In an Unspoken Voice

by Peter A Levine

  Although relatively few therapists have cultivated the precise reading of postures, they are still being impacted by them. We all subconsciously mirror the postures of others and register them as sensations in our own bodies. This occurs presumably through the operation of mirror neurons and postural resonance. Since spontaneous postural changes are generally subtle, it takes a lot of practice to observe them. Resonance is particularly compelling with survival-based postures such as the nuanced varieties associated with the premovements and movements of flight, fight, freeze/fright and collapse.

  If a posture is rigid from bracing or is collapsed, we can assume that it was a preparation for some particular action, an action that was thwarted and that the muscles are still programmed to complete. If this dormant sensorimotor trajectory had not been impeded, it would most likely have had a more triumphant outcome—as it still can retroactively. In recounting my accident, I described what I was aware of in my body as I lay helpless in the ambulance. It was, first, from a subtle twisting sensation in my spine that I felt my arm initiate an upward move to protect my head from being smashed on the windshield and, consequently, on the road.

  Observing spontaneous (intrinsic) postures gives the therapist a vital window into the state of a client’s nervous system and psyche. The body benevolently shows us when we are preparing to act and precisely what incipient premovement action is being prepared for. Most often, we as keen observers see before our very eyes a bodily orchestration unfolding that neither the therapist nor the client could ever have rationally predicted. The therapist begins by noticing postures that show rigidity, retraction, poised preparation for flight, twisting and collapse, as well as those of openness and expansion. I think of the unforgettable postural ease in someone like Nelson Mandela who, despite both the magnitude of his trauma and his advanced age, maintains a natural, graceful posture. And numerous people have described how they felt deeply relaxed and open in the presence of the Dalai Lama. The adroit therapist both sees and senses the opposite of such grace in a client whose spine becomes more rigid, braced against a perceived assault, or collapses (sometimes nearly imperceptibly) while experiencing difficult sensations and emotions. In the same manner therapists (and mothers, fathers and friends) are also able to observe and reflect momentary states of grace and goodness in others.

  Autonomic Signals (Cardiovascular and Respiratory)

  Visible autonomic behaviors include respiratory and cardiovascular signposts. Breathing that is rapid, shallow and/or high in the chest indicates sympathetic arousal. Breathing that is very shallow (almost imperceptible) frequently indicates immobility, shutdown and dissociation. Breathing that is full and free with a complete expiration, and a delicate pause before the next inhalation, indicates relaxation and settling into equilibrium. This type of spontaneous and restorative breath can be easily distinguished from a person who is “trying” to take a deep breath. Often, this kind of voluntary forced deep breath can actually increase imbalance in the nervous system and, at the very least, gives only temporary relief.91

  Next are signs from the cardiovascular system, which include heart rate and the tone of the smooth muscles lining certain blood vessels. Heart rate can, as I have said, be monitored by observing the carotid pulse, which is visible as a pulsation in the neck. A therapist can, with a little practice, discern increases and decreases in rate, as well as estimate their magnitude. It is also possible to estimate changes in blood pressure from the strength or weakness of the pulse.

  The therapist can identify the tonus of the blood vessels by noting alterations in skin color, although doing so requires a refined level of perception. In the case of a very high tone (vasoconstriction), a client’s cold fingers will have, for example, a whitish/bluish tint, reflecting—along with increased heart rate—sympathetic hyperarousal. On the other hand, when the blood vessels are relaxed and dilated, or open, the fingers are a lively pinkish hue. Yet another variation arises when the capillary vessels dilate abruptly, causing a red flush, noticeable particularly in the face and neck. In addition, the observer can sometimes actually feel a wave of heat emanating from the client’s body.b

  The next observation point is pupil size. A very wide pupil is associated with high sympathetic arousal, while a very small pupil can be indicative of immobility and dissociation. “Pinhole”-sized pupils can also be an indicator of drug use—generally of opiates. Interestingly, these opiates are also released by the body’s own internal pain relief system92 and are an integral part of the immobility system and dissociation.93

  Visceral Behavior

  Visceral behavior refers to the motility of the gastrointestinal tract, whose movements can actually be “observed” by the sounds that it makes. The wonderful onomatopoetic word for these intestinal rumblings and gurglings is borborygmus (plural: borborygmi). An entire system of body-therapy is based upon listening to a spectrum of these gut sounds with an electronic (fetal) stethoscope while different parts of the body are touched and gently manipulated.94

  A therapist who is able to track all of the various behavior indicators discussed above has access to critical information that will help her to time various interventions efficaciously. She knows, for example, that cold hands generally indicate fear and stress; while warm ones signify relaxation. Flushed skin can reflect emotions like rage, shame and embarrassment. What is not widely known is that flushed skin can also be the sign of a strong release of energy and a movement toward greater aliveness. As with all such observations, sequence must be understood together with context: no single indicator stands alone. And, of course, the content that the client is currently processing must be considered in the mix. In this way, the therapist can artfully map an accurate topography relating what he is observing (Behavior) to what the client is experiencing (Sensation). In general, there is a correspondence between the level of Sensation and Behavior: that is, when the therapist gives the client feedback about a change in the latter’s autonomic nervous system, such as heart rate or skin color (Behavior), he or she will generally be drawn to exploring autonomic Sensations, such as the level of cardiopulmonary/sympathetic arousal.

  Archetypal Behaviors

  Last, but not least, is the subsystem of archetypal behaviors coming from the deep “collective unconscious.” In tracking people’s postural shifts, I began to notice subtle hand and arm gestures that were clearly different from voluntary ones. These gestures often appeared at moments of significant therapeutic movement and frequently indicated pleasingly unforeseen resources and shifts toward flow and wholeness. Moreover, I became fascinated by the similarity of these involuntary gestures to those of the sacred dances that I had seen at various cultural performances presented at University of California–Berkeley’s Zellerbach Hall. These hand/finger/arm movements, called mudras, are all-embracing and inclusive, across the spectrum of the human experience and throughout the world. Particularly in Asia, the way one’s hands and fingers are poised communicates very deep and universal meanings, ones that are related more than just personally to dancer or audience member.c When the therapist observes such spontaneous mudras, then pauses, taking the time to bring them to the client’s attention, the client can then use that information to explore how his “outside” posture feels on the “inside.” It is not surprising, at this juncture, for the client to contact a treasure chest of powerful resources of connection, empowerment, flow, goodness and wholeness. I believe that these archetypal movements arise at unique moments when the instinctual is seamlessly wedded with one’s conscious awareness—when the primitive brain stem and the highest neocortical functions integrate.

  In summary, Behavior is the only category that the therapist is directly aware of. As clients become aware—at first only marginally—of their own behaviors, they may incorporate these perceptions into an observer role where they are reminding themselves to note sensations associated with those behaviors. When linked with thoughts, this is a powerful tool to dissolve compulsions and addictions.
/>   The Affect Channel

  The two subtypes in the fourth channel are the categorical emotions and the felt sense, or contours of sensation-based feeling.

  Emotions

  Emotions include the categorical ones described by Darwin and refined in extensive laboratory studies by Paul Ekman. These distinct emotions include fear, anger, sadness, joy and disgust. Again, these are feelings that the client is experiencing internally and that the therapist can deduce from the client’s face and posture even when the client is unaware of them.

  Contours of Feeling

  Another level of affect—the registration of contours of feeling—is, perhaps, even more important to the quality and conduct of our lives than are the categorical emotions. Eugene Gendlin extensively studied and described these softer affects and coined the term felt sense.95 When you see dew on a blade of grass in the morning light or visit a museum and delight in a beautiful painting, you’re usually not experiencing a categorical emotion. Or when meeting a good friend you haven’t seen for months, you’re probably not feeling fear, sorrow, disgust or even joy. Contours are the sensation-based feelings of attraction and avoidance, of “goodness” and “badness.” You experience these nuances countless times throughout the day. While it’s easy to imagine a day without perceiving any of the categorical emotions, try for a moment to conjure up a day without any felt sense affects. On such a day you would be as lost as a ship at sea with no rudder or bearings. These contours guide us throughout the day, giving us orientation and direction in life.

  The Meaning Channel

  Meanings are the labels we attach to the totality of experience—that is, to the combined elements of sensation, image, behavior and affect. Meanings are like descriptive markers that we use to get a quick handle on the whole spectrum of inner experience so that we can communicate these to others and to ourselves. We all have fixed beliefs, or meanings, that we take to be the unequivocal truth. When a person is traumatized, his or her beliefs become excessively narrow and restrictive. Examples of these crystallized mantras are: “You can’t trust people”; “The world is a dangerous place”; “I won’t ever make enough money to support myself”; or “I’m unlovable.” These beliefs are often connected to primal fears and are, by and large, negative and limiting.

  As incredible as this might sound, we are likely to be programmed to have negative beliefs for survival purposes. For example, if you are walking in an area where you are confronted by a bear, you have likely gained the meaning that “this is a dangerous place” and “don’t go that way next time.” Unfortunately, when one has been traumatized or deeply conditioned through fear while young and impressionable, such meanings become pervasive and rigidly fixed. Later in life, rather than a client freely accessing the full spectrum of developing sensations and feelings, conclusions are drawn based on meanings born out of past trauma or early conditioning. I have called this kind of limiting prejudgment premature cognition.

  Using the SIBAM model, the therapist can help the client work through the first four channels of awareness in order to reach new meanings. When cognition is suspended long enough, it is possible to move through and experience flow via these different channels (and subsystems) of Sensation, Image, Behavior and Affect. Then it is probable for fresh new Meanings to emerge out of this unfolding tapestry of body/mind consciousness. As an example, a client may start with specific fixed beliefs such as “my spouse is not behaving properly” or “I am unlovable.” The therapist, rather than trying to talk them out of the belief, may instead encourage the client to examine the physical loci of these thoughts, to notice which areas are tense, which are open and spacious, and to locate any feelings of collapse. More importantly, perhaps, clients are also asked to note a vacancy of feeling. A common example (especially in clients who have had sexual trauma) is the sense that one cannot feel one’s pelvis at all, or that it is disconnected from one’s torso or legs. A client asked to scan his body from head to toe might convey an uncanny absence of pelvic sensations. Of course, such an absence gives the therapist an idea of what the client is avoiding.

  Working with the Five Elements of SIBAM

  The SIBAM model includes the neurophysiologic, behavioral and somatic aspects of an individual’s experience, whether traumatic or triumphant. When there is a successful outcome, or a corrective experience occurs during therapy, the elements of SIBAM form a fluid, continuous and coherent response that is appropriate to the immediate situation. When individuals suffer from unresolved trauma, these various aspects of traumatic association and disassociation continue in fixed, now-maladaptive patterns that are distortions of current reality.

  An example of this fixity follows: A woman loves nature, parks, meadows and grassy knolls; however, every time she smells new-mown grass she feels nauseated, anxious and dizzy. Her belief (M) is that grass is something to be avoided. The olfactory and visual image (I) is associated with, or coupled to, the sensations of nausea and dizziness (S) coming from her visceral and vestibular systems. This positive feedback loop, with negative consequences, is an enigma. Part of the event is disassociated from her awareness: she has no idea why this happens; she just knows that she has a strong dislike (M) of grass. As this woman explores her sensations and images, seeing and smelling cut grass in her mind’s eye, she takes time to explore her bodily sensations in detail. As she does, she has a new sensation of being spun in the air and held at the wrists and legs. Next she gets a tactile image of her bullying brother giving her an airplane spin on the front lawn of her childhood house when she was four or five years old.

  She feels scared (old A), but as she trembles and breathes, she realizes that she is no longer in danger. She now orients (B) by looking around at the peaceful office and then turning her head toward the open face of her therapist. Feeling intact with this newfound safety, she settles a bit. She experiences a spontaneous breath (new B), feeling secure in her belly (new S) now. Then she notices some tightness around her wrists (old S) and the impulse to pry her wrists loose (new S). Now, she feels a wave of anger (new A) building up inside as she yells “Stop!” using the motor muscles of her vocal cords (new B). She settles again and feels (new I) the tactile pleasure of lying on the soft new-mown grass in the warmth of the springtime sunshine. Fresh grass is no longer associated with unpleasant sensations (old M); green, freshly groomed grass is good, parks are wonderful places and “all is well” (new M). She no longer feels nauseated or anxious again in that situation.

  The simple example above shows us how the elements of this biological model fit together to create a web of either fixity or flow. In nature, when one feels an internal sensation, frequently an image appears simultaneously or shortly afterward. If a client is bothered by an image, a sensation may accompany it that he is not aware of. When, with the therapist’s guidance, the client becomes conscious of both elements, a behavior, affect or new meaning generally follows.

  Once we understand the process and do not interfere with it, biology works to move it along. The sensation-based brain stem has the job of bringing homeostasis and, thus, goodness back to the body. Therefore, it naturally follows that when the client’s body’s behavior becomes conscious in the safety of the present moment, the thwarted movements come to an intrinsic resolution or a corrective experience—as happened with me, Nancy and the woman in the example above. This resolution leads to a discharge of energy, resulting in a fresh, new affect (A) that brings with it brand-new options or meanings. If the client is unaware of behavior or sensation, the fixed image generally leads to fixed affects and/or thoughts that were troubling the client to begin with. When a fixed behavior does not complete in a new way, the result is a habitual, or (over) coupled, affect. Because behavior reflects preparatory, protective and defensive orienting responses, assisting clients to follow their sensorimotor impulses to completion, as they come out of freeze, is a key to unlocking the constrictive and limiting prison of posttraumatic stress disorder.

  The therapist’s task
as healer is to notice which SIBAM elements a client presents with are old, conditioned, ineffectual patterns and which are missing completely because they are unconsciously hidden. When we can read this map, we can provide the somatic tools to free the client from being tangled up in these habituated physiological associations from the past. In this way people are, thankfully, restored to a healthy, flexible and dynamic way of relating to all of the new experiences life brings.

  * Recall Step 3 (pendulation and containment) from Chapter 5.

  † It does this specifically from what are called “stretch receptors”—specialized fibers in the muscle called intrafusal fibers.

  ‡ The senses of sound and touch are actually similar. In the inner ear there is a membrane called the basilar. Sound waves make this membrane vibrate, stimulating hair receptors to send impulses to the brain. The hairs on our skin function in a similar way. Indeed, deaf individuals have some sense of hearing through the skin.