Pat Ogden Quotes

Pat Ogden and Peter Levine have each developed powerful body-based therapies, sensorimotor psychotherapy29 and somatic experiencing

Although most psychotherapeutic approaches "agree that therapeutic work in the 'here and how' has the greatest power in bringing about change" (Stern, 2004, p. 3), talk therapy has limited direct impact on maladaptive procedural action tendencies as they occur in the present moment. Although telling "the story" provides crucial information about the client's past and current life experience, treatment must address the here-and-now experience of the traumatic past, rather than its content or narrative, in order to challenge and transform procedural learning. Because the physical and mental tendencies of procedural learning manifest in present-moment time, in-the-moment trauma-related emotional reactions, thoughts, images, body sensations, and movements that emerge spontaneously in the therapy hour become the focal points of exploration and change.

Top-down cortically mediated techniques typically use cognition to regulate affect and sensorimotor experience, focusing on meaning making and understanding. The entry point is the story, and the formulation of a coherent narrative is of prime importance. A linguistic sense of self is fostered this process, and experience changes through understanding

As connection to the therapist is established, the therapeutic relationship offers an opportunity for the client to experience a present attachment, but it also brings up transferential tendencies associated with past attach ment relationships (Sable, 2000). Informed by the experience of interperesonal trauma and betrayal, posttraumatic transferential relationships can be exceptionally potent and volatile. In response to the therapist, clients experience fear, anger, mistrust, and suspicion, as well as hope, vulnerability, and yearning, and they are acutely attuned to subtle signals of disinterest or interest, compassion or judgment, abandonment or consistency (Herman 1992; Pearlman & Saakvitne, 1995).

In bottom-up approaches [to processing trauma], the body's sensation and movement are the entry points and changes in sensorimotor experience are used to support self-regulation, memory processing, and success in daily life. Meaning and understanding emerge from new experiences rather than the other way around. Through bottom-up interventions, a shift in the somatic sense of self in turn affects the linguistic sense of self.

When clients are hyperaroused or overwhelmed emotionally, voluntarily narrowing their field of consciousness allows them to assimilate a limited amount of incoming information, thereby optimizing the chance for successful integration. For example, as one client began to report her traumatic experience, her arousal escalated: Her heart started to race, she felt afraid and restless, and had trouble thinking. She was asked to stop talking and thinking about the trauma, to inhibit the images, thoughts, and emotions that were coming up, and orient instead to her physical sensation until her arousal returned to the window of tolerance. With the help of her therapist, she focused on her body and described how her legs felt, the phyisical feeling of anxiety in her chest, and the beating of her heart. These physical experiences gradually subsided, and only then was she encouraged to return to the narrative.

When the attachment figure is also a threat to the child, two systems with conflicting goals are activated simultaneously or sequentially: the attachment system, whose goal is to seek proximity, and the defense systems, whose goal is to protect. In these contexts, the social engagement system is profoundly compromised and its development interrupted by threatening conditions. This intolerable conflict between the need for attachment and the need for defense with the same caregiver results in the disorganized–disoriented attachment pattern (Main & Solomon, 1986). A contradictory set of behaviors ensues to support the different goals of the animal defense systems and of the attachment system (Lyons-Ruth & Jacobvitz, 1999; Main & Morgan, 1996; Steele, van der Hart, & Nijenhuis, 2001; van der Hart, Nijenhuis, & Steele, 2006). When the attachment system is stimulated by hunger, discomfort, or threat, the child instinctively seeks proximity to attachment figures. But during proximity with a person who is threatening, the defensive subsystems of flight, fight, freeze, or feigned death/shut down behaviors are mobilized. The cry for help is truncated because the person whom the child would turn to is the threat. Children who suffer attachment trauma fall into the dissociative–disorganized category and are generally unable to effectively auto- or interactively regulate, having experienced extremes of low arousal (as in neglect) and high arousal (as in abuse) that tend to endure over time (Schore, 2009b). In the context of chronic danger, patterns of high sympathetic dominance are apt to become established, along with elevated heart rate, higher cortisol levels, and easily activated alarm responses. Children must be hypervigilantly prepared and on guard to avoid danger yet primed to quickly activate a dorsal vagal feigned death state in the face of inescapable threat. In the context of neglect, instead of increased sympathetic nervous system tone, increased dorsal vagal tone, decreased heart rate, and shutdown (Schore, 2001a) may become chronic, reflecting both the lack of stimulation in the environment and the need to be unobtrusive.

This reorienting is not an attempt to avoid or discount clients' pain and ongoing suffering. Rather, it is a means to help them observe, firsthand, how their chronic orienting tendencies toward reminders of the past recreate the trauma-related experience of danger and powerlessness, whereas choosing to orient to a good feeling can result in an experience of safety and mastery. As clients become able to do so the new objects of orientation often become more defined and & Goodman 1951). Rather than attention being drawn repeatedly to physical pain or traumatic activation, the good feeling becomes more prominent in the client's awareness. This exercise of reorienting toward a positive stimulus can surprise and reassure clients that they are not imprisoned indefinitely in an inner world of chronic traumatic reexperiencing, and that they have more possibilities and control than they had imagined. These orienting exercises need to be practiced again and again for mastery.

The redirection of orientation and attention can be as simple as asking clients to become aware of a "good" or "safe" feeling in the body instead of focusing on their physical pain or elevated heart rate. Or the therapist can ask clients to experiment with focusing attention away from the traumatic activation in their body and toward thoughts or images related to their positive experiences and competencies, such as success in their job. This shift is often difficult for clients who have habituated to feeling pulled back repetitively into the most negative somatic reminders of their traumatic experiences. However, if the therapist guides them to practice deeply immersing themselves in a positive somatic experience (i.e., noting the changes in posture, breath, and muscular tone that emerge as they remember their competence), clients will gain the ability to reorient toward their competencies. They experience their ability to choose to what they pay attention and discover that it really is possible to resist the somatic claims of the past.

Every waking moment, our brains and bodies assimilate a myriad of sensory stimulation from the environment, as well as images, thoughts, emotions, body sensations, and movements from our internal state. In a millisecond, through operations so complex that they elude the full understanding of even the most brilliant minds, our brains compare this wealth of current data to memories of past experience. The most critical purpose of this comparison is to predict the next moment with sufficient accuracy so that we can make an adaptive physical action (Llinas, 2001). What we expect to happen in the very next instant determines the immediate action we make, whether it is reaching out to another person or for an object, such as a cup of tea.

Although Megan "knew" she was not in danger, her body told her that she was. If sensorimotor habits are firmly entrenched, accurate cognitive interpretations may not exert much influence on changing bodily orgamzation and arousal responses. Instead, the traumatized person may experience the reality of the body rather than that of the mind. To be most effective, the sensorimotor psychotherapist works on both the cognitive and sensorimotor levels. With Megan, a purely cognitive approach might foster some change in her integrative capacity, but the change would be only momentary if the cowering response were reactivated each time she received feedback at work... However, if she is encouraged to remember to "stand tall" in the face of criticism, her body and her thoughts will be congruent with each other and with current reality.

These initially adaptive responses to immediate danger turn into inflexible and pervasive procedural tendencies when trauma is unresolved. Once these actions have been procedurally encoded, individuals are left with regulatory deficits and “suffer both from generalized hyperarousal [and hypoarousal] and from physiological emergency reactions to specific reminders” (van der Kolk, 1994, p. 254). Traumatized clients often experience rapid, dramatic, exhausting, and confusing shifts of intense emotional states, from dysregulated fear, anger, or even elation, to despair, helplessness, shame, or flat affect. They may continue to feel frozen, numb, tense, or constantly ready to fight or flee. They may be hyperalert, overly sensitive to sounds or movements and easily startled by unfamiliar stimuli. Or they may underreact to stimuli, feel distant from their experience and their bodies, or even feel dead inside.

having clients orient to the stimulus on which they are very fixated helps them consciously and directly attend to reminders of past trauma. This provides the opportunity for the reactions to the trauma-related stimulus to change from involuntary and reflexive to reflective awareness and assimilation. The client's sense of control and efficacy is often enhanced, whereas simply orienting to new, neutral, or pleasurable stimuli may not accomplish this (Ford, personal communication, August 12, 2005).

In sensorimotor treatment, traumatized clients are taught to become aware of trauma-related tendencies of orientation and to redirect their attention away from the past and toward the present moment. Repeatedly "shifting the client's attention to the various things going on outside of the flow of conversation [evokes] experiences which are informative and emotionally meaningful" (Kurtz, 2004, p. 40). Redirecting orientation and attention from conversation to present-moment experience-that is, from external awareness to internal awareness, and from the past to the present⎯engages exploration and curiosity, and clients can discover things about themselves that they did not know previously (Kurtz, 2004).

Another characteristic they shared was that even their most relaxed conversations seemed stilted, lacking the natural flow of gestures and facial expressions that are typical among friends. The relevance of these observations became clear only after I’d met the body-based therapists Peter Levine and Pat Ogden; in the later chapters I’ll have a lot to say about how trauma is held in people’s bodies.

Translating the body's language, from nonverbal and conscious, leads to greater integration of the body and mind.

Trauma has shut down their inner compass and robbed them of the imagination they need to create something better. The neuroscience of selfhood and agency validates the kinds of somatic therapies that my friends Peter Levine13 and Pat Ogden14 have developed. I’ll discuss these and other sensorimotor approaches in more detail in part V, but in essence their aim is threefold:

Some people collapse under the belief 'I'm never good enough'-- their whole body just collapses, and they feel like crap. They have to find a different way of living in the body.