University of St. Thomas, Minnesota St. Catherine University Social Work Master’s Clinical Research Papers School of Social Work 2017 The Body Recovers: Practitioner Perspective on Somatic Experiencing Saoirse McMahon University of St. Thomas, Minnesota, saoirse.com Follow this and additional works at: https://ir.edu/ssw_mstrp Part of the Clinical and Medical Social Work Commons, and the Social Work Commons Recommended Citation McMahon, Saoirse, "The Body Recovers: Practitioner Perspective on Somatic Experiencing" (2017).
Social Work Master’s Clinical Research Papers.edu/ssw_mstrp/765 This Clinical research paper is brought to you for free and open access by the School of Social Work at UST Research Online. It has been accepted for inclusion in Social Work Master’s Clinical Research Papers by an authorized administrator of UST Research Online. For more information, please contact libroadmin@stthomas. Running head: PRACTITIONER PERSPECTIVES ON SOMATIC EXPERIENCING The Body Recovers: Practitioner Perspective on Somatic Experiencing by Saoirse M.
MSW Clinical Research Paper Presented to the Faculty of the School of Social Work St. Catherine University and the University of St. Paul, Minnesota In Partial fulfillment of the Requirements for the Degree of Master of Social Work Committee Members Renee Hepperlen, Ph., AM, LICSW (Chair) Mark Olson, MSW, LICSW, SEP Joyce Arendt, MSW, LICSW, RPT-S, SEP The Clinical Research Project is a graduation requirement for MSW students at St. Catherine University – University of St.
Thomas School of Social Work in St. Paul, Minnesota and is conducted within a nine-month time frame to demonstrate facility with basic social research methods. Students must independently conceptualize a research problem, formulate a research design that is approved by a research committee and the university Institutional Review Board, implement the project, and publicly present the findings of the study. This project is neither a Master’s thesis nor a dissertation.
2 PRACTITIONER PERSPECTIVES ON SOMATIC EXPERIENCING Abstract Most individuals are exposed to a traumatic event in their lifetime, but not all go on to develop post-traumatic stress disorder (PTSD). PTSD is characterized by symptoms of intrusion and avoidance of stimuli related to the traumatic event, as well as dissociation. PTSD has been linked to a number of somatic syndromes including chronic fatigue syndrome (CFS), chronic lower back pain, hypertension, and hypothalamic-pituitary adrenal (HPA) axis dysfunction resulting in hormonal imbalance. Several evidence-based interventions for PTSD exist, including prolonged exposure therapy (PE), eye-movement desensitization and reprocessing (EMDR), and cognitive processing therapy (CPT), however many of these approaches address trauma using components of exposure or are not well-researched in addressing somatic symptoms related to trauma.
Somatic Experiencing (SE) is an emerging intervention conceptually framed by the “bottom-up” processing theory. SE has been demonstrated to improve PTSD symptoms in early intervention studies across a variety of contexts and diverse populations, however research on SE is limited and the literature on SE is concentrated primarily in the theoretical realm. No prior studies have explored practitioner’s perspectives on how SE benefits trauma survivors and which clients are best suited for SE. This study explores this question through qualitative interviews with three practitioners in a Midwestern metro area.
A common theme of practitioner-client fit emerged in the data, as well as four main subthemes: (1) conceptualization of trauma, (2) psychoeducation of the Somatic Experiencing approach, (3) clients who do not benefit from Somatic Experiencing, and (4) self-awareness. Implications are discussed as well as gaps and suggestions for future research. Key words: somatic experiencing, bottom-up theory, post-traumatic stress disorder, somatic interventions 3 PRACTITIONER PERSPECTIVES ON SOMATIC EXPERIENCING Acknowledgments Tremendous gratitude and appreciation is owed to many individuals who helped make the completion of this clinical research paper and graduation possible. Thank you to my chair, Renee Hepperlen, who was flexible and gave me helpful guidance through the course of this research project.
Thank you to my committee members, Mark Olson and Joyce Arendt, who I was lucky to have, as they are experts and leaders in the SE field and provided me with immensely helpful books on SE which guided my research. I would also like to dedicate this paper in memory of Mark Albert DiCastri, who passed away recently. Mark drove me to my interviews, encouraged me to pursue graduate school, and was my best friend and biggest supporter who stood by me for the six wonderful years of our close relationship. He will always be remembered.
Thank you to Mark’s daughter, Aurora, who, just like her father, inspires me to find joy in life, work hard, and look at things from a different perspective. I would like to also thank Mark’s parents, Kevin and Mavis, and brother Brad, as well as Laura Houlding, Dawn Kuzma, and Alex Houlding, who have been a family to me and have shown me love and support in times of hardship for all of us. I am very grateful to have two very supportive, witty, and smart little sisters, Chantal and Siobhan, who I have always hoped to set a good example for and am very proud of. Thank you to my parents, as well as my late grandfather Patrick, who valued education and enrolled our family in the Visa lottery to immigrate from Ireland so that our family could see a better life in America.
This has allowed me to have the opportunity and privilege of pursuing the first American undergraduate degree in our family and now the first Master’s degree. Thank you to the faculty at St. Catherine University – University of St. Thomas for supporting me in pursuing this dream.
Thank you to my aunt Deborah whose intelligence and pursuit of a law degree inspired me to further my education. I would also like to thank my granny Mary, who is a pillar of strength, a pool of wisdom, and the glue that holds our family together. Thanks to all my other family members: uncles, aunts, and cousins, abroad in Ireland and France. I want to send a warm thanks to Kat Bernhoft, who inspired me to become a clinical social worker and supported me along the way.
Thank you to my close friend and roommate, Elizabeth Wegman, and Amanda Schaller, who has been a constant support, as well as Julia Schwartz and family, Nick Gunn, Frankie Barth, Liz Casey, and Tylor Firouzi. Thanks for the helpful consultation and genuine support from my IPC crew: Susanne Desmond, Scott Grandt, Lisa Holliday, Lynn Whitfield, Britt Were, and the best clinical supervisors I could have asked for this year, Theresa McPartlin and George Baboila, as well as my fantastic field instructor, Jane Hurley Johncox, who I am continually inspired by. And thank to all my past, present, and future clients who I learn from as much as they learn from me, and who show me the strength of human resiliency and spirit in the face of great challenges. 4 PRACTITIONER PERSPECTIVES ON SOMATIC EXPERIENCING Table of Contents Introduction and Purpose Statement .5 Literature Review and Research Question.8 Conceptual Model: Bottom-Up Framework .45 Appendix A: Consent Form .53 Appendix B: Interview Questions.57 Appendix C: Recruitment Email.59 5 PRACTITIONER PERSPECTIVES ON SOMATIC EXPERIENCING The Body Recovers: Practitioner Perspective on Somatic Experiencing Practitioners are increasingly incorporating somatic therapy techniques as interventions to address symptoms of trauma as researchers gain knowledge in the underlying neurological effects of trauma on the autonomic nervous system, including somatic symptoms.
Somatic Experiencing (SE) is an emerging trauma intervention that addresses the immediate effects of trauma on the nervous system by utilizing body-oriented introspection. Practitioners use this technique as an early intervention to address the effects of acute traumatic events such as natural disasters, and more recently the intervention had been implicated as a treatment for military sexual trauma. Utilizing qualitative interviews, the researcher will explore in more depth the ways in which Somatic Experiencing (SE) practitioners describe the process of addressing symptoms of trauma, which clients are best suited for Somatic Experiencing, and the manner in which this intervention alleviates symptoms of trauma. Many people experience traumatic events in their lifetime, but not all develop post- traumatic stress disorder (PTSD) as a result.
Trauma is defined as exposure or threat of death or serious injury or sexual violence that is directly experienced or witnessed by a close friend or family member, or through repeatedly being exposed to details of the trauma in the case of first responders or those working professional who are exposed to secondary trauma (American Psychiatric Association, 2013). Examples of traumatic events include chronic developmental trauma such as physical, sexual, psychological childhood abuse or neglect; mass interpersonal violence such as wars or mass casualties; natural disasters; accidents; rape and sexual assault; stranger physical assault; intimate partner violence; sex trafficking; torture; witnessing or being confronted with the homicide or suicide of another person; life-threatening medical conditions; and emergency 6 PRACTITIONER PERSPECTIVES ON SOMATIC EXPERIENCING workers exposed to various traumatic events (Briere & Scott, 2015). Individuals who are at higher risk for developing PTSD are members of marginalized groups such as women, younger or older individuals, African Americans and Hispanics, lower socioeconomic status, those with a personal or family history of a psychological disorder, those will less functional coping skills, individuals from a dysfunctional family, previous history of trauma, hyperactive or dysfunctional nervous system, or have a genetic predisposition (Briere & Scott, 2015, p. A significant predictor of the development of PTSD is distress during or after the trauma including feelings or horror or helplessness during or after the event (Briere & Scott, 2015).
Dissociation, which is a feeling of disconnection from surroundings or one’s own body, including features of derealization and depersonalization, at the time of trauma and after, is also a significant risk factor for developing PTSD (Briere & Scott, 2015). It is estimated that 8.3 percent of Americans meet the Diagnostic and Statistical Manual of Mental Disorder’s criteria for PTSD (American Psychiatric Association, 2013), at some point in their lifetime (Kilpatrick et al. PTSD is characterized by experienced or being exposed to a traumatic event and clusters of symptoms including intrusive symptoms associated with the trauma, “persistent avoidance of stimuli associated with the traumatic event(s),” and a shift in mood characterized by “negative alterations in cognitions and mood associated with the traumatic event,” (American Psychiatric Association, 2013). An additional feature of PTSD is irritability, emotional reactivity, or emotional arousal, as well as dissociative symptoms including derealization and depersonalization, or feeling outside of the body and a feeling of being disconnected form surroundings (American Psychiatric Association, 2013).
Current evidence-based interventions targeting symptoms of PTSD include prolonged exposure (PE) therapy, eye-movement desensitization and reprocessing (EMDR), and cognitive 7 PRACTITIONER PERSPECTIVES ON SOMATIC EXPERIENCING processing therapy (CPT) (Acarturk et al., 2016; Briere & Scott, 2015; Farmer, Mitchell, Parker- Guilbert, & Galovski, 2017; McLay, et al., 2016; Zandberg, Porter, & Foa, 2017). Additional emerging interventions for PTSD that are more focused on “bottom-up” processing than evidence-based interventions include sensorimotor psychotherapy, acupuncture, and yoga (Feinstein & Church, 2010; Langmuir, Kirsh, & Classen, 2012; Ogden, Minton, & Pain, 2000). Somatic Experiencing is an emerging “bottom-up” intervention for trauma, which aims to regulate the nervous system’s response to trauma, and has been found significantly effective in reducing symptoms of trauma, and has been implicated as a long-term trauma treatment as well (Leitch, 2007; Leitch, Vanslyke & Allen, 2009; Levine, 2010; Parker, Doctor & Selvam, 2008). The following research paper explores research in the area of trauma intervention, somatic symptoms of trauma, as well as previous studies exploring the efficacy of somatic interventions including Somatic Experiencing.
A qualitative study on Somatic Experiencing practitioners in a Midwestern metro area is outlined, including the identified main themes of the interviews, followed by the results and implications of the study. 8 PRACTITIONER PERSPECTIVES ON SOMATIC EXPERIENCING Literature Review and Research Question The field of clinical social work is increasingly becoming awakened by the idea that emotions, cognitions, and the physical body cannot be separated when considering the neurological effects of trauma on the body, just as the person cannot be separated from the impact of their social environment.