*I wrote this article for body-psychotherapists - a kind of do-no-harm piece. "Shock" is a common term for "trauma" in the BPT world. It will also give you an idea of a few things a body-psychotherapist might do with trauma. It was published in 1993 in a body-psychotherapy journal called Energy and Character (and was also published in Danish and German journals). If you would like a reprint for duplication and/or other articles, let me know. You are welcome to distribute it to others so long as my copyright and signature remain included.*

A basic knowledge of Post-Traumatic Stress or Shock is crucial for the Body-Psychotherapist. Shock reactions often present themselves in body work. Much of what we observe as discharges of fear and probably all of what we observe as discharges of terror are expressions of shock. Most people with marked Schizoid tendencies, Psychotic experiences and Borderline traits have significant amounts of shock. In my personal Reichian body work I was, unknowingly by my therapist, pushed into the core of my own shock which resulted in my falling apart 2 times (See: Rothschild, 1991). I have also heard of many other instances in body-psychotherapies -- clients (and therapists) in the U.S and Europe that have had similar problems, although many of these cases are not talked about openly. I believe that a knowledge of the theory, identification and treatment of shock could prevent some, if not all, of these breakdowns.

"Shock" is a nervous system reaction to threat to life. You have likely heard the term referred to in cases of physical harm or accidents. That is its most extreme occurrence. Shock also occurs under lesser forms of threat, and even when the body is not actually harmed.

Animals of prey can have shock reactions when stalked by predators whether or not they are caught and eaten. Very simply, in threat a natural escape response is fight or flight. This activity is assisted by the Sympathetic branch of the Autonomic Nervous System : blood flow comes strongly to the muscles of the limbs, breathing increases, heart rate increases, the system is all-alert. If the threat is repeated before the animal has had time to recover, or if it becomes caught, the Parasympathetic branch will also come into play and may even "mask" the Sympathetic, i.e.: blood may flow to the center of the body, respiration decrease, and heart rate drop, while the skin becomes cold, and paralysis, or "tonic immobility" will occur (See: Levine, 1990/91).

Shock/Post-Traumatic Stress can result from any traumatic situation(s) in which a person's life is at risk or where s/he perceives it as such. Examples include: war, surgery, rape, sudden loss, incest, assault, abuse, accidents, etc. Shocks can be single standing, i.e.: an accident. Or they can be linked in chains: abuse, incest, torture (which usually involve several incidents over time), or seemingly single-standing shocks that are connected by an underlying -- usually unconscious -- theme, i.e., loss, invasion, etc. When the shock(s) and accompanying fear are not worked through at the time of occurrence -- usually because adequate help, support, safety and contact was not available -- psychological and physical symptoms can develop. Typical complaints include: phobias, panic attacks, night terrors, dizziness and fainting, heart palpitations, tremors, feeling paralyzed to act, speak, decide when under stress, unexplainable physical symptoms, and much of what is diagnosed as "Borderline Personality" (See: Levine, 1992).

We often see these kinds of symptoms in clients, but can mistake their meaning. A common indication of shock reaction in body work is a client who seems relaxed and expansive after a session, while the heart pounds, and has an anxiety attack within a few hours of the end of the session. We have, traditionally, interpreted that s/he has orgasm anxiety, or fear of streamings or expansion -- but something much deeper and important may be happening. S/he may actually be contacting the center of a shock experience and then dissociating from it -- as s/he had to do originally, for survival. The clients who are panicking after session, or in their daily lives, seem to be getting less, rather than more connected through their body work, do not experience the feeling they discharge, etc. are likely to be ones with underlying shock. If you don't think in terms of or look for shock, you can risk re-traumatizing them.

Case example #1. A man was referred to me in crisis suffering severe anxiety and "strange" body sensations: streamings up the back, heart palpitations, and "strange visions". This had begun after his last Bioenergetic therapy session where he worked with grief over the loss of a lover and had cried deeply. He further reported that his father was currently critically ill. In taking a trauma history it became clear that the recent loss and father's illness had provoked contact with a trauma he suffered at 6 years old when his mother suddenly died. Signs of shock beyond the physical ones described above included memory block of his mother, although he could remember other events before he was six, and dissociation from emotions tied to the mother's death. Here the therapist made the mistake of focusing on the acute situation, and not observing the extreme reactions and symptoms in the client which indicated earlier shock, This therapeutic oversight resulted in the client's "Borderline crisis". I began crisis work with this client by first educating him about "shock" and helping him understand why he had had such severe body symptoms. I then went on to help him develop body awareness and some ability to contain his reactions. These were first steps to a longer shock-therapy process.

Dissociation is the first line of human defense in shock. The person "splits" from the experience in memory and/or emotion. The extremes of this are "Multiple Personality" and "Borderline Personality" -- usually indicators of severe abuse/shock. But we encounter lesser forms of dissociation all the time: often the significance of a shock is dismissed by the therapist because the client speaks of it without emotion or involvement, or because whole blocks of the client's life are "forgotten". These splits are major signs of shock.

So, what do you do? The first step in treating shock is to identify it. Identification can spare the client further trauma. It is important to take a careful trauma history beyond the usual "Case History". Clients aren't likely to name their most crucial traumas, even if remembered, if not directly asked. What kinds of possible traumas has the client been exposed to? Ask about them at 5-year intervals (i.e., birth-5, 5-10 years, etc.): accidents, losses, divorce, sudden moves, witnessing accidents, violence, rape, etc. And watch how the client responds to the questions and answers them. Does she talk about a rape with absent expression and vacant eyes, or with the same tone she might discuss a laundry list? Does he have pictures of the accident from outside his own body? Does he remember his experiences in the war, but not remember being scared? Does she speak of the car accident with trembling cold hands and flushing red cheeks? These are signs of shock. Are there blocks of time in the person's life that are not remembered? Strongly suspect shock(s) there. And suspect a forgotten shock in any phobia, especially agoraphobia.

You will know the client is discussing a trauma that is worked through (either previously, or in work with you) if s/he remembers the whole event and details around it, can speak of it in contact without any of the shock symptoms discussed above and below, and has appropriate emotional response, e.g., sadness over a loss, fear at remembering a gun, anger at the rapist, etc. These "worked through" traumas may still have elements to work on, but no longer be "shock".

Next, be aware of shock when you give a session -- look for signs of shock reaction: Is the pulse going up while the respiration is going down? Are there wide differences in temperature over the body? Is there cold sweat in the extremities and flush in the face? Are the pupils small and contracted, or very dilated? Are the eyes "bugged out" or sunken? Does the client become paralyzed or stiff, faint, go "dead", or seem to have left his body? This is by no means a complete list, but if any of these or similar signs appear in a client, DO NOT work towards a discharge or catharsis. Get here-and-now eye contact, and, if ok with the client, give supportive body contact -- like holding a hand or placing a hand to support the back. Have the client describe in detail what s/he is experiencing in his/her body. And have him/her to tell you what scared him/her, but keep him/her in the here-and-now, away from the "center" of the shock.

It is important before and during work with shock to teach body awareness -- not just of the energy flow, but of the body: skin -- temperature, moisture; muscles -- tense, slack; joints; heart -- rate, regularity; digestive organs; sexual organs; posture; etc. Ability to be aware of what is happening in the body is the major tool of containment. It is not good to work with shock unless the client is able to hold awareness of his body. Body awareness is actually the greatest single tool and resource you can give your client in working with shock.

Case example #2. A young woman was referred to me for therapy because of panic attacks and agoraphobia. She was so dysfunctional in her life, with many Borderline symptoms, that we couldn't begin to work with shock issues until she had built some resources for containment and functioning in her daily life. Our first work involved focusing on building her body awareness; sense of and control of her energetic and psychological boundaries; and establishing a network of friends (normal prerequisites for such a client (See: J=F8rgensen, 1992)). She was able to begin a job that was close to her home, and move from her parent's house (although still coming home to sleep when she was very afraid). After 5 months she came to therapy and announced that she had recently had the worst panic attack of her life one day at work. She proceeded to describe in bodily detail the course of the attack: where the anxiety began, what happened in her breathing, heart rate, muscles, temperature. She ended the report, "and then I became very warm all over, and then it ended" -- it had lasted only 1 or 2 minutes. She was tremendously proud of herself. It was the first time in her long history of such attacks that she was able to follow a course of anxiety to it's conclusion -- which she never knew was possible or that such a course was actually so short. Having built this crucial resource of control over herself, we could now begin to slowly approach work with the underlying shock, focusing on body awareness. Now she will be able to judge the level of work she can tolerate, and to contain the feelings that may come up in the work and between sessions.

Work with and respect for the client's boundaries is another crucial area to attend to before, during and after work with shock. A shock trauma always includes a breach of physical and/or psychological boundaries. This may mean that in some therapy sessions, or perhaps over many sessions, "body work" must be done without touching the client, and possibly with client and therapist physically distant from each other. This will be especially -- but not only -- important when working with shocks involving sexual and physical assault and abuse (See: Ollars 1992). It goes without saying that a therapist never touches a client who asks not to be touched and never touches a client sexually or in sexual areas of the body -- even if the client requests it.

An abused client may not realize that it is physical touch (or certain kinds or places of touch) that sometimes result in his/her shock reactions. Exploring these physical and distance boundaries with the client -- using the tools of body awareness -- will help him/her to gain more control over his/her body -- something usually lost in shock. Experiencing the therapist's respect for his/her boundaries will facilitate the client in rebuilding trust in contact with others.

Case example #3. A middle aged man was referred to therapy because of a history of failed relationships. Part of my work with him involved direct contact with his body -- releasing or supporting muscles. When he began to have dissociative reactions after therapy sessions I began looking for shock in his background and uncovered several occurrences of abuse by his mother which he had "forgotten". Through body awareness-based boundary experiments he discovered that any kind of touch or nearness was actually very unpleasant and frightening for him. We proceeded to begin each therapy session with his determining just where he and I should sit. Sometimes we sat about 5 feet apart, sometimes at opposite ends of the room. After establishing this "therapeutic space" we would proceed with other aspects of shock work. He kept his distance for many months. Gradually there came periods where he could sense a desire to be touched, and he explored very precisely just where and how that should be. He began with requesting a supportive hand at his back, and at first could only tolerate a couple of minutes at a time. Gradually, at his pace, he learned when he wanted to be touched, where, how and how long. He used the tools he gained in the therapy to begin a relationship with a woman, learning to be aware of and assert his touching and distance boundaries in a sexual relationship.

It is important when working with shock, no matter what techniques are used, to follow these basic theoretical principles:

1) Never go directly to the shock center or have a client "re-live" a shock. This is the major way that clients become re-shocked in therapy.

2) Always begin from events around the shock (both before and after), slowly integrating emotion and meaning of all details.

3) Touch on the periphery of the shock and go away from it again. This will give the client a greater sense of control over the work and the trauma over which s/he had no control. And it will allow a slow integration of bodily and emotional changes and meanings.

4) Never "charge" the client (build up energy or excitement with breathing, provocation or other such techniques) -- in shock the body and psyche are already over-charged, the nervous system overly excited. You want to slowly bleed the charge from the system and gradually lower the level of excitement.

5) Never push or control the breathing -- but watch the natural breathing as an indicator of where the client is in the shock process.

6) Help the client to uncover the decision (s) s/he made during or shortly following the shock event. This is a key to the working through, containment, and integration of the shock.

The staff of the Bodynamic Institute in Copenhagen, Denmark and Peter Levine in Reno, Nevada, USA have developed two very excellent bodily-based methods for working with shock. They have developed them separately, while sharing with and being influenced by each other's. Each system has it's own strengths and weaknesses, but each follows the above principles I have outlined.

I would like to encourage those interested in further reading on work with Shock to read the articles listed in the Bibliography and to also obtain Peter Bernhardt's up-coming article: "Somatic Approaches to Shock: A review of the work of the Bodynamic Institute and Peter Levine". All of these articles are available through: The BODYnamic Institute, Schleppegrellsgade 7, 2200 Copenhagen N, Denmark. Peter Levine's up-coming book manuscript is available from: PO Box 1247, Boulder, CO 80360, USA.

REFERENCES

Jørgensen, Steen, Cand.Psych, "Bodynamic Analytic Work with Shock/Post-Traumatic Stress", Energy and Character, Vol. 23, No. 2, September 1992.

Levine, Peter D., Ph.D., "The Body as Healer: A Revisioning of Trauma and Anxiety", Somatics, Vol. VIII, No. 1, Autumn/Winter 1990/1991.

Levine, Peter D., Ph.D., THE BODY AS HEALER: TRANSFORMING TRAUMA AND ANXIETY, unpublished book manuscript, 1992.

Ollars, Lennart, Cand.Psych, "Bodynamic Analytic Work with Assault" BODYnamic Institute, 1992.

Rothschild, Babette, M.S.W., "Bodynamic Body-Psychotherapy", Radix Review, Vol.1, No. 1, 1991.