Friday, November 26, 2010

INTEGRATING INTO A PROGRAM OF THERAPY


I would like to start with a qualification; I do not believe there is only one “cause” for PTSD, therefore there should not be one “therapy”. The causal circumstances, the surrounding context, individual psychological states, genetic proclivities, and the potential for a wide range of differing factors can make the basis for each individuals PTSD unique and probably difficult to define. It follows, then, that dealing effectively with an individuals PTSD would require exposure to as wide a range of therapeutic approaches as possible, and treatment should involve a team of therapists from a variety of disciplines.

Given the kinesthetic realities I outlined in the previous blog, several physical approaches should be offered; exposure therapy, EMDI, Yoga, tai chi, physical therapy and Aikido all have their strengths, and different individuals may respond effectively to one or more. When offered along with talk therapies and medication in an integrated team approach, sort of a therapeutic smorgasbord, a “prescription” can be developed that is most effective for each individual.

This would mean that the instructors would need to be fully integrated in to the therapy team. There should also be an initial two way training/familiarization program between the instructor and the therapy team. This is to enable both sides to understand the basics of what they both have to offer. It will allow the instructors to structure their programs to complement other aspects of the veteran’s therapy programs, and give therapists a deeper understanding of what the veterans are experiencing, and how they can best take advantage of this during their sessions.

The best example of this would be “relaxing to center”. This is a key aspect to aikido and the vets soon experience it when a technique works best when they do it successfully. A therapist, observing a vet begin to tense up, should be able to tell him to relax to center, to inhale and as he exhales slowly let his muscles to open and allow the energy to flow down to his center.
As I have indicated above, there are any number of lessons, behaviors, attitudes, mind-sets, etc., absorbed kinesthetically in the practice of Aikido techniques that can be utilized in conjunction with more traditional therapies to excellent effect. The end result will be to provide a more holistic approach to a causally differentiated disability.

Monday, November 22, 2010

BLENDING; MIND, BODY AND SPIRIT

11/22/10
As I said in my last blog, this will be an attempt to clarify in my own mind why I believe Aikido has a place in the treatment of Vets with Combat Related Post Traumatic Stress disorder. It is still a bit of a mishigas, but moving toward some sort of clarity none the less. The ultimate measure of success, of course, will be if my arguments are instrumental in getting Aikido included as an intrinsic part of a full program of PTSD therapy. With this in mind, this is written more toward PTSD therapists than other Aikidoka.

I’m not a psychologist, psychiatrist or psycho- of any kind, so a lot of what follows is based on my direct experience. I may traffic in generalizations, but I have found them to be generally true. I do not espouse Aikido as a therapy for Combat Related PTSD. My experience is that it can be therapeutic, and when utilized as part of an overall therapy prescription it can support and amplify other therapeutic approaches and be especially effective with individuals with different learning processes. I have come across a significant amount of material which tends to support this and has influenced what I have done with the Vets.
Which gets me to the theme of this blog, the mind/body/spirit dichotomy that seems to pervade current therapeutic approaches to CRPTSD. Is it valid, and what is the role Aikido can play in bringing about a more holistic therapy? To start with, the concept of a separation of mind, body and spirit is an artificial construct which arose in Western thought. In most Eastern thought the mind and body are recognized, but as integral parts of a whole. One could not be considered except in a relationship to the other.
The current treatment of PTSD is oriented primarily toward the mind, the mental/emotional state, utilizing medications and various forms of talk therapy. However, the root of most PTSD, especially Combat Related PTSD, comes from physical trauma, fear of physical trauma, or the dehumanization an individual undergoes from having done or acquiesced to things which have been deemed heinous their entire lives. This could be termed kinesthetic trauma. [An interesting question might be whether people who are kinesthetic learners have a higher rate or deeper symptoms of PTSD.] In that case, to treat PTSD on a intellectual/mental/emotional basis with out a strong kinesthetic component might be less than effective.

One of the strengths inherent in the practice of Aikido is that we always work with a partner. This is a collaborative partnership with one person called nage [which roughly translates as student], practicing a technique, and the other person, called uke [which roughly translates as teacher], executing an attack,. This is not the violent attack/defend/defeat dynamic common to many martial arts, which can trigger many of the negative reactions of someone with PTSD. The student does not take an attacker’s energy and use it against them, Rather the student moves off of the line of attacking energy, blending that energy with their own, and bringing themselves and the attacker to a place which is safe and secure. The teacher does not attack in order to crush or defeat, but rather to enable the student to practice and learn a technique. In Aikido, the emphasis is on doing something with someone, not to someone.

Many treatment programs do encourage participation in Yoga, Tai Chi, Qui Gong, etc. These definitely bring a physical component to the treatment program and can be very effective in promoting inner calm, centering, reduced stress and relaxation. However, they are arts in which you essentially work alone. These forms lack a direct, physical relationship with the feelings of vulnerability and helplessness that are often the root of the underlying trauma. While an instructor can correct a technique, there is little immediate and direct feedback and the tactile experience is minimal. Introspection also does not deal directly with the sense of guilt and shame which come from having done vicious, violently repulsive things to others in order to preserve the self, nor does it give access to ways to deal effectively with the guilt of having to respond to aggression with greater aggression, violence with greater violence.

Unlike the other arts, working with a partner on an Aikido technique involves close proximity with an “aggressor” and a simulated attack. This gives rise to feelings of vulnerability. Even 41 years after any combat experience and 42 years practicing Aikido, I can still experience this feeling of vulnerability, and the fear of being harmed or having to react “wrongly”. Properly taught, Aikido gives effective, non-violent, non-aggressive methods, physical, mental and spiritual, for resolving this dilemma. Aikido has taught me to relax my tension, center myself physically, mentally and emotionally, to welcome the aggression as an opportunity to learn. It has taught me to move into the aggression, but off the line of the “attack”, to accept the energy of the attack and blend it with my own energy, to move this blended energy until the aggressor and I are both in a safe and secure place. Of course, I want to make certain that I am the most secure.

An additional kinesthetic re-enforcement is that techniques work really well only when the individual is centered, relaxed and balanced mentally and physically and follows the above steps. As it is learned physically, on the mat, it is internalized and becomes an integral way to deal with feelings of vulnerability, attack and situations of aggression off the mat. This “way of dealing” quickly becomes the method for dealing with all forms of conflict and potential conflict, not just the physical. It does not matter how conscious one is of this learning. Covert is often much more effective than overt.
Most forms of PTSD therapy pay scant attention to the spiritual aspect of being human. There may possibly be some religious intervention, but in general short shrift is given to the moral, ethical, quandary victims of combat related PTSD often must confront. While Aikido is definitely not theological/ religious, it has a pervasive spirituality. The founder of Aikido, Morihei Ueshiba [O Sensei] wrote "The secret of Aikido is to harmonize with the movement of the universe and bring ourselves into accord with the universe itself." O-Sensei maintained that Aikido is a work of love, a path to overcome discord in ourselves and bring peace to the world, "to make the heart of the universe one's own heart." He described Aikido as an art of peace and viewed its practice as a spiritual endeavor. O-Sensei taught that, while it was important to become proficient in physical technique, this is not the ultimate purpose of training. He taught that the principles learned through training in physical technique are universal and are to be applied to all aspects of one's life "The secret of Aikido is not how you move your feet, it is how you move your mind. I'm not teaching you martial techniques. I'm teaching you nonviolence,” Giji Munetaka Kuki sums up: "O-Sensei said Aikido is not about technique, but that it is about how humans should live their lives. Aikido is not really about theory or rationalization. The spirit of Aikido is to create a sphere, a warm sphere, a warm circle of harmonious feeling among people so that people can get along with each other with warm-hearted feeling."

Again, one can not execute truly effective technique without achieving, even if subconsciously, this sense of being one with ones attacker, that uke and nage are both of the same universe. The physical process of learning is one with growth of the mental/emotional/spiritual parts of being a human being.

Thus, Aikido can be a powerful, effective therapeutic tool when integrated into a varied program of therapy. More in my next blog as to how this might happen.


Monday, November 15, 2010

HOW DO YOU "LAY OFF" A VOLUNTEER?

11/15/10 NOTE: This might be the next-to-the-last entry in this blog for a while. I’ve been “laid off”. I don’t know how you lay off a volunteer, but someone or ones in Ward 8 decided that with program changes, etc. they did not have a time when they could offer Aikido. Whatever! I don’t want to try to figure why this actually happened, but as most of the key staff are “shrinks” of one kind or another, I don’t think they place much credence in the therapeutic value of physical activity or that they understood the mental/motional the practice of Aikido can have..
This happened back mid September, and I haven’t posted anything because I wanted to take this time to define why I think Aikido can particularly useful in helping people deal with PTSD as a critical part of a “treatment plan”, and not just physical exercise or to merely amuse or occupy time. My belief, and experience, is that properly taught, Aikido can complement and amplify more traditional therapies and be used by therapists in grounding their more intellectually based, “talk therapy” efforts.
I’m going to take some time and try to write out exactly why I think this is true. I have a lot of ideas, thoughts, theories and vague hunches so I need to clarify this mishigas, and bring it together into something concrete. When I get this done, once again I will rely on your feedback and criticism.