A Somatic Approach to Stabilisation when Working Therapeutically with Children and Young People who have Experienced Child Sexual Abuse and who Display Harmful Sexual Behaviour – Jo Drew
Trauma is generally understood to be as a result of an experience or experiences where we feel helpless, overwhelmed and our life may be at risk. Trauma is evident in the profiles of many children and young people who display harmful sexual behaviours (HSB). In a study of 700 British children and young people who displayed HSB two thirds of the children and young people referred (n= 412) were known to have experienced… at least one form of abuse or trauma including physical abuse, emotional abuse, sexual abuse, severe neglect, parental rejection, family conflict, domestic violence, and parental drug and alcohol abuse (Hackett et al., 2013). Given this picture, this article considers how a somatic approach in the stabilisation stage of HSB treatment programmes can help to provide a secure base from which to complete psychotherapy/counselling with those children and young people who have experienced sexual abuse.
The Neurobiology of Trauma
It is important to consider the basic neurobiology of trauma in order to ascertain why a somatic approach may be effective. Ordinarily when we are in danger, the fight and flight response which is connected to the primitive brain activates. Where there is little or no chance of escape the only response left is to ‘freeze’ and/or dissociate. Dissociation at this point serves as a survival response as we are able to disconnect from our thoughts and feelings and reduce feelings of pain. With such a threat to our survival the function of the hippocampus is disrupted and our ability to recall details and the timing of the traumatic event is reduced. The amygdala, which is connected to our processing of fear, is equally disrupted and fragments of memory, sensation, smells and felt experiences are recalled as flashbacks when triggered by the environment. In addition, the brocas area of the brain, which is connected to language, is impacted in a way that disables the capacity to verbalise coherently.
Such a significant threat to survival can have a lasting effect; the primitive brain continues to operate in survival mode causing continued states of hyperarousal and hypoarousal. Pat Ogden et al (2005) explain this process; ‘At the moment of threat, instinctual survival defenses take precedence over cognitive functions. Long after the traumatic events are over, activation of the prefrontal cortices and cognitive functions can be intermittently inhibited in response to trauma-related stimuli, hindering the capacity for successful self-observation, exploration, and new learning. The therapist’s job is to “wake up” the exploratory capacities by promoting a somatic sense of safety and cultivating the capacity for observation, curiosity, and mindfulness in the client’.
A body-based orientation to treatment is generally considered to be a ‘bottom up’ approach; working with the primitive brain prior to any cognitive processing. Trauma therapists generally agree that stabilisation work is necessary prior to any therapeutic processing or integration work (Fisher 1999).
Both experiencing child sexual abuse (CSA) and behaving in a sexually harmful way are directly connected to the abuse of the body, and therefore traumatic. Trauma reduces our ‘window of tolerance’, so that states of hyper- and hypo-arousal are easily entered and there is limited capacity to self sooth (Ogden 2015). With a narrowed ‘window of tolerance’, maladaptive survival mechanisms are easily triggered so it is necessary to ensure that our clients can begin to feel safe and learn to self-regulate. Without this ability, any therapeutic and/or cognitive behavioural programmes are unlikely to be effective.
Building a therapeutic alliance with a somatic approach requires attention to the client’s verbal and non-verbal responses.; modelling a calm open posture such as leaning slightly forward towards the client; and noticing any relaxing in the client’s body and mirroring this body movement. Developmentally, body mirroring is aligned to a positive carer/child relationship and the experience of being seen and validated in the world. As therapy progresses mirroring can be introduced as an interactive game; for example, ‘follow the leader’ which can be as simple as hand gestures or more elaborate dancing. The process of ‘being seen’ in mirroring helps clients to feel safe, regulated and present.
Traumatised clients will often describe dissociative experiences such as feeling ‘spaced out’, not being in their body and/or not being able to connect to the world. The therapist can help the client connect to their body and their body’s senses in a positive and safe way through a range of interventions, for example:
- The use of clay. The experience of working with clay can allow clients to connect to their bodies through exploration of the body boundary of skin, connecting to their inner and outer worlds and establishing a sense of being grounded. In the case of sexual or physical abuse where touch has been experienced as negative, this connection to skin can help to re-establish a positive association to their body in a grounded way.
- Movement can be introduced to help connection to the body and grounding. Simple swaying movements that promote self-soothing will help with self-regulation.
- Discussion can be encouraged around the feelings they experience in their body, connecting these to being grounded as opposed to being dissociated. Clients can be encouraged to try grounding techniques at home.
Once the client has a sense of their body, then it is possible to start to explore their sense of emotions. Clients may explain that they feel ‘dead inside’ or ‘emotionally numb’. As a client talks, therapists can pay particular attention to their body movement, posture and gesture, and draw attention to this. For example a therapist might notice when a client is talking about a particular topic their head moves down towards their chest and their shoulders move in. This posture can be explored alongside any feelings and sensations that accompany it. Slowing down the process and paying attention in this mindful way helps the client to make connections between body, sensation and feeling, which in turn allows them to be able to identify and feel emotion in a safe and contained way.
As the client is enabled to feel safe, grounded and able to self-regulate effectively then any therapeutic or cognitive behavioural programmes can begin. Moving out of survival mode and into a more stable space means those who need to process their trauma, can start on their journey where important healing can take place without fear of dysregulation.
Jo Drew, PG Dip, DMP
Movement and Body Orientated Psychotherapist
Barnardos Bridgeway Project, Tees Valley.
Hackett, S., Masson, H., & Phillips, S. (2006). Exploring consensus in practice with young who are sexually abusive: Findings from a Delphi study of practitioner views in the United Kingdom and the Republic of Ireland. Child Maltreatment, 11(2), 146–156.
Hackett, S., Phillips, J., Masson, H., & Balfe, M. (2013). Individual, family and abuse characteristics of 700 British child and adolescent sexual abusers. Child Abuse Review, 22(4), 232–245. doi:10.1002/car.2246
Fisher, J. (1999), The Work of Stabilization in Trauma Treatment, Trauma Center Lecture Series, Boston
Levine, P., (2007). Trauma through a Childs Eyes.
Ogden P, (2015) Sensorimotor Psychotherapy; interventions for Trauma and Attachment.
Ogden P, Pain C and Fischer J (2005) A Sensorimotor approach to the treatment of Trauma and Dissociation
Schwartz, A (2018) The neurobiology of Traumatic memory. Drarielleshcwartz.com/theneurobilogyoftraumaticmemory