Bottoms Up, Going with the Flow

Helping a person release and heal trauma from the body through manual therapy.

By Rebecca M. Ridge, PhD. CST-Dip, Health Psychologist

The study of Post-Traumatic Stress Disorder (PTSD) and acute stress disorders has been ongoing since first described in 1980 in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM3) (APA 1980) and later editions into the mid 1990’s until current. However, the phenomenon of stress disorders with both combat and civilian veterans of wars has been examined and explored since World War II and even suggested during World War I. Based on this psychological diagnosis, there has been an evolution of knowledge and treatments that have grown with our understanding of the implications and long-term ripple effects of ‘trauma’. It is now accepted by many therapists and health care workers that an integrative and holistic treatment is required to help those who suffer with this dis-order to recover a semblance of normal functioning. “Integrative” is the key word and Dr. Bessel Van Der Kolk, one of the formative pioneers in this field, has been a proponent of a variety of therapies      now established as necessary and helpful to strengthen the healing process. His most recent course for professionals      includes a comprehensive list of therapies that can be utilized in the treatment of traumatic experiences. The      integrative therapies combine cognitive and body-based approaches, such as:  Attachment theory and relationships, neurobiology of PTSD and developmental trauma, Internal family systems, EMDR, Sensorimotor, Somatic experiencing, Neurofeedback, sand tray, “Play  and Activity’ therapy, theatre and trauma drama (psychodrama), yoga, self-care practices, and body therapies including craniosacral therapy and Feldenkrais .(Tippet 2021).

Going with the flow, is a body-oriented term describing the action of ‘following the movement of fluids through tissues, membranes, organs and cells. Fluid supports all the structures and systems in the body, from cerebrospinal fluid in the brain, to lymph in lymphatics, to blood in cardiovascular system, to interstitial fluid in organs and fascia, to cellular fluid. Manual therapists, particularly CranioSacral Therapy practitioners, are taught to ‘listen’ with their hands and sensory awareness to the movements of these various fluids and to track, follow and explore the origins and flow patterns, noting areas of restriction, pain, or the absence of feeling. Thomas Myers (2001), certified Advanced Rolf practitioner and senior faculty anatomist of the Rolf Institute, suggests in his book Anatomy Trains that fluid carries the emotional memory within the body-mind. Thus, fluid is key to working with the history of trauma in the body. By following the fluid systems and having both tactile communications, as well as verbal conversation with the patient’s ‘felt’ experience, allows the patient to make sense and meaning of the events that have both shaped them and caused injury or trauma. The body is the container of mental, emotional, and physical experiences as well as the origin of most traumatic experience on the psyche of the person. Going with the flow helps to restore the natural flow of fluids that support the health of all structures and systems within the body. This is the bottom-up approach working at the physical sites of injury where memory and experience are stored. Working with the body offers the possibility of a more holistic healing and recovery from complex trauma and abuse. Bottom-up suggests beginning with the primitive responses compressed and frozen into the brain stem and nervous system and processing these experiences through body-based responses.

Because psychology has long held a rule of ‘no touch’, the practice of hands-on body therapies is often not included in therapeutic modalities for trauma therapists. It is paradoxical that the harm in developmental trauma and abuse is often caused or accompanied by inappropriate, invasive, and even painful touch. Often the energy of verbal/emotional, physical, and sexual abuse is left within the body long after the abuse has stopped. It remains in the body and the mind and is easily triggered by sensations and reminders of that same abuse and violence. The body has been violated and the psyche remains damaged, and trust is broken or lost. The time of the experience is recorded in the tissues and the brain, encapsulated at a particular age in the person’s psyche. These experiences remain hidden like time bombs waiting to explode again and continue the damage to one‘s sense of ‘self’ while the consequences are frequently enacted in their relationships with others.

In the late 1990’s the work of Daniel Siegel (1999), Lou Cozolino (2003), Daniel Stern (1994,1997,2003), and others from UCLA post-doctoral research community combined their knowledge and research in neurobiology to create the focus on relational neuroscience offering new tools to psychological theories and practices of trauma therapy. Psychotherapists could more clearly address the importance of how the brain and nervous system are instrumental in the response to the wide variety of traumatic experiences.

Psychologists and somatic body psychotherapists are aware of the body’s involvement and the vital need to include an approach of talking to the ‘body.’ Various somatic body therapy practices apply Gendlin’s approach known as Focusing (1981) to work with the actual ‘felt response within the body’.  However, ‘talk therapy’ is often not enough in repairing the long-term aftershocks of trauma, abuse, and neglect, nor does it touch the places where harm has left an indelible mark. Trauma also leaves a half-life (similar to radioactivity) of energy within the body and its surrounding energy fields. Peter Levine addresses this most coherently in his early work Waking the Tiger and his early studies of animals who were traumatized in the wild and their embodied responses. Levine evolved his work into Somatic Experiencing, a therapy that promotes a ‘bottom-up’ approach.

Another approach that deserves recognition for its contribution to the trauma-based therapies is CranioSacral Therapy developed by Dr. John E. Upledger (1983), an Osteopathic pioneer in the mid-1970s who researched the influence of ‘chaotic energy ‘or entropy in the brain-body connection. He used terms such as ‘energy cyst’—an implosion of chaotic energy that the body recognizes as foreign. Dr. Upledger hypothesized that in order to protect the organism it ‘walls it off’ until there is the appropriate support and/or intervention to help the body release or redirect this blockage of energy. He described this intelligence of the body as ‘Inner Physician’, which holds keys to the recovery and restoration of wellbeing within the tissues, organs, and vitality of the person. He introduced and explored the potential for CranioSacral Therapy to be ‘cutting edge in working with victims of trauma’. He and his staff created an innovative treatment program for Vietnam Vets at his institute in Palm Beach Gardens in 1991. He put into practice the ‘bottom-up’ approach by addressing the insults within the body and psyche through a gentle, hands-on touching into the fluid systems of the body; literally touching the brain and nervous system through the delicate membranes that surround the brain and spinal cord, known as the craniosacral system. He, along with his colleagues and advanced practitioners, formed teams that were able to touch the pain inside the body and give voice to the Veteran’s suffering. By facilitating the release of restrictions in the body with manual therapy, physical symptoms resolved, and traumatic memories were released verbally and non-verbally, which lessened their hold on the Veteran. This allowed them to restore an inner peace and hopefulness into their bodymind.

A key difference of hands-on manual therapy is that the therapist is working within the tissues, muscles, fluid and organs as the client tells or senses their story which allows the body to unravel the threads of memory and suffering suppressed in the body. Thus, allowing a more integrated healing process.

Once trauma is released through the body/psyche, the nervous system is restored to more optimal functioning. The sympathetic, parasympathetic, and polyvagal nervous systems begin to synchronize harmoniously and the whole person is freed to restore full functioning and vitality. The body is the key and the recovery is through safe, gentle, and compassionate touch. To be truly holistic in one’s approach we know that it is critical to get to the core of the aftershocks and layers of distress and immobilization. The whole person needs to be addressed from the skin and places in the body where invasive or violent touch has occurred. Bottom up means from the internal organs with their containment of suppressed memories, to the layers of fascia and muscle restrictions guarding the psyche, to dysregulation of the nervous system, to imbalances within the meridians, as well as to loss of vitality within the lymphatic, endocrine, and immune systems.

CranioSacral Therapy practitioners are trained to recognize the value of physically listening to the fluids, tissues and organs, following the threads and strain patterns within the body and tracking the subtle releases on multiple levels of consciousness within the body. Learning to respect the client’s inner physician and reflections so that they might discover and release what is harmful within their personal histories within their bodies. Being a patient and considerate guide to the client’s process is paramount to allowing the client to move at their own pace and readiness. CranioSacral Therapy provides a deep level of touch that goes to the heart and soul of the human psyche offering another bottom-up approach and opportunity for the treatment and recovery of a person from trauma, abuse, and neglect. CranioSacral Therapy has demonstrated its ability to support the rewiring of the nervous system and opening the doorway to relational readjustment and restoring a trust in self and others. Research has shown that it is a valuable part of the process for the long-term healing of the whole person. Returning to flow from a body-oriented prospective is a key component to healthy body-mind functioning.

References

• American Psychiatric Association (APA) (1980). Diagnostic and statistical manual of mental disorders (3^rd edition) Washington, DC
• Cozolino, L. (2002). The neuroscience of psychotherapy. New York: WW Norton.
• Gendlin, E. T. (1981). Focusing. New York: Bantam.
• Tippet, K. November 11, 2021 Interview with Bessel van der Kolk, On Being
• Myers, T. (2001) Anatomy Trains. London: Churchill Livingstone.
• Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum Associates.
• Schore, A. (1997). Interdisciplinary developmental research as a source of clinical models. In Moskowitz, M., et al. (Eds.) The neurobiological and developmental basis for psychotherapeutic intervention. Northvale, N.J.: Jason Aronson.
• Schore, A. (2003). Affect regulation and the repair of the self. New York: Norton.
• Siegel, D.J. (1999). Developing mind: Toward a neurobiology of interpersonal experience. New York: Guilford
• Stern, D. (2004). The present moment. New York: W. W. Norton.
• Upledger, J. E. & Vredevoogd, J. D. (1983). Craniosacral Therapy. Chicago: Eastland Press.
• van der Kolk, B. A., McFarlane, A.C., & Weisaeth, L. (Eds.). (1996). Traumatic stress: The effects of overwhelming experience on mind, body and society. New York: Guilford Press.