This month, I am adding coaching sessions to my menu of offerings for clients in any kind of pain, be it physical, mental, or emotional (hint: I think they’re related). After three years of continuous studies in trauma-informed counseling, I’m ready to see clients by Zoom as another way, in addition to offering bodywork, to be of help.
I’m especially interested in working with chronic pain, but any limitation you’d like to explore is welcome. As I am not a licensed psychotherapist, I do not work with those who are in danger or extreme states, nor do I advise anyone on changes in medication. My ideal clients are functioning people who want to understand themselves better and suffer less.
In this blog, I’ll talk about my learning journey on how our thoughts, emotions, and physical sensations all influence each other, as well as what to expect if you see me for Mind/Body Wellness Coaching. It’s been a long process that is ongoing, and it started in a yoga class…
MY YEAR OF SCIATICA
In March of 2000, I took a class that was a bit beyond my capacities. In trying to keep up, I awkwardly attempted some jump-backs, and by the time I got home, my low back was “out.” I’d had occasional backaches before, and I assumed it would be gone the next day. It wasn’t.
Weeks turned into months, and I found myself with a terrible case of sciatica. I wasn’t yet a bodyworker then, I had a 9-5 office job, and didn’t know much about how to make it better, aside from heat and stretching. Some days I had to call in sick; sometimes walking down the street I would suddenly be stabbed in the butt with a hot knife – that’s what sciatica feels like – and one time it even made me fall to my knees.
That summer, I saw an acupuncturist. I went in with the usual nagging pain, and walked out utterly free of it, feeling “myself” for the first time in months. A miracle! As I walked the two or three blocks to the subway, I was chagrined to feel twinges returning, and by the time I reached the train it was totally back, as bad as ever. The whole thing was a mystery: how did it go away immediately? Why did it come back so quickly?
Long before I “hurt” my back (more on the quotes later), I had arranged a three-month leave from my job in the fall/winter, a trip to Kalani Honua, a rustic rainforest eco-camp on the Big Island of Hawaii where I was going to volunteer as a kitchen worker and, the plan was, take lots of yoga classes. I did go, in spite of the back pain, and it was wonderful, in spite of the back pain. If I moved carefully, I could enjoy long walks up the Red Road overlooking the sea, but yoga was impossible.
One morning I woke up in the dark feeling shaken and extra-tense, but I hobbled over the dewy grass to the kitchen for breakfast duty anyway. Working proved impossible, and I was sent back to my room. My back stiffened up more and more as a wave of pain, fear, and muscle contraction flowed inexorably over my body like Pele’s lava, until I felt it in my arms, my hands, my neck, my legs. Two friends who were studying Hawaiian healing saw my fingers contracted into claws. They carried me down to their car and drove me into Hilo to see their teacher, the kapuna (Hawaiian elder) known as Papa K. Papa K put me on a massage table and did lomilomi for hours, calling in another healer, a beautiful soul named Auntie Mary. They chanted over me, their hands gently grasping my contracted limbs. The contractions grew worse and worse, even my cheek muscles pulled back into a grimace. The pain was terrible, a full-body charley horse that went on for hours. It felt like a possession. Slowly I grew calmer, better, and Papa K took me to stay with him in Hilo for a couple of nights, and we became good friends. He spoke Hawaiian in his sleep, talking, as he said, with his deceased grandfather, who had been his teacher. After that the sciatica was better, but not healed. I never managed to be able to sit on the floor for a yoga class. Neither did I find out what had caused that “possession.” Some say the Big Island pushes you to deal with your issues, especially base chakra stuff.
I was still in pain when I returned to New York, and I continued to try different approaches and therapies, to no avail. In early spring 2001 I read the book Healing Back Pain by Dr. John Sarno. An orthopedic surgeon, he believed most back pain was due entirely to muscle tension, rather than disc anomalies, pinched nerves, or other pathological explanations. In his view, we distract ourselves from emotional pain by creating physical pain, the latter being more socially acceptable. He’s not saying the pain is “all in our head,” it comes about through a physical mechanism. When we (unconsciously) “armor up” against stress by holding muscles chronically contracted – the neck, shoulders, jaws, hips, stomach, diaphragm, etc. – this tightness cuts off fluid exchange in our muscle tissue, the flushing-out of lymphatic waste and deoxygenated blood, and the pumping-in of fresh lymph and oxygenated blood. When the tissue is deprived of these fluids, the mind sends a pain signal to let you know there is danger. As a cured sufferer and a massage therapist, I agree with Dr. Sarno: most chronic (ongoing) body pain is not caused by structural damage, and can be alleviated by simply relaxing the muscles we’ve been unknowingly holding tense, probably for years, until the pain hits us like a scream of anguish. We often hear of someone’s back “going out” when all they did was reach for a car door handle or swing a golf club – or in my case, doing jump-backs without enough strength (combined with insecurity, trying to keep up with younger, fitter classmates) – but those ordinary movements didn’t create the chronic pain or even cause an injury, that was just the moment years of tension reached critical mass.
Like many others have reported, merely reading Sarno’s book healed my back pain. Bringing awareness to the tension allowed me to consciously release it, and when I did so, the pain was gone instantly. The practice thereafter was to remember that my habit was to hold my gluteal muscles contracted, and to notice when it happened again. Until relaxed muscles became my new normal, I would catch myself tensing up dozens of times a day, like, “Oops, I’m doing it again,” and again, I would let it go. When sometimes just intending to release didn’t fully work, I would imagine a tightly coiled spring unwinding, and that helped. To this day, if I get an occasional twinge, I just remind myself to let go, and I’ve been 99% free of back pain for over twenty years now. I can’t say I definitely found what exact emotions I was suppressing. I do remember being a preteen and feeling menaced when men looked at my hips. That could have been a factor in my unconscious “decision” to keep my hips straight and tight, more boy-like, not “girly.” Relatedly, I found that if I walked down the street allowing a full, wide swing of the hips side to side, everything felt better.
Anything that relaxes muscles helps with pain: bodywork, heat, vibration, exercise, magnesium, drugs, alcohol, going on vacation, sex – you name it. The question is, as with my acupuncture session, does it come back? If it does, what’s going on inside us that keeps our muscles “armored” without our consent or, often, knowledge?
COMPASSIONATE INQUIRY (CI)
I first learned about the work of Dr. Gabor Maté in 2012. As I was finishing massage school, I wrote a paper on PTSD, and for that I read his book When the Body Says No as well as others by Peter Levine and Bessel van der Kolk, all still leading lights in trauma studies. After that I read everything Dr. Maté wrote as it came out; his perspective on wellness resonated with me. As a massage therapist, I can probably help you with today’s pain, but even more, I’d like to help you with the roots of the pain so it doesn’t have to keep recurring. In 2020 I was unable to practice massage for six months due to the pandemic, and I wondered if there was another way to work and be of help to my clients when personal contact was not possible. I learned that Dr. Maté was offering a yearlong 240-hour online training in his approach to talk therapy, Compassionate Inquiry, open to any kind of therapist, including massage therapists like me, and I applied and got in. I’d had a few talk sessions over the years, and while it was satisfying to get things off my chest, I didn’t have a good grasp of what the end goal of therapy was. As I made my way through the CI course, I felt I got it, or got something that made sense to me.
A Canadian medical doctor, Maté developed his own style of therapeutic dialog while working in Vancouver’s Downtown Eastside, a neighborhood with a large homeless and addicted population. He saw that his patients needed counseling in addition to medical care, and began to set aside time for it, developing a non-pathologizing approach to mood and behavior dysfunctions. He’s especially known for his work with addiction, put forth in his book In the Realm of Hungry Ghosts. Here’s how he defines addiction: 1) someone craves a substance or behavior and 2) they engage in it in order to experience pleasure and/or temporary relief from pain but 3) in other ways it is harmful and 4) they are unable to stop. Before we can address the harmful aspects of the addiction, we want to inquire into it, with a conversation like the following: What does it do for you? Relieves the unbearable pain you’re in otherwise? Makes you feel more alive? What’s wrong with relieving pain and feeling alive? That’s something we all want.
For Maté, the addiction is not the primary problem, it’s a coping mechanism to keep pain from overwhelming us, and it’s hard to make abstinence stick when the addiction is doing such a crucial job. So the answer to stopping a harmful addiction is to address the cause of the pain so it’s no longer needed, and demonizing the addiction does not help with this. Addiction is only one of many trauma adaptations we make unconsciously in order to avoid unbearable emotions. For the purposes of CI, trauma is the inner event (repression) put in motion by an outer event that results in our becoming less free, less flexible in our ability to respond to situations. We all have some degree of trauma, and it doesn’t have to be Trauma with a capital T (violence, disaster, violation) to have a limiting effect. In addition to material needs, all children have a basic need to be seen, heard, and loved for who they are, just as they are, without having to earn it. When that need is not met, we shape ourselves to fit our environment, and these adaptations – also known as attachment trauma – occur in infancy and childhood when our bodies, brains, and nervous systems are developing. The popular book The Drama of the Gifted Child by Swiss psychologist Alice Miller, in which she outlines the personality manifestations of adults who were abused as children, was originally published under the grimmer but perhaps more accurate title Prisoners of Childhood. Most of us, in some way or to some degree, are prisoners of childhood.
For example, a little boy falls down, skins his knee, and bursts into tears. His parent picks him up and says, “Big boys don’t cry, shake it off.” The message he hears is that his sadness or fear is unacceptable to his parent. And that’s where another of our basic needs comes in: for attachment, connection to others, to care and be cared for. When we’re children, pleasing our parents or guardians – who house, clothe, and feed us when we cannot do that for ourselves – can feel like a matter of life and death. So the unwelcome emotion – sadness, fear, anger, shame, disgust – gets put away, like a little child locked alone in a basement, and this is unconsciously linked to survival. We adapt in order to make things work with our caregivers, often at the cost of our authentic nature. As Maté says, we trade our authenticity for attachment, and that’s the smartest move – maybe the only move – we can make when we’re small; it’s safer than losing our parents’ approval. This unconscious strategy of repression can get us through childhood, but it’s not the best way to navigate adulthood: we also have an innate need to be our own authentic selves. In any case, it’s a stopgap measure. Locked in the basement, the feelings will inevitably bust out, which is what happens when something in the present triggers an emotional response that’s outsized for the present situation, because the feelings belong to the past. Or they might show up in the form of anxiety, depression, chronic pain, auto-immune conditions, or any number of physical illnesses. As Dr. Maté says, “If it’s chronic, it’s trauma.”
Because this all goes on unconsciously, there is no one to blame for it. Our unexamined trauma passes from one generation to the next, even if everybody is doing their best. In the above example, the parent might have (unconsciously) feared their own repressed sadness would be triggered if they let the boy express his. But ideally, that’s exactly what the parent would have done: allowed the child to feel his pain for as long as he needed to, staying with him, letting him know it’s natural to cry and that it’s going to be okay. Had they done so, there would be no repression. That parent would be breaking the cycle of generational trauma. Even capital T Traumatic events do not necessarily result in lasting trauma: if the child is allowed to feel what they need to feel and is emotionally supported, they will eventually get through it and can fully recover. That ideal parent is not common in this world, but we each have an essential self, an original nature, that can re-parent our inner children and be present with their stuck emotions, freeing them from the obligation to hold onto old pain. When pain arises, we can sit with it, just allow ourselves to feel it, as an ideal parent would have done. Old emotions can be given their due attention and released, so they no longer need to express through chronic pain.
But our own personal experience is not the only way we take on trauma. Along with our bodies, we inherit the imprint of our ancestors’ lives (we may even carry wounds from our soul’s karmic journey through incarnations), and individuals are affected by the societies they live in. Children pick up and internalize attitudes aimed at them, and for those born into dominated groups, the external danger may be ongoing in adulthood. Violence traumatizes both the dominant and the dominated in different ways. As Resmaa Menakem, a psychotherapist and practitioner of Somatic Experiencing, says in his essential book on racialized trauma, My Grandmother’s Hands: “The trauma in white bodies has been passed down from parent to child for perhaps a thousand years, long before the creation of the United States. The trauma in African-American bodies is often (and understandably) more severe but, in historical terms, also more recent. However, each individual body has its own unique trauma response, and each body needs (and deserves) to heal.” We are better equipped to deal with external danger in the present when we have released our old arrested pain.
Where do these buried emotions live? In our physical body, it would seem. As we massage therapists like to say, “the issues are in the tissues.” Dr. Candace Pert, the neuroscientist dubbed “the mother of psychoneuroimmunology” due to her work on peptides as the carriers of information between mind and body, said, “Your body is your subconscious mind.” An example: imagine a fright that makes you gasp, and unconsciously you tighten your diaphragm. If that fear is not fully experienced but is instead repressed, the tension could remain in the diaphragm, impeding your breathing, digestion, and circulation, making you sick or uncomfortable. When we feel threatened, the immune system shuts down so we can marshall our forces to respond to the present danger (we go into fight, flight, or freeze). However, this is designed to happen only briefly, until the emergency has passed. When fear is chronic and the nervous system remains on high alert long-term, auto-immune conditions arise. For a fascinating tour of how this works, see the PBS documentary led by neuroscientist Robert Sapolsky, Stress: Portrait of a Killer.
In a talk session, we get in touch with our trapped emotions primarily through turning our attention to the body itself, and that’s a skill we can develop, starting with simple noticing – what your seat feels like beneath you, the pull of gravity keeping your bones on the chair, your shirt’s texture against your arm, the rise and fall of your breath... Can you notice your heartbeat without putting your hands on your body? This is called the felt sense, or interoception, the knowing that tells us what’s happening in our subjective experience of our bodies. Remember that being able to notice when my muscles were tensing up was the key to healing my sciatica pain. Practitioners of mindfulness meditation and hatha yoga know that by simply noting the body’s sensations while sitting or holding a pose rather than trying to flee them, pain will ease. Another saying of Maté’s: “where there’s tension, give it attention.” When we sit with our sensations, we may also find emotions there (“my knee is screaming, afraid, in tears”). Other impressions may arise, such as colors, temperatures, characters, scenes (“the feeling is red-orange, hot like an explosion, there’s a crouching, terrified child in a closet”). We gently stay with it, as tolerated, give the feeling our compassionate presence as well as inquiry, and see how it goes from there. We wade softly into presence in the body, as for many it does not feel safe to jump right in.
Being present in our body is the same as being grounded, and we can also be ungrounded, as if we’re trying to escape from our body and its feelings, from the gravity of Earth. I have sometimes felt as if an invisible ghost shaped just like me – that ideally ought to line up with me toe to toe, eyelash to eyelash – is pulling away towards the sky, and is halfway gone out the top of my head. This ungroundedness is a form of dissociation, which can be a useful adaptation for escaping painful situations in childhood, but a hindrance for adults. It could be mild, like daydreaming at work, or it could make us unable to function, depending on the severity of our trauma.
Because as a bodyworker I often work with chronic pain, I’m especially interested in exploring that as a mind/bodyworker; but ultimately the client’s system knows what is most needed in a session. My job is to attune with you and guide you to safely be present with your own emotions, buried or otherwise, and then help them connect with your essential self. We give the feelings plenty of time and space to express, and once they feel thoroughly heard, they don’t have to make you anxious or unwell to get your attention. There’s more freedom, more room for the whole of your original nature in your day-to-day life.
INTERNAL FAMILY SYSTEMS (IFS)
I discovered IFS through CI, and the two ways of working are very compatible. Many people, like me, are guided by both in our talk sessions. In 2021 Gabor Maté invited his friend Richard Schwartz, the originator of IFS, to give an online workshop for CI students, and it was fascinating. I was already reading the book Internal Family Systems Therapy by then and felt instantly in tune with the model. IFS posits that everyone is born with multiple subpersonalities, or “parts,” and this is universal and healthy. Many of us have heard of multiple personality as a pathology (now called DID or dissociative identity disorder), but this is rare and only occurs when, as a result of extreme trauma, parts may hijack the system with their own agendas, unaware of other parts. We can all relate to the idea that, “Part of me wants to do this, and another part wants to do that.” Schwartz began as a clinical psychologist specializing in family systems therapy, meaning that he found it most helpful to work with a patient’s family as a system rather than only with the individual. When in the 1980s he began to hear from patients about their subpersonalities, some of whom were holding onto old pain or beliefs or strategies for life while others had conflicting views, he began to talk to each of the parts as if they were members of a family and applied his understanding of family systems to his patients’ “inner family,” hence, Internal Family Systems.
Ideally each part contributes its own gifts and strengths to who we are as a whole. The trouble comes when parts become burdened with stuck emotions. What CI calls an adaptation is a burdened part in IFS. Our inner child in the basement is a part who’s been forced by circumstances into the role of holding the burden of unprocessed sadness, fear, anger, shame, etc. (in IFS this part is called an exile), and other parts (called protectors) have the burden of trying to make sure the exile’s feelings stay locked away. Whenever the banished feeling threatens to arise – and exiles are always trying to escape – a protector will activate the person to, say, play the clown, drink to excess, cut their skin, watch TV, tune out, explain things logically, stay busy, go into a rage – any number of diversions will do: the only imperative is never to experience the buried emotion. All these parts are frozen in childhood, and when we dialogue with them, which most people, surprisingly, are able to do, we find they are usually aged 0-9 (the age at which they took on their burden and got stuck), and do not know the client’s life has changed. Like a soldier who was never told the war is over, they fight on, making sure the little child they still believe themselves to be does not suffer from disapproval, punishment, or overwhelm – to the unconscious mind, this is still a matter of survival. The delightful animated Pixar film Inside Out is an entertaining demonstration of how this works in our systems.
Parts, however, burdened or otherwise, are not the wisest leaders of our system, and that brings us to the other essential tenet of IFS: the concept of Self with a capital S. Self is not a part, but could be likened to our original nature, soul, or Atman: it’s the essence of who we are that knows how to manage our life with grace and ease. It has the qualities of the eight C’s: confidence, clarity, compassion, creativity, calm, connectedness, curiosity, courage. It has many more qualities, but that’s a useful checklist to see if we have a bit of Self energy at a given moment. Self cannot be harmed, sullied, or altered, but it can be buried or ignored, especially when parts are heavily burdened and do not trust the Self. When burdened parts are in charge of the system, we act out of our wounds rather than our ultimate best interest.
To go back to the example of the little boy who skinned his knee and his parent told him not to cry: let’s say he internalized the message that it wasn’t safe to express or even feel his pain, so he put away his tears and toughened up. The next time he fell down he didn’t cry, but instead brushed himself off, gritted his teeth, and ran back to play. IFS would say that a part had been (unconsciously) given the burden of holding the tears, and would call that part an exile. Another part, a protector, would be gritting his teeth in order to keep the exile, exiled. As an adult, he might have trouble accessing genuine sadness and suffer from jaw pain. The uncried tears of a lifetime might be expressing as stomach trouble, chronic eye infections, or some other malady.
The philosophy of trauma in IFS is very much like that of CI, it’s non-pathologizing, that is, it doesn’t make moods or behaviors wrong, but instead seeks to understand the function of them in a person’s system, to befriend and negotiate with them rather than demonize them. Schwartz’s most recent book is called No Bad Parts, and that’s just it: none of our parts, no matter how destructive their actions, means to harm us, but only to help. The part gritting its teeth is just trying to keep the man in good stead with his parents. These parts don’t yet know of a better way, because they’re stuck in childhood, with a child’s coping strategies. In mind/body wellness coaching, we would talk with the parts and invite them to come into the present, release their old burdens, and contribute to our system in a happier way. What I wrote above about CI also applies to IFS, the difference being that Schwartz believes we are born and die with parts, while Maté believes parts talk is therapeutically useful, but does not see our system as ultimately multiple. Personally, I don’t need to decide, but find parts work to be extremely beneficial, and that’s what matters to me.
MY TRAINING, CREDENTIALS, AND PHILOSOPHY
Obviously, I am a massage therapist, licensed to practice in the State of New York since 2012. Compassionate listening has always been part of my massage work, and I’ve been health coaching since 2016 when I began to do Abdominal Therapy, which addresses all aspects of the person: physical, emotional, and spiritual. Since 2021, I am a trained practitioner of Compassionate Inquiry. In 2021/22, I completed two coaching courses with an IFS focus, and I’ve read a dozen books on IFS and do my own internal parts work daily. I have completed IFS Level 1 training (90 hours) and am working towards official certification over the next two years. I now see clients as a CI- and IFS-trained mind/body wellness coach.
I believe that our true nature is healthy and our troubles have clouded that natural health. I believe this applies to humanity as a whole, and that the violence, destruction, and misery we witness every day are the result of our collective trauma, not our intrinsic nature. CI and IFS are both constraint-release models, meaning we needn’t add goodness, but if we can let go of enough limitations, our natural goodness shines out. I like to think of my mind/bodywork as guiding the client to, as they say in Zen, “polish the mirror” (wipe off the dust) so they can see their original face. Our buried emotions are like children who just need someone to sit with them until they feel fully understood, and that someone might be me at first, but ultimately my job is to help the client connect their Self to their parts so they don’t need me.
WHAT TO EXPECT IN A MIND/BODY SESSION WITH ME
I meet with clients by Zoom. So that each of us can determine if we’re a good fit, I offer a free 30-minute session to start. After that, sessions are 60 minutes and you’ll pay out of pocket on a sliding scale – you’ll be the judge of what you can afford. I strongly suggest that you commit to at least three sessions in order to give the work a chance to take root.
We usually begin with a short guided meditation so that we can ground ourselves and sync up our nervous systems. After that you will either tell me what you’d like to explore that day, or we’ll check in with previous concerns, or we could focus on the body and see what’s asking for attention.
Most of us are comfortable explaining things from our cognitive mind, telling the story, analyzing all the factors. And while that might be helpful up to a point, it can also function as a diversion (a protector part will be doing the talking) from what’s going on inside, and if we don’t go inside, nothing will change. So I might interrupt your story at some point and invite you to slow down and notice the body, bringing you into the present in order to explore what got stuck in the past.
There may be a lot of space, a fair amount of quiet in the session. We want to allow parts to be heard and seen, not coerce them into what we wish they were. It’s not crucial that you tell me what happened to you or who did it, or even that you know what happened. There’s explicit memory, when we recall past events, and you may or may not have that – it’s surprisingly common to remember little of childhood – but there’s also implicit memory, the emotions buried in the body, and everybody has that. The latter will be the main focus of our sessions. I think of it as something like a shamanic journey to visit our inner children stuck in the past – and invite them into the present. Once they’ve put down their burdens they are free to rest or draw or ride bikes – whatever they wish to do, contributing their special talents, leaving the running of the system to Self. To find out who they can be once they are no longer “prisoners of childhood.”
The Guest House
Jalāl ad-Dīn Muhammad Rūmī[1] Translated by Coleman Barks
This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes as an unexpected visitor.
Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.
The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.
If you’d like to learn more:
Books:
Dr. Gabor Maté: When the Body Says No, In the Realm of Hungry Ghosts, Scattered, Hold on to Your Kids (co-author), The Myth of Normal (co-author)
Dr. John Sarno, Healing Back Pain
So many IFS books, so many good ones, see the IFS online store: https//ifs-institute.com/store. My favorite is Internal Family Systems Therapy, second edition (Richard C. Schwartz, Martha Sweezy)
Resmaa Menakem, MSW, LICSW, SEP, My Grandmother’s Hands
Dr. Candace B. Pert: Molecules of Emotion: The Science Behind Mind-Body Medicine
Dr. Bessel van der Kolk, The Body Keeps the Score
Peter Levine, PhD, founder of Somatic Experiencing, Waking the Tiger
Alice Miller, The Drama of the Gifted Child: The Search for the True Self
Websites:
Videos:
Many great talks: Dr Gabor Maté - YouTube
Resmaa Menakem on The Breakfast Club: https://youtu.be/omyzEvVvjog
A fascinating documentary on the effects of stress on our health: Stress, Portrait of a Killer: Robert Sapolsky: Full Documentary 2008, National Geographic - YouTube
Genes, and how and why they express: Human Nature talk with Robert Sapolsky, Gabor Mate, James Gilligan, Richard Wilkinson - YouTube
Inside Out, animated film, Pixar, 2015. Check online for streaming options.
[1] Jalāl ad-Dīn Muhammad Rūmī was a 13th-century Persian Sufi mystic, poet and theologian. Rūmī was born in modern-day Afghanistan into a family of well-regarded Islamic Sufi scholars and he lived most of his life in modern-day Turkey.
