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Case Study - Page 4

Sensorimotor Psychotherapy assumes that since the body's answers don't come in the form of words, we must discover the "right" answer through a process of mindful trials of new movements, postures, words, and attentional focus. In that spirit, Carrie was asked if she'd be willing to try something else: "Notice what happens if you make the same Stop movement with one hand and reach out with the other hand." With this action, she observed a feeling connected to the raised hand of being centered and solid, but also a sense of tenderness connected to the reaching-out hand. I asked her to practice these movements over and over, while keeping in mind an image of meeting her husband at the airport. Excited, she began to entertain the possibility that she could have both her boundary and her connection with him. "I can hardly wait for him to get here so I can try this out!" She was encouraged to keep practicing the movement during the next 24 hours before his arrival, and to make it again several times at the airport.

At the next session, she proudly reported the results of her efforts at brain change: "I saw him waiting for me outside—he never waits inside because he feels trapped—pacing impatiently, and I could feel a little anxiety come up. But then I made my movement a few times while I was waiting for his bags, and when I turned to go to him, I felt better about seeing him and calmer inside. I wasn't so afraid anymore, even though he was impatient. And I think he treats me better when I'm not afraid!"

Over the next few months, attentively practicing just these new patterns of lengthening the spine and the "Stop and Reach Out" gesture, both at home and in session, helped Carrie begin to renegotiate her relationship with her husband. Instead of feeling frightened, frozen, and hopeless, she increasingly felt stronger and calmer, at times a little annoyed by his behavior, and at times wanting to roll her eyes and laugh at his outbursts as his friends typically did. Instead of being inflamed by her old procedurally learned patterns, he recovered faster from his outbursts. He responded to her nurturing in a more relaxed manner—gruff instead of angry and defensive. And when he did blow up, she found it easier to give him time and space to recover on his own, rather than to rush in with her procedurally learned, anxious caretaking. His trauma symptoms continue to be activated; he still isn't very good at expressing his feelings; she still longs for more closeness. What's changed is that she's no longer afraid and hopeless, no longer trapped by the neuroplastic patterns that were adaptive for her childhood, but are maladaptive in her marriage.

In our practice, we've found that focused attention to in-the-moment responses can activate the neural circuits driving established patterns, while mindful trials of new responses can help encode new neural circuits that override the old. It appears that applying the principles of neuroplasicity to psychotherapy through this and other interventions can create structural alterations in the brain, which, as Daniel Siegel writes in The Mindful Brain, are likely to stimulate changes in brain function, emotional experience, stress response, and even immune function.

Perhaps more important, Carrie would tell us about the positive effects on her marriage and well-being of the changes she's experienced, and how grateful she is to feel closer to her husband again—compassionate and warm, yet with boundaries and a feeling of safety. Are all her challenges behind her? No, but she's facing them with more equanimity. She's still vulnerable to the reactivation of old "scripts" and behavior patterns. Changing our brains takes focus and repetition. Carrie has just begun to explore what it means to harness her innate neuroplasticity. What she takes from these sessions is a new feeling of mastery—"I can do it"—and greater hope for the future.

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