Most of us have felt 'butterflies in our chest', a 'knot in our stomach' or 'heartache'. These experiences are so universal that they have become part of everyday language.

Many publications in the field of PTSD and trauma treatment build on our increasing knowledge of neuroscience to understand the lingering impact of trauma. Neuroscience is the study of the nervous system, including the brain and the central and peripheral nervous systems King 2016 , and the way our body communicates with the brain. It is this very connection that often seems to be disrupted with traumatised clients, whose brains and bodies can behave as though past events are recurring in the here-and-now.

Developmental trauma and somatic memory

The limbic system, and especially the amygdala, are important for memory storage - with the amygdala specifically linked with emotional memories Craig 2015 . In contrast, the hippocampus appears to 'file' memories in a chronological way, contextual to our life's narrative. It seems that the hippocampus can be suppressed during traumatic threat, meaning it is unavailable to store and process the event.

Studies have shown that people with PTSD have a smaller hippocampus than the general population Rothschild 2000 . Links have also been made between a predisposition to developing PTSD and stressful events during childhood, including abuse and neglect. As therapy involves working with clients' dysregulated nervous systems and related somatic experiences, it is important to be mindful of the role of neuroplasticity King 2016 - both in terms of unhelpful, trauma-related learning and in terms of healing and recovery. As therapists, it is our role to support our clients to expand their survival repertoire and to learn to connect with feelings of safety.

Rothschild 2000 discusses somatic memory, suggesting that trauma is held in the nervous system. Van der Kolk 2014 similarly writes about trauma's impact on the thalamus, a part of the brain that processes sensations and integrates them into our autobiographical memory. Referring to brain scans demonstrating that trauma can lead to dysfunction in the thalamus, he writes that this 'explains why trauma is primarily remembered not as a story, a narrative with a beginning, middle and end, but as isolated sensory imprints...that are accompanied by intense sensations, usually terror and helplessness'.

Working with embodied approaches

People who have been traumatised have experienced alterations in their nervous system that over-sensitised their threat and survival mechanisms, causing them to have hypervigilant or hypovigilant responses to their environment. Their bodies respond to benign situations as though they are dangerous. They have lost the ability to trust their interoceptive awareness, or 'attune' to themselves, as they have repeatedly experienced a disconnection between the instinctive messages from their bodies and their cognitive knowledge of their external reality. They might struggle with decision-making, as their somatic markers and gut feelings are not appropriate to their reality in the 'here-and-now'. Their implicit and somatic memories can lead to a fragmented sense of autobiographical memory. They may exist in a state of nameless dread or terror, or mistrust and resent their bodies for 'making them' repeatedly re-live traumatic experiences.

Since these experiences are so distressing and overwhelming, traumatised clients often want these feelings to 'just go away!' Consequently they can become less self-compassionate, more punitive and more disconnected from their bodies; they override and silence the body's messages through overwork, substances, impulsive behaviour, medications, disordered eating, self-harm or dissociation.

Instead, we would like to gently invite our clients to learn to self-soothe, to find ways to ground and care for their physical selves as they would care for a terrified or distraught child their 'inner child' . To show them ways to provide their panicked and confused nervous systems with the nurturing and calming signals associated with safety, bringing it back to the 'window of tolerance' and therefore feeling safe and integrated in order to begin to process their trauma, instead of pushing the distress away and disconnecting from it even further.

The mistrust and hostility that traumatised clients sometimes feel towards their bodies can be specifically directed towards the part of the body that has been traumatised, for example through self-harm, or it leads to clients living mostly 'in their heads'. The body is not a place that feels safe to inhabit: it holds the pain, the confusion, the hatred, the anger, the trauma. It sends them mixed signals. It presents them with distressing sensations and images. It tells them to flee, or makes them dissociate in a perfectly safe situation. Conversely, the dissociation from their own distress is also the very reason they attack their body; clients say that they feel self-harm is the only way to emerge, temporarily, from a dissociative fugue as the pain and the sight of blood makes them 'feel something' for a while. However, the feelings of guilt and shame that follow and the self-loathing when the cravings start can lead to further alienation and distancing from the body. This can also be true of impulsive behaviours, eating disorders and addictions. The very relationship between body and mind, then, becomes distorted, corrupted.

My main therapeutic goal with these clients is to help them to re-establish and rediscover their own relationship with their bodies. To trust their body's signals and their gut feelings, while also learning to soothe and understand their physiological responses and the somatic memories leading to their distress. While the therapeutic relationship is vital, the focus is on healing internal fragmentation. This is something that can easily be overlooked in therapy, as some traumatised clients seem to struggle mostly to connect with themselves, rather than others, and especially with their own physicality. This goal can be difficult to achieve if we don't make the implicit explicit - if we don't focus on, talk about and consider these clients' relationships with their own bodies as an important and central part of the therapeutic process.

Nili Sigal is an art therapist and the founder of the Complex Trauma, PTSD and Dissociation Special Interest Group for BAAT. Her full essay appears in James D. West's collection Using Image and Narrative in Therapy for Trauma, Addiction and Recovery