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Behavior:
Client presented with noticeable physical tension, including raised shoulders and tightly crossed arms. Client reported experiencing body-based reactions such as a tight chest, shallow breathing, and shaking hands, which occur even when not consciously thinking about past trauma. Client stated, "I don't even have to think about the details, my chest just gets tight and I can't breathe right." Client described a persistent sense of threat manifesting in her body.
Intervention:
50-minute session conducted in the office. Therapist explained how the body retains trauma and how physical sensations are part of the nervous system's protective response. Therapist guided client through orienting exercises, such as noticing five visible objects in the room, to establish a sense of safety. Grounding techniques were introduced, including focusing on the sensation of feet on the floor and the chair's support, with pauses to track and explore sensations like chest tightness. Interventions aimed to help client build tolerance for these sensations without becoming overwhelmed.
Response:
Client engaged in the exercises and demonstrated progress during the session, as evidenced by her shoulders relaxing and her ability to track sensations without becoming overwhelmed. By the end of the session, client reported feeling "a little less stuck in it," indicating a reduction in distress and increased capacity to remain present with her physical sensations.
Plan:
Client is assigned homework to practice orienting and grounding exercises daily, particularly when noticing body-based cues of threat. The next session is scheduled for next week in the office, where the focus may continue on building her capacity to safely engage with and tolerate these sensations.
We had a 50-minute office session today. Alicia came in and right away I could see she was holding a lot of tension, shoulders up, arms crossed tight. She said she's been noticing that whenever certain topics come up, even just in passing, her body reacts before her mind does. She said quote 'I don't even have to think about the details, my chest just gets tight and I can't breathe right' unquote. She described this sense of threat that shows up in her body, tight chest, shallow breathing, sometimes her hands start shaking, even when she's not consciously thinking about the trauma.
We talked about how the body holds onto trauma, and how those sensations are the nervous system's way of trying to protect her, even when there's no actual danger in the present. I explained that we don't need to go into the details of what happened, we can work with what's happening right now in her body. We started with some gentle orienting, I asked her to look around the room and notice five things she could see, just to help her nervous system register that she's safe here in this moment. She took a few deep breaths and her shoulders started to drop a little.
Then we did some grounding work. I guided her to notice her feet on the floor, the chair supporting her, and to press her feet down gently and feel that solid contact. We went slow, checking in with her sensations as we went. Whenever she noticed her chest getting tight, we paused and just tracked it, where exactly is it, does it have a shape, does it change when you breathe into it. The goal was just to build her tolerance for those sensations without getting overwhelmed. By the end of the session, she said she felt a little less stuck in it. Her homework is to practice that orienting and grounding exercise once a day, especially if she notices those body-based cues of threat coming up. We'll meet again next week and keep building her capacity to stay present with those sensations safely.
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