Chap­ter 18: Fill­ing in the Holes: Cre­at­ing Struc­tures. Address­ing trau­ma is more than just remem­ber­ing the past—it involves con­fronting the deep voids left by feel­ings of neglect, fear, and aban­don­ment. Grow­ing up with­out affec­tion, in a world where your pain went unseen, often leaves a per­son strug­gling to feel loved or want­ed. The emo­tion­al scars from such expe­ri­ences can dis­tort one’s sense of self-worth and agency, cre­at­ing a life­long chal­lenge in form­ing a healthy iden­ti­ty.

Research by Judy Her­man and oth­ers has demon­strat­ed that indi­vid­u­als who felt unwant­ed or unsafe as chil­dren often strug­gle to ful­ly ben­e­fit from con­ven­tion­al ther­a­py. These peo­ple may pos­sess a deep intel­lec­tu­al under­stand­ing of their issues, yet find it hard to engage with the emo­tions and mem­o­ries that would allow for heal­ing. As a psy­chi­a­trist, I wit­nessed first­hand how this emo­tion­al dis­con­nect pre­vent­ed some of my most com­mit­ted patients from mak­ing mean­ing­ful progress in ther­a­py. They could not access the emo­tion­al mem­o­ries that could reframe their neg­a­tive beliefs and feel­ings about them­selves.

A break­through came when I attend­ed a work­shop led by Albert Pes­so, a for­mer dancer and the cre­ator of PBSP (Pes­so Boy­den Sys­tem Psy­chomo­tor Ther­a­py). Pesso’s approach was cen­tered around using phys­i­cal move­ments and group inter­ac­tion to help indi­vid­u­als recon­nect with their emo­tions and mem­o­ries. His tech­nique involved cre­at­ing “struc­tures,” phys­i­cal role-play­ing sce­nar­ios where par­tic­i­pants could explore and re-enact crit­i­cal moments from their past. Through these struc­tures, the pro­tag­o­nists could con­front the emo­tion­al absence in their lives, often for the first time, and begin to fill the void with expe­ri­ences of care and val­i­da­tion. The phys­i­cal­i­ty of this approach helped the par­tic­i­pants expe­ri­ence emo­tions in a vis­cer­al way, some­thing tra­di­tion­al talk ther­a­py often strug­gled to achieve.

This inno­v­a­tive approach was espe­cial­ly pow­er­ful when deal­ing with unre­solved trau­ma. By using role play and “con­tact per­sons,” par­tic­i­pants could recre­ate sit­u­a­tions where they felt neglect­ed or unloved, and then insert ide­al­ized fig­ures into these scenes, such as a nur­tur­ing par­ent or a sup­port­ive friend. This process allowed them to expe­ri­ence what it would have felt like if their needs had been met, giv­ing them a new inter­nal map of safe­ty and care. Research on neu­roimag­ing sug­gests that trau­ma is often imprint­ed on the right hemi­sphere of the brain, the area respon­si­ble for non­ver­bal com­mu­ni­ca­tion, such as facial expres­sions and body lan­guage. By engag­ing this part of the brain, PBSP ther­a­py facil­i­tates a deep­er, more pro­found heal­ing expe­ri­ence than cog­ni­tive approach­es alone.

Through these phys­i­cal struc­tures, indi­vid­u­als could also explore new forms of emo­tion­al expres­sion and release. For instance, when one par­tic­i­pant con­front­ed her father’s abuse, she was able to cre­ate an ide­al­ized ver­sion of him, one who could pro­vide care and pro­tec­tion. As the exer­cise unfold­ed, she not only expe­ri­enced the pain of the past but also began to feel the relief of wit­ness­ing a father who was capa­ble of love and under­stand­ing. This process helped shift her per­cep­tion of her­self, allow­ing her to inter­nal­ize a more bal­anced and car­ing image of her father, which in turn improved her sense of self-worth.

The role of the ther­a­pist in these ses­sions is crucial—they guide par­tic­i­pants in cre­at­ing these emo­tion­al shifts by facil­i­tat­ing the move­ment of the struc­tures and offer­ing feed­back through “wit­ness­ing.” The wit­ness­ing pres­ence pro­vides val­i­da­tion and recog­ni­tion of the par­tic­i­pan­t’s feel­ings, offer­ing a safe space for deep­er explo­ration. As the pro­tag­o­nist moves through their struc­ture, they often have pow­er­ful emo­tion­al break­throughs, expe­ri­enc­ing a cathar­sis that is dif­fi­cult to achieve through words alone. For many, these break­throughs are essen­tial for over­com­ing the trau­ma that has shaped their iden­ti­ty for so long.

In these types of ther­a­py, indi­vid­u­als not only come to terms with the hurt of the past but also cre­ate new, empow­er­ing nar­ra­tives for their futures. Just like revis­it­ing a dif­fi­cult child­hood mem­o­ry, these ther­a­peu­tic exer­cis­es help indi­vid­u­als rewrite the sto­ry of their lives, giv­ing them a sense of con­trol and agency over their emo­tions. The result is not only a change in how they see them­selves but a trans­for­ma­tion in their abil­i­ty to relate to oth­ers, ulti­mate­ly fos­ter­ing health­i­er, more ful­fill­ing rela­tion­ships. As we have learned through decades of psy­cho­log­i­cal research, chang­ing the emo­tion­al land­scape of the past can have a pro­found impact on the present, allow­ing indi­vid­u­als to rewrite the script of their lives.

Psy­chomo­tor ther­a­py offers a tan­gi­ble and trans­for­ma­tive way to recon­nect with lost parts of one­self and heal from the wounds of trau­ma. By cre­at­ing struc­tures, indi­vid­u­als can relive past events in a con­trolled, safe space and exper­i­ment with rewrit­ing them in a way that ful­fills unmet emo­tion­al needs. This approach helps break the cycle of trau­ma and aban­don­ment, offer­ing par­tic­i­pants a chance to rebuild their self-worth and reclaim their emo­tion­al agency.