The Wilheim Reich Center for the Study of Embodiment Feb 24, 2024
Reflections On How Trauma and Dissociation Are Embodied
Heather Ferguson, LCSW
I want to acknowledge the panelists’ significant contributions to the study of aesthetic, improvisational, sensorial, unconscious, and intergenerational dimensions in the therapeutic exchange. Recently, I have integrated creative imagery from clinical hypnosis, attention to the felt bodily experience (inspired by sensorimotor psychotherapy), and the guided process of Eye Movement Desensitization and Reprocessing (EMDR) into my trauma-informed psychoanalytic thinking. These “bottom-up” approaches bring a somatic focus to the blocked embodied responses to trauma by addressing my patient’s states of hyperarousal, overwhelming affect, and negative self-schemas. When words fail to capture my patient’s experience, imagery, metaphor, and the hypnotic induction of EMDR can help them feel grounded and engaged as an improvisational partner.
Let me offer a clinical example: With my patient Amy[1], when flooded by childhood memories of sexual trauma, these embodied tools provide a bridge to
help her regulate her mind/body while catalyzing her imagination in the present.
She recalls affectively charged images and sensations in manageable bites. Amy’s early trauma, never spoken or shared before, is held and communicated through her bodily symptoms. We understand her caloric restriction, violent purging, and other self-harm as her embodied form of remembering. Her reenactment through the bodily domain is her means of showing, telling, and searching for repair. She says, “His memory is inside of me.” Indeed, for Amy, her embodied trauma haunts her daily experience and colors her future expectancies (Brothers & Sletvold, 2023).
As Amy invites me into her private world as a witness and companion, we untangle the self-regulating and repetitive dimensions of her symptoms. Her embodied experience of undereating and purging is our point of inquiry. I register the high-risk, dangerous aspects of her behavior and quiet the internal pressure I feel to rush to remedy. I imagine, “feel into,” and dwell in the meaning of her symptoms—and words—as crucial embodied communication to me and vital to her survival.
Undereating stimulates hypo-arousal, creating a numb and dissociative state, yet offers a transient means of asserting bodily control. Purging is less about food and more about a reenactment of her under-symbolized, traumatic experience. She says, “Feeling full reminds me of being filled by him. I want to hurt, to feel the sensation of razor blades cutting my throat from the inside out.”
Philosopher Mark Johnson (2007) notes that we are “creatures of the flesh”—meaning takes shape through our bodily perceptions, movements, and emotions (p. ix). So, I focus on helping Amy affectively connect with her embodied states, bit by bit, as we understand, more fully, the emotional context that drives her behaviors. Amy brings drawings and poetic journal entries into the session, providing a communicative bridge as she draws on her inner resources to weave a narrative. This creative source material helps her find language to animate her more dissociated experiences. In this process, I highlight her unique gifts—her artistic sensibilities and empathic depth—to mark her vitality, idiom, and signature.
Amy suspects that the same perpetrator sexually assaulted her aunt, 30 years her senior—an aunt who similarly had anorexia as a young girl. The family fails to connect their mutually emaciated bodies, their silent screams across two generations, or acknowledge the family violence and chaos. I offer, “You are holding both stories—in and through your body– across two generations or more.”
Amy identifies simmering anger–dangerous and unwieldy–that belongs to her abuser. Amy protects her parents as they remain blind to the questions surrounding her chronic disordered eating. In a millisecond, this rage is turned against herself.
In the session, Amy struggles to tell me how she hurt herself. “I took a belt buckle and bruised my body where no one can see,” she later tells me. She shares her journal entries. She writes: “I deserved the pain.” “I let it happen.” “Disgusting Girl”. With each punishing thought and feeling, I imagine, and almost feel, the sting, the bruising, of the heavy belt buckle.
I ask Amy if she can stay with these sensations, the embodied feelings. I try to convey compassion and steadiness with my eyes. She pauses and offers, “It’s an awareness of myself in space—visible, exposed—the hate about myself that bubbles up.”
As we explore her impulse to inflict pain, I think about Ferenczi’s identification with the aggressor—a hypnotic order flowing from the early traumatic scenes, not as an identification per se but an embodied replication of what was done to her—to signify and make meaning of the unsayable—the ungrievable (Ferenczi, 1932; Frankel, 2004; Howell, 2014).
I invite Amy to try a hypnotic script in which she conjures a soothing scene and locates an inner resource flowing from her imagination. As I guide this open-ended visualization, I match the rhythm of our breaths with the cadence of my speech. In deep relaxation, I prompt, “Perhaps you will discover a ritual that unburdens you in some way.”
Amy writes about her imaginative reverie: The residue within is thick and resin-like – the shame and hurt stick to my throat, lungs, and stomach, so much so that I am filled with darkness. I reach inside, lift the mass out of my chest, and hold it in my arms. It is heavy, as though it has been filled with bronze, as though within the grossness, hot liquid metal has been poured, as though it is a casting of moments surrounded by toxic remnants of feelings. I…walk until I find a deep hole partially concealed by a fallen tree. I place the darkness inside, covering it with soil rich in decomposing leaves. I bury it, knowing that in time, nature will eat away at the shame, the hurt, the self-hate, leaving behind the solid bronze marker wrapped in vines and saplings, cushioned by fallen leaves, the beauty formed from ugliness. One day, the pain will be less. One day, you will feel free.
In dreaming up this reparative scene, Amy begins to symbolize her toxic shame and self-hate. She calls upon an observing adult self-state. She draws on her creative mind and counters familiar immobilization with a future vision.
My training in EMDR further helps us address her split-off traumatic memories that remain unmodified in state-dependent memory. We focus on current and past scenes, charged with unresolved feelings. We explore fragments—images, emotions, body states—with dual awareness, one foot in the present. Amy requests the EMDR sessions when she is ready, and we discover our rhythm. When we are in the processing phase, between sets, she sometimes accesses words to describe an emergent sensation, image, or feeling; at other times, she writes it down for me to read silently. Sometimes, she nods her head, and we proceed. Most importantly, Amy controls the pace of our process and is empowered to stop at any time. Interspersed, our talk therapy sessions provide a reflective space to build a coherent embodied narrative.
Recently, we discussed Amy’s need to feed herself for an upcoming road race, which aroused a searing feeling. She explained, “It’s the evocation of a body.” Directing attention to her body– the need to eat– is anathema to the project of forgetting she has a body. Running helps her leave her body. She feels most alive when her heart beats as if she is flying– a signification of her inner strength, endurance, and survival. We are aware of this paradox, and our treatment bind.
As hope and dread enter our intersubjective dialogue, I have a dream, a prospective vision: Amy and I are in a downtown art space bustling with activity. We sit at a long table. Amy is absorbed in doing an art project. We both help ourselves to the delicious array of gourmet food left out for all to share. We sit contentedly, eating side by side.
As I reflect on the meaning of my dream, I see the intermingling of our histories— an evocation of the unhealable, beloved figures in my life and my reparative wish for Amy.
References
Brothers, D., & Sletvold, J. (2023). A New Vision of Psychoanalytic Theory, Practice, and Supervision Talking Bodies. Routledge.
Ferenczi, S. (1932). The Clinical Diary of Sándor Ferenczi. J. Dupont (Ed.), M. Balint &N. Z. Jackson (Trans.). Cambridge, Mass: Harvard University Press, 1988.
Emanuel, C. (2022). A White and Nondisabled Psychoanalyst: Owning Racism and Ableism in the Clinical Process, Psychoanalysis, Self & Context, 17(2), 181–195.
Frankel, J. (2004). Identification with the Aggressor and the ‘Normal Traumas’: Clinical Implications. International Forum of Psychoanalysis, 13(1/2):78–83.
Howell, E. (2014). Ferenczi’s Concept of Identification with the Aggressor: Understanding Dissociative Structure with Interacting Victim and Abuser Self-States, American Journal of Psychoanalysis, 74, 48–59.
Johnson, M. (2007). The Meaning of the Body. University of Chicago Press.
Knoblauch, S. H. (2021). Bodies and Social Rhythms. Routledge.
Ogden, P. (2021). Sensorimotor Psychotherapy in Context. WW Norton & Co.
1 I have omitted biographic details to protect my patient’s anonymity. Our social and cultural embeddedness informs our embodied experience. Bodily experience evolves through the contingencies imposed by social location; for example, the experience of gender, race, class, and abilities (See Emanuel, 2022; Knoblauch, 2021; P. Ogden, 2021).