Stabilization, Pendulation and Titration
Cornelia Elbrecht AThR, SEP, ANZACATA, IEATA, IACAET
In a recent group discussion, the question arose about the difference between stabilization and pendulation. The term stabilization in the context of trauma therapy was coined by psychiatrist Pierre Janet (1859 – 1947), a pioneer, who profoundly influenced the work of Freud, Jung and Adler. His approach to treating traumatized clients was a three-stage model that is still relevant today.
Stabilization: before it is safe to access any upsetting material, it is important that the client is sufficiently resourced, because otherwise any recall of a traumatic event will be again overwhelming.
Trauma Exploration: only now is it safe to allow the deeper layers of wounding and fear to surface; when big emotions emerge, clients need to be able to know how to calm down or where to be safe, when it gets too much. This is where pendulation and titration come into play.
Integration: describes the reflection of events, possible adjustments to lifestyle that have become necessary, acceptance of what happened, grief of what has been lost, and updating existing belief systems.
Many clients are highly invested in their trauma story. They are overwhelmed, but also fascinated by it, or they have built an identity around it such as being a victim or the villain. In the terminology of Peter Levine, they all have a highly activated trauma vortex, and a weak counter or healing vortex (Levine 2010). These are the clients who need stabilization first before any trauma exploration can safely occur. In this case the intention is to strengthen the counter vortex like a muscle, to exercise it, until this healing vortex can be accessed under duress. The latter is an expression by Babette Rothschild (Rothschild, The body remembers 2000). Stabilization needs to be practised to such an extent that it can be remembered when we have a panic attack for example.
Stabilizing a client can potentially be the whole therapy and may require several years. Some clients will never get to trauma exploration, because any trauma exploration would be too unsettling for them. Especially when we work with complex childhood issues these clients’ nervous system may have lost its natural ability to pendulate. To be overwhelmed is their ‘normal’. Any art therapy exercises that are based on a positive psychology approach stabilize these clients. (Elbrecht, Healing trauma with guided drawing; a sensorimotor art therapy approach to bilateral body mapping 2018) (Elbrecht, Healing traumatized children at the clay field; sensorimotor embodiment of developmental milestones. 2021) They may not resolve the underlying traumas, but they will add to improving these clients’ lives; they will reduce suffering and bring some joy into their troubled existence.
The term Pendulation was coined by Peter Levine (Levine 2010), describing a process of oscillating between two vortexes, a trauma vortex, and a healing vortex, to titrate the recall of stressful events. Pendulating between fearful and hopeful or joyful memories makes the trauma therapy process manageable, rather than re-traumatising. Levine’s insight into Pendulation has informed my approach to trauma therapy fundamentally. Thousands of therapists and clients have benefitted from this approach.
Pendulation Model based on Peter Levine’s Somatic Experiencing approach.
Levine states that this counter or healing vortex is an innate ability of our nervous system. It helps us to regulate our ANS. We share this ability with all animals. However, animals in captivity, and those who suffer from complex trauma lose this natural way of dealing with adversity. In therapy we need to remember overwhelmed clients of their healing vortex, but once they can tap into it, many begin to self-regulate, being again able to reconnect with this natural ability of our nervous system. As in the image above, clients will begin to pendulate between their trauma vortex and their healing vortex in a figure eight movement. They will touch on stressors, and then on their resources, until the dissociated part, pictured as a trauma vortex can be reintegrated.
Titration in this context encourages the processing of a potentially overwhelming event in manageable segments. Rather than being flooded with recall, the remembering happens in droplets. I am always surprised how these crucial components can turn trauma exploration into a safe, even peaceful and joyful experience.
Bibliography
Elbrecht, Cornelia. 2018. Healing trauma with guided drawing; a sensorimotor art therapy approach to bilateral body mapping. Berkeley, CA: North Atlantic Books.
—. 2021. Healing traumatized children at the clay field; sensorimotor embodiment of developmental milestones. Berkley CA: North Atlantic Books.
—. 2013. Trauma healing at the clay field, a sensorimotor art therapy approach. London/Philadelphia: jessica Kingsley.
Levine, Peter. 2010. In an unspoken voice; how the body releases trauma and restores goodness. Berkeley: North Atlantic Books.
Rothschild, Babette. 2000. The body remembers. New York: Norton and Company.
—. 2011. Trauma Specialist Babette Rothschild: Description of Dual Awareness for Treating PTSD. YouTube.
AThR, SEP, ANZACATA, IEATA, IACAET
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