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  • 1. Compose: Singing as a Depth Modality in the Treatment of Trauma by Jamie Rattner Submitted in partial fulfillment of the requirements for the degree of Master of Arts in Counseling Psychology Pacifica Graduate Institute 15 March 2012
  • 2. UMI Number: 1509820 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent on the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscriptand there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMI 1509820 Copyright 2012 by ProQuest LLC. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 - 1346
  • 3. ii© 2012 Jamie Rattner All rights reserved
  • 4. iiiI certify that I have read this paper and that in my opinion it conforms to acceptablestandards of scholarly presentation and is fully adequate, in scope and quality, as aproduct for the degree of Master of Arts in Counseling Psychology. ____________________________________ Thomas Elsner, M.A., L.P.C. Faculty AdvisorOn behalf of the thesis committee, I accept this paper as partial fulfillment of therequirements for Master of Arts in Counseling Psychology. ____________________________________ Tina Panteleakos, Ph.D. Research CoordinatorOn behalf of the Counseling Psychology program, I accept this paper as partialfulfillment of the requirements for Master of Arts in Counseling Psychology. ____________________________________ Avrom Altman, M.A., L.M.F.T., L.P.C. Director of Research
  • 5. iv Abstract Compose: Singing as a Depth Modality in the Treatment of Trauma by Jamie Rattner The author situates the human singing voice at the axis of Psyche and Soma,suggesting vocalization as vital in the transformation of any trauma complex. UsingIntuitive Inquiry as a methodology, the results of the study are presented as a pre-recorded vocal method for survivors of trauma supported by a qualitatively researchedrationale. In the Compose method, imagistic representations and sonic manifestations areinitially culled through visceral interoception and exteroceptive sensory awareness. Theseimages are then externalized in freely associated dreamlike scenes. Since singing isphysical and imagistic, the entirety of the body (as a biological organism and symbolicfield) is engaged in transforming the traumatically induced complex. Drawing fromheuristic self-exploration, the depth psychological tradition, and contemporary somaticapproaches, findings indicate that vocalization may be instrumental in the healing oftrauma survivors.
  • 6. Table of ContentsChapter I Introduction ..................................................................................................1 Research Method .....................................................................................................2 Researcher’s Area of Interest ...................................................................................5 Guiding Purpose.....................................................................................................11 Organization of Study ............................................................................................12Chapter II Literature Review.......................................................................................13 Overview ................................................................................................................13 The Body in Psychoanalysis ..................................................................................15 Trauma and Body Memory ....................................................................................17 The Human Animal and Seven Stages of Traumatic Response ............................19 Stifled Vocalization During Trauma ......................................................................20 Limitations of Talk Therapy in the Treatment of Trauma .....................................21 Singing and Depth Psychology ..............................................................................23 Organism + Image = Body.....................................................................................24Chapter III Compose: Singing as a Depth Modality in the Treatment of Trauma .......26 Overview ................................................................................................................26 Session Structure....................................................................................................28 Using the Recording ..............................................................................................32 Part One: Introduction, Flooding, Grounding ....................................32 Part Two: Breathwork and Relaxation ...............................................34 Part Three: Resonance .......................................................................35 Part Four: Range and Images .............................................................38 Part Five: Embodiment and Free Association with the Image ..........38Chapter IV Summary and Conclusions ........................................................................42Appendix A Worksheet for Therapists ...........................................................................45References....... ...................................................................................................................46
  • 7. Chapter I Introduction Compose results from researching the human singing voice as the potentiallypivotal bridge between Psyche and Soma, making it instrumental in the treatment of anytrauma complex. The outcome is presented as a recorded approach to symptoms inducedby catastrophe supported by a qualitatively researched rationale. Compose is acontribution to the many voices in trauma studies that have emphasized the humanorganism’s response to harrowing episodes. However, this writing simultaneouslysuggests this as a reductionistic understanding that does not take into account a notion ofSoma that is trans-organismic, one that is inclusive and ultimately moving beyondbiology. The Compose method allows for both a literal and non-literal approach to body,thus making sound with the symbolic orientation of the depth psychological tradition. This research supports that an approach to trauma, one which arises out ofLacan’s notion of the body as an organism unified by image, more readily addressesassociated symptomatology (as cited in Soler, 1995, para 12). In the Compose method,visual imagery and sound are derived through interoception and then externalizedthrough voice into freely associated, dreamlike scenes. Since singing is somatic andsymbolic, the entirety of the body (as literal and emblematic) is engaged in transformingthe traumatically induced complex. The basis for Compose is both analyticalpsychology’s foundational notion that overwhelming psychic material is unconsciouslyexpressed by the body through symbolic conversion (Freud & Breuer, 1895/2004, p. 81)
  • 8. 2and contemporary trauma research on literal physiognomic trauma response, whichfound: 1) Trauma was somatic in nature to begin with and was encoded, stored, and retrieved in memory along somatic sensory channels; 2) The physical dimension of the trauma was an intensive foreground experience; 3) The original experience was never articulated beyond the level of the physical aspect; and 4) The somatic nature of the memories concretized and validated the reality of the traumatic experience. (Droga, 1997, p. 191) This research supports the voice as symbol of Psyche (Soul) and supportsincreased vocal freedom as indicative of increased liberation from a trauma complex.Research Method Droga (1997), Levine (1997), and van der Kolk (2006), among others, haveargued that traumatic memories are primarily somatic, and even that vocal freedom isreflective of psychological dynamism. But few have turned their research and findingstoward the development of modalities addressing trauma through the voice. This is withthe exception of the comprehensive research of voice movement therapy founder PaulNewham (1994) and the vocal psychotherapy of Diane Austin (2008). However, until thispaper, intuitive inquiry methodology had not yet been used to investigate the use ofsinging as a depth approach to trauma in psychodynamic therapy. As a method, “intuitive inquiry is an epistemology of the heart that joins intuitionto intellectual precision in a hermeneutical process of interpretation” (Anderson, 2004, p.
  • 9. 3307). The research in this method is comprised of a cycle of five stages. The firstinvolves being captivated by the material and in some way called to the research, whichwill be revealed more fully in the succeeding chapter. The emphasis of stage two is thedisclosure of the “preliminary lenses” which are the initial postulates and preconceivednotions that shape the exploration (p. 307). Some of my initial lenses at the threshold ofresearch included the following: ▪ Trauma is stored somatically and sensorially ▪ The voice is emblematic of Psyche ▪ Breath, tone resonance, quality, pitch, registration, and range can indicate hyperarousal, vigilance, and anxiety indicating possession by the trauma complex ▪ Vocal limitation is symbolic of traumatic impact in the form of tension ▪ Singing is trans-organismic and transpersonal ▪ Increased vocal freedom indicates increased liberation from the complex ▪ Communication about trauma is both desired and repulsive to the survivor ▪ Singing must be vocal but not necessarily verbal ▪ Language is limited in the treatment of trauma The third stage of work was the creation of Compose, which negotiated theseideas through a recorded method over a period of several months. The recordings werecreated intuitively and out of heuristic trial-and-error. This allowed much of theinstrumental material to arise from a semi-conscious creative state while paying attentionto my own embodied responses to the material. During the fourth stage of intuitiveinquiry, there is refining of the lenses and a return to interpretation of the various
  • 10. 4literature. At this point, three additional lenses emerged: ▪ Vocalizing can be an area prone to inauthenticity and self-consciousness ▪ Singing can create increased tension if understood as performative ▪ A new aesthetic understanding of symptoms allows for transformation of the complex Compose is the vocal process that has resulted through the fifth stage (and anothercycling through of the previous stages). It is a composite not only of my own research butalso many healing approaches introduced by psychological theorists and vocal therapists,each of whom have their own means toward processing psychologically harrowingepisodes and events. Compose emphasizes as its rationale the body-centeredpsychoanalytic school and research by somatically oriented trauma specialists such asPeter Levine (1997) and Judith Herman (1992). Its contributions from the arts emphasizethe foundational work of Alfred Wolfhson (as cited in Newham, 1997), an admirer ofJung whose research has informed a generation of protégés interested in a psychoanalyticview of the voice including Roy Hart (1967), Paul Newham (1994), and Diane Austin(2009). Although teachers from Wolfsohn’s lineage certainly have their own nuancedstyles, some traits comprise a common philosophy which has contributed to thedevelopment of Compose, including “a pedagogy that encourages expression of the manycolors of the voice, from the ugly to the beautiful and from the angelic to the demonic [aswell as] the philosophy that the voice and body are inseparable and can only beeffectively worked on in tandem” (Overland, 2005, p. 27). Intuitive inquiry was chosenas a research method because it also seeks to tether what is often thought of as separate. Itis a method that allows for the simultaneous insights of both art and science (Anderson,
  • 11. 52004, p. 307). Hopefully, Compose will also bridge the gap between a poetically basedand physiognomically grounded approach to the treatment of those who have sufferedtragedy.Researcher’s Area of Interest Trauma Storm Hunkered down, nerve-numb, in the carnal hut, the cave of self, while outside a storm rages. Huddled there, rubbing together white sticks of your own ribs, praying for sparks in that dark where tinder is heart, where tender is not. Orr, 2002, p. 7 The refrain of life itself is suffering and relief. As the poem above suggests, theinstrument that sings the tune is the human body. Being of an artistic temperament, I havealways been attracted to a certain intensity, though I can acknowledge that spending timestudying severe psychic injury is not for everyone. Had it not been for a certain series ofliterally inescapable events in my life, I may have not developed my passion for thedesperate and dramatic nor been compelled toward creating this work. My own history oftrauma hurled me into a need for relief when my primary therapeutic salve was singing. Ihave had the privilege and misfortune to often ponder the aforementioned metaphorthrough my own lifelong pairing of singing and psychic anguish. The stunning impact of
  • 12. 6trauma has been utterly shaping of both my personal and professional life. It is important to state from the outset my definitions of trauma and singing. Forthis work, trauma will be defined as any psychologically catastrophic instance requiringcoping resources beyond those possessed at the time of the event. This thesis will addresstrauma that results in (symptoms fitting) the following criteria for Posttraumatic StressDisorder (PTSD), since most trauma manifests with this cursory list of diagnostic traits.However, trauma resonates much deeper. There is much hesitation here in pathologizingsurvivor as disordered; to label the survivor rather than the traumatic instance asdisordered can often feel exonerating of the traumatic event. Nevertheless, the followinglist of traits in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., textrevision) (DSM-IV-TR) (American Psychiatric Association [APA], 2000) characterizedmost survivors: A. The person has been exposed to a traumatic event in which both of the following have been present: 1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others 2) the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. B. The traumatic event is persistently reexperienced in one (or more) of the following ways: 1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. 2) Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
  • 13. 7 3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur. 4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.C. Persistent avoidance of stimuli associated with the trauma and numbingof general responsiveness (not present before the trauma), as indicated bythree (or more) of the following: 1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma 2) Efforts to avoid activities, places, or people that arouse recollections of the trauma 3) Inability to recall an important aspect of the trauma 4) Markedly diminished interest or participation in significant activities 5) Feeling of detachment or estrangement from others 6) Restricted range of affect (e.g., unable to have loving feelings) 7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)D. Persistent symptoms of increased arousal (not present before thetrauma), as indicated by two (or more) of the following: 1) Difficulty falling or staying asleep 2) Irritability or outbursts of anger 3) Difficulty concentrating 4) Hypervigilance 5) Exaggerated startle response
  • 14. 8 E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. (p. 468) For this thesis, singing is broadly defined as any oral intonation that may includebut ultimately moves beyond simple conversational speech. It may be what one wouldcolloquially call musical or melodic, or it may not. Singing, defined as such, includes therange of vocal sounds inherent to the human organism such as breathing, moaning,screaming, gasping, and laughing. This can also include melody but may be monotone orpercussive in nature. This sound is inherently vocal but not necessarily verbal or inclusiveof substantive linguistic content. As described by Jung: Language was originally a system of emotive and imitative sounds—sounds which express terror, fear, anger, love . . . sounds which imitate the noises of the elements: the rushing and gurgling of water, the rolling of thunder, the roaring of the wind, the cries of the animal world. (as cited in Segal, 1998, p. 111) This thesis does not focus solely on the aesthetics of the voice but also on its rolein trauma as our most primal and native means of expression. This is essential becausetrauma also takes place at this most primordial, animal level of the psychosomatic field,which will be discussed later in this paper. The writing, conversations, and works oftheorists and other practitioners who have also explored the salvific properties of“content-free vocalization” have been foundational in this research (Starkwather, 1956, p.121). I offer Compose in the hopes of helping survivors assimilate the conscious andunconscious effects of intense psychic violation and readjust to PTSD symptomatologyby stirring the voice. The mysterious potency of the human instrument became of sincere interest to methrough years of ambitious singing, culminating in my attendance at Boston’s Berklee
  • 15. 9College of Music. Coursing alongside this artistic maturation was the steady developmentof a sordid eating disorder that emerged immediately after childhood trauma and reachedits fever pitch in my second year at Berklee. Such intense daily engagement with mybody in music school and its stirring of negative associations with my own physicalityhad unanticipated consequences. As a result of trauma, I unconsciously associated certain aspects of myembodiment with perilous danger. Intense somatic focus as a result of singing broughtforth an overwhelming flooding of emotions and excessively symptomatic behavior. Thepower of contacting the body through singing proved that voicework allows access tolatent trauma. However, it was introduced into my life without the support ofpsychotherapy or a rationale for the resulting symptomatic manifestations. When I wasable to engage a psychotherapist and process the feelings, sensations, and, ultimately,memories that emerged as a result of my voicework, my symptoms began to retreat. After graduating from Berklee College of Music, I relocated to New York Cityand determinedly pursued a career as a singer-songwriter. Like many artists, in spite ofambitious performing and several award-winning albums, I was unable to support myselfsolely on my creative work while living in Manhattan. I began to teach voice lessons outof my apartment in Greenwich Village. On a number of occasions, after a trusting rapportwas established with a student, they would begin to complain about physical symptoms.This would soon unfold into their discussion of the accompanying emotional suffering.Many of these confessional sessions included the disclosure of major traumas. I felt incredibly privileged to be their supportive confidant but also unprepared tocontain their vulnerability. My scope of worked seemed to be expanding beyond that of a
  • 16. 10singing teacher, but I lacked the professional skills to support these individuals in anethical fashion. I was concerned that some of my students were on the threshold of thesame emotional chaos that ensued for me in college due to singing. I had becomemesmerized by this mysterious connection between voice and psyche. My hope was tolearn something that could be of help to those who had sought out my support and trustedme with their disclosure. This inspired the pursuit of my master’s degree in counseling psychology with anemphasis in depth psychology, which prepares its graduates for practice as apsychotherapist. Alongside this work, I explored additional healing modalities thatengage the numinous and creative. This resulted in my acquiring additional certificationsin expressive arts therapy and transpersonal studies from The Institute of TranspersonalPsychology. Today, more than a decade of personal recovery and training has inspired myprofessional work as a therapist with anorexics, bulimics, and binge eaters at the inpatientand outpatient levels of care. The vast majority of the women with whom I work havetrauma in their history and entered eating disorder treatment with co-occurring issuesranging from substance abuse to mood disorders. Not surprisingly, most fulfill thediagnostic criteria for Posttraumatic Stress Disorder (PTSD). Many of the eating disordered women with whom I work have returnedrepeatedly to treatment, often feeling as though their complexes only marginally evolved.When I began at these facilities, I noticed the tremendous bias in favor of talk therapyand was fortunate to have the freedom to explore sensorial engagement through visualart, body movement, and, ultimately, singing. Since the trauma had happened at the level
  • 17. 11of the body it seemed natural to me that this is where the healing must begin.Guiding Purpose Carl Jung wrote that an encounter with the numinous was the essence of thehealing experience and releases one from “the curse of pathology” (Jung, 1973, p. 377).Alex de Mijolla (2005) described Rudolf Otto’s characterization of the numinous as thatwhich offers a “‘sense of one’s creature state,’ mystical awe (tremendum), a presentimentof divine power (majestas), amazement in the face of the ‘completely other’ (mysterium),demoniacal energy, and paradox” (p. 1164). My aim is to understand the potential numinosity of singing, aspiring to providerelief for those who have survived terrific pain. Nearly every spiritual tradition makes useof song for its ability to possess us and lead us toward both the majestas and mysterium,perhaps pointing toward the inherent numinosity of singing. Our voices allow us to stepinto the aforementioned “creature state” and touch upon the many paradoxes that seemnecessary for healing of trauma. My guiding purpose in this research was to discover a vocal method to traumarecovery that could simultaneously soothe and empower, a form that would allow asensitive survivor to reduce emotional overwhelm while allowing one to be whollyexpressive. I hoped to find a technique to give voice to trauma but not necessarily wordsthat could never fully capture the experience. I wanted to find a process that was sensualand physical without being explicitly sexual or athletic, a somatic experience that couldbe shared and personal. Singing became the modality that manages to share somethingabout the human experience that is both personal and universal. The recording thatcomplements this paper can be used by clinicians and survivors as a resource for
  • 18. 12restoring the emotional and somatic connection shattered by trauma.Organization of Study In order to understand the effect of singing as a somatic trauma therapy, I willbegin by reviewing some of the available literature on the psychosomatic phenomena, thebody’s response to traumatic events, and the history of psychotherapeutic vocalizationand trauma. This writing will then explicate the limitations of talk therapy in treatingpsychic injury, while introducing the research of others who have brought vocal work tothe healing of human travesty. After exploring these seminal writings, I will introduceCompose and a summary of research.
  • 19. Chapter II Literature ReviewOverview In the opening of her seminal book titled Trauma and Recovery, Judith Herman(1992) said, “The conflict between the will to deny horrible events and the will toproclaim them aloud is the central dialectic of psychological trauma” (p. 1). As atherapist attempting to be a harbinger of relief to survivors, the limitations of language totransform the aftermath of trauma in the face of these contradictory pulls has becomefrustratingly evident. The Romantic Victor Hugo (2007) stated that “music expresses thatwhich cannot be said, and on which it is impossible to be silent” (p. 63). Perhaps a riddlemust be solved with another riddle, and music, in sharing the paradox inherent withPTSD, can bring healing where other modalities cannot. For those who have been through horribly overwhelming events, recurringsymptoms like insomnia, nightmares, illusions, and intrusive flashbacks make it seem asthough the event is happening in every moment. In a certain sense, it is. After trauma, thebody remains perpetually locked in a state of arousal, incessantly screening theenvironment for threats. This results in prolonged states of sometimes crippling anxietyand people who are easily startled and can erupt unexpectedly into rage. Yet, trauma is ariddle, so simultaneously, the survivor alternates with periods of numbness, detachment,and ghostlike physical states of dissociation (DSM–IV–TR (APA, 2000), p. 468). Thebody is still responding as though the trauma is in the present moment. This is because
  • 20. 14trauma is not in the event, but rather, in the nervous system (Levine & Kline, 2008, p. 8).Therefore, it is imperative to understand not just Psyche but its dialogue with Soma. Thefirst portion of the literature review will look at various historical views of the body-mindrelationship with an emphasis on the foundational somatic work of psychoanalysts. By definition, trauma is an occurrence so overwhelming that whatever innerreserves were possessed prior to this profoundly painful and frightening event cease tosuffice in managing the psychological consequences of the traumatic event. It is aneglected point that our linguistic capacity is one of these lost resources during a tragicepisode. Although one may have had vocal capacity during a trauma, language is aseparate phenomenon, one that is severely impaired during psychically overwhelmingepisodes. The experience is most often processed somatically rather than verbally.Therefore, the second area of the literature review will explore the deficits of utilizinglanguage as the primary methodology in therapy. The final area of the literature review will look at how the vocal rather than solelythe verbal can be involved in the treatment of trauma. The body is the site and location ofevery human trauma and in singing, the instrument is the very flesh, bone, and sinew ofthe survivor. This allows the practitioner to work at the very site of the trauma and allowfor a healing of the event in situ. At first glance, singing as a therapy can appear trivializing or minimizing of thedevastating impact of trauma. However, due to the human instrument’s mysterious abilityto capture the historical essence of an event without linguistic narration, singing can beespecially powerful in communicating the experience and aftermath of trauma. The voicecan eloquently reveal emotional nuance without even naming an emotion. This area of
  • 21. 15the paper will extend beyond the bias of image as a visual phenomenon and explore howthe voice can serve as imagistic material. Singing enigmatically allows for thecommunication of profound emotion with skillful self-possession, a peculiarity that haspointed toward my creation of Compose.The Body in Psychoanalysis “The body is often the narrator of feelings [one] cannot bear to hold in consciousthought, much less express in words” (Krueger, as cited in Solnit, Neubauer, Abrams, &Dowling, 2007, p. 239). From the earliest days of psychoanalysis, the idea of theindissolubility of psyche and soma has been present. In 1923, Freud reinforced theprimacy of the body, stating, “A person’s own body, and above all its surface, is a placefrom which both external and internal perceptions may spring . . . the ego is first andforemost a bodily ego” (pp. 25-26). Wilhelm Reich took this to its furthest reach,declaring the body as the countenance of psyche, with the two being “functionallyidentical” (1942, p. 41). Adler (1931) claimed that psychology itself is “theunderstanding of an individual’s attitude toward(s) the impressions of his body . . . bodyand mind are co-operating as indivisible parts of one whole” (p. 34). This all suggeststhat to work somatically with trauma through singing is far more than superficial; to workwith the body is to work with the totality of Psyche. Jung did not see the body as interchangeable with Psyche but did acknowledgetheir interdependence, a living image. As Jungian training analyst and author MurrayStein (1998) wrote, Jung derives psyche from a combination of physical nature and transcendent mind spirit or mind…psyche and body are not coterminous, nor is the one derived from the other . . . . The ego is based in the body only in the sense that it experiences unity with the body, but the body that the ego expresses is psychic. It is a body
  • 22. 16 image and not the body itself. (p. 24) Jacques Lacan has also been particularly influential in the creation of Compose,with a specifically depth approach to the body that is less literal. Much of the historicaland contemporary writing on trauma focuses solely on the human organism and itsbiological functioning. However, Lacan said that the human body is more than theorganism. Rather, it is a phenomenon integrated by an image through which the egomaintains a sense of realness. Though Lacan’s work emphasizes the linguistic, his mirrorstage suggests that the ego-solidifying image was provided by a visual, such as areflection in a looking glass (as cited in Soler, 1995, para. 12) Since Lacan, many from the analytical and archetypal school, including JamesHillman, have rigorously emphasized that an image need not be visual, but can also besensori-kinesthetic and thus somatic. The body symbolically interacts and interpretsrather than solely interfacing with its world on a literal level. This makes somatictherapies like Compose inherently metaphoric and depth-oriented. In Re-visioningPsychology (1977), Hillman reminded us the body is a fantasy system of complexes, symptoms, tastes, influences, and relations, zones of delight, patholigized images, trapped insights . . . body and soul lose their borders, neither more literal or metaphorical than the other. Remember: the enemy is the literal, and the literal is not the concrete flesh but negligence of the vision that concrete flesh is a magnificent citadel of metaphors. (p. 174) Jung understood a complex as a charged cluster of images and ideas (Samuels,Shorter, & Plaut, 1986, p. 234). Therefore, if one thinks of a traumatic episode, theassociated images are not solely visual but engage the entire sensate capacity of sight,smell, touch, taste, and sound. Through the gathering of the senses, viscera, organs,muscle, and tissue, the whole body itself becomes the symbolic mediator between self
  • 23. 17and all lived experience. Even if the trauma complex is not held in the form of ideas dueto memory loss or dissociation, it is accessible in the form of images via the body, withthe voice at its epicenter. Roy Hart, a major predecessor of all voicework, also saw thevoice as the harbinger of the healing numinous when he wrote: For singing, as we practice it, is literally the resurrection or redemption of the body. The capacity to “hold” the voice in identification with the body makes biological reality of the concept “I am.” The ability to hold fast with whole body in vocal production can, with correct training, develop an ability to hold fast in complex real life situations. (Hart, 1967, para. 9)Trauma and Body Memory The body is the breathing, living, and moving history of a person, and if that pastincludes profound tragedy, that memory becomes embodied and lived out throughmovement, sensation, patterns of breathing, and all of the activities of the body. The bodybecomes a moving image, an emblem of the event. The idea that memory is stored in thebody can be perplexing to some due to limitations in understanding memory processingas solely a verbal and narrative affair. The psychoanalytic school has emphasized thatwhat is both unavailable or unbearable psychically is somaticized. Psychoanalyst andsomatic psychology expert John Conger writes on this in his text entitled Jung and Reich:Body as Shadow. Conger said (1988), “The shadow is physically revealed. What we havehad such difficulty in gaining access to stands blatantly before us in the body. We aregiven the most direct access to what has been rejected and inaccessible” (p. 192). This aspect of the thesis will look at body memory from a different angle. WilmaBucci (1985) clarified a distinction between verbal and non-verbal or perceptual memory.Verbal memory is language-based and accessed by using words such as in talk therapy.On the other hand, perceptual memory is the aspect of our recollection that is encoded
  • 24. 18with our five senses or kinesthetic movement (n.p). This is why a particular perfume canseem to bring a long-lost friend into the room if she wore the same scent, why a song canviscerally bring a person back to the initial experience, or why one can remember how toride a bike after not doing so for years. Trauma is primarily stored non-verbally due to the fact that during the exposure tothe traumatic incident, the pre-frontal cortex containing the language centers of the brainis effectively hijacked by the limbic system, which is responsible for our survivalresponses including fight, flight, or freeze. Trauma often leaves us quite literallyspeechless, without words to recapitulate what has happened. However, being leftwithout a verbal narrative does not leave us without a memory of traumatic events.Perlman stated: The predominance of somatic expressions in the first stages of recovery of traumatic memories arises out of the . . . original defense against the awareness of the trauma by splitting the memory off into the body. Such an interpretation presupposes the . . . achievement of an integrated experience of the trauma prior to the defensive dissociation of the memory into the body. Although, at times, body memories may serve a defensive function, I propose the likelihood that the original experience may never have been articulated and integrated beyond the level of the physical aspect in the first place, thereby leaving the memory of the trauma locked in a somatic-sensory state, another reason for the abundance of somatic manifestations. (as cited in Droga, 1993, para. 37). Our wordless encryption of the trauma into memory is what results in oftensomaticized symptomatology of survivors, eating disorders and self-mutilation beingcases in point. Due to the traumatic event itself not being coded in a linguistic narrativebut in a body memory, therapies that are verbal are rather limited. Droga (1997) wrote,“encoding and storage of the experience would be processed in the perceptual mode(Bucci, 1985, 1994) . . . . Retrieval of these memories would likewise be accessed andexpressed along perceptual channels, that is, in somatic-sensory form” (para. 35). Unlike
  • 25. 19using the voice to speak, singing with non-verbal sounds could be more effective inameliorating trauma symptoms due to the effect of the human instrument dialoguing inthe native tongue of trauma: the un-worded body. Clinical psychologist and Jungian analyst Donald Kalsched (1996) providedfurther support for the argument (theory) that trauma victims benefit from singing. Henoted that in the case of trauma, that which is too unbearable to be conscious splits intothe body: The affect and sensation aspects of the experience stay with the body and the mental representation aspect is split off into the “mind.” Such a person will not be able to let somatic sensations and excitedly bodily states into mental awareness . . . instead messages from the body will have to be discharged in some other way. (p. 66)The Human Animal and Seven Stages of Traumatic Response Another reason why “content-free singing” can be remedial in the treatment ofsurvivors is due to its emphasis on what is affectively communicated while vocalizingrather than what is semantically conveyed through words (Starkwather, 1956, p. 121).This would be useful in the treatment of survivors since much vocal tension and itsaffective core has been smothered since the time of trauma. To truly understand the ideaof stifled somatic responses, it is important to look at our primitive, organismic responseto trauma and its relationship to the strangling of vocalization. Researchers Ogden,Minton, & Pain saw the following in common between adults with trauma and the sevenphases of defensive responses in animals: a) Marked change in arousal; b) Heightenedorientation response; c) Attachment and social engagement; d) Mobilizing defensivestrategies e) Immobilizing defensive strategies f) Recuperation; and g) Integration (ascited in Norton, Ferriegel, & Norton, 2011, para. 4):
  • 26. 20 Each defensive response is typically definitive, primitive, inflexible, and hierarchal because the preceding defense in the hierarchy must be completed before the next one can be initiated (Ogden, Minton, & Pain, 2006) . . . . Repeated use of these defenses without completion either overactivates or inhibits the neurology, short-circuiting the recuperation and integration stages. (para 4.)Stifled Vocalization During Trauma There are two responses to danger made by the voice; hyperarousal is firstindicated by a kind of paralysis: Indigenous opiates are released causing a reduction of fear, pain, and panic and inhibits the production of sound and vocalizations and soothing behavior (Nijenhuis, Vanderlinden, & Spinhoven, 1998; van der Kolk, McFarlane, & Weisaeth, 1996). Because vocalization is especially dangerous at this point, the Broca’s area of the brain is incapacitated by the increased opiates, reducing the possibility of inadvertent, fearful vocalizations that would attract the predator. (Norton, Ferriegel, & Norton, 2011, para. 5)This points to the benefit of vocalization for the survivor, which at one point may havebeen associated as a dangerous behavior in itself. Deliberately engaging the voice, then,is associated with empowerment and can serve as a indication of a freed state. However,during trauma, one may cry out with “a primordial scream for mother . . . the involuntaryscream we often make when someone jumps out at us in the dark. For weaker or smalleranimals, this is often suppressed. Freezing is the most common response, even when anescape is available” (Nijenhuis, Vanderlinden, & Spinhoven, 1998; Ogden, Minton, &Pain, 2006 as cited in Norton, Ferriegel, & Norton, 2011, para. 7). Trauma expert Peter Levine noted that if an animal escapes after the freeze state itengages in seizure behavior and discharges the traumatic energy; this is imperative for itssurvival because it allows recuperation stages and integration to take place. However,findings suggest that in cases of PTSD, human beings fail to discharge this containedenergy (Levine, 1997, p. 35). This immobility includes the holding back of the voice.
  • 27. 21Limitations of Talk Therapy in the Treatment of Trauma Language has been praised as the pinnacle of human achievement, yet it poses anumber of limitations in the treatment of trauma where the talking cure falls short. Asexperts Pat Ogden and Janina Fisher (2006) said: Traditional “talk therapy” approaches, a category that includes any method that depends on the words of the client as the primary entry point of therapy, have tended to address the explicit, verbally accessible components of trauma. They emphasize the role of narrative, emotional expression, and meaning-making (Brewin & Holmes, 2003; Herman, 1992) . . . . As the narrative or explicit memory is re-told, the implicit, somatosensory components of the memory are simultaneously activated, frequently leading to a re-experiencing of somatoform symptoms which can include: autonomic dysregulation, dissociative defenses associated with hyper and hypoarousal states, intrusive sensory experiences and involuntary movements. This debilitating, repetitive cycle of mind-body triggering can thwart desensitization regimes and keep past trauma “alive,” prolonging rather than resolving, trauma-related disorders (Aposhyan, 2004; Kepner, 1987; LeDoux, 1996; Rothschild, 2000; Siegel, 1999; Van der Hart & Steele, 1999; van der Kolk, McFarlane, & Weisaeth, 1996). (p. 265) Furthermore, Bessel van der Kolk noted that when survivors later recall atraumatic event, the Broca’s area of the brain, the center of speech, shut down on the lefthemisphere. However, areas of the right hemisphere connected to emotion and autonomicarousal become activated (Wylie, 2004, para. 40). Curiously, in the research of A.Yamadori, Y. Osumi, S. Masuhara, and M. Okubu (1977) on Broca’s aphasia, a conditioncharacterized by the loss of ability to produce language due to impairment of the Broca’sregion of the brain, the ability to sing text is preserved. This has been well known since1836, when he described a patient who was able to sing La Marseillaise or La Parisiennewhile his speech was limited to “tan-tan”(Behir as cited in Yamadori, Osumi, Masuhara,and Okubu, 1977, p. 221). When these patients sing, they have access to language whilebeing otherwise verbally impaired. I can only offer the anecdotal evidence of my own relative ease in singing about
  • 28. 22my trauma rather than speaking of the few aspects for which I do possess narrative,verbal memory. In my own songwriting, I have been able to sing the stories of mytrauma. Implicit memories are sounded in the color, tone, and style while language isused for non-literal metaphor, simile, and poetic analogy. However, my attempts torecapitulate literal stories about the trauma in typical speech during talk therapy results inconsistent frustration, with only a few shreds of literal, explicit memory accessible forconscious recall for the past 20 years. Perhaps further research could scientificallysubstantiate the possibility that delivering one’s traumatic memories melodically throughsong could circumvent some of the psychotherapeutic challenges associated with Broca’simpairment in survivors telling their stories (Wilson, Parsons, & Reutens, 2006, p. 23). If trauma is to be approached with language, it seems to be most effective if it isfacilitated by a return to its most vestigial, right-brained, and emotive form. Merleau-Ponty (1973) noted: Our language is less emotional than its rudimentary forms. There would not have been an initial difference between the act of speaking and the act of singing . . . . The initial form of language, therefore, would have been a kind of song. Men would have sung their feelings before communicating their thought. Just as writing was at first painting, language at first would have been song . . . . It is through the exercise of this song that men would have tried out their power of expression. (p. 81) Again, the trauma response initiates from the vestigial level of our being; in casesof PTSD, proper discharge, recuperation, and integration of the trauma did not occur.This means full expression of emotion, production of sound, vocalizations, and soothingbehavior was inhibited. An effective therapy for trauma survivors would facilitate theaforementioned traits of completing the unfinished business in the trauma response cycleand any narrative, re-exposure, or verbal recapitulation of the traumatic incident may be
  • 29. 23best accomplished in vocal form. As Samuels said: The voice, whether worded or unworded, stands as a bridge over the gulf we call mind-body or psyche-soma . . . the voice’s roots are in the functioning and evolution of the human body. Its branches and leaves are in the realms of advanced cognition, spirituality, and interpersonal relationships. Hence the voice itself is a crucial mediation between the sensual world and the life of intellect, spirit, and love. (as cited in Newham, 1994, p. 9)Singing and Depth Psychology The idea that vocalization is therapeutic for trauma has origins that long precedeWestern analytic psychology and finds its roots in the realms of religious, folk, andshamanistic healing ways. Vocal therapy in the context of depth psychoanalysis can traceits roots to Alfred Wolfsohn, an admirer of Jung. Wolfsohn returned from World War Isuffering from psychosis and haunted by aural hallucinations of wounded and dyingsoldiers. After taking it upon himself to perform an “oral exorcism,” he engaged severalvocal teachers in order to cathartically replicate the sounds in his traumatized mind(Salomon-Lindberg as cited in Newham, 1992, para. 23). He was healed of the psychosisand went on to take on his own protégés, including the renowned Roy Hart. After Wolfsohn’s death, Hart furthered his work with the creation of an ensemble,going on to perform pieces often consisting solely of bodily movement and non-linguisticvocal sounding. The radical and experimental Roy Hart Theatre grounded its training ofsingers in the analytic work of Jung. This resulted in a vocal aesthetic that focused not onnarrating the human condition as much as symbolically imbuing the phenomenologicalexperience of human drama. This was done often while performing recognizable workssuch as The Bacchae. Philosopher Catherine Backes-Clement said of their performance,entitled AND, that the troupe displayed “the meeting point of voice and myth . . . thevoice alone, apparently liberated from the constraint of the rational meaning, finds
  • 30. 24meaning on the Other Stage; in the presence of the Unconscious” (as cited in Hart, 1998,p. 380). Additional seminal work was then put forth by Hart’s student Enrique Pardo, whojoined with post-Jungian James Hillman to expand his work into the post-modernarchetypal school. Hart (1998) described his work as employing “a dance of vocal soundto paint images in space which, to an audience, resound with an uncanny recognisabilityand yet defy reduction to a linguistic or otherwise codified schema”; hence, what couldbe called an archetypal image (p. 339).Organism + Image = Body We have explored the benefits of singing in accessing somatic responses totrauma, completing the reregulation and integration of the trauma cycle, and as agrounding tool. Although these are crucial in the treatment of trauma, this writing hasprimarily focused on the organismic level of the body. However, as Lacan suggested, abody extends beyond the organism and must integrate an image in order to be whole.Using the voice to provide what Jung called “acoustic images” (Jung, 1926/1970, p. 322[CW 8, para. 608]) is what allows Compose to be relevant to the depth psychology andpsychoanalytic tradition. The first section of Compose focuses on the organism and thesecond on the image; the two aim to provide a healing synthesis for the interrelatedphenomena of body and psyche. For this psychosomatic field to be healed from trauma, the organism requiresinteraction with its images for the complex to be mediated. One must differentiatebetween the classical and archetypal schools of depth psychology as approaches tohealing, since each suggests a different role for the therapist. To analogize: if a suffering
  • 31. 25self is a building on fire, the classical analyst wants to discover the origin of the flames,find the course of the flames, and ultimately save the building while maintaining his orher distance from the crisis as much as possible. A therapist from the archetypal schoolworks through James Hillman’s (1977) approaches of personifying, pathologizing,psychologizing, and dehumanizing. The therapist animates, embodies, and cries out asthe fire, demanding its right to be witnessed rather than deemed an affliction andextinguished. Rather than being concerned with firefighting, the therapist enters theburning building and goes down in flames. The classical method is heroic (though oftenbeautiful) and the archetypal is aesthetic and empathetic (though often heroic). Classicalanalysts works against the symptom; the archetypal analyst takes “a more homeopathicapproach, accepting what is given in the symptom while at the same time deepening it”(Moore, 1992, p. 70). Therefore, my efforts to be remedial through the voice and its imagery may springforth from the classical Jungians and could be perceived as tyrannical of the imaginal bythe archetypalists. However, the approach toward image which eschews cracking its codefor grand archetypes or additional meaning specifically springs forth from the archetypalschool. This method does not seek to collect and mine the image for any particularmeaning. It trusts that the way out is through the embodiment and imagination, notinsight alone.
  • 32. Chapter III Compose: Singing as a Depth Modality in the Treatment of Trauma Voice movement therapy is conducted with individuals and with groups. The clients begin by making their most effortless and natural sound while the acoustic tones of the voice are listened to and the muscle-tone of the body observed. In response to an informed analysis of breathing, sound, and movement, the therapist massages and manipulates the client’s body, gives instruction in ways of moving, and suggests moods and images which the client allows to affect and infiltrate the vocal timbre. The voice is thereby sculptured and animated by subjection to a kaleidoscope of shifting moods and shapes, colors and images, by which it increases radically in range, tone, and substance. Newham, 1994, p. 18Introduction The paragraph above provides a good working synopsis of voice movementtherapy, which serves as the basis for this method. Therefore, Compose is best practicedwith someone trained in singing and psychodynamically oriented toward trauma. Onewould need some pedagogical awareness of vocal anatomy, breath, onset, resonance,registration, and range. This allows for an understanding of the dynamism and range ofthe human instrument. Yet, understanding of only the aforementioned areas may makefor a therapist who is a thorough vocal technician but lacks a capacity for aestheticappreciation, nuance, or imagination; the method requires both attitudes. The aim of Compose is to take an appreciative artistic approach to trauma thatbeatifies the symptom into its ultimate appreciation and thus transformation. In this sense,Compose does not strive for a permanent cure in the typical way it is understood butrather a “readjustment of psychological attitude,” a new perspective toward symptoms
  • 33. 27which may bring relief (Jung, 1916/1970, p. 72 [CW 8, para. 142]). For example, thecroaking tension heard in the throat of a survivor while singing may not initially change.However, that does not mean no transformation has occurred. The shame and associatedwith that tension (and thus the trauma) may be ameliorated when the client is able to findwhat is praiseworthy, true, and beautiful in that strain. Thus, what Wilhelm Reich (1961)called the defensive and muscular “character armor” of an individual is ultimatelysoftened by realizing one is sufficient (p. 10). One becomes less defensive andsymptomatic—a byproduct of Compose’s aesthetic orientation but not its aim. The attitude of Compose is one of honor and acceptance. This may intrinsicallyappear riddling, but as Carl Rogers (1961) noted, “the curious paradox is that when Iaccept myself, then I can change” (p. 17). When the traumatized individual decides somesymptom is an emblem of a damaged and defective nature, the defensive character armoronly becomes more dense, possessive, self-identified, and impenetrable. On the otherhand, looking at one’s symptoms through the eye of an artist or poet, an individual cansee beyond his or her unique pathology (Hillman, 1975, p. 57). If I see a rotten applefrom the medical model or religious model, I see a problem because both of those sphereshave a certain teleological understanding, orientation, and aim. If I see the apple from theeye of an artist, it simply is what it is without needing to become something else in orderto suffice. Compose begins by grounding in the present moment. It then guides the survivor ininitiating internally derived touch through vocal vibration. This stimulates free-associative imagery which then manifests in a scene, much like a dream. Finally, thisdream is embodied through the sounding of the voice, movement, and detailed
  • 34. 28mindfulness of somatic responses similar to what is found in Robert Bosnak’s embodiedimagination (2007, p. 117). The Compose method lacks the manual manipulation oftenused by voice therapists; touch is often met with intense hypervigilance by manysurvivors and is generally disapproved of in psychotherapy. Compose and its accompanying recording addresses what Colette Soler (1995)summarized as Lacan’s total body, the synthesis of the organism and image (para. 12).The rationale for each part of the recording engages the literal biological effect of traumawhile holding simultaneous awareness of its symbolic nature.Session Structure Typical therapeutic hours utilizing the Compose method will begin with some timefor the patient to check in about his or her symptoms, move into utilizing the recording,and then close with some time to process the session that day. One of my initialpostulates in creating this method was that communicating about trauma is both desiredand repulsive to survivors. In many of my own talk therapy sessions intended to focus ontrauma (ranging from EMDR to somatic experiencing to Jungian analysis), I spend muchtime reporting on the events of my week and other minutia while avoiding discussion oftrauma symptoms. Of course, the symptoms were present in my tone, pace, tempo,breath, and other vocal indicators. The Compose method emphasizes immediately givingattention to vocal indicators in the session, directing the practitioner to focus on processand prosody of the vocalization rather than its linguistic content. Another initial postulate in this research was that language is limited in thetreatment of trauma. Although the literature review focused on language as ahandicapped means of communicating about trauma due to a number of biologically
  • 35. 29derived limitations, I have found that verbosity can also be a form of psychologicalresistance, particularly in the form of intellectualization. In his research, Leon Wurmser (1996) posited that intellectualization “may becomenecessary during severe affect regressions and provide a momentary relief from anxietyand a reduction of tension in the analysis, and can thus protect the continuation of ourwork. Here, the distancing, even intellectualization, may mean a kind of guard-rail at theedge of the abyss” (para. 142). Remaining in the realm of words and concepts is a meansof staying away from the body and emotions. Due to the affective/somatic coding oftrauma, intellectualization affectively allows the survivor to be insulated and remain at adistance from the catastrophic event. Intellectualization was definitely present in my development of this method, whichinvolved tremendous procrastination from the vocal research and the somatic exploration.Instead, I would continuously review the literature and feel unfounded in my subjectiveexperience, not trusting my body to be substantive enough as a basis for this method. Ineeded words as proof and evidence, giving them more credence than my own embodiedexperience. If this mistrust of the body becomes the case in a session, it is important thatthe therapist mirror verbosity, intellectualization, or isolation of affect in a timely andsensitive manner, reminding the patient that “your body doesn’t lie” (Diamond, 1997, p.23). Another initial hypothesis in the research was that vocalizing can be prone toinauthenticity and self-consciousness, arising in tension especially if understood asperformative. It is difficult to derive here if the ongoing sense of my own illegitimacy inthe creation of this work was due to singing or due to being a trauma survivor.
  • 36. 30 Adult survivors . . . may have painstakingly constructed a public persona that is superficially friendly, vibrant, and efficacious, this identity is experienced as inauthentic and extraordinarily fragile. Just below the surface of this often impressively functioning veneer, the trauma survivor is trapped in an inner world of fragmentation, dissociation, terror, and rage. Often frightened that others will discover the hidden truths about them, trauma survivors . . . remain essentially disconnected from others. (Davies & Frawley-O’Dea, 1994, p. 33) This fear of being “found out” is why it was imperative for me use a heuristicmethod that utilized me in the research; exploring fragility in the survivor (whethertherapist or patient) will impact the efficacy of Compose. In summary, I think it is helpfulfor both parties to be transparent about feelings of inadequacy and inauthenticity. One of the limitations of utilizing myself as a subject in this research was theinability to conduct an intake session and introduce the Compose method. This wasimportant since in my own history as a patient, the assessment session was a time wheremy tendencies toward inauthenticity were at their strongest. Particularly as a teenager, Itried to appear less symptomatic to therapists. As an adult, I have often tried to impressupon therapists that despite my poise, I can often feel like my stability is delicate.Therefore in the assessment, it is also important to pay attention to the body since it canbe more honest than words. I already discussed the importance of paying attention toprocess, especially vocal cues, rather than content, but there are other considerations aswell. In her book Cultural Competence in Trauma Therapy: Beyond the Flashback,Laura Brown (2008) presented a thorough framework for intake of survivors that Irecommend for use in sessions. She began by discussing assessment and the initialCompose session. Several guidelines are worth bearing in mind when doing a trauma-minded intake. Brown (2008) stressed the importance of staying away from specific
  • 37. 31terms like trauma or disaster during assessments, because many survivors don’t feel theirexperience “qualifies as traumatic.” She suggests the therapist simply ask if the patienthas experienced anything they would consider “painful, humiliating, or frightening”because these are emotional responses to trauma that can be followed up with clarifyingquestions (p. 65). Additionally, Brown focused on the importance of using language thatis more open than specific when trying to elicit information about trauma. As an example,Brown referred to the research of Estrich and Koss: Research on sexual assault trauma, particularly at the hands of known others, has shown that if women are asked if they were raped, many who are survivors of acquaintance rape will respond in the negative because the term rape is coded conceptually as representing a violent act perpetrated by a stranger, what Estrich (1988) calls “real rape.” However, asking the same group of women if they have experienced sex that was un-wanted, coerced, or occurred while they were asleep or drugged yields more accurate information about a type of trauma that may indeed have long-lasting psychological consequences (Koss, 1988). (2008, p. 64) It is also important to remember that the therapist may unknowingly trigger ahypervigilant, traumatic response in the survivor. This can occur whether or not thesurvivor experiences him or herself as part of the outgroup or ingroup. For example, inthe case of a female sexual abuse survivor, being alone in a closed room with a maletherapist could be highly triggering due to the sexual differential. Alternatively, evenwhen there is an apparent shared ingroup (for example, if both parties are Catholic), thesurvivor may fear coming forward about abuse at the hand of a priest or speaking badlyof the church if she notices a cross around her therapist’s neck (Brown, 2008, p. 66).Each of these situations requires skillful negotiation and power dynamics are besthandled by being discussed candidly in the first session. In addition to gathering information about the trauma, it is important in an intakesession using Compose to discuss the rationale behind the method, as well as making
  • 38. 32clear that the survivor is in charge of the timing, pace, and activities of every session. It isnot recommended to utilize the method on the first assessment beyond the first fewminutes of the recording which emphasize breathing and relaxation. This followingsection of this thesis focuses on how to use the recording.Using the Recording Part one: Introduction, flooding, grounding. Compose initially orients sessionsaround becoming present and is based on Babette Rothschild’s (2000) dual awareness asdiscussed in her book, The Body Remembers. Dual awareness brings survivors into anawareness of their body’s paradoxical response to trauma. Even though they arephysically observing the present, their nervous system is physically experiencing the past.This method emphasizes that “both realities count” and that being able to hold themsimultaneously is healing (p. 132). However, hyperarousal ultimately leads to asurvivor’s sensory dissociation from the present moment, which prevents dual awareness. Becoming present in the Compose method is assisted by a guidedintroduction/meditation in the accompanying recording. The first part of the recording isabout setting a safe container and grounding the individual by engaging their sensorysystems toward awareness of the present moment. As electricity is grounded to allowenergy to pass through safely, so a survivor can ground his or her body in sensoryawareness to allow the stored traumatic energy to move through the body withoutdissociative shock or overwhelm. One of my initial postulates was that trauma is storedsomatically and sensorially, so these are the areas to which a therapist must be attuned inorder to continually reflect to the survivor any signs of dissociation or hyperarousal.According to the Clinician-Administered Dissociative States Scale (CADSS), thetherapist can note several somatic indicators of dissociation including “show[ing] no
  • 39. 33movement at all, being stiff and wooden . . . unusual twitching or grimacing in the facialmusculature . . . unusual rolling of the eyes upward or fluttering of the eyelids” (Bremneret al., 1998, p. 131). Additional signs include a general sense that the survivor is“separated or detached from what is going on” or if they “blank out or space out, or insome other way appear to have lost track of what was going on” (p. 131). On the other hand, hyperarousal indicates being overly vigilant and attuned to theenvironment. The somatic manifestation of this is observable in the form of “trembling,shaking, hot and cold spells, heart palpitations, dry mouth, sweating, shortness of breath,chest pain or pressure, and muscle tension” (Barlow as cited in Clark & Beck, 2010, p.17). These are all indicators of a stimulated sympathetic nervous system primed for afight/flight response. These are all areas that the therapist can bear in mind as signs ofincreased agitation and mirror to the patient. Babette Rothschild outlined the two methods of sensory perception: interoception,which receives information from inside the body using viscera, muscles, and connectivetissue, and exteroceptors, which engage the five senses in receiving information fromoutside of the body (2000, p. 41). Singing requires tremendous interoceptive awareness,of which Bessel van der Kolk noted the importance: Interoceptive, body-oriented therapies can directly confront a core clinical issue in PTSD: traumatized individuals are prone to experience the present with physical sensations and emotions associated with the past. This, in turn, informs how they react to events in the present. For therapy to be effective it might be useful to focus on the patient’s physical self-experience and increase their self-awareness, rather than focusing exclusively on the meaning that people make of their experience— their narrative of the past. If past experience is embodied in current physiological states and action tendencies and the trauma is reenacted in breath, gestures, sensory perceptions, movement, emotion and thought, therapy may be most effective if it facilitates self-awareness and self-regulation. Once patients become aware of their sensations and action tendencies they can set about discovering new ways of
  • 40. 34 orienting themselves to their surroundings and exploring novel ways of engaging with potential sources of mastery and pleasure. (2006, p. 289) Part two: Breathwork and relaxation. Compose also assists the survivor inreducing agitation by engaging the parasympathetic nervous system (PNS) or relaxationresponse. The ability to engage the PNS is indicative of the recuperation stage takingplace, an important function in healing PTSD, as previously noted in this research. Theclinician and survivor can observe a number of signs to see if this response is takingplace, including “decreased heart rate and force of contraction, constriction of pupils, andrelaxed abdominal muscles” (Barlow as cited in Clark & Beck, 2010, p. 17). Relaxing ofthe abdominal muscles is a common instruction in singing as it assists in thediaphragmatic breathing required to power the voice. Diaphragmatic breathing is not onlythe sine qua non of singing but is also our only means of tapping into the otherwiseuncontrollable processes of the sympathetic nervous system such as sweating and pupildilation. The breathing that is required for singing is a powerful means of regulating thefight/flight response in trauma survivors. Those familiar with singing can use a number ofmeans to assist survivors in breathing from their diaphragm. Signs for the practitionerthat breathing from the diaphragm is not occurring include tension in the clavicle,movement of the shoulders, a puffing out of the upper chest, and a contraction of theabdomen during exhale. Instructions for diaphragmatic breathing are included on theaccompanying recording. Diaphragmatic breathing can assist an individual an entering a hypnagogic state, animage-rich waking state which precedes sleep onset and REM sleep. This state may beinstrumental in processing traumatic information, something that may be responsible forthe efficacy of EMDR in the treatment of trauma. A description follows:
  • 41. 35 REM sleep enables emotional processing, which is certainly paralleled in EMDR. Clients begin with feelings of shame or guilt and progress to anger, acceptance, or forgiveness. In addition, EMDR clearly process(es) experiential information, as is the case with REM sleep. That is why dream images seem to make perfect EMDR targets. For instance, one woman complained about a nightmare in which she was being chased by a monster through a cave. We targeted the image, and after a couple of sets, the symbolic overlay peeled off and she said, “oh, that’s my stepfather chasing me through my childhood home.” When a recurring nightmare image is targeted with EMDR, people generally uncover the real-life experience involved and process the incident, and the dream does not recur. (Shapiro & Forrest, 1997, p. 92) Furthermore, diaphragmatic breathing as a harbinger of the hypnagoic state allowsfor liminal, dual state of consciousness between waking and dreaming. Similar to RobertBosnak’s embodied imagination, Compose enables the user to enter the hypnagogic stateusing breathing to source images from the body, manifesting them into a dreamlike scenefor further exploration. Part three: Resonance. The breath work is continued on the recording while thethird part enlists the survivor in observing and describing energy in different areas of thebody; this requires use of the interoceptors. The recording guides the survivor inobserving the body from head to toe, asking him or her to describe in detail the sensationnoticed and then to give it a sound. This is a chance for the survivor to engage internally-derived touch and vibrate that tone against the areas that are storing the trauma. PeterLevine (2005) devised the following helpful list of sensations which can supports thesurvivor in generating a word to describe the sensations he or she is feeling as each toneis sounded: • Dense Thick Flowing • Breathless Fluttery Nervous • Queasy Expanded Floating
  • 42. 36 • Heavy Tingly Electric • Fluid Numb Wooden • Dizzy Full Congested • Spacey Trembly Twitchy • Tight Hot Bubbly • Achy Wobbly Calm • Suffocating Buzzy Energized • Tremulous Constricted Warm • Knotted Icy Light • Blocked Hollow Cold • Disconnected Sweaty Streaming (p. 50) The therapist can make note of these qualities in the chart found in the appendixwhile guiding the survivor to describe their sensations in detail. One of my initialhunches was that tone resonance, quality, and pitch can indicate hyperarousal, vigilance,and anxiety indicating possession by the trauma complex. Depending on the degree ofbreath and tension a patient is holding in the body (and thus the level of hyperarousal),tone, resonance, quality, and pitch are effective in obvious, trackable ways. Again, thetherapist here may be very interested in the word used to describe the sensation found inthe body, but much information can be derived from the sound, particularly the degree oftension in the survivor. While in this phase the survivor is noticing tension being felt, andthe therapist takes this report and also notes tension he or she can hear and see. A trained singer and therapist will recognize many signs of muscular tension but afew include obvious reports of soreness, pain, strain, fatigue, hoarseness, or losing the
  • 43. 37voice altogether. Otherwise, the therapist should be mindful of other cues of musculartension such as visible or reported tightness or redness of the muscles in the face, jaw,neck, shoulders, and upper chest as well as fatigue in these areas. Vocal tension can beheard through hard glottal attack during vocal onset, some pitch breaks, high laryngealposition resulting in a sound of reaching for the notes, and excessive medial compression,which can sound excessively loud and forceful (Colton, Casper, & Hirano, 1996, p. 78).The table below, adapted from Ingo Titze (1994) at the 8th Vocal Fold PhysiologyConference, can also be helpful for therapists in describing vocal qualities.Voice Quality Perceptionaphonic no sound or a whisperbiphonic two independent pitchesbleat (see flutter)breathy sound of air is apparentcovered muffled or “darkened” sound sounds like two hard surfaces rubbingcreaky against one another pitch supplemented with another pitch onediplophonic octave lower, roughness usually apparent often called bleat because it sounds like aflutter lamb’s cryglottalized clicking noise heard during voicinghoarse (raspy) harsh, grating soundhonky excessive nasalityjitter pitch sounds roughnasal (see honky)pressed harsh, often loud (strident) quality sounds similar to food cooking in a hotpulsed (fry) frying pan brightened or “ringing” sound that carriesresonant (ringing) well uneven, bumpy sound appearing to be unsteady short-term, but persisting over therough long-termshimmer crackly, buzzy effort-fulness apparent in voice, hyperfunction of neck muscles, entirestrained larynx may compress
  • 44. 38strohbass popping sound; vocal fry during singingtremerous affected by trembling or tremorstwangy sharp, bright soundventricular very rough (Louis Armstrong-type voice)wobble wavering or irregular variation in sound quality is akin to sounds made during ayawny yawn (n.p.) Part four: Range and images. The fourth part of the recording leads theindividual to return to each sound associated with a body part, toning from the lowestpoint to the highest point in one’s range. For example, if the sound of vrooom isassociated with the foot, the individual will be guided to sound that tone on the lowestnote possible all the way to the highest reach of the voice, finally sounding the tone oncewhere it intuitively feels “just right” and is most expressive of the sensation. This allowsthe therapist to see whether the survivor is moving through his or her full vocal range andshifting registers without breaks, indicating a tension-free placement of the voice thatallows for best use of the relaxed body as a resonant cavity. One of my initial researchlenses was that registration and range were affected by trauma since resonance and rangeare affected by tension. After noting registration and range, the therapist then asks if thereis an image associated with this sound. In this instance, say the image suggested is that ofa car. The therapist writes down this association on the chart in the appendix. Dependingon how prolific the survivor is with generating images and how emotionally activated theindividual is by this process, the therapist may decide to work with only a few images at atime so as to not overwhelm either party. Part Five: Embodiment and free association with the image. At this stage inthe session, there is a collaborative return to the images generated by the body and therecording is stopped to allow for the session to take its own pace. There are a number of
  • 45. 39ways the images can be worked with but this technique emphasizes the primacy of theimage and shies away from attempting to crack any code or get to some underlying issueor encrypted meaning. As in Gestalt dreamwork, a scene has been created by thecollection of images and the therapist and survivor enter the images and simply expressthe energy of the scene rather than searching for new insights or recovering oldmemories. For example, a session might begin like this: Therapist: When you were scanning your body, there were images of sparkles and a lamb that came forth. Can you tell me more about that? Patient: The lamb is small and white, very precious and sparkling. Therapist: So there is a sparkling lamb, does this lamb make a sound? Patient: Yes, the sound is like ting-ting-ting-ting. Therapist (mirrors): Ting-ting-ting-ting.After a few rounds of repeating the sounds, the image can lead to additional associations. Therapist: Does that ting-ting-ting-ting remind you of anything else? Patient: I guess it reminds me of a needle. Therapist: So we have an image of a needle and a sparkling lamb—can you say more about that? Patient: The needle is going to stab the lamb if she isn’t careful. Therapist; What does the needle sound like? Patient: That horror movie sound, you know, dum dum dum dum. Therapist: Dum dum dum dum—what movie is that from? Patient: I don’t know, I think it’s from that new picture out, you know, the one with the girl on the train. Therapist: I don’t know if I know that movie but tell me, in your imagination, what does a girl on a train sound like?
  • 46. 40The session may continue on like this and, simultaneously, the energy of the traumastored in the body is released with the sounding of each freely associated image. Themetaphorical storyline sourced from images from the body may also be related to theliteral storyline of the trauma. One of the initial lenses is that the voice is a symbol of Psyche, so as the voicechanges, Psyche is simultaneously shifting. As I worked through this process, cultivatingmy own cascade of images sourced from my body, I came to have a new appreciation ofwhat my trauma offered aesthetically to my life. Holding the tension of this beautyalongside the terrific horror of my trauma unifies the conscious elements of my woundsavailable to me and their unconscious aspects, realized only through sound. The mindsays the trauma is terrible but the psyche, through its own aesthetic and soulful lens, saysthat trauma brings beauty. From a Jungian perspective, healing occurs when one “entersthe conversation of opposites, lets each side have its say, endures the struggle betweenthe opposing points of view, suffers the anguish of being strung out between them, andgreets the resolving symbol with gratitude” (Young-Eisendrath & Dawson, 1997, p. 328).For a survivor to do this time and again may allow for the manifestation of Jung’s healingtranscendent function, one which “makes organically possible the transition from oneattitude to another, without loss of either one” (Jung, 1916/1972, p. 73 [CW 8, para.145]The survivor need not exonerate the trauma as terrible by praising its creative fruits—thebeauty and terror equally hold true, resulting in the synthesis of a third, transcendentview. An initial contention in research was that singing must be vocal but notnecessarily verbal, but my own heuristic self-searching with this process led to many
  • 47. 41moments of truly contented silence. Silence is certainly part of singing, and it isimportant to differentiate between the stamped-out muted survivor who is lost inalexythymia and one who is experiencing moments of silent repose. Ultimately, my hopeis that Compose will allow survivors to use their voices to arrive in the place wheresoundlessness is no longer a sign of shock, but rather relief.
  • 48. Chapter IV Summary and Conclusions Transformation of a trauma complex does not require the survivor to have a newmental concept of the traumatic experience, but rather, a new physical experience of thebody. This ultimately allows for the development of a new psychological framework.Jung understood: Psyche and matter interact much like water can become ice or ether—the body and psyche are two expressions of the same phenomena (1947/1970, p. 215[CW 8, para. 418]). To address the body is to address Psyche. Rather than insight alone,the patient must habitually have a new felt experience in the body. Over time, this allowsfor the interdependent responses of cognition, soma, and emotion to create a newframework, a new Gestalt, around the event. Most importantly, singing offers the traumatized person new sensations, but also anew embodied consciousness. The survivor can experience a sense of boundariedindividuality by discovering the unique resonance and timbre felt in the body cavity.Through singing, the body has a chance to move from the frozen, dissociative numbnessassociated with trauma toward awakened sensation and full expression. Most survivors of trauma enter therapy in some degree of the arousal state and, ifabused at the hand of another, will likely be stimulated solely by being alone in a roomwith a therapist whom they may not know very well. Thus, they are rapidly agitatedthrough the nervous system into archaic psychological defenses, making them
  • 49. 43impenetrable to therapeutic intervention. Singing is effective in these cases as a method of grounding. In Paul Newham’scomprehensive text The Healing Voice, he discussed the research of sound healer DonCampbell, who found that vocalization “can ‘directly and efficiently effect the limbicsystem,’ creating a positive ‘response within the hypothalamus,’” all of which are areasthat keep a trauma survivor stuck in the holding pattern of the trauma and the past (1998,p. 290). Singing offers a way to ground the organism in the present moment, re-regulatesensory response, and reestablish an awareness of being in the present moment ratherthan the past. Through the use of interoceptors and exteroceptors in singing, receptivity inthe organism can return. Naturally, the healing of trauma requires a re-regulation of body responses totriggers, and the sensation of touch is often a trigger, such as in the case of sexual andphysical assault survivors. However, this is often the most difficult task due to the intensehypervigilance of the survivor in the presence of another as well as the sanction againsttouch in traditional psychotherapy. Singing is a somatic modality that allows for sensoryconnection that is different from most. Singing can be thought of as internally derivedtouch rather than externally applied sensation, which can assist in re-establishing bodyconnection and re-regulating somatic responses in trauma survivors. Voicework offersthe opportunity for survivors to experience the sensation of touch from within their ownbody by allowing for the self-modulation of vibration and pressure through the use of thesinging voice. Furthermore, singing allows for breathwork, which assists in re-regulating thesystem and is a soothing behavior that was inhibited during the trauma. Hypervigilance is
  • 50. 44calmed through singing’s engagement with the breath and the body relaxation required tosing. Emotional expression is somaticized and expressed rather than intellectualized orrepressed. The voice is permitted its full breadth and range of authentic feeling where itwas once stifled and held back due to the silencing of the Broca’s area during the trauma.The body is sensed and felt from the inside out rather than objectified from the outsideinward and intellectualized. Each of these results addresses a phenomenon or symptomtypically associated with trauma and helps to repair the body-mind split in survivors. From this point, the survivor is able to freely associate between body sensationand imagery through song, which allows a sequence of images to be created, much like ina dream. In this method, the therapist allows for the further embodiment of these imagesthrough singing; the expression creates a new aesthetic experience around the trauma,inspiring the transcendent function. With the Compose method, the patient is able to holdthe tension of pain and beauty arising from unbearable trauma, which, in turn, results in anew transcendent view.
  • 51. Appendix AWorksheet for Therapists
  • 52. Body Part:Reported Sensation:Observed Tension:Sound:Image:Notes:
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