Case Study 2
Karen sat beside me at the piano. I suggested we do some breathing together before singing. Singing
was very risky for Karen, but she felt it would benefit her. As a child, she tried to avoid her mother's
physical attacks and her father's verbal attacks by making herself as invisible as possible. She was thin
and wraithlike and spoke in a quiet, tense voice. Being seen or heard was dangerous while growing up,
and even though she yearned to be listened to and acknowledged, the old fears were deeply embedded
in her psyche.
We began to breathe together, sipping the air in slowly as if through a straw, then exhaling on
an "s-s-s" sound, like a balloon slowly deflating. As we began the second round, she looked at me and
said, "I'm flying off," shaking her body as if she had chills. Karen remembered "blanking out a lot" as a
child. When her mother hit and kicked her, she would leave her body and go off into her own world. This
dissociative defense that initially protected her psyche from annihilation no longer served her, but had
become habitual and took over in times of stress and anxiety. I asked her what would help her feel safer
and she said, "Close to the ground feels safer ... to sit on the floor." I grabbed two pillows and we sat
on the floor facing each other.
I suggested that for today we stay with the breathing and work on ways to help her stay in her
body. We began the breathing exercise again, and I asked her to slow down the process and tell me
everything she was experiencing. She started feeling anxious on the exhalation and felt herself starting to
"go up." I suggested we use movement to ground her. We raised our arms on the inhalation and on the
exhalation we pretended to be pulling a heavy bar down. We kept eye contact throughout. After several
attempts, she was able to stay present during the exhalation. She said the movement and the support she
experienced through moving together and keeping eye contact was very helpful. "I felt you wouldn't let
me go off-I started to. I was very scared but I stayed with you .... I felt the breath going down into
my lower body-scary, very scary there. That's where the terror lives. I couldn't stay there too long, but
I didn't fly off! That's good. I'm getting better."
Breathing exercise. Another breathing exercise that I often use, especially with clients who suffer
from anxiety, is one that I learned from my yoga teacher. It is called alternate nostril breathing. I usually
7Cj
do the exercise with a client after I have explained and demonstrated it. We prepare by sitting opposite
each other on chairs and keeping the head and spine in a straight, upright position. The feet are planted
firmly on the ground. We begin by bringing the right hand to the nose and covering the right nostril with
the right thumb and inhaling through the left nostril. We then cover the left nostril with the right index
finger and exhale through the right nostril. We keep the index finger covering the left nostril and inhale
through the right nostril. Again we cover the right nostril with the right thumb and exhale through the
left nostril. We then inhale and switch sides so that we are exhaling and inhaling through one nostril
then switching to the opposite nostril and continuing to exhale and inhale on that side. We continue this
breathing pattern for several minutes.
When clients become comfortable with this exercise, Imay suggest a more advanced version in which
the exhalation is prolonged. We count to 5 as we inhale, then count to 10 as we exhale. The idea is to
double the time given to the exhalation. Another variation is to count to 5 on the inhalation, hold the
breath (both nostrils closed) for a count of 5, and then exhale while counting to 10. Imagery can be
useful, such as asking clients to imagine they are inhaling their favorite color or fragrance or something
they need to take in and then imagine they are exhaling stress, stale air, or something they want to
release.
Exhalation is the most relaxing part of the breath cycle and promotes the release of feelings that are
being held onto. Deep exhalation empties the body of all stale air and makes it ready to receive fresh air.
The nervous system is quieted and the body begins to relax and come to a state of relative balance.
Case Study 2
Karen sat beside me at the piano. I suggested we do some breathing together before singing. Singing
was very risky for Karen, but she felt it would benefit her. As a child, she tried to avoid her mother's
physical attacks and her father's verbal attacks by making herself as invisible as possible. She was thin
and wraithlike and spoke in a quiet, tense voice. Being seen or heard was dangerous while growing up,
and even though she yearned to be listened to and acknowledged, the old fears were deeply embedded
in her psyche.
We began to breathe together, sipping the air in slowly as if through a straw, then exhaling on
an "s-s-s" sound, like a balloon slowly deflating. As we began the second round, she looked at me and
said, "I'm flying off," shaking her body as if she had chills. Karen remembered "blanking out a lot" as a
child. When her mother hit and kicked her, she would leave her body and go off into her own world. This
dissociative defense that initially protected her psyche from annihilation no longer served her, but had
become habitual and took over in times of stress and anxiety. I asked her what would help her feel safer
and she said, "Close to the ground feels safer ... to sit on the floor." I grabbed two pillows and we sat
on the floor facing each other.
I suggested that for today we stay with the breathing and work on ways to help her stay in her
body. We began the breathing exercise again, and I asked her to slow down the process and tell me
everything she was experiencing. She started feeling anxious on the exhalation and felt herself starting to
"go up." I suggested we use movement to ground her. We raised our arms on the inhalation and on the
exhalation we pretended to be pulling a heavy bar down. We kept eye contact throughout. After several
attempts, she was able to stay present during the exhalation. She said the movement and the support she
experienced through moving together and keeping eye contact was very helpful. "I felt you wouldn't let
me go off-I started to. I was very scared but I stayed with you .... I felt the breath going down into
my lower body-scary, very scary there. That's where the terror lives. I couldn't stay there too long, but
I didn't fly off! That's good. I'm getting better."
Breathing exercise. Another breathing exercise that I often use, especially with clients who suffer
from anxiety, is one that I learned from my yoga teacher. It is called alternate nostril breathing. I usually
7Cj
do the exercise with a client after I have explained and demonstrated it. We prepare by sitting opposite
each other on chairs and keeping the head and spine in a straight, upright position. The feet are planted
firmly on the ground. We begin by bringing the right hand to the nose and covering the right nostril with
the right thumb and inhaling through the left nostril. We then cover the left nostril with the right index
finger and exhale through the right nostril. We keep the index finger covering the left nostril and inhale
through the right nostril. Again we cover the right nostril with the right thumb and exhale through the
left nostril. We then inhale and switch sides so that we are exhaling and inhaling through one nostril
then switching to the opposite nostril and continuing to exhale and inhale on that side. We continue this
breathing pattern for several minutes.
When clients become comfortable with this exercise, Imay suggest a more advanced version in which
the exhalation is prolonged. We count to 5 as we inhale, then count to 10 as we exhale. The idea is to
double the time given to the exhalation. Another variation is to count to 5 on the inhalation, hold the
breath (both nostrils closed) for a count of 5, and then exhale while counting to 10. Imagery can be
useful, such as asking clients to imagine they are inhaling their favorite color or fragrance or something
they need to take in and then imagine they are exhaling stress, stale air, or something they want to
release.
Exhalation is the most relaxing part of the breath cycle and promotes the release of feelings that are
being held onto. Deep exhalation empties the body of all stale air and makes it ready to receive fresh air.
The nervous system is quieted and the body begins to relax and come to a state of relative balance.
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