PTSD and Veterans

Somatic Experiencing and Military Mental HealthArticle by Nancy Eichhorn

There’s no tried and true training manual for therapists working with today‟s terror-torn veterans returning from Iraq and Afghanistan. Hundreds of thousands of soldiers are filtering back into our communities who have survived multiple stressors from bomb explosions and amputations, to deaths and scenes of complete horror as well as experiencing excruciating hours of boredom and heat stress; and then adding to all of this are multiple deployments. Their entire physiology, as well as their mental and emotional states have been impacted beyond their capacity to adapt. Reconnecting with spouses, offspring, extended family members, professional colleagues and friends is challenging. Those who contemplate treatment may be cautious and dubious. And those who accept the responsibility of working with returning veterans may be assuming an undefined role.

“Therapists have to understand they have no credibility at all, ”explained Peter A. Levine, PhD*, the originator and developer of Somatic Experiencing® (SE) and Founder and Senior Advisor of The Somatic Experiencing Trauma Institute (http://www.traumahealing.com). After 40 years in the field, Dr. Levine has worked with many veterans from several wars. “Soldiers have their own code, and we‟re outsiders. We have to gain their trust and respect. They have to develop a confidence in our competency.

“Therapist have to make assessments when and where to go with an individual,” he continued. “Some of that I can teach but so much comes from your own experiences, trusting your own intuitive sense.”

According to the Somatic Experiencing Trauma Institute website, “Somatic Experiencing® (SE) is a body-awareness approach to trauma” based upon Dr Levine‟s “realization that human beings have an innate ability to overcome the effects of stress and trauma.” SE is designed to help traumatized clients restore a sense of self-regulation allowing a renewed sense of aliveness, relaxation and wholeness. Dr Levine “has applied his work to combat veterans, rape survivors, Holocaust survivors, auto accident and post surgical trauma, chronic pain sufferers, and even to infants after suffering traumatic births”


Embodied Practices

Passed over by the draft board in the 1970s because he was “fortunate enough to be involved in a medical scientific field that was deemed essential for “national security‟. ”Dr Levine said he “felt obligated to give to people who didn’t have that advantage and were drafted into the Vietnam War”. His clients became his teachers as he listened to their stories, watched their embodied behaviors and in turn tracked his own physiological responses.

“This one guy came to my office, and I knew that I should not be between him and the door so I rearranged my office to give him direct access to the door. He was telling me horrific stories that I will not even hint at. As he told me these stories—I think in part to test me– I felt dizzy and nauseous and was almost ready to faint. I went inside, felt and allowed the sensations to move through.

“I told this vet”: “When you told me that story, what they made you do, I felt dizzy, nauseous, like I wanted to puke. But I know how to deal with those kinds of feelings and, let them move through; and I guess you might benefit from learning that”, he said “Therapists have to be real; they can‟t fake it with people who have gone through horrific events”.

“In our SE training”, he added, “we help therapists to differentiate their senses from their clients‟ (sensations); they become so familiar with their own inner landscape that they have a good idea when they pick up (resonate with) sensations of their clients.

”If there was ever any doubt where trauma is housed, Dr Levine says it‟s clear when you work with returning veterans that the body is the repository. Therapists cannot simply sit down with a returning war vet and talk about things. Approaching the work from a purely cognitive behavioral perspective offers a limited scope, while extreme exposure treatments, where veterans are made to relive the terrors haunting them is not the direction to go in either. According to Dr Levine, it is often not in the client‟s best interest to dredge up the trauma, abreact them, and then get them to think differently about what happened. Certainly, cognitive approaches may be a valuable part of the process, but they are, by no means, the whole thing.

“What resolution really has to do with is „renegotiating‟ these horrific experiences,” he said. “Trauma isn’t just coming from flashbacks, it is coming from the sensations in the fragmented, activated body reactivating. Then the body becomes the enemy. SE gradually helps people 3 befriend and transform these sensations, and then to discharge the “locked-in” activation. This way equilibrium is reestablished. Rather than flood (the client’s body) with emotions or change their thoughts, you have to gradually desensitize and integrate the imprints lodged in the body and then to help form a coherent narrative so they can weave it into the fabric of their lives.

”Therapists working with veterans who have completed multiple deployments resulting in multiple layers of trauma need to be seasoned. This work is not something that can be “put on the shoulders of new SE practitioners without adequate supervision,” Dr Levine said. “Senior clinicians can help guide newer therapists until they can get a feel for this kind of challenging work. It is only ethical to provide that support.” There‟s also the reality of secondary stress as therapists face their own overwhelm of being exposed to the effects of stories absolutely foreign to their own experiences. They need to seek out peer support to avoid facing therapist burn out.


Bringing Therapy Home

While therapists and returning veterans need support, family members also need to learn ways to negotiate new realities with their loved ones. Partners may need to protect themselves and their children when their spouses flip out into reenactment states (flash-backs). And, if they are really feeling threatened, they may need to find ways to temporarily separate, despite having suffered deployment separations already. Furthermore, for the first time in U.S war history, unprecedented numbers of parental units are being deployed—both parents are overseas in active duty—leaving their children in the care of relatives or close family friends. These children need ways to deal with their own sense of loss, their own stressors, both while their parents are absent and when they return.

Along with increasing numbers of female recruits are the unfortunate effects of intensified harassment—physically, emotionally and sexually. Female military personnel are often abused by men in their squadron—the very people who are supposed to be their source of safety are the ones abusing and threatening their survival.

“These are the people who are supposed to be your source of safety, and they are the ones who are abusive,” Dr Levine said. “It can feed back to early childhood when parents were supposed to love and protect them; yet, the real experience has to be validated, (the therapists has to say)
“Yah you were raped and harassed. Dr Levine continued: Therapists have to see which one (the rape or war experiences) is best to deal with first. There is no formula for that, you have to assess and go with one or the other, or even interweave them sometimes. Intuition comes from knowledge and lots of experiences; therapists have to trust their own organisms.

”Dr Levine noted that early life events can potentially impact the development of post-traumatic stress disorder. Dr. Levine explained that, “certain experiences early in our relationships with our parents, even stressors while in-utero sensitize our nervous system to be more likely traumatized by events like war, rape and harassment.” As well, it is thought that some people are genetically more resilient to stress than others. However, when this is used as a “legitimate” argument against supporting what military personnel need in terms of mental health services then Dr Levine is clear that the military simply needs to provide help to all trauma sufferers or to no longer deploy anyone with these “pre-existing” problems. “You broke it; you have to fix it,” he said.

Discussing possible treatment approaches targeting children, he mentioned building on work being done internationally in war torn communities as well as disaster relief work (first responders to communities impacted by hurricanes, tsunamis, and earthquakes). He also referenced a video clip that he shares at conferences and trainings working with a young male veteran named Ray. Potential interventions may involve a team approach on military bases with someone like Ray working as a link between therapists and “these guys from a very different culture.”


*Peter A. Levine, Ph.D. holds doctorate degrees in Medical Biophysics and in Psychology. He has received the Lifetime Achievement award from the United States Association for Body Psychotherapy (USABP), in recognition of his original and pioneering work in trauma. He also received an honorary award as the Reiss-Davis Chair for his lifetime contributions to infant and child psychiatry.

During his forty year study of stress and trauma, he has contributed to a variety of scientific and popular publications as well as authored and co-authored numerous books including the following:

• In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness by Dr. Peter A. Levine (2010)
Healing Trauma: A Pioneering Program for Restoring the Wisdom of your Body by Dr. Peter Levine Ph.D. (2008)
Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences by Dr. Peter Levine and Ann Frederick (1997)

Link to PDF of article