control this in a positive way. With practice, their confidence and capabilities are increased, affirming their sense of self in relation to other people as well as the physical world around them. Breathing in “survival mode” The normal response to threatening situations is an increase in breathing in readiness for action. This involves a change in the body’s physiology and is appropriate at times when an immediate, physical reaction is required. However, in cases where people are forced to operate in “survival mode” for a long period of time, over-breathing becomes habitual and self-re-enforcing. The state of continuous over-breathing is known as “chronic hyperventilation”. It has far reaching consequences due to its capacity to shift the delicate balance in the body’s physiology. Physical symptoms can include: headaches, chest pain and tightness, physical tension, tiredness and sighing/yawning, visual disturbance, dizziness, stomach upset, tingling fingers, tightness of the throat and jaw, cold and clammy hands and feet, erratic or faster heart beats. Psychological symptoms can include “impairment of thought processes, disrupted mental stability, hyper-emotionality, sustained anxiety, restricted reality orientation and limited awareness of available options for coping with anxiety triggers.” In such circumstances it becomes clear that the interlinked problems of body and mind must be addressed simultaneously. Movement and posture Trauma from interpersonal violence can cause people to lose their physical stability, which impacts their mobility. Violent assault including beatings, rape and sexual abuse result in profound physical and psychological injuries which are inter-connected. For example, the seemingly simple act of sitting down can become a physically painful experience, accompanied by traumatic memory that causes overbreathing and compounds pain. Rape and sexual abuse are a source of deep and enduring shame for victims. Clients may consciously or unconsciously try to “mask” their injuries from violent assault, fearing that these reveal a “shameful” history to others, or expose weakness that makes them vulnerable to further harm. They may minimize the significance of their injuries or avoid speaking about them at all; cover scars with clothing or bleach their skin to hide them, or contort their body in response to perceived threat or to physically “compensate” for injuries. These responses become habitual and exacerbate physical problems. Physical and psychological self-effacement is integral to the trafficking process and victims who have been forced to be subservient to others are conditioned to behave in this way. For example they may minimize the amount of space they occupy when sitting or standing, avoid eye contact and be completely unable to assert themselves, or request even the most minor forms of assistance from others. It is common for victims to be hyper-vigilant at all times and fear danger even when none is present. This causes confusion and contradictory mind states which can be echoed in their body language. “A man positioned himself by the therapy room door to ensure that he would be able to ‘escape’ if necessary. However, at the same time he expressed relief that he had managed to come to his therapy appointment. Some clients become pre-occupied with worry about whether it is safer for them to stay at the session or to leave it: they are alarmed by the street sounds outside or by the sound of distant voices, footsteps, a door shutting inside the building. Nowhere feels safe, inside or out. “In such cases, safety needs to be established by directing a person back into the direct moment (the ‘here and now’). It helps to appeal directly to their senses to lessen their fear and assist them to ‘return’ to being present in the session. For example, I might say, ‘I am here with you’, ‘Can you see the plant?’, ‘Can you hear me?’, ‘squeeze my hand’ or ‘right now, in this room, you are safe’.” Carrie Tuke, HBF Body-Mind Therapist Body-Mind therapy in practice The first stage in Body-Mind therapy is to achieve a sense of calm and safety with the client in order to establish a therapeutic relationship of trust. This is essential for working towards recovery but it is rarely within clients’ conscious control at the outset. It is only when a person feels safe that their system can self-regulate, and their breathing, heart rate, rest and digestion function calmly, so they are able to be “present” in the session. Working in close contact with clients, and acknowledging their most intricate physical and psychological responses within the session, establishes the consistency and mutuality of the therapeutic relationship. Acknowledgement of how the person feels and responds demonstrates trust, creating new confidence. This enables clients to further explore physical touch and emotional feeling in a safe and appropriate way. Breathing is always the starting point, as it is fundamental to every aspect of body and mind. Clients need to become aware of their own breathing patterns. They may be given 105