This article is a resource of for therapists. If you are not a therapists maybe check out this article about Brainspotting.

Wait! If you are a therapist and don’t know what Brainspotting is, then watch this first!

How do you Brainspot patients with severe dissociation? Brainspotting is one of the fastest ways to treat severe trauma and PTSD. However for severe dissociation the dissociative reaction may make Brainspotting impossible. How do you get around this?

In cases of severe trauma the body may not be safe at all. Dissociation arises as a protective part for a patient to avoid feeling any emotion or bodily sensation. However, the Brainspotting process requires us make contact with the body and deep emotional self as a way to access the subcorticle brain. How do we get around the dissociation to help a patient access the body in a safe way?

One way is to find one of the five senses that is safe for the patient to feel. Touch can sometimes be scary, but usually smell or hearing do not have a negative association. In these cases I will play a Tibetan begging bowl or light something fragrant like Palo Santo or sage. I invite the patient to let everything else go and bring 100 percent of your awareness into this one sense. Often this is empowering and relaxing as the patient has now found a safe way to experience the body and the felt sense.

After beginning to make contact with the body is safer we pick a place where a patient is able to feel touch in a limited way. We choose a part of the body that is safe for the patient to feel and I begin to invite the patient to experience touch again when they are in control of the experience. I will invite the patient to feel something with a strong texture like a stone ball or metal bar. The patient brings all of their attention to this one sense and we feel the body with baby steps this way.

The key to inviting the patient into the subcorticle brain is to help someone be curious about the experience even when it is unpleasant. Curiosity is key to engaging creativity and inviting the patient into rewiring the trauma reaction in the deep brain.

When the experience of the body is overwhelming patients often say that they feel “everything” or “nothing” and become stuck in processing. When a patient becomes stuck processing because the sensation of feeling the somatic experience is overwhelming, I ask a series of guiding questions to facilitate creativity.

Asking something like “Where is the most energy in your body?” or “Where is it hardest to feel your experience in your body?” help you find areas where the most trauma is stored.

You can engage creativity by asking questions about weight, temperature, texture, and energy that help the patient become curious about somatic reactions.

Try questions like:

“Does your heart feel heavier or lighter than the rest of your body?”

“Does you the pressure come outward from your chest like bursting or downward like you are being crushed? ”

“Does the heat have a texture, like a warm fire, hot stove, or an explosion?”

“Does the sensation have an age like it is 7 years old, or older than you?”

Questions like these help the patient flesh out the experience and foster curiosity.

Further Reading:

Van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books, 2014.

Ogden, Pat, and Janina Fisher. Sensorimotor Psychotherapy: Interventions for Trauma and Attachment. W.W. Norton & Company, 2015.

Shapiro, Francine. Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition: Basic Principles, Protocols, and Procedures. Guilford Press, 2017.

Grand, David. Brainspotting: The Revolutionary New Therapy for Rapid and Effective Change. Sounds True, 2013.

Key Points:

• For clients with severe dissociation, the dissociative reaction can make standard Brainspotting impossible, as it requires accessing the body and emotional self.
• Strategies include:
  • Finding a “safe” sensory experience (smell, hearing) to ground the client
  • Slowly introducing touch by having the client feel textures in a controlled way
  • Using curious, open-ended questions to help the client describe somatic experiences
• The goal is to foster curiosity about the body’s sensations, even if they are unpleasant, to help rewire the trauma response in the subcortical brain.
• This gradual, sensory-based approach can help bypass severe dissociation and allow access to the deep emotional processing that Brainspotting facilitates.