Moving through Trauma: Phoung Ertley talks Blending Somatic Psychotherapy and the Feldenkrais Method®
Thursday, January 24, 2019
by: Ira Feinstein, MFA

Section: Practitioner Spotlight




Phuong Ertley is a licensed marriage and family therapist, with a specialty in somatic psychotherapy. She works primarily with survivors of trauma. In addition to being a therapist for nineteen years, Phuong has been a Feldenkrais® practitioner since 2016.

In Touch Editor, Ira Feinstein recently spoke with Ertley about trauma, somatic psychotherapy, and the Feldenkrais Method. She also shared some valuable tips for Feldenkrais practitioners working with people in a trauma state.


Ira Feinstein: Have you noticed similarities between your Feldenkrais practitioner and somatic psychotherapy trainings?
 
Phuong Ertley: During my Feldenkrais training, I learned how to work with movement to help people rewire and enrich their nervous system. During my somatic psychotherapy training, I learned how to track a client’s autonomic nervous system and their movements; how to pay attention to a person’s breathing and the quality of the way they say things and understand how that interweaves with their emotional and intellectual experience. In both cases, I've been trained to perceive the whole person, and frequently, the communication below conscious awareness.
 
The key, whether it is psychotherapy or a Feldenkrais lesson, is linking one’s awareness to what one is doing. When I say “doing,” I mean it in an expansive sense. It could mean breathing or the way you're expressing anxiety—all of these behaviors are opportunities for conscious awareness. Whereas in an ATM® lesson where we ask explicit, verbal questions or in an FI® lesson where we ask implicit, kinesthetic questions, in psychotherapy, I can do both. I can ask a client to explore a movement slowly so that they can feel how they're doing it and I can also give them a language for the things that are movement-based so that they can join me in that inquiry. They’re both collaborative experiences, but the experience of that collaboration is on a continuum.

IF: As a somatic psychotherapist, what is your understanding of trauma?

 
PE: Trauma is a cluster of symptoms that someone experiences after negotiating what is perceived by them to be an overwhelming event. A telltale sign of trauma is the feeling of fear. That fear could be related to external events or to the feelings inside our own bodies that may feel unpredictable, unpleasant, or out of control. People who suffer from trauma have fear-based responses to life, meaning they avoid certain places, activities, or people for fear of what may happen. So trauma essentially means that at some point in your life, you didn’t get away. You might have survived, but the way in which you did it feels incomplete to your nervous system even today.
 
IF: When someone comes to see you for somatic psychotherapy, what does the process look like?

PE: I have phasic goals for my clients, meaning we master skills in developmentally appropriate stages. The first task is stabilization. Being stable in life could mean holding a job or having access to medical care. On a somatic level, it includes developing a felt sense of safety. During this phase, our primary goal is to develop resources. Resourcing on a somatic level can mean a lot of different things: centering, breathing deeply, having a felt sense of support, or movement. Sensing the ability to move is critical because trauma survivors often feel immobilized. Resourcing can also mean feeling a sense of connection—being connected to your feet, your legs, your stability in any given moment. A lot of people who have survived trauma often feel disembodied, or they can't feel a specific part of themselves. In the therapeutic setting, the connection to another person in a safe and caring way is also essential.

 
The second phase after stabilization is trauma reprocessing. To put it in a nutshell, the way to heal a trauma memory is to reintegrate the missing piece: what wanted to happen but didn’t happen? Often the missing experience is that the person was frozen in some aspect of their body, and the impulse to move was thwarted. For example, a client of mine remembered witnessing a car accident as a child. At the time, she didn't get hurt. But the feeling and the impact of what she saw was so overwhelming, she froze. What her body actually wanted to do at the time was to run to safety. In cases like these, I help the person recall that experience simultaneously with their present-time awareness. If they can keep their present time awareness online, they can allow their bodies to move in a way that didn't happen back then. In this particular case, she recalled the moment of the accident and then allowed her body to run away. Her arms and legs were able to negotiate the event successfully the second time around.    

The brain is fascinating in how it regards time. The time lapse between the original, traumatic incident and the present time doesn’t matter as long as the movement in the present-time causes neural connections to form. In the therapy room, I would track all the autonomic nervous system signs that someone is actually reliving a traumatic incident, such as sweating, rapid pulse, or heavy breathing. However, because they are actually able to move in this iteration of events, I’ll also see a big exhalation, waves of joy, and a sense of excitement because they got away. This process allows for the person to reintegrate what the body naturally wanted to do and to let it complete that nervous system cycle. We call that nervous system resolution an “act of triumph.”
 
After an act of triumph, clients are not only physically, but mentally and psychologically reorganized to a more powerful place. Before, even though they’d survived, it wasn’t—on an unconscious level--considered a success and their bad feelings about themselves became embedded in that moment in time. Merely surviving didn’t give them the sense of “I can do this.” But when you get to feel in your body what it's like to get through the trauma in a way that’s satisfying or empowering, your brain replaces negative thoughts and feelings with more positive, self-affirming ones. 
 
I think this process is very similar to an ATM lesson, even though the goal is non-specific in an ATM lesson. A lot of what we’re doing during ATM lessons is making neural connections that we didn’t make at some point in our lives. Take the act of walking: what I learned from the Method is that we all kind of winged it. We got to the point where we’re upright and mobile, and that was good enough. During an ATM lesson, we have the opportunity to comb through the learning process and pick up the pieces that we had missed the first time. We get to learn how to walk again, but this time with some feeling of pleasure and ease. As the missing pieces reintegrate back into your body, you feel more whole, accomplished, and satisfied. Sometimes when I see absent experiences in my clients, an ATM lesson will spontaneously pop up in my head like, “Oh, that's ‘Spine Links like a Chain.’” So, we’ll do a few moments of that.
 
The beauty of being in a psychotherapeutic environment is that clients can verbalize all the feelings and thought processes that come with the movement, so that it doesn't become a private experience that they have with themselves, like when they're doing an ATM lesson. By forming words for the felt experience and then sharing it with me, clients are linking more parts of their brain, and it becomes more integrated into their concept of themselves. So, while I’m leading my clients through a mini-ATM lesson, they might say to me, “I feel more of myself,” or “I can feel myself moving more powerfully, and I feel more powerful as a person.” During these A-ha moments, I'm there to say, “Yes, go with that.” Validation helps enrich the client’s sense of self. Additionally, because I’m seeing them in that new way, the learning is socially reinforced, creating an even more powerful, transformative experience.

IF: How has integrating the Feldenkrais Method into your therapy practice facilitated outcomes you might not have arrived at otherwise?

 
PE: I think the following story illustrates how well the two blend together in my practice.
 
I had a client who was working on overcoming traumatic experiences he’d had growing up as a refugee. As a child, he’d been bullied because he was small in stature and couldn’t speak English. All of that manifested in a recurring nightmare from his childhood that had continued until I met him in his forties. In the nightmare, he was a young, frightened kid running through an alleyway in the neighborhood where he grew up. Nightmares are typically more about a feeling than anything else, and the feelings for him were around being young, scared and running.
 
He and I then agreed to go into the nightmare together. He was seated while telling me about the nightmare, but his pelvis was moving—something he was unaware of. He started to feel nauseous, which is a sign of overwhelm. From a Feldenkrais point of view, I understood that the pelvic movement was an excellent thing, so I asked him to notice his pelvis moving and inquired if he was able to track and follow it. When he could feel the movement, it traveled only from his seat to his belly and then stopped.

I had him lie on the floor with his knees bent and his feet on the floor to help him feel the movement throughout his spine in a more complete way. We started doing the pelvic clock ATM lesson where I asked him to point to 6 and 12 o’clock with his navel. Once he found that motion, he began linking his awareness higher and higher up his spine. Then I asked him to connect the back of his head to his pelvis. When he was able to feel all the way up his spine, he started feeling older and more empowered because his spine was long, like an adult’s, and not short, like a child’s.  He still, however, had this sense of being afraid. When he got tired, he lengthened out his legs and took a break.

 
I then took out one of my garden pads, and we did a tiny moment of artificial floor. The moment he made contact with his feet, he exclaimed, “Oh my God, my self-image just totally changed.” He had transformed from a little boy into a giant who was bigger than his neighborhood. The connection to the floor delivered a more accurate sense of how big he actually was. It gave him a sense of time and place, and he was able to view everything he'd accomplished in his life since he was a little kid. He saw himself as a person with a successful career and a family. He experienced a beautiful integration of who he is now and his life story since the moment of that childhood fear. As this man was growing up before my very eyes, I became so grateful for the Feldenkrais Method because I wouldn't have had the inspiration to do the artificial floor if I hadn't done the training. 
 
IF: What kind of rapport might a Feldenkrais practitioner consider developing with their clients to minimize the chances of them experiencing trauma during a lesson?
 
PE: It’s important to remember that when students are on the table, they're in a different state of consciousness. They’re not in their “normal-ordinary consciousness,” as we’d say in psychology. From that first act of simply lying down, they're more prone to remembering a memory. Because of this, I think it is vital to establish a good rapport with them beforehand. As a practitioner, I would be careful not to address someone coldly or clinically before, during, or after a session, because that could be a reenactment of something frightening that had happened to them before. For example, I’ve worked with a number of clients who, if you looked at their history, you wouldn't see anything that you would categorize as trauma. Over the course of a session, they’ll remember that they had undergone surgery. While they were under anesthesia and on the surgical table, they didn’t see any warm eyes. The vulnerability of being on the table combined with the lack of warmth meant something bad had happened to them. This is a bodily feeling, not a cognitive thought. When we put someone in a position of trusting us with their bodies, it's critical to have a warm, connected feeling so that if they do go into an uncomfortable state, they would feel comfortable enough to say, “This doesn't feel good to me.” Having a voice and voicing boundaries are critical elements of a safe relationship, but clients may not always feel comfortable doing that so we practitioners need to cultivate that environment actively.
 
Something that people don't think about is that when we lie on the table for a while, we get cold. So if you want someone to feel safe, offer them a blanket. Tending to that part of the experience helps clients avoid going into a feeling of discomfort. From discomfort, it is easier to slip into a sense of unsafety. 
 
IF: Regarding trauma, what signs would a practitioner want to look out for?
 
PE: Practitioners could look for cues from the autonomic nervous system. It’s important to look for a constellation of signs, not just one thing. Are they suddenly breathing too fast or maybe unconsciously holding their breath? If it’s a traumatic memory, it usually comes with a racing heart. Also, pay attention to their skin tone. Is the person turning gray? Red? Are they flushing? Other good indicators of trauma are involuntary trembling or shaking, making noises, and dilated eyes. Also, notice if their body temperature is getting colder, which could indicate going into a freeze response. It’s better to catch these things earlier than later, but sometimes with trauma, the person can slip into a hard place quickly. This is why an intake interview is helpful before tablework or touchwork.  

IF: What advice would you have for a Feldenkrais practitioner unsure of how to interact with a student who appears to be going into a traumatic state during a Feldenkrais lesson?

 
PE: If you see signs of distress, stop and take a break. Then, say something to the student to acknowledge that something had happened. Your voice will remind people of where they are — even saying something simple like, “Hi Samantha. How are you doing?” in a gentle, moderate tone can help someone reorient to time and place. If they're shaking or trembling, ask them if they’d like a blanket. Offer them a glass of water. When we enter a state of fight or flight, our salivary glands dry up, which signals to our brain the message, “You’re not safe.” We can interrupt that cycle by simply offering someone a drink of water. 
 
If they need to say something about what they're going through, I would ask them to keep it brief. Talking about traumatic memories opens the risk of uncovering a whole memory network and could lead to other unpleasant or out of control feelings. If necessary, it is ok to remind them that delving into a more therapeutic conversation isn’t within your scope of practice. A great idea is to have two or three psychotherapists in your referral network. Tending to a client’s psychological needs in this way builds trust and further reinforces your expertise as a knowledgeable healthcare provider.  
 
IF: Thanks for those excellent tips and for taking the time to speak with me about the work you're doing. 

PE: People often think that doing this kind of work with people is draining and depressing, but to me, it is just the opposite. When I’m at the finish line with someone after they’ve moved through something traumatic and I get to see them awaken to their own power and excitement for life, there's nothing else I would rather be doing. Lastly, stage 3 of trauma work is 
integration of the powerful lessons learned into daily life and cultivating a new life of post-traumatic growth.
Phuong Ertley has a passion for destigmatizing mental health and empowering people to live their best lives.  She has a private psychotherapy and Feldenkrais practice in San Francisco and delights in giving trainings and consultations in the SF Bay Area and abroad. Find out more at www.phuongertley.com.
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Comments (2)
Kevin Cassity
1/26/2019 2:06:54 PM
Wow, wonderful interview ... such a beautiful intelligence and passion and interweaving of practices for releasing human suffering! Thanks.


Stacy
1/26/2019 1:30:14 PM
This is so well discussed and explored. Thank you for this wonderful interview.


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