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InterPlay and Therapy

A Neurobiological Rationale for Using InterPlay in Therapy
By Sharie Bowman
June15, 2007
I. Introduction
                While attending the Evolution of Psychotherapy Conference held in Anaheim, CA in December 2005, I attended a workshop entitled “Frontiers of Trauma” given by Bessel van der Kolk. He showed brain scans of what happens in the brain when traumatic memories are being re-experienced. I became totally excited as he began to explain my life to me. He gave many details about why, physiologically, traditional talk therapy is not completely effective for people who have experienced developmental trauma. As he was talking I realized that he was giving a scientific explanation for my own experience with psychotherapy in which talk therapy often served to re-traumatize me as I recounted memories that brought up bodily sensations that I had no tools to manage and often found that I could no longer speak while experiencing these memories, resulting in the development of anorexia and severe depression. Following my intuition, I began to explore body-centered treatment modalities and eventually discovered InterPlay, which has gradually helped me heal many childhood traumatic experiences and begin to create a life that I enjoy living.
                Based on the Bessel van der Kolk’s and other neurobiologist’s research, as well as my own experience, I believe that a body-centered approach to treatment is not only warranted, but also necessary for adults who experienced complex trauma as children, to begin to heal. Complex developmental trauma is defined as the impairments that occur due to living with continuous exposure to domestic violence, neglect, or loss of caregivers as children. This paper explains the pervasive effects of trauma, explores the biological reasons that a body-centered approach to treatment is necessary and offers ideas for using InterPlay forms and philosophies to heal the effects of complex developmental trauma.
 
II. Biological Effects of Trauma
A. Neurological
In the article, The neurobiology of childhood trauma and abuse, Bessel A. van der Kolk, MD, explains how prolonged exposure to traumatic life experiences as in the case of domestic violence or child abuse, or chronic maltreatment such as neglect alters the child’s biology and places them at risk for many psychological as well as physical disorders as they mature.  
Often psychological distress is expressed in “problems with self-regulation, aggression against self and others, problems with attention and dissociation, physical problems, and difficulties in self-concept and capacity to negotiate satisfactory interpersonal relationships.” (van der Kolk, 2003, 293-294) Research has begun to show that many of these “psychological” problems could be attributed to changes in the child’s biology that have occurred due to attachment issues or inadequate parenting.    “The more children live in a disorganized physiological state (hyperarousal or detachment), the less they are capable of dealing with stressful experiences and the more likely their development is thrown off course by exposure to traumatic experiences.” (van der Kolk, 2003, 298)
In infancy the brain stem area responsible for breathing and keeping the heart beating functions on its own. Although these responses happen, it is noted that people with PTSD have resting heart rates similar to those of people who are responding to stressful stimuli. Regulation of the parasympathetic nervous system in infants requires assistance from caregivers and is a learned response. Gabor Mate, MD author of Scattered: How Attention Deficit Disorder Originates and What You Can Do about It insists that an emotional security and warmth in the infant’s environment are essential for the neuron-physiological circuits of self-regulation. The sharing of emotional spaces between an infant and his caregiver is known as attunement. If the mother is too preoccupied or experiencing stress, they are unable to give the baby the nonverbal cues that allow the baby’s brain to develop the neurochemical pathways for attention and self-regulation, which correlates to the symptoms of ADD in older children and adults. (Mate, 1999, 68) The parasympathetic nervous system plays a significant role in regulating affect. Recovery from stressful situations often requires a caregiver’s assurance to help the child regain balance. Without the support of a healthy caregiver the parasympathetic nervous system in the child does not come to homeostasis on its own, thus leaving the child in a constant state of hyperarousal. 
The amygdala is also affected by developmental trauma. The amygdala is the part of the brain that initially interprets experiences as threats and then sends hormonal signals to the rest of the body increasing the heart rate and blood pressure and activating the fight, flight, or freeze reactions. Thus the body reacts without a conscious decision from the cortex. Van der Kolk has done extensive research on the brains of people who suffer from PTSD. He has found
increased activation of the right amygdala…when reminded of their trauma, accompanied by decreased activation of the speech center of the brain, Broca’s area changes. When amygdala activation in response to sensory stimuli reminiscent of a trauma causes the misinterpretation of an innocuous stimulus as a threat, this precipitates inappropriate fight/flight/freeze responses. This causes this system to reaction to minor irritations in a stereotyped, totalistic manner, preventing learning from experience. (van der Kolk, 2003, 305) 
 
Because Broca’s area of the brain is related to speech, it is often impossible for a person to talk when reexperiencing their trauma. Some therapists have said that it is impossible to extinguish limbic reactions, which may be true if only using “talk therapy” which assumes healing happens when a person talks about their traumatic experiences. In reality only talking about experiences can retraumatize the individual because as they begin to talk memories surface that are as vivid as if it were happening in the moment. The physiological responses are the same as when the original trauma occurred. (Van der Kolk, 2002, 45)
                Another system associated with the amygdala that is often affected in children who have been physically abused or neglected is the vestibular system. 
The vestibular system, or balance system, is the sensory system that provides the dominant input about our movement and orientation in space...The vestibular system sends signals primarily to the neural structures that control our eye movements, and to the muscles that keep us upright. The projections to the former provide the anatomical basis of the vestibulo-ocular reflex, which is required for clear vision; and the projections to the muscles that control our posture are necessary to keep us upright. (Wikipedia: Vestibular System, 2006)
 
These children may have had to learn to be very still to avoid harm or not been given the stimulation needed to allow the vestibular system to fully develop. “The brain senses and responds to vestibular input long before we process visual and auditory inputs, and this vestibular activity provides some of the building blocks for the later development of seeing and hearing.”(Ayers, 1979, 70) Since the vestibular system is so essential to later processing of sensory information, disturbances in development can cause the person to react intensely or disordered in emotionally charged situations and have difficulties with self-soothing. 
Another area of the brain that is significantly impacted by trauma is the hippocampus, the part of the brain that plays a significant role in the ability of the person to remember life events consciously. Studies have shown that people with histories of severe abuse are vulnerable to developing smaller hippocampi over time, attributed to high levels of cortisol killing brain cells in this part of the brain. With this reduction, the effect seems to be that it makes it more difficult for people who have experienced trauma to learn from their experiences and children would likely display strong emotions in inappropriate contexts. (van der Kolk, 2003, 306)
The prefrontal cortex also is impacted by experiences of prolonged trauma. Children who have a breach in attachment to their primary caregiver are particularly vulnerable in this area because the function of the prefrontal cortex is developed through relating to people. In healthy environments, “Children learn to regulate their impulsive behavior by being able to anticipate the mother’s response to it. Neural development and social interaction are inextricably intertwined…the baby brain must begin participating effectively in the process of social information transmission that offers entry into the culture.” (van der Kolk, 2003, 307). Children need to feel calm to be able to learn and interpret social interactions accurately. When children are in a constant state of hyperarousal it alters the ability of the brain to discriminate between subtle differences and makes learning and problem solving very difficult. Antisocial and aggressive behaviors have also been attributed to underdevelopment in this part of the brain, which contributes to a lack of inhibitory control and is associated with violent acting out especially in adolescents. (van der Kolk, 2003, 307)
Research also has shown that there is a difference in the activity level of the right and left hemispheres of the brain in adults who were abused or neglected as children compared to control groups who had not experienced abuse when recalling a traumatic experience. The right side of the brain is significantly more active than the left side in people who experienced trauma as children compared to those who had not, whose brain activity was more balanced while recalling memories. Research also showed a difference in the corpus callosum, the connective pathway between the two sides of the brain. The middle part of the corpus callosum in boys who experienced neglect, and in girls who experienced sexual abuse, is significantly smaller than in people who have not had these experiences. Integrating information from both sides of the brain is a challenge for people who have had these experiences and the difference in the vermis, or narrow middle zone between the cerebellums, could be responsible for it. (van der Kolk, 2003, 308)
Teicher et al [8] found the vermis plays a role in controlling and quelling electrical irritability in the limbic system. It seems that the cerebellar vermis not only is important for postural, attentional, and emotional balance but also plays a role in regulating emotional instability. Teicher proposed that stimulation of the vermis through exercise, rocking, and movement may exert calming effects on traumatized children and adolescents. (van der Kolk, 2003, 309)
 
 
 
B. Muscular
Wilhelm Reich observed that when a simple organism, such as a worm, was subjected to poking it would contract and then gradually relax into its previous shape. As the frequency of the poking increased, it would take longer for the worm to reach relaxation. And if poked frequently enough and long enough the worm would begin to stay contracted, and its ability to relax fully was inhibited. The human body is similar to a worm in that it has a basic cylindrical tube shape with one opening at the mouth and the other at the anus. A similar physiological response happens when humans experience unexpected intense stimulus or startle response. (Reich, 1973, 275) Alexander Lowen, a student of Reich explains further:
When an impulse reaches a muscle, the muscle becomes set to act. If it is a voluntary muscle, the action is under control of the ego and can be restrained or modified by the conscious mind. Blocking the action creates a state of tension in the muscle, which is energetically charged to act but is unable to do so by the restraining command from the mind…if the insult or injury which provoked the anger continues as a disturbing irritant, the angry impulse cannot be withdrawn. This is true of conflicts between parents and children since the latter cannot escape a parent’s hostility. And in most cases the child has no means to discharge their impulse without provoking more anger and hostility form the parent. In this situation the tension becomes chronic and painful. Relief is possible only by numbing the area, rendering it immobile so that all feeling is lost. (Lowen, 1995, 13)
 
The breath gets held and the muscles contract. The muscles develop in the state of hyper vigilance. Often children are seen as uncoordinated and may fall or bump into things because their muscles are so contracted that their balance is off. This habitual contraction of the musculature Reich refers to as “armouring”.   Since the muscles are developing at the time the trauma occurs, they hold a muscular memory of a person’s experiences. Reich believed that “every muscular rigidity contains the history and the meaning of its origin.” (Reich, 1973, 300) Reich experimented with confronting the armouring, physically with psychiatric patients using a variety of hands on techniques. He noted that intense emotions often arose when the armouring was confronted, sometimes with visual or auditory memories or flashbacks to previous traumatic experiences. (Reich, 1973, 298)  
III. Psychological Effects of Trauma
                A. Memory
Trauma affects the memory of people, either with an extreme of remembering every detail in full sensory awareness or the opposite extreme of totally forgetting the traumatic event.
While people seem to easily assimilate familiar and expectable experiences, and while some memories of ordinary events disintegrate in clarity over time, some aspects of traumatic events appear to get fixed in the mind, unaltered by the passage of time or by the intervention of subsequent experience…traumatic memories may be encoded differently than memories for ordinary events, perhaps via alterations in attentional focusing, perhaps because of extreme emotional arousal interferes with hippocampal memory functions.(van der Kolk & Fisher, 1995, 5) 
 
While some people experience continuous recall of events, others experience amnesia or more global memory impairment. The amnesia may last for periods of hours, weeks, or years. In a study done of 485 people who had a variety of stimulus that created PTSD there was a noted correlation that when people experienced trauma at a younger age they were more likely to have significant amnesia. (van der Kolk & Fisher, 1995, 6) “Recall is triggered by exposure to sensory or affective stimuli that match sensory or affective elements associated with the trauma…Affect seems to be a critical cue for the retrieval of information along these associative pathways.” (van der Kolk & Fisher, 1995, 6) It was noted that people with histories of trauma tend to function well in life unless feelings similar to the ones of the traumatic event are stirred up, which may serve as a trigger for the brain to retrieve trauma-related sensations including fear, anger, longing, intimacy, and sexual arousal. (van der Kolk & Fisher, 1995, 6)
                B. Attachment
Children who have experienced developmental trauma often experience disorganized attachment. Because their primary caregivers have been the perpetrators of physical, emotional, or sexual abuse the child becomes confused as to the role of the caregiver.
In the first year of life, these dyads (parent-child) are characterized by unusual forms of communication from the caregiver. This communication has the quality of a ‘paradoxical injunction’ ‘Come here and go away’ is a mild version of this conflictual communication. These communications present a child with an unsolvable and problematic situation…these dyadic interactions involving parental frightened, disoriented, or frightening behaviors toward the infant are inherently disorganizing. (Siegal, 1999, 108)
 
If the parent loses control and attacks the child, the child often experiences fear or terror in the presence of the caregiver.   Often when the parent regains control they will attempt to apologize and draw the child close to them. The child becomes confused because they cannot use the parent to help them become soothed or oriented because the parent is also the source of pain. Siegal also explains that these infants learn to freeze into trance like stillness, which is the beginning of dissociation. Later in life these children grow into adults who have difficulties with regulating affect, social difficulties, attentional problems and cognitive impairment, along with symptoms of dissociation. (Siegal, 1999, 108- 109) “…the child has the double trauma of experiencing terrifying events and the loss of a trusted attachment figure. Terrifying experiences that have occurred early in life, during the normal period of infantile amnesia (before explicit episodic memory is available), will be processed in only an implicit manner.” (Siegal, 1999, 110) It would be impossible to treat these children with traditional narrative therapies that depend on verbal recalling of traumatic events.
                C. Compulsive Reenactment
                Another far-reaching effect of developmental trauma is the compulsive need to reenact the trauma. Since children have often witnessed or experienced a variety of trauma, the trauma becomes “imprinted” into their makeup. Often this is manifest in a variety of ways of acting out including fear of novel situations, aggression or sexual acting out that mirrors what was done to them, or uncontrolled emotional reactions.   Often people misinterpret what the children are saying by acting out and the children are further punished rather than treated with compassion. These children feel threatened by new stimuli and often see teachers or therapists as projections of their perpetrator. (van der Kolk, 2005, 7) This compulsion to reenact the trauma is clearly manifest by the pattern of the many women who grew up with domestic violence often choose partners who abuse. Those who avoid an exact reenactment often project the perpetrator onto loved ones and behave as if they are being abused, making it impossible to develop authentic relationships.
                D. Difficulties with Self-Regulation 
               The lack of capacity for self-regulation is usually the reason children who have experienced complex l trauma are brought in for treatment. The symptoms often include:
 
 “(1) a lack of a continuous, predictable sense of self, with a poor sense of separateness and disturbances of body image, (2) poorly modulated affect and impulse control, including aggression against self and others, and (3) uncertainty about the reliability and predictability of others, leading to distrust, suspiciousness, and problems with intimacy. They have distinct alterations in states of consciousness, with amnesia, hypermnesia, dissociation, depersonalization, and derealization, flashbacks and nightmares of specific events, school problems, difficulties in attention regulation, with orientation in time and space, and they suffer from sensorimotor developmental disorders.” (van der Kolk, 2003, 298-299) 
 
The multitude of challenges these children face make growing up and learning basic life survival skills very difficult. Most of their relationships are strained due to their behaviors. Making friends is often impossible. These children must navigate life without the benefit of family or social support systems.  
III. Spiritual Effects of Trauma
Often children who live in challenging circumstances turn to God for solace. A child’s prayer of “Help me God!” or “Please don’t let them beat me again” is offered up to a God who seems to turn a deaf ear to the child’s plea. The child can become bitter toward any concept of God or Spirit, especially one that includes a God who is in the image of the abuser. Often children develop a concept of God that mirrors their parents who may be vengeful or angry, always waiting for the next opportunity to abuse them, thus fulfilling the compulsion of reenacting their trauma in their relationship with God.     These concepts of God carry with them into adulthood where they may be constantly searching for God as a projection of parent who may have abandoned them. The child may feel separate from others and wonder why God chose to put them in a family that was so difficult while others seem to have an easier life. Often this causes them to believe that they are inherently evil or that God loves them less than other people. Trust is a constant issue for people who have been traumatized and a major focus of many spiritual traditions is having faith in “God”. This may be nearly impossible for someone who has had to be hypervigilant. They may constantly be reaching for “God’s approval” when really they just wanted their mother and father to love them. Many people who were abused as children develop an unhealthy religious addiction. (Booth, 1991, 91-120) Because of the alterations in the brain and limbic system changing these belief systems like any other learning from experience is extremely challenging.    In a book entitled Healing the Whole Person, Merwin and Kurtz explains:
Spirituality is a state of being fully alive and open to the moment. It includes a sense of belonging and of having a place in the universe. A deep appreciation of the natural world, and openness for surprise, gratefulness for the gratuity of everything, joy and wonderment are all a part of spirituality. Although spiritual growth is a type of healing form which most of us could benefit, a victim’s sense of spirit may be acutely dimmed for a period after the victimization.
                Over time, time however, as the victim heals in all areas, the potential for spiritual growth may become greater than ever before and greater than for many people show have not face the reality of their individual death. (Ochberg, 1993, 10)
 
The impact of developmental trauma creates challenges on all levels of a child’s being because the brain is impacted in so many ways; therefore interpretation of all life experience is through a trauma filter. 
IV. Trauma Treatment
 
                Because the effects of trauma are so pervasive and physical, the treatment for trauma must also encompass a wide range of modalities. Simply talking about trauma and its symptoms does little to inhibit the continuing rash of symptoms. Talk therapy is clearly not enough to help someone recover from complex trauma especially since the part of the brain necessary for verbalization is often not active while remembering trauma. Because the brain and nervous system have been affected in numerous ways the challenge of healing trauma can be difficult. In the Waking the Tiger: Healing Trauma leading trauma treatment expert Peter Levine explains “If we attempt to treat trauma head, on it will continue to do what it has always done—immobilize us in fear.” (Levine, 1997, 65) Van der Kolk suggests that many trauma victims suffer from anxiety, which would best be treated with “training in deep muscle relaxation, control of breathing, role playing and yoga.” (van der Kolk, 2002, 47) A study done questioning the efficacy of body-oriented therapy for women who had been sexually abused as children demonstrated “improvement for both the massage and body-oriented therapy groups, which provides preliminary support for the efficacy and effectiveness of body therapy in recovery form childhood sexual abuse.”(Price, 2005, 13) Because the philosophies and forms of InterPlay encompass the whole person, body/mind/spirit/heart using body wisdom practices as well as storytelling, singing, and movement, areas of the brain that were affected during childhood developmental stages are challenged to grow and change. People are able to use the InterPlay playground as a microcosm for life and have experiences of healthy interactions with people that they may not have experienced as children making InterPlay helpful and effective in treating adults who have experienced developmental trauma. 
 
Treating Complex Trauma with InterPlay
 
 “Instead of attacking problems…Play welcomes woundedness without making a huge deal out of it all. Play concentrates upon and elevates wholeness rather than weakness…Play heals in part because it takes the pressure off what hurts. Our bodies love to create. Play activates the best in us for nothing but recreation. In recreation we are created anew. Our creative energy, like a tide of health, sweeps our challenges in the direction of well-being.” (Winton-Henry, 2004, 182)
 
InterPlay is particularly helpful in treating children and adults who have experienced complex developmental trauma due to continuous abuse, neglect, or death of primary caregivers. Recent brain scan technology has revealed differences in midbrain and brain stem areas of people who have experienced complex trauma. I propose that symptoms related to these changes can be addressed through InterPlay and that healing of those areas of the brain can occur through the practice of InterPlay. Some of the symptoms associated with complex trauma and the benefits of InterPlay exercises that I’ve experienced and observed in my child and family therapy internship and working with private clients are outlined below.  
 
Complex Trauma Symptom
InterPlay’s therapeutic modality
Explanation
Self-Regulation
All exercises may evoke emotions of joy, sadness, pain, delight, etc.
Following and leading, Affirming Internal Authority while allowing another to lead.
Because InterPlay exercises shift quickly, it allows an opportunity to move through a variety of emotions and not stay stuck in any single emotion. Children who have lived in an out of control environment often struggle to follow another person’s direction. Following and leading gives opportunities to practice. Exercises between parents and children help over authoritarian parents to become more flexible and children to follow with less power struggle.
Attention
Witnessing, Affirmation, Practice focusing on instructions for new exercises. Pace of the class.  
Because something new is being called forth in each exercise a person must stay focused and develop their ability to pay attention. The exercises move at a quick pace and require constant awareness. Parents often are distracted and not paying attention to their children. InterPlay exercises can teach parents how to offer a container of affirming presence for their family.
Dissociation
Big body stories, DT3’s, babbling with affirming witnesses
When people who have experienced trauma are able to tell the story to an audience, creativity allows expression of the experience and some distance from the experience so they can stay in the present without dissociation because the witness provides anchoring.
Self-concept
Affirmation, contact, ability to connect and communicate, witnessing and being witnessed.
New neuro-pathways are created in the brain that allows the self-concept to change as people experience contact and being seen in a loving environment. Often people who have experienced complex trauma have experienced touch in unhealthy ways. InterPlay offers an opportunity to learn that touch can be healing and healthy.
Interpersonal Relationships
Noticings, witnessing, interacting through movement, babbling
Because of the structured nature of InterPlay forms people are given opportunities for interaction that would not happen for people who struggle to have relationships.
Attachment/ Attunement
Hand to hand contact, contact duets, Following and leading, Walk, stop, run, witnessing and being witnessed
Mirroring is important in the process of attachment. Opportunities to join or be joined by another and to be seen and offered compassion help build the capacity for attachment. Parent-child hand to hand contact is very helpful in strengthening the attachment bond. Attunement is learned through exercises that require people to focus on the other, matching, complementing, and regulating in regard to the other. 
Fight, Flight, Freeze Response
All forms are taught Incrementally
Because InterPlay exercises are taught in incremental steps the amygdala’s signals are moderated gradually and become less threatening.
Verbal Expression
Babbling, Big Body Stories, DT3’s
Because Broca’s area (speech center) of the brain is unavailable during trauma speaking is often difficult. Words are more available without pressure or when combined with movement.
Interpretation of social cues, lack of inhibitory control
Practice interacting in group setting. The balance of structure and freedom to create contains many challenging behaviors.
 
Right brain over-stimulated when recalling traumatic events
Solo-witness dance, DT3, Big body story
Short time of exercises allows a person to dive deep but also requires quick rebalance back to homeostasis.
Difficulty Integrating Information from both sides of the brain
DT3, Big Body story
These exercises engage both sides of the brain and can prevent emotional flooding.
Difficulty learning from experience
All forms
Repetitive nature of exercises allows people to grow at their own pace and learn gradually.
Electrical irritability of limbic system
Warm-up, movement patterns, one hand dance
Helps induce a feeling of calmness, balance, and openness.
Habitual Muscular tension, shallow breathing, lack of coordination
Warm-up, movement patterns, WSR, one-hand dance, breathing, having stillness, interactive movement
Muscles relax, breathing becomes deeper, coordination becomes smoother.
Hypernesia/amnesia
Potential stimulation of sensory triggers that allow for a new experience and memory to be encountered
 “Recall is triggered by exposure to sensory or affective stimuli that match sensory or affective elements associated with the trauma…Affect seems to be a critical cue for the retrieval of information along these associative pathways.” (van der Kolk & Fisher, 1995, 6) 
Compulsive Reenactment
 
Group setting becomes a microcosm for potential for reenactment in a safe environment and allows person to realize they have the ability to make new choices.
Spirituality and trust issues
Group setting, community building value, experiences of being affirmed
Creative process allows for moments of grace. Spiritual disciplines that build internal authority, affirmation, witnessing, practicing “I can do that”.
Severe anxiety
Warm-up, reminders to take a breath, incrementality
Van der Kolk suggests that many trauma victims suffer from anxiety, which would best be treated with “training in deep muscle relaxation, control of breathing, role playing and yoga.” (van der Kolk, 2002, 47)
 
 
 
 
Combining InterPlay with writing reflections between sessions is particularly helpful to create the reflective loop that allows people to learn from their experiences and integrate the experience of the group microcosm into the rest of their lives.
                At the Trauma Center in Boston, the therapists collaborate with various theater groups to work with traumatized inner-city children.
Theater is used as a way of dealing with, narrating, and transforming their traumatic experiences—both by sharing their experiences and by finding ways of coming to an alternative resolution to the once-inevitable outcome of the original traumatic event. This work is predicated on the notion that to overcome a traumatic experience, one must have a physical experience that directly contradicts the helplessness and sense of defeat associated with the trauma.” (van der Kolk, 2002, 46) 
 
InterPlay consists of vocalization or singing, movement patterns, story telling in community to bring people together and allow them to tell their stories using their whole bodies in an affirming environment. The exercises change quickly and often involve shifting emotional states quickly. This process gives people new experiences that can help them learn to regulate affect and create new possibilities for attunement and attachment altering their neurochemistry. In the storytelling process, people gain perspective on their stories, are witnessed, and are able to share in the stories of others. (Winton-Henry, 2004, 181)
Betsey Beckman, InterPlay leader, trainer for a spiritual direction and creativity program, and movement therapist suggests that creative expression can also help heal the spiritual aspects of trauma. 
The creative path can open a fountain of expression for deep human emotions and spiritual longings that are not easily put into ordinary conversation.  Dances, songs, stories, poems, prayers, and artwork all have the potential to help a survivor give expression to deep pain, and can be especially effective for pre-verbal experiences as well.  These creative outpourings can also help to clear a space within for possibilities of healing to arise. 
 
Creative modalities can be deep enough to speak the truth in symbolic and artistic ways, but the next step is for those expressions to be received and honored.  When the truth is received within the therapeutic/spiritual direction relationship, the possibility of right relationship (with the other and with God) can begin to grow.  The therapist or spiritual director can model and embody the possibility of a God who cares enough to be present to the healing journey in a world which includes deep human suffering. Through this process, as a sense of well-being and energetic flow are restored within the survivor, possibilities of connection, soul, receptivity, relationship and spirit open.  As the journey unfolds, creative modalities can also be the welcome vehicles for expressions of forgiveness, awe, joy, humility, grace and thanksgiving.  (Beckman, 2006) 
 
Dance and movement therapy is another part of InterPlay. Using the body to access unresolved feelings and learning to listen to the impulses of the body are two main goals of dance and movement therapy.
 “The feedback process between movement and feelings is an essential ingredient of expressive movement. When you understand this movement becomes a vehicle for releasing feeling, which is essential in the healing process. Repressed or incongruent emotions shut down the immune system, causing pain and illness. We are working toward expression and congruency, and understanding movement and feelings in a constantly circulating feedback loop facilitates this process.” (Halprin, 2000, 24) 
 
InterPlay also directly addresses disturbances in the vestibular system and helps create balance. 
 
                Van der Kolk suggests: “Imagining new possibilities, not merely repetitively retelling the tragic past, is the essence of post-traumatic therapy.”(van der Kolk, 2002, 49) Using InterPlay therapeutically can provide the container for new possibilities to emerge.
 
V. Conclusion
In general, traumatized people respond to the world differently than those who have not experienced trauma. Their neurobiology has changed as a result of their developmental trauma. Their bodies are ready for survival even when there is no real danger around them. 
At the core of the posttraumatic symptomatology is the tendency to remain biologically ‘fixated’ on reliving the traumatic past and shut oneself down for new experiences that might provide restitution and resolution. Learning from experience is only possible when children are in a physiologic state that allows them to consider new possibilities. (van der Kolk, 2003, 309).
 
Because the brain stem, limbic system and midbrain have been most dramatically affected by the developmental trauma, traditional therapies that rely heavily on words or meaning seem to do little to help change the neurobiology of the adult who has experienced developmental trauma.
 Parents and teachers do not necessarily help children deal with extreme stress by talking or drugs, however, but by providing a physical sense of safety, including holding and rocking, and demonstrating when the child’s own resources fail, someone else is there to take over to reestablish a sense of safety and predictability. In the absence of such soothing presences, children are likely to demonstrate difficulties with cognition, impulse control, aggression, and emotion regulation. (van der Kolk, 2003, 309) 
 
Van der Kolk, leading researcher on PTSD and complex trauma in children believes the most appropriate therapy for children who have been traumatized involves helping the child learn how to feel safe physically by providing a safe, consistent environment that allows the child to learn how to regulate their arousal. Once they are able to regulate their arousal they will be able to tolerate and learn from new experiences and gain a sense of accomplishment and self-mastery. He believes these children need to learn to focus on activities without becoming disorganized so that they can learn to relate to other children. Once these children begin to feel safe they can begin to express their experiences of trauma through drawing or play acting which begins to give them an objective distance between their past experience and current reality. Eventually they may be able to express their feelings in words or use their imaginations to change the outcomes of some of their memories or fears. He recommends body focused therapies to help children coordinate and integrate their bodily perceptions and overcome problems with their vestibular systems. They need to have experience with pleasant bodily sensations that signify safety. (van der Kolk, 2003, 311)
The body tells the story—with striated muscles—in action or smooth muscles—as psychosomatic problems. The task of therapy is to help these children develop a sense of physical mastery and awareness of who they are and what has happened to them to learn to observe what is happening in present time and physically respond to current demands instead of recreating the traumatic past behaviorally, emotionally, and biologically. (van der Kolk, 2003, 311)  
 
                Without treatment these children grow up to be adults who also struggle to with the same challenges as the children. Adults who experienced complex trauma as children will also benefit from body-centered treatment. InterPlay provides an environment for adults to have new experiences and challenges, stimulating their brain in new ways that can allow healing to occur. 
 
                 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Appendix A:
 
Specific Ideas for Using InterPlay in Therapy
By Sharie Bowman
 
Here are some specific ways that I’ve used InterPlay as part of my therapy practice.
 
  1. Warm-up to help anxious/traumatized client shift from sympathetic to parasympathetic nervous system allowing them a feeling of calm. They are then able to work on anxiety producing issues because they have a tool to help them restore calm.
  2. Following and leading…in family relationships to help support renegotiating “whose in charge” deals in families. I used it with a previously drug addicted mother and her 8 year old daughter. The daughter was used to being in charge and the mother was attempting to regain control. Playing with the issue allowed more freedom to shift leadership. I’ve also used it with couples who are struggling to help each other with projects or take the lead in their families. 
  3. Babbling   Babbling works well with children and teens who come to therapy reluctantly and don’t have anything to talk about. It’s also helpful to support couples in learning to listen and pay attention to each other. 
  4. Gibberish Gibberish is great to access stuffed emotions… Use a made-up language to describe a stressful situation. For couples, one person comes up with a language to talk about their children…the partner’s job is to try to talk in same language about the topic. Builds attachment/connection as the couple has the experiences of really listening to understand each other making eye contact and having a new experience of being present with each other.
  5. One hand dance—teach to single client as a mediation/relaxation device. Also could put worry or deal in hand and let it dance and see if something new emerges. 
  6. Hand to hand contact—builds attachment bonds between couple. Gives them a playful, non-sexual physical way to communicate taking pressure off difficult issues and helps them have a new physical experience of communicating. I often invite evil twin to the situation and the couple begins to see smiles on each other’s faces that they haven’t seen for a very long time. 
                        Also helpful between a parent and younger child (under age 8) to help parent really see and play with the child…strengthens the relationship and gives a new experience of how relationship could be.
  1. Solo-witness dance—Use with clients to access Unconscious conflicts and resolutions. It can be especially helpful for clients who find word difficult due to trauma in their childhood (when they are ready for it.)
  2. Big-body stories about childhood deals. It’s often helpful to have client talk from child’s point of view about what happened…and then do a story of redemption…what did the child want to have happen? What could be a better ending? It can work with dreams as well. 
  3. DT3   Often a client will begin with something that is challenging them…but by the end they have some resolution to their issue.
  4. Toning/and or singing helps balance the two hemispheres of the brain and can bring someone back into balance if they get too dissociated.
  5. Having Stillness gives a client an experience of stillness and breath beyond all of their “mind chatter”. It can be a helpful tool for future anxious moments.
  6. InterPlay body wisdom tools are helpful to give clients reframe situations.
  7.  Exform group—I often structure many of these experiences in a group InterPlay setting specifically focused on working through personal issues through using InterPlay forms.
 
All of these exercises can be used in individual therapy or if used in a group then the group can process the experience for the rest of the session. It’s also helpful to use regular InterPlay as a microcosm for the rest of life and write about how interactions are similar to childhood issues…and work them through with the new group of people. 
 
 
 
 

 
 
References
 
Ayers, A. J. (1979). Sensory integration and the child.Los Angeles, CA: Western     Psychological Services.
Beckman, B. (2006). Email correspondence to Sharie Bowman received May 28, 2006. 
Booth, L. (1991). When god becomes a drug: breaking the chains of religious addiction     and abuse. Los Angeles, CA: Jeremy P. Tarcher, Inc.
. Halprin, A. (2000). Dance as a healing art: returning to health with movement and          imagery. Mendocino, CA: Life Rhythm. 
Levine, P. A. (1997) Waking the tiger: healing trauma. Berkeley, CA: North Atlantic           Books. 
Lowen, A. (1995). Joy: the surrender to the body and to life. New York, NY: Penguin         Books.
Mate, G. (1999). Scattered: how attention deficit disorder originates and what you can     do about it. New York, N.Y.: Penguin-Putnam. 
Price, C. (2005). Body-oriented therapy in recovery from child sexual abuse: an efficacy    study. Alternative Therapies in Health and Medicine. Aliso Viejo: 11(5), 46-58.
Ochberg, F. (1993). Gift from within: posttraumatic therapy. Retrieved May 2, 2006 from             http://giftfromwithin.org/html/trauma.html.
Reich, W. (1973a). Function of the orgasm. Newly translated by V. R. Carfagno.      Wiltshire, England: Condor Book Souvenir Press.
Siegal, D.J. (1999). The developing mind. New York, New York: Guilford Press.
van der Kolk, B. (2005). Developmental trauma disorder: a new, rational diagnosis for      children with complex trauma histories. Retrieved on May 26, 2006 from      http://www.traumacenter.org/PsychiatricAnnals3a.pdf.
van der Kolk, B. A. (2002). In terror’s grip: healing the ravages of trauma. Cerebrum, 4,          New York, NY: The Dana Foundation, 34-50..

Winton-Henry, C. (2004). What the body wants. Kelowana, BC, Canada: Northstone          Publishing.


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