Psychoanalytic Dialogues

The International Journal of Relational Perspectives

ISSN: 1048-1885 (Print) 1940-9222 (Online) Journal homepage: http://www.tandfonline.com/loi/hpsd20

Reintegrating Fragmentation of the Primitive Self:

Discussion of “Somatic Experiencing”

Peter A. Levine, Abi Blakeslee SEP, MFT & Joshua Sylvae

To cite this article: Peter A. Levine, Abi Blakeslee SEP, MFT & Joshua Sylvae (2018)
Reintegrating Fragmentation of the Primitive Self: Discussion of “Somatic Experiencing”,
Psychoanalytic Dialogues, 28:5, 620-628, DOI: 10.1080/10481885.2018.1506216

To link to this article: https://doi.org/10.1080/10481885.2018.1506216

Published online: 23 Oct 2018.

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Psychoanalytic Dialogues, 28:620–628, 2018
Copyright © Taylor & Francis Group, LLC
ISSN: 1048-1885 print / 1940-9222 online
DOI: https://doi.org/10.1080/10481885.2018.1506216

Reintegrating Fragmentation of the Primitive Self:

Discussion of “Somatic Experiencing”
Peter A. Levine, Ph.D.
Abi Blakeslee, SEP, MFT, Ph.D.
Joshua Sylvae, Ph.D.
Somatic Experiencing Trauma Institute

This paper, solicited for discussion in response to Levit’s interweaving of psychoanalytic theory with
Somatic Experiencing® (SE™), was written by the founder of SE and two SE instructors. Building on the
work of Levine (1976, 1997, 2010, 2015, 2018), the authors elucidate the theory and application of SE,
highlighting the importance of attending to neurobiological and physiological processes in healing trauma.
Interoception, or the conscious awareness of one’s own bodily sensations, is outlined, with an emphasis on
the relationship between interoception, empathy, and physiological regulation. Core physiological reg-
ulators (like the autonomic nervous system) are detailed, with suggestions for tracking autonomic shifts
and supporting completion of survival and defensive responses (social engagement, fight, flight and
freeze) in therapeutic encounters (Levine, 2018; Porges, 2001). The functional purpose of dissociation
and traumatic memory is reviewed (Levine, 2015). Clinical applications for resolving traumatic implicit, or
nonconscious memories, are explored. Finally, the authors conclude the paper by affirming the utility of
integrating SE into psychoanalytic approaches to therapy.

It is an honor to be able to offer commentary on this psychoanalytic paper. As the founder of the
Somatic Experiencing® (SE) method and two SE™ faculty members, this team of authors finds it
encouraging to see the skillful application of SE principles. If you’ve read Levit’s case study, you likely
have realized that SE is a powerful psychobiological model for treating trauma and distress (Brom
et al., 2017). Somatic is a reference to the Greek soma, signifying something that is of the living body.
Experiencing is a verb, alluding to interventions that access the phenomenological level of being and
are focused on the present moment. One of the primary mechanisms of SE is enhancing the client’s
ability to access bodily sensation, technically called interoception. Interoception is partially mediated
by brain regions such as the insula (Critchley, Wiens, Rotshtein, Öhman, & Dolan, 2004) and the
cingulate (Craig, Reiman, Evans, & Bushnell, 1996), which forms a functional bridge between
subcortical and cortical structures. Levit’s report on this series of sessions contains many excellent
examples of interventions designed to elicit interoceptive awareness, and he describes shifts that arise
from present-tense alterations in patterns of attention. Levit’s paper describes the successful applica-
tion of many of SE’s basic principles. The authors would like to further detail the science and theory
behind the clinical application of SE for the psychoanalytic community.

Correspondence should be addressed to Joshua Sylvae, Ph.D., E-mail: jsylvae@traumahealing.org

 REINTEGRATING FRAGMENTATION OF THE PRIMITIVE SELF 621

One benefit of interoception is that it can facilitate awareness of autonomic changes in one’s
physiology, as well as directly potentiate the shifting of autonomic states (Levine, 2018). The
autonomic nervous system (ANS) comprises two primary branches. Generally speaking, the
sympathetic branch is responsible for excitation and the parasympathetic for relaxation. The
parasympathetic branch is primarily mediated by the tenth cranial nerve, the vagus. According
to Porges (1995) and his polyvagal theory, there are, however, two distinct branches of the
vagus: the dorsal vagal complex (DVC) and the ventral vagal complex (VVC). The dorsal
aspect of the vagus innervates primarily sub-diaphragmatically, exerting strong effects on the
smooth muscles of the stomach and intestines (though it also has some connections to the heart
and lungs). In addition to regulating digestion and elimination, this neural system is involved
with freeze and death feigning (thanatosis) behaviors in the context of life threat.1 The ventral
aspect of the vagus primarily innervates the structures of the upper thorax, including the heart
and the lungs. According to polyvagal theory (Porges, 1995), there is also bidirectional
signaling between the VVC and other cranial nerves. In particular, the neural pathways
controlling the use of muscle groups involved in social engagement behaviors are implicated.
This includes the nerves that control the larynx and pharynx (used for producing speech used in
verbal communication), muscles in the middle ear (used for tuning the eardrum to extract the
speech of others from our complex acoustic environment), and facial muscles (utilized for
expression and engagement), as well as others. These nerves are the infrastructure used by
social mammals to engage with other individuals, and the activation of this complex appears to
be a primary pathway for the parasympathetic system to calm human physiology.
One of the primary tasks of an SE practitioner is tracking change or movement in the ANS
and other core regulatory systems. One of the ways that movement occurs is activation and
deactivation, or arousal and dearousal (relaxation). As clients process personal material, the
nervous system will exhibit the pattern Levine (1997) calls pendulation, or oscillation between
aspects of this polarity. One of the primary forms this takes is expansion and contraction, as the
body pulses back and forth. This pulsing may be related to the system’s cycling between
sympathetic and parasympathetic, and the presence or absence of this oscillatory pattern
provides important cues to the observant practitioner in regards to therapeutic engagement.
In the SE paradigm, it is important to recognize that arousal, or stimulation in response to
internal or external cues, can result in either heightened sympathetic nervous system (SNS)
activity or high tone in the DVC (or both). That is to say, some activated systems will look
stressed, influenced by the SNS (as well as neuroendocrine pathways) to exhibit increases in
heart rate, respiration, and other autonomic variables. In addition, the client may appear
excited: gesticulating more, speaking more rapidly, and in other ways displaying the influence
of the excitatory branch of the ANS. However, another possibility is that the individual will
exhibit greater DVC influence, which is the branch of the parasympathetic involved with
energy conservation (called the freeze/collapse response). This system shuts down arousal
when the organism perceives life threat and where possibilities for mobilization and active
coping have been prevented. This will look like the low-energy state it is, potentially including
depression, anhedonia, and alexithymia. Although the energy conservation response is designed

1
Of great importance in resolving traumatic states, the (dorsal) vagus is more than 80% afferent. In other words, it
is relaying sensory information from the gut to the brain stem. This can provide a therapeutic avenue for shifting out of
the shutdown state (see Levine, 2010).
622 LEVINE ET AL.

to be time limited, in humans this state can become chronic, and reiteratively engaged as a
compensatory pattern in life.
When Levit (this issue) wrote, “She oriented toward me and the activation continued to
subside” (p. 590), this alludes to decreases in sympathetic arousal. Often, orienting to the
external environment can facilitate settling. SE recognizes that many traumatized individuals
have a strong, nonconscious draw to go inward, often toward their distressing thoughts, painful
emotions, and uncomfortable sensations. We may as practitioners want to support orientation to
the external environment (exteroception) instead, to balance the compulsive draw of what
Levine (1997) calls the “trauma vortex.” The trauma vortex describes an involuntary preference
for attending to stimuli possessing a negative valence, often seen in trauma survivors.
SE practitioners are trained to monitor SNS activation in a client’s body visually, as well as
to attend to the client’s interoceptive descriptors of these autonomic shifts. Examples of this in
regards to the sympathetic system include sweating, a sense of pressure, increased heart rate
and/or breathing, muscle tension (especially in the extremities as the body readies itself to fight
or flee), cold hands, pupillary dilation, and dry mouth. Parasympathetically dominant states are
observable through lower heart rate, slower and deeper breathing patterns, pupil constriction,
dry and warm skin, increased digestion and peristalsis, and relaxed but responsive musculature.
A shutdown response innervated by the DVC, on the other hand, is autonomically accompanied
by a drastically slowed heart rate that lacks variability (low HRV), depressed and shallow
breathing, little digestion, and low blood pressure, as well as hypotonic (collapsed) or hyper-
tonic (braced) musculature. Often, but not always, some quality of dissociation accompanies
these DVC-dominant freeze/collapse states.
In his paper, Levit refers to states of overactivation and underactivation. We disagree that
freeze (with or without dissociation) is an exclusively “underactivated” state. In part, this is
because freeze may have components of sympathetic activation. In addition, though, collapse is
the last-ditch effort of mammalian physiology to survive situations that would otherwise
destroy bodily integrity. This is the state that, in a sense, lies beyond the threshold of
sympathetic excitation, and thus represents the highest state of vagal arousal possible. High
tone in the DVC leads to a highly activated state of freeze, numbing, collapse, and potentially
dissociation. Immobility in the body may look underactivated, and a client may report being
distressed by how enervating this state is, but we would want to recognize the high charge
potentially underlying this lack of vitality.
When human beings have the experience of feeling threatened, a rapid cascade of noncon-
scious survival responses are generated. Sensory inputs are processed rapidly in the amygdala
(the smoke detector of the brain), which mobilizes a predictable threat response cycle when
stimuli are tagged as dangerous. The threat response cycle has been identified by Levine (2015)
as exhibiting a predictable sequence. The first is startle (or alert), a brief immobilization and
bracing pattern that arrests movement and minimizes the possibility of detection. The next is
the defensive orienting response, which involves moving from exploratory visual processing to
threat detection (or, moving from curiosity to an effort to localize the source of the threat). If
this defensive orientating response facilitates a discovery that one is actually in a relatively safe
environment, and a recognition that there is nothing to defend against currently, bodily systems
are designed to enter back into the exploratory orienting response. If a threat is perceived, the
individual will engage self-protective responses modulated by the different branches of the
ANS. The first of these involves the VVC, the branch of the PNS extensively interconnected
 REINTEGRATING FRAGMENTATION OF THE PRIMITIVE SELF 623

with nerves innervating the muscles of social engagement. When this system is dominant, the
individual may try to consciously assess the situation, call out for help, or attempt other social
strategies to defuse the threat. If these are unsuccessful, the SNS will be employed to support
mobilization behaviors, or active coping. This is the “fight or flight” response, well known in
the behavioral sciences. If these responses are unsuccessful, the freeze response will ensue,
with collapse inducing quiescence. This biophysiological cascade follows an evolutionarily
determined trajectory, in which the body relies on more recently evolved—and more adaptive—
systems first. Porges (2001) referred to this as the phylogenetically determined, hierarchically
ordered ANS, though it is important to remember that this is modifiable by aversive
conditioning.
If the organism successfully defuses a threat at any point in this process, the body is designed to
down-regulate, releasing the survival energy mobilized to manage dangerous situations. People may
report waves of heat, which often shift to warmth as deactivation occurs. Sensations of gentle shaking,
vibration, or tingling may be described as the system settles. The parasympathetic system may
innervate crying, as the lachrymal glands release tears. In these and other ways, the body may enact
its instinctual and intelligent response to highly stressing scenarios, releasing the accumulated over-
activation and returning the organism to efficient equilibrium and homeostasis. It is when this does not
occur that an organism is vulnerable to accumulated stress or traumatization (Levine, 1976).
As mentioned, one of the tasks of an SE practitioner is encouraging clients to access interoceptive
awareness. Blakeslee (2008) identified common interoceptive experiences related to fight, flight, and
freeze. In addition, there are cross-cultural similarities in the ways that individuals describe the
physical experience of emotional states (Nummenmaa, Glerean, Hari, & Hietanen, 2014), illustrating
the ubiquity of somatic experiencing in emotional and psychological processing. Levit’s paper
references multiple occasions when he asks his client to focus on sensations and procedural (physical)
movements in the here and now. For example, Levit assisted Sue in completing an incomplete self-
protective response as she recalled her trauma of sexual violation. At hearing the word “metal,” her
legs began to close, and when conscious attention was joined to this automatic movement it facilitated
the emergence of an appropriate sense of self-protection. This may entail slowing movements down, or
in other ways supporting a fuller internal registering at the proprioceptive level of experience. Levit’s
noticing of this procedural movement, embedded in what we might call the body narrative, facilitated
renegotiation as Sue’s nervous system had a reparative experience of being able to access a powerful
sense of protection. If a person’s body is not able to settle or down-regulate after extreme stress,
associative networks in implicit (nonconscious) memory systems may remain activated, triggering an
ongoing stress response as a reaction to internal or external information associated with the traumatic
content. This may create a draw back to the original trauma, potentially explaining the repetition
compulsion introduced in the psychoanalytic literature (van der Kolk, 2014).
An SE practitioner’s goal may reflect working with the body narrative, attending to somatic cues
before developing an interpretation of the verbal narrative, and this may differ from psychoanalytic
approaches that prioritize associative memory and unconscious fantasies. However, there is similarity
in that both work to make unconscious stimuli accessible to support a return of the Self. In SE, the
practitioner would first attend to and follow sensations, bodily impulses, and movements, which may
entail paying attention in a more bottom-up way. For this reason, SE can be effective with or without
content. It is important to emphasize, we believe, that these bottom-up processes can facilitate the
spontaneous reorganization of meaning-making. Releasing implicit survival arousal often leads to new
624 LEVINE ET AL.

insight, as well as an individual’s return to a sense of empowerment and relaxed readiness in their lives,
as one is able to meet new demands in the here and now.
Levit references how the SE approach to trauma healing accesses implicit memory, which warrants
expansion. Implicit memories can be nonconsciously encoded, recorded in the brain without conscious
awareness (Graf & Schacter, 1985; Squire, 2004), and retrieved without intentional recall. Implicit
memories lack a sense of conscious intention when they are evoked. They are often experienced as
dissociated sensory fragments rather than as autobiographical details woven into a personal narrative.
Habits, physical movements, conditioned emotional responses, and other nonconscious processes can
all be implicit, mediated by brain structures such as the amygdala, the midbrain, thalamus, the basal
ganglia, and others (Pally, 2000).
Implicit memory can be characterized by the following: (a) being present at birth; (b) being
subcortical; (c) lacking a sense of conscious recall as memory is evoked; (d) also called nondeclarative
memory, or procedural memory; (e) including behavioral, emotional, perceptual, and possibly bodily
memory; (f) not requiring conscious attention for encoding; and (g) not involving the hippocampus and
cerebral cortex. In contrast, explicit memory is characterized by (a) not being present at birth (it
generally develops during the second year of life); (b) being cortical/hippocampus-based; (c) including
a sense of conscious recall when memory is accessed; (d) also being called declarative memory, or
autobiographical memory; (e) if related to the self, possessing an intrinsic quality of temporality; (f)
including semantic (factual) and episodic (autobiographical) memory; (g) requiring conscious atten-
tion for encoding and recall; and (h) if autobiographical, also involving the prefrontal cortex. SE
directly access implicit memory, both in emotional and musculoskeletal associative memory systems
(Blakeslee, 2008), and through procedural movements via interoception. Tracking and allowing shifts
in interoceptive and kinesthetic internal states without overwhelm facilitates the release and reorga-
nization of a wide range of traumatic symptoms.
Multiple associative learning experiments have studied the emotion of fear, appraisal of danger, and
posttraumatic stress disorder (PTSD). The pairing of highly charged survival states with particular
stimuli may lead to the development of PTSD and other stress disorders (LeDoux & Gorman, 2001). In
the development of PTSD, the central nervous system (brain and spinal cord) and ANS kindle synaptic
responses toward fear and mobilization. Long-term potentiation (LTP), enduring synaptic efficacy
built through patterns of neural activity, is part of how this is accomplished. LTP of fear-based
memories has been shown to occur in rats, particularly in regards to learning tasks related to the
inhibition of avoidance (Whitlock, Heynen, Shuler, & Bear, 2006). Through an associative process of
neural firing and LTP, trauma can leave a powerful imprint in the nervous system, the brain, and within
the psyche of an individual.
In the SE approach, we encourage clients to attend to particular elements of interoceptive
information, which differentiates this modality from various mindfulness practices. SE clients are
often asked to pay attention to certain sensations over others, especially during the beginning phases of
treatment. These may be sensations that are pleasant or perceived as helpful in some way to the client
in the present moment. Levit helps Sue discover “resources,” which in SE would have physiological
and somatic markers attached to them. In other words, we endeavor to connect a client with a sense of
pleasantness in their bodies, rather than attending only to a mental image or a state of mind. For
example, a person may consciously sense their legs. They may feel this sensation as stabilizing, which
could increase sensations of relaxation (e.g., weightiness, deep breathing, or warmth). Or, as a client
thinks about an activity that was relaxing or enlivening, the SE practitioner may ask, “What sensations
do you notice in your body right now?” Being curious about embodying resources may help a person
 REINTEGRATING FRAGMENTATION OF THE PRIMITIVE SELF 625

feel “more like themselves.” Calming or pleasantly enlivening sensations contradict those of traumatic
overwhelm, creating new neural pathways that can implicitly facilitate habituation to the experience of
well-being. SE practitioners pay attention to the client’s descriptions of sensation and, in particular,
notice shifts in interoceptive awareness, always tracking whether experience becomes more or less
organized as a result. The clinician may coax the system toward relaxation or aliveness, reinforcing
spontaneous shifts or employing interventions to facilitate an experience of integration.
Many psychodynamic approaches emphasize the therapeutic relationship, so it is potentially
important to note that the size and connectivity of the insula may improve empathy and rapport
(Singer, Critchley, & Preuschoff, 2009). Lazar et al. (2005) demonstrated that long-term meditators
have a thicker right anterior insula, a brain region strongly implicated in interoception. Mindfully
paying attention to the body in structured meditation practice seems to physically thicken this structure
(as well as other cortical areas, sometimes in as little as 8 weeks; Hölzel et al., 2011). We can thus
hypothesize that somatic psychological practices, in which clients connect awareness to a variety of
internal stimuli and sensations, may improve empathy and enhance relationship to self and other.
Much anecdotal data support this conclusion, and we further hypothesize that this occurs via effects on
brain structures implicated in both interoception and empathy, such as the insula. For example, Levit’s
client was deeply affected by his ability to attune to her sensory and affective states. In the second part
of treatment, when SE was employed, she was able to access a “felt sense” of connection and rapport.
This body-to-body coregulation facilitates the maturation of the nervous system in infants and
children. Through sensory tracking, Sue was able to have a more empathic response to her father’s
fear, depotentiating the traumatic imprint created by his punishment. Her psyche spontaneously
reorganized the way this memory was held, facilitating a new understanding of the temporal sequence
and its meaning.
Levit references Sue’s dissociation, crediting Levine for the insight that cognition is inaccessible to
a traumatized brain flooded by lower brain activation. This recognition is central to the SE approach.
Before a practitioner works with cognition, or even works directly with affect, instinctual shock states
and developmental trauma must be worked with first. Working with survival and implicit associative
memory facilitates access to information processing at higher brain levels. Dr. Ruth Lanius and
colleagues conducted an original fMRI experiment showing how a particular trauma survivor,
diagnosed with PTSD and experiencing symptoms of dissociation, had little metabolic activity in
her brain while listening to her narrative of a car accident (Lanius, Hopper, & Menon, 2003). The way
in which states of terror overwhelm thinking capacities is well established, likely related to the
inhibition of cortical areas (such as Broca’s area for speech production). We hypothesize, based on
the available evidence, that psychoanalytic approaches not attending to body process would be less
effective than those incorporating SE or other somatic methodologies.
The diminishment of hippocampal and cortical activity demonstrated in PTSD is also related to
activation of the amygdala. The amygdala modulates and consolidates explicit memories formed
during emotional arousal (LeDoux, 2002), leading some theorists to describe two separate memory
encoding systems: one hippocampal and one modulated by the amygdalae, utilized in nonthreatening
and threatening situations respectively. Arousal results in the strengthening of memory formation
(McGaugh, 2002); however, if emotional overwhelm is significant, memory consolidation can be
impaired (Sapolsky, 1998). LeDoux (2002) wrote,

When stress is induced by threatening stimuli, the amygdala is activated and cortisol is released.
The hormone then travels to the brain and binds to receptors in the hippocampus, the net effect of
626 LEVINE ET AL.

which is to disrupt hippocampal activity, weakening the ability of the temporal lobe memory
system to form explicit memories. (p. 223)

Therefore, depending on the intensity of an emotional event, memories (including those related
to traumatic or disturbing events) may be enhanced or impaired (Rothschild, 2000). Terr (1994)
distinguished two types of traumatic memory. Type I memories, often related to single-incident
traumas, are vividly experienced as imagistic and detailed representations and are accessible to
verbal recall. Type II memories differ in that they often involve ongoing inescapable traumatic
experiences or a potent (real or perceived) life-threatening event that induces dissociation. Type
II memories are most often not accessible to verbal recall and are more likely to appear during
therapeutic treatment as disturbing, fragmented sensory experiences. If memories are particu-
larly traumatic, a person may not be able to consciously recall the event (Stern, 1995) at all,
though the information may continue to be accessed and expressed via nonconscious patterns of
physiological arousal and behaviors such as play (in children) or postural habits (Terr, 1994;
van der Kolk, 1994; van der Kolk & Fisler, 1995).
In short, interoception and introspection may be more intrinsically related than we might
assume. Postural cues, incomplete motoric sequences, and other sensorial aspects of biological
life condition meaning-making. Attending to an embodied dimension of experience facilitates
shifts within cognitive, emotional, and spiritual facets of being. We have seen, again and again,
how the renegotiation of trauma results in the spontaneous reorganization of core beliefs and
patterns of transference. We celebrate the integration of somatic perspectives into all healing
traditions and honor Dr. David Levit’s important contribution to a synthesis of SE and of its
application in psychodynamic and psychoanalytic work.
Before concluding, we would like to address a commentary of Levit’s on the possible
positive bias that SE may lead to more positive transference. Often the client’s anger comes
out toward the practitioner as negative transference. A skilled practitioner can help contain this,
allowing clients to feel the power and intensity of their emotions, acknowledge those emotions,
and then gradually explore where those feelings come from. Levit’s paper shows Sue’s recovery
progress as he integrates perspectives and practices from his SE training. The authors support
more academic and clinical application between the complimentary practices of SE and
psychoanalysis.

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CONTRIBUTORS

Peter A. Levine, Ph.D., holds doctorates in both medical biophysics and psychology. He is the
developer of Somatic Experiencing®, a naturalistic and neurobiological approach to healing
trauma; the founder of the Somatic Experiencing Trauma Institute and Ergos Institute for
Somatic Education™; and author of several best-selling books on trauma, including Waking
the Tiger, which is published in more than 28 languages. Dr. Levine is currently a Senior
Fellow and consultant at The Meadows Addiction and Trauma Treatment Center in
Wickenburg, Arizona and continues to teach trauma healing workshops internationally.
Abi Blakeslee, SEP, MFT, Ph.D., is Faculty at the Somatic Experiencing Trauma Institute and
teaches and consults worldwide. Dr. Blakeslee integrates SE with clinical research, secondary
trauma interventions, and the psychobiological principles of attachment and shock trauma. She
treats individuals, couples, children, and families in her clinical practice. Her most recent
publication is in the International Journal of Neuropsychology (Vol. 5, No. 1A) with
Dr. Jospeh Riordan and Dr. Peter Levine titled “Toddler Trauma: Somatic Experiencing,
Attachment and the Neurophysiology of Dyadic Completion.”
Joshua Sylvae, Ph.D., is a licensed marriage and family therapist and Somatic Experiencing®
Practitioner from Oregon City, Oregon. He is a faculty member for the Somatic Experiencing
Trauma Institute, facilitating the SE™ Professional Training in locations across the country,
and is an adjunct faculty member at Prescott College.