The article below was featured in the Belgian ‘Psychologies’ magazine in March of 2023. It is a transcription of a Somatic Experiencing® session. It has been translated from Dutch.
Eline worked as a well-functioning businesswoman when she came into a burnout for no apparent reason. This soon became accompanied by pains in her body, and she was later diagnosed with fibromyalgia and CFS. About 3 years after her initial diagnosis, she came to Somatic Experiencing® (SE) as no other therapy had worked until then. At that time, just about everything in her life was too much, she was sensitive to noise, proximity to others, spent most of the day on the couch and had trouble sleeping. Even the idea of getting out and maybe bumping into people was too much. After about a year of almost weekly sessions she had more energy, she was able to take on household chores again and she also started a hobby again. The pain in her body was less, but it remained, especially in her back and neck. She also always had the feeling that she had no strength in her arms. In this session, her wish was to gain more insight around this pain and hopefully get some relief. There is no specific context or story of why there is pain in her back. In SE we don’t need a cognitive narrative to start working with symptoms as we can use the physiology as an entry point. The physiology is most likely still in the sensory-motor reaction that is connected to one or multiple events. Working with the physiology can possibly bring back memories or even flashbacks of the different experiences that lead to the symptoms.
CC: Take a moment to bring the focus to your back. Is there a spot in your back that stands out the most?
E: Between my shoulder blades
CC: Is it the whole zone or a specific spot?
E: Take a moment to feel in – It seems to be like a vertebra between my shoulder blades, a little more below.
CC: Okay nice. Can you describe what sensations you experience when you are in that place with your attention?
E: Tension.. Narrowing, both from the sides and from top to bottom..
As she describes this, a slight contraction happens in her upper arm / shoulder
E: I also feel a kind of fear, almost like panic. The image of a little girl who is in pain and all alone.
CC: As long as it’s ok, just stay with it for a while. Short break. Without anything having to change, if you would expand your attention to the rest of your body. What would your body want to do from this feeling?
After empathizing for a while, E raises her right arm reasonably quickly
CC: Okay good! Would you like to do that movement again, but slower, so you have even more time to feel what is about to happen?
Slowly E brings her arm back up. This time she also fastens and the move seems to be a blocking move and pushing anything coming from the right to the side. At the end of the movement E keeps her arm on the spot and takes a deep breath.
CC: Yes good. What’s happening now?
E: I notice that I sit a little more upright and feel a little more space.
CC: Take your time to feel this. Is there an image that comes with this?
E takes another deep breath/sigh and her whole body shakes briefly. She also opens her eyes.
E: Not an image but a memory. I completely forgot about this. When I was about 6-7 years old I once played on the street and was hit by a car coming from the right. I landed first on the windshield and then hard on the ground.
As she describes this, her right upper arm is once again tensing up.
CC: Okay take a break, I’d love to hear the rest of this incident, but first go back to your body and your arm. What happens when you tell this?
E takes a few moments and while she is sensing there are short contractions in her right shoulder and upper arm.
E: It’s like I want to stop the car or push it aside..
CC: Yes indeed. We can’t change the past, but we can accommodate in the now the reactions of our nervous system that it couldn’t do in the past. What would it be like to imagine walking back out onto the street, but this time giving way to your body’s response?
E: Okay. Again E’s arm slowly rises. This time the movement is slower and more clearly defined. At the end, her upper arm turns out and she sits straighter. As she remains in this position for a moment, her breathing slows and her shoulders soften. E takes a deep breath.
E: My whole body relaxes. Even my neck doesn’t hurt anymore suddenly.
CC: Okay nice. Just take a moment to stay with this. What else do you notice?
E: If I keep my arm here, I also feel more strength in myself.
CC: Do you have any idea what sensations in your body give you the feeling of power?
E: My feet are on the floor and I feel space in my chest. I suddenly realize that I did nothing wrong. I still remember that after the accident my father was angry with me and my mother looked at me funny and.. E falls silent and there is clearly emotion present
CC: Take your time. Pause. Before you tell us about what exactly happened, can you remember the first time you felt safe after the accident?
E: The day after when the nurse put my arm in plaster.
While E is telling this, some relaxation returns to her body.
CC: What happens now?
E: My shoulders relax. I can breathe a little more. I feel my feet back.
CC: What was it like being there with the nurse?
E: I can still see the white ceiling tiles of the hospital and someone – the nurse – who paid attention to me. Who believed me..
Tears roll down E’s cheeks and she continues sobbing
E: She believed I was in pain. My forearm was broken and my foot also had to be in some sort of support bandage and I was not allowed to lean on it for a while. My parents didn’t believe me, they never believed me, I always exaggerated. “It won’t be that bad” they kept saying.. I’m not worthy of attention.
CC: Sorry to hear that your parents didn’t believe you. That must not have been nice for you.
E: No indeed. Everything was minimized. What I feel is not important.
CC: Oh, it pains me to hear you say that. It is certainly important what you feel. How else can we make the right choices for us if our feelings are not important?
E: Yes indeed..
E takes a deep breath as another tear rolls down her cheek.
E: I’ve never actually made choices for myself, I realize now. No wonder I got burned out. I did my job and I was good at it, but I didn’t feel anything about it. I don’t even know what I would want if I had to choose..
CC: If you like that, go back to the moment in the hospital with the nurse.
E: Okay.
E takes a moment to check back in with that moment and with her body
CC: What do you notice?
E: My body relaxes again. My shoulders drop and my neck can move more. It actually feels strange.. I’m not used to anyone taking me seriously.
CC: Take your time.
E takes her time and her body and nervous system seem to relax a little more step by step.
CC: What happens now?
E: The pain between my shoulder blades is less. But I’m afraid it will come back.
CC: Okay. Do you feel like trying something small? And you can always say no. If you imagined that the nurse could say something to your parents for you. What would that be?
Some tears come back to E, but this time there is less tension as she holds back the tears. As she utters the sentences below, there is more power in her voice and attitude at times.
E: She would say something like: You are irresponsible as parents! You should have called the ambulance immediately after the accident and not wait a day to come here. As a parent you have to take care of your child! Shame on you!
CC: Okay nice! What happens when you say this?
E: I get angry. I feel both my arms getting stronger as I express myself. The pain in my back is completely gone.
CC: Yes nice! Take your time again.
As she takes her time, her posture relaxes a bit and she breathes softer.
CC: Is there anything else the nurse would say?
E: It’s about time you started listening to Eline!
CC: Yes indeed. What’s happening now?
E: Yes it touches me. Something inside me softens. E takes a deep breath. I can indeed listen to myself.
CC: Yes indeed, you can listen to yourself. Short break. What is it like to listen to yourself?
A smile appears on E’s face.
E: It’s like something clicks into place. I can’t describe it well yet. Like I’m getting my own space again.
In subsequent sessions, we continued working with the car accident, as several aspects of the experience and the associated survival responses still need to be expressed and processed. At the same time, we continued addressing what we call pervasive trauma—the relational and developmental trauma that emerged during the session.
The session described above illustrates how shock trauma and developmental trauma can become intertwined: when one is activated, the other may also surface. It is therefore important to uncouple them so that each can be processed separately.