awayfrom the viscera. The goal is to run away, or if we feel that we can't escape or if we perceive that theindividual that's trying to attack us is less strong than we are, to attack them. Or if we're cornered by apredator—in other words, if there's no way to escape—then we'll fight back. Now, if none of thoseprocedures are effective, and it looks like we're going to be killed, we go into the shock state, the tonicimmobility. Now the key is that when people get into this immobility state, they do it in a state of fear. Andas they come out of the immobility state, they also enter a state of fear, and actually a state in which theyare prepared for what sometimes is called rage counterattack.

MY: Can you say more about that?

PL: For example, you see a cat chasing a mouse. The cat catches the mouse and has it in its paws, and themouse goes into this immobility response. And sometimes you'll actually see the cat bat the mouse arounda little bit until it comes out of the immobility, because it wants the chase to go on. Now, what can happenis that the mouse, when it comes out of the immobility state, goes into what is called nondirective flight. Itdoesn't even look for where it can run. It just runs as fast as it can in any direction. Sometimes that's rightinto the cat. Other times, it will actually attack, in a counterattack of rage. I've actually seen a mouse whowas captured by a cat come out of the immobility and attack the cat's nose. The cat was so startled itremained there in that state while the mouse scurried away. When people come out of this immobilityresponse, their potential for rage is so strong and the associated sensations are so intense that they areafraid of their own impulse to strike out and to defend themselves by killing the predator. Again, this allgoes back to our animal heritage.

So the key I found was in helping people come out of this immobility response without fear. Now, withNancy, I was lucky. If it were not for that image, I could just as easily have retraumatized her. As a matterof fact, some of the therapies that were being developed around that time frequently retraumatized people.I think particularly of Arthur Janov's Primal Therapy, where people would be yelling and screaming out,supposedly getting out all of their locked-in emotions, but a lot of times they were actually terrorizingthemselves with the rage and then they would go back into a shutdown, and then be encouraged to"relive" another memory, and then this cycle would continue.

MY: It becomes addictive sometimes, right?

PL: That's correct. It literally becomes addictive. And one of the reasons is that when you do these kinds ofrelivings, there's a tremendous release of adrenaline. There's also a release of endorphins, which is thebrain's internal opiate system. In animals, these endorphins allow the prey to go into a state of shock-analgesia and not feel the pain of being torn apart. When people relive the trauma, they recreate a similarneurochemical system that occurred at the time of the trauma, the release of adrenaline and endorphins.Now, adrenaline is addictive, it is like getting a speed high. [section;And they get addicted not only to theadrenaline but to the endorphins; it's like having a drug cocktail of amphetamines and morphine.] So whenI was at Esalen I actually noticed that people would come to these groups, they would yell and scream,tear a pillow apart that was their mother or their father, and they would feel high. They would feel reallygreat. But then when they would come back a few weeks later, they would go through exactly the samething again. And that's what gave me a clue to the fact that this might be addictive.

VY: So getting back to Nancy, from what you observed and what you learned from the animals' various

You're not actuallyexposing the person to atrauma—you're restoringthe responses that wereoverwhelmed, which iswhat led to the trauma inthe first place.

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responses, what was your understanding of what happened with Nancy and what you did that was actually

helpful?

PL: What was helpful is that her body learned that in that time of overwhelming threat she could not defendherself. She lost all of her power. Her muscles were all tight. She was struggling to get away—this wasthe flight response—to get out of that, to get away from those people who were holding her down and torun out of the room and back to her parents. I mean, that's what her body wanted to do, her body neededto do—to get out of there and get back to where she could be protected. So what happened is all of thisactivation, this "energy" that was locked into her body when she was trying to escape and then wasoverwhelmed, was still there in a latent form. When we're overwhelmed like that, the energy just doesn't goaway—it gets locked very deeply in the body. That's the key. It gets locked in the muscles.

MY: And that's the foundation of your understanding of trauma—this locking of energy?

PL: That's right, exactly. How the energy, how this activation gets locked in the body and in the nervoussystem.

MY: And so your objective is to help the person release that energy?

PL: Yes, to release that energy, but also to re-channel that energy into an active response, so then the bodyhas a response of power, of its own capacity to regulate, and the person comes out of this shutdown stateinto a process in which they re-own their own vital energy—we use the term "life energy." It's not generallyused in psychology but I think it's a term that is profound in people's health, that people feel that they havethe energy to live their life fully, and that they have the capacity to direct this energy in powerful andproductive ways.

VY: Now obviously you're just giving a snapshot of the case and we can't capture the depth and the nuances

of it. But someone who doesn't know about this could think it sounds a little simplistic. This woman had a

tonsillectomy decades ago, and you're having this one session with her and somehow you're freeing up

some energy that was trapped back then. How would you respond to that?

PL: Well, it was simplistic, and of course I was to learn that one-time cures were not always the case.However, over the years I started to develop a systematic approach where the person could graduallyaccess these energies and these body sensations—not all at once, but one little bit at a time. It's aprocess that I call titration. I borrowed that term from chemistry. The image that I use is that of mixing anacid and a base together. If you put them together, there can be an explosion. But if you take it one dropat a time, there is a little fizzle and eventually the system neutralizes. Not only does it neutralize but afteryou do this titration a certain number of times, you get an end result of salt and water. So instead of havingthese toxic substances, you have the basic building blocks of life, I use this analogy to describe one of thetechniques I use in my work with trauma patients.You're notactually exposing the person to a trauma—you're restoringthe responses that were overwhelmed, which is what led tothe trauma in the first place.

VY: And you're doing it very slowly, one little step at a time.

PL: Very slowly.

VY: Would you say that is the key?

PL: That's the key. So you get a little bit of discharge, you get a little bit of a person's body, like their hands andarms, feeling like they want to hold something away from them, that they want to push something away.So they feel that energy, that power into the muscles in their arms. If they want to run they feel the energy,the aliveness in their legs. The ideas are extremely simple, but the execution of them is much morecomplex. Actually we have a training program and the training program is a three-year program.

VY: I think this is really nicely demonstrated in the video that we're just releasing at the time of this interview,

where you demonstrate five sessions with Ray, who's an Iraq vet, who was in an IED explosion. And when

he first presents, his body is visibly twitching every few seconds, and you came up with an explanation that

he's actually trying to reorient himself to the original trauma, that he was never able to face the trauma.

PL: Yes, well, exactly. This was a young Marine. While he was on patrol two explosive devices blew up rightnear him and he was thrown into the air, and woke up two weeks later in Landstuhl, at the military hospitalin Germany. Afterwards he was diagnosed with traumatic brain injury and PTSD and also Tourettesyndrome, and this was, I think, because of this extreme twitching. You saw this kind of twitching, theseneurological presentations in the World War I soldiers. Some of them could barely walk, and they weretwitching and in near convulsion. And I think these people who are exposed to these bombs actually havesimilar presentations. But let's go back to the day when he's on patrol. The bomb blows up. Now whathappens whenever there's a loud sound is that it startles us, right? And we arrest what we're doing and wetry to localize that sound because that sound could be a threat. That's something that's hard-wired in ourbodies. These responses were actually discovered by Pavlov in the 1920s. So there's an explosion andwhat we do is we turn toward the source of the explosion.

VY: That's how we know where it's coming form.

PL: Exactly. And so what we do is we start to turn our eyes, our neck and head, turn towards that source to tryto localize it. In Ray's case, as soon as his eyes and head began to orient, in milliseconds, he was thrownup into the air and this defensive response, this orienting response became completely disorganized andkept repeating itself. It's what many psychologists see in people who are perseverating. They'll go oversomething...

VY: So your understanding of his constant visible twitching which presented in the first few sessions was that

he was still trying to orient himself to the trauma. He'd never been able to complete that orienting

response.

PL: Exactly. Because as soon as he began to orient, as soon there was that pre-motor impulse and beforethat orientation could be felt—much less executed—he was thrown into the air, and in the air his wholebody was trying to say, "What can I do?" And so all of his muscles contracted together. Again, this is anarchaic response that we've inherited from monkeys. For example, if a monkey falls out of a tree, its wholebody flexes. And it does that to protect the vital organs. So in a situation like this, if we're thrown into theair, or even with extreme startle, all the muscles in the front part of our body, the abdomen and the legflexors and so forth, go into this protective response. So that also contributed to Ray's symptoms, to hischronic pain, because his whole body was locked to protect himself from falling. And of course there werealso many emotional issues, such as a tremendous amount of loss and survivor's guilt—he saw many ofhis best friends killed—that grafted themselves onto the physical trauma.

VY: So in terms of titration that you were talking about, your goal initially in therapy, in the treatment, is to do

what?

PL: The goal is to very gradually help him get in touch with the sensations that precede the twitching and thatwill eventually enable him to complete the orienting responses that were interrupted. It wouldn't haveworked if I had said: "We're going to work on controlling the tics." If you tell somebody with Tourette, forexample, to not twitch, they may be able to control it for a while, and they do it generally, because in socialsituations they don't want it to happen. But then the more they try to control it the more explosive itbecomes. It is similar to glowing embers—if you blow on the embers, it ignites into a flame. So the key is tocool the embers before they ignite into flame. The flame is this convulsive response.

This is a concept that exists in migraines or epilepsy. Before a seizure, a person experiences prodromalsymptoms. So for example, before they get the migraine attack, they may see flickering lights or they mayhave a particular smell or a body sensation. And they know when they experience those symptoms thatthey will go into a seizure or a migraine or even an anxiety attack. I focus on something I call the pre-prodromal, because once the person experiences the prodromal, then they go into the attack, theparoxysm. So if you are able to get them to just feel before that—in the pre-prodomal stage, they canredirect that energy, and as they do so they begin to complete the orienting responses that wereoverwhelmed by the trauma. And in the video, you see Ray little by little begin to reestablish his orientingresponses, and this triggers very profound sensations of cold and heat, coolness and warmth, tingling andrelaxation.

MY: And that's the energy being released.

PL: Yes, that's the energy being released that's shifting from one system to another.

VY: And you gradually help him to spread that energy, rather than just being in the neck or head, so he

experiences it going through the rest of his body.

PL: Exactly, exactly. At first these sensations are only local, mostly in the head or the neck. Then as we do thisrepeated times, and you'll see this is done several times in each of the first four sessions, gradually theconvulsive reaction attenuates and then almost disappears. And in its place he feels pleasure in his body. Iwas able to invite him to Esalen at one of the workshops I give once a year titled "Awakening the OrdinaryMiracle of Healing." By then he had been able to resolve the physiological aspect of the trauma, he was

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until the person has dealtwith and sufficientlyresolved the physiologicalshock, they really can'tdeal with the emotions

able there to address the emotional aspects of it. Two things happened in that workshop. First of all, hedealt with the different emotions—his loss, his anger, and his guilt that he survived and that many of hiscomrades did not. But he was also able to reenter and engage with a group of people around feelings ofgoodness and of social engagement, of hunger for being able to relate to people in a non-aroused....

MY: In a nonviolent way.

PL: In a nonviolent way, exactly. And you see so many vets now—when they come back, they go into maybenot complete convulsions like he did, but into an exaggerated fight-flight-freeze response which can lead toattacks on their children or their spouses. And they do it in an involuntary way, and are helpless to changethat. And unfortunately there's little help available for these soldiers to resolve their trauma reactions andbe able to reintegrate....

MY: Peter, you talked about how it's only in session five that Ray started expressing his emotions. You

approach trauma in a very different way than most traditional psychotherapists would, where they would

focus probably sooner on dealing with emotions.

PL: Yes.

MY: And you have strong feelings about that.

PL: Actually, what you are alluding to is the whole idea of bottom-up processing. So maybe let's get back tothat, okay? In top-down processing, which is normally what we do in psychotherapy, we talk about ourproblems, our symptoms, or our relationships. And then the therapist often tries to get the client to feelwhat they're feeling when they talk about those kinds of things. Or they try to work with them to becomemore aware of their thoughts so that they can change their thoughts. In this model the language that you'retalking with the client is in the realm of symbols, of thoughts, of perceptions. The language of the emotionsis the language of the emotional brain—the limbic system. And in order to change emotions, people haveto be able to touch into the emotions, to express the emotions.

In the case of trauma patients, we have a person who is locked in the fight-or-flight response and as Iexplained earlier in the Polyvagal theory, a person who is functioning primarily in the brainstem, and thelanguage of the brainstem is the language of sensations. So if you are trying to help the person work withthe core of the trauma response, you have to talk to that level of the nervous system.

MY: So what you're saying is a person who has been traumatized cannot really process emotions if they are in

the early stages after the trauma until they have dealt with their physiological traumatization.

PL: Right, until the person has dealt with and sufficientlyresolved the physiological shock, they really can't deal withthe emotions because the emotions actually will throw themfurther back into the shock, if the emotions occur at all. Manyof these people are so shut down that it's very difficult to getat any emotion. But if some kind of therapy forces them intothe emotions, that can have a deleterious effect. That cancause them to further withdraw into the immobility, into theshock reaction. So you have to dissolve the shock first.

VY: What you're saying, though, flies in the face of most of conventional therapy, which goes straight for the

emotions. Do you think that most therapies are actually not helpful, or is something else happening during

that time?

PL: Many therapists are doing something different from what they think they're doing. And if you're working withemotions in a very titrated way, then you can actually go from the emotions to the sensation, and begin toresolve things at a sensation level. But therapies that really work to provoke emotions or the exposuretherapies... I know that they do get some results, but I think that they can easily lead to retraumatization.

VY: How so?

PL: One of the things that Bessel van der Kolk showed when he first started to do trauma research withfunctional MRIs is that when people are in the trauma state, they actually shut down the frontal parts oftheir brain and particularly the area on the left cortex called Broca's area, which is responsible for speech.When the person is in the traumatic state, those brain regions are literally shut down, they're taken offline.When the therapist encourages the client to talk about their trauma, asking questions such as, "Okay, sothis is what happened to you. Now, let's talk about it," or, "What are you feeling about that?" The clienttries to talk about it. And if they try to talk about it, they become more activated. Their brainstem and limbicsystem go into a hyperaroused state, which in turns shuts down Broca's area, so they really can't express

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And they go sometimesinto something thatresembles a bliss state. Butit's really an ungroundedbliss state. I call that thebliss bypass.

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in words what's going on. They feel more frustrated. Sometimes the therapist is pushing them more andmore into the frustration. Eventually the person may have some kind of catharsis, but that kind of catharsisis due frequently to being overloaded and not being able to talk about it, being extremely frustrated. So ina sense, trauma precludes rationality.

MY: So what do you think is the hardest thing for traditional talk therapists to learn when dealing with trauma

patients?

PL: I think the most alien is to be able to work with body sensations. And again, because the overwhelm andthe fight-or-flight are things that happen in the body, what I would say is the golden route is to be able tohelp people have experiences in the body that contradict those of the overwhelming helplessness. And mymethod is not the only way to do that. It's certainly one of the most significant. But many therapists, forexample, will recommend that their clients do things like yoga or martial arts.

MY: Or meditation?

PL: The thing about meditation, though…. With some kinds of trauma, meditation is helpful. But the problem iswhen people go into their inner landscape and they're not prepared and they're not guided, sooner or laterthey encounter the trauma, and then what do they do? They could be overwhelmed with it, or they find away to go away from the trauma. And they go sometimesinto something that resembles a bliss state. But it's really anungrounded bliss state. I call that the bliss bypass. It's a wayof avoiding the trauma. It was very common in the ‘60s whenpeople were taking all of these drugs, and a lot of thesepeople were traumatized from their childhood. And what theywould do is they would go into these kinds of dissociatedstates of bliss and different hallucinatory imageries, but in away it was avoiding the trauma. So in a way the traumabecame even a greater effect, and then often people would then wind up having bad trips in which theywould go into the trauma but without the resources to work them through.

MY: I guess that's what I find inspiring about your approach. Ultimately you really want to enable the

traumatized person to regain their autonomy, not just find palliative methods of dealing with their trauma.

PL: Yes. One thing therapists are really good at, I think, is they're good at helping people calm. We set up ouroffices so they're conducive, so they're friendly, they're cheerful, there are things in the room that wouldevoke interest and curiosity. And many therapists can actually help calm the traumatized person. This issomething that's a necessary first step, but if it's the only thing that happens, the clients become more andmore dependent on the therapist to give them some sense of refuge, some sense of okayness. But whentherapists are helping the clients get mastery of their sensations, of their power in their body, than they aretruly helping them develop an authentic autonomy. And from the very beginning, the client is beginning toseparate.

So this is a gradual process, where the client really becomes authentically autonomous, authentically self-empowered. And if we don't do this, the client tends to become more and more dependent on thetherapist, and this is when you see these transferences where all of a sudden the client depends on thetherapist for everything. At this point the therapist can go from being the god or the goddess up on thispedestal to being thrown down and the client having rage about the therapist for not helping them enough.So the key out of these conundrums is through self-empowerment, and I know of no more direct andeffective way of doing this than through the body.

MY: You use an accident that happened to you—you were hit by a car—and your own experience of trauma as

a way to demonstrate some of the principles of Somatic Experiencing®. You describe how some people

were helpful to you and some were not. It seems like a good example to illustrate what to pay attention to

when interacting with a traumatized person. Would you say more about that?

PL: Actually I got a good dose of my own medicine. Thankfully. I was walking a crosswalk five or six years ago,and a teenage driver went through the stop sign. I didn't see her because there was a large truck parkedwaiting at the stop sign and she didn't see the stop sign and she was passing the truck. So she hit me atabout 25 miles an hour, and I was splatted out on the pavement. And in shock, disoriented, I didn't knowwhat had happened. And at that moment, or probably shortly thereafter, an off-duty paramedic came andhe sat by my side and said, "Don't move." Now remember how previously I was talking about Ray, and hisorientation to the explosion when he heard the blast. Well, similarly my survival response is to orient

by re-experiencing thosemovements and letting mybody shake and trembleand feel the differentemotions—one was therage at this woman, thedesire to kill this girl—Iwas again able to groundthese feelings in my body.

towards where that command came from. But then he's telling me, "Don't move."

MY: So it's a contradiction.

PL: Exactly, it's a complete contradiction. So I go into a freeze, into a panic. And at that moment, I dissociatefrom my body—it's like I'm out of my body and I'm looking down and seeing this man kneeling by my sideand seeing me in this frozen state. Of course, somebody called on their cell phone for an ambulance. Butthen after a little while, he kept asking me questions, and I was able to get enough orientation to say,"Please just give me time, I won't move my neck," and I didn't want to answer questions about what myname was, where I was going, what the day was. I needed to collect myself, and all of those things weremaking things much worse. So I was able to set enough of a boundary to have him back off. Thenmiraculously, serendipitously, a woman came, much calmer, sat by my side, and she said, "I'm a doctor.I'm a pediatrician. Can I do anything?" And I said, "Please just sit here by my side." And she touched myhand with her hand, and we folded our hands together.

VY: She worked with kids so she probably knew how to calm children down.

PL: Exactly. And that's what we need when we're traumatized. We need that kind of direct contact where weknow somebody is protecting us. Because when we're in trauma, we go back to a pretty infantile state offeeling completely unprotected. So it was really, really important, and I know I couldn't have done what Idid without her being there. I could have done some of it, but her presence really was very important. Andthen what I was able to do was recollect myself. I was actually able to experience being hit by the car,being thrown in the air, how my arms and hands went out to protect myself first from the window of the car,and then protect my head from getting smashed on the road.

MY: When you say experience, do you mean mentally, or do you mean literally by moving your arms?

PL: I literally experienced my arms as though they were moving. I mean, you could barely see it. These arewhat are called micro-movements. But as I felt that, I felt that instead of my body becoming limp, I startedto get more strength in my body. As I started to get more strength in my body, my physiological systemsstarted normalizing. When the guy first took my blood pressure it was about 170, and my heart rate was100 beats per minute. When I was in the ambulance, by re-experiencing those movements and letting my body shakeand tremble and feel the different emotions—one was therage at this woman, the desire to kill this girl—I was againable to ground these feelings in my body. That was the key. Icould ground them in my body. And by doing this, my heartrate and blood pressure went to a normal level when I was inthe ambulance—it dropped to 120/72.

MY: And you said to the paramedic "Thank God, I won't be getting PTSD."

PL: There was actually some research done in Israel with people who went into the emergency room. Ofcourse, everybody's heart rate and blood pressure is recorded. And people who had a normal heart rateand blood pressure when they left had a very low likelihood of developing PTSD. Those who left with ahigh heart rate and blood pressure were very likely to develop PTSD.

MY: So what caused some of them to leave with a lower heart rate versus high?

PL: Well, that's hard to know, and unfortunately this wasn't studied. It could have been that somebody thereactually helped them calm down, saying things like, "It's okay, I'm here to help you, we're going to takecare of you, we're going to help you." I mean, I don't know that. That's a guess. These people may havebeen more resilient; the other people may have had more trauma. These variables weren't controlled for.But the basic idea is that if we're able to reset our physiological system, able to reset our nervous system,then we don't develop the symptoms of trauma. That's a little bit of oversimplification, because somepeople, instead of going into the sympathetic response, go into the shutdown state more directly. That's alittle bit more complicated. But in my case, by being able to reestablish that my body knew what to do—toprotect itself—I&allowed my body to come back into present time, to re-orient and to get through thisunscarred. And I'm sure if I hadn't been able to do that, I would have been highly traumatized from thatevent. I have no question about that.

VY: You mention in the ambulance trembling and shaking. What's the significance of that?

PL: That was similar to what I described with Nancy, my first client. The shaking and trembling has to do withthe resetting of the autonomic nervous system. I was so curious about this that I interviewed a number ofpeople who work with capturing animals and releasing them into the wild. And they described to me verymuch the kinds of shaking and trembling that I see with my clients and that happened to me. A number of

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these folks said that they knew that if the animals didn't go through this kind of shaking and tremblingwhen they were captured and put in cages, they were less likely to survive when released into the wild. Soit appears to be a way in which the physiological autonomic nervous system resets itself. Very often thisshaking and trembling can be so minute that you barely perceive it from the outside. And the client or theperson experiencing it, experiences it in a very subtle, nonthreatening way. As a matter of fact, after ashort period of time, they often experience it as being pleasurable. Exactly what it is, we don't know, butagain, I've talked to Stephen Porges, who is probably the preeminent psychophysiologist working withthese kinds of nervous system states, and it does appear that this occurs as the autonomic nervoussystem shifts, particularly out of the shutdown states into the mobilization states and then into the socialengagement states. So it's something that goes on as the nervous system comes out of shock.

MY: Peter, you mentioned PTSD earlier. You've worked with numerous clients who had PTSD. Many of them

heavily medicated. Has there been any research done about the impact of somatic therapies versus

medication, and what is your experience of the effect of medication in cases of PTSD?

PL: Well, first of all, I'm not against medication.

MY: Sure. And actually, Ray is taking quite a lot.

PL: He was. But he felt like he was just completely blotted out. He was put on an antipsychotic medication andantidepressant medication. Medications that help stabilize clients enough so that you can begin to accessand work with them can be important. For example, the SSRIs are sometimes helpful in that regard.However, with many of these people, most of the SSRIs are so activating that it actually makes thingsworse. But if it works, if it helps a person even a small percentage, that can be of real value.

Benzodiazepines, which are often prescribed, in my experience, interfere with the healing process. Somepsychiatrists have prescribed very small doses of the atypical antipsychotic Seroquel to help PTSD peoplesleep. And that seems to be helpful, —because if the person can get some restorative sleep, then they canbegin to process the trauma. But just drugs by themselves—the person will very often have to take thedrug basically forever. There's a saying: meds without skills don't do the trick. So the key is for the personto be self-regulating.

VY: How would you compare Somatic Experiencing® from EMDR?

PL: Well, EMDR basically works with one technique. And actually, many of the people who have studiedEMDR have trained with us, and vice versa as well. The key here, and nowadays I think EMDR is doingthis more, is to reference things as sensations in the body. Again, I think without the body things arelimited. It's really, really key to work with the body, or to reference in the body. I do some work with theeyes, but I do it in a different way from the EMDR movement—it's actually quite different. And EMDR hashad research, and they have often had good results. We haven't had the same kind of extensive researchthat EMDR has. My approach is a much older approach—I developed that in the late ‘60s and early ‘70s—but we haven't had the extensive research.

VY: We've covered a wide span of your fascinating career. What's exciting you now? What are you working on

now?

PL: I just completed two books on preventing trauma in kids—one for therapists and medical workers andteachers, and the other for parents. The one for parents is called Trauma-Proofing Your Kids: A Parents'Guide to Instilling Confidence, Joy, and Resilience. And the book for therapists, teachers and medicalpeople is called Trauma Through a Child's Eyes. And then I am just in the process of completing my mainwork, really. It will be released in September. It's called In an Unspoken Voice: How the Body ReleasesTrauma and Restores Goodness. So those are my big projects right now, and I'm actually kind of underpiles of chapters right now doing the final completion on that book.

MY: Do you still have time for patients?

PL: Not really. Most of my time is with teaching. I do see people… Occasionally people will come from out oftown or out of the country and then I work with them for a few days, I do intensive work with them. But Idon't have any kind of a regular practice anymore.

MY: I have one more question for you, Peter. You were telling us before this interview that you are coming

back from Esalen where you were teaching a group of therapists who were primarily talk therapists with

any kind of tools thattherapists have to be ableto help clients referencetheir body, and particularlyto find the ways that theirbody experiences powerand mastery, are going todramatically inform thetype of therapy they'redoing.

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Peter A. Levine, PhD, is the developer ofSomatic Experiencing© and founder of theFoundation for Human Enrichment. Heteaches trainings in this work throughout theworld and in various indigenous cultures.Levine is the author of the best-selling bookWaking the Tiger : Healing Trauma : TheInnate Capacity to TransformOverwhelming Experiences and he has

recently co-published a comprehensive book on childhood trauma,Trauma Through a Child's Eyes: Awakening the OrdinaryMiracle of Healing as well as a guide for parents, Trauma-Proofing Your Kids: A Parents' Guide for Instilling Confidence,Joy and Resilience. He is the recipient of the 2010 LifetimeAchievement Award from the the US Association of BodyPsychotherapy.

Victor Yalom, PhD is the founder, president

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little somatic therapy experience. And you said they were like kids. What was so exciting for them?

PL: Actually this is a class I teach with Bessel van der Kolk, and Bessel is one of the leading researchers inthe field of trauma research. He's done some of the main core studies in the neuroscience of trauma. Heand I teach a workshop together every year. I think we've done it for ten years. In the group we had thistime, there were about 60 to 65 people, and almost all of them were talk therapists of one kind or another.And it was really tremendously exciting and gratifying for both of us, for Bessel and me, and also ofcourse for the students, for them to realize, "Oh my gosh, there's a whole other universe beyond just usingtalk." And I think we also gave them some simple tools that they could begin to incorporate into theirconventional psychotherapy practice. And that's another thing that we're doing with my institute—programs for different kinds therapists where they don't have to have full training for working with trauma,but they begin to get some simple tools that they can incorporate into whatever kind of therapy they do,whether it's cognitive therapy, psychodynamic therapy...

MY: You think it works with most therapies?

PL: Yes. There's no therapy that can't be made better by referencing the body. Actually Eugene Gendlin, whocoined the term "the felt sense" in his seminal book, Focusing, did his PhD thesis on what therapiesworked best. And he found that there was very little correlation between whether a patient improved andwhat kind of therapy he had. So he said, "Well, maybe it's the experience of the therapist." Well, there wasa small correlation. "Well, maybe it's the relationship between the therapist and the client." And again,there was a small correlation, but really nothing that explained why some clients really got well in therapyand others didn't. And what he discovered was that the single variable that was the most robust waswhether clients were able to reference different changes, different experiences they had in their bodies. Soany kind of tools that therapists have to be able to helpclients reference their body, and particularly to find the waysthat their body experiences power and mastery, are going todramatically inform the type of therapy they're doing.

VY: Well, I understand that talk alone cannot heal all, but certainly our talk has been tremendously informative

to us and hopefully to those who have a chance to read this. So thank you very much for taking the time

to explain this all to us.

PL: Gladly. I hope it was of value.

Copyright © 2010 Psychotherapy.net. All rights reserved. Published April 2010.

and resident cartoonist of Psychotherapy.net.He also maintains a part-time practice inindividual, group and couples therapy inSan Francisco and Mill Valley. He hasconducted workshops in existential-humanisticand group therapy in the US, Mexico, andChina, and also leads ongoing consultationgroups for therapists.

Marie-Helene Yalom holds a PhD in physicsfrom University of Paris VI, an MBA fromNorthwestern University, and has over 15years experience in corporate strategy andmarketing, primarily in technology relatedindustries. She is the Marketing and StrategicDirector for Psychotherapy.net and was theco-producer and director of the DVDResolving Trauma in Psychotherapy: A

Somatic Approach.

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