What is trauma?
Trauma is the designation for:
- The experience or observation of an unusual event
- That which comes unexpectedly and is inevitable
- That which is a serious threat to physical health and existence, and
- That which has consequences that might last for a long time.
In a traumatic situation it is not possible to escape or defend oneself anymore. The protective mechanism is overpowered and an overwhelming violation happens. Traumatic events often happen to fast and to intense and sometimes also to often.
A crucial element of trauma is that there are subsequent consequences. After the first shock the trauma still sits in the nervous system. Usually, the consequences diminish by themselves again. Sometimes they influence the life in the here and now for a long time after the event and influence thinking, feeling and acting.
The following symptoms are indicative for trauma:
- Hyper arousal: quick activation, overly sensitive, irritability, being jumpy, panic, fear attacks, obsessive compulsion – which mirrors the constant expectation of danger
- Hypo arousal: emotional anaesthesia, indifference, speechlessness (“I don’t have the words to describe the horror”), avoiding people, places (for example not using an elevator anymore), directions (left, from where the car came) and emotions – because they mirror the capitulation, freezing and powerlessness
- Reliving in the form of visual flashbacks (as if seeing the scene with the inner eye) and nightmares – they mirror the undeletable imprint through the traumatic experience
The consequences of trauma are even more serious if the trauma has been caused on purpose and it is effected by:
- The closeness of the relationship with the person that committed the crime
- The length the traumatizing actions happened
- The age the person was at the time of the traumatization
- The bigger the danger and the affectedness were
Natural disasters and accidents that where unavoidable or strokes of fate create less stress than violence, abuse and violations.
Traumatized people often react within rigid patterns in stress situations. These stereotypical ways of reacting are selfprotecting automatisms of the organism. Traumatized people aren’t capable to react to different degrees of stress in an accurate way and with the right dosage anymore. Their perception is distorted and is “stuck” to the past. Traumatized people are prisoners of their emotions, a vicious cycle of fear and helplessness. Trauma victims also show strong psychosomatic reactions that have to do with the organ functions (asthma, heart racing, insomnia, sleeping disorders, diarrhea, strong sweating, skin rashes and others). Secondary consequences can be addictive behaviour, depression, isolating behaviour, eating disorders etc.
Traumatized clients can usually be supported well with Shiatsu. It is recommendable that they also get traumatherapy and medical support as well as having a social network. In trauma-therapy it’s about bringing back into flow that which has frozen, to regain broken connections and to strengthen the ability to lead a content life in self-responsibility. Traumatherapy contains three phases: stabilization, trauma-confrontation and integration.
Shiatsu for the consequences of trauma
Shiatsu for traumatized people can generally contribute in:
- Soothing physical symptoms
- Increasing emotional stability, wellbeing, life-joy and life-quality
- Releasing energy-blockages and regaining connections
- Strengthening body awareness, selfesteem and the ability to draw clear boundaries
Fundamentally we need to keep in consideration that:
- Trauma is death proximity, existential helplessness, basic fear, and the loss of continuity, connection and trust.
- Trauma is overwhelming, a massive violation of boundaries, a rupture of the natural protective system.
- Trauma is complete loss of control, which is then compensated with over-control (which can lead to obsessive compulsion).
- Trauma is dissociation and disorientation; the clients are not fully present in the here and now anymore.
- Trauma is a deregulation of the nervous system, an inadequately strong over-stimulation (Jitsu), or under-stimulation (Kyo).
- Trauma is immobility, frozenness, and an incompleted movement of escape or defense.
- Trauma is a reaction of the organism that has been frozen in time.
- Trauma has linking-dynamics, meaning is often linked with other traumas.
For the work with Shiatsu we can extract the following conclusions:
- Regarding 1: It is central to first create a feeling of connectedness and trust, security, protection and positive support with trauma-clients and to create an according“energetic space” on the relationship level. Our own inner stability, centeredness, alignment and confidence is perceived on the vibrational level by the client. On the other side she also feels insecurity, injury, sucked in. She will possibly continuously be testing: ”am I safe here?” In a compassionate, stability-giving containment she will feel safe, respected and in good hands. This is a basic requirement for the nervous system to be able to relax. We need to respect that some clients will not be able to close their eyes during a treatment and trustingly give themselves into it in the beginning. Some can only bear short sequences of body-contact at first. Centering, alignment and the power to act are as important as focus. Working with the Hara (center), with governing- and conception vessel and bladder-meridian (central-line), head and feet (connection of heaven and earth) and with the hands (regaining the power of action) can strengthen inner stabilization.
- Regarding 2: The violation of boundaries of which the client has been suffering must be addressed by the practitioner and must be respected and strengthened. Trust into the body must be rebuilt. Avoid inattentive touch. We ask whether what we are doing is okay for the client. We need to find out if certain body-areas are taboo and should not be touched. We should ask how the pressure should be to be accurate. That’s how the client can become aware of her body again and gain the courage to express needs. This strengthens her selfresponsibility and personality. The client can feel her own body, herself and her boundaries better again if we bring her awareness on the physical experiencing of the body by asking her about the changes she is feeling. Shiatsu will then give internal space to the client.
- Regarding 3: A traumatized organism functions in rigid, narrow patterns and is afraid of loosing control. Controlling mechanisms give the feeling of security, even if this is a false security. Not having any control is associated with the trauma and a threat for life. Over-control may only be released slowly and step by step. Controlling means holding, holding on to something. Physically this expresses as permanent muscle contraction. Active stretching can be interpreted as reviolation by the nervous system and have a re-traumatizing effect. Tension in the system should only be taken away successively. Releasing the Jitsu must happen very carefully. We offer the Jitsu a vessel for relaxation. Being able to let go is being free of fear and trusting. This is only possible when one can build on inner resources. With trauma it is especially important to not have the aim to release frozen, concentrated energy in the beginning, even though the trauma-vortex draws the attention to the Jitsu. It is important to first bring attention to the Kyo. We connect ourselves with the unfulfilled need to e.g. receive consolation, nourishment or to be held and support the strength and resources of that.
- Regarding 4: The stronger the mental distancing, the disconnection from the here and now has taken place, the more important the usage of our whole body-weight becomes, so that the client feels herself, life, the material beinghere, the earthly basis, the substantial and the stable again. Often it’s about simply getting a sense of one’s own body again, to feel parts of the body that have been separated (“this is my arm”) and to reconnect these parts with the whole (armshoulder- torso). Dissociation is also emotional numbness and the incapability to think clearly. In trauma the reptile brain takes over the directing. The goal is to give space for feelings again and to let racing thoughts settle down. In Shiatsu we can reactivate the different frequency levels again and bring them into connection.
- Regarding 5 and 6: In trauma a strong movement (fight/flight), which is crucial for survival and therefore especially strong, has been interrupted forcefully. This movement is then stuck in the body in the form of blocked energy. Maximal strain is followed by a collapse of the energy system in the case of traumatizing violation. So we will find very extreme energetic phenomenas: Jitsu (fullness, compressed energy that is calling for movement and liberation) and Kyo (emptiness that calls for nourishment, grounding and the re-creation of connections). If there is an overstimulation, the organism needs to be relaxed and calmed down. If there is frozenness, a gentle return into motion is required. Through a gentle alternation between Jitsu and Kyo we want to cause a natural movement and the re-creation of the self-regulation-mechanisms. Through e.g. rhythmically moving the arm a gentle motion between opening (lung) and closing/protecting (large-intestine) can be evoked, so that the organism can remember this quality.
- Regarding 7 and 8: In case of post-traumatic stress disorders the energetic pattern of the event that happened has an effect for a long time. In Shiatsu we can contact energy patterns that have been created earlier in time and support the release of the still effective energy pattern that has been frozen in time. We can make a Hara diagnosis for the traumatic point in time and find out which meridian energy was Kyo at the time and strengthen that unfulfilled need. We can find out in the energetic evaluation in which years the energy feels significantly different (condenses, becomes empty etc). Like that we can recognize possible trauma-times and find out about the contexts.
Depending on the trauma category there are additional aspects that need to be considered
A whiplash trauma is the result of a to fast physical contraction and collapse. We find highly compressed muscular“protection-shields” as well as zones that
are completely lacking energy and restricted in their physical ability to move. That’s how the typical symptoms of becoming tired easily, vertigo and headache are triggered. Initially Shiatsu helps to strengthen the Kyo. In the place of the maximal Jitsu the work is “offering”, never demanding. That means for example that sideways movements of the head can be made possible through simple holding or be initiated through very small movements, but never forced. Decisive is the loving attention and the giving of time and space. When the head does not want to go into a rotating movement, we offer it an open vessel that supports and protects and allows it to find motions autonomously. That’s how the organism can be successful in regaining trust in these movements and to avoid retraumatizations. Often internal encouragement is helpful (“see, it is safe again on the left side, the danger is over”). Our inner attitude helps the nervous system to relax and to give up patterns, which are not required anymore. At the same time energetically weak areas need to be strengthened and connections recreated. In case of a frontal collision small intestine- and bladder/kidney meridian are usually affected by the shock – physically and emotionally. If the accident was lateral, especially gallbladder/liver- and spleen meridian are often affected.
If the trauma has occurred a long time ago, we can also work in history, based on a Hara diagnosis for the period of concern. We can refer to these energetic conditions with Shiatsu and strengthen the unfulfilled needs (Kyo) with the energetic resources (Jitsu). The time period right after the event is important regarding the question of what was most helpful and what could have needed even more support. Energetically we search for the need (Kyo). Sometimes we ourselves receive a topic in the form of an image or a word.
If the trauma has been caused on purpose, it is oftentimes important not to“do”, but rather to “be there” with the touch, to transmit trust and well-being and to work in a nourishing and consoling way. One must be able to wait, resonate, and go into contact with the inner strength of the client. That’s how we can give space and time to their organism so they are able to process and integrate that which needs it.
Meridian-energies and trauma
The starting point and basis of every Shiatsu treatment is the energeticevaluation. In a workshop I let twenty participants mentally experience an “almost car-accident”. The Hara diagnoses that refered to the time before and after the accident where, as expected, very different. And also the diagnosis for the stage of shock where different in each person. Very significant where fire Jitsu (heart/small intestine) and earth Kyo (stomach/spleen). I interpreted this is a taking off of the Shen, connected with the need and the necessity to re-ground. Bladder and large intestine Jitsu and liver and heart-governor Kyo also showed up.
The meridian energies give us important information with which we can work in reverence to the trauma. In the following I give examples, although further interpretations are also possible. The headwords help to find access and contact, and to strengthen the positive forces of effect.
- Heart: trauma shatters the heart, gives it an almost deathly blow. The heart is still bleeding. The spiritual soul Shen has escaped from its home and lost its identity. In Shiatsu we go into contact with the attentive consciousness and the deepest inner core of the client. Through large intestine- and heart-governor meridian we can support the recreation of the protection of the heart. With the earth energy we can give home, compassion and consolation.
- Small intestine: the overwhelming event is only partially remembered. Things have fallen apart, are disconnected, not understandable and cannot be integrated. In Shiatsu we connect all levels of vibration with each other (physical sensation level, repressed and split off feelings, thoughts, spirituality and level of meaning). We connect and integrate body parts (for example arms with the torso).
- Stomach: the affected person has lost the ground under her feet. Centering and stability are not there anymore; the experience is not digestible and takes the appetite of the client. We work physically and with a lot of our body weight, strengthen the contact with the earth through the feet, call out to their hunger for life.
- Spleen: pitying oneself, feelings of guilt, racing thoughts and melancholy can be effects of trauma. The working focus in Shiatsu is to nourish and console.
- Bladder: escape was not possible in the trauma, panic-like fear is constantly present, the flow of life has frozen, the bones are ice cold. We try to bring the blockages to melt or flow and to appeal to the courage to live. We connect the water element with the fire element, with life, consciousness, joy, warmth.
- Kidney: trauma affects the kidneys. The universal trust has been lost, its connection with the heart is broken, and the nervous system is de-stabilized. We try to get in touch with the deep, fundamental life force and a deep confidence and to embed the kidney energy in universal, great heart energy.
- Liver: aggression and anger are over abundant. As a consequence of the violation, traumatized people are easily irritated. But as a consequence of resignation and repression the anger can be completely suppressed, not be felt and be feared, because it contains a latent “potential to blow up” (fear of being overwhelmed by the anger). First the work is simply about attentively perceiving negatively rated emotions, being with them, holding them lovingly.
- Gall bladder: movement and orientation are lost in the trauma and afterwards they are restricted. We can lead out of immobility with rhythmical Shiatsu and promote the physical self-perception by asking about it and using a lot of our body weight.
- Lung: In shock the breath is taken. Life stands still. Asthma and breathing difficulties are often consequences of trauma. We can give the body space to breathe again. We find trust in the rhythm of life that always goes on, that indicates towards the future and stands for the autonomous force of life. So it is important to consciously work with rhythm and giving space.
- Large intestine: boundaries have been violated. Becoming conscious of the physical borders can recreate integrity. The full use of body weight is important. We can consciously work with the topic of opening/closing or the topic of letting go (for example joint rotations, aligning downwards).
- Heart-governor: The protective mechanism has been overwhelmed, which has the consequence of immobility, withdrawal and an inability to have relationships. Protecting oneself is strongly connected with closing, making boundaries. We can e.g. consciously “oscillate” between protecting and opening: first working on the protective yang-side of the arm (large intestine, gall-bladder), and then gently opening the arm and working with yinmeridians (spleen, heart-governor, lung). When the person is stable, he can open himself and still feel protected.
- Triple heater: trauma causes fragmentation, a loss of connections, for example in the interrelation of the organ functions (digestion-, circulatory- and breathing system). The relationship between up, down and center is disordered. With Shiatsu we can integrate disconnected things again.
The body remembers
Tensions caused by trauma can be released with Shiatsu. Physical reactions such as tiredness, yawning, tears, shacking of the body, and others can show up. These discharges are to be rated positively. Encourage the client to let them happen. Under certain circumstances Shiatsu can reactivate traumatic feelings and experiences. This can express in different forms:
- Physical symptoms: pulse getting higher, nervousness, sweating or cold skin, dizziness, breathing insufficiency, touch is experienced as unpleasant, body parts become insensitive.
- Flashbacks (memories of the trauma in the form of images)
- Emotional arousal, fear and anger coming up
- Racing thoughts
- Speaking fast and wanting to tell, denying (“no no, it’s nothing”).
That’s why tension should be released slowly and step by step. We need to be especially careful with certain body parts. With strongly traumatized clients we should not work with the jaw-joint to much because screaming and experiences of sexual violations can be stored there. The neck is another zone that should not be touched at all as a consequence of the experience of being chocked. Already touch close to the neck can create a certain activation that could show through the head becoming hot and red, the upper body becoming stiff and the breathing difficult. A slight activation can surely be positive. But it mustn’t go over a certain point and it should be released again, discharged or relaxed. To strong activations lead to re-traumatizations and to an overwhelming by the negative vortex of the trauma. They need to be stopped early enough.
Tools to avoid to strong activation are:
- Changing the work, for example the position, the area you are working on, the meridian (for example changing to the feet)
- Changing from meridian work to physical work (“grounding”)
- Interrupting the treatment, asking questions about how the client is doing so that she keeps the contact with herself and the therapist
- Taking a break and recreating the orientation in the here and now (the client should open the eyes, sit up, look around and say what she sees; the therapist shall use every-day language and bring the attention to something beautiful and positive)
- Stop the treatment
If you stop a treatment you need to ask the client what she requires now; physical contact or a tissue that you offer her respectfully. You need to signalize to the client that you are capable to hold the process, that you yourself are not overwhelmed, that you can be with the situation and are capable to bring it to a safe completion.
The accompanying dialog
Often a client is not aware of early traumas. But based on their inappropriate behavior we suspect such a background. It can also be that the client is aware of early traumas, but she doesn’t talk about them with the Shiatsu therapist because she feels ashamed or because she is avoiding her link with that situation.
We need to deal with such situations very subtly. The path is best taken through questions. Are there especially heavy feelings and situations in your life? Do they come back regularly? Since when is it like that? What connection do you see between symptoms and events? One can offer conversation as an open vessel to the client, which leads to self-perception and self-recognition and supports her being resilient. Through that the understanding might develop, that psychotherapy or a trauma-therapy could be helpful.
There are clients that see the connection between their problems and their traumas very clearly and come to Shiatsu precisely because of that. Some are in psychoanalysis, psychotherapy or trauma-therapy at the same time and others are not. We need to find that out in the first conversation. They are primarily looking for support through energetic bodywork, not through conversation. But still the dialog is an important part of every therapeutic encounter and can be utilized in a useful way additional to the treatment.
If there is a trauma, leading a therapeutic dialog has two main goals as orientation:
- Avoid the overwhelming (feeling powerless etc)
- Building stability and resources
Before every treatment emotional and spiritual stability must be tested. We must develop a feeling for which field we are allowed to move in and what the client can hold emotionally. If the client gets overwhelmed anyway, the orientation in the here and now is crucial. This is an indication that professional trauma-therapy is necessary.
It is not recommendable that the client speaks about her traumatic experiences. But it is good if the Shiatsu therapist knows that there are traumas. It is enough to know the “chapter titles” of the book; one doesn’t need the contents of the story. Often the client has the need to tell everything and virtually floods the therapist. We need to draw clear borders here for the sake of both parties. Talking about traumaexperiences to much and over and over again has, in my experience, a re-traumatizing effect on the client, because feelings such as panic-like fear and being at someone’s mercy are reactivated and enhanced at the neuronal level. One can only succeed in cutting the vicious cycle of such a strong trauma with professional trauma-therapy.
An important goal of every traumatherapy is that the client learns to withdraw from the suction of the trauma-vortex and to develop competences to be able to deal with the subject consciously and in small doses. One of the goals for this is to recognize the signs early enough when the vortex starts to unfold and to “get off” early enough and to not get overwhelmed. Getting off means finding a way back to the resilience factors. The importance of the ability to not get flooded by feelings and retrieving your own, inner strength must be made aware to the client. And the client must want change. If this is a fact, then the Shiatsu therapist can help with pursuing the goals mentioned above with the dialog that accompanies the treatment. In this way the client should not only perceive the obviously damaged, but bring her attention to the strength that made it possible for her/him to keep on surviving under bad conditions. Or the support can be to value her ability to be a good mother. This shifting back and forth must be explicit and happen in a very subtle way, to avoid a“push-and-ull” situation between the client and the therapist, in which the client doesn’t feel understood because the therapist is constantly bringing the attention away from her suffering. So an explicit agreement is required that it is the role of the therapist to continuously navigate the attention towards the healthy, the strengthening and the nourishing. Questions are most suitable to dissolve negative vibrations and feelings. They are questions like: What would help? What would feel good at the moment/ bring relieve?
Building up resources and developing stabilizing attitudes and patterns is hard work. It must be persuade with willpower and persistence. Without willingness and motivation on the part of the client, every effort of the therapist will lead to nothing except frustration. In dialog Shiatsu therapists can support traumatized clients to recognize their mental strength and to develop stability. The goal is that clients recognize the possibilities to choose in life and to take those choices.
- The first step is to do all actions with as much attention as possible, which means to not let the mind race but to keep it in the here and now. I ask them for example to pay attention to the contact with the ground and to feel into their feet while walking, to develop self-perception.
- The second step is self-observation, in loving and indulging perception of one’s own reaction-patterns, attitudes and behaviors.
- The third step is to recognize their own strengths and “nourishing” resource and to take care of positive things and to develop rituals for that.
- The fourth step is to visualize alternative ways of reacting and to visualize what effect that would have and to try to feel the sensation connected with it.
- The fifth step is to make small“practice fields” (for example regarding the topic of “setting boundaries”), to search for little successes in expanding one’s own borders and reaction-choice (don’t immediately use husband/wife as practicefield if the relationship is difficult and linked with trauma).
If the client is in psycho- or traumatherapy simultaneously, we should talk with the respective therapist to find out how we can support their work. We shouldn’t do anything that contradicts their concept. And we should also avoid overloading the client with additional ideas and exercises.
We can help the client to find inner and outer resources and to develop and stabilize them. Through questions and impulses we lead them to the following possibilities:
- Looking for supportive relationships, cherishing them, taking care of them and utilizing them.
- Doing joyful things (movement in nature, making music, being with people, cooking well and eating consciously, reading emotionally nourishing books, contact with animals etc.)
- Keeping a “joyful-diary”. The goal is to write something every day, to bring the attention to the joyful things existing and away from the problems and to prove that positive aspects are increasing and to discover resources.
- Making a list of personal strengths
- Looking consciously for little experiences of success and creating them.
- Balance exercises, Tai Chi, Yoga, breathing exercises and/or meditation (to regain the lost control and inner stability).
Positive feelings such as being contempt, gratitude, joy and trust are important. They should be brought about on intentionally, recognized and valued (e.g. eating by candlelight, visualizing joyful experiences). The sense of self-value and treating oneself lovingly must be recreated. In the end it’s the mental attitude that needs to re-orient itself away from the negative and from the trauma, towards the positive and the resources. For every aspect of the trauma-vortex there’s at least one resilience-factor:
Powerlessness “I can” have support and ask for it
Helplessness, despair Confidence, hope
Feeling overwhelmed Feeling borders and drawing those lines
Life is not making any sense What was learned through the trauma
Anger, hate Gratitude, forgiving
Immobility, rigidity Movement
Dissociation Contact, body
Rigid patterns Attention
The therapeutic field
From psychotherapy we know that a compassionate relationship is co-decisive for the success of therapy. We need to“tune in” with the client and create a field in which transformation and healing of the wounds is possible. This field must be constellated consciously. With traumatized clients, this requires especially a lot of attention. With trauma it is important that the therapist is stable emotionally and spiritually so that she/he is able to hold the space and the orientation in the here and now compassionately and she/he can keep the confidence and wisdom of life upright.
Trauma requires the ability of the therapist:
- To address the wounds and physical injuries and to perceive them full of compassion, to touch their energy on the level of vibrations but to not get overwhelmed and drawn into the emotions
- To always keep the contact with the here and now and to stay oriented about what is happening
- To recognize when the vortex starts happening and to interrupt the client respectfully, so that she will not be overwhelmed by the trauma-vortex
- To hold all experiences of the client in a “larger context”, i.e. being connected not only with the “surface” but also with the inner life force, the confidence and the“cosmic-context”.
The danger is to do too much and want things the way we expect them to be with the well-meant intent to help but overwhelming and restricting the client. It is essential to find a good sense of yourself, observation of yourself and to be able to take yourself back and to consciously find the right measurement of closeness and distance, intervention and not doing when in contact with trauma clients. There is a difference between compassion and feeling sorry, in which the therapist looses his boundaries, identifies with the client and burdens himself with their suffering. The consequence of that are burnouts.
Things a client says can activate own traumas, so that you might feel dissociated yourself. And clients have the un-conscious tendency to draw therapists into their energetic pattern. Typical are idealizations (“you are my last hope”), depreciation (“Shiatsu doesn’t help either”) and blackmail (“if you don’t help me, then…”). As therapist one should not be savior, not give any smart recommendations and not have any private relationships with the client. Self-devalidations happen often. The client unconsciously is always looking for the confirmation that she is “the last person” and a hopeless case. One should not use any devaluating formulations – also not in a joking way.
You should not treat any trauma clients if this work appears to be to burdening. Working with strongly traumatized people is only possible, if you as therapist have worked with your own personality intensively and if you can deal with “relationship-traps”. Additionally, you should definitely take supervision.
Literature (in German)
- Peter Levine, Trauma-Heilung, Synthesis, 1998
- Judith Herman, die Narben der Gewalt – traumatische erfahrungen verstehen und überwinden, Junfermann, 2003
- Diane Poole Heller. Laurence Heller, Crash Kurs zur Selbsthilfe nach Verkehrsunfällen, Synthesis 2001
- Peter Levine, Maggie Kline, Verwundete Kinderseelen heilen, Kösel 2004
- Luise Reddemann, Imagination als heilsame Kraft – Zur Behandlung von Traumafolgen mit ressourcenorientierten Verfahren, Pfeiffer bei Klett-Kotta, 2003
- Luise Reddemann, Eine Reise von 1’000 Meilen beginnt mit einem ersten Schritt, Herder Spektrum 2004
- Luise Reddemann, Cornelia Dehner-Rau, Trauma. Folgen erkennen, überwinden und an ihnen wachsen – Ein Übungsbuch für Körper und Seele. Trias 2004
- Michaela Huber, Wege der Traumabehandlung, Junfermann, 2004
- Babette Rothschild, Der Körper erinnert sich – Die Psychophysiologie des Traumas und Traumabehandlung, Synthesis, 2002
- Angwyn St. Just, Soziales Trauma, Kösel 2005
© Peter Itin (http://peteritin.wordpress.com), Swiss Shiatsu therapist and teacher. Author of “Shiatsu als Therapie”.