Calatonia and Subtle Touch in the Healing of Trauma
This chapter addresses the application of Calatonia and Subtle Touch techniques (Farah, 2017; Sándor, 1982) in the healing of trauma. A definition and some background about the effects of trauma will be given first, followed by an exploration of the scientific rationale and specific principles for the application of Calatonia and Subtle Touch in the healing of trauma.
How Trauma Affects Us
Traumatic events can have a profound and shattering effect on our healthy functioning in life. Trauma is defined as any situation or event that is experienced as too overwhelming, out of control, threatening or dangerous to be able to be processed and worked through cohesively at the time. Under such circumstances our nervous system dysregulates, conscious awareness fragments and different aspects or parts of the Self are formed to enable us to survive the trauma (van der Hart, Nijenhuis, & Steele, 2006). This split consists of an aspect or several parts of the Self, that help us cope after a trauma to get on with everyday life as it presents itself and of other parts that store the emotional, physiological and sensory impressions of the trauma. This split happens automatically, and is governed by unconscious processes of our autonomic nervous system; thus, different parts are usually only partially and sometimes not at all aware of each other. This is referred to as dissociation. For example, the coping parts hold the masks or roles we present to the outside world, so that we appear to be functioning and apparently ‘normal’. These aspects are also referred to as the Apparently Normal Personality/ies or ANP/s (van der Hart et al., 2006). These protective aspects of the Self help us to adapt to what an environment requires us to do to ensure our survival. This enables ongoing survival in what might be an emotionally, physically or spiritually toxic environment under circumstances in which escape does not seem possible, for example, during early developmental stages.
The other aspects that hold the unprocessed emotional, physiological and sensory memories of the trauma, including the coping responses acquired during this event are referred to as Emotional Personalities (EPs; van der Hart et al., 2006). To regulate the potential emotional, physiological and sensory overwhelm held in the memory systems of the EPs, the ANP/s attempt/s to employ various strategies to organise life in a way that keeps these parts dissociated from our conscious awareness, by maintaining a so-called ‘dissociative barrier’. For example, the traumatic experience may not be fully remembered or may only be partially recalled; likewise, certain places or issues that might trigger painful memories might also be avoided.
Although these mechanisms have an adaptive survival-based function they carry with them high personal costs. They prevent a person from fully consciously experiencing themselves in life. Moreover, these strategies often do not work perfectly and situations in the here-and-now that may resemble aspects of the past traumatic experience can pierce through the dissociative barrier. This will trigger the EPs, causing distressing flashbacks, re-experiencing of fragments of the past experience and other uncomfortable symptoms.
How The Effects of Trauma Manifest Themselves
In clinical practice this means that clients who have experienced trauma often alternate between feeling numb or shutting off from their emotions and body sensations thereby struggling to regulate their feelings, which can result in uncontrollable emotional or sensory overwhelm. Frequently they are hypervigilant, anxious, frightened, easily terrified, under permanent tension and pressure and subsequently find it difficult to relax and let go.
A client’s window of tolerance (Ogden, Minton, & Pain, 2006; Siegel, 2010), which describes the zone or range in which clients can comfortably tolerate and regulate their emotions is often very narrow. This results in uncontrollable reactions of hyper- or hypo-arousal in response to perceived triggers relating to the past traumatic experience, making clients’ behaviour unpredictable thereby rendering their lives very uncomfortable.
Depending on the nature, severity, longevity, developmental age and resources available at the time of the trauma, clients will vary in their degree of dissociation. If clients have endured repeated, complex trauma they may experience themselves as multiple totally separate identities (DID), which may not be conscious of each other. These identities may carry completely different personalities with different body postures, facial expressions, voices, gender, taste, behaviour and life choic-es and even different physiological metabolisms. Memories of the traumatic events are very fragmented and often not acces-sible to the client. Clients may have a distorted sense of reality fluctuating between feeling under constant threat or danger and engaging in risk-taking behaviour, thus compromising their safety. They may find themselves doing things which they later cannot remember having done. Difficulties in concentrating and focussing on tasks is frequently a problem and general memory can be impaired.
How Therapy Can Facilitate Trauma Recovery
The aim of trauma therapy is to enable clients to become increasingly conscious of the traumatic nature and content of their past experiences so that gradually they will be able to remember and process their traumatic experiences in the safety of the ‘here-and-now’. This will enable the overwhelming feelings and frozen terror (numbness), as well as unhelpful survival-based coping strategies, acquired by the traumatised parts to loosen their hold. Previously fragmented or inaccessible memories can be processed and, as a consequence, the gradual integration of the various parts of one’s identity into a cohesive, whole Self can be achieved. This work is a deeply spiritual, transformational healing process in which clients are facilitated into climbing out of the abyss of their own terror into finding and (re-) discovering their unique, authentic Self, which becomes the healer of the traumatised parts. It is a deep honour for every trauma therapist to be able to bear witness to such a sacred process. Indeed, Peter Levine (2005) referred to the process of trauma healing as one of the four routes by which enlightenment can be attained. The other routes being death, sacred sexuality (tantra) and meditation.
The Challenges of Overcoming Survival-Based Coping Strategies
Talking therapy may, to a certain extent, be helpful to a person in understanding their life experiences, the context and nature of their trauma, their underlying coping patterns and the way in which they may have had to dissociate from their unique, authentic Self for survival reasons. However, in order to enable a person to fundamentally shift and transform some of the deeply embedded, trauma-based survival patterns into a pathway for positive growth it requires a much deeper, integrative and holistic approach (Herbert, in preparation). One of the therapeutic challenges is that many of these survival-based coping strategies are controlled by the autonomic nervous system and in the context of the past, traumatic experiences were stored as functionally adaptive by the intricate memory systems of body, mind and Soul. This explains why clients may logically know that their survival-based coping behaviour may no longer serve them in the context of their here-and-now life, but despite this, when triggered, feel out of control and powerless to change this, despite their best intentions. The reason for this is that autonomic processes, especially, when they form part of different dissociated aspects of the Self, cannot be controlled by the rational mind because they are governed by different neurophysiological pathways (Corrigan, 2014; Lanius, Corrigan, & Paulsen, 2014) from the rational, logical mind system.
For example, one of my clients, Rebecca (whose name has been changed to preserve her anonymity), a lady in her 40’s who was sexually abused over a prolonged period of time during her childhood and adolescence coped by blocking out her pain and distress with alcohol. She had been struggling with alcohol addiction all of her adult life, despite knowing that it was harmful to her, when she came to me wanting to stop it. Cognitively she fully embraced her intention to stop drinking and could keep this up, until an unexpected trigger in her day-to-day life brought her back to the distressing traumatic experiences. At that point a different part of her took over, governed by autonomic responses and she could not prevent herself from numbing herself to oblivion with alcohol. This had been a neverending cycle despite her attending established alcohol support groups and several forms of other therapy in the past, including trauma-focussed CBT, EMDR and psychodynamic therapy.
This raises the question as to what might help clients transcend those challenges and transform their unconscious, autonomic responses into conscious choices that can be maintained. Essentially, it requires the ‘re-wiring’ of the underlying pathways that generate the autonomic, survival-based responses, into a system that allows for the realistic appraisal of each here-and-now situation so that appropriate, healthy choices of behaviour, can be made. This proposal of ‘re-wiring’ is based on the understanding that trauma is maintained through complex electrochemical processes, which are set in motion on a neurobiological level by specific structures of the limbic system in our midbrain region. These include the Thalamus, Amygdala, Hippocampus, Hypothalamus, Periaqueductal Gray (PAG) and others, which respond to a trauma client’s external and internal environment in a manner that interprets information as dangerous and unsafe, which in the here-and-now, would be safe to engage in (Herbert, 2017). Thus, essentially, trauma is maintained by a complex, autonomic, neurophysiological signalling system that operates on information from the past, which no longer accurately applies to the here-and-now reality. Therefore, this process of ‘re-wiring’ requires sending novel information to this autonomic signalling system that enables it to experience moments of calm rather than re-triggering the hyper- or hypo-arousal responses.
EMDR (Eye Movement Desensitization and Reprocessing; Shapiro, 1989; Shapiro & Forrest, 2016) therapy as well as TF- CBT (Trauma-Focussed Cognitive Behavioural Therapy; Cohen, Mannarino, & Deblinger, 2006) have been found to be very effective therapies for PTSD (Post-Traumatic Stress Disorder; Seidler & Wagner, 2006). Both are recommended, as the treatment of choice for PTSD by the National Institute for Clinical Excellence in the United Kingdom (NICE, 2005) and the World Health Or-ganisation (WHO, 2013). However, for severely traumatised clients, who can be hypersensitive, both the standard EMDR pro-tocol and TF-CBT need to be especially adapted. Generally, it is agreed that work with survivors of childhood abuse and other forms of chronic traumatisation should be phase-oriented, multimodal, and titrated (Korn, 2009).
The Therapeutic Role of Calatonia and Subtle Touch
This is where Calatonia and Subtle Touch (Sándor, 1982; Farah, 2017) can be brought in as therapeutic methods to support and aid in the healing of trauma. I have now been using Calatonia and Subtle Touch techniques for more than 9 years and many of my clients have found it very helpful as part of their trauma healing journey.
Although Calatonia and Subtle Touch have not yet been scientifically evaluated, findings of several recent research studies might lend a scientific rationale as to why Calatonia and Subtle Touch might have a helpful role in the healing of trauma. Two different nerve receptor systems for touch have been detected. There are the so-called myelinated nerves (LTMs, low-threshold mechanoreceptors) that register touch to the skin. These have an immediate discriminative function, helping to assess the nature of touch so that it can be responded to promptly and appropriately by a person. This system relays our day-to-day touch experiences, for example, if we brush against a piece of furniture and need to adjust our distance this has obvious advantages to our survival. However, there is also another privileged peripheral nerve pathway, a system of so-called C-tactile afferents, which responds to gentle, pleasant tactile stimulation of a social nature (Loeken, Wessberg, Morri-son, McGlone, & Olausson, 2009). This nerve system has a very different function (McGlone, Wessberg, & Olausson, 2014). C- tactile afferents are most excited by stroking velocities which resemble the type of slow, tender touch which a mother or father would use to stroke a baby (3cm per second on the skin). It has been found that gentle touch decreases stress activated cortisol production allowing for increased cell development in the hippocampus, positively impacting on short-term and long-term memory function (Miles, Cowan, Glover, Stevenson, & Modi, 2006).
Gentle stroking touch has also been shown to lower blood pressure (Knox & Uvnäs-Moberg, 1998) and increase pain thresholds (Olausson et al., 2008). On a neurobiological level there is evidence that oxytocin, opioids, serotonin and dopamine are released in response to this gentle touch, as expressed via stimulation of CT afferents, leading to a sense of increased psychological well-being, happiness and calm. Interestingly, McGlone and colleagues (2014) have suggested that, in a wider perspective, the CTs may be regarded as an afferent system that is basically concerned with the representation of the Self, rather than being focussed on external events. This would lend support to the reason why Calatonia and Subtle Touch methods might enable clients to experience an inner connection to the Self, which feels pleasant and safe; thus, they do not re-trigger the autonomically-wired trauma-maintaining looping system. We could hypothesise that this may, with continued and repeated use of Calatonia and Subtle Touch, over time, lead to the emergence of new physiological response modes in a client and potential rewiring or weakening of the previously inscribed autonomic trauma-response loops. Another rationale for the application of Subtle Touch techniques as part of specialist trauma therapy relates to the brain activity in traumatised clients.
While trauma has not been processed and integrated, clients frequently find themselves in repeated states of hyper-alertness in response to perceived threat triggers which have been found to activate high frequency Gamma Brain Waves (oscillating up to 100Hz). This leads to the chemical release of excitatory neurotransmitters, such as cortisol, noradrenaline, glutamate and others, putting strain on a person’s heart rate, blood pressure, immune system and other metabolic functions. These stress hormones have been proposed to cause glutamate receptors, called AMPA receptors, to become activated on the postsynaptic surface of the lateral amygdala, and due to the chemical environment created by these neurotransmitters, phosphorylates them, which permanently anchors them into place and fixes the content from the trauma as memory in the hippocampus for future reference (Ruden, 2011). These activated AMPA receptors are proposed to be contributing to the ongoing activation of the Amygdala and other limbic structures, keeping a traumatised person locked in their stressful hyperarousal loop. In contrast, soothing strokes and slow, light, gentle touch have been found to induce Delta brain waves (4-8Hz), leading to a meditative, slightly drowsy, sleepy state (Kim et al., 2007). Delta brain waves are also associated with Stage 3 and 4 of our sleep phases and have been linked to the release of calming neurotransmitters, such as Serotonin, GABA (Gamma Aminobutyric Acid) and Oxytocin. The release of these calming neurotransmitters has a positive, restorative and pleasurable effect on a person. Moreover, it has been proposed (Clem & Huganir, 2010; Kim et al., 2007) that these calming neurotransmitters create a calcium rich environment which enables the production of an enzyme that enables the depotentiation of these activated AMPA receptors in the lateral Amygdala; thus stopping the stressful hyperarousal loop. According to this hypothesis, soothing touch can be used for the de-coding of trauma, as also utilised in the Havening Technique (Ruden, 2011). Although more specific research is required for Calatonia and Subtle Touch, it might be proposed that any therapeutic method that enables a client to experience a subjectively felt alternative to their survival-driven autonomic responses, warrants genuine consideration in the treatment of trauma.
The Importance of Strong Trust Between Client and Therapist
With clients suffering from complex developmental trauma certain aspects need to be considered when using Calatonia and Subtle Touch. Firstly, many clients have had past experiences of either aversive touch or total isolation and abandonment (no touch) or both, which will have had detrimental effects on them. The prospect of touch for these clients is therefore frequently a traumatic trigger in itself, which will take them out of their window of tolerance into either a hyper- or hypo-arousal loop. Therapeutic touch in trauma must be approached very carefully and it is a matter of appropriate timing as to when this can be safely introduced. I have worked with some very complex trauma clients whom it has taken several years of in-depth, specialist trauma therapy (Herbert, 2019), which predominantly focussed on intense safety-building, grounding, stabilisation, resourcing, attachment repair and also, their getting to know their internal organising system, before they were able to contemplate the possibility of any form of touch.
It requires comprehensive, ongoing assessment by the treating trauma therapist before deciding whether touch may be appropriate and in what manner it could most helpfully be introduced that would not re-trigger past trauma memories or negative arousal loops in a client. This is of utmost importance because, unless the administration of Calatonia and Subtle Touch feels safe for a client, it will become yet another trigger, and will not achieve its desired effect of re-wiring previously acquired, (and now unhelpful), response loops. Sometimes, when Calatonia is tried and a client does not yet seem to feel comfortable with this form of touch, it is far better to honour and validate this client’s feelings at that point rather than push on. This way, trust can be established, and therefore it is possible to come back to Calatonia at a later stage in therapy when the client may feel ready.
Secondly, it is very important for the trauma therapist to be familiar with and recognise dissociative responses in their clients and carefully assess when and how these might operate in each of their clients. For example, clients who were physically and/or sexually abused as children, often had to acquire complex dissociative response structures for their survival, that enabled them to be compliant with their perpetrator (frequently a parent, close family member or friend of the family) in order to survive or receive any form of attention or what was perceived as love. They may have had to allow themselves to be touched and maybe even show some form of pleasure, depending on the nature of their traumatic circumstances. These clients may host several different dissociated personality parts, some that took on the role of allowing themselves to be touched and be compliant with the perpetrator; other parts that felt terrified of being touched and other parts that hated and detested being touched. When working with such clients, it is important that their internal organising system is explored, and the personality parts made conscious to both the client and therapist before any work with direct touch is attempted. It is important to remember in this context that the trauma memories and response patterns which the different personality parts hold are timeless and encoded in their original context. This means that these dissociated parts (although now personality parts of the client in an adult body) are still holding the emotional and sensual information of how it felt to them at the time of the abuse (which is likely to have been when they were in a much younger body). Once the internal organising system has been understood (which can take many months or years of specialist trauma therapy) it is important to involve the relevant parts in determining and controlling how they want to be touched and where, in order to provide a safe, healing touch experience.
Release and Rescripting of Past Patterns
This, together with other specific trauma processing techniques, can enable the release and rescripting of past encoded patterns. It cannot be stressed enough that touch must always be administered in a way that feels safe to the client now. An essential part of trauma therapy includes a collaborative working relationship between therapist and client. One which feels solid and empowering enough for clients to be able to express and share their needs with their therapist and for therapists to feel grounded and centred within themselves to be able to hear and deeply attune to their clients’ needs and maintain safe and healthy boundaries. Even for clients who have experienced less complex trauma it is important for the therapist to have an awareness of possible dissociative responses in the client when considering introducing and administering Calatonia and Subtle Touch. Indicators for dissociation, may be, for example, changes in breathing pattern, voice, eye movement, tracking and gaze; agitation; restlessness; changes in body posture; changes in muscle tone; repetitive micro movement patterns; spacing out; numbing in particular parts of the body and many others. Such reactions need to be addressed by the therapist and mutual exploration of the potential trigger/s and stabilisation techniques, to enable the client to re-ground and come back into their window of tolerance. If the client is already familiar with Calatonia or Subtle Touch, elements of this could be included as part of the stabilisation and grounding process.
Thirdly, the timing as to when and how Calatonia and Subtle Touch may be used as part of trauma therapy needs to be carefully tailored to each client’s individual needs. As a broad observation I have found that the more complex and severe the trauma and the more fragmented the client’s personality, the longer it will take until the application of Calatonia and Subtle Touch will feel safe enough to be helpful for a client. I have observed that once trauma clients are able to receive touch that Calatonia is often a very helpful first step into touch experiences. One of the benefits of Calatonia is that it follows a prescribed set of movements which over time becomes predictable to clients.
This can feel very reassuring and containing, especially to clients for whom touch has been very unsafe and unpredictable in the past. For many clients when their feet are touched this may not hold as many triggers as if they were touched on another part of their body. However, this cannot be assumed and must be gently explored with each client. For example, one of my clients, Victoria (whose name has been changed to preserve her anonymity), who suffered DID (Dissociative Identity Disorder) as a consequence of severe institutional abuse, was unable to tolerate any form of touch. After several years of specialist trauma therapy, this client allowed me to show her the sequence of Calatonia touches first on one of my hands. She then tried out this sequence on one of her own hands. Gradually, this client was able, under her own control, to allow me to touch both of her hands, later her feet and eventually, became very comfortable with lying down fully clothed, but with her socks off, on top of a massage couch, enjoying the whole Calatonia sequence, including on her head. She also frequently reported seeing colours, hearing sounds, and feeling that she was being helped by a divine presence, all of which she experienced as very soothing, deeply relaxing and healing.
Touch in Calatonia is performed in such a subtle, light and consciously attuned manner that most clients have not been able to experience such quality of touch ever in their life before. Clients are often surprised at how deeply relaxing and nourishing Calatonia feels once they are able to allow themselves to experience it. I tend to meet with many of my trauma clients for a 2-hour long treatment session (Herbert, 2006) and have found it helpful for most of my clients to weave Calatonia into the latter part of their trauma treatment session on a regular basis. Calatonia seems to beautifully complement and integrate the more active trauma processing methods (such as EMDR, TF-CBT, Havening technique (Ruden, 2011) or Comprehensive Resource Model (CRM; Schwarz & Corrigan, 2016), imagery re-scripting, and/or shadow-transformation work) which, with many of my clients, will take place in the earlier parts of their treatment session. Once clients are comfortable with receiving Calatonia, I may also use it at the beginning of a trauma treatment session to help ground, resource and stabilise a dysregulated client in order to facilitate other subsequent work during that session.
Subtle Touch techniques can be introduced once a trauma client feels safe and familiar with Calatonia and comfortable about being touched by their therapist. It can then be used to work on particular areas of the body where the energy is blocked thereby preventing clients from “feeling” themselves. Subtle Touch techniques can be used to clear blocks in the physical as well as in the energy bodies (subtle body) of a client and it can be helpful for grounding, stabilising and self-regulation. Applying Calatonia and Subtle Touch to the healing of trauma requires the trauma therapist to carefully attune to the therapeutic process and to the client’s needs at all times. Comprehensive training in and experience of working with trauma are equally necessary. In order to meet clients at this level of skill, therapists will have needed to have undergone their own trauma healing work, including body-focussed therapy.
Establishing New Connections in The Central Nervous System
In summary, working with trauma is complex and requires the gradual processing of adverse past experiences and the eventual integration of aspects or parts of the Self that have been dissociated in order to ensure survival at the time. Such integration can only happen if different internal and external conditions in a client’s body and mind, as well as, in the actual reality of their here-and-now life are created. It is proposed that Calatonia and Subtle Touch, if skilfully and correctly applied with trauma clients, can be very helpful in the healing of trauma. I have used Calatonia and Subtle Touch across the whole spectrum of traumatic experiences, from very early and prolonged developmental abuse trauma, including with clients who have suffered from Dissociative Identity Disorder (DID), as well as, multiple and single incident traumas. It requires skilful tailoring and interweaving of these approaches into each client’s individual process of trauma therapy. Without thorough scientific investigation, it is difficult to discern which specific aspects of trauma therapy have led to the healing in a client and what part Calatonia and Subtle Touch have played in this. However, clinical observation suggests that Calatonia and Subtle Touch are able to induce a depth and level of relaxation, which many trauma clients have not been able to access before. This would suggest that on a neurophysiological level, Calatonia and Subtle Touch enable the body to establish new connections in the central nervous system which counteract the psychophysiological symptoms of stress, tension or trauma-related hyperarousal. This neural integration should lead to a broadening of a client’s window of tolerance and emotional comfort zone. Clinical observation suggests that clients become more receptive to trauma processing, as they are learning to self-regulate and are less easily triggered by reminders of their trauma. Calatonia and Subtle Touch seem to be able to down-regulate clients’ brain wave activities and enable clients to access feelings of positivity, calm, wellbeing and internal balance. Some of my clients have been able to enter into deep transcendent states of bliss during their Calatonia session, during which they report seeing colours, images or feeling sensations, which usually have a very peaceful, restorative and calming effect on them.
While more specific, targeted research is needed, clinical experience suggests that the integration of Calatonia and Subtle Touch into specialist trauma therapy can play an important role in bridging the gap between body- and mind-oriented approaches. Thus, supporting and enabling a deep and profound trauma healing process which works towards the eventual embodiment of a person’s authentic Self.
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