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Inside-Out Paradigm

By Dale G. Alexander, LMT, MA, PhD

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Enhance Healing With Therapeutic Endings

To support your clients' healing process from chronic somatic difficulties, you may want to consider therapeutic endings, which can assist the human nervous system in updating and recalibrating itself across its vast lattice of neurovascular relationships. I consider it to be similar to a musical symphonic resolution, encouraging a more expansive state of neurological balancing. Let's discuss three suggested protocols which can be exceptionally helpful in increasing the effectiveness of your work.

The essential condition of any client presenting with chronic somatic dysfunction is that their nervous system has adapted to their ongoing troubles. Even though they desperately want their pain to go away and desire a return to normal function and range of motion, their autonomic, sensory, and motor systems have adjusted to their dysfunction in order to provide stability, and to minimize their pain – so much so that even the anticipation of movement can provoke a limitation in its range and the onset of the sensation of pain.

Adaptation is the evolutionary genius of our species. Survival at all costs, even for just one more day, was the innate drive for our species' biological progression into our human form and its diverse varieties of function. Yet, I propose that this same capacity for adaptation can have a dysfunctional echo into our modern lives.

healing - Copyright – Stock Photo / Register Mark A current definition of chronic is any condition lasting more than three months. Previous definitions were six months or longer. However, the duration is of little concern to a client who can no longer maintain their daily functions without noticeable disruption, especially while experiencing pain most or all of the time.

Regardless of the therapeutic bodywork strategy you may employ, the actual experience of a client to feel that they made progress as a result of your touch and interaction with them quickly determines whether they continue to make future appointments with you. Their perceived progress influences your prosperity.

Discussion of effective therapeutic session endings has had little attention in our literature or any other. However, my clinical experience suggests that it is a significant variable. I postulate that effective therapeutic endings are intended and designed to consolidate the gains of an individual therapeutic session and to build a momentum toward a more normal state of physiologic homeostasis from one session to the next.

Parasympathetic Ending

During my first advanced training in 1980 with Bill Williams and Ellen Gregory, the developers of Soma Neuromuscular Integration, I was first introduced to the concept of a parasympathetic ending. This ending sequence consisted of an active connective-tissue stretch on each side of the client's neck; while supine, a stretching of their sacrum caudally; and then while seated, an inferior bilateral fascial stretch of their lower back applied caudally, as the client actively rolled their torso forward.

My comprehension of the autonomic nervous system and the importance of enhancing parasympathetic outflow took a huge leap while studying CranioSacral Therapy with John Upledger, DO, and other physicians during my intensive studies at his institute.

One particular protocol was an exceptionally gentle stretching of the dural tube, which was intended to stimulate the outflow from the vagal nerves exiting the brain and from the pelvic splanchnic nerves within the sacral portion of the spinal cord. The contacts for this technique are organized with the client supine and therapist at the side; cradling the occiput with the palm of one hand, while accessing and cradling the sacrum with the other.

Many variations are possible with this gentle approach: stretching both ends away from the other, holding the upper end and stretching the lower end toward the feet, or reversing the more fixed end toward the sacrum and stretching the occiput superiorly, or gently counter-rotating the opposite ends, like very gently wringing a wash rag.

Considering that the brain and spinal cord float within an internal sea of cerebral spinal fluid, and that circulation of the fluid can be noticeably enhanced in this manner, this technique has an awesome track record as an effective therapeutic ending.


Often, when using this technique I create or invite my clients to create a visualization. Asking them to recall a time when they simply floated comfortably and effortlessly in water can deepen their state of relaxation and increase parasympathetic outflow. With others, I have encouraged them to recall an image of the person they feel has loved them the most consistently in their lives; and then further inviting them to recall additional sensory elements associated with that individual such as their smell, quality of touch, texture of their clothes, the look in their eyes, and the adoring smile of their face.

Ilana Rubenfeld once commented that remembering the loving moments of one's life is as important as clearing the pain often sequestered behind closed or locked doors.

My 36 years of clinical experience strongly supports the concept that enhancing parasympathetic outflow is a key contributor to the re-booting, recalibrating, and rebalancing within all branches of the central nervous system, supporting one's emotional healing as well.

The goal of effective therapy is to create a new, more efficient normal – an updated reference point for the nervous system to reorder itself with additional and enhanced options and choices. It is a form of educating, supporting, and soothing that may transform what has been negatively anticipated toward an open moment of neutrality, and then toward new possibilities for movement and an expanded range of emotional and physical responses. Therapeutic endings function as a bridging structure from what was to what may now be possible.

Integrated Awareness

A third original therapeutic ending that has shown consistent results with many of my clients has been to create an energetic two-way linkage between the heart and the brain. The organization for this connection are palmar contacts with the anterior heart and the forebrain, or sometimes with the parietal portion of the cerebral cortex, while forming a clear intention to energetically reconnect these essential parts of our bodies.

An image of a lava lamp, with its base being the heart and its top being the brain, is a useful analog to most clients. This style of touch and communication between organs reflects decades of training with Lansing Barrett Gresham, founder of Integrated Awareness.

The epiphany of this technique occurred quite spontaneously one day in a moment when I realized that the brain and the heart are the true parents of the human body. All cells are dependent upon the electromagnetic and electrochemical vitalization of the brain/nervous system and upon the nutrition, oxygen, and hormones delivered by the heart/circulatory system.

Many possible implications flow from this analogy. Foremost, given that heart disease is the No. 1 reason for our collective demise and that Alzheimer's is in sixth place, the intuitive question arose in my brain: What if assisting these organs to prioritize each other might be an overlooked therapeutic goal? What characterizes one of the most noble qualities of mammals is their capacity to sacrifice themselves for the good of the whole. Maybe this happens within our bodies more often than we imagine and involves the heart and the brain specifically.

Consider that the heart and the brain work so very hard to support and maintain our bodies that they may be actually sacrificing themselves individually. Extending the parenting analogy, many families that descend into dysfunction are characterized by very well- intentioned parents, endeavoring to raise their children with love; yet, they grow out of step with one another. Neglecting to nourish each other or even themselves, the family slides into a downward spiral.

What happens on the outside is so often a reflection of what is going on inside is my obvious premise. Kinesthetically planting this seed of the heart and brain, prioritizing each other to support the function of the whole, has resonated and contributed to positive therapeutic improvements for many, many clients.

Please allow your own creativity to discover and evolve novel therapeutic endings for your clients. Your clients will notice the difference, and as a result they will schedule more often.

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