Aquapoetics blog: In the Flow

Integrative opportunity: trauma healing and aquatic bodywork

2010-07-06T15:23:26-05:00

Because we've witnessed the power of trauma healing in water, we see an excellent opportunity for therapists from a wide variety of disciplines to expand and integrate their therapeutic repertoire. Aquatic therapists can get training in effective land-based trauma healing strategies. Talk therapists can learn the basics of aquatic bodywork to discover new ways of working with people in severe trauma. For example, several aquatic bodywork practitioners have sought training in Somatic Experiencing or Energy Psychology to increase the effectiveness of their aquatic bodywork practices. Mental health professionals, nurses and physical therapists have brought their respective skills into the water's warm embrace. Because of this integration, many of those who suffer from Pre-natal trauma, PTSD and Dissociative Identity Disorder have found relief after years of trying other ways to heal their trauma. Diane Tegtmeier and Inika Spence

To round-up the recent series on the potential applications of aquatic bodywork in trauma healing, I am delighted to reproduce here with kind permission an article by aquatic bodyworkers and teachers Diane Tegtmeier and Inika Spence. At the end, you will find links to more about and by these two experienced land-and-water healers.

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Trauma Healing and Aquatic Bodywork

Diane Tegtmeier and Inika Spence (copyright reserved)

When trauma surfaces in the body's memory while being held in warm water, it enters the flow of life. While it’s often terrifying, somehow it also seems 'normal'. By normal I don't mean 'acceptable' but that which is a part of the ebb and flow of life's energies. When memories of trauma arise in water, within the arms of one dedicated to holding others in unconditional love, the energy of trauma lets go. Aquatic bodywork creates an environment so different from the traumatizing event that frozenness yields to warmth and numbness to feeling. Movement, expression and transformation follow and the trauma becomes simply another memory.

Of all the benefits we've witnessed in our many years of offering aquatic bodywork, our work with those who suffer from trauma is the most rewarding, confounding and profound. Often our partner doesn't know they've suffered from trauma until the body memory of it surfaces while being held in the safe, nurturing environment of warm spring water. Here's Diane's account of one such session:

Renee began to draw her knees to her chest. I followed her movement with awareness and touch. I listened and watched closely, and placed my hand mindfully on Renee's belly, which seemed to be the center to which she was bringing her legs. The constriction of both muscle and energy was palpable. Rather than try to massage it away, I just stayed there with my awareness, meeting the pressure with the touch of my hand, following her breath. When I say I listened and watched, I don't mean there were sounds or something to see externally. I was sensing deeply into what was being held without the need to do anything about it. The tension mounted for a while and then her body began to unwind. Her legs began to kick slowly, then more vigorously. My hand stayed at her belly, holding the fulcrum from which the release could happen. I tracked and followed the movement of energy as Renee began to move her arms and then shake her hands. Her voice joined in, haltingly at first, but then with the full-power sound of release.

Following the release, Renee's body softened. I held her in stillness, fully aware of the space between our hearts and inviting healing light to it. Very slowly I began to guide Renee's body into a wave-like movement, right to left, front to back. She sighs, and her tears flow gently and sweetly. She's calm. Tension arises again later in the session, and we repeat a similar process as each layer of trauma releases, followed by integration and transformation.

As the session ended, it took a while for Renee to come into ordinary consciousness as I brought her to the support of the pool wall. I helped her ground by touching her shoulders, elbows, wrists, knees and feet. Once fully back and able to talk, Renee reported that a memory of an abusive childhood experience came to her during the session. Even though she had talked about this incident with her psychotherapist, this was the first time, she said, that she both felt the experience so deeply and was able to release it. More than that, Renee felt a quality of compassion and love all around her in the water such that when she thinks of the incident now, it doesn't create the emotional reaction and fear it once did.

Many experiences like Renee's have shown us the power of aquatic bodywork in helping someone heal from trauma. Whether it's a small trauma, like being yelled at or a big trauma like severe abuse, the healing space that is created by the warm water, the aquatic therapist and the person whose trauma is ready to be healed, aquatic bodywork can be just what's needed. In this article we'll briefly describe what trauma is, some of its symptoms and the common elements shared by effective treatment strategies. Then we'll look at how aquatic bodywork naturally incorporates those elements and describe the skills aquatic bodyworkers need to facilitate healing from trauma.

What is Trauma?

Peter Levine, the author of Waking the Tiger (and creator of the Somatic Experience approach to healing trauma) simply summarizes trauma as, 'Too much, too fast' to which we would add 'not enough' as in severe neglect, especially in infancy. Trauma ('wound' in Greek) is generally defined as any deeply distressing or disturbing experience, which often leads to emotional shock and/or physical injury. Experiences such as torture, natural disasters, war, physical and sexual abuse, surgery, severe neglect or accidents (including witnessing these events) can cause severe Trauma (big T). These can result in Post-Traumatic Stress Disorder (PTSD), a prolonged state of Trauma, for weeks and years following the traumatic event. All of us have experienced trauma (small t) as we encounter life's physical and emotional bumps and bruises, the effects of which can still linger long past the event itself, especially if we didn't have the support we needed to heal from the trauma at the time it occurred. The degree of trauma follows a continuum from simple and mild to severe and complex, all of which can be healed. Trauma affects the nervous system, the emotions, thoughts and energy field of its survivors, all of which interact to create its characteristic symptoms.

Symptoms of Trauma

Because the limbic system of the brain and the autonomic nervous system become hyperaroused in trauma, a memory of the trauma can evoke a similar hyperarousal in the person. They may become hypervigilant, startle at the slightest touch and/or simply become numb or frozen in the presence of an event that triggers a memory of trauma. Conversely, in a situation like Renee's, tension held by trauma comes into the person's awareness when they experience a safe space. The body seems to know when conditions are right for healing. Once triggered, however, the nervous system responds in its conditioned way. With Renee, her belly tightened up and she drew into a protective posture. Other symptoms (described by Feinstein) that may not show up in a bodywork session, but are observed or reported by survivors of trauma include:

fear and avoidance of cues reminiscent of the original trauma

flashback memories (triggered by people, places, things, sounds, smells or thoughts)

anxiety/depression/emotional numbness

panic attacks

dissociation

restlessness

uncharacteristic irritability or outbursts of anger

problems focusing or concentrating

feeling isolated, disconnected and 'different' from others

insomnia, excessive sleep, nightmares

excessive use of alcohol or drugs

conditioned neurologic response to internal and external triggers

While many of us experience some of these symptoms some of the time, for someone with PTSD, they are a part of daily life. We often find trauma hidden in the chronic pain or illness, depression and/or relationship problems our clients bring to aquatic bodywork sessions. Like with Renee, it's rare that our healing partners come with the intention to heal trauma; it just shows up in the session, sometimes for the first time.

Treatment of Trauma

Throughout our history, humans have tried everything from drumming circles to electric shock therapy to free our brothers and sisters from the life-diminishing effects of trauma in our lives. From our collective training and study of trauma studies, we've identified those elements that are common to the most effective approaches to healing trauma. In order to be effective in healing trauma a therapeutic practice must:

bring a traumatic memory into awareness,
calm the nervous system,
reduce hyperarousal, and
reprogram the nervous, emotional and energy systems toward health.

Shamanic, psychodynamic and cognitive behavioral approaches to treating trauma have achieved varying degrees of success (Gallo). Chemicals and botanical substances to calm the nervous system have provided symptomatic relief, but not without side effects and dependency. More recently, somatic and energetic practices have demonstrated good success in not only bringing the traumatic event into awareness, but literally releasing and transforming the neurologic and energetic messages held in the body that are programmed to trigger a traumatic response. Many of our clients have tried years of talk or pharmaceutical therapy only to find the trauma still binding their bodies and hearts. Once they are held in water, it comes into deeper awareness. Let's look now at how aquatic bodywork can incorporate what’s been learned by all these modalities into the unique healing environment of warm water.

What Makes Aquatic Bodywork Effective?

As mentioned earlier, warm water creates a safe, comforting and nurturing environment in which a traumatic memory often comes into consciousness in a natural, unforced way. Since water also holds and magnifies the energy of the healing partners' intentions, those intentions become more potent in water. Compassion, when transmitted by the practitioner, literally bathes the entire body of the receiver.

The emotional and spiritual development of the practitioner is especially important in aquatic bodywork because the person is physically held within the energy field of the practitioner's heart. Here, the receiver's energy field can entrain with the coherent waves of the practitioner's heart field, which research tells us radiates several feet outward and profoundly influences those nearby

Gentle movement through water engages the parasympathetic nervous system for overall calming of the activated sympathetic nervous system. Multidirectional movement allows full release of the energy of trauma from the body. The brain can achieve greater balance with bilateral movement as the body is waved right to left, left to right, through the water. While not researched, this effect may be similar to that achieved in Eye Movement Desensitization and Reorganization (EMDR) trauma healing practices.

Depending on the training of the practitioner, aquatic bodywork enhances and integrates the therapeutic advantages of the acupuncture meridian and subtle energy therapies shown so effective in healing trauma. The water allows for easy stretching of the acupuncture meridians. Acupuncture and subtle energy points can be readily accessed, on both the front and back of the body, to facilitate release and transformation of traumatic energy patterns. Color and sound healing, effective energetic interventions, gain potency when brought into water. In Healing Dance, one form of aquatic bodywork, the body is moved through sacred geometric forms such as the spiral and infinity symbol. A body/soul held in the grips of trauma recognizes these inherently healing energy patterns as it seeks to re-organize itself toward health. We've often seen our partners spontaneously move their bodies into these geometric patterns when given the space to do so and come out of the movement into a calm and peaceful state of being—another layer of trauma transformed.

Finally, aquatic bodywork treats trauma in present time where it is — in the body tissues and energy field. The Presence of the practitioner in warm water creates the conditions needed for in-the-moment release and transformation of trauma, not re-traumatization. To do this, much is required of the practitioner.

The Aquatic Bodywork Practitioner and Trauma

Those well trained in the various aquatic modalities (Watsu, Waterdance, Healing Dance, etc.) are already prepared to offer much of what we've described as the effective elements of healing trauma in water. They use good body mechanics, support their partners safely in the water and hold them in compassionate presence. Many practitioners are helping clients heal from trauma and may not even know it has happened as their client walks blissfully away from the pool.

However, when it comes to working skillfully with someone going through an intense hyperarousal from trauma, most of even the best-trained therapists feel ill prepared to meet the challenge. Also, when people are suffering from Post-Traumatic Stress Disorder (PTSD), more training in the neurology, psychology and energetics of trauma is needed to support someone in treatment over a longer time period. It's advisable for aquatic bodyworkers to work collaboratively with mental health and medical professionals in treating severe PTSD.

The water invites flow and integration with a number of other effective modalities In healing trauma. In Diane's work with Renee, for example, she drew upon her social work education and experience, Hakomi and energy healing training to co-create sessions that specifically met Renee's needs. With other clients she may also incorporate energy psychology strategies. Inika brings her Somatic Experiencing and Cranio-Sacral training into the trauma healing sessions. The heart of the practitioner and her willingness to consciously work on healing her own trauma shapes the foundation of the work, however. It's also essential that the practitioner be able to stay centered in the eye of an emotional storm, to contain her own feelings of fear or a need to rescue, all of which takes more training and practice than the basic aquatic modality training. A person in trauma needs a practitioner who can 'ride the rapids' with them, as Ron Kurtz, the founder of Hakomi therapy says. The practitioner needs to have developed the skills to facilitate the release and transformation of the traumatic pattern without acting on a need to change anything. Even though silence pervades most aquatic bodywork sessions, for serious trauma work, it's essential that an aquatic bodyworker be skilled in therapeutic dialogue (verbal and non-verbal) and an understanding of how to communicate and work with someone in a non-ordinary state of consciousness.

Opportunity for Integrative Therapies

Trauma, both simple and complex, mild and severe is prevalent in our times, and never have there been so many effective options for treatment. We have a wonderful opportunity, by integrating the best of these options to reduce suffering in those so wounded by violence and fear. In so doing, we foster peace. (For references cited see below.)

With thanks to Diane and Inika for sharing their work and art. Sulis

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Inika Spence and Diane Tegtmeier will be presenting their findings in treating trauma with aquatic bodywork at the United States Association for Body Psychotherapy Conference 'Unraveling trauma: Body, Mind and Science' (CA, 22 Oct. 2010).

Further reading

A page giving links to the full series on Aquapoetics: Trauma healing

In particular, I recommend:

Aquatic bodywork and trauma healing (more about Inika and Diane's work)

A moving article by Inika Spence 'Somatic Experiencing: Healing Journey' can be found in the Summer 2010 Harbin Quarterly (2.7MB pdf)

Relationships that Heal: book review (Diane Tegtmeier's book on ethics for bodyworkers, with special reference to aquatics)

References cited in article reprinted above 'Trauma healing and aquatic bodywork' by Diane Tegtmeier and Inika Spence:

[1] Feinstein, David, PHD. Presentation, Energy Psychology in Disaster Relief. at Association for Comprehensive Energy Psychology 10th Annual Conference. Albuquerque, NM. 2008

[2] Gallo, Fred, PHD. Presentation, at Association for Comprehensive Energy Psychology 10th Annual Conference. Albuquerque, NM. 2008

________Energy Tapping for Trauma: Rapid Relief from Post-Traumatic Stress Using Energy Psychology. New Harbinger Publications, Inc. Oakland, CA. 2007.

Waking the tiger in water: trauma to tranquility

2010-06-27T06:00:00-05:00

Aquatic bodywork and trauma healing: After Peter Levine, PhD. NICABM Seminar title: Healing Trauma Through Somatic Experiencing

This post is part of the series New treatments for trauma: a review with special reference to aquatics. (Subscribe to keep up with future posts here.)

When an aquatic bodywork client shows subtle shifts in posture, or parts of the body begin trembling, vibrating, pulsing, or moving in other ways, they may be showing signs of the somatic release of old trauma. This is a natural, healing response shared with other mammals. Peter Levine's Somatic Experiencing® method demonstrates why the body matters so much in trauma healing. He also talks of a possible link with ecstatic states.

The yogi's judicious use of natural forces [kundalini] can be compared to the farmer who floods his fields one by one within their earthen banks, letting the water thoroughly drench the soil before breaking open a new channel into another. For safety's sake, the yogi employs method and restraint so as to use nature's energy intelligently to gain wisdom. BKS Iyengar Judicious use of natural forces (kundalini yoga)

Somatic Experiencing® is a body-awareness approach to trauma that is based upon the realization that humans have an innate ability to overcome the effects of trauma. This is the seminar I was most looking forward to in the NICABM series; it was so popular that a repeat play was requested and 7,752 practitioners signed up representing countries all over the world.

Peter Levine outlined what animals can teach us about the experience and resolution of trauma and what it is about human biology in particular that can turn this natural response into pathology. He related this to the neocortex, a part of the brain that is involved in higher functions such as sensory perception, generation of motor commands, spatial reasoning, conscious thought, and language.

When restrained, animals go into tonic immobility - they stop moving and lose muscle tone. If frightened before or after a traumatic event the immobility response can go on indefinitely. In people, fright can remain for a long time also, since the neocortex resists the response that moves someone out of immobility - 'fear of fear'. It is important then to uncouple fear from immobility.

To provide a metaphor for this, Peter invited listeners to look at their open hand, then make a fist - this is like trauma he said. Opening that fist reveals your hand but where did the fist go? Trauma recedes through this rhythm of contraction and expansion (called 'pendulation' in Somatic Experiencing® terminology). The fundamental aim of SE is to re-educate the neocortex to experience this natural healing rhythm.

This immediately struck me as resembling one of the rhythms of aquatic bodywork where the whole body and its limbs are expanded out and folded in many times during a session. In my post, Aquatic bodywork and trauma healing, Diane Tegtmeier describes pendulation as 'releasing and resourcing'. She has incorporated this concept into the aquatic training program for trauma healing that she is currently developing with Inika Sati (a Somatic Experiencing® practitioner).

How a practitioner responds to someone who has entered a trauma state can affect their healing. Peter Levine sees the immobility response as an 'arrest' after which an animal or person orients towards the danger and moves into fight-or-flight or seeks help. If someone is frightened as they come out of freeze (or the therapist working with them becomes afraid - postural and facial aspects of fear are immediately picked up), the trauma may be reinforced.

Deepening core awareness and the implications for aquatic bodywork, Part 3: Some ways of working with the psoas on land and in water (elsewhere on Aquapoetics) Extract: Somatic Experiencing®. This body-oriented method of working with trauma, developed by Peter Levine, has been mentioned in Parts 1 and 2. He believes that trauma is the result of physiology, not psychology, specifically our instinctual fight/ flight drives. According to this approach, discharge of repressed emotions is not sufficient to address underlying developmental and psychophysiological stress. A practitioner is trained to notice subtle shifts in posture or parts of the body trembling, vibrating, pulsing, or moving in other ways. They then guide someone in following their internal sensations while staying very present....This technique appear to have much to offer as an adjunct to psoas-trauma healing, especially where resolution and reintegration is needed in addition to releases. Read more.

Kundalini and trauma processing

At the end of this NICABM seminar with Peter, I was thrilled to hear his brief mention of the possible connection between effective trauma processing and the release of kundalini energy through the chakras of the body. This link is something I've been exploring in the water also, as described in An aquatic kriya: the bodywave.

He pointed out that some ecstatic states include combinations of sympathetic and parasympathetic arousal, but without the fear that triggers trauma. This brings me full circle to Bill O'Hanlon's insights into the positive value of trance in the first seminar of the NICABM series. Working in this arena requires skill and subtlety; and also a willingness to explore beyond the boundaries of conventional understanding.

Questions: 1. Have you used the 'releasing and resourcing' cycle in your own practice? Give an example? 2. Do you have any thoughts on this possible link between ecstatic states and trauma? (Add your comments below. Please be careful to protect the confidentiality of clients in anything you share.)
I'll leave you with some extracts from further posts on Aquapoetics that explore kundalini, altered states, shadow work, and energy healing in the context of aquatic bodywork and trauma work. A full list of other posts I have extracted to use in this series on trauma is also given below. Please enjoy browsing and commenting on the blog or writing to me wherever you feel inspired to do so.

An aquatic kriya: the bodywave (elsewhere on Aquapoetics) Extracts: I have a body that has tended to be physically expressive (especially in water) of the impact of not only physical but also emotional and spiritual experiences in my life. From a difficult birth to the usual gamut of life challenges, I have found bodywork to be an intriguing way to bear witness to and (in my subjective experience) transform positively the negative effects these mind-body-spirit impacts have had. The bodywave was an effect that opened me up to this 'healing' possibility more fully than I believe would otherwise have occurred.

...

There is the additional curious finding that even though an outside person can see the distortions or twitches or jerks the person's body makes, the person themselves is often completely unaware of them. They go into a kind of trance state which seems to prevent 'normal' inhibition of these movements. It is possible that this is just a curious side-effect of nervous system dis-inhibition that occurs in some people and has no benefit or significance regards health or otherwise. It is also possible that it does have a benefit. So far, my informal questioning of those who have neuroscientific backgrounds has not produced any useful insights into this.*

In my own experience as a receiver, there have been phases during which my body repeated strange nervous system effects. It's important to note that I am always aware of these effects, but I am able to allow them, and that this is a choice I make. After a certain time and repetition, and perhaps the consciousness I brought to them as body memories (reactions to trauma) that were no longer appropriate or necessary, most of these effects have stopped happening. I believe that this made a difference to me - a beneficial one. But it is no quick fix and it requires a certain willing surrender. Also I can't prove the benefit, or that it was due to the water work.

*I now realize that these insights may be provided by the new studies of trauma and neurobiology.

Read more.

A return to the water (elsewhere on Aquapoetics) This is the first of a series of five posts inspired by my own personal aquatic therapy work as a receiver in 2009. I worked with Inika Sati, Diane Tegtmeier and Sunheart, all practitioners based at Harbin Hot Springs, home of Watsu. The series also takes my explorations of altered states, kundalini and shadow work to deeper levels. Extract: My personal experience is that the physical body is intimately linked with and affected by state of consciousness; and that both exist within a dynamic energy field that immersion in body-temperature water can be extraordinarily effective in revealing and transforming. I believe that attending to the troubles of the body in the purely physical dimension is not as likely to be of lasting value, or as effective in healing, as setting the body in a context where its energy field can be attended to also. Water offers such a setting. Read more.

Pristine waters: murky depths (elsewhere on Aquapoetics) Extract: We ought to be as willing and capable of guiding someone through the murky, monster-ridden deep as we are at playing in the pristine, glistening realm of spiritual waters. And for that, it's best to be well-acquainted with both places ourselves.....Ideally we hold space for both aspects when working in water since aquatic bodywork seems to trigger both transcendent and descendant experiences in people. Read more.

Water bridges a therapeutic gap (elsewhere on Aquapoetics) Extract: Water is not only a bridge between energy and matter, but also between the conscious and unconscious minds, the rational and the emotional, waking state reality and altered states, and the subjective and objective realms. Currently science does not know how to bridge this gap. Read more.

Go back:

New treatments for trauma: a review with special reference to aquatics

Bad trance to good trance: finding resource in the (aquatic) trance state ( after Bill O'Hanlon)

Working on your own trauma history before working with others in the water (after Babette Rothschild)

Fire and water: what happens in the brain during trauma (after Robert C. Scaer)

The body speaks its trauma: nonverbal and preverbal expression (after Pat Ogden)

Caught fish or floating seaweed: signs of trauma in the water (after Diane Poole Heller)

Select list of other posts on this blog mentioned in this review of trauma treatments (click link)

Building a body of evidence for aquatic bodywork: drop by drop

2010-06-26T14:32:38-05:00

Where does aquatic bodywork stand in the wellbeing, healing and medical arenas? Recently, I highlighted some special series of posts on Aquapoetics, one of which was: Healing or therapy

It's a topic that interests and challenges me as I continue to explore what I most value about my experience and practice of working in water in this way. And I admit that I'm often disappointed by the apparent lack of interest or challenge among most of my colleagues.

With evidence-based medicine becoming a buzz word of increasingly signficant regulatory influence in the spa world and in integrative health practices, it's helpful to know what David Sackett et. al. had to say in the British Medical Journal back in 1996.

Three components of this way of providing medical care were given. I've highlighted the two that you may not have realized (I did not) were included in their definition, emphasizing valuing individual experience, practice and choice in health.

I feel a lot more comfortable with this concept than I have done to date. As aquatic bodyworkers, if we can provide clinicians with experience of the effectiveness of our work, we can begin to build the body of evidence that is currently lacking. We don't have to wait for clinical trials alone.

Clinical expertise (experience and practice of individual clinicians)
+
Clinical evidence from systematic research
+
Patient's choice (taking into account individual values and preferences)

Here is an extract from the BMJ Editorial. The full link is given below; I recommend reading more recent comments on the topic linked to from the article.

Evidence based medicine is the conscientious, explicit, andjudicious use of current best evidence in making decisions aboutthe care of individual patients. The practice of evidence basedmedicine means integrating individual clinical expertise withthe best available external clinical evidence from systematicresearch. By individual clinical expertise we mean the proficiencyand judgment that individual clinicians acquire through clinicalexperience and clinical practice. Increased expertise is reflectedin many ways, but especially in more effective and efficientdiagnosis and in the more thoughtful identification and compassionateuse of individual patients' predicaments, rights, and preferencesin making clinical decisions about their care.

Evidence based medicine: what it is and what it isn't -- Sackett et al. 312 (7023): 71 -- BMJ.

Recently, a friend who lives in Denver shared with me that her primary health care physician (through a private health care service that comes with her husband's work in emergency medical services) gave her a glowing referral to a Watsu practitioner in the area. Evidence at work?

My suggestion: Start sharing what you have learned through your aquatic bodywork practice - with your colleagues, your clients and their clinicians. Find online venues - like this one and others I have highlights on this website - and get the flow of discovery going.