Loosening the Knot, Part II

In the first post on this topic (Loosening the Knot, Part 1 – finding the client’s neutral), I briefly discussed the client’s state of neutral, why it is important, and the involvement of the autonomic nervous system in prohibiting its expression. I will now present three of the more common situations of inhibited neutrality that we encounter in clinical work and offer some practical suggestions for how to work with them.

Overidentification with Mental Processes

Many of our clients lead busy lives. As a parent of two young children, I know what this is like! Life presents problems to solve and challenges to deal with on a daily basis. Our clients frequently arrive at our doorstep with a lot on their minds! Besides the health concerns that bring them to us, they have deadlines at work, family problems, melodies stuck in their heads, financial worries, groceries to buy, questions about your therapy, and the list goes on and on. Even clients with relatively healthy nervous systems undergo periods of stress that exacerbate speed and noise in the mind and its corresponding biology.

Unfortunately, strong engagement of the attention in mental processing activities can keep people from entering biological neutral. Clients with this tendency may reveal it through excessive and rapid verbalization, mental preoccupation, overt worry, etc. When we get them on the table (or even before), it may be useful to enter into their mental world a bit to get their attention where it is focused most. I will sometimes engage the client in conversation to find out what is going on and then introduce some pauses into the conversation in an attempt to slow down communication. The point here is to meet them where they are at in a genuine manner while encouraging a slower-paced interaction.

After I slow down our interaction a bit and recognize some of the content of their mental world, I may ask them to bring their attention to their breathing or some pleasant aspect of their sensory experience. This is often all that is needed to break the mental streaming and set the stage for some space to emerge. What usually does not work is just letting them run with their mental content in the hope that they will eventually shift on their own. Some clients have so much cerebral momentum that they will spend an entire hour lost in their forebrain, completely unaware of their sensory world. We need to get in there and respectfully help them shift the quality of their awareness through verbal interaction, relocation of the attention, and slow pacing.

If such efforts are not well received or simply ineffective, you also have the option of inducing a stillpoint mechanically. An EV4 may bring some quiet to the system and slow down rapid frontal lobe activity. We should feel comfortable using direct action in cases where it is needed! I realize that for people with biodynamic tendencies, this can take some getting used to.


Pain is a factor in the internal experience of many clients that come to us for help. Pain creates noise in the nervous system and erects an obvious barrier to relaxation. My heart goes out to these people in the midst of such sensory struggles. Sympathy and genuine concern for their experience help to take the edge off and alleviate the isolation that pain can bring.

Finding a physical position that facilitates as much comfort as possible for the client is essential. If they can’t lie on their back, then work with them prone. If they need pillows under their knees to be comfortable, then get some. If they need to move every few minutes, then go with that.

After finding a position that facilitates as much ease as possible, it may be helpful to empower them by consciously working with their awareness. Their pain is usually at the forefront of their sensory world, but we can give them a useful tool by asking them to locate a place in their experience that feels “good.” This is often not easy for them at first if they are not well resourced in working with sensation. But stick with it. Most will be able to identify some part of the self that feels okay. It may be a single finger, their contact with the table, a point distant to the site of the pain, etc. In extreme cases they might need to rest their awareness in a belief or spiritual truth in order to find some safety and comfort. This is highly individualized. Go with whatever works. If you are skilled in such matters, a guided visualization may be effective.

Following the breath is a time-honored technique that may prove useful at loosening the grip of pain as well.

If the client is pulled back into their painful experience, acknowledge it and ask him/her to explore their safe points of contact again. This swinging of the pendulum of awareness slowly resources them by revealing that they may have perceptual options they have not considered. If they can grow their skill with this, enough pressure may be taken off of their nervous system to allow a settling into a neutral. I have seen this work with very extreme cases of pain.

For those clients with whom this is not effective or meaningful, I may suggest that they take a pain medication (clients dealing with significant pain often have a prescription) before the next treatment so that we may be given a window of relief to work through. This approach obviously depends on the beliefs and predisposition of the client, but it can be a very useful tactic.

I have become increasingly aware that for some clients, persistent pain is best dealt with by directly entering into the experience and “embracing” it rather than trying to “manage” it. Sometimes the sensory pressure of pain can only be released by letting it deeply permeate the sense of self. This is an interesting topic that I will save for another post.

My faith in the ability of craniosacral therapy to offer help in the midst of pain grows stronger every year. With some patience and practice, you will find that many cases of stubborn pain can be quelled and great relief delivered to your clients as they learn to safely navigate the forces present in the neutral. The possibility of normalcy becomes more evident to the client as the neutral increasingly gives way to alignment with patterns of freedom.

Staring at the Moment

I borrowed this phrase from Dr. Jealous, who uses it to describe a common error made by practitioners while learning to perceive the long tide. It involves anchoring into a fixed state of awareness that denies fluidity to the senses. There is an intensity and rigidness to this state of awareness that blocks our ability to perceive motion because our will is pointedly engaging in anticipation of an unknown event.

I see this phenomenon in clients – particularly new clients who are not familiar with the spacious quality of contact we utilize in this style of bodywork. New clients who seek our help may have a misunderstanding of how this type of therapeutic contact works. They may be expecting us to “do something to them” or apply a gross technique that they can feel immediately affecting their soma. When clients come to me and say that they heard they should try “craniosacral massage” for their problem, a red flag goes up for me. If the client gives signs that they are expecting gross mechanical work, I explain to them that this approach begins with deep listening to their body through gentle contact. I tell them that I am seeking to understand some deep movements in their body that are effecting the way they feel, and the way I get the most accurate information is to begin with gentle touch. I will even go so far as to say “You may not feel very much at the beginning while I am getting to know how your body functions. I am going to be pretty still for a while. Just relax and bear with me until I better understand what your body needs to feel better.” A statement like this takes the edge of expectation out of the client’s experience. It enables them to relax in the midst of a spacious contact that may be very foreign to them in the context of a healthcare setting.

When the client is not informed that this may be “a little different” they are left in a state of expectation, wondering when you will begin fixing them. They are left wondering what you are doing! If you tell them up front what you are doing and reveal that your plan involves very gentle contact, then they can relax into it. This change of expectation is often all that is needed to allow the system to settle and move toward neutrality in tissue tone. As the inherent treatment plan arises, the client then begins to feel engagement in a genuine way, not a preconceived idea of what will happen. The process itself can then lead the way. I cannot stress enough how much communication beforehand helps facilitate ease in the therapeutic experience for clients who are new to this style of bodywork.

Staring at the moment is also a hurdle for those who have trauma or dissociation issues. Such clients are locked in a fixed autonomic state that prohibits their biology and awareness from shifting with the rhythms of the natural world. Their mind may be quiet, and they may be cognitively comfortable with the therapeutic interaction, but they just won’t shift. Their neurological function and field of awareness has been distorted, and as a result, their sensory experience is limited and rigid. I usually try basic exercises of following the breath or body scans at first, while soliciting feedback regarding the client’s experience. Such exercises may help create some wiggle room in the nervous system. Additionally, the information you glean from verbal communication may give you some insight as to where to locate the window of new movement.

I will also sometimes utilize mechanical techniques to introduce motion into a system that is staring at the moment. Utilizing a gentle lever in the form of mechanical technique can begin a dialogue revolving around motion rather than fixedness. Some traumas have locked up clients for many years before they come to you. Skillfully applied and carefully monitored direct interaction can work wonders to free up stagnation in a system that has removed itself from a response to healthy biological rhythm.

Well, those are three of the more common situations regarding “difficult neutrals” you are likely to face on the table. I hope this post stimulated your thinking on the topic and presented some helpful tools for you. The possibility of neutrality in the client is almost always there, even when it seems far away!

2 thoughts on “Loosening the Knot, Part II

    • Hi MaryAnn,
      EV4 is short for “expansion of ventricle four.” It can be seen as the opposite principle of the CV4. Dr. Jealous introduced this term to describe a resuscitative technique that can be applied to the tissue/fluid body. Whereas the CV4 is a directive technique that focuses fluid and potency resources into the midline in the extension phase, the EV4 holds the body in inhalation and brings about a distribution to the periphery by synchronizing with inhalation through several cycles.

      The EV4 is often used to normalize fluid body lesions, augment fluid drive, bring about a sense of cohesiveness and wholeness, or to simply clear noise out of the tissue and fluid fields. It is traditionally applied through a contact with the cranium.

      We go over application of this principle in Level 4.
      I hope that helps!

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