Healing
Auto Accident
Trauma
By
Diane Poole Heller, Ph.D. and Laurence Heller, Ph.D.
We chose to write this article and recently published our book entitled, Crash Course: A Self-Healing Guide to Auto Accident Trauma and Recovery, because we feel that auto accident trauma is one of the most misunderstood, under-treated and even incorrectly treated of all traumas. Auto accidents are increasing, affecting more than ten million people worldwide each year. According to the National Center for Statistics and Analysis, in 1999 there were over six million auto accidents and over three million people injured in the United States alone. A study, reported in the American Journal of Psychiatry (April, 1999), stated that most auto accident victims showed symptoms of Post Traumatic Stress Disorder (PTSD) and that symptoms remain high more nine months after the accident. Of course, not everyone who is in an auto accident suffers from Post Traumatic Stress.
There are essentially two different types of people that are troubled with PTSD symptoms related to auto accidents. The first group is comprised of those people who have been in an accident and suffer from a variety of cognitive, physical and emotional symptoms including confusion, chronic pain, anxiety, angry outbursts, weight gain, insomnia, as well as driving related fears. They realize that these symptoms are related to their auto accident. There is a second group of people who have many of these same symptoms, but have no idea that these symptoms have anything to do with an auto accident that may have taken place earlier, even years ago. Also, because most people cannot avoid driving, they are continuously exposed to their trauma triggers on an everyday basis in a way that people suffering from other types of traumas are not.
As teachers of Somatic Experiencing ® (SE) developed by Dr. Peter Levine, we find SE to be invaluable in the treatment of a variety of traumas. We have adapted SE and designed the Heller Resiliency Model© specifically for working with automobile accidents. We will begin with a general clinical example illustrating how SE and the Heller Resiliency Model© differ from other modalities in the treatment of trauma (PTSD).
When a client comes in for treatment of auto accident trauma, normally practitioners will ask her to tell what happened, to go through the accident as it actually happened. This usually fits with the person's natural tendency to want to tell the story. She has probably already gone through the trauma event with many people, including other practitioners. She is in our office because she is still experiencing a variety of symptoms - anything from anxiety while driving to flashbacks or persistent physical pain.
Our first intervention is to gently encourage the client not to repeat her story. We let her know that we do want to hear the whole story eventually, but to begin we have another focus for her. The question we ask, a key to how our work differs from other modalities is, "Can you tell me the first time you remember feeling safe after the accident?" It may be that she will respond, "I felt such relief when I saw my husband's face when I awoke in the Emergency Room". As she relates that memory, the therapist will usually see marked signs of relief - from muscles relaxing to breathing becoming fuller and deeper. Then we use specific languaging to help the client more fully feel this sense of relief and safety in her body. Helping the person ground their experience in sensation is what Levine calls working in the "felt sense". "Felt sense" is a term coined by Eugene Gendlin in his book, Focusing. For example, we ask her to pay attention to the physiological shift that is taking place. We ask her where in her body she feels this shift and to describe the sensation physically. She may reply, "I feel a loosening and warmth in my chest and arms" We respond, "And when you feel this loosening and warmth in your chest and arms, what else do you notice or what happens next?" We will continue in this manner helping the client track her physiological responses until she feels relatively stable. We want to help the client build an awareness of what we call an "Oasis of Safety" before beginning to work with the traumatic material.
There are two reasons we want to start this way. When the client is telling her story in the order it originally happened, the retelling activates the client's physiology as if she were actually reliving the accident. She may respond by feeling flooded or by dissociating. Symptoms may worsen or intensify. A well-meaning therapist may unintentionally retraumatize the client by having her go through the traumatic event too quickly, in the order it happened, and with insufficient support. It is easy to safeguard against these difficulties, which we will explain shortly.
Secondly, the image of the husband coming into the ER and the subsequent physiological discharge of traumatic energy becomes the first resource that we may return to again and again in the course of actually dealing with the traumatic event itself. Personal resources may include any memory or fantasy of people, places, skills or experiences that trigger relaxation in the body, a sense of well-being or comfort, as well as autonomic nervous system discharge. We recommend building an inventory of resources that originates out of the client's own experience related to the specific traumatic event that she is currently processing. We do not suggest or insert resources for her; she accesses her own. As she discovers resources co-emergent in her experience with the symptoms related to the trauma, the client feels increasingly empowered, dispelling the overwhelming helplessness that accompanies the traumatic event. This way of working enhances her sense of self-efficacy and rebuilds her trust in the innate healing wisdom of the body.
If the client does not have an experience of feeling safe that she can call on since the accident, we may have to find another situation from before the accident to start this process. It is always essential to begin working from both an Oasis of Safety and a sense of stability, with resources in place that will help neutralize the traumatic energies. It is very important that those resources come from the client's own experience and not from the therapist's suggestions. Many trauma survivors feel particularly betrayed by symptoms in their body. To rediscover the body's innate capacity for healing lays a foundation for the client to begin trusting her own body again and eventually to come home to it. It is of crucial importance that the work on the trauma progress slowly, and that the client have resources in place. Another key concept of Somatic Experiencing® is called "pendulation" or "looping". Looping is a technique where the therapist helps the client move back and forth between small pieces of the traumatic material to one of the client's resources. This looping back and forth helps discharge the activation in the nervous system that emerges as the person slowly works though the traumatic event. In contrast to how EMDR® is usually practiced, for example, we always begin at the least charged aspects of the accident first and wait to deal with the most difficult aspects of the trauma last.
Basic to the understanding of Somatic Experiencing® is the concept that trauma is in the nervous system, not in the event. In the face of threat, all organisms enter into survival mode. When these defensive reactions are not able to be completed due to the suddenness or the overwhelming quality of the event, these energies remain bound in the body in the form of symptoms. Survival mode is a highly aroused state to enable short-term defensive reactions of running away, fighting or freezing. Very powerful energies of fight, flight and freeze become mobilized. If these defensive mechanisms get overwhelmed and we are unable to use them to successfully defend ourselves, these highly charged energies get bound in the body. If left undischarged, they begin to form the symptoms of trauma. Quoting Peter Levine from the forward to our book, "The very structure of trauma, including hyperarousal, dissociation and freezing , is based on the evolution of predator versus prey survival behaviors. The symptoms of trauma are the result of a highly activated, incomplete biological response to threat, frozen in time. By enabling this frozen response to thaw, then complete itself, trauma can be healed."
In most car accidents, drivers have very little or no warning. They often occur at high speed with great force. Consequently, we often use a strategy called "Freeze Frame". Once the client identifies the moment she first glimpsed the car that hit her, we ask her to stop, to freeze the image. Then we ask her to mentally move the car back as far as she needs to in order to regain a relative sense of safety. This enables her to feel how her body would have initiated a survival response if she had had more time and space. Completing the instinctive defensive survival responses of fight and/or flight in fantasy, as well as slowly completing the actual sensorimotor patterns that accompany them, creates a corrective experience that releases thwarted impulses and frees bound energy. This strategy of facilitating biological completion is central to our work. Explaining this process in depth exceeds the scope of this paper, but there are specific examples in our book, Crash Course: A Self Healing Guide to Auto Accident Trauma and Recovery, as well as in Waking the Tiger by Peter Levine. For those who have never seen SE work, the amount of discharge and physiological release that is effected by using this gentle technique is always surprising.
As we explain in our book, people have the perception that time and space collapses at the moment of impact. Due to the velocity and force of impact, it is particularly important to tease the intensely activating material apart, one moment at a time, and to work before and after the accident. We start by establishing the previously described Oasis of Safety that a client can continually build on and touch back into. And we make sure to focus her attention on establishing a sense of "after". Most clients, early on in the treatment, are unconsciously stuck in the time of the accident and are expecting it to happen again - what we call a "futuristic memory". Also the reptilian brain takes a "snapshot of the scene" anytime it feels threatened. Because of this reaction, clients often fear anything that reminds them of the original circumstances of their accident. Triggers for fear and anger may be activated by re-exposure to particular intersections or highways, tailgating drivers, or even cars of a certain color, if those elements were relevant in the client's particular accident.
For most people, the moment of impact is the most overwhelming and highly charged part of the accident. Usually people dissociate or disconnect, experience a discontinuity of self, and often a gap in memory, related to the impact.
Only by going slowly, directing attention to events before and after the impact and working gradually toward the center, is it possible to begin closing the gap in awareness to regain a continuity of self. By looping between resources and the triggers of high activation, there is an experience of moving from fragmentation toward integration. Clients find they can gradually slow down and maintain an integrated awareness from start to finish throughout the accident including impact. Then, perceptually, the accident can move from seeming to be ever present, or fixated in the future, into the past where it belongs. Symptoms diminish, triggers of fear, panic and anger are extinguished as continuity of self is re-established. The accident is experienced as truly over.
Bibliography
Gendlin, Eugene. Focusing, New York, Bantam Books, 1998.
Heller, Diane and Laurence. Crash Course: A Self-Healing Guide to
Auto Accident Trauma and Recovery, California, North Atlantic Books,
2001.
Levine, Peter. Waking the Tiger, California, North Atlantic Books,
1998.