Post-Traumatic Stress Disorder: Treatment With An Emphasis On The Role of Nature in Healing

Running head: TRAUMA, HEALING, AND NATURE
Post-Traumatic Stress Disorder Causes, Effects, and Treatment With an Emphasis on the Role of Nature in Healing
Yvonne
May 2, 2006 Naropa University
Yvonne 2006. You may read and print this paper for personal use.
Trauma, Healing, and Nature
Abstract This paper explores how trauma affects the body, emotions, psyche, soul, and relationships with others. The paper discusses seven treatment methods for Post-Traumatic Stress Disorder (PTSD), seeking ways that biophiliaour innate biological connection with the natural worldcan be an ally in healing. Treatment goals of somatic release, safety, reconstruction, and reconnection are used to evaluate Eye Movement Desensitization and Reprocessing (EMDR), Somatic Experiencing, Bodynamic Analysis, Internal Family Systems (IFS) therapy, ecotherapy, and shamanic counseling. The paper briefly discusses the roles of memory and contemplative practices in healing PTSD. The author provides examples of her own experience using EMDR and IFS therapy.
Contents Abstract ..........................................................................................................................2 Introduction ...................................................................................................................6 The Role of Nature in Healing Trauma........................................................................7 Definitions and Causes of Trauma and Post-Traumatic Stress Disorder.....................8 Causes of Trauma ................................................................................................................................8 Post-Traumatic Stress Disorder ............................................................................................................9 Group trauma and group trauma treatment ..........................................................................................9 Effects of Trauma ........................................................................................................ 10 What Happens to the Body During Trauma.......................................................................................10 Physical and Emotional Symptoms of Trauma....................................................................................12 Psychological Effects of Trauma in Early Childhood ...........................................................................15 Relational Effects of Trauma..............................................................................................................17 Effects of Trauma on the Soul ............................................................................................................18 The Phenomenon of Re-enactment .......................................................................................................20 The Role of Memory in Trauma Treatment.........................................................................................20 Methods for Healing Trauma......................................................................................22 Methods Not Discussed in this Paper .................................................................................................23 Animal therapy ..........................................................................................................................23 Art therapy .................................................................................................................................23 Color therapy .............................................................................................................................23 Energy psychology techniques ................................................................................................23 Exposure therapy ......................................................................................................................23
Horticulture therapy .................................................................................................................23 LSD therapy ...............................................................................................................................24 Neuro Linguistic Programming (NLP) therapy....................................................................24 Repressed memory therapy......................................................................................................24 Eye Movement Desensitization and Reprocessing (EMDR)................................................................24 The EMDR method. ................................................................................................................25 Evaluation of the EMDR method..........................................................................................27 Personal experience with the EMDR method......................................................................27 Somatic Experiencing .........................................................................................................................29 Evaluation of Somatic Experiencing......................................................................................32 Bodynamic Analysis ...........................................................................................................................33 Example of the Bodynamic Analysis methods Character Structure model.....................33 The Bodynamic Analysis method. ..........................................................................................34 Evaluation of Bodynamic Analysis.........................................................................................34 Somatic Trauma Therapy...................................................................................................................35 Methods of Somatic Trauma Therapy. ..................................................................................35 Evaluation of Somatic Trauma Therapy................................................................................37 Internal Family Systems Therapy........................................................................................................37 Understanding parts..................................................................................................................37 Parts and the Self.......................................................................................................................38 The IFS method. .......................................................................................................................39 Evaluation of the IFS method.................................................................................................41 Personal experience with the IFS method.............................................................................41
Ecotherapy .........................................................................................................................................43 Example of ecotherapy.............................................................................................................43 The vision fast. ..........................................................................................................................44 Evaluation of ecotherapy. ........................................................................................................44 Shamanic Counseling..........................................................................................................................45 Shamanic counseling methods. ...............................................................................................46 Evaluation of shamanic counseling. .......................................................................................46 The Role of Contemplative Practices in Healing Trauma.....................................................................47 Comparison and Analysis of Methods for Healing Trauma .......................................48 How Nature Can Participate in the Healing ......................................................................................49 Self-Reflection ..............................................................................................................50 Conclusion ................................................................................................................... 51 Appendix A: Tips for Managing Trauma Symptoms ..................................................53 References ....................................................................................................................54
Post-Traumatic Stress Disorder Causes, Effects, and Treatment With an Emphasis on the Role of Nature in Healing She did not know that this was the best thing she could have done She ran only to make herself warm, and she hated the wind which rushed at her face and roared and held her back as if it were some giant she could not see. But the big breaths of rough fresh air blown over the heather filled her lungs with something which was good for her whole thin body and whipped some red color into her cheeks and brightened her dull eyes when she did not know anything about it. ~ The Secret Garden (Burnett, 1911, p. 39) Introduction The Secret Garden is a beloved story of childhood trauma, isolation, and loneliness. Mary Lennox was an unhappy, neglected little girl whose parents died of cholera. The servants who didnt die during the epidemic ran away, and nine-year-old Mary was left alone in a house with the bodies of the dead for several days. As the story unfolds, nature is one of the most important characters in the book, bringing healing, connection, and eventually joy to the traumatized little girl. This paper examines the themes of trauma, healing, and nature from a somewhat more concrete viewpoint than classic literature. The paper describes different sources of trauma, the effects of trauma, and methods for healing from trauma. I conducted an independent study at Naropa University in the spring of 2006 to investigate these subjects, with an emphasis on discovering how the healing powers of nature can help with trauma. The underlying premise of the independent study was that biophilia, or our innate affinity for and connection with nature, can be used to help heal trauma. I sought to discover whether the healing powers of nature have been used successfully in this way, and to compare methods that incorporate nature in the healing process with other currently accepted techniques for working with trauma. This paper reports on my findings.
The Role of Nature in Healing Trauma The benefits of time in nature are well-documented and substantiated by research, particularly the mental health benefits. Davis (1998) provides a good summary of these findings. The field of ecopsychology is interested in the human-nature relationship. Where people position themselves on a continuumfrom nature as a dangerous force that must be controlled, to nature as a resource to be used, to nature as home and family, to nature as oneselfilluminates the spectrum of possibilities of human-nature relationship. Biophilia is the term used to describe humans innate interconnection with naturean interconnection that is part of our evolutionary heritage. Biophilia is based on the understanding that each of our atoms arises from nature, and that we have evolved with and in nature for hundreds of thousands of years. It is primarily since the industrial revolution that humans in some societies have begun to be cut off from their connection with nature, though arguably this split happened with the development of agriculture, with its emphasis on controlling both plants and animals. Sadly, the forces of globalization are driving more and more people away from the land and into cities. In the year 2000, 47% of the human population lived in urban areas. In contrast, 200 years ago only 3% lived in cities (Population Reference Bureau, 2006). I recently heard that we have now passed the 50% mark. The impact of these changes on our psyche is not generally understood, even within mainstream psychological theory, but the field of ecopsychology has emerged to address this gap. In most methods of psychological healing, the role of nature is ignored. Even in cases where clients report feeling despair about what is happening to the earth, psychologists have tended to attribute their concern to traditional psychological mechanisms such as projection. The reality of our connection with the earth mother has been forgotten. In my review of trauma and trauma treatment methods, I have paid particular attention to this forgotten aspect, our connection with nature. I have
looked for ways that nature is being used to help in the healing of trauma, and discuss several methods in this paper. Definitions and Causes of Trauma and Post-Traumatic Stress Disorder The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, 4th Edition defines events as traumatic if a person experiences a threat to his or her life or bodily integrity, witnesses such a threat to another, hears of such a threat to a loved one, or hears of the unexpected or violent death of a close associate (quoted in Rothschild, 2000). Often, the trauma sufferer feels overwhelmed and helpless during the traumatic event. Causes of Trauma Causes of trauma include car accidents, other physical accidents and human-caused disasters, surgeries, medical and dental procedures, anesthesia, prolonged hospitalization, incest, rape, sexual abuse, physical abuse, assault, war, being held hostage or imprisoned, and torture. There is also fetal trauma and birth trauma. Prolonged immobilization due to casts or splints on the legs or torso can cause trauma. In addition, to an infant or young child, prolonged separation from our mother, or the absence of food or love are traumatic (Maitri, 2005, p. 160). These causes of trauma are a result of human actions. Another category of trauma is natural disasters, such as floods, hurricanes, tornadoes, earthquakes, and avalanches. However, in the chaos that ensues after a natural disaster, human actions such as rape and looting often compound the trauma experienced by those affected by the natural disaster. Another type of trauma caused by nature is being attacked, bitten, or mauled by animals, both wild and domestic. As mentioned earlier, a less-understood form of trauma is caused by an awareness of the harm being done to the earth today. Environmental damage causes harm to a loved one (for those who consciously care about the earth) and also threatens our capacity to live on this earth. Rayner (2005) calls this ecological trauma.
Post-Traumatic Stress Disorder. Obviously, trauma has existed as long as humans have. But it was not until researchers investigated the symptoms of soldiers who fought in the Vietnam war that Post-Traumatic Stress Disorder (PTSD) was recognized. Therefore, the study of trauma and trauma treatment has developed within the last 30 years or so. While many people experience trauma in their lives, not everyone develops PTSD. Rothschild reports that [r]esults of studies vary but in general confirm that only a fraction of those facing such incidentsaround 20%will develop PTSD (p. 6). Levine (1997) postulated that PTSD develops when the autonomic nervous system is prevented from completing its natural cycle of charge and discharge in response to a traumatic event. He noticed that prey animals are routinely threatened, yet they do not develop PTSD! Other factors that have been identified as influencing whether or not a person develops PTSD include previous history of trauma and the type of support the person receives after the traumatic event. It is common to experience symptoms after a traumatic event. When the symptoms persist for more than 30 days, and are combined with a loss of functioning in areas such as work or personal relationships, a person might have PTSD. The types of symptoms to look for include having flashbacks or intrusive memories of the event, avoiding reminders of the event, and chronic hyperarousal in the autonomic nervous system. Symptoms can be triggered by external situations or by internal reminders of the traumatic event (Rothschild, 2000). Group trauma and group trauma treatment This paper focuses on trauma from the perspective of the individual, although some of the treatment methods presented later can be done in group settings. (Working in groups can assist in an important outcome of healing PTSD, that of reconnecting with others.) Another subject of study is
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collective and societal trauma and its treatment. Collective trauma is beyond the scope of this paper, but I do want to mention briefly that ecological trauma, being caused by large-scale environmental disaster, is most effectively addressed within groups and communities. The Work that Reconnects, developed by Joanna Macy and others, provides methods for group work to heal the personal suffering caused by ecological trauma. These healing methods help people become empowered to take effective action to protect the earth (Macy & Brown, 1998). Effects of Trauma In this section I explore the physical, emotional, psychological, and relational effects of trauma in greater detail. I also pause to explore a few related byways that I came across on the research journey, including the effects of trauma on the soul, the phenomenon of re-enactment, and the role of memory in trauma treatment. What Happens to the Body During Trauma The autonomic nervous system (ANS) plays a key role in the bodys response to trauma. Understanding its functioning helps to understand both what happens during the trauma, and the role it plays in the symptoms of PTSD. The ANS has two branches, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS is responsible for stimulating the body to take action, while the PNS is responsible for stimulating the body to relax. The body responds to the real or perceived threat of danger by mobilizing an enormous amount of energy via an intricate series of chemical reactions. At the first sign of danger, the SNS is activated and the chemicals epinephrine and norepinephrine are released into the bloodstream. This prepares the body for fight or flight. Pupils are dilated as part of the orienting response, enabling the person to quickly assess the situation. Blood flow to the digestive and reproductive systems is reduced, and breathing quickens, bringing more blood and oxygen to the muscles needed for fight
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or flight. It is this incredible physiological response that mobilizes resources that are not usually available to us, allowing a woman to fight off a much larger attacker, or to lift a car off her child. Once the danger is over, the bodys release of a chemical called cortisol stops the alarm reaction and restores the body to homeostasis. However, if the organism assesses the situation and believes that fight or flight are not possible, or if the fight or flight attempt fails, the PNS is activated, causing the freeze response. This response is an effective strategy for prey animals, for some predators will not eat dead meat. Heart rate and respiration decrease so much that the animal appears dead. Some prey animals go limp, while others stiffen. Pain receptors shut down, so that if the animal is eaten it suffers less. But if the predator loses interest in the prey, after the danger has passed the animal revives, shakes off the charge of the energy mobilized during the fight or flight response, and walks away. This is the phenomenon that Peter Levine observed, leading to his pioneering work in developing effective treatment for PTSD. He noticed that the previously frozen animal discharges the energy that was mobilized for fight or flight. He postulated that when humans develop PTSD, it is because something prevented the discharge of the enormous amount of energy that was mobilized in response to the danger. The energy remains frozen in the body, stored in the nervous system. One theory of the chemistry involved in the failure to discharge is that the activation of the PNS during the freeze response disrupts the production of cortisol, so the body never receives the message that the danger is over (Rothschild, 2000). Essentially, the body remains in a state of hyperarousal of the ANS, always ready for the danger that it believes is still coming. If a person suffers repeated trauma, such as in the case of ongoing abuse or combat, the state of hyperarousal is even more likely to become chronic. The SNS, responsible for mobilizing energy for fight or flight, is always active. But at the same time, the PNS is also overstimulated, as it tries to protect the body by freezing. Thus trauma survivors may
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experience extreme swings between sympathetic and parasympathetic arousal. They oscillate between overstimulation and numbness; between being triggered and enacting avoidance behaviors; between periods of overactivity and periods of exhaustion. Physical and Emotional Symptoms of Trauma In the period of time shortly after the trauma, survivors usually experience symptoms of hyperarousal, constriction, dissociation, and freezing. These symptoms can occur during the trauma, but they might also appear after the trauma event is over. Symptoms vary from individual to individual, including the time when the symptom first appears. Symptoms of hyperarousal and constriction include: accelerated heart rate cold sweating rapid or shallow breathing cold hands and feet heart palpitations tingling muscular tension or jitteriness hypervigilance hyperstartle response (jumpiness) mind racing or worrying extreme sensitivity to light and sound Symptoms of dissociation and freezing include: spaciness lack of continuity of awareness forgetting
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being in ones head denial a feeling of being numb low energy lack of emotional responsiveness feeling helpless feeling paralyzed When hyperarousal becomes chronic, people may experience additional physical and emotional symptoms: difficulty sleeping lack of appetite anorexia sexual dysfunction promiscuity manic hyperactivity difficulty concentrating exaggerated emotional responses feelings of shame abrupt mood swings being easily stressed out In an attempt to sooth these symptoms (and simulate the relaxation response of the PNS), people often turn to nicotine, caffeine, chocolate, alcohol, or drugs. This is why the time-honored
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remedy of a cup of tea is so soothing. It also explains why many people who have PTSD end up with substance abuse problems. As time goes on, if the energy from the traumatic event is not released from the body, other symptoms can appear (in addition to those previously mentioned): panic attacks, anxiety, and phobias nightmares and night terrors avoidance behavior attraction to dangerous situations frequent crying inability to love, nurture, or bond with other people fear of dying, going crazy, or having a shortened life Symptoms that tend to develop last include: excessive shyness muted or diminished emotional responses inability to make commitments chronic fatigue immune system problems psychosomatic illnesses depression feelings of impending doom feelings of detachment, alienation, and isolation diminished interest in life
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According to Levine, from whom these lists of symptoms were adapted, [t]he symptoms of trauma can be stable (ever-present), unstable (will come and go), or they can hide for decades. Generally, these symptoms do not occur individually, but in constellations (1997, p. 149). These symptoms are the bodys way of binding the energy stored in the nervous system. It bears repeating that when a person has PTSD, the body is frozen in the state it was in when the trauma happened. The body believes the danger is still presentthat the trauma is still happening or about to happen. The human being is an intelligent system, and this system seeks congruence. If the body feels there is danger, the mind will look for the danger in an attempt to make sense of the felt perception of danger. This can lead to seemingly irrational behavior such as the well-known phenomenon of a combat veteran hearing a car back-fire and falling to the ground. Sensory inputs are immediately interpreted as a source of danger. I experienced an example of this recently that may further illuminate this point. I heard the rain strike the wall of my house in an unusual way and immediately imagined someone was going to break through the wall of the house (on the second story) and attack me. In a flash I was hyperalert, heart racing, straining to hear the sound and make sense of it. Knowing that PTSD causes the mind to seek danger where none exists might help trauma survivors to understand why fantasies of danger occur and not get caught up in them. Treatment of PTSD requires both releasing the energy that is stored in the body at the time of the trauma, and communicating to the body that the traumatic event is over. Psychological Effects of Trauma in Early Childhood Freuds drive theory postulated that all human behavior is motivated by instinctual drives towards pleasure and away from pain. In contrast, object relations theorists and researchers have found that humans are primarily motivated by their relationships with others. For the infant to develop, a bond is formed first with the primary mothering figure, and later with the fathering figure
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and others who are close to the infant. Good enough mothering describes the situation where the mothering figure is adequately attuned to the baby, meeting its needs for food, holding, soothing, diaper changing, and so on often enough that a bond can form. Forming bonds with others and experiencing the surrounding environment as a safe place are essential for a child to form a healthy sense of self, which includes a cohesive body image. Judith Herman (quoted in Gerity, 1999) found that early physical and sexual abuse deforms the personality, disrupting the formation of bonds with others and a healthy sense of self. In order to survive, the dependent child adapts to the abusive environment by developing psychological defenses. The most common defenses are dissociation and the development of a fragmented identity. Grand and Alpert describe the way that incest threatens the childs development: Incest violates two critical areas of object relating, which results in a double-layered threat to the childs basic integrity. The first area involves the childs experience of being connected to others or, in psychoanalytic terms, fundamentally attached to objects. The second involves the childs elemental sense of physical-sensory continuity, secure sense of existence, or as Winnicott (1958a, 1958b) described it, going-on-being. These aspects of object relations will be shown to be interrelated and vital to a basic sense of psychic integrity and survival. Where parenting is essentially loving, these areas of object relating are consolidated in a sense of basic security; where parenting is abusive, they deteriorate into a sense of basic dread or annihilation terror. (1993, p. 331) Thus early abuse disrupts the childs ability to form relationships with others, prevents the formation of a cohesive body image, and can create an ongoing sense of dread or terror. (Of course, when this situation is severe, the trauma survivor may develop other forms of psychological illness
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as well as PTSD.) The themes of safety and connection will continue to develop throughout this paper. Although the development of a cohesive body image will not be addressed specifically, the resourcing in the body that occurs during trauma treatment can certainly aid in forming a sense of cohesiveness. Relational Effects of Trauma Trauma that is caused by human actions can easily weaken ones abilities to trust other humans. In the case of car accidents, the lack of trust might be restricted to other drivers, or even to other drivers in specific kinds of driving situations. But in the case of physical harm caused by violent actions, especially when the harm is caused by family members in early childhood, the inability to trust can extend to most or all human relationships. The fear of imminent danger caused by PTSD can persist even in relationships that are not dangerous (Matsakis, 1998). For some people, the opposite result can occur, and they might trust people too easily. For example, some trauma survivors tend to automatically and completely trust others if they are members of a safe group such as their church or their veterans association. This trust is based on group membership, not on the actual character of individual members of the group. Trusting too easily can also occur when the trauma survivor was abused early in life by someone she or he trusted. Just as the energy from the traumatic event is frozen in the body, the survivors attitude towards others is frozen in the pre-trauma state of childhood innocence (Matsakis, 1998). People who trust too easily as a result of trauma are most likely to be revictimized. Trauma also affects the survivors capacity for relationships in other ways. The painful symptoms of PTSD can occupy so much of the survivors attention that there is little energy left for relationships with others. Substance abuse and other forms of addiction are also common among trauma survivors, making genuine relationships difficult. In addition, people often blame the victim
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for the traumatic event. As psychotherapist Aphrodite Matsakis explains, the very existence of trauma survivors challenges peoples belief that they can control their own lives (1998, p. 26). Blaming the victim for doing something wrong, or not being fast enough or smart enough, helps people maintain the illusion that they can prevent similar bad things from happening to them. But this provides yet another difficulty in the relationship realm for the trauma survivor. Effects of Trauma on the Soul For this discussion of the effects of trauma on the soul, I use the meaning of the soul as it is understood in the Diamond Approach to inner realization: The soul of the human being is the underlying consciousness of the individual, its living, intelligent awareness (Davis, 1999, p. 46). The soul is a malleable substance, which includes the physical body, thoughts, and emotions. It is both the medium of experience and that which is experienced. The soul also includes a deeper dimension of experience, which can be called our true nature or the ground of our Being. Our true nature can manifest in the form of particular qualities or essential aspects, such as love, joy, and will. The intelligence of Being is such that aspects arise as needed in response to a particular situation. As our experience of true nature deepens, our awareness moves into the transpersonal realms of Being. That is, this movement into the deeper ground of Being moves us beyond the personal, individual soul and into oneness with all that is. It is our birthright as humans to experience our true nature the deeper ground of our Beingand to experience the unity of oneness. When trauma occurs, it can severely disrupt the capacity to experience our true nature. In this context, Almaas (2004) describes trauma as any experience that the soul is not able to tolerate with the resources available to her at the time of the event (p. 171). The way that the soul deals with the intolerable event is by dissociating, either by splitting off the memory of the entire event, or by splitting off certain elements of the event, such as physical sensations or emotions. This impacts
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the soul in two ways. Because the deeper ground of our Being is pure awareness, and the intolerable event requires a splitting of awareness, access to the ground of our Being is inadvertently dissociated as well. The other consequence is that the split-off material becomes a structure in the soul. This is one way of understanding what happens to the energy that is trapped in the autonomic nervous systemit forms into a rigid structure. Thus the original nature of the soul, which is flowing, changeable, and responsive, becomes calcified into a structure by the trauma, and access to the ground of ones being is cut off. Such structures become part of the survivors character and identity. In terms of object relations theory, a structure might form around being a victim, or the survivor might identify with the aggressor. This helps explain the multi-generational patterns of abuse that can occur. In addition, according to Almaas (2006), [s]tructures around shame, self blame, wounding, and vulnerability are particularly strong in these situations (p. 3). In terms of the aspects of true nature that are cut off, he says I have also noticed that there are specific difficulties around basic trust and hence about the living daylight aspect. Other aspects that tend to be problematic are those of strength and personal will (p. 3). Until the structures that were created in response to trauma are worked with and loosened, releasing the energy that is bound up in the nervous system, survivors of trauma will have great difficulty in contacting their true nature. It can be very frustrating for those on the inner journey to work for years and not seem to make progress. I hope that the discussion of trauma and trauma treatment methods in this paper will help people with PTSD find ways to work with these obstacles on the inner journey.
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The Phenomenon of Re-enactment It is in the nature of the soul to heal. When people have experienced trauma, the urge to resolve trauma through re-enactment can be severe and compulsive. We are inextricably drawn into situations that replicate the original trauma in both obvious and unobvious ways (Levine, 1997, p. 173). The recreation of situations and relationships that resemble those involved in the trauma is a very painful way that survivors of trauma attempt to heal. This phenomenon is called re-enactment. Re-enactments can be carried out in seemingly random events in which the trauma survivor appears to have no role in making the event happen, such as being in car accidents in which others are driving. Repetitive accidents and situations often occur on or near the anniversary of the original trauma. Levine (1997) relates an example given by psychiatric researcher Bessel van der Kolk: a Vietnam veteran carried out a fake armed robbery every July 5th at 6:30 am (except the years when he was in prison) until finally his trauma was resolved in therapy with van der Kolk. Knowing about the phenomenon of re-enactment can help trauma survivors understand the patterns of traumatic events that occur in their lives. The pattern can also help in identifying the originating trauma. The Role of Memory in Trauma Treatment Memories are stored in the nervous system. They can be stored as images (cognitive memory), or as sensations that use any of the five senses (somatic memory). Implicit memories are those stored using non-verbal methods. Typically these are memories of events that happened before language skills were developed, or when the child was too young to explicitly remember. The age of this varies from individual to individual. Some people are able to explicitly remember events as early as the womb (though the memory would be in the form of a sensation, not words). Other people have no memory of events before the age of six or seven. Frequently, survivors of trauma have incomplete or fragmented memories of traumatic events, or no explicit memory of these events
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at all. The event may be stored in implicit, somatic memory. Memory recall is not necessary for healing. In the case of partially remembered events, the formation of a cohesive story about the trauma is important. Whether or not there is explicit memory of a traumatic event, what is of vital importance is the physical release of the energy stored in the body. The role of memory in trauma treatment can be controversial, especially when court cases are involved. During a trauma, memory is not stored in the usual way, which involves organized processing by both the amygdala and the hippocampus prior to storage in the prefrontal cortex. Instead, during trauma hippocampal activity is suppressed, and the more primitive cerebellum takes over some brain functioning, causing storage of pieces of memory in seemingly random places. This is why some survivors of trauma do not remember what happened, have false memories, or have different memories at different times. They might seem to be lying, or giving inconsistent stories. However, the fact is they just do not have access to the memory of the event in the sequential, cohesive way that we usually remember things. (And of course, even in the memory of regular events, different people will focus on different aspects and therefore might have completely different recollections.) When working with clients to form a cohesive story about remembered or partially remembered events, it is helpful to know that the mind will provide the material necessary for healing. In some cases it might invent the story needed for healing by filling in missing pieces to create a cohesive, meaningful narrative. It is not important whether events actually happened the way that the client reports them. The mind might use symbolism, or it might reveal in a very direct way what the trauma sufferer was afraid was going to happen. For example, if a child was afraid that her father was going to kill her mother during a fight, the adult working with this event during therapy might remember her father saying Im going to kill you! It doesnt matter whether the
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father actually said thiswhat is important is that the mind is revealing this element of the story so that the childs fear is revealed and can be healed. When working with clients to heal unremembered trauma, the somatic memories stored in the body will provide the information needed to process the event and bring energetic discharge. This is one reason why body-centered approaches to trauma treatment can be quicker and more effective than other methods. Methods for Healing Trauma In this section I describe and discuss various methods for healing trauma. Some methods for the treatment of trauma are in the experimental stages, while others have been studied more extensively. There is little or no research to date on treating trauma using methods in nature, though of course this is what shamans have been doing for 40,000 years or more. The list of methods considered here is by no means exhaustive, but I sought to include methods that are either known for healing PTSD or are known for healing in nature. Beginning with body psychotherapies, I present Eye Movement Desensitization and Reprocessing, Somatic Experiencing, Bodynamic Analysis, Somatic Trauma Therapy, and Internal Family Systems therapy. Concluding with nature-based approaches, I discuss ecotherapy and shamanic counseling. I also briefly discuss the role of contemplative practices in healing trauma. Judith Herman identified three essential steps to healing PTSD: creating safety, reconstruction (witnessing memories and constructing a meaningful narrative), and reconnection (quoted in Gorman, 2001). Reconnection is a vital step because sufferers of PTSD often feel isolated. I would add, based on Levines findings, that the release of energy trapped in the body is also vital. I will use these four criteria, as well as research findings when known, to evaluate the efficacy of each of the methods discussed.
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Methods Not Discussed in this Paper There are many therapy methods for working with trauma. Due to time and space constraints, I do not discuss these methods: Animal therapy, including equine therapy, teaches people how to give and receive unconditional love by working with animals that the patient can touch in a therapeutic setting. This work is congruent with the biophilia hypothesis, as people are generally fascinated by animals and crave contact with them. There was enormous interest in the results of a recent British Medical Journal study in which the biophilia hypothesis was tested by patients swimming with dolphins to heal depression (Antonioli & Revely, 2005, Abstract). Art therapy includes drama, drawing and painting, pottery, and puppet making. These methods can be very effective in the treatment of strongly dissociated clients who are unable to speak about the traumas they have survived. Art therapy methods are also particularly useful in helping clients develop an integrated body image (Gerity, 1999). Color therapy involves beaming colored light into the eyes to activate repressed memories which can then be worked with therapeutically. Energy psychology techniques change the energy in the meridians, acupressure points, chakras, and biofield systems. One of the main energy psychology techniques, the Emotional Freedom Technique (EFT), uses tapping on energy meridian points to release negative emotions. Exposure therapy involves repeatedly exposing the trauma survivor to a recording of the telling of the traumatic event. The patient listens to the recording as homework, in addition to working with a therapist. Eventually the repetition desensitizes the patient to the traumatic event. Horticulture therapy involves working with plants to establish a connection with nature. This method has been used with survivors of trauma, including refugees.
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LSD therapy was conducted in the Netherlands during the 1950s through the 1980s for treatment of war trauma. Shivitti: A Vision (1998), written by Holocaust survivor Ka-Tzetnik 135633, provides a compelling first-person account of a course of LSD therapy that provided remarkable healing. Neuro Linguistic Programming (NLP) therapy uses various techniques, including time line therapy, to alter the narrative of the disturbing event until it is no longer disturbing. Repressed memory therapy has been used to retrieve memories that have been accepted as evidence in court cases of childhood abuse, but the method has been accused of retrieving false memories. Eye Movement Desensitization and Reprocessing (EMDR) Eye Movement Desensitization and Reprocessing (EMDR) was developed by psychologist Francine Shapiro. She noticed while walking in the park one day that rapidly moving her eyes back and forth seemed to reduce the distress she was feeling about a recent incident. This led to further investigation and the development of the EMDR method. EMDR is an information processing therapy that uses alternating left brain-right brain stimulation and repeated shifts from past to present to gradually replay the memory of the traumatic event in a way that feels safe and does not overstimulate the sympathetic nervous system. Before and during the telling of the story, negative and false beliefs are exposed. Energy that is stored with the traumatic memory is released gradually. This release often occurs through tingling sensations or shaking. The event is released from its frozen place in time and woven into the patients life story in a new way. Positive beliefs about the self replace the previous negative beliefs.
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EMDR can be a very fast treatment method, especially for single-event traumas. Clients have shown complete recovery from PTSD in as few as 3 sessions (Wylie, 1996). Of course, clients who have suffered multiple or ongoing traumas require longer treatment. The EMDR method. EMDR uses an eight-phase approach. The first phase involves history taking and developing a treatment plan with the client. Past traumas and current disturbing situations are considered. The second phase of EMDR therapy corresponds to Hermans first step of establishing safety. The client describes a safe place that will be used throughout the therapy as an anchor to return to if the treatment becomes too disturbing. People often choose a real or imagined place in nature as the safe place. All of the senses are used to experience the place (except perhaps taste). If the client is suffering from severe PTSD, it may be that no place, real or imagined, seems safe. In this case, the place can be renamed something that works for the client, such as the peaceful place. During the second phase, in addition to creating the safe place and learning to experience through the body senses, the client may learn techniques such as grounding to help shift awareness out of the head and into the whole body. Grounding can also help the client to feel the support of the earth and begin to experience interconnection. Other self-calming activities may be taught as well. During phases three through six, a specific traumatic event is worked with using EMDR procedures. Usually, the therapy begins with the most vivid, disturbing portion of the event, which the client describes using as many senses as possible. The client states an associated negative belief, for example, I am helpless, and notices any sensations and emotions that accompany the belief and the image of the event. The client also identifies a preferred positive belief, for example, I am strong and capable. The validity of the positive belief is rated, and so is the level of disturbance, for later comparison.
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Bi-lateral stimulation is performed for a brief period of time (20 to 50 seconds), while the client remembers the disturbing image. The stimulation can be in the form of moving a pen or two fingers back and forth in front of the clients eyes, gently tapping alternate knees, using a hand-held stimulus that provides a slight buzz, or using auditory tones via headphones. After the brief period of stimulation, the client takes a breath, takes a break from the disturbance and reports on the experience in the moment, including sensations, thoughts, and emotions. Depending on what is reported, the therapist directs the clients attention for the next set of stimulation. Periodically the therapist draws attention back to the traumatic event, checking on the rating of disturbance. If the client becomes too distressed, the anchor is used to decrease the level of disturbance by focusing on that place for one or more sets of bi-lateral stimulation. When the event is no longer disturbing (both by the clients evaluation and the therapists observation of autonomic nervous system activity), the therapist brings the positive statement into awareness. If a better statement arose during the processing, that one is used rather than the original statement. The positive statement is used for several sets of bi-lateral stimulation. Students of the Diamond Approach find that at this stage of the treatment essential aspects frequently arise, for example, love, strength, or spaciousness. This description provides the basic framework, but individual therapists will customize the procedure to the clients needs. For example, for an extremely traumatic event the therapist might have the client imagine the event is a video being replayed on a TV screen, to provide a sense of distance. Using this method, the client provides an overview of the entire movie, defining the beginning and ending points. Gradually, the whole movie is played, 10 or 20 seconds at a time. The most disturbing parts can be sped up so that the client is not re-traumatized by getting stuck at the most painful points. This method helps the client to realize the event did end, it is over, she survived.
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Phase seven is the closure of the session. The client is asked to notice what comes up between sessions. In phase eight, the next session, the previous work is revisited. Any related difficulties are worked with, including any material that arose between sessions, so that all past and current distressing situations related to the trauma are processed and resolved. Evaluation of the EMDR method. The EMDR Institute (2004a) states that following treatment, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Furthermore, these emotional and cognitive changes usually result in spontaneous behavioral and personal change. Over one million people have been treated using EMDR, and repeated studies have demonstrated its efficacy (EMDR Institute, 2004b). A. H. Almaas, founder of the Diamond Approach, describes EMDR as particularly effective (2004, p. 628). With its emphasis on repeatedly checking into ones sensations, emotions, and thoughts, this method is very helpful in teaching dissociative clients to reinhabit their bodies. In terms of Hermans three steps, there is no explicit step for reconnecting with others. This often occurs as one of the clients spontaneous behavioral and personal changes. Or, it can be a goal of the therapy to work specifically on relationship difficulties. There is no question that energetic release occurs during EMDR. Therefore, in terms of the evaluation criteria I have set out, backed by strong research findings, EMDR is an excellent method for healing PTSD. Personal experience with the EMDR method. I have been working with an EMDR therapist since January 2006. I started with one therapist and then switched to another one who is a senior student of the Diamond Approach. It was important to me to be able to incorporate my spiritual practice into the healing work. With the first therapist I healed the trauma of two surgeries. With the second therapist, I healed an early instance of child abuse (one of the first instances). I am currently working
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to heal an extremely traumatic event that occurred when I was seven years old. We are about to begin phase eight of healing this trauma. At the moment I am experiencing some anxiety as a result of the work in process. However, overall there is no doubt that I feel clearer and lighter as a result of the EMDR work. I have come to welcome certain body parts, and I have even initiated contact with someone I met last summer and we are going to have a date. I mention this as an example of reconnection that spontaneously occurred after an EMDR session. Id like to share my experience of the first EMDR session in which I worked on a traumatic event. We completed phases one and two in the first two sessions, and practiced the technique using a pleasant experience. Now we tried the technique on something I chose that was not too traumatic, laser eye surgery. The surgery was something that I experienced as bringing enormous benefit to my life. Susan began by getting me to describe the surgery, including the most traumatic part of it. I described the scene: the research, preparation, meditation beforehand. How I was responsible for keeping my eyes focused on the red light as the laser burned the surface of my cornea. The smell of my eyes burning, which smelled like human hair burning. How I could see better immediately afterwardI was able to read the clock on the wall. The post-operative carecontact lens bandages, eye drops, sunglasses. The smell of my eyes burning was the most difficult part. She asked me to consider that part and make a statement of negative belief about myself to do with that difficult part. The belief was I cant trust my own judgment or see things clearly. She also asked me to rate the disturbance I felt about the most difficult part. The disturbance was four (on a scale of one to ten), due to the risk of blindness the surgery entailed. Then, holding the memory of the smell of my eyes burning in my awareness, I watched as Susan moved her fingers back and forth in front of my eyes. She asked me to take a deep breath, and asked what I was getting. I reported on thoughts, body sensations, images, and emotions. We repeated this quite a few
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times. At one point I had a sense of the caring of the people in white coatsthere were two or three in the room during the surgerya loving feeling, and a sense of loving, supportive white light. I sensed spaciousness. Then a belief arose that no matter what the benefit, its not okay to willingly harm my body that way. She agreed with the truth of that to the physical organism. I felt my vulnerability as a human in a body. I said, The body can be hurt, and I will die eventually. She acknowledged the truth of that. We did a few more repetitions, and eventually I came to a place where I was desensitized to the memory of my eyes smelling like hair burning. The fear that arose with my awareness of vulnerability was gone. She asked me what the rating was. It was a one (the lowest on the scale). She asked me to make a positive I statement. The statement I made was I know whats best for me. This carried through as a sense of confidence in my own judgment during the next week. This confidence enabled me to state my truth to several people. I think it was also at this point that I summoned up the energy to call the other therapist. Even though the work with this therapist was going so well, I knew that I wanted to work with someone who would recognize essence when it arose in my experience. I knew what was best for me! Somatic Experiencing Peter Levine developed Somatic Experiencing specifically as a method of healing trauma. Much of what is known today of the physiological effects of trauma arises from Levines groundbreaking work. He began developing the method in the late 1960s, after a visionary breakthrough while working with a client who was having an anxiety attack. Levine had a fleeting vision of a tiger, and he exclaimed loudly, You are being attacked by a large tiger. See the tiger as it comes at you. Run toward that tree; climb it and escape! (Levine, 1997, p. 29). His clients legs began to make slight running movements, she screamed, and her body began to tremble uncontrollably. They were
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both surprised at the success of this event, which mobilized his clients instinctive flight response, and, with some subsequent work, resolved her chronic acute anxiety attacks. This got him thinking about the parallels between humans and other animals. From this beginning he came to understand our instinctive physical responses to traumatic events, and how these can become blocked. Eventually he understood that the symptoms of PTSD were a direct result of these blocked instinctive impulses. The Somatic Experiencing method. Somatic Experiencing is a relatively short treatment method, and works by paying attention to body sensations. Without limiting its effectiveness with other types of trauma, Heller and Heller (2006) have stated that Somatic Experiencing is particularly helpful in treating the trauma caused by car accidents. As discussed earlier, PTSD symptoms arise when the functioning of the sympathetic and parasympathetic branches of the nervous system become deregulated during a traumatic event. Without adequate discharge, the energy aroused by the sympathetic nervous system has nowhere to go, leaving the trauma survivor in a constant state of high charge. In response, the parasympathetic nervous system also becomes overactivated, and the trauma survivor swings between these two extreme states, while experiencing symptoms of flooding alternated with freezing and dissociation. The Somatic Experiencing method helps the client to discharge the previously undischarged energy, in a slow, safe way, like a pressure cooker just letting off a little steam at a time. The way that the therapist works with a client resembles EMDR, but without the bi-lateral stimulation. It also resembles NLP in the way it disrupts the clients rote narrative structure, beginning with after the trauma, and then moving to before, slowing things down, and imagining alternative outcomes. I wonder if both NLP and EMDR borrowed from Levines treatment
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methods, or whether, as so often happens, similar methods were invented synchronistically by different people at roughly the same time. Treatment begins by establishing a safe place for the client, which is termed an Oasis of Safety in Somatic Experiencing. Then the client is guided to develop an inventory of other resources, which the client suggests (not the therapist), for becoming calm when stress builds up. Examples might include drinking a cup of tea or taking a hot bath. These are methods for stimulating the parasympathetic nervous system, allowing relaxation to occur. Once the client is resourced in these ways, work can begin on the traumatic event. The therapist might begin by asking when was the first time the client felt safe after the accident. The client is asked to describe how this feels in the body, which serves as further resourcing. Beginning with after the event also helps to reinforce that the event is over, and it breaks the usual narrative flow. Telling the whole story without interruption can be retraumatizing, keeping the body frozen in the belief that the trauma is still happening. Instead, the therapist uses a Somatic Experiencing technique called pendulation or looping. In looping, the focus shifts back and forth between small pieces of the traumatic material and one of the clients resources. This looping back and forth helps discharge the activation in the nervous system that emerges as the person slowly works through the traumatic event (Heller et al., 2006). When focusing on a resource, the client brings her awareness into the sensations in her body, so that the client is directly aware of the effects of being comforted and soothed. At key points in the narrative, the client is stopped so that time and space are created for taking in what is happeningresources that are seldom available during the traumatic event allowing the client the time to develop responses to the situation. Heller et al. (2006) provide the example of a car accident, in which the client imagines that the vehicle that rear-ended her car is still
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three blocks away. This gives her plenty of time to strategize how to avoid being hit. Again, working with the body, the client senses how her body wants to respond to the threatperhaps by flooring the gas to move away, or perhaps by honking the horn and yelling to prevent the other driver from hitting her vehicle. By working in this way, bit by bit, and sensing into the bodys responses to the event, each part of the traumatic event is deactivated. The event becomes located in the past, and symptoms decrease. Clients experience moving from fragmentation toward integration as they regain a continuity of self (Heller et al., 2006). Evaluation of Somatic Experiencing. The first two steps in Hermans model for healing trauma are explicitly performed during treatment using Somatic Experiencing. According to the Foundation for Human Enrichment (2004), reconnection occurs as a natural result of the healing. By releasing the energy stored in the nervous system, and also establishing resources that were previously unconscious or undeveloped, people can open portals to rebirth and achieve an increased sense of aliveness and flow. The experience can be a genuine spiritual awakening, one that allows people to re-connect [sic] with the world (Foundation for Human Enrichment, 2004). I am not aware of any studies evaluating the effectiveness of the Somatic Experiencing method. Levine (1997) states: Somatic Experiencing is new and is not subject to rigorous scientific research at this time. What I have to support the validity of this approach are several hundred individual cases in which people report that the symptoms which once impaired their ability to live full and satisfied lives are gone or greatly diminished. (p. 7)
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Anecdotal evidence from a university department chair indicates that this method is effective for working with trauma (J. S. Swift, personal communication, March 17, 2006). Almaas (2004) describes Levines methods as particularly effective in the treatment of trauma (p. 628). Bodynamic Analysis Bodynamic Analysis is a body psychotherapy developed by Lisbeth Marcher, using the understanding of child psychomotor development combined with current research in psychotherapy. Bodynamic Analysis has mapped the muscles that correspond with particular developmental phases in childhood. By evaluating (palpating) the muscles in the clients body to see whether they are flaccid (hypo-response), overly tense (hyper-response), or balanced in resiliency, it is possible to determine the phases during development at which disruption or injury occurred. A body map that presents a visual depiction of the state of all the muscles can be used to determine whether the client has PTSD. The map can also be used later in the treatment to show whether progress has been made. The Bodynamic Analysis theory contains 15 different models. Example of the Bodynamic Analysis methods Character Structure model. Character structure is developed during seven phases, with overlapping age ranges from age 3 months inter-uterine to age 12 years. The Need character development phase occurs from age 1 month to 1-1/2 years. At this stage the baby learns to sense its own needs. If there is disruption right from the beginning, in the early part of this developmental stage, and the babys needs are not met, it will experience despair. The muscles related to this phase will be collapsed or hypo-responsive, resulting in a collapsed, resigned body-psychological-social pattern. If there is disruption later in this developmental stage, in which the babys needs are met sometimes but not consistently, the baby will become distrusting of its caregivers, resulting in a distrustful, rigid, hyper-responsive body-psychological-social pattern. If there are no major disruptions in this stage, the muscles develop a balanced response, and the
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resulting body-psychological-social pattern is termed self-satisfying: The child whose needs are met by a good enough mother would experience the feeling of being self-satisfied; whether it be for food, safety, love, play, or a clean diaper (Bodynamic Canada, 2004). The Bodynamic Analysis method. This method builds significantly on the somatic work of Alexander Lowen and Wilhelm Reich. As with object relations theory, this method is based on a view of humans as being primarily motivated by the need for connection with others. There is an understanding that defensive behaviors serve a protective purpose and must never be forced to change. The philosophy of the Bodynamic Analysis method is that through experiencing healthy connection with the therapist, the client will no longer need the old defensive postures, and will let them go naturally. Bodynamic Canada (2004) provides further description of the method: Emphasizing and developing areas of competence in the personality and building a foundation of inner security from which to approach traumatic experiences are integral to the Bodynamic approach to psychotherapy. The actual methods of therapy vary depending on the nature of the trauma and the age at which it occurred. However, for all types of trauma Bodynamic Analysis works with the body in a direct way. Evaluation of Bodynamic Analysis. Steps one and three in Hermans model for healing trauma are considered using this method. Step two, the witnessing of the story of trauma, is not explicitly a part of the method, but can certainly occur within the therapeutic setting. While this method works on the body level, and with specific muscles, it is not clear from my research whether energetic release of energy stored in the autonomic nervous system occurs.
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I am not aware of any studies evaluating the effectiveness of Bodynamic Analysis in the treatment of PTSD. Almaas (2004) describes Bodynamic Analysis as particularly effective in the treatment of trauma (p. 628). Somatic Trauma Therapy Somatic Trauma Therapy (STT) was developed by psychotherapist and bodypsychotherapist Babette Rothschild. This therapy has been in development since 1992. It is a synthesis of the most relevant theory and the most suitable techniques for the understanding and treatment of trauma and Post-Traumatic Stress Disorder (Rothschild, 2003). STT works with the body, thoughts, and emotions to heal the effects of trauma and put the traumatic event in the past. Rothschild has been practicing psychotherapy since 1976, and has trained extensively in EMDR, Somatic Experiencing, Bodynamic Analysis, and other therapeutic methods. Methods of Somatic Trauma Therapy. There is no one single method or technique for STT. Elements are drawn from the most effective methods of other systems, so some of what follows will seem familiar. Rothschild begins with assessment, developing a therapeutic relationship, finding oases, anchors, and safe places, and developing and reacquainting the client with existing resources. She uses the concept of accelerating and braking to describe the process of working with traumatic material for a period of time, and then slowing down and grounding in resources or the safe place (thereby regulating the functioning of the autonomic nervous system). Rothschild teaches her clients to pay attention to body sensations, and to use somatic memory as a resource. Perceptive abilities can become narrowly focused as a result of PTSD, thereby cutting off the clients awareness of the full information that is available in a situation (Bryant & Harvey, 1995). Rothschild helps clients develop the capacity for dual awareness of the internal, experiencing self
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and the external, observing self, thus widening the perceptual arena and making more choices available. Rothschild helps clients work to develop muscle tone to find the right balance between tension and relaxation. People are often told to relax, but relaxation can actually induce anxiety in those who suffer from PTSD. Rothschild recognizes this and, where appropriate, teaches clients to tense their muscles rather than relaxing them. This can help with developing body boundaries, and also helps with symptoms such as sleeplessness and unpleasant physical sensations. As others have done, Rothschild recommends working with the aftermath of the trauma first. Not only does this have the benefits mentioned earlier, but it also helps make the trauma event seem smaller and more manageable to the client. Fully one-third or more of the trauma event can occur after the main traumatic incident, so dealing with this part first might leave just two-thirds of the trauma to deal with. Finally, Rothschild helps to bridge the implicit and explicit elements of the traumatic event. One result of PTSD is that different elements of the traumatic event are split off, becoming implicit. Rothschild helps link the split off aspects of the trauma (which could be any of sensations, images, behaviors, emotional affects, or meanings, according to Levines SIBAM model) with the elements that are explicitly held in conscious awareness. When all elements are available to conscious awareness, the client is able to form coherent conclusions about the event, creating a cohesive narrative that allows the incident to occupy its proper place in the clients past (Rothschild, 2000, p. 161). However, Rothschild also notes that it is not necessary to remember the traumatic event at allit is still possible to heal the symptoms of PTSD using the methods described in the previous paragraphs.
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Evaluation of Somatic Trauma Therapy. STT covers steps one and two in Hermans model for healing trauma. Step three, reconnection, is addressed by establishing the therapeutic relationship, which is the first priority for the healing work. STT works on the body level, with a strong understanding of the role of the autonomic nervous system in PTSD. Rothschilds braking and accelerating method is a way of working to release the energy stored in the body. I am not aware of any studies evaluating the effectiveness of STT in the treatment of PTSD. Given the effectiveness of therapy methods discussed previously, which Rothschild incorporates into STT, it seems likely that STT is an effective treatment method. Internal Family Systems Therapy The Internal Family SystemsSM (IFS) Model of therapy was developed by family therapist Richard Schwartz over the past 25 years. He noticed that his therapy clients often spoke in terms of inner parts, and he became interested in what kinds of parts people have, how they interact with each other, and how to use this understanding in healing. He discovered that each part, no matter how destructive its behavior, has a good intention for the overall system. For example, a part that causes a person to overeat could be motivated by the intention to cover up painful feelings and soothe the person. The IFS Model provides a way of understanding the psyche, as well as a method for healing. Understanding parts. Schwartz (2001) delineates three categories of parts: exiles, managers, and firefighters. Exiles are the parts of the psyche that are repressed, usually because they carry pain, although they could also be parts that are repressed for other reasons such as parental judgment. For example, if it was not safe for a child to express her anger, she will likely develop one or more exiles that hold the forbidden anger. Even attributes such as liveliness or joy might have been forbidden
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and therefore exiled. Managers are responsible for protecting the exiles and keeping them out of conscious awareness. Each exile has one or more managers, which are responsible for controlling your relationships and environment so that youre never in a position of being humiliated, abandoned, rejected, attacked, or anything else unexpected and hurtful (Schwartz, 2001, p. 127). Typical types of mangers include caretakers, critics, and over-functioners. For example, if someone makes me angry, I might go into a caretaking role of looking after the others needs as a way to avoid feeling the anger. On the other hand, if anger was not a forbidden emotion, I might have a manager that uses an angry response as a way of avoiding feeling the pain of an exile. Firefighters are similar to managers, but they only take action when the manager has failed to suppress the pain of an exile. That is, they go to work when the situation gets extreme, and their methods are extreme. For example, firefighters might manage the pain of exiles using eating disorders, self-mutilation, or addictions. Milder forms of firefighting are familiar to most of us: work, food, exercise, television, shopping, dieting, flirting, sleeping, prescription drugs, cigarettes, coffee, daydreams and fantasies, gambling, meditating, thrill-seeking activities Anything to distract from the flames until they burn themselves out or are doused (Schwartz, 2001, p. 139). Parts that are in conflict with each other (for example, the part that wants to eat ice cream for soothing and the part that wants to lose weight to gain approval via body image) can become polarized, thus binding an enormous amount of energy in their struggle with each other. Parts and the Self. People might have as many as 40 or more different parts, each with its own burden and role to play. (This is not the same as dissociative identity disorder, but rather the normal way that the psyche is structured.) All of these parts exist and act within a larger container that Schwartz calls the Self. The Self is what is present when the parts step back. Schwartz (2001) writes
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at your essence you are pure joy and peace, and from that place you manifest clusters of wonderful leadership and healing qualities and sense a spiritual connectedness (p.25). When no parts are active, the Self functions in an undistorted way. It has qualities such as caring, curiosity, compassion, connectedness, and clarity. Schwartz says that his clients report and display inherent wisdom and compassion, a sense of freedom, lightness, release, stability, lucidity when their parts step back and their Self is released (p. 35). The goal of IFS therapy is to unburden parts so that a person can function more and more of the time from Self. An important contribution of the IFS Model is the understanding that to heal the pain of the exile, it is necessary to first work with the managers that are protecting the exile, and gain their permission to work with the exile. Once the pain of the exile has been released, the manager is unburdened from its role of protecting the exile. It is then free to choose a healthy role within the internal family system. For example, an over-functioning part would be free to stop overfunctioning. It might still wish to contribute its skills to functioning when that is needed, or it might choose to help the system in a new way, for example by finding ways to play. The IFS method. IFS therapy uses a very precise method for unburdening parts. The method can be practiced alone, with a peer-partner, or with a therapist. This model can be very effective with healing trauma, by releasing the burden of the exiles that hold the pain of the traumatic event. In the case of trauma, I believe it is important to do this work with the support of another person, whether a peer or a therapist. Before and during work with the model, it is important to get into Self. In the steps that follow, unblending refers to getting into Self, rather than being identified with the part and its feelings and attitudes.
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These are the steps of the IFS method (adapted from Earley, 2006a, p. 1): 1. Accessing a protector. 2. Unblending from the protector. 3. Checking for Self-leadership and unblending from any concerned parts. 4. Getting to know the protector. 5. Developing a trusting relationship with the protector. 6. Getting permission to access the exile it is protecting. 7. Accessing the exile. 8. Unblending from the exile. 9. Checking for Self-leadership and unblending from any concerned parts. 10. Getting to know the exile. 11. Developing a trusting relationship with the exile. 12. Accessing and witnessing childhood memories or traumatic memories. 13. Reparenting and retrieving the exile. 14. Unburdening the exile. 15. Integration and unburdening the protector. The steps of the IFS method are followed while paying attention to ones inner experience emotions, thoughts, images, fantasies, and sensations (Schwartz, 2001). This concrete, linear approach can give people a sense of structure that provides safety when tackling the scary territory of trauma. Another important element of the model is that the Self always treats the parts with respect. Parts are never forced to unblend, talk, or do anything they dont want to do. The method involves making requests of the parts, listening to their answers, and negotiating and communicating
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with them. Thus trust is built in a genuine way. It is interesting to note that the skills developed for working with parts are also useful for healthy relating with other people and beings. Evaluation of the IFS method. In terms of Hermans three steps to healing trauma, IFS steps 1 through 11 involve establishing safety and inner resources. (Inner resources are developed by learning to pay attention to ones inner experience and to separate from parts to experience Self.) Steps 12 through 15 involve witnessing the trauma and releasing and healing the emotions, thoughts, beliefs, and sensations connected with it. While somatic release does occur, unblending is used to prevent being flooded by the painful feelings of the exile, so that the practitioner is not retraumatized. There is no explicit step for reconnecting with others, but Schwartz (2001) states that as we increasingly embody Self, we will feel a growing sense of connectedness to all the Selves around us (p. 55). From here, the connection widens so that you are likely to feel increased connection to the oneness of the universe or of nature (p. 57). Thus, reconnection is a goal of IFS therapy, though not one of the steps in the method. I am not aware of any studies evaluating the effectiveness of the IFS method. Anecdotal evidence from a practicing therapist indicates that this method is extremely effective (Earley, 2006b, p. 1), and an excellent way of working with trauma (J. Earley, personal communication, January 18, 2006). The IFS method of understanding and working with parts can be integrated into and enhance other treatment methods, such as EMDR. Personal experience with the IFS method. I started using the IFS method in January 2006. I havent reached the stage of unburdening an exile on my own yet, but I have gotten to know a few parts quite well, and have had glimpses of many more. So far I have identified 24 parts, including
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managers, firefighters, and exiles. Interestingly, some parts are male and some are female. The young parts all seem to be female or genderless. I would like to share an example of getting to know a buzzing, reactive part of me that is frequently active; it is a major part of my ego self. I accessed the part by feeling into the familiar angry energy, and then unblended from it. I felt curiosity, appreciation, and joy about talking to the part and getting to know it. I found out that its role is to prevent people from taking advantage of me. This part has a sense that it is protecting the whole system. I noticed the part spoke with a gruff male voice. I asked him for a name I could call him, and heard Buzz. Of course! He has been actively doing his role since Grade 1 or 2. Several times as we spoke I became more blended and asked him to separate from me so I could get to know him from a clear, open place. I felt very confident following the steps for getting to know the protector. Each time I asked the part to separate and felt into Self I felt joy, appreciation, and enjoyment of the process. I learned that Buzz interacts with people in a very aggressive waybiting their heads off, slapping his hand down on the desk, laying down the law. I had no sense of judgment towards him. At the end I thanked him for talking to me. I invited him to rest for a little while, but he didnt want to and went buzzing off. Although this work is just beginning, already I notice a deep feeling of love and appreciation for the parts I have worked with. Some of the inner struggle between parts has subsided. During work with a therapist I reparented one young, traumatized part. She released her burden in the session, and I have since spent some time holding her and dancing with her. It seems the system of parts has witnessed this (at least some have) and appreciates the work I am doing to heal and unburden the parts. The understanding I have gained of some of the manager parts has caused a shift in my experience, so that I feel less anxiety and less need to overfunction.
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Ecotherapy Ecotherapy is based on the view that mental and emotional health are inseparable from connection with the natural world. Therapy methods usually take place within nature. Ecotherapy is also called nature therapy. Adventure therapy is related, although its emphasis is usually on building identity, inner strength, and group connection through overcoming challenges in nature. The examples of ecotherapy presented here have both group and individual components. However, many practicing ecotherapists also work with clients on a one-on-one basis, using nature as an ally in the healing process. Ecotherapy encompasses a broad range of tools and methods. It does not have a clearly defined, step-by-step approach like the methods previously discussed, although sometimes the three-stage model of separation, threshold, and reincorporation is used. Example of ecotherapy. A powerful example of ecotherapy is a 5-day group hike in the wilderness for former freedom fighters in South Africa who are suffering from PTSD. The hikes are called ecotherapy wilderness trails. Strengthening their relationship with nature helps participants find balance, direction, and healing in their lives, enabling them to move beyond the nightmares of killing that they witnessed and perhaps participated in during South Africas struggle for freedom from apartheid. These hikes have been effective with PTSD symptoms including flashbacks, intrusive memories, and difficulty sleeping. The Programme Coordinator for the National Peace Accord Trust, which offers the innovative ecotherapy trails, Tozi Sabi, says that treatment involves setting in motion a processvia naturethat supports an individuals attempts to confront their problems (Irin News, 2006). The South African program uses several ecotherapy tools for healing. A difficult group hike teaches that challenges are surmountable. Education and discussion about the cycles of life allows participants to place their problems within a larger context and helps them identify the issues that
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are affecting them. Once these issues are identified, participants go on a 24-hour solo (called isolation time), allowing time for reflection and for receiving guidance from nature. Then the participants regroup and share their stories, which many participants have never done before. This stage brings healing and integration. A follow up support group session a month or two later helps participants deal with issues that have arisen since the wilderness hike, bringing further integration. The hikes usually take place near a sacred spot in nature, such as a water source. Sabi says: [I]t is important to have a sacred site or water source at hand because participants often experience a spiritual awakening during the trail that can be magnified by a place they believe to be special. They frequently feel the need for a physical cleansing, a washing away of their past lives. (Irin News, 2006) The vision fast. There are many groups in North America that incorporate elements similar to those used in the ecotherapy vision trail. For example, vision fast ceremonies that include solo time in the wilderness are used to mark initiations and life changes, and can help people overcome addictions. Although healing PTSD is not usually a specific aim, people are often drawn to the vision fast because of a powerful need for healing and connection with nature. The video Coming of Age in the Wilderness (Shelton, 1998) documents a youth vision fast trip in which several participants had witnessed or suffered extreme violence. Many of the participants found healing, empowerment, and connection during the trip. Evaluation of ecotherapy. Hermans three steps to healing trauma are usually an inherent part of ecotherapy methods. Safety is established through creating a safe group environment (or therapeutic relationship, in one-on-one therapy) in which sharing can occur. This is done partly by the therapist or group leader, but I think nature is the active agent in creating a safe container in many situations (except for people with biophobia, the fear of nature). The telling of stories is also a key step, and
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may occur at multiple stages during ecotherapy and wilderness trips. Creating reconnection occurs both in the group, and with the individuals connecting and resourcing in nature. Participants are usually guided to bring the insights, self-discovery, and healing gained from the trip into their regular lives, often with the support of follow-up after the trip is over. For clients in one-on-one therapy, this kind of support is ongoing until the therapy treatment is over. Ecotherapy uses a different healing modalityconnecting and resourcing in naturethan body psychotherapies. Therefore the release of energy stored in the nervous system is not specifically addressed. However, it seems that some kind of release occurs in other ways. The ritual cleansing that often occurs as part of wilderness rites probably plays an important role in this release. Other possible ways that energy release can occur include through drumming, chanting, dancing, and crying. Perhaps even through sitting or lying on the earth. I was not able to find research studies that prove that ecotherapy heals PTSD. However, I find the anecdotal evidence compelling. Shamanic Counseling Shamanism is a form of healing that has been practiced for 40,000 years, archaeologists estimate. Shamans use altered states of consciousness to heal physical illness and emotional disturbances such as feelings of helplessness. Shamanism has been practiced continuously by almost all indigenous peoples up to the present (Gray, 1995). The practices of shamanism arise from a worldview that all living things must be in balanced relationship, and ill health occurs when relationships are out of balance. Shamanism has an understanding of the interconnection of all thingsthe entire natural world, including rocks, plants, animals, and so on. Modern ecopsychology has its roots in the transpersonal, nature-based worldview of shamanism.
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Leslie Gray is an ecopsychologist and psychotherapist who has also trained extensively with shamans from different traditions. Gray has created a form of shamanism called shamanic counseling that is suited to urban settings. Meeting her clients in an office, Gray nonetheless incorporates shamanic practices into the healing of psychological problems. Shamanic counseling methods. Gray uses drumming, rattling, and chantingwhat she calls sonic drivingto help shift the clients state to access problem-solving abilities that do not use ordinary thinking. She journeys to consult with spirits about her clients problems. Other traditional techniques that she employs with her clients include: [m]aking allies with the things in the natural world around us; talking to the stone people; acquiring an animal as a guardian spirit; [and] soul retrievals (Gray, 1995, p. 175). Often clients are given homework assignments that require them to go out into nature and use ritual. I think it is important to note here that many ecotherapy and ecopsychology practices are drawn from traditional shamanic methods. Evaluation of shamanic counseling. The source material for this method does not mention using shamanic counseling in the treatment of PTSD. In the examples given in the source material, the counselor listened to the clients stories, fulfilling the witnessing role of step two of Hermans model. This method appears to strongly address step three in Hermans model: reconnection. Shamanic counseling restores the clients awareness of her place in the world, including her connection with nature. Although step one, establishing safety, is not addressed explicitly in the source material, it seems unlikely that a shaman would work without establishing safety for the client. Shamanic healing works with energies of all kinds. During healing ceremonies the beneficiary of the healing almost always shakes and trembles as the event nears its conclusion (Levine, 1997, p. 58). This engenders the physical energetic release needed to heal PTSD. The fact that shamanism
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has been used to heal people for 40,000 years leads me to trust in its efficacy for all kinds of healing, including PTSD. The Role of Contemplative Practices in Healing Trauma Many of the methods for working with trauma use body awareness. Staying with the felt sensation in the body can lead to energetic release and healing of the trauma, and to becoming resourced in the body. Van der Kolk (quoted in Rothschild, 2000) says, [O]ur therapy needs to consist of helping people to stay in their bodies and to understand these bodily sensations (p. 3). Meditation and other mindfulness and awareness practices from contemplative traditions can assist people who have experienced trauma to develop the capacity for staying with their experience from moment to moment, including experience of body sensation. Contemplative practices can also help people to become aware of oneness and interconnection. Reconnection to others, to nature, and to the oneness of existence is an essential step in the healing of trauma. Therefore, I propose that contemplative practices can likely help in healing trauma, but I also acknowledge that each persons situation is unique, and there may be people for whom contemplative practices are inappropriate, particularly in the early stages of treatment if symptoms such as intrusive memories are severe. No discussion of the role of contemplative practices in the healing of trauma would be complete without mentioning the Nobel Peace Prize nominee Thich Nhat Hahn, the Vietnamese Buddhist monk who has helped to bring peace to many American veterans who fought in Vietnam. His healing work with the veterans included teaching them mindfulness techniques. Nhat Hahns mindfulness teachings begin with awareness of the breath and expand to include awareness of all that is wonderful and refreshing (Nhat Hanh, 1992, p. 5). He teaches people to appreciate the wonders of existence, and especially of the natural world. I dont know whether the soldiers that Nhat Hanh taught were suffering from PTSD, though it is well-documented that many Vietnam
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veterans had PTSD. It is certain that his work with the soldiers brought about emotional healing and reconciliation. Comparison and Analysis of Methods for Healing Trauma In the preceding section I evaluated whether the methods for healing trauma met these four criteria: safety, reconstruction, reconnection, and somatic release. I also considered whether research exists to support the methods effectiveness. The following table presents the results of the evaluations. The o symbol signifies that the criterion is not explicitly addressed, but its satisfaction can be inferred from the information given. Method Safety Reconstruction Reconnection Somatic Release o o Research Support
EMDR Somatic Experiencing Bodynamic Analysis STT IFS Ecotherapy Shamanic counseling
Table 1: Comparison of Methods for Healing Trauma
Of the methods considered in this paper, EMDR is the only method that has been the subject of extensive research that supports its effectiveness as a treatment method. Somatic Experiencing, Somatic Trauma Therapy, and IFS therapy satisfy all four evaluation criteria by addressing them as part of the treatment method or goals. The remaining methods seem likely to satisfy all four criteria, but I did not have enough information to establish this with certainty.
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All of the methods have been used to treat PTSD except shamanic counseling, for which I found no evidence. Further research would be necessary to determine whether practicing shamans (who might not call what they do shamanic counseling) treat people who have PTSD. How Nature Can Participate in the Healing Of the methods discussed in this paper, only ecotherapy and shamanic counseling work directly with nature to effect healing in humans. However, the techniques that use a safe place or oasis (EMDR, Somatic Experiencing, and Somatic Trauma Therapy) can easily incorporate nature into the healing if the clients choose their safe places in nature. In Bodynamic Analysis, when clients are given homework tasks to help them complete developmental stages, the therapist or client can suggest tasks that occur in a nature setting, bringing nature into the healing process that way. In IFS, nature can be invited into the healing process by finding out which parts feel a connection with nature and whether any parts are afraid of nature. For all people with PTSD, whatever method of treatment they choose, I believe that spending time in nature is beneficial. (An exception would be people with biophobia or other phobias that prevent them from feeling safe in the outdoors.) Finding a real-life safe place in the natural world can help create and strengthen connections with nature. As Almaas (2006) says, The more we feel connected to [nature], and have an intimate affinity with it, the more chance it can aid in healing us from trauma (p. 4). Ecotherapist Philip Sutton Chard has been sending his clients to nature for healing for many years. He writes: Healing is there. It is made of sky and wind, clouds and storms, trees and berries, creatures of wondrous variety, soil and rock, vistas and valleys, water and air, and things dying and being born. It is a place where the earth reaches out to each of us with a touch that we remember, somehow, from an unremembered time. (1994, p. 139)
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Self-Reflection I was drawn to study this subject because of my souls yearning and readiness for the healing of the traumas I have experienced. I have been in four car accidents, and in all four of them the damage was so great that the cars were written off. (I notice that I choose to focus on the damage to the cars, rather than the harm to my own body.) I have had five surgeries and several emergency room visits for myself and family members. There is inter-generational abuse on both sides of my family. And thats not a complete list! Clearly I have a very personal interest in this topic. I have spent six years in therapy, and have healed in concrete ways from this therapy, yet I still experience many symptoms of PTSD. I am very optimistic about the healing work I am doing using EMDR. I feel that finally I have found a systematic way to heal all of the traumas, one by one. The independent study this semester has truly been a journey of discovery for me. Learning about the effects of trauma and the symptoms of PTSD helped me understand my experience. Reading the accounts of many others who have PTSD helped to normalize it for me. There have been so many exciting discoveries, such as reading about re-enactment in Peter Levines Waking the Tiger (1997) and seeing the pattern that has recurred in my own life. One of the outcomes of this study is to feel a sense of responsibility for my own healing. I let go of the hope that some magical therapist will come along and tell me what I need to do, and take care of me in the way I wished my parents had done more often. While recognizing my responsibility for healing, I also sought and found a therapist who can help me heal these traumas. This has been very empowering. I am committed to the healing, and make that a priority in my life. In this regardmy personal healingI feel the independent study has been a success. This independent study has taught me so muchmuch more than I can communicate in this paper. I feel inspired to share what I have learned with the others in my life who have
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experienced trauma. This is an unexpected outcome of the studythat I have learned things that might help others. One of my initial goals in this study was to demonstrate the role that nature can play in healing PTSD. I feel I have failed to establish this to my satisfaction. It seems there is the potential for much more research and learning in this area. My own direct experience has been that moving to a place in nature has created a feeling of safety and holding for me. I have received comfort from trees on many occasions. I have practiced ecopsychology methods in nature, and gained insight, guidance, and emotional healing. I have grown and healed in many ways, both from nature and from therapy, yet I still have PTSD symptoms. Healing is a very mysterious thing. As Almaas says, it is not as straightforward as many of us want to believe (2006, p. 4). My love of the natural world and the experiences of interconnection I have felt in nature motivate me to continue my research into natures role in healing. Conclusion The symptoms of PTSD can create enormous misery in peoples lives. The good news is there are many methods for healing PTSD. I have shown that each of the methods discussed in this paper is likely to be effective. I also believe that peoples inner guidance draws them to find the healing method that is right for them. It is in our nature to heal. I have demonstrated that nature can aid in the healing process in three ways: by using methods of healing that incorporate nature directly; by bringing nature into treatment methods as an adjunct to the primary method; and by spending time in nature. In our increasingly urbanized lives, I hope that people find ways to keep their connection with nature awake. I believe that regular contact with nature is vital for good health and a satisfying life.
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May all who suffer from PTSD find the healing they wish for. It is my special hope that those who were abused as children find healing so that they can stop the cycle of abuse.
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Appendix A: Tips for Managing Trauma Symptoms This list of tips for managing the symptoms of trauma was adapted from Mary Sise (2006). 1. Use all of your senses to help you. Play soothing music, light a candle, take a bubble bath, get out in the sunshine. Seek safe physical contact. Hug each other. Talk to your body-mind. Tell it that it is safe now. 2. Exercise helps to release endorphins in the body. Walk, move the body, swing your arms back and forth. 3. Breathe deeply, sending oxygen all the way to the bottom of the lungs. That brings more oxygen up to the brain, which sends a signal that you are safe again. During trauma, many people hold their breath without realizing it. Deep breathing restores the feeling of safety. 4. 5. Eat healthy. Minimize sugar. Your body has been in a shock. It needs help to recover. Sleep may be disturbed. Your brain is trying to process the trauma to help you know that it is over. If you wake up having nightmares, read a book you enjoy or use relaxation or muscle tensing techniques to calm the body down and help you to sleep. 6. Avoid alcohol or illegal drugs. While they may initially put you to sleep, they will disturb the processing that the brain can do at night. Use regular medicines under the direction of a physician. 7. Spend time in nature. Find a safe place nearby that you can visit often. Make friends with a tree, rock, stream, or other natural creature. 8. 9. Limit how much trauma you watch on TV. Distract yourself with more hopeful things. Be active. Dont sit around. Do something that empowers you, rebuild something, take action in a positive direction. 10. Learn some simple techniques such as yoga or meditation to help the body calm down. Seek the help of a therapist or a trusted friend if needed. Or rent a yoga video. 11. Think of someone you care about and send them good wishes. Sense your heart.
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References Almaas, A. H. (2004). The inner journey home: Souls realization of the unity of reality. Boston, MA: Shambhala Publications, Inc. Almaas, A. H. (2006, Spring). Ask Hameed. Diamond Dust: Newsletter of the Ridhwan School. Antonioli, C. & Revely, M. A. (2005). Randomised controlled trial of animal facilitated therapy with dolphins in the treatment of depression [Abstract]. British Medical Journal. November 26, 3311231. Retrieved April 29, 2006, from http://bmj.bmjjournals.com/cgi/content/full/331/7527/1231 Bodynamic Canada. (2004). Theory. Retrieved March 4, 2006, from http://www.bodynamic.ca/theory.htm Bryant, R. A. & Harvey, A. G. (1995). Processing threatening information in posttraumatic stress disorder. Journal of Abnormal Psychology, 104, 537-541. Burnett, F. H. (2004). The secret garden. Franklin, TN: Dalmation Press. (Original work published 1911) Chard, P. S. (1994). The healing earth: Natures medicine for the troubled soul. Minnetonka, MN: NorthWord Press. Davis, J. (1998). The transpersonal dimensions of ecopsychology: Nature, nonduality, and spiritual practice. The Humanist Psychologist, 26(1-3), 69-100. Davis, J. (1999). The Diamond Approach: An introduction to the teachings of A. H. Almaas. Boston, MA: Shambhala Publications, Inc. Earley, J. (2006a). IFS practice manual: Level 2. Unpublished manuscript. Earley, J. (2006b). What IFS has to offer Diamond Approach inquiry. Unpublished manuscript.
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EMDR Institute, Inc. (2004a). Eight phases of treatment. Retrieved March 4, 2006, from http://www.emdr.com/briefdes.htm EMDR Institute, Inc. (2004b). History of EMDR. Retrieved March 4, 2006, from http://www.emdr.com/history.htm Foundation for Human Enrichment. (2004). What is Somatic Experiencing? Retrieved April 30, 2006, from http://www.traumahealing.com/ Gerity, L. A. (1999). Creativity and the dissociative patient: Puppets, narrative and art in the treatment of survivors of childhood trauma. London: Jessica Kingsley Publishers. Gorman, W. (2001). Refugee survivors of torture: Trauma and treatment. Professional Psychology: Research and Practice, 32, 443-451. Grand, S. & Alpert, J. L. (1993). The core trauma of incest: An object relations view. Professional Psychology: Research and Practice, 24, 330-334. Gray, L. (1995). Shamanic counseling and ecopsychology. In T. Roszak, M. E. Gomes, & A. D. Kanner (Eds.), Ecopsychology: Restoring the earth, healing the mind, (pp. 172-182). San Francisco, CA: Sierra Club Books. Heller, D. P. & Heller, L. (2006). Somatic Experiencing in the treatment of automobile accident trauma. Retrieved April 30, 2006, from http://www.traumahealing.com/art_Auto.html Irin News (2006, March 23). South Africa: Walking the long trail to reconciliation. Retrieved April 29, 2006, from http://www.irinnews.org/S_report.asp?ReportID=52478&SelectRegion=Southern_Africa Ka-Tzetnik 135633. (1998). Shivitti: A vision. Nevada City, CA: Gateways. (Original work published 1987)
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Levine, P. A. (with Frederick, A.). (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. Berkeley, CA: North Atlantic Books. Macy, J. & Brown, M. Y. (1998). Coming back to life: Practices to reconnect our lives, our world. Gabriola Island, BC: New Society Publishers. Maitri, S. (2005). The enneagram of passions and virtues: Finding the way home. New York, NY: Jeremy P. Tarcher/Penguin. Matsakis, A. (1998). Trust after trauma: A guide to relationships for survivors and those who love them. Oakland, CA: New Harbinger Publications, Inc. Nhat Hanh, T. (1992). Touching peace: Practicing the art of mindful living. Berkeley, CA: Parallax Press. Population Reference Bureau. (2006). Human population: Fundamentals of growth patterns of world urbanization. Retrieved May 1, 2006, from http://www.prb.org/Content/NavigationMenu/PRB/Educators/Human_Population/Urb anization2/Patterns_of_World_Urbanization1.htm Rayner, L. (2005, July). Ecological collapse, trauma theory, and permaculture. Gatherings: Journal of the International Community for Ecopsychology. Retrieved April 29, 2006, from http://www.ecopsychology.org/journal/ezine/archive2/ecological_collapse.html Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York, NY: W. W. Norton & Company, Inc. Rothschild, B. (2003). Somatic Trauma Therapy. Retrieved March 4, 2006 from http://home.webuniverse.net/babette/somatic.htm Schwartz, R. C. (2001). Introduction to the Internal Family Systems Model. Oak Park, IL: Trailheads Publications.
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Shelton, K. (Producer). (1998). Lost borders: Coming of age in the wilderness [Motion picture]. (Available from Bullfrog Films, PO Box 149, Oley, PA 19547) Sise, M. (2006). Ten tips for trauma recovery. Retrieved April 30, 2006, from http://energypsych.org/ Wylie, M. S. (1996). Under the microscope: Scrutinizing some promising approaches to treating PTSD. Family Therapy Networker, July-August.

Post-Traumatic Stress Disorder: Treatment With An Emphasis On The Role of Nature in Healing

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Running head: TRAUMA, HEALING, AND NATURE

May 2, 2006 Naropa University

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Table 1: Comparison of Methods for Healing Trauma

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

Trauma, Healing, and Nature

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