Distinguishing Between Trauma Activation and Healthy Discharge of Trauma
Melanie Rubin and Kristen Kuester know that bodywork techniques, such as massage therapy, can provide extraordinary relief to trauma sufferers. But the authors of the article “Safe Haven” also know that bodyworkers must be able to recognize when a client is experiencing traumatic activation during a session. That’s because symptoms of trauma activation can look a lot like healthy trauma discharge. If a client’s activation is escalating quickly, this is a signal of hyperarousal leading to activation. Healthy discharge on the other hand is released gradually. Other signs of trauma activation may include the following:
- Quick body movements
- Rapid talking
- Vocal constriction
- Startled look
- Rapid breathing
- Increased heart rate
- Out-of-body appearance
Understanding How Trauma Lodges in the Body
Trauma is physiological, not psychological—trauma literally lodges in the body. The sympathetic nervous system is responsible for most of the processes that occur under the conditions of danger, while the parasympathetic nervous system is responsible for a variety of processes that take place under conditions of safety and relaxation, as well as for the freeze response that takes place during extreme danger.
Neuroscientist Dr. Stephen Porges, who developed the polyvagal theory, explains that when any animal—especially the human animal—faces a threat to its survival, it will assess whether social engagement or social disengagement will manage the challenge. Under conditions of increased threat, the animal will go into hyperarousal and respond by fleeing or fighting. If either strategy does not work, the animal will freeze and become immobile.
Once the threat has passed, this biological response is “shaken off” and the animal’s autonomic nervous system returns to normal. However, if this natural, biological discharge does not take place, the animal becomes fixated in a state of hyperarousal.
In essence, the sympathetic nervous system is stuck in the on position and the parasympathetic nervous system is unable to fully return the body to rest. In this state, the animal (human) will quickly re-experience the traumatic event if any situation feels like the past trauma.
While PTSD is most often associated with war veterans, it can happen to anyone, even children. Sometimes an apparently minor incident can create a lasting effect in a person’s nervous system. Medical procedures, accidents, natural disasters, abuse—even simply witnessing an act of violence—can cause trauma in an individual. The chance that a bodyworker will have a client with PTSD is therefore relatively high. The good news is that touch therapies can work wonders.
Healing Trauma with Touch Therapies
Because trauma originates in the body, there is clearly a place in the healing process for bodyworkers. Bodywork helps trauma sufferers to heal because it can stimulate a healthy, safe discharge of trauma. Trauma discharge will manifest in sweating, laughing, sighing, yawning, crying, shaking, flushing and tingling—these are all symptoms of good release.
But what if your client goes into trauma activation on your table? Rubin and Kuester suggest these six quick response steps:
- Make sure that you feel safe yourself in order to effectively address the situation.
- Keep clear professional boundaries at all times.
- Orient your client to “being in the moment.”
- Encourage your client to stay with current sensory experiences rather than recount the traumatic event.
- Once the client is out of cathartic re-enactment, explain how discussion of the trauma could have triggered the activation.
- Tell your client that he has the resources within to heal; let the client know that you can refer him to a specialist for additional support.
Creating the Safe Haven
If you are considering working with someone you know who has experienced trauma, it is wise to find out more about the person’s background and healing process first. The client should be working with a trauma-therapy specialist at the same time. It’s a good idea to speak with the specialist before beginning treatment, that way you can get a sense of whether bodywork is appropriate for the client.
If you do proceed, make sure that you are creating a safe space for your client:
- Ask your client about situations and places where he feels safe and comfortable.
- Invite your client to access these “good” memories during the session.
- As the session begins, ask client to pick out an object in the room that feels safe. (If the client becomes activated during the session, have him look at the object.)
- Ask the client how he would like to lie on the table.
- Provide a blanket. (This creates an additional sense of protection.)
- Throughout the session ask your client for feedback and check on his comfort level.
- Before touching a new area of the body, inform the client.
- Invite the client to take control of the session by communicating what is or is not comfortable.
If you know of specific areas of trauma in your client’s body, avoid these during the first session. Only work in these areas during subsequent sessions. Safety, trust and excellent communication should be established first. It is good to start with the arms or legs, since that is where the flight or fight responses commonly get locked in the body.
Remembering Your Scope of Practice
The boundaries between talk and touch therapy are not always black and white. However, there are critical guidelines bodyworkers should follow in order to stay within their scope of practice when working with clients who present symptoms of trauma.
Never guide a client to pursue an in-depth description of what he or she is feeling emotionally during traumatic activation. Never give an opinion or interpretation of your client’s symptoms or in any way diagnose what is happening emotionally with your client.
If a client presents symptoms that are severe, and unless you have had extensive training in trauma therapy, refer the client to another practitioner who does specialize in trauma therapy. Techniques often used in providing body-centered trauma therapy include Somatic Experiencing, Emotional Freedom Techniques (EFT) and Eye Movement Desensitization and Reprocessing (EMDR), to name but a few.
In summary, it’s important that professional bodyworkers have a basic understanding of the physiological origin of trauma and are able recognize its symptoms so that they know how to manage trauma activation when it occurs. Moreover, bodyworkers are in an excellent position to communicate this knowledge to others. As touch therapy professionals, you can help create a greater general awareness of how trauma resides in the body, not in the brain.
To read Melanie Rubin’s and Kristen Kuester’s informative article in its entirety, access Safe Haven: Trauma Awareness for Massage Therapists now.