Trauma and the Body (2006, Norton) is the new must-read book. Pat Ogden, Kekuni Minton, Clare Pain (with one chapter by the Lanius siblings) have written a comprehensive book about using "bottom up" processing  to stabilize clients, clear trauma, and integrate people into healed lives. The book is readable, it incorporates all my favorite theories (with one major omission), and it tells you what to do.

The first 2/3’s of this 300 page book cover research and theory. They discuss the triune brain–evolutionary development of the reflexive lizard brain, cuddly/feeling mammal brain, and thinking human brain– and that too many therapies deal only with thoughts and emotions (top down processing). They overlay van der Hart’s Structural Dissociation theory with Porges’ Polyvagal research. (I thought I invented thinking of them together–I guess they did too.) They bring in all the best attachment research and explain it all more clearly than anyone else. I’m citing their elegant explanations of other theories all over my new book, because they explain them so well. In most cases they say it better than the originators of the theories.

Here’s the gist: When we get traumatized, it affects us on the reflexive (sensorimotor) level, the emotional/attachment level, and the cognitive/taking care of business level. Many trauma therapies try to deal with only the emotions and the cognitions. Sometimes that works. Often it doesn’t. The authors believe that in trauma treatment, directing attention to the body sensations; differentiating sensations from emotions; and keeping the attention on the sensations and yet-to-be-completed movement will clear the trauma and bring integration to the client. They talk about "dual process" the way that EMDR therapists talk about "dual attention". I think it’s the same thing. Just as Diana Fosha uses the therapeutic relationship as the dual attention stimulus, the Sensorimotor folks use the attention on the here-and-now body sensations. It works.

They follow the 3-phase model of therapy: Stabilize, Clear Trauma, Integrate. They show the use of sensorimotor therapy in each phase. They give case examples so that you know how they use it. If you have no background in this work, you’ll find some useful skills in the book, and you should go get some training. The book can’t give you the pacing and the exquisitely connected tracking that are essential parts of this work.

Why do I know this? Thom Negri and Peter Geiler cofounded the Institute of Movement Therapy (later the Institute of Transformational Movement) in late 70’s Seattle. Many of movement exercises and concepts in Sensorimotor work started long before then. I took movement classes for years. I learned to stand my ground, reach for what/who I wanted, and feel everything. I learned my physical boundaries and how to help my clients stand, ground, reach, feel, and know their boundaries. The bodily experience was an essential part in doing the work. Ogden, et al., bring two huge dimensions to the work. They slow it down, and bring in "dual process", having their clients notice each minute shift in sensation and involuntary movement, instead of the repeated catharses of the old movement therapy. And they emphasize the "coregulation" of the attached therapeutic relationship. I’ve seen videos of Ogden working. You’ve got to see the work to "get" it.

What didn’t I like? There wasn’t one mention of EMDR in the entire book. And EMDR brings in "bottom up" as well as "top down" processing, at the same time, and often works faster than Sensorimotor work. Many people are combining the two, to good avail. (I think that Ulrich Lanius’s chapter in the new book will be about that.) I like Sensorimotor therapy’s emphasis on the stabilization phase. That phase in EMDR says, "stabilize the client before you do the real work." I think the stabilization phase of Sensorimotor therapy would easily fit into Phases One and Two of the 8-phase EMDR model. I think that Ogden and company should have mentioned the overlap between their model and EMDR. They didn’t.

My second quibble is the same on I have about most therapy books. 200 pages of theory and 100 pages of how to do the therapy, which were also full of theory. I’d love to see 2/3 of any therapy book be about the therapy. Don’t justify! Show me!

Other than that, I think this book is valuable, especially to therapists who have never considered the body and "bottom up" processing as essential to good work.