Craniosacral Attention, Somatic Awareness and Resourcing
When working with trauma clients, we can assume that there is some level of nervous system dysregulation – either a high tone sympathetic base line (fight or flight) or a high tone dorsal base line (freeze/shut down). It is also possible that the nervous system is jumping between polarised states of dysregulation. In any case, the client is operating outside their window of tolerance; devoid of access to safety. When the nervous system is oriented in survival physiology it is on constant look out for danger. As such, discreet aspects of reality (qualia) are more likely to be assessed as dangerous and the brain’s capacity to blend various aspects of reality together to create a truthful coherent experience is compromised. Perception of both internal and external stimuli becomes distorted. It is as if there is no space for re-entry (the process of blending qualia to form a perception based on actual experience). Because the amygdala in the brain stem is constantly signalling danger, the shortest route to danger evaluation is taken. Basically, the brain is wired to seek out and respond to threat – there is no time for a proper careful assessment. This is why verbal narratives can initially be fragmented or lack linearity and a sense of wholeness. The brain has not had a chance to organise and categorise traumatic experience.
When working with somatic integration therapy, it is prudent to first turn down the level of dysregulation in order to afford the nervous system some time and space in which to better assess and categorise experience. While as therapist we cannot create instant safety, we can create a space in which a question may arise ‘what am I experiencing now? Is it dangerous or safe?’ Simply accessing space for sorting and categorising of qualia allows a new neural assessment of experience. When a new experience is accessed it can be more accurately categorised and integrated.
The brain has a propensity towards pattern matching – comparing present experiences to past experiences and responding accordingly. When the brain is wired towards danger, the pattern matching experience is undertaken in less accuracy causing a miscalibrated response. That is, a present experience may be confused for one that has occurred in the past. For example, a chronic pain client may continue to identify with old pain in the present moment. In this case, the client becomes effectively ‘trapped’ in their old experience of pain. When the brain is operating in survival physiology, there is no space to assess present experience independent of the past and create a new category or template of experience. This explains why complex health and trauma clients can find themselves stuck in chronic symptom patterns.
Before attempting to understand these chronic templates and disentangle present from past experience, a certain level of regulation is required. There must be enough resource to support self-inquiry. In order to achieve this, craniosacral attention through gentle touch can be helpful. This level of touch can down-regulate the nervous system and also provide an experience of co-regulation, that is often lacking in trauma clients. In a way, the touch may offer a safe haven that is reflective of being held by one’s mother. In early development gentle touch is vital to the development of the nervous brain; starting at the brain stem. In fact, touch qualifies as a basic human regulatory need, no matter one’s age.
Making Touch Safe- Suggestions for Craniosacral Attention though Gentle Touch
For many trauma clients, there can be a palpable sense of invasion of their nervous system at all times. In effect the world is a threat. Therefore, people may be perceived as a threat. Touch may be perceived as a threat.
Before touching, always ask the client for permission and explain where they may feel the touch. This process of preparation may deactivate an in-built ‘defend and protect’ mechanism such as bracing.
Hold #1
Simply touch the top of the client’s head and hair in a very gentle manner. While this is not a traditional craniosacral hold it is offered and received as a point of contact. The therapist is letting the client’s system get to know theirs. This is a little bit like letting a dig sniff your hand before you pat it. It further dissolves an inbuilt physiological response to danger. It provides a space of subconscious somatic inquiry – ‘is this person safe? Am I ok with this touch?’. When working with a new or highly sensitive client, it is prudent to check in with them ‘ how is this touch. Do you feel safe or unsafe?’ This re-stimulates both their sensory perception and their sense of personal control – nothing is happening to them without their express approval.
Note: For highly sensitive clients or where there is a case of shock trauma or chronic tension at the head/neck, it may be helpful to start by touching the feet or ankles instead. If you are unsure, ask the client their preference for initial touch.
After some time, you may notice that the client’s breathing pattern changes (longer deeper breathes) and sense some level of muscle relaxation. This indicates that an increased level of safety has been accessed.
Hold #2
Place both hands under the client’s head/nape of the neck. Here you are accessing the brain stem directly which is where survival physiology originates. Because the therapist’s hands have already been identified as safe, the brain can continue to respond to the connection and co-regulation can come into greater effect. You may like to offer the client to ‘relax into my hands’ or ‘connect to the safety in my hands’. Paying attention to the client’s bodily responses is key to assessing the impact of the craniosacral attention. Look for changes in breathing, muscle relaxation and nervous system discharge (small shudders/jerks). These signs all indicate increasing safety.
Once a palpable increase in safety is accessed, the client is ready to proceed with somatic awareness and resourcing.
Somatic awareness and resourcing
For a first session, a body scan may provide an initial assessment of safety/danger and highlight points for exploration – both resourcing and future release work.
To facilitate a body scan, slowly bring awareness over the whole body from the top of the head down to the tips of the fingers and toes. This is similar to a yoga Indra meditation experience, however there is no suggestion to relax. We are asking the client to simple notice their body and breath with no need to change anything. Factors to notice include: heat/cool, muscle tension/relaxation, sensations such as tingling or palpitating, sense of colour, movement/stillness, speed of movement. Presence and listening are the key to connection which will be required for deeper work at a later time. In a first session, guide the client to find the part of the body that feels most connected/safe and share it with you. It is in the safest most connected part of self that resourcing can commence.
One of the golden rules of somatic integration therapy is: resource first, resource last. When the client experience begins and ends with resourcing, a new map towards regulation and safety is created.
Once the client has identified their connected/safe place, ask them to direct their attention and breath there. You may bring your hands there, or if the client is touch sensitive, you may ask that they bring their hands there. In this instance, you can either proceed with no touch or gently hold the client’s feet to offer an experience of grounding. If unsure, you can ask the client what they would prefer.
Ask the client to describe the somatic sensations at their connected/safe place. Invite them to go deeper into them and ‘allow the whole body to respond to the sense of connection and safety.’ Look for the client’s body responses such as a change in breathing, drop in body temperature, slowing of heat rate, strengthening of craniosacral rhythm, muscle relaxation or nervous system discharge. It is ok to dialogue with the client to gauge their experience if needed, however allowing a space of silence for the client to feel may be helpful. The less words here, the better.
Once the somatic experience of safety is established, an ‘anchor resource’ has been created for the client. This place in their body is somewhere they can return to again and again to connect to and re-stimulate feelings of safety. This is an exercise that they can use for self-care in daily life.
To deepen and integrate the experience you can suggest that the client ‘expand the experience of connection and safety to the whole body’. A helpful metaphor may be to experience it like ‘concentric circles of safety or ripples that emanate out’ from the ‘anchor resource’ to the whole body. Once this suggestion is made, it is time for supported integration. Let your client know that you are going to be silent while they integrate. Depending on your client and comfort using touch, you may like to integrate a hold either at the sacrum or feet. Both holds incite further down-regulation and grounding which supports the nervous system to reorganise and create new neural circuits steeped in safety. Hebbs Law suggests that ‘cells that fire together, wire together’. This integration process allows the nervous system to disentangle present from past and categorise new pathways of regulation and safety.
At the end of the session, you can provide further integration from the somatic / physiological experience to one of conscious awareness by asking the client o share their experience and anything they noticed. This verbal exchange allows the experience of the body to integrate with conscious thought and create a body-mind feedback loop.
A Note on Somatic Resourcing
Somatic resourcing can be integrated into all therapy sessions to support increased regulatory capacity and empower the client to start creating a new neurological map that is geared towards self-inquiry and access to safety.