The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

CHAPTER 18

FILLING IN THE HOLES: CREATING STRUCTURES

The greatest discovery of my generation is that human beings can alter their lives by altering their attitudes of mind.

—William James

It is not that something different is seen, but that one sees differently. It is as though the spatial act of seeing were changed by a new dimension.

—Carl Jung

It is one thing to process memories of trauma, but it is an entirely different matter to confront the inner void—the holes in the soul that result from not having been wanted, not having been seen, and not having been allowed to speak the truth. If your parents’ faces never lit up when they looked at you, it’s hard to know what it feels like to be loved and cherished. If you come from an incomprehensible world filled with secrecy and fear, it’s almost impossible to find the words to express what you have endured. If you grew up unwanted and ignored, it is a major challenge to develop a visceral sense of agency and self-worth.

The research that Judy Herman, Chris Perry, and I had done (see chapter 9) showed that people who felt unwanted as children, and those who did not remember feeling safe with anyone while growing up, did not fully benefit from conventional psychotherapy, presumably because they could not activate old traces of feeling cared for.

I could see this even in some of my most committed and articulate patients. Despite their hard work in therapy and their share of personal and professional accomplishments, they could not erase the devastating imprints of a mother who was too depressed to notice them or a father who treated them like he wished they’d never been born. It was clear that their lives would change fundamentally only if they could reconstruct those implicit maps. But how?How can we help people become viscerally acquainted with feelings that were lacking early in their lives?

I glimpsed a possible answer when I attended the founding conference of the United States Association for Body Psychotherapy in June 1994 at a small college in Beverley on the rocky Massachusetts coast. Ironically, I had been asked to represent mainstream psychiatry at the meeting and to speak on using brain scans to visualize mental states. But as soon as I walked into the lobby where attendees had gathered for morning coffee, I realized this was a different crowd from my usual psychopharmacology or psychotherapy gatherings. The way they talked to one another, their postures and gestures, radiated vitality and engagement—the sort of physical reciprocity that is the essence of attunement.

I soon struck up a conversation with Albert Pesso, a stocky former dancer with the Martha Graham Dance Company who was then in his early seventies. Underneath his bushy eyebrows he exuded kindness and confidence. He told me that he had found a way of fundamentally changing people’s relationship to their core, somatic selves. His enthusiasm was infectious, but I was skeptical and asked him if he was certain he could change the settings of the amygdala. Unfazed by the fact that nobody had ever tested his method scientifically, he confidently assured me that he could.

Pesso was about to conduct a workshop in “PBSP psychomotor therapy,”1 and he invited me to attend. It was unlike any group work I had ever seen. He took a low chair opposite a woman named Nancy, whom he called a “protagonist,” with the other participants seated on pillows around them. He then invited Nancy to talk about what was troubling her, occasionally using her pauses to “witness” what he was observing—as in “A witness can see how crestfallen you are when you talk about your father deserting the family.” I was impressed by how carefully he tracked subtle shifts in body posture, facial expression, tone of voice, and eye gaze, the nonverbal expressions of emotion. (This is called “microtracking” in psychomotor therapy).

Each time Pesso made a “witness statement,” Nancy’s face and body relaxed a bit, as if she felt comforted by being seen and validated. His quiet comments seemed to bolster her courage to continue and go deeper. When Nancy started to cry, he observed that nobody should have to bear so much pain all by herself, and he asked if she would like to choose someone to sit next to her. (He called this a “contact person.”) Nancy nodded and, after carefully scanning the room, pointed to a kind-looking middle-aged woman. Pesso asked Nancy where she would like her contact person to sit. “Right here,” Nancy said decisively, indicating a pillow immediately to her right.

I was fascinated. People process spatial relations with the right hemisphere of the brain, and our neuroimaging research had shown that the imprint of trauma is principally on the right hemisphere as well (see chapter 3). Caring, disapproval, and indifference all are primarily conveyed by facial expression, tone of voice, and physical movements. According to recent research, up to 90 percent of human communication occurs in the nonverbal, right-hemisphere realm,2 and this was where Pesso’s work seemed primarily to be directed. As the workshop went on, I was also struck by how the contact person’s presence seemed to help Nancy tolerate the painful experiences she was dredging up.3

But what was most unusual was how Pesso created tableaus—or as he called them, “structures”—of the protagonists’ past. As the narratives unfolded, group participants were asked to play the roles of significant people in the protagonists’ lives, such as parents and other family members, so that their inner world began to take form in three-dimensional space. Group members were also enlisted to play the ideal, wished-for parents who would provide the support, love, and protection that had been lacking at critical moments. Protagonists became the directors of their own plays, creating around them the past they never had, and they clearly experienced profound physical and mental relief after these imaginary scenarios. Could this technique instill imprints of safety and comfort alongside those of terror and abandonment, decades after the original shaping of mind and brain?

Intrigued with the promise of Pesso’s work, I eagerly accepted his invitation to visit his hilltop farmhouse in southern New Hampshire. After lunch beneath an ancient oak tree, Al asked me to join him in his red clapboard barn, now a studio, to do a structure. I’d spent several years in psychoanalysis, so I did not expect any major revelations. I was a settled professional man in my forties with my own family, and I thought of my parents as two elderly people who were trying to create a decent old age for themselves. I certainly did not think they still had a major influence on me.

Since there were no other people available for role-play, Al began by asking me to select an object or a piece of furniture to represent my father. I chose a gigantic black leather couch and asked Al to put it upright about eight feet in front of me, slightly to the left. Then he asked if I’d like to bring my mother into the room as well, and I chose a heavy lamp, approximately the same height as the upright couch. As the session continued, the space became populated with the important people in my life: my best friend, a tiny Kleenex box to my right; my wife, a small pillow next to him; my two children, two more tiny pillows.

After a while I surveyed the projection of my internal landscape: two hulking, dark, and threatening objects representing my parents and an array of minuscule objects representing my wife, children, and friends. I was astounded; I had re-created my inner image of my stern Calvinistic parents from the time I was a little boy. My chest felt tight, and I’m sure that my voice sounded even tighter. I could not deny what my spatial brain was revealing: The structure had allowed me to visualize my implicit map of the world.

When I told Al what I had just uncovered, he nodded and asked if I would allow him to change my perspective. I felt my skepticism return, but I liked Al and was curious about his method, so I hesitantly agreed. He then interposed his body directly between me and the couch and lamp, making them disappear from my line of sight. Instantaneously I felt a deep release in my body—the constriction in my chest eased and my breathing became relaxed. That was the moment I decided to become Pesso’s student.4

RESTRUCTURING INNER MAPS

Projecting your inner world into the three-dimensional space of a structure enables you to see what’s happening in the theater of your mind and gives you a much clearer perspective on your reactions to people and events in the past. As you position placeholders for the important people in your life, you may be surprised by the unexpected memories, thoughts, and emotions that come up. You then can experiment with moving the pieces around on the external chessboard that you’ve created and see what effect it has on you.

Although the structures involve dialogue, psychomotor therapy does not explain or interpret the past. Instead, it allows you to feel what you felt back then, to visualize what you saw, and to say what you could not say when it actually happened. It’s as if you could go back into the movie of your life and rewrite the crucial scenes. You can direct the role-players to do things they failed to do in the past, such as keeping your father from beating up your mom. These tableaus can stimulate powerful emotions. For example, as you place your “real mother” in the corner, cowering in terror, you may feel a deep longing to protect her and realize how powerless you felt as a child. But if you then create an ideal mother, who stands up to your father and who knows how to avoid getting trapped in abusive relationshipsyou may experience a visceral sense of relief and an unburdening of that old guilt and helplessness. Or you might confront the brother who brutalized you as a child and then create an ideal brother who protects you and becomes your role model.

The job of the director/therapist and other group members is to provide protagonists with the support they need to delve into whatever they have been too afraid to explore on their own. The safety of the group allows you to notice things that you have hidden from yourself—usually the things you are most ashamed of. When you no longer have to hide, the structure allows you to place the shame where it belongs—on the figures right in front of you who represent those who hurt you and made you feel helpless as a child.

Feeling safe means you can say things to your father (or, rather, the placeholder who represents him) that you wish you could have said as a five-year-old. You can tell the placeholder for your depressed and frightened mother how terrible you felt about not being able to take care of her. You can experiment with distance and proximity and explore what happens as you move placeholders around. As an active participant, you can lose yourself in a scene in a way you cannot when you simply tell a story. And as you take charge of representing the reality of your experience, the witness keeps you company, reflecting the changes in your posture, facial expression, and tone of voice.

In my experience, physically reexperiencing the past in the present and then reworking it in a safe and supportive “container” can be powerful enough to create new, supplemental memories: simulated experiences of growing up in an attuned, affectionate setting where you are protected from harm. Structures do not erase bad memories, or even neutralize them the way EMDR does. Instead, a structure offers fresh options—an alternative memory in which your basic human needs are met and your longings for love and protection are fulfilled.

REVISING THE PAST

Let me give an example from a workshop I led not long ago at the Esalen Institute in Big Sur, California.

Maria was a slender, athletic Filipina in her midforties who had been pleasant and accommodating during our first two days, which had been devoted to exploring the long-term impact of trauma and teaching self-regulation techniques. But now, seated on her pillow about six feet away from me, she looked scared and collapsed. I wondered to myself if she had volunteered as a protagonist mainly to please the girlfriend who had accompanied her to the workshop.

I began by encouraging her to notice what was going on inside her and to share whatever came to mind. After a long silence she said: “I can’t really feel anything in my body, and my mind is blank.” Mirroring her inner tension, I replied: “A witness can see how worried you are that your mind is blank and you don’t feel anything after volunteering to do a structure. Is that right?” “Yes!” she answered, sounding slightly relieved.

The “witness figure” enters the structure at the very beginning and takes the role of an accepting, nonjudgmental observer who joins the protagonist by reflecting his or her emotional state and noting the context in which that state has emerged (as when I mentioned Maria’s “volunteering to do a structure”). Being validated by feeling heard and seen is a precondition for feeling safe, which is critical when we explore the dangerous territory of trauma and abandonment. A neuroimaging study has shown that when people hear a statement that mirrors their inner state, the right amygdala momentarily lights up, as if to underline the accuracy of the reflection.

I encouraged Maria to keep focusing on her breath, one of the exercises we had been practicing together, and to notice what she was feeling in her body. After another long silence she hesitantly began to speak: “There is always a sense of fear in everything I do. It doesn’t look like I am afraid, but I am always pushing myself. It is really difficult for me to be up here.” I reflected, “A witness can see how uncomfortable you feel pushing yourself to be here,” and she nodded, slightly straightening her spine, signaling that she felt understood. She continued: “I grew up thinking that my family was normal. But I always was terrified of my dad. I never felt cared for by him. He never hit me as hard as he did my siblings, but I have a pervasive sense of fear.” I noted that a witness could see how afraid she looked as she spoke of her father, and then I invited her to select a group member to represent him.

Maria scanned the room and chose Scott, a gentle video producer who had been a lively and supportive member of the group. I gave Scott his script: “I enroll as your real father, who terrified you when you were a little girl,” which he repeated. (Note that this work is not about improvisation but about accurately enacting the dialogue and directions provided by the witness and protagonist.) I then asked Maria where she would like her real father to be positioned, and she instructed Scott to stand about twelve feet away, slightly to her right and facing away from her. We were beginning to create the tableau, and every time I conduct a structure I’m impressed by how precise the outward projections of the right hemisphere are. Protagonists always know exactly where the various characters in their structures should be located.

It also surprises me, again and again, how the placeholders representing the significant people in the protagonist’s past almost immediately assume a virtual reality: The people who enroll seem to become the people he or she had to deal with back then—not only to the protagonist but often to the other participants as well. I encouraged Maria to take a good, long look at her real father, and as she gazed at him standing there, we could witness how her emotions shifted between terror and a deep sense of compassion for him. She tearfully reflected on how difficult his life had been—how, as a child during World War II, he had seen people beheaded; how he had been forced to eat rotten fish infested with maggots. Structures promote one of the essential conditions for deep therapeutic change: a trancelike state in which multiple realities can live side by side—past and present, knowing that you’re an adult while feeling the way you did as a child, expressing your rage or terror to someone who feels like your abuser while being fully aware that you are talking to Scott, who is nothing like your real father, and experiencing simultaneously the complex emotions of loyalty, tenderness, rage, and longing that kids feel with their parents.

As Maria began to speak about their relationship when she was a little girl, I continued to mirror her expressions. Her father had brutalized her mother, she said. He was relentlessly critical of her diet, her body, her housekeeping, and she was always afraid for her mother when he berated her. Maria described her mother as loving and warm; she could not have survived without her. She would always be there to comfort Maria after her father lashed out at her, but she didn’t do anything to protect her children from their father’s rage. “I think my mom had a lot of fear herself. I have a sense that she didn’t protect us because she felt trapped.”

At this point I suggested that it was time to call Maria’s real mother into the room. Maria scanned the group and smiled brightly as she asked Kristin, a blonde, Scandinavian-looking artist, to play the part of her real mother. Kristin accepted in the formal words of the structure: “I enroll as your real mother, who was warm and loving and without whom you would not have survived but who failed to protect you from your abusive father.” Maria had her sit on a pillow to her right, much closer than her real father.

I encouraged Maria to look at Kristin and then I asked, “So what happens when you look at her?” Maria angrily said, “Nothing.” “A witness would see how you stiffen as you look at your real mom and angrily say that you feel nothing,” I noted. After a long silence I asked again, “So what happens now?” Maria looked slightly more collapsed and repeated, “Nothing.” I asked her, “Is there something you want to say to your mom?” Finally Maria said, “I know you did the best you could,” and then, moments later: “I wanted you to protect me.” When she began to cry softly, I asked her, “What is happening inside?” “Holding my chest, my heart feels like it is pounding really hard,” Maria said. “My sadness goes out to my mom; how incapable she was of standing up to my father and protecting us. She just shuts down, pretending everything’s okay, and in her mind it probably is, and that makes me mad today. I want to say to her: ‘Mom, when I see you react to dad when he is being mean . . . when I see your face, you look disgusted and I don’t know why you don’t say, “Fuck off.” You don’t know how to fight—you are such a pushover—there is a part of you that is not good and not alive. I don’t even know what I want you to say. I just want you to be different—nothing you do is right, like you accept everything when it is totally not okay.’” I noted, “A witness would see how fierce you are as you want your mother to stand up to your dad.” Maria then talked about how she wanted her mother to run off with the kids and take them away from her terrifying father.

I then suggested enrolling another group member to represent her ideal mother. Maria scanned the room again and chose Ellen, a therapist and martial artist. Maria placed her on a pillow to her right between her real mother and herself and asked Ellen to put her arm around her. “What do you want your ideal mother to say to your dad?” I asked. “I want her to say, ‘If you are going to talk like that, I am going to leave you and take the kids,’” she answered. “‘We are not going to sit here and listen to this shit.’” Ellen repeated Maria’s words. Then I asked: “What happens now?” Maria responded: “I like it. I have a little pressure in my head. My breath is free. I have a subtle energetic dance in my body now. Sweet.” “A witness can see how delighted you are when you hear your mother saying that she is not taking this shit from your dad anymore and that she will take you away from him,” I told her. Maria began to sob and said, “I would have been able to be a safe, happy little girl.” Out of the corner of my eye I could see several group members weeping silently—the possibility of growing up safe and happy clearly resonated with their own longings.

After a while I suggested that it was time to summon Maria’s ideal father. I could clearly see the delight in Maria’s eyes as she scanned the group, imagining her ideal father. She finally chose Danny. I gave him his script, and he gently told her: “I enroll as your ideal father, who would have loved you and cared for you and who would not have terrified you.” Maria instructed him to take a seat near her on her left and beamed. “My healthy mom and dad!” she exclaimed. I responded: “Allow yourself to feel that joy as you look at an ideal dad who would have cared for you.” Maria cried, “It’s beautiful,” and threw her arms around Danny, smiling at him through her tears. “I am remembering a really tender moment with my dad, and that is what this feels like. I would love to have my mom next to me too.” Both ideal parents tenderly responded and cradled her. I left them there for a while so that they could fully internalize the experience.

We finished with Danny saying: “If I had been your ideal dad back then, I would have loved you just like this and not have inflicted my cruelty,” while Ellen added, “If I had been your ideal mom, I would have stood up for you and me and protected you and not let any harm come to you.” All the characters then made final statements, deenrolling from the roles they had played, and formally resumed being themselves.

RESCRIPTING YOUR LIFE

Nobody grows up under ideal circumstances—as if we even know what ideal circumstances are. As my late friend David Servan-Schreiber once said: every life is difficult in its own way. But we do know that, in order to become self-confident and capable adults, it helps enormously to have grown up with steady and predictable parents; parents who delighted in you, in your discoveries and explorations; parents who helped you organize your comings and goings; and who served as role models for self-care and getting along with other people.

Defects in any of these areas are likely to manifest themselves later in life. A child who has been ignored or chronically humiliated is likely to lack self-respect. Children who have not been allowed to assert themselves will probably have difficulty standing up for themselves as adults, and most grown-ups who were brutalized as children carry a smoldering rage that will take a great deal of energy to contain.

Our relationships will suffer as well. The more early pain and deprivation we have experienced, the more likely we are to interpret other people’s actions as being directed against us and the less understanding we will be of their struggles, insecurities, and concerns. If we cannot appreciate the complexity of their lives, we may see anything they do as a confirmation that we are going to get hurt and disappointed.

In the chapters on the biology of trauma we saw how trauma and abandonment disconnect people from their body as a source of pleasure and comfort, or even as a part of themselves that needs care and nurturance. When we cannot rely on our body to signal safety or warning and instead feel chronically overwhelmed by physical stirrings, we lose the capacity to feel at home in our own skin and, by extension, in the world. As long as their map of the world is based on trauma, abuse, and neglect, people are likely to seek shortcuts to oblivion. Anticipating rejection, ridicule, and deprivation, they are reluctant to try out new options, certain that these will lead to failure. This lack of experimentation traps people in a matrix of fear, isolation, and scarcity where it is impossible to welcome the very experiences that might change their basic worldview.

This is one reason the highly structured experiences of psychomotor therapy are so valuable. Participants can safely project their inner reality into a space filled with real people, where they can explore the cacophony and confusion of the past. This leads to concrete aha moments: “Yes, that is what it was like. That is what I had to deal with. And that is what it would have felt like back then if I had been cherished and cradled.” Acquiring a sensory experience of feeling treasured and protected as a three-year-old in the trancelike container of a structure allows people to rescript their inner experience, as in “I can spontaneously interact with other people without having to be afraid of being rejected or getting hurt.”

Structures harness the extraordinary power of the imagination to transform the inner narratives that drive and confine our functioning in the world. With the proper support the secrets that once were too dangerous to be revealed can be disclosed not just to a therapist, a latter-day father confessor, but, in our imagination, to the people who actually hurt and betrayed us.

The three-dimensional nature of the structure transforms the hidden, the forbidden, and the feared into visible, concrete reality. In this it is somewhat similar to IFS, which we explored in the previous chapter. IFS calls forth the split-off parts that you created in order to survive and enables you to identify and talk with them, so that your undamaged Self can emerge. In contrast, a structure creates a three-dimensional image of whom and what you had to deal with and gives you a chance to create a different outcome.

Most people are hesitant to go into past pain and disappointment—it only promises to bring back the intolerable. But as they are mirrored and witnessed, a new reality begins to take shape. Accurate mirroring feels completely different from being ignored, criticized, and put down. It gives you permission to feel what you feel and know what you knowone of the essential foundations of recovery.

Trauma causes people to remain stuck in interpreting the present in light of an unchanging past. The scene you re-create in a structure may or may not be precisely what happened, but it represents the structure of your inner world: your internal map and the hidden rules that you have been living by.

DARING TO TELL THE TRUTH

I recently led another group structure with a twenty-six-year-old man named Mark, who at age thirteen had accidentally overheard his father having phone sex with his aunt, his mother’s sister. Mark felt confused, embarrassed, hurt, betrayed, and paralyzed by this knowledge, but when he tried to talk with his father about it, he was met with rage and denial: he was told that he had a filthy imagination and accused of trying to break up the family. Mark never dared to tell his mom, but henceforth the family secrets and hypocrisy contaminated every aspect of his home life and gave him a pervasive sense that nobody could be trusted. After school, he spent his isolated adolescence hanging around neighborhood basketball courts or in his room watching TV. When he was twenty-one his mother died—of a broken heart, Mark says—and his father married the aunt. Mark was not invited to either the funeral or the wedding.

Secrets like these become inner toxins—realities that you are not allowed to acknowledge to yourself or to others but that nevertheless become the template of your life. I knew none of this history when Mark joined the group, but he stood out by his emotional distance, and during check-ins he acknowledged that he felt separated from everyone by a dense fog. I was quite worried about what would be revealed once we started to look behind his frozen, expressionless exterior.

When I invited Mark to talk about his family, he said a few words and then seemed to shut down even more. So I encouraged him to ask for a “contact figure” to support him. He chose a white-haired group member, Richard, and placed Richard on a pillow next to him, touching his shoulder. Then, as he began to tell his story, Mark placed Joe, as his real father, ten feet in front of him, and directed Carolyn, representing his mother, to crouch in a corner with her face hidden. Mark next asked Amanda to play his aunt, telling her to stand defiantly to one side, arms crossed over her chest—representing all the calculating, ruthless, and devious women who are after men.

Surveying the tableau he had created, Mark sat up straight, eyes wide open; clearly the fog had lifted. I said: “A witness can see how startled you are seeing what you had to deal with.” Mark nodded appreciatively and remained silent and somber for some time. Then, looking at his “father,” he burst out: “You asshole, you hypocrite, you ruined my life.” I invited Mark to tell his “father” all the things that he had wanted to tell him but never could. A long list of accusations followed. I directed the “father” to respond physically as if he had been punched, so that Mark could see that that his blows had landed. It did not surprise me when Mark spontaneously said that he’d always worried that his rage would get out of control and that this fear had kept him from standing up for himself in school, at work, and in other relationships.

After Mark had confronted his “father,” I asked if he would like Richard to assume a new role: that of his ideal father. I instructed Richard to look Mark directly in the eye and to say: “If I had been your ideal father back then, I would have listened to you and not accused you of having a filthy imagination.” When Richard repeated this, Mark started to tremble. “Oh my God, life would have been so different if I could have trusted my father and talked about what was going on. I could have had a father.” I then told Richard to say: “If I had been your ideal father back then, I would have welcomed your anger and you would have had a father you could have trusted.” Mark visibly relaxed and said that would have made all the difference in the world.

Then Mark addressed the stand-in for his aunt. The group was visibly stunned as he unleashed a torrent of abuse on her: “You conniving whore, you backstabber. You betrayed your sister and ruined her life. You ruined our family.” After he was done, Mark started to sob. He then said he’d always been deeply suspicious of any woman who showed an interest in him. The remainder of the structure took another half hour, in which we slowly set up conditions for him to create two new women: the ideal aunt, who did not betray her sister but who helped support their isolated immigrant family, and the ideal mother, who kept her husband’s interest and devotion and so did not die of heartbreak. Mark ended the structure quietly surveying the scene he had created with a contented smile on his face.

For the remainder of the workshop Mark was an open and valuable member of the group, and three months later he sent me an e-mail saying that this experience had changed his life. He had recently moved in with his first girlfriend, and although they’d had some heated discussions about their new arrangement, he’d been able to take in her point of view without clamming up defensively, going back to his fear or rage, or feeling that she was trying to pull a fast one. He was amazed that he felt okay disagreeing with her and that he was able to stand up for himself. He then asked for the name of a therapist in his community to help with the huge changes he was making in his life, and I fortunately had a colleague I could refer him to.

ANTIDOTES TO PAINFUL MEMORIES

Like the model mugging classes that I discussed in chapter 13, the structures in psychomotor therapy hold out the possibility of forming virtual memories that live side by side with the painful realities of the past and provide sensory experiences of feeling seen, cradled, and supported that can serve as antidotes to memories of hurt and betrayal. In order to change, people need to become viscerally familiar with realities that directly contradict the static feelings of the frozen or panicked self of trauma, replacing them with sensations rooted in safety, mastery, delight, and connection. As we saw in the chapter on EMDR, one of the functions of dreaming is to create associations in which the frustrating events of the day are interwoven with the rest of one’s lifeUnlike our dreams, psychomotor structures are still subject to the laws of physics, but they too can reweave the past.

Of course we can never undo what happened, but we can create new emotional scenarios intense and real enough to defuse and counter some of those old ones. The healing tableaus of structures offer an experience that many participants have never believed was possible for them: to be welcomed into a world where people delight in them, protect them, meet their needs, and make you feel at home.