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Case Study - Page 5

Case Commentary

By Susan Aposhyan

"Neurons that fire together wire together," neuropsychology founder Donald Hebb's fundamental axiom, stated in 1949, remains central to our understanding of neurological patterning and change. Carrie's case, as presented here by Sensorimotor psychotherapists Janina Fisher and Pat Ogden, illustrates this tenet simply and clearly.

Since childhood, Carrie was neurologically habituated to freeze in the face of her parents' rage and then attempt to placate them—a pattern stored in her procedural memory. In the course of her treatment, she becomes aware of the somatic components of her behavior through focused attention. After many repetitions of new movements and behaviors, she's able to change longstanding emotional and relational patterns.

I appreciate the care with which Fisher and Ogden delineate the stages of this process. As a Body-Mind psychotherapist who works through similar stages of treatment, I'd like to point out an important component of Carrie's therapy that wasn't explicitly articulated. As she began to focus on experiencing the old pattern of paralysis and collapse somatically, a neurological loading process occurred in which she consciously recognized her problematic behavior patterns and the discomfort she felt when carrying them out. As this came to conscious awareness, a healthy nervous system would naturally search for options that might alleviate the discomfort. We're told that Carrie "felt paralyzed, unable to speak or act. Her body couldn't shift its longstanding childhood Ôscript'. She felt little, scared, sad, and helpless." It was then that her therapist suggested that she lengthen her spine. This pacing—allowing the client's nervous system to exhaust its known resources—is essential for this simple, somatic change process to be effective.

I generally encourage my trainees to add an additional step here: permission to change. This step increases the possibility that clients will utilize their own resources a bit more, allowing a tad more self-determination. It's an addition to the process of exhausting accessible options before directing the client toward change. As Carrie was mindfully aware of her sensations and emotions, her therapist might have said, "Give yourself permission to shift your body as you feel all this."

The authors describe three simple suggestions made by the therapist: lengthening the spine, putting both hands out in a "stop" gesture, and finally the "stop and reach out" gesture. By accessing these simple behavioral resources, Carrie was able to move through a lifelong developmental and relational impasse.

In essence, the kind of somatic interventions described in this case might be seen as the new behavioral therapy. They allow us to "chunk down" a new behavior so we can master it. Perhaps by breaking down new behaviors into simple movement components or micro behaviors, we're harnessing the neurological bedrock of behavior and facilitating the learning process of macro behaviors—in Carrie's case, self-regulation and relational equality.

Fisher and Ogden have portrayed how easy and direct this sort of somatic awareness and change can be. Try this at home, or in your office! If you're intrigued, seek out ways to cultivate your own embodied awareness, which will enhance your comfort with this approach.

Janina Fisher, Ph.D., is a licensed clinical psychologist and instructor at the Trauma Center in Boston, a senior faculty member of the Sensorimotor Psychotherapy Institute, and a former instructor at Harvard Medical School. Contact: drjjfisher@

Pat Ogden, Ph.D., the founder and director of the Sensorimotor Psychotherapy Institute, is a clinician, lecturer, and first author of Trauma and the Body: A Sensorimotor Approach to Psychotherapy. Contact:

Susan Aposhyan, M.A., L.P.C., developed Body-Mind Psychotherapy, a method of integrating the body into psychotherapeutic work. She trains professionals internationally in Body-Mind Psychotherapy and is the author of Natural Intelligence: Body-Mind Integration and Human Development and Body-Mind Psychotherapy.

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