L’ostéopathie psychosomatique dans les traumatismes à l’aide de l’exemple de l’intégration bifocale

Table of contents

Résumé

Psycho-emotional traumatic experiences are often manifested by states of agitation with hyperactivity and sympathy or by a behavior of immobilization and retraction. A person who has had such a traumatic experience may display an autonomous reaction that keeps them in a state of continuous defense, which becomes a source of stress over time. In addition, the stress associated with the dysfunctional symptoms of somato-energetic experience occurring in the course of ostheopathic treatment can be related to the patient’s symptoms and complaints. In this article, the authors discuss an ostéopathic approach to psycho-emotional trauma and somatic-psychic dysfunction using psychosomatic ostéopathy as an example of bifocal multimodal integration (IBM). The emphasis here is on the promotion of physical and mental relaxation and on the active involvement of the patient in the recovery process. The role of body-spirit therapies is discussed, taking into account neuro-psycho-physiological treatment methods. Emphasis is also placed on clinical practice and an introduction to the various elements of osteopathic treatment, including the context and integration of the descending and ascending dynamics in diagnosis and therapy.

Mots-clés:

Intégration émotionnelle, thérapie corps-esprit, traumatisme psychoémotionnel, traumatisme, ostéopathie psychosomatique, dysfonctionnement somatique-psychiqueUn traumatisme psycho-émotionnel est généralement considéré comme un événement psychologique ou physique très stressant. A traumatization can be defined as an “event that is stressful and invariably subverts the person’s existing adaptation mechanisms” [1]. This definition of trauma includes reactions to a singular event such as a natural disaster, an accident, a death or a crime, as well as to recurrent experiences such as abuse, negligence, violent relationships and deficits in the satisfaction of needs and the construction of relationships (privation) during childhood [2]. It is important to understand that the traumatic event is defined in the context of the experience of the victim – when two people experience the same thing, one may feel traumatized and the other not [3].The effects of traumatic experiences can be multiple. For example, people who have experienced trauma can develop anxiety and depression, toxicomania, food problems, personality problems or post-traumatic stress syndrome (SSPT) [2]. Traumatized children and adults may lose their ability to transform their emotions into effective actions. They may not be able to recognize their own sensations, feelings and physical conditions and may have difficulties in recognizing the emotional states and needs of others [4].At the physiological level, trauma results from a breakdown in physiological activation and the hormonal response necessary to respond effectively to a threat. While a person in good health responds successfully to a fight or attack, the traumatized person often remains immobile, which results in an inconsistent behavioral response [4]. Complementary therapies – especially body-spirit therapy (TCE) – arouse great interest because they are thought to reduce the symptoms associated with trauma and emotional dysregulation [5], [6]. The therapies corps- esprit focus on the interaction between the brain and the body. The aim is to promote the influence of the mind on the body. Therapy generally comprises psychological, behavioral, spiritual and social approaches, such as cognitive-comportional therapy (TCC), meditation, respiratory training and imagery, and research has shown that TCE has a positive effect on the symptoms of SSPT. These include therapeutic effects on the response to stress, reduction of anxiety, depression and sadness, increased tolerance to anxiety, improved self-esteem and increased ability to cope and face stress [6]. Various publications recommend a cognitive-complementary therapy based on trauma in patients suffering from SSPT who have experienced a series of traumatic events [7], [8], [9], [10]. Therapies for the body and mind focus on the perception of the body through interoception and proprioception as well as on attention in order to accept and not judge. Les patients sont soutenus et guidés dans un processus de réorientation afin de devenir plus adaptables et résistants aux facteurs de stress perçus [11], [12]. Les TCE sont un outil efficace pour réguler la fonction vagale, notamment en améliorant l’autorégulation et la résilience du système nerveux autonome [13], [14], [15], [16].In this article, we describe the principles of psychosomatic ostéopathy in psychoemotional trauma and somatic-energetic-psychic dysfunctions using bifocal integration in the context of the available research results. We also include a brief case report to explain the different elements of this treatment approach in clinical practice.

Mécanismes des thérapies du corps et de l’esprit

Descending therapies such as clinical hypnosis, imagery or meditation initiate conscious and voluntary mental processes at the level of the cervical cortex [29]. They provoke a change in cerebral functions, associated with a reorganization of neuronal representations in the SNC and an improvement in bidirectional communication between the cervical cortex and the limbic system and the structures of the cervical trunk that regulate autonomic, neuroendocrine and emotional behavior [21], [22], [23]. In turn, the ascending therapies (e.g. progressive muscular relaxation) function by stimulating the somatic, visual and/or chimiosensory receptors. They influence the central neuronal and mental processes via ascending signaling pathways from the periphery to the cervical cortex. Cela entraîne une augmentation de la variabilité du rythme cardiaque et une réduction de l’expression des cytokines [21], [24], [31], [32].Taylor et al. proposent un modèle psychophysiologique intégratif pour illustrer les mécanismes sous-jacents de la TCE. They take into account the different levels of the neuronal axis where the interactions between the mind and the body take place [29]. According to this model, the symptoms of stress are manifested by functional problems of the executive homeostatic network, i.e. a dysbalance in the activation of the prefrontal cortex and the manifestations of superior visual coding in the prefrontal, insulaire and cingulaire antérieur cortex. Ces troubles se manifestent ensuite en périphérie par une réduction de la variabilité du rythme cardiaque et de l’expression des cytokines pro-inflammatoires [29]. Taylor et al. suggest that an effective TCE induces functional changes in order to activate the regional homeostatic excretory network, increase the variability of the cardiac rhythm and reduce the production of cytokines [29]. Les états comportementaux tels que le combat et la fuite, l’immobilization/la sidération et l’évaluation des risques – avec les effets moteurs, autonomes et endocriniens associés – sont coordonnés par le mésencéphale périaqueductal gris (PAG) [17], [18], [19], [20]. The PAG is related to the hypothalamus and the limbic system (especially the amygdale and the prefrontal cortex) [18], [19] as well as to various noyaux prémoteurs et autonomes du tronc cérébral qui coordonnent la respiration et le système moteur émotionnel [20]. Psychosomatic osteopathy aims to intervene through the neuroendocrine networks mentioned above by means of different approaches and techniques.

Neuroception de la sécurité dans la relation thérapeutique

Research has shown that the therapeutic relationship is essential for obtaining the desired therapeutic result and that therapeutic outcomes are only very slightly dependent on the use of specific techniques. [32], [33], [34] Effective therapeutic outcomes are only possible if patients feel safe in the therapeutic environment. The patients’ sense of safety and the development of a healthy therapeutic relationship often depend on the therapist’s ability to be fully present and engaged [35], [36]. Geller and Porges cite the fact that the therapist must be anchored, focused and present, as well as open and receptive to the patient’s experiences, as conditions prerequisite to such a relationship [37]. The authors suggest specific characteristics of the therapist’s presence that can strengthen the patient’s sense of security. For example, certain non-verbal signs are therapeutically essential for communication with the patient, such as a soft voice, amiable visual contact and an open and receptive posture. Thanks to a constant presence, the therapist can regulate the patient’s stress reactions. This approach can lead to a synergistic relationship in which the patient’s reactions can be transformed over time into non-defensive social interaction [37]. The therapist must be sensitive to the patient’s experience and physiology and must encourage the patient to be open and present [37]. In addition, patients can benefit from neuronal exercises that promote the experience of inner security, such as deep abdominal breathing, social games, yoga, meditation, full awareness and experiences in nature [37].

Ostéopathie psychosomatique

Les expériences traumatisantes se manifestent souventent par une hyperactivité sympathique, des états d’excitation ou par un comportement d’immobilization et de retrait. Over time, these initially vital reactions become stress factors. In a traumatized person, an autonomous reaction can develop that permanently maintains the state of defense, so that the defense system can no longer be regulated downwards.Even in the case of less severe stress associated with dysfunctional patterns of somatic-energetic experience, successful therapy requires an understanding of the ways in which the major and minor factors of daily stress affect the communication between the body and the mind, especially the ability to pay attention to the internal signs of emotions related to stress and to interpret them.By creating an environment of trust and safety, combining palpation and corégulation with the patient’s attention, the osteopaths enable their patients to perceive physical response patterns such as interoception and to improve their ability to recognize, accéder, comprendre et répondre de manière appropriée à des schémas de signaux internes et à augmenter leur propre régulation.L’ostéopathie psychosomatique développée par l’un des auteurs (T.L.) incorporates ascending and descending dynamics (see below) both in diagnosis and treatment and includes general principles and models on the one hand and different methods on the other, approches et techniques spécifiques pour le diagnostique et le traitement des schémas d’expérience somato-énergétique dysfonctionnelle (= complexes dysfonctionnels somatiques-énergétiques-psychiques) ainsi qu’une pratique de palpation spécifique. The palpation of the tissues takes into account the dynamics of human development and incorporates elements of respiratory techniques from yoga, resource work, positive psychology, bifocal and bilateral stimulation, stimulation of the vague nerf [47], Vipassana meditation and physical therapy, neuro-linguistic and hypnotic physical programming, myofascial vibration, somatic experience, non-violent communication and pure awareness.Among the approaches and techniques, we mention palpation ostéopathique centrée sur le cœur (voir encadré) et le “Felt Sense” ostéopathique, a process in which the osteopath palpates the regions with the greatest rhythmic débit and the greatest vitality, while the patient concentrates on the sensations associated with the palpated regions [38], and bifocal integration. These approaches allow the patient to understand the relationship between the dysfunction, the somatic dysfunction and the internal and external factors [39] and to resolve the stressful somato-énergétiques schémas of the experience.Indications – Les indications possibles d’un traitement ostéopathique psychosomatique sont les suivantes

• en cas d’apparition d’expériences stressantes, de souvenirs ou d’états d’excitation lors d’un traitement ostéopathique ou d’une palpation
• schémas dysfonctionnels de l’expérience énergétique des soma
• les douleurs chroniques 
• les déclencheurs actuels et les schémas habituels limitant la vie quotidienne
• Negative emotions, such as pain, phobias and behaviors of dependence
• dysfonctionnements chroniques avec des composantes psychologiques, comme d’éventuels troubles de l’apprentissage
• Traumatism

Palpation ostéopathique centrée sur le cœur pour la régulation neurovégétative et le traitement des patients souffrant de traumatismes psychologiques [38]

• 1 Synchronization of the perception of physical awareness, of the mind and of emotions
• 2 Palpation du champ cardiaque
• 3 Harmonization of the cœur, abdomen and chest
• 4a Palpation du cœur par l’ostéopathe
• 4b Palpation du cœur par le patient
• 5 Identification du point final de la palpation
• 6 Visual contact between the patient and the therapist so that the patient can establish a new relationship between internal perception and sensory perception of the environment
• 7 Équilibre vertical entre le vertex, la région pelvienne et la plante des pieds en utilisant la respiration

With the help of these techniques (and of a confrontation traumatique corégulée et adaptée individuellement pendant le traitement – par exemple, l’intégration bifocale), le patient peut de plus en plus associer les expériences traumatiques à une sensation corporelle détendue, par exemple une respiration calme, un rythme cardiaque régulier et des muscles faciaux détendus. This state is enhanced and reinforced by the afferent vagal cardiopulmonary and trijumeral nerves (originating from sensors of the facial myofascial system) which activate the limbic-prefrontal circuits of the PAG.If the patient has sufficient resources, he also becomes aware of his life circumstances, his experiences, his behavior and his current feelings in the course of the treatment and recognizes the associated problems and dysfunctions. The patient is actively involved in the process of recovery. Thanks to the treatment, the patient must acquire the skills to progressively accede to this state of détente in everyday life. In addition, the patient is encouraged to concentrate on the present more than on the past, to recognize and accept his limitations, to establish positive and rewarding relationships with himself and others, and to pursue goals that give meaning to his life [30].  The patient has more chances of feeling safe if he is in a calm treatment environment and if he meets a sensitive therapist who has good communication skills, who uses a gentle palpation style and who carries out the treatment without wasting time [39]. Elkiss and Jerome also emphasized that a close and intimate connection is established between the therapist who touches and the patient who is touched, which complements the empathic verbal communication and supports the synchronized therapeutic guidance [40].The basis of psychosomatic osteopathy is the integration of descending and ascending dynamics into the diagnosis and therapy (Fig. 1). 

* Le dysfonctionnement somatique, dans une perspective intégrative, est un schéma/complexe multimodal et holarchique, qui interagit et s’associe, non seulement comme un schéma tissulaire palpable, mais d’une manière spécifique dans des références ascendantes et descendantes – intégrées dans des contextes intersubjectifs et biosociaux. In short, it can be described as a complex of tissue and energy experience [42].

Fig. 1: Integration of the top-down and bottom-up processes in the therapeutic consultation. In the case of dysfunction and also during convalescence, various ascending and descending dynamics interact as descending and ascending mechanisms between the peripheral tissues and the cervix, including the immune system and the nervous system. They contribute to both physical and mental health. For example, the belief that “life is insecure” can trigger emotions such as anxiety in the limbic system, leading to increased sympathetic activity with rapid and shallow breathing and physical manifestations such as a feeling of tension on the chest, tired and frozen muscles and tension in the chest and legs  

Le traitement par ostéopathie psychosomatique est divisé en quatre phases/aspects :

• 1. établissement de la relation thérapeutique, y compris les diagnostics
• 2. phase de stabilization
• 3. phase d’intégration/confrontation, for example with bifocal integration
• 4. l’intégration dans la vie quotidienne

Each of these phases/aspects is characterized by specific processes. Although they are built on top of each other, they are not strictly separate from each other. For example, the therapeutic relationship is essential throughout the duration of treatment. In addition, the stabilization resources during the integration/confrontation phase are adapted individually and applied in doses like a co-regulation.

Établissement de la relation thérapeutique

During this phase, the treatment objectives are discussed and agreed upon, and a transparent and stable therapeutic relationship is established. The patient and the therapist recognize the patient’s needs (for example, to ensure monitoring) and the strategies for adaptation [41]. In this phase, it is crucial to realize the therapeutic process. The therapist confirms the presence of emotional centers in the body by palpating the tensions in the solar or cochlear plexus, the suboccipital region, the neck, the eyes and the throat, and by examining the transition zones in the vertical column and other possible signs of traumatic stress. The palpation includes, for example, the cochlear ganglion, the other sympathetic ganglia, the region of the cœur, the gorge, the suboccipital region, the eyes, the peripheral and central sensitization, the pressure gradients and the reflex tests.

Phase de stabilization

During the stabilization phase, the focus is on the concepts of stress reduction, including the identification of adaptation strategies, understanding the consequences of trauma, stress reduction exercises, differentiation and regulation of emotions/effects and the development of trust. This phase also includes psychoeducation. Other stress factors that can contribute to the current state of health are taken into account, such as psychological stress, social factors, certain foods and xenobiotics, infections, nicotine, alcohol and drug abuse, oxidative stress, electromagnetic pollution, the intestinal microbiome and sedentariness.  The methods used in this phase improve the patient’s emotional state in order to open up the possibility of conflictual approaches to stressful problems in the subsequent phases of treatment. This also includes functional osteopathic therapy to manipulate the parts of the body in which the effects of psychological trauma manifest themselves.

Phase d’intégration/confrontation

In this phase, the complexes dysfonctionnels somatiques-énergétiques-psychiques, les charges, les douleurs chroniques, le stress ou les expériences traumatiques non traitées sont traités et intégrés dans un cadre clairement défini – au moyen d’une activation dosée et d’une corégulation simultanée par le thérapeute. A slight activation is necessary in order to be able to work with stressful and untreated experiences. At the same time, it is essential to avoid any form of retraumatization. Several approaches and techniques are possible here. The procedure is illustrated below as an example with a simplified description of bifocal integration developed by one of the authors (T.L.). This includes a specific practice of palpation ostéopathique, an alternance de focalization bifocale, the corégulation, l’ancrage et la perception de l’interception, les sensations corporelles, l’éveil, les émotions, les pensées et les images, les interventions respiratoires, l’écoute réflexive, etc..  

Intégration dans la vie quotidienne

An important step for patients is the integration of their progress into everyday life. During treatment, the skills essential for this integration are continually encouraged, for example presence, confidence in oneself and openness to life [44]. By being able to perceive and regulate themselves in a state of awareness of their physical sensations, states of mild excitement, feelings and thoughts in harmony with external and internal influences, patients achieve a vitality, a connectivity and a strong presence that no longer support dysfunctional patterns and contractions of self [43].It is essential in ostéopathie psychosomatique in general and in IRM in particular that the respective discoveries and “techniques” can only develop in an appropriate therapeutic relationship. This depends on the ability of the therapist to be aware of the qualities of the tissues, the physical sensations, the excitation, the emotions, the cognitions in his own experience and in the relational interactions with the patient, in order to allow an appropriate and adjusted intervention and co-regulation.

Méthodologie de l’intégration bifocale

• 1ère préparation : At the beginning, the procedure is explained and a signal to stop is given if the patient – for any reason whatsoever – wishes to stop. This allows you to monitor the progress of the treatment. As a result, resources independent of the respective source are incorporated, such as a papillary treatment or a safe place, etc.  
• 2. identification and evaluation of stress: the patient identifies and focuses on the most stressful situation/image/emotion/doubt, etc. and evaluates it on a scale of 0 to 10.
• 3. localization of the associated stress region: the patient perceives the region of the body that reacts most strongly when he focuses on the image/situation of stress. It may be necessary to help the patient to perceive the sensations/interceptions in the body, to direct attention towards them and/or to develop a final adjustment of attention, for example by means of a reverent listening session.  
• 4. localization de la direction de vision du stress associée : la direction de vision qui augmente le niveau d’excitation du stress dans la région du corps mentionnée est ajustée au moyen d’un retour d’information du patient. 
• 5. localization of the corresponding resource region: the patient identifies the region of the body that is most alert; it may be necessary to support the patient, for example by means of a reflexive interview, in order to perceive the sensations/interceptions of the body, to direct attention towards them and/or to develop a final adjustment of attention.
• 6. localization de l’orientation de vision de la ressource associée : l’orientation de vision qui augmente le bien-être et le sentiment agréable dans la région du corps mentionnée est ajustée au moyen d’un retour d’information du patient. 
• 7e palpation: The therapist palpates the region of stress and/or the region of resources as well as the stress and resource patterns associated with the reactions produced in the patient. This palpation is carried out according to the parameters of tonality, three-dimensional approximation, palpation in couches, compression champ, centrifuge process, final regulation and specific procedures for the upward and downward regulation of the states of excitation, etc., as well as other specific methods of palpatory attention.
• 8. les perceptions du champ corporel sont suivies 
• 9. the rhythmic alternation of the movement at the point: the patient places the movement at the point dynamically and at his own pace between the two identified lines of vision. For example, the frequency of the alternating movement must be chosen in such a way that it is comfortable for the patient and helps them to enter a state of flow/coupling characterized by effortless attention and automatic experience.
• 10. dynamique du processus : the patient is invited to be surprised in a “state of flux” without waiting and to be open to everything that happens or that appears in his consciousness. It can be certain physical sensations, states of excitement, feelings, thoughts, perceptions, souvenirs, images, etc. With only a slight excitation/revival, the process takes place at its own speed and dynamism and only with the least amount of intervention by the therapist.
• 11. Corégulation et ressources : the therapist acts as a corégulator to support the state of flow and the treatment of the associate or to regulate the state of relaxation. It identifies the level of excitation at each moment of the process by means of somatic markers such as respiration, cardiac frequency, variability of cardiac rhythm, facial expressions of the patient, pupil size, posture and other reactions of the body. In the dynamics of the process, there is a virtually infinite number of resources and possibilities for co-regulation to keep the process in a dynamic state of equilibrium and flux and adapted to the patient’s proximal learning zone. The therapist provides support, for example, to make the distinction between thinking and forgetting, in the fear of experiencing physical sensations or sensations that are unpleasant, etc. By means of the 5 sensory channels (visual, auditory, kinesthetic, olfactory, gustatory and interceptive; VAKOGI), of behavior and emotion and their signification, the patient is helped, if necessary, to specify and complete the content of the experience. Le cas échéant, le patient est informé de certain sensations corporelles (interoception) ou réactions corporelles “Pouvez-vous sentir comment vous avez pris une profonde respiration ? “D’autres corégulations possibles sont  : conscience de la respiration (en cas d’excitation accrue, le patient est invité à respirer dans l’abdomen et à respirer plus lentement, en cas de léger état de “gel”, à respirer doucement plus profondément), modification de la région et des qualités de la palpation, équilibrage du système nerveux autonome, stimulation du nerf vague [47], changement de la direction du regard, de la posture/position/mouvement et de l’expression du visage, ralentissement du processus, modification des sous-modalités de la perception sensorielle (dissociation, association), musique au moyen de sons bilatéraux et induction d’ondes alpha z. par exemple le CD “Grounding Waves” de T Liem 2018, les vibrations myofasciales intrinsèques, l’ajout d’archétypes, le guérisseur intérieur, etc. 

• 12. presser le citron : à la fin du traitement, lorsque l’evaluation a atteint 0-1 de 10, le patient peut essayer d’augmenter toute excitation associée à la situation vécue, afin de rendre accessibles d’autres expositions possibles d’un traitement, si nécessaire.
• 13 Adjustment [48] : The treatment can lead to perceptions of the patient that are characterized by a modified understanding, for example with regard to his or her own references and relationships in life (see “Context” in the box), and/or an accrue change in awareness. If these perceptions and/or changes of conscience occur and if the charge is reduced (charge from 0 to 1 out of 10), an adjustment can be made. For example, the patient can concentrate on the sensation and other qualities of the most pleasant part of the body by closing his eyes and performing a papillon adjustment. The patient is then given the necessary space and time to open their eyes based on this experience and possibly establish visual contact.
• 14. voûte et autres techniques de distanciation : Si le temps du traitement est terminé ou si le traitement est interrompu pour toute autre raison et qu’il y a charge supérieure à 2 sur 10, le contenu de la conscience de la charge peut être “stocké” dans un coffre-fort visualisé ou au moyen d’autres techniques de distanciation jusqu’au prochain rendez-vous.
• 15e réévaluation : at the end, the patient is invited to verbalize the points of the treatment and to give significant indications. This allows the treatment to be integrated and the knowledge and skills acquired to be put into practice in everyday life.

Contexts

This includes, for example, a new awareness of the links between physical sensations (e.g. tension in the neck and spine) and feelings (e.g. anxiety) and certain concepts of faith (e.g. “life is uncertain”), as well as health problems and life circumstances (e.g. pain in the heart due to tension), “la vie est incertaine”), as well as health problems and life circumstances (e.g., the lack of strength due to tension and the limitations of the triple role of worker, mother and partner vis-à-vis one’s husband). This new awareness or insight allows, among other things, better resilience, emotional regulation and the promotion of situational flexibility in one’s own life.During the process, the patient remains in contact with his resources and with the details of his trauma, while the therapist ensures that the patient, who is normally in a mild state of relaxation, is simultaneously anchored in relaxation [41]. A slight relaxation of the sympathetic nervous system can occur when the patient is mentally in contact with stressful situations or traumatic experiences. Throughout the duration of the treatment, the therapist acts as a co-regulator. The aim of ostéopathic intervention is to prevent the stimulation of the sympathetic nervous system by stimulating the PAG limbic circuits. This process is characterized by a dynamic transformation. The main question to which it is necessary to answer is not “What is it like” but “What is happening? [42], [43].  Palpation of the tissues is essential to accompany the internal experience of the treatment. Palpation and the energetic interactions in the corpus muscles are combined with respiration, myofascial vibration, meditation, double consciousness and internal dialog, the stimulation of the vague nerve [47]. Les patients perçoivent leur interoception de manière différenciée, les souvenirs implicites deviennent explicites [39].

Rapport de cas

A 42-year-old woman presented with a malaise that she had been suffering from for many years. Her medical file contained evidence of prenatal stress and physical abuse during her childhood. She tested positive for unfavorable childhood experiences (5 points out of 10). Certain events in her childhood – especially between the ages of 5 and 7, when she was a victim of physical violence – were still very stressful for her (9.5 points out of 10 on a numerical score table to assess the level of stress; where 0 means no stress and 10 means the highest stress imaginable).A complete structural osteopathic examination was performed to assess, among others, asymetries and sensitivity (to pain) [45]. After ensuring that sufficient resources were available, bifocal multimodal integration was launched. Adapted to the recently developed method of “brain spotting” [46], the patient imagined the most perturbing moment of the specific traumatic situation and localized the region of the body that reacted most désagréablement – in this case the solar plexus, which resembles a severe pain. The position of the eyes that intensified this disagreeable physical sensation was identified. To do this, the patient was asked to move her eyes horizontally and then vertically to find the line of vision that increases the stress, and then the area of the body that felt most at rest was localized. This was the region of the sternum, which was hard to palpate. We then found the position of the eyes that would improve this pleasant physical sensation (direction of regard that increases resources) and asked the patient to move her eyes rhythmically from front to back, from the line of vision that favors resources to the line of vision that is difficult to reach. The therapist palpated the region of the sternum and followed the micro movements of the tissues. He then palpated the region of the solar plexus and also followed the micro-movements of the tissues. At the same time, the therapist registered all the patient’s vital signs (e.g. breathing) and asked her to remain open to everything that was happening. During the 30 minutes that followed, the subjective charge on the stress level decreased from 9.5 to 0.5. The tension in the solar plexus also decreased. Respiration, which had been slightly increased during the treatment, became more profound and more lent.Trois semaines plus tard, le patient a de nouveau évalué le stress perçu au début de la séance avec 6 points sur 10 sur l’échelle de stress. However, during the course of two other treatments, the stress level was permanently at 0. Other interventions were followed, and the patient also carried out exercises to reduce stress, differentiate the effects and regulate independently between the sessions.

Conclusion

The neuro-psycho-physiological model of psycho-emotional trauma presented here offers an explanatory approach to the possible effects of psychosomatic osteopathy using the example of bifocal integration including effective interaction between the patient and the therapist. The first, and most important, step consists of establishing trust and creating a sense of security for the patient. It is followed by the stabilization phase with stress reduction exercises and the integration of adaptation strategies. During the integration/confrontation phase, the complex dysfunctional tissu-énergie vécu, the traumatic event or the stress is treated within a defined framework. This includes the palpation of the tissues, the ancrage des ressources, the double conscience du VAKOGI, the stimulation du nerf vague [47] etc., the corégulation constante par le thérapeute et le travail de sensibilization active du patient. Finally, the patient is encouraged to integrate the skills acquired and the confidence in himself emotionally and socially newly acquired into everyday life.

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SourceBasedon Liem T, Neuhuber W. Osteopathic Treatment Approach to Psychoemotional Trauma by Means of Bifocal Integration. Journal of the American Osteopathic Association March 2020, Vol 120 (3) : 180-189, with kind permission.Adresses de correspondanceTorstenLiemÉcole d’ostéopathie en Allemagne OSDMexikoring 1922297 Hambourgtliem@osteopathieschule.de Winfried NeuhuberInstitut d’anatomieUniversité Friedrich-Alexander de Nuremberg-ErlangenKrankenhausstraße 991054 Erlangenwinfried.neuhuber@fau.de