An Interview with Peter Levine


An Interview with Peter Levine

Turning Psychotherapy Bottom Up

March/April 2019


Psychotherapy Networker: How did you first get interested in taking a body-based approach to therapy?

Peter Levine: Back in the 60s, I started developing various kinds of mind–body methods with people who had high blood pressure. When I taught them how to relax certain muscles in their neck and jaw, their blood pressure would sometimes drop 20 or 30 points, well into the normal range. But my real breakthrough came in 1969, when I was asked to see a woman named Nancy. It was that experience that changed the course of my work, and my life.

Nancy had all kinds of physical complaints, including what would now be called fibromyalgia, chronic fatigue, irritable bowel, urinary problems, and migraines—the kinds of chronic conditions that are confounding to conventional medicine. In addition, she was suffering from panic attacks and agoraphobia, which made it impossible for her to leave the house without her husband. The psychiatrist seeing her thought that some mind–body exercises might be of benefit to her, at least in reducing her anxiety, and so he referred her to me.

When Nancy arrived, her heart was pounding frantically, at about 120 beats a minute, and she had the frozen deer-in-the-headlights look. I began by trying to help her relax the muscles in her jaw and neck, and in the process, her heartbeat soon started coming down. Then suddenly, it shot up to about 160 beats a minute. Not knowing what else to do, I just said, “Nancy, you need to relax. You must relax.” To my great relief, her heart rate started going down. However, it kept going down and down and down, from 80 to 70 to 60, and then into the mid-50s. Nancy turned a deathly shade of pale, and looking at me in terror, she cried out, “Help me! Help me! Don’t let me die!”

As I held my breath, an image somehow came to me. At the far corner of the consulting room, I saw a tiger crouching, ready to spring forth. And without quite knowing why, I commanded, “Nancy, there’s a tiger chasing you. Run, run, climb those rocks, and escape!” After about 30 minutes of gentle shaking and trembling, she began to breathe more fully and spontaneously as her face became rosy and warm. When she finally opened her eyes, she reported that when I gave her the image of the tiger, she saw herself starting to run, though her legs felt like lead at first. But then, with my encouragement, she began to imagine—and feel—herself climbing the rocks and escaping. From that vantage, she could look down at the tiger and feel safe, maybe for the first time in decades.

She reported that the image of the tiger then morphed into an image of herself when she was four years old. She was being etherized for a tonsillectomy and saw herself being held down by doctors and nurses while they forced the ether mask over her face. Suffocating, in sheer terror, she realized that she’d wanted to run and escape, but hadn’t been able to. That overwhelming sense of helplessness, fear, terror, and bodily fragmentation is the core of the experience of trauma and had been expressed in the theater of her bodily symptoms and in her panic attacks. Indeed, not only did her anxiety resolve, but after a few more sessions, so did many of her physical symptoms.

At the end of the session, Nancy opened her eyes and gazed softly toward me. In that tender moment, she said that she felt like she was “being held by warm, tingling waves.” This surprising side effect of deeply pleasurable and salubrious sensations was something I’d hear about from thousands of other individuals over the decades that followed. Those types of responses seemed to be similar to various spiritual and mystical experiences described in different traditions around the world. The mystery deepens!

PN: Where in the world did the image of the crouching tiger come from?

Levine: Back in graduate school, one of my professors had described a phenomenon called tonic immobility. An animal being attacked by a predator freezes as if it’s dead. The prey becomes motionless, and its heartbeat and breath descends to a very low level, as Nancy’s had. But then, when the animal senses an opportunity, it springs into action and escapes from the threat, bounding off to live another day. As I came to understand, the great survival value of such a freeze response is that predators often won’t dismember and eat an animal that doesn’t offer resistance and put up a fight—an instinct that’s likely to inhibit them from eating infected carrion. In addition, the expulsion of vomit and diarrhea that often occurs with immobility may make the prey an even less desirable meal. In Nancy’s case, however, it resulted in chronic gastrointestinal (and other physical) symptoms.

Later, as I thought about what had happened with her, I began to see the parallels between what animals do in the wild and what happens when horrible things happen to people. Our guts twist up, our muscles tighten, and our heartbeat starts racing or, conversely, slowing to a low level. Those sensations of twisting and turning in the gut get relayed back to the brain, which reinforces and amplifies the original message of danger and threat. But, unlike the wild animals, we don’t release this shock reaction. Traumatized people get stuck in a vicious cycle. The therapist’s job is to help them interrupt that cycle and return to the land of the living.

PN: How does a body-based Somatic Experiencing (SE) therapist try to do that?

Levine: One simple but especially powerful tool for helping the person interrupt this gut distress is something I call the Voo Exercise. You take a deep, full, easy breath, and on the exhalation, make the sustained sound “vooooo,” directing the vibration to your gut. Once you let the air all the way out, you just allow the next breath to come in, spontaneously filling the belly and chest. In continuing this deep, resonant breathing, you slowly shift out of the freeze response and the attendant “yuck” feedback loop.

PN: To many therapists, SE still seems a bit mysterious, even mystical. Can you concretely describe what a first session of SE looks like?

Levine: When we feel overwhelmed by trauma, talk alone isn’t going to do very much. We have to go to the unspoken voice of our bodies: one that doesn’t use words to create experiences that contradict those of fear and helplessness. An SE therapist may begin engaging with clients in much the same way as a talk therapist: inviting them to speak about the issues or feelings that are haunting them. But rather than focus on the content of what’s upsetting them, the therapist might say, “This may seem strange to you, but bear with me. I wonder if you would be willing to identify where, in your body, you feel those difficult emotions (or conflicts), and what do they feel like physically.”

As this exploration begins, we try to help them become not only aware of their feelings or hauntings, but curious about the physical sensations that underlie them. My experience is that chronic negative emotions often don’t change until the underlying sensation patterns change. And this can only happen through enhanced body awareness.

PN: So give me an idea of how you work with sensations to help cut-off clients get in touch with their anger.

Levine: With suppressed anger, the underlying sensation is often a particular tension in the jaw, neck, and arms. So I might start by having someone feel that tension in their jaw and fist and then allow the jaw and fist to open just a teeny bit, until they feel an increase in tension. From there, I might have them then focus on closing and then opening the mouth and hand a little bit more. Then I might say, “And how about your neck? Are you still feeling the constriction there?”

“Yes, I feel it, but it’s not quite as bad,” they might say.

“Okay, would you be willing to do an experiment? I’m going to offer you my arm, and I’d like you to put both your hands on my arm. Just take the tension in your neck and chest, and move it into my forearm. Let my arm know how that tightness in your neck and chest feels.”

At this point, the person might report, “As I do this, I can feel the tension letting go. It’s like it’s going into your arm. Is that okay? It’s not hurting you?”

“No,” I’d say, “not at all.”

Or the person might say, “Oh my God, I can’t express this inner tension because I might do something violent.” So I’d assure them that I can handle whatever sensations arise for them and will tell them to stop if I need to. Then as they squeeze my forearm, I’d ask them to feel what’s going on in their arms, their hands, and their chest. As they continue, they’ll likely feel a release in the neck and chest, along with a burst of energy. Here, my job is to help them contain that energy so the anger doesn’t feel overwhelming.

In some of the older models of body therapy, you might have the person scream and hit on a pillow or twist a towel to get in touch with the anger. But the problem with those cathartic approaches is that they don’t actually release or dissolve the anger. I’ve found that a much better way is to proceed more slowly, layer by layer, using the principle of titration to find a path to discovering the strength and power that reside within (or beneath) the anger. When that happens, the emotion often shifts, or at least loosens its grip, and the person feels more freedom. In this way, rage can transform into strength and purpose—what I call healthy aggression.

PN: What special skills does an SE therapist need to have?

Levine: To be sure, SE therapists need to be able to read bodies—postures, facial expression, color changes, micromovements. But beyond that, to do body-oriented work, you need to learn to pay close attention to the sensations in your own body. You need to learn to listen to your clients in a different way, so that when a shift happens in a session, you can notice it in their body as well as in your own.

One of the primary tools in SE is open-ended, or “clean,” questions that help focus people on their immediate bodily experience. So let’s say a client is struggling with an uncomfortable heart sensation. I might start with, “As you feel your heartbeat, I want you just to notice if it increases, decreases, or remains the same, or if something else happens.” I’m encouraging the person’s curiosity about what’s going on in their body. If the person responds, “I feel my hands beginning to tremble,” I might just say something like, “And as you notice that, what else happens, does it seem to spread or move around in any way?”

In trauma, people’s bodies are continually replaying things that have happened to them years and even decades before. It’s as if time has gotten stuck inside them. The purpose of open-ended questions and body sensing is to help bring time forward, into the present.

PN: What does SE offer that conventional talk therapy doesn’t?

Levine: Too often talk therapy alone can devolve into a kind of a flat, devitalized conversation; it can be a way of trying to explain to ourselves what we feel. Talk is certainly a part of SE, but the goal is to add another dimension to that conversation, to root it in the person’s immediate bodily experience, in a way that brings them more fully and vitally into the present.

A French term, élan vital, describes the essential energy that animates us and moves us through life. I believe most people come into therapy, ultimately, in search of that sense of vitality. Because it’s so alien and frightening to them, it may initially be difficult for many people to feel this aliveness. But as they become more familiar with the world of enlivening sensations and the eidetic images that live inside of them, they learn to experience a living, “knowing” body as an ally, not as a persecutor.

PN: From an SE perspective, what happens in trauma?

Levine: Basically, people initially respond to trauma and other disturbing emotions in two ways. One is through chronically tight muscles, especially in the jaw, chest, belly, neck, and shoulders. That tension has the effect of dimming our awareness of things we don’t want to feel or know. The problem is that one tension leads to another. It may start with a tight jaw, then the neck tightens, and then the breath is inhibited, the chest becomes tighter, breathing becomes more difficult, the neck contracts even more, and so forth. Again, it’s a vicious, runaway cycle. One of the things that we do in SE is to help people separate out, or decouple, those different sensations. And each time they do so, there’s a release of the energy, and the trauma begins to loosen its grip.

The other way of responding to the difficult emotions of trauma is via dissociation. This fragments the experience of our body, brain, and mind, and reduces our capacity to feel any sense of integration, coherence, and flow. Think of a submarine that’s been hit by a torpedo. After the breach, the doors between compartments automatically close, preventing the sub from sinking by cutting off the different sections from each other, thus protecting the majority of the sub from the complete devastation of an all-encompassing flood. This compartmentalization is what can happen to our inner experience when we get traumatized. We have a sensation here, an image there, or a strident emotion that seems to erupt out of the blue. The pieces don’t connect coherently.

But when given proper support, people can bring their body more and more into awareness, and they can begin to bridge the disconnection between parts of their body, mind, and spirit. Initially, they may not feel a connection between their shoulders and their arms, and their shoulders and their neck. But as you help them develop this awareness, an image related to some trauma or to a developmental attachment issue will often appear. Sometimes an archetypal healing image might even come. As those memories and associations emerge, you can work with people to develop more expansiveness inside themselves, creating a larger container for their sensations. In this way, they no longer feel overwhelmed like they did in their traumatic past.

PN: Does touch play a role in SE?

Levine: Oh, there’s definitely a role for touch. Let’s say a person has tension in the belly and has tried various ways to help release it, but nothing has happened. That’s where touch work can be extremely helpful. Of course, you must first negotiate this intervention with the client, since we don’t just rush ahead without clear consent. It’s also important to get a full understanding of the person’s trauma history. Since our sensations and feelings are primarily in the gut, the heart, and the chest, you might use a gentle yet firm touch, so the person can develop a deeper awareness of what’s going on in that area. But the key thing is having a specific, clear rationale for where you’re touching and why. You can’t justify it by simply saying, “Well, I want the person to be able to feel more.”

PN: What’s the hardest thing for your students to learn about doing SE?

Levine: To not talk too much and to keep reminding themselves that they need to be in contact and present within their own bodies first. In SE, we’re always bringing students back to their own internal body experience. I think most people are probably like me when I first started; they don’t have a very good sense of their own body, an interoceptive awareness. But when they develop that somatic sensitivity and literacy, it can really be life changing.

There’s a Sufi saying: “The body is the shore of the ocean of being.” Learning how to tune into the subtle shifts that are going on inside us all the time can open us to the experience of wholeness and what I call the Authentic Self.

PN: As a body therapist, what do you think about the increasing interest in using psychedelics in therapy these days?

Levine: I do think they’re potentially valuable. Whether it’s MDMA or psilocybin or LSD or ayahuasca, certain substances can open doors to seeing the world in a different and expanded way, while facilitating self-compassion. But even though they may open the doors of perception, they don’t necessarily take the person through these portals and help them navigate on the other side. In other words, while many people do have valuable experiences while they’re on a substance, it may be less accessible in the normal waking state and is, therefore, not embodied. So how you make that bridge to ordinary, sensate reality is a key issue. You have to understand how and why you closed those doors in the first place. That takes additional work, which includes asking questions like, “How did I close down my body? How did I dissociate? What am I dissociating from now?”

PN: What place does spirituality have in your approach to therapy?

Levine: I think spirituality is an intrinsic quality of all living beings. When good SE therapists are working, even with someone with severe trauma, they’re guided by a trust that we all have the innate capacity to heal from even the most horrific events. They understand that successful therapy is not just about reducing a symptom or a problematic behavior. As the ineffable wisdom of the I Ching offers, “We must go down to the very foundations of life. Any merely superficial ordering of life that leaves its deepest needs unsatisfied is as ineffectual as if no attempt at order had ever been made.”

***

Rich Simon, PhD, is the editor of Psychotherapy Networker.

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