Tami Simon: You’re Listening to Insights at the Edge. Today I Speak with Peter Levine and Maggie Phillips. Maggie Phillips Is a Licensed Psychologist and Currently Serves as Director at the California Institute of C

a threatening situation, such as being frightened by a loud sound. And again, they go through the whole day regulating their level of tension through stretching and through other similar kinds of movements, gentle shaking and trembling, and again, people don’t know that this is actually helping them come back into equilibrium, come back into inner balance. They fight against it. And guiding people through this, they get to say, “Oh my gosh, the thing that I was frightened about is exactly the thing that’s making the tension and the pain disappear.”

TS: Now, you introduce a term in the Freedom from Pain approach that I think is really interesting: the term “self-regulation.” And in the book, it states, “Self-regulation is the cornerstone of our approach.” So can you explain to me what you mean?

PL: What goes up will come down. Animals are threatened on a routine basis in the wild. A predator is always stalking prey, and prey is always trying to get away from a predator to not be eaten. And what happens is after an encounter—well, in a successful encounter—the prey animal, let’s say a rabbit, runs away and escapes from the coyote. But another thing is possible, and you see this, for example, with an opossum, because the opossum doesn’t really have the speed to escape, so what it does is it “plays opossum.”

Well, it’s not playing opossum. It’s a profound physiological response that actually inhibits the aggression and the eating behavior of a predator. So in other words, instead of running, this charge, this energy, this arousal, it goes into this shock response, this immobility response. But the nervous system is still supercharged. It’s sort of like our brake and our accelerator. Our accelerator is going on at a hundred miles an hour, and we have the brake put on at the same time, so it keeps us paralyzed.

But underneath the stillness of the coyote, of the opossum, underneath this stillness is this tremendous arousal of the fight-flight fear, sympathetic adrenal response. And so the animal has an innate ability—and so do we because really, ultimately, we are animals—to discharge that aroused state and to bring us back to equilibrium so that we don’t take that into the next day or even to the next moment. So we always go back to neutral; we always go back to balance. This is built in; it’s innate. That’s what self-regulation is about. And, as I said before, many people have learned to not trust that. We help people learn to re-gather trust for these mechanisms, which will take them back into healing.

MP: Right. And the example I gave earlier about the young man with the back problem—one of the things that he learned to do was to regulate not only his fear, but also the kinds of movements that he was doing. I asked him to show me some of the movements. For example, you learn a lot by asking someone, “Well, have you been given exercises for recovering from this surgery?” or whatever they’re dealing with. I asked him to show me what are some of the exercises, “Show me one exercise that you usually do.”

And he showed me, and he was moving so quickly, and with jerky motions, that I knew there was no way that the exercise was really doing him much of any good because he wasn’t really connected to his body experience. So I helped him learn. I said, “Let’s see if we can find a feeling of balance in your body as you’re doing the exercise, even if you just do one little part of it. Let’s find out what difference it makes.” So I had him slow down his movement and make it very intentional instead of like a reflex, like being afraid to touch a hot stove, and you draw back quickly. That was the kind of movement he was making.

As he slowed down, and we added in some breathing, and some rhythmic breathing, that helped the movement become more smooth and easy. After about two or three minutes, he says, “I haven’t felt like this in months.” He says, “I certainly haven’t felt like this since the surgery.” I said, “Well, what are you learning right now that may explain that?” He said, “Well, I can see I am not connected with my body. I’m not working with my body at all. I’m not even in my body.” So that’s what we found that a lot of people need help with is the simple practice—and it’s an early exercise in our program—of reclaiming and reinhabiting our body.

TS: Have you ever encountered people who were in such dire chronic pain that you couldn’t help them at all—that they were beyond help?

PL: I can’t think of any that were beyond help. No. I mean, in over 40 years, there have been cases where a surgery had to be done. Even when surgery is necessary, you still can help reduce the pain somewhat and also help increase their recovery after the surgery. But especially when there wasn’t a tissue damage site, not everybody is completely free of pain, but I can’t think of anybody that was in such pain that they weren’t able to get some significant relief.

MP: Yes. I would agree. First of all, I just categorically don’t believe that anyone is beyond help. They can always learn something from what we are offering them. Why? Because it makes sense to them once they understand what’s going on. And understanding what’s going on, as we’ve been explaining in this interview, gives them a sense of empowerment. It gives them a sense of choice. So, they may decide to go on with the surgery with the understanding that they can use the tools that we’re teaching to help them recover from it if that’s what the best choice is for them.

Now, there are a couple of people that I have found very difficult to work with. That’s a different issue. There are some people who really, I believe, have had attachment or relational trauma very early, so their problem is they can’t trust anyone to help them. They want desperately to believe that someone can give them some tools that will really make a difference or that somebody cares enough about them that they want to try to help them out of pain. But for their own good reasons, in being traumatized and abused, it’s very hard for them to persist long enough against the fear that they have about trusting you, that you’re not going to be one more person that lets them down or manipulates or exploits them in some way.

And so when we get into cases like that, it’s much more complex. But I don’t ever believe that anyone is beyond help, and it’s very important, I believe, to keep trying to repair the relationship that you’re forming with the person at the same time you are offering them tools. You can’t just be a mechanic. Neither Peter nor I believe in that at all. We put as much thought and care into the relationship as we do into the tools we’re teaching.

PL: And we’ve tried to convey some of that feeling in the program itself. So even though obviously we’re not seeing each person individually, we try to convey that kind of openness and invitation to people because, like we said at the beginning, people with early trauma can tend to have higher instances of chronic pain. And these are people who have not been understood, or not been cared about, or [have] people who have given up on them in the past. Obviously, this doesn’t in any way substitute for individual therapy, but it certainly can be a very helpful adjunct. It can be something that both clients and therapists can use to help continue the therapy outside of the individual session work.

TS: Now, I’m going to take this just a little bit further because I have personally known people who have really suffered from chronic pain, and I’m imagining one of those people listening to our conversation and feeling, “You know, I just feel like my situation is hopeless. I’ve tried for so long, and now a book-and-CD is going to help me? A series of exercises are going to help me? I just don’t buy it. I’m just in pain.” What would you say to such a person?

PL: Well, helplessness is a characteristic of trauma. And so when we help people begin to—and we have a chapter on depression—to move out of helplessness and depression, then, you know, it’s kind of like, “OK, if it’s a cloudy, rainy day, there’s nothing you can do, if you want sun, except to wait for it to change.” And so we have this mood of resignation and depression.

Well, actually, if we can do something that can change the depression, then the light on the problem will be different. Now, look, I don’t think anyone who has had chronic pain doesn’t at some time feel, myself included, “I’m never going to get better. This is going to go on forever.” It’s a normal part of the process. But again, if we can help people deal with the resignation, then they have a brighter light to shine on the problem and on the tools that might be able to help them. Now, some of the tools—and we’re very clear about this—won’t work for you.

But we have given, hopefully, a number of tools that—at least some of them will work for most people. Hopefully, something will work for everybody. The only thing we could say is, “Look, we hope you give this a try. Of course, it’s not a guarantee.” And it’s something that—in our total 80 years of clinical experience, we’ve found that these kinds of tools are helpful. And we sincerely believe that they will be helpful as we present them here, not for every single person, as much as everybody would want, but I think that most people can get something out of the program.

MP: Yes. I tell people that my job is to help them find at least one tool that they haven’t been able to find or to use successfully before that really makes a significant difference in their pain. And I take that really seriously as a challenge with each person that I work with. And that’s our challenge with people who are going to consider the Freedom from Pain program—is that we believe that we have put together the best of our thinking, the best result of 80 years of combined clinical practice of things that have worked with people that have never had hope before in many cases. We teach people to try something once. The very first possibility and invitation is “Are you willing to try this one tool to see if it can make a difference?” And if it doesn’t, move on, because there are at least probably 40 more tools in this program, and one of them is going to work for you.

So it really is a question of helping people feel empowered and also teaching people that a lot of this is about choice. The choice is not about being in pain. That’s not what we’re saying. We’ve had a lot of people that have had terrible things happen to them, and it’s amazing that they’re still alive. Their suffering is overwhelming, and we have great empathy with that. However, it is a question of choice about what they are willing to try, about what they’re willing to experiment with. And on the basis of those experiments, we are able to learn, as they learn, what happens as they encounter the tool or work with the tool, and then we can modify it. We can modify it so that the tool begins to work in a more and more effective way.

And so really, we’re not telling people that we’re miracle workers. Far from it. We’re just saying we believe in the tools, and we believe in the method, and we want you to find one thing that will work for you.

TS: Now, Peter, you said something very interesting: that hopelessness, depression is actually part—is intrinsic to the trauma experience. Can you explain that?

PL: Yes. Well, look at the opossum. The opossum goes in this immobility response where it’s motionless. Then when the coyote goes off and goes away, it comes out of this and goes off to finish its day. Now, humans go into this immobility response, but we sometimes find it more difficult to come out of it. And the experience of this immobility response is of helplessness. It is of helplessness.

So as people learn to actually complete this and to come back into life, then the helplessness is reduced. So helplessness, you could say, is a psychological component or a psychological aspect of the biological immobility response, which we share with all mammals. Actually, we share it even with many insects. This is a very powerful survival response.

But if we get stuck in it, we don’t come out of it. Instead of perceiving that we feel immobile and that that’s a physical thing in the body and that it can change, we tend to psychologize it as feeling helpless. When we can change the physiology, then the psychology will follow.

MP: Just another word about this is that I think most people are familiar with “fight, flight, and freeze.” They know that these are the three survival responses that we have inherited as animals on this earth. One of the things that we do is to educate them as to which symptoms, so to speak, are connected to each of those incompleted or thwarted responses. In other words, unlike the animals in the wild, we can’t keep running and running and running away from a danger. I mean, how do you run away from a car accident if you’re involved in it? You can’t. How do you run away from somebody who’s trying to abuse you? Fight back? You can’t complete the fight response because of the same kinds of issues. But freeze—like Peter was saying about the opossum—that is the only avenue that’s left open to human beings in many cases.

And so we educate people about this, and we tell them that if you’ve been in the freeze response for a long time, and it’s been held in your body as this huge constriction and immobility, then you are going to go into a state of collapse and frozenness at the emotional level that takes the form of depression. At the physical level, it can take the form of massive constriction that creates terrible pain that you don’t get relief from. So I think that education is really, really important for people to understand that.

PL: Yes. Because out of education comes self-compassion because when you see that there’s a reason, you first of all have more compassion—there’s less self-blame, and second, it gives you a clear pathway or some pathways to explore to come out of this and to return to reregulate, to find our inner balance again.

TS: We started by talking about the puzzle of pain and how it’s a lot more complicated than somebody might think at first. It’s not just, “I’m in physical pain, and I need someone to fix my body.” I think this conversation has helped underscore, highlight, and show the complexity of the puzzle of pain. So here, as we’re coming to a conclusion, if you had to summarize what you think the keys are to solving this puzzle for an individual, if you could just give them a small key ring of the most important keys to solving the puzzle of pain, what would be the keys on that key ring?

PL: First would be that one size doesn’t fit all. The tools that work with one person may not work with another. And to be open to explore different possibilities.

MP: The second key might be healing through the body, that we understand that you’ve disconnected from your body—for good reason—as an attempt to regulate the suffering you’ve had that just feels unbearable. And yet, the challenge is to find out how a connection with your body can make all the difference, can bring you into contact with resources that you’ve never found before.

PL: And that there are tools that can help us befriend, re-friend, our bodies and begin to come out of the pattern, the body patterns, the tension patterns that are actually generating a significant portion of the pain, if not the entire pain.

TS: Wonderful. Maggie Phillips and Peter Levine summarizing solving the puzzle of pain with three keys. Thank you so much for that terrific summary and mostly for the important work you’re doing and for the program you’ve put together: Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain. It’s a book and a CD of guided practices, a self-guided program that people can work with in their own way to overcome physical pain. Thank you both so much.

PL: By the way, thank you, Tami, for [helping] us until we finally did it.

TS: Wonderful. That was a great conversation. Peter Levine has also created a series of audio programs with Sounds True on Sexual Healing: Transforming the Sacred Wound, and a program for guiding your children through trauma called It Won’t Hurt Forever. He’s also written a book that also has an accompanying CD, Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body.