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Indespensible survival guide for Psychotherapy Treatment


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Lisa Loustaunau, MFA, CCEP, …

Lisa Loustaunau, MFA, CCEP,
OSC is Director of Education
and Assistant Director of the
Institute of Core Energetics in
NY. Lisa teaches and supervises
body psychotherapists around
the world in the Core Energetics
approach developed by the late
John Pierrakos MD, whom she
frequently assisted. Her private
practice is in Norwalk, CT.

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  • 1. New TherapistIndispensable survival guide for the thinking psychotherapist September/October 2012 The Body Edition 81
  • 2. Features EDITOR John Söderlund MANAGING EDITORS Lee-ann Domoney Sue Spencer6 Body of Evidence: The head-to-toe CONTRIBUTING EDITORS Dylan Evans history of body use in Graham Lindegger Jacqui de Mare psychotherapy Julie Manegold Tim Barry Tom Strong Kelly Quayle Robert Langs Simone Descoins14 Every body needs some body Robert Waska CONTRIBUTIONS Submissions for inclusion in New Therapist are welcomed. Jack Lee Rosenburg, Lisa New Therapist reserves the right to edit or exclude any submission. Names and identifying information of all Loustaunau and Frederic individuals mentioned in case material have been changed to Lowen on body-based protect their identities. The views expressed herein do not necessarily represent those of New Therapist, its publishers or psychotherapy distributors. ADVERTISING Advertising deadlines for New Therapist are six weeks prior to the first Monday of the month of publication. Please call or email for a media pack and rate card, or visit our web site at26 Minding the body: SUBSCRIPTIONS Feeling and sensations— Subscription charges are $48 per year to all international what they offer us destinations (including postage). To South African destinations, subscription charges are R320 per year (including VAT and postage). If you would like New Therapist By Trish Bartley delivered to your door every second month, please send your payment (by Master or Visa card or cheque) and full postal address to New Therapist Subscriptions, 27 Kitchener Road, Clarendon, Pietermaritzburg, 3201, South Africa. For further information, call +27 (0)33 342 7644 or visit our website at to subscribe online. Please allow up to 10 weeks for first delivery. CONTACT NEW THERAPIST Tel/fax: +27 (0)33 342 7644 Regulars Email: Web: 27 Kitchener Road, Clarendon, Pietermaritzburg, 3201, South Africa New Therapist (ISSN 1605-4458) is a professional resource3 published by New Therapist Trust every second month and Drug watch distributed to psychotherapists around the world. Copyright © New Therapist 2012. All rights reserved. No part4 Research of this publication may be reproduced or disseminated by any means whatsoever without the prior permission of the publishers.32 From the therapists chair A publication of New Therapist Trust.
  • 3. Drug watch Creatine boosts effectiveness of antidepressants for women C linically depressed women appear to respond better to antidepressants when they are taken in conjunction with creatine, according to researchers at the University of Utah. The findings were published online in American Journal of Psychiatry in July, 2012. The authors of the study note that creatine is a naturally occurring amino acid typically associated with providing fuel for intense bursts of energy during high-intensity, short-duration exercises. The mechanism by which creatine works againstNegative suggestion can induce depression is not precisely known, but the authorssymptoms of illness of the study suggest that the pro-energetic effect of creatine supplementation, including the making ofU ndesired effects of drugs can sometimes more phosphocreatine, may contribute to the earlier be attributed to nocebo effects, according and greater response to antidepressants. to researchers at the Technical University The eight-week study comprised 52 South Koreanof Munich. The findings appeared in the journal women with major depressive disorder betweenDeutsches Ärzteblatt International in July, 2012. the ages of 19 and 65. All the women took the Nocebo effects are the adverse events that occur antidepressant Lexapro (escitalopram) during theduring sham treatment and/or as a result of negative trial.expectations. Twenty-five of the women received creatine with Nocebo responses can, for instance, be brought the Lexapro and 27 were given a placebo. Neitherabout by unintended negative suggestion on the the study participants nor the researchers knew whopart of doctors or nurses, e.g., when informing received creatine or placebo.the patient about the possible complications of a The study showed that depressed participants whoproposed treatment. augmented their daily antidepressant with 5 grams The mechanisms behind this phenomenon of creatine responded twice as fast and experiencedare—as with placebo effects—learning by Pavlovian remission of the illness at twice the rate of womenconditioning and reaction to induced expectations. who took the antidepressant alone. There wereWhile the positive counterpart—the placebo no significant adverse side effects associated witheffect—has been intensively studied in recent years, creatine.the scientific literature contains few studies on The researchers hold that their findings arenocebo phenomena, the researchers note. significant because antidepressants typically don’t The researchers say that the consequences start to work until four to six weeks. They also notefor clinical practice are that doctors may find that creatine under a doctor’s supervision couldthemselves in an ethical dilemma between their provide a relatively inexpensive way for women whoobligation to tell the patient about the possible side haven’t responded well to SSRI (selective serotonineffects of a treatment and their duty to minimize reuptake inhibitor) antidepressants to improve theirthe risk of a medical intervention and thus to avoid treatment outcomes.triggering nocebo effects. “If we can get people to feel better more quickly, One possible strategy to solve this dilemma, they’re more likely to stay with treatment and,suggested by the authors, is to emphasize the ultimately, have better outcomes,” said senior authortolerability of therapeutic measures. Another of the study Perry F. Renshaw.option, with the patients permission, would be to The researchers say that future research effortsdesist from discussing undesired effects during the will test creatine supplements in men and women aspatient briefing. well as individuals of different nationalities. Indispensable survival guide for the thinking psychotherapist 3
  • 4. ResearchBelieving in a mind-body connection Sleep deprivation linked to hungerlinked to better health and weight gainT S he more individuals perceive their minds and leep habits affect body weight by influencing bodies to be distinct entities, the less likely an individual’s caloric intake and energy they will be to engage in behaviors that protect expenditure, according to researchers at thetheir bodies, according to researchers at the University Society for the Study of Ingestive Behaviour. Theof Cologne, Germany. The findings appeared in findings appeared in PsychCentral in July, 2012.Psychological Science, a journal of the Association for The authors of the study observed the effect ofPsychological Science in July, 2012. short-term sleep deprivation on hunger as well as on The researchers note that many people are physical activity and energy used by the body.philosophical dualists—believing that the brain and The researchers monitored the physicalthe mind are two separate entities. Their findings activity of participants by attaching accelerationshowed that people primed with dualist beliefs had detection devices to each of their wrists. They alsomore reckless attitudes toward health and exercise, monitored participants’ energy levels using indirectand also preferred (and ate) a less healthy diet than calorimetry—a method that estimates how much heatthose who were primed with physicalist beliefs. is produced by a person as they use oxygen. Furthermore, they found that the relationship The researchers found that participants who sleptalso worked in the other direction. People who were less had higher traces Ghrelin (or what they term theprimed with unhealthy behaviors—such as pictures of “hunger hormone) in their blood. Those who slept forunhealthy food—reported a stronger dualistic belief shorter periods also moved around less.than participants who were primed with healthy Results also showed that after staying awake forbehaviors. one complete night, the amount of energy used by the Specifically, these findings suggest that dualistic body when resting was significantly reduced amongbeliefs decrease the likelihood of engaging in healthy participants.behavior. The researchers say that their findings suggest Evidence of a bidirectional relationship further that when individuals are sleep-deprived they aresuggests that metaphysical beliefs, such as beliefs in likely to eat more calories because they are hungrier.mind-body dualism, may serve as cognitive tools for This alone might cause them to gain weight overcoping with threatening or harmful situations. time. Sleep loss also means we burn off fewer The researchers say that the fact that the simple calories, which adds to the risk of gaining weight andpriming procedures used in their studies had an developing type-II diabetes.immediate impact on health-related attitudes The researchers conclude by saying that althoughand behavior suggests that these procedures may much is still to be learned about the correct sleep doseeventually have profound implications for real-life for obesity and diabetes, the available research resultsproblems. Interventions that reduce dualistic beliefs clearly supports the notion that sleep is involvedthrough priming could be one way to help promote in the balance between the amount of calories wehealthier—or less self-damaging—behaviors in at-risk eat and the amount we use up through activity andpopulations. metabolism.4 New Therapist September/October 2012
  • 5. ResearchFathers’ rejection can have particularly Snacking linked to brain activity andadverse effects on children self-controlA F study by researchers at the University of ood consumption and BMI (Body Mass Index) Connecticut shows that while mothers have are linked to both brain activity and self-control, unique social and emotional bonds with their according to researchers at the Universities ofchildren, a father’s love contributes as much—if not Exeter, Cardiff, Bristol, and Bangor. The study appearedmore—to a child’s development. The findings appeared in the journal NeuroImage in July, the journal Personality and Social Psychology Review in The authors of the study found that individuals’ brainJune, 2012. reward centre responses to pictures of food predicted The researchers analysed the power of parental how much they subsequently ate. This had a greaterrejection and acceptance in shaping our personalities as effect on the amount they ate than their consciouschildren and into adulthood. feelings of hunger or how much they wanted the food. In a review of 36 international studies that involved A strong brain response was also associated withmore than 10,000 participants, the researchers increased weight (BMI), but only in individualsdiscovered that parental rejection causes children to feel reporting low levels of self-control. For those reportingmore anxious and insecure, as well as more hostile and high levels of self-control a stronger brain response toaggressive toward others. food was related to a lower BMI. “Children and adults everywhere—regardless The researchers note that their study adds toof differences in race, culture, and gender—tend to mounting evidence that overeating and increased weightrespond in exactly the same way when they perceived are linked, in part, to a region of the brain associatedthemselves to be rejected by their caregivers and other with motivation and reward, called the nucleusattachment figures,” said co-author of the study Ronald accumbens.Rohner. Responses in this brain region have been shown The authors of the study found that the pain of to predict weight gain in healthy weight and obeserejection—especially when it occurs over a long period individuals. The current study adds to this by showingof time in childhood—tends to linger into adulthood, that this is independent of conscious feelings of hunger,making it more difficult for adults who were rejected as and that self-control also plays a key role.children to form secure and trusting relationships with The study comprised 25 young healthy females withtheir intimate partners. BMI’s ranging from 17-30. The researchers elected to Rohner notes that prior studies have shown that the observe female participants as they typically exhibitsame parts of the brain are activated when people feel stronger responses to food-related cues than men. Thisrejected as are activated when they experience physical is due to hormonal changes during the menstrual cycle.pain. All participants were taking the monophasic combined “Unlike physical pain, however, people can oral contraceptive pill.psychologically relive the emotional pain of rejection Participants had not eaten for at least six hours. Theyover and over for years,” Rohner said. were given a bowl containing 150 g of potato chips to eat The results showed that while children and adults at the end of the study.often experience more or less the same level of The researchers used MRI scanning to detect theacceptance or rejection from each parent, the influence participants brain activity while they were shownof one parent’s rejection—often the father’s—can be images of household objects, and food that variedmuch greater than the other’s. in desirability and calorific content. After scanning, Researchers at the International Father Acceptance participants rated the food images for desirability andRejection Project explain that children and young rated their levels of hunger and food craving.adults are likely to pay more attention to whichever Lead author of the study Natalia Lawrence of theparent they perceive to have higher interpersonal power University of Exeter says, "Our research suggests whyor prestige. some individuals are more likely to overeat and put So if a child perceives her father as having higher on weight than others when confronted with frequentprestige, he may be more influential in her life than the images of snacks and treats. Food images, such as thosechild’s mother. used in advertising, cause direct increases in activity Rohner notes that fatherly love is critical to a in brain reward areas in some individuals but not inperson’s development. The importance of a father’s others. If those sensitive individuals also struggle withlove should help motivate many men to become more self-control, which may be partly innate, they are moreinvolved in nurturing child care. likely to be overweight." Indispensable survival guide for the thinking psychotherapist 5
  • 6. Features Body of evidence Body of Evidence: An overview of body use in psychotherapy By Kelly Quayle M uch as Descartes might have theorised that the mind and body are separate entities in his famous Cartesian dualism, it has long been understood that mind non for any interpretation offered by psychologists of the state of their clients. But many schools of thought in the psychology field have long considered the central role of and body are not neatly distinct the body in not only expressing from one another. To a large mental trauma or imbalance, but extent, the focus of traditional also as a tool for therapeutic change psychotherapy is in working with and for tracking the progress of one’s thoughts and beliefs. The clients. This overview will cover the old adage of psychotherapy as the work of some leading writers and ‘talking cure’ priveleges verbal psychotherapists in this evolving communication to the sine qua area of psychotherapy.6 New Therapist September/October 2012
  • 7. Features Body of evidenceUnderstanding the body in mental Clarifying ‘body in psychotherapy’illness: From hysteria to conversion versus other disciplinesdisorders Although, by definition, most psychotherapeuticHysteria is an obsolete medical term that is still approaches involving the body have a holisticused colloquially to refer to a state of extreme fear or understanding and work towards some form ofemotion and the resultant irrational behaviour. The body/mind integration, there are considerableterm was originally employed to describe women who differences in terms of technique, therapeuticacted irrationally due to a supposed disturbance of the stance and the role of the therapeuticuterus, and dates back as far back as Hippocrates. relationship in the process. It is important to The notion of hysteria was revived through distinguish the various forms of body therapythe influence of Freud’s theories about hysterical from psychotherapy that integrates bodyconversions, which no doubt influenced the current work into its understanding and treatmentthinking, namely that people may have physical techniques. Body healers may, for instance, usemanifestations of psychological distress as an some form of massage or physical exercises,unconscious way of repressing, expressing and coping work simply to improve physical well-being andwith it. see inner balance and psychological benefits In modern psychological thought the term hysteria as indirect results. Other approaches, such asis no longer considered a diagnostic category, although martial arts or cranio-sacral therapy, go furtherphysical manifestations of psychological conditions and aim to involve the client more pro-activelycan be diagnosed as somatoform and dissociative in increasing inner awareness and healing thedisorders. A somatoform disorder is characterised by body-mind split.physical symptoms that have no identifiable physical But psychotherapy with a ‘body’ focuscauses. These symptoms usually mimic real diseases or is distinct from the above in that it alwaysinjuries. Such disorders include conversion disorder, works from and within the client’s subjectivebody dysmorphic disorder and somatization disorder. reality, which includes an awareness of theDissociative disorders are psychological disorders different levels of body, emotion and mindthat involve dissociation or interruption in aspects that shape this reality. The understanding andof consciousness, including identity and memory. use of the body in psychotherapy probablyThese types of disorders include dissociative fugue, stands in most stark contrast to other bodydissociative identity disorder and dissociative amnesia. therapies in its conception of the therapeutic Routinely, the body is considered when diagnosing relationship. Although a holistic model of themental imbalance and psychologists are trained to client is common to all approaches involvingassess a client’s vegetative functioning, take into the body, most non-psychotherapeutic bodyaccount their general physical functioning and observe therapies tend to rely on a quasi-medical ‘expert’non-verbal behaviours. But many psychotherapists and relationship between patient and healer. Withinbranches of psychotherapy are attempting to recognise the psychotherapeutic realm, no one specificthe body not simply as a diagnostic agent, but as a technique is considered therapeutic in itself,living source of intelligence, information and change. but only as an integral part of a therapeutic relationship.Conceptualising the body in psychotherapy on a continuumThe therapeutic approaches that incorporate the body in psychotherapy may be depicted along a continuum. Onthe one end, predominantly verbal therapies pay little or no attention to the body. On this extreme, the spokenword dominates the therapeutic interaction and in the verbal interventions, there is little or no reference to bodyaspects. However, even on this end of the continuum, nonverbal interactions have an important and unavoidableimpact on practice. Therapists and client are never just ‘talking’, they are always bodies interacting. Furtheralong the continuum, there are therapies that display increasing body-orientedness. There may still be a focus onverbal interventions, but the body is recognised as an explicit source of information. And moving further alongthe continuum, there are approaches that are sometimes called “body therapy”. Major methods here are workingwith movement, nonverbal expressions and direct touch. These are the focus of this overview. Indispensable survival guide for the thinking psychotherapist 7
  • 8. Features Body of evidence History of the body in psychotherapy: From the 1900’s to the present A brief, incomplete history of the body therapies is captures both the defensive and self-protective depicted below, followed by a fuller description of aspects of ‘repression’ which have long been a some of the theorists that have contributed to the cornerstone of analytic theory. Reich called his developments in this field. way of working with the body ‘vegetotherapy’, which he considered ‘character-analysis in the zz Freud, early 1900’s: The grandfather of modern realm of the body’. For Reich, the therapeutic psychotherapy was clear that the ego is first and process is liable to remain bound by the linear foremost a ‘body-ego’ (certainly a statement world of mental understanding and insight unless integrating body and mind) and, for a while, the underlying ‘body armour’ is addressed—the assumed that some day psychoanalysis would be body is just as effective and necessary an arena grounded in physiology and biology. His early for change as is the mind. conceptualisation of libido within a framework of homeostasis is much more aligned with zz Neo-reichian theories, originating from Reich’s biology and physics than with psychology, and work, which focus on somatic healing and there was a strong subversive impetus to liberate consider the mind-body interrelations and the body’s energies. From early on, Freud used a connectivity in order to heal the whole person. wide variety of techniques, including massage. Various techniques are utilized, including Later in his professional life he veered more breath, physical touch and movement. Known towards seeing the body as representing the generically as ‘body psychotherapy’, contributors dangerously dominant force of the instincts to this line of work include Georg Groddeck and which had to be kept in check by an increasingly Sandor Ferenczi, whilst Alfred Adler and C.J. conscious mind. Jung and others contributed to its development through their concern with the distribution zz Reich, from 1920: Reich was probably the of psychic energy within the body and the first psychoanalyst to give significant impetus relationship between body and mind. Specific to Freud’s early ideas about the body and therapies that emerged from within these libido. He eventually became the pioneer of a developments include (cited in Eiden, 1999): school of thought known generically as body {{ Bioenergetic Analysis developed by Alexander psychotherapy, although he began with an Lowen, who emphasised the importance of approach he labelled ‘vegetotherapy’. Reich ‘grounding’—being in strong contact with the recognised that all neurotic symptoms also have ground through feet and legs. a physiological and physical aspect and that {{ Core energetics: Developed by John Pierrakos. the body is closely linked to the psychological It emphasised the bridge between psychology process. His central understanding was that and spirituality. body and mind interact dynamically with, and mirror, each other. If the mind forms a {{ iodynamic psychology: Developed by Gerda B conclusion, the body has a reaction. Tension Boyesen. She theorized that the dismantling in physical form is connected to a mental state of psychological stress is also connected with and releasing it has a freeing effect on the mind. the digestive system. Reich’s concept of ‘character armour’— {{ e Chiron approach was founded by Bernd Th habitual and chronic fixed relational Eiden and Jochen Lude in the early 1980s and positions— emphasises an integral-relational approach to therapeutic healing.8 New Therapist September/October 2012 New Therapist September/October 2012
  • 9. Features Body of evidenceOther body-therapies:zz Rolfing: Developed by Ida Rolf in the 1930’s. It is a mode of treatment which physically manipulates the body, creating a postural release which aims to loosen up and realign the body. It aims to release past trauma and built-up stress as a way of enhancing mind-body health.zz Primal therapy: Developed by Arthur Janov in the 1970’s and based on the thinking that neurosis is caused by the repressed pain of childhood trauma, primal therapy is used to re-experience childhood pain as an attempt to resolve these feelings. Some more current mind-body psychotherapies: zz Pat Ogden’s sensorimotor approach to on traditional psychotherapeutic understandings, psychotherapy: For many years, the realm of but includes the body as central in the therapeutic implicit nonverbal communications and bodily- field of awareness and employs a set of based affective states was largely ignored by observational skills, theories, and interventions not mainstream psychoanalysis. The result was a usually practiced in psychodynamic psychotherapy. traditionally strong bias in favour of explicit, Ogden argues that therapy is the context in verbal, cognitive mechanisms (Schore, 1994). which we work with the wisdom of the body in an However, advances in our understanding attempt to integrate sensations, images, feelings of the psychology and biology of bodily-based and thoughts that constitute ongoing experience. emotional states and neuropsychoanalytic The experience of trauma is recognised as being concepts that bypass the Cartesian error, significantly body-based. Sensorimotor approaches along with the developmental psychoanalytic recognises and use this to allow the therapist to discoveries of how affect regulating attachment open up the client’s non-verbal world and make it experiences positively and negatively impact available for integration and processing. By being evolving structure, are being incorporated aware of how a client stands, sits, walks, talks into more complex clinical models of the or gestures, the therapist can hypothesise about psychopathegenesis and treatment of brain/ these bodily gestures and client and therapist mind/body disorders. can learn what these might be communicating. Until recently, body psychotherapy The therapist also attends to the way in which progressed independently, and somewhat bodily organisation reflects competence and well- apart from, contemporary psychoanalysis. being. Techniques may include the inculcation of This field has focussed more intensely on the deep and regular breathing, relaxation, physical somatic expressions of psychobiological trauma, flexibility and physical alignment. especially trauma and affect dysregulation that The sensorimotor therapist is concerned occur in the histories of severe self pathologies. with “top-down” management skills, such as But the body psychotherapists appear clarifying meaning, formulating a new narrative, increasingly to be adopting an interdisciplinary and working with emotional experience, as well perspective (Schore 2002). as with “bottom-up” interventions that address Pat Ogden and her colleagues are a the repetitive, unbidden, physical sensations, prominent source of neurobiologically, movement inhibitions, and somatosensory psychodynamically, and developmentally intrusions of unresolved trauma (Ogden, Pain informed clinical models in the expanding & Fisher, 2006). Such an integrative approach world of somatically-focussed psychotherapy. attempts to help clients experience a reorganised Dubbed the sensorimotor approach, it builds sense of self. Indispensable survival guide for the thinking psychotherapist 9
  • 10. Features Body of evidence zz Mindfulness-based psychotherapies, eg. zz Post-modern contributions (Tom Andersen and Jaakko the Hakomi Method: In the last decade Seikkula):The late Tom Andersen, a well-respected mindfulness has become increasingly Norwegian therapist who co-developed a form of popular within many branches therapy known as ‘collaborative therapy’ and Jaakko of psychotherapy, based on the Seikkula, a renowned Finnish psychotherapist and growing recognition that the ancient academic who borrowed from this approach and mindfulness teachings can reduce stress successfully developed social network based and contribute to the healing process practices in psychiatry, brought about an for a wide-range of difficulties (Kabat- increasing recognition of the dialogical and Zinn, 2005). Within mindfulness, ‘embodied’ nature of therapy. the somatic realm is not only deeply Andersen observed the work of tied into all our emotional and physiotherapists who worked intuitively with mental processes, but it reflects them a person’s body to effect change and he drew precisely, allowing the uncovering of forth many observations to apply to his therapy fundamental issues and memories that with clients. He stated that therapy must be give rise to them (Marlock & Weiss, like a ‘pain producing hand’ in the sense that 2006, in Weiss, 2009)). Mindfulness a therapist’s words must be unusual enough to encourages ways of becoming more incite change in the client. He also observed ‘aware’ or more conscious of bodily that a good therapist is guided by his or her processes. Patients are usually client’s signs, which are often very subtle encouraged to sense, feel and observe ones, and from this his ‘slow’ way of working their bodies at great length. evolved. Tom Anderson’s approach to therapy Body psychotherapist Ron Kurtz highlighted the importance of a responsive and pioneered the integration of embodied contact with an others expressions mindfulness into psychodynamic and following these moving’ expressions therapy in the 1970’s. In his approach, wherever they might lead (Shotter, 2007). The Hakomi Method, the therapist Jaako Seikkula developed Open Dialogue, constantly monitors and helps to a group therapy method in which ‘team regulate the state of consciousness members’ bring new words that offer an of the client. In the course of alternative language to those of symptoms a successful Hakomi process, and problem behaviours. Network members there is an expanding sense of are encouraged to sustain intense painful mindfulness and the core of the emotions of sadness, helplessness, and process usually takes place in hopelessness as a multi-voiced picture of this state. As an experiential the event evolves. A dialogical process is a process, the therapist is necessary condition for making this possible. radically nondirective in To support diaological process, team members order not to interfere with attend to how feelings are expressed by the many mindfulness. This shifts voices of the body: tears in the eye, constriction the focus of the therapist in the throat, changes in posture, and facial from a ‘thinking’ expression. Team members are sensitive to how the to an ‘observing’ body may be so emotionally strained while speaking mode. When of extremely difficult issues as to inhibit speaking completely in tune further, and they respond compassionately to draw with mindfulness, the forth words at such moments. “The experiences that therapist will manifest a had been stored in the body’s memory as symptoms state of being that Kurtz calls are “vaporised” into words” (Seikkula & Trimble, ‘a loving presence’ (Martin, 2005, p. 468). In this approach, dialogue is not just a 2007). The mindful approach form of communication, but a way of engaging with requires a fundamental shift in others in a way that forms minds. ‘Mind’ is not seen attitude that is hard to fathom for as an independent element of human psychological those schooled in traditional ways of structure, but an ongoing process from one second to Western psychotherapy (Weiss 2007). another between living (embodied) persons.10 New Therapist September/October 2012 2012 New Therapist September/October
  • 11. Features Body of evidenceTowards an integration: Drawing from the The body perceived fromconcepts and practices of ‘body’ psychotherapies outsideIt is clear that body psychotherapies do not emanate from a A person’s facial expressions, bodycommon theoretical base. Support for body work is found postures, gestures, breathing, evenin different theoretical models: psychodynamic theories, voice quality, sighing and laughing,including Reichian and non-Reichian theories, humanistic and are commonly used by theexistential psychology, transpersonal psychology, and behaviour therapist to aid insight. People alsotherapy. Despite the number of specific models and therapies have a natural tendency towardsthat incorporate the body into psychotherapy, Leijjsen (2006) mimicking the posture, gestures,suggests that a psychotherapist wanting to validate the body in facial expressions of the peoplepsychotherapy can work with one or a combination of these aspects they are looking at, referred to asof the body, which might include the body perceived from outside, empathic attunement. Researchthe body in action in movement and other nonverbal expressions, shows that mirroring of bodilyand the body in physical contact with another body, usually by positions and an unconscioustouch. These are outlined below, with practical illustrations of how synchronisation of actions betweenthese techniques might be used in the therapy context. people helps to develop and maintain rapport and relatedness (Cooper, 2001 in Leijssen, 2006). The nonverbal communicationThe body sensed from inside may complement the client’s narrative or even reveal somethingThe body as sensed from inside, the experiencing body, relies on different from the spokenthe premises that what is most essential can be experienced in the narrative of which client maybody. This is a visceral process, rooted in emotional experience, not be conscious. An awarenesswith cognitive activity as secondary. The inclusion of the simple and reflection on the non-verbalinvitation to pay attention to the body as sensed from inside can communication of the client canenhance each method of therapy without changing it very much bring greater awareness and insight(Gendlin, 2003 in Leijjsen, 2006). The therapist may ask: “Wait to the issue being discussed. Fora moment, can you check inside, in your body, what you are instance, a client may verballyfeeling there?” If this bodily source is not too alien for the client, express that they are no longerthe symbols arrived at from that place will deepen the therapy by affected by an experience fromaccessing the emotional material on more than just the cognitive their past, but the therapist maylevel. observe the client holding her In the interaction with the client, the therapist can also rely on hands across her abdomen and thishis or her body orienting sense, which some might call ‘somatic might cue the therapist to notecountertransference’. In their research on therapists’ experiences that she is trying to protect herselfof empathy, Greenberh and Rushanskiu-Rosenberg (2002) from something that she is notinvestigated therapists’ internal process while being empathic. verbally expressing.Therapists reported often using their own bodily responses as tools However, sometimes clientsto finding the most accurate connection with the client’s experience may be confused when theand as feedback for the accuracy of the interaction. A therapist therapist draws attention tomight notice that they have a physical sensation mirroring the physical components of theirclient’s experience. This might be felt as a shiver down the spine or communication or feel intrudeda feeling of excitement; or as a body resonance that recognises the upon and thus therapists wouldpain of the client. The therapist can even verbalise their own bodily ideally move the client along suchexperience with comments, such as “I notice that my heart beats observations or interpretations onlyfaster when you talk about that.” at a pace that does not disrupt the There are also many benefits to experiencing the body from therapeutic process, particularlythe inside, such as increased self-awareness, a capacity for less when dealing with the results ofimpulsive or automatic behavioural responses to feelings and trauma (Rothschild, 2002).delaying automatic behaviour, and the attendant calming, relaxingand grounding effects that follow from these. Indispensable survival guide for the thinking psychotherapist 11
  • 12. Features Body of evidence The body perceived in action: The body in physical contact: Touch Movement How touch is experienced is often subjective. The same In this step of validating the body, sensory stimulus, like a tap on the shoulder, might be the therapist pays more explicit seen as an encouragement by one person and a reprimand attention to kinaesthetic, movement- by another. Touch crosses a body border and there is, related experiences and also may also inevitably, a correspondingly heightened sensitivity and experiment with guiding the client to intimacy involved in the act of touch. For these reasons, new movements and body postures. it is hardly surprising that touch has been been considered The therapist might, for instance, ask a controversial and usually undesirable practice in the client to exaggerate a movement ethical codes that guide the practice of therapy. Where to increase its emotional salience and it has been used in therapy, touch might extend from a to bring the client in contact with handshake in almost exclusively verbal therapy to intensive something that is further away from bodywork at the other end of the touch continuum. awareness. Or the therapist might While making physical contact with clients is indeed a introduce small steps of experiential ‘touchy’ topic amongst therapists, a survey of members of learning and invite the client to the American Academy of Psychotherapists (Tirnauer et experiment with active behavioural al, 1996 in Leijjsen, 2006), indicated that only 13% “never expression. For example, a client touch” their clients. Ethical fears of touch are typically reporting that he is “fed-up” with centred around a fear that physical contact may lead to doing something and hunches his exploitative or sexual interactions. Therapeutically, there is shoulders as he says it might be invited also a fear that touch may create transference issues and/ to exaggerate the moment in his body or retraumatisation when misuse of touch was part of the posture, or alternatively he might be client’s original trauma. Leijssen (2006) suggests that encouraged to explore the opposite acknowledging these concerns doesn’t imply that touch has body position. to be problematic in therapy. The therapist may also modulate One way of framing touch in therapy is that, when body posture or movement that are used appropriately, it is a genuine expression of person- unusual for a client in order to help the to-person relating, and a strategic means of providing client achieve a recognition of alternate nurturance and support. Touch is clearly a more intrusive bodily experiences and explore new technique, but Leijjsen (2006) argues that touch, possibilities. For instance, a dependent used appropriately, can provide a physical holding or person who ‘holds on’ to others and containment of the client in trouble. Take the example has difficulty standing on her own of a trauma therapist, working with survivors of political legs might be encouraged to plant her torture, who used kind and gentle touch to help them feet firmly on the ground. Movement ‘come back into their bodies’ (Bingham Hull, 1997, p.6 in exercises and experiements can also Leijjsen, 2006). Touch in these instances would appear to activate muscle functioning and assist the traumatised individual to move beyond a layer create bodily flexibility, creating the of fear that ‘freezes’ their ability to benefit from other possibility of new awareness and new interventions. As a guide, therapists are encouraged to ask experiences. However, Leijjsen (2006) permission and state the intention behind touch before cautions against the pitfalls of working making contact. Touch should also only be employed once with the body in action in the sense the therapeutic relationship is well established and should that the therapist may take too much always be congruent for the therapist and feel comfortable control, or see himself or herself as the and appropriate to the client. Neither the therapist nor agent of change. patient should experience the touch as a demand, nor as an expression of intimacy beyond that felt on an emotional level (Kertay & Reviere, 1993).12 New Therapist September/October 2012
  • 13. Features Body of evidence Womens Sexual Satisfaction. Baltimore: The Johns Hopkins University Press. ISBN 0-8018-6646-4. Martin, D. (2007). Tracking and contact. In H. Weiss, G. Johanson, & L. Monda (Eds.), The Hakomi Method. Boulder, CO: The Hakomi Institute. McNeely, D.E. (1987). Touching. Body therapy and depth psychology. Toronto: Inner City Books. Ogden, P., Pain, C. & Fisher, J. (2006). A sensorimotor approach to the treatment of trauma and dissociation. Psychiatric Clinics of North America, 29: 263-279. Rothschild, B. (2002). Body psychotherapy without touch: applications for trauma therapy. In T. Staunton (Ed.), Body Psychotherapy (pp. 101-115). New York: Brunner- Routledge.The body in action: References Seikkula, J (2008). Inner and outerNonverbal forms of self Andersen, T. (1997) Researching client- voices in the present moment of familyexpression therapist relationships: a collaborative and network therapy. Journal of Family study for informing therapy. Journal of Therapy. 30: 478-491.This way of validating Systemic Therapies, 16(2), pp 125-133. Seikkula, J. and Trimble, D. (2005).the body is an extension Eiden, B. 1999. The History of Body Healing elements of therapeuticof movements in more Psychotherapy—An Overview. This conversation: Dialogue as annonverbal actions. The article was written in January 1999 embodiment of love. Family Process. 44:therapist may introduce for Counselling news—the voice of 461-475.expressive arts (dance, counselling training—a magazine published by CSCT. Schore, A.N. (2002). The right brain asdrawing, painting, sculpting, the neurobiological substratum of Freudsmusic, sound) as an alternate Greenberg, L.S., Rushanski-Rosenberg, dynamic unconscious. In D. Scharff (Ed.),path for exploration and R. (2002). Therapist’s Experience The psychoanalytic century: Freud’s legacycommunication. In the of Empathy. In J.C. Watson, R.N. for the future. (pp. 61- 88). New York: Goldman, & M.S. Warner (Eds.), Other rooms of Carl Client-Centered and ExperientialJung for example, people Psychotherapy in the 21st Century: Shotter, J. (2007). Not to forget Tomdanced, sang, acted, mimed, Advances in theory, research and practice Andersen’s way of being Tom Anderson:played musical instruments, (pp. 168- 181). Ross-on Wye: PCCS the importance of what ‘just happens’ topainted, modelled with Books. us. Draft of paper delivered at The 12thclay (McNeely, 1987, p.39). International Meeting on the Treatment of Kabat-Zinn, J. (2005). Coming to Psychosis, Lithuania, September, 2007.In this way of validating our senses: Healing ourselves and thethe body, it is important world through mindfulness. New York: Weiss, J. (2009). The use of mindfulnessto remind the client that Hyperion. in psychodynamic and body orientedperforming visibly is not psychotherapy. Body, Movement and Kertay, L., & Reviere, S. L. (1993). Dance in Psychotherapy, Vol. 4, No.essential—these methods are The use of touch in psychotherapy: 1, April 2009, 5-16.used to increase self-insight. Theoretical and ethical considerations.Nonverbal expressions can Psychotherapy: Theory, Research, andalso replace or supplement Practice, 30(1), 32-40.words when talk fails toproduce results. What is Leijssen, M (2006). Validation of the About the author Body in Psychotherapy. Journal ofcreative is often therapeutic Humanistic Psychology. 46, 2, 126-146. Kelly Quayle is a psychologist in private(Adzema, 1985; Kahn, 1985 practice in Pietermaritzburg, Southin Leijssen, 2006). Maines, Rachel P. (1998). The Technology Africa, and a contributing editor to New of Orgasm: "Hysteria", the Vibrator, and Therapist. Indispensable survival guide for the thinking psychotherapist 13
  • 14. Features Every body needs some body Every body needs some body An interview featuring Jack Lee Rosenburg, Lisa Loustaunau and Frederic Lowen14 New Therapist September/October 2012
  • 15. Features Every body needs some body “Everybody needs somebody to love” Frederic Lowen Frederic Lowen, son of - Song by Bert Berns, Alexander Lowen, M.D., is Solomon Burke and Executive Director of The Alexander Lowen Foundation. Jerry Wexler, which first With long term and extensive charted in 1964. experience in Bioenergetics, Bioenergetic therapy, workshopL and training attendance since et’s face it: Our 1966, Fred seeks to expand the most archetypal visiblity, appreciation, and use of Bioenergetics. attachment scripts Fred lives in Vermont, USA withare predicated upon a his wife and daughter.fundamental urge to fulfilthe longing of every bodyfor some body to love. Our bodies are, Lisa Loustaunauwhether we like it or not, Lisa Loustaunau, MFA, CCEP,the vehicle of expression OSC is Director of Educationfor a great deal of what and Assistant Director of the Institute of Core Energetics inwe feel, think and NY. Lisa teaches and supervisesconfront in our daily body psychotherapists around the world in the Core Energeticspsychic life. So maybe we approach developed by the latepsychotherapists should John Pierrakos MD, whom shejust get over ourselves frequently assisted. Her private practice is in Norwalk, CT.and our obsession with www.LisaLoustaunau.comthe talking cure. Couldwe contemplate thatthe bodily cure mightbe just as powerful and Jack Lee Rosenbergimportant a route to Dr. Jack Lee Rosenberg ishealing? internationally recognized We asked three as a pioneer for his innovative approach toprominent body therapy body psychotherapy, humanpractitioners and writers sexuality, and couplesto back us up on this counseling. He is founder of the Integrative Body Psychotherapybody check for overly Institutes. He has conductedtalkative shrinks. This is workshops at the Esalenwhat Frederic Lowen, Lisa Institute for more than twenty- eight years. The author of TotalLoustnaunau and Jack Orgasm, Body, Self and Soul,Lee Rosenberg had to say. and The Intimate Couple, he is in private practice in Los Angeles. Indispensable survival guide for the thinking psychotherapist 15
  • 16. Features Every body needs some body New Therapist: Mainstream psychology relies principally on verbal communication. In what ways does your working with the body supplement or extend this? Jack Lee Rosenburg: The body and the mind cannot be separated. They must be worked with simultaneously to help the client release somatic holding patterns, awaken, integrate and clarify the body and mind. In IBP (Integrative Body Psychotherapy) we use breath, movement and awareness work to open and release holding patterns that are both physical and psychological. We are psychotherapists working with the body with limited touch. Breath work can bring deep-rooted psychological material to the surface and intensifies it so that it is available to talk about. We work with the energy of the body to increase aliveness and release holding patterns to create flow. We use two intertwined approaches for working with the client. To begin with, we have the client sitting up while we take a history on a large white board. We use breath, movement, presence, contact, boundaries, and awareness of history, defensive styles and many tools to bring awareness of the source of holding patterns. We also look for thought, belief and behavior patterns that support unwanted results. At the same time we track somatic energy and provide experiences that lead to energetic release. Once trust has been established, we have the client lie down on a table. First, we track how they breathe. We want to know if they can breathe and stay present and be in contact. Can they tolerate the increased aliveness? Then, while they breathe fully to build a charge, we use several different weighted balls to help the movement of energy and for grounding. We usually have the client start lying on their back with their feet balanced on a 6-pound rubber ball. We have a number of varying weighted balls depending on the client’s size and strength that can be held between client’s knees to tire out the adductor muscles. This begins the process of tiring the muscles of the pelvis as a method to release fixed muscular holding patterns of the legs and pelvis. In this position the client must sustain core to balance and at the same time talk to the therapist and remain present. As the client fatigues from this position, we exchange holding the ball between their legs for a stretchable strap that fits around their legs. The client now is stretching against the strap held just above and around their knees. This tires the abductor muscles. The instruction is to push out against the strap. Remember the client is lying on their back still balancing their feet upon a ball. The final result is that this process releases specific muscles often held in the pelvis that are important for body psychotherapy and at the same time it opens and releases holding patterns of the body without touching the body, or going past the clients boundaries. The nice thing about this is that the process works very profoundly and effectively without the many problems that can arise when working with the pelvis.16 New Therapist September/October 2012
  • 17. Features Every body needs some bodyLisa Loustaunau: Frederic Lowen:Working with the body opens an entirely The client’s conscious mind is an unreliable source of usablenew dimension in the treatment room, information. Irrational behaviors, emotions, thoughts,providing a wealth of material that could beliefs, and attitudes are justified, defended, rationalized,take months or years to access through and/or denied by the conscious “rational” mind. So, theverbal therapy alone. Words just as easily value and usability of verbal communication is limited. Ahide or alter the truth as reveal it and, as we client’s “truth” must be discerned from the motivations of aknow, most communication is non-verbal. client’s words, not from the words themselves. Talk therapyI am always struck by the depth of feelings is like a mental chess game in which, too often, the patientand experience that my work with the body is better than the therapist. Driven by a desperate need toelicits which the client could not verbally maintain “control,” present an image, or to perpetuate aor consciously communicate previously. relatively comfortable, seemingly safe homeostasis despiteThis is much more than body language, the complaint/symptom, patients present all manner ofwhich reveals the truth of the moment. resistances; some hardened to the point that talk therapy isThe practice of body psychotherapy goes virtually impotent.far beyond body language in that the body In Bioenergetic Analysis, the body is the focus of thecommunicates the story of a lifetime and therapeutic work. Like the annual rings of a tree, theoffers a direct channel to experience past and traumatic experiences of the individual are recorded in thepresent. body. When I look at a clients body I see Originating in psychoanalysis, and developed fromthe story of a life journey. It is a moving the work of Freud’s student Wilhelm Reich, Bioenergeticand vulnerable experience to receive the Analysis examines character and personality in termsuniqueness of a human being in this way. of the energetic processes of the body. An individual’sThe body speaks to me about their history, energy is expressed psychologically in thoughts, beliefs,their patterns of relating, their gifts and and (motivations for) behavior, and physically andstrengths and innate potential, as well as physiologically in form, structure, and movement. The selfof their primary defenses and repetitive comprises both, as well as the psychological unconsciouslimiting life-patterns, which will be and the autonomous physiology. Like two faces of a coin,important to challenge in therapy. The body each face may be radically different, and neither face is thegives me the direction of the work. Working whole coin.physically opens deeply held or denied To an experienced Bioenergeticist, the body isfeelings which, when integrated, expand an expression of a person’s self. Unlike the mind’sthe individuals awareness of who they really rational verbal exchange, the body does not lie to theare. The body tells the truth without all the knowledgeable, aware therapist. All of us in the developedembellishments and smoke screens that the world, to varying degrees, have been restricted in fullyego mind at times constructs. expressing our feelings and our selves. To a point, this is Body work offers me a way to open necessary for social cohesion. But when our feelings andthe door to new or different energetic and the expression of those feelings are rejected, suppressed,emotional experiences. They happen right humiliated, threatened or denied, especially in childhood,there in session. We aren’t figuring out what the energy of those feelings becomes “frozen” intothey feel or what they should do about this structure, subsequently restricting the motility of ouror that. The feelings emerge from within bodies.the body and are felt right there. It is very This frozen structure and the quality of expression: theimmediate and very powerful when clients inability to express, or inappropriateness of expression, areexperience themselves having feelings the elements used in Bioenergetic Analysis diagnosticallythey didn’t know they had or were able to and directly in treatment, hugely leveraging the value oftolerate and having them freely and honestly. verbal communications in uncovering and integratingI engage the person physically to effect a trauma, and relieving the conflict between conscious andtransformation that occurs on every level unconscious energies.of being—psychologically, energetically, In addition to improving integration of conscious andemotionally, mentally and spiritually. It is a unconscious, and mind and body, body work enhancespowerfully healing expansion. physical and physiological health. Indispensable survival guide for the thinking psychotherapist 17
  • 18. Features Every body needs some body NT: What, in your opinion, can we not access through verbal communication? Frederic Lowen: In Bioenergetic Analysis, or body-psychotherapy, direct body work improves the effectiveness of time in therapy. Theoretically, all traumatic material is available verbally. Practically, for reasons discussed above, direct body work is a reliable means to by-pass the “monkey mind” of consciousness, and access the unconscious and autonomic systems directly. Motivated by unconscious desires to maintain homeostasis, with effects of transference and counter- transference, willful verbal exchange often thwarts the therapeutic process. Even in seemingly successful cases, the patient’s conscious mind can feint progress, or offer false leads to protect the fearful self from painful realities and truths associated with the trauma the therapist is attempting to uncover or evoke. In contrast, the body does not lie. Bioenergetic Analysis normally begins with simple exercises and stress positions designed to increase a client’s energy level, and highlight the distortions and blockages of energy flow, evidenced by chronic tension and muscular tightness. Most usually, these tensions have been held so long, they are outside of conscious awareness; that is, they are unfelt. The exercise and stress positions make the areas of chronic tension apparent to both therapist and, more importantly, to the client. Restricted or disturbed breathing patterns, lack of alignment or balance, collapsed or inflated chests, weak legs and feet, poor ground contact, skin tone, muscle tonicity, facial masking, eye contact, voice expression, arms and hands, rigidity of pelvic movements, tightness of belly, are some of the common indicators of unresolved trauma, and the fears and constraints the individual lives with. Together with the verbal history and the client’s perceptions and awareness of his issues (to the extent he can articulate them), the body evaluation guides and confirms or refutes the therapist’s lines of inquiry. For the client, the bodywork enhances energy by improved breathing, and re-connecting to the natural energy flow in the body as tensions are perceived in a new way. Increasing energy to the client’s homeostatic state brings emotional material and related memories in the unconscious up towards, and into consciousness. For the therapist who is unaware of this dynamic, the client may engage in increased “acting-out,” or other patterned behavior with renewed energy and vigor. However, for a Bioenergetics therapist, it is an opportunity to focus the client’s higher energetic state on these issues, and accelerate the appearance of repressed or suppressed traumatic material. Upon release of the tension and trauma, integration is necessary. Verbally, and consciously, the client gains intellectual understanding of his story. The client’s ability to relate his traumatic experiences, feelings, and memories to how his body felt and responded to the trauma allows integration into the body and the unconscious, thereby eliminating the associated psychic conflict and enabling better alignment of 1) unconscious motivations with conscious desires; 2) the client’s self-image with the reality of his body/self.18 New Therapist September/October 2012
  • 19. Features Every body needs some bodyJack Lee Rosenburg: Lisa Loustaunau:We cannot access the deeper holding We cannot access verbally what the unconscious intends topatterns of the body/mind. IBP breath is used to change the balance In body psychotherapy we see the unconscious not asbetween the sympathetic and the a vague psychological sphere but as located in areas of theparasympathetic nervous systems, body where energy is being managed or blocked. In Coreallowing a sense of wellbeing to unfold Energetics we see energy and consciousness as unified, so ifin the clients body/mind. There are you repress energy you repress consciousness.certain emotions that cannot be known If you block pain, you block the mind alone: such as love, trust, How this happens in the body is through the formation oferotic sexuality. what is known as armoring, set patterns of muscular holding. We cannot access holding patterns A tight jaw prevents us from crying or expressing our anger,stored in the body without some form vacant eyes caused by chronic tension in the intra-ocularof manipulation of the body. Therefore muscles protects us from the intimacy of contact. These arewe must use a number of techniques for some examples of how our unique pattern of armor servesworking using minimal physical contact to protect us from particular feelings or experience. Armorand yet still opening or releasing fixed (often called blocks) develops as a process over time as amuscular patterns held throughout the result of repetitive significant experiences during criticalclients’ body. formational periods in early life that the psyche was not able Verbal communication alone does to handle. Better said, the armor in the body is the way thenot access early, emotional, relational psyche handled the developmental frustrations.limbic memory upon which our What is significant is that the same armoring whichfoundation is built. And yet, it is vital to originally served an adaptive purpose—protecting us fromget to the roots of holding patterns for knowing and feeling what would have been too painful tohealing. Also, when the body is tight, fully experience at the time—keeps us living and acting asparticularly in the chest, it shuts down if those early realities continue, and thus we find ourselvesaccess to the energetic feeling of love, repeating certain patterns over and over. These patternscausing love to remain a less satisfying contain what in Core Energetics we call an “image,” a fixedmental construct or idea. This is a belief.particular problem between parents and Let me give you an example of an “image.” Someonetheir children. who was deeply frustrated around needs may develop an Simply talking doesn’t reopen the image that goes “if I allow myself to need then I will bebody to core self agency functions. disappointed, if I don’t need then I can’t be disappointed.”Without this opening clients remain In this case closing off consciousness of real needs woulddisassociated from core experience become the solution to the frustration. This may never haveand just learn more effective coping been formulated as a distinct thought, the wound havingstrategies rather than accessing their been experienced before this thinking was possible. It wouldauthenticity. Most profoundly, the however be revealed in the body. You can see it in a sunkenawakening of the body allows the chest that takes in little breath, (refusing the energy andemotional heart to feel and connect with sustenance), and in de-energized arms that have difficultyothers. It also allows access to deeper reaching out toward what is wanted or needed. The bodywisdom. If we remain in our heads having formed itself in such a way as to literally close itselftalking, life remains flat. Awakening the off from needing too much by a contraction of the receptiveenergy of the body brings deeper, truer centers in the front of the body.emotions, essence of being and meaning. The experience of embodiment, the way a person feelsEmotions available without grounding and breathes and inhabits their body, needs to be changedin the body are usually re-enactments in order to really transform a life issue. It is impossible toof old archaic emotional injuries and are challenge the physical component of the defense with wordsimpervious to change. alone. Indispensable survival guide for the thinking psychotherapist 19
  • 20. Features Every body needs some body NT: To what extent to you use touch in your work with clients and how do you implement it? Frederic Lowen: Touch is not necessary for Bioenergetic work. However, the use of touch can improve effectiveness materially. In the Bioenergetic work I do, I use touch cautiously and with consent. I most commonly apply pressure on the client’s chest with my hands, while using the Bioenergetic Breathing Stool*. This helps a client deepen their breathing and experience a rigidity of the chest and constriction of their breathing they were not fully aware of. I will also manually adjust a person into specific exercises and stress positions. Occasionally, the application of pressure with hands or fingers to the musculature of the jaw or the neck, in conjunction with vocal expression, helps tire the muscles. It is necessary to stress and tire musculature to reduce it’s ability to retain its tension, thereby allowing the streaming flow of energy, which is evidenced by visible tremoring, or vibration. Many Bioenergetic therapists use these and other techniques of touch. Examples include deep tissue massage, Rolfing, or other massage; tender contact through a timely hug can be hugely effective; providing support through contact with the client’s back as he faces his issues (“got your back!”) can be a new experience for those who lacked that support; and the common issues people have with boundaries can be made real using their arms and hands to define their space and gently challenging them physically to both defend their space and to contain and maintain their own energy within their space. In group work, participants often pair up for various forms of physical interaction. One of the important aspects of such activity is to encourage people to explore and recall the childhood pleasure and fun of physical interactivity and games. * The Bioenergetic Breathing Stool is a 24” (60 cm) high kitchen stool, with a rolled up blanket, on which the client rests his back, keeping feet flat on the floor, allowing the stool to take the full weight of the person. This is simply a more extreme position that one takes when stretching across the back of a chair while sitting. Lisa Loustaunau: I use touch every day, though not with everyone and never gratuitously. There are of course many kinds and uses of touch. I might use touch to direct the breath, to bring awareness to a part of the body, or to support the release of energy and feelings from a tightly defended area. Touching generally “charges,” adds energy to, the area being touched. A client that has an area of the body that is energetically “undercharged,” lacking energy, indicates that feelings are being avoided there. Adding energy through touch will focus the clients awareness and make it more possible for them to make contact with feelings in that area. A different use of touch would be adding pressure to an area of the body that is “overcharged,” meaning too much energy is held and over-contained thereby creating a block which prevents the flow of energy into another part of the body. This condition distorts sensation and perception in the location of the block and prevents awareness of feelings in the area that the block is protecting. Using touch, such as squeezing or pressing, would increase charge in that part of the body to encourage a movement of energy into another area of the body that is being defended. In this way the client can become conscious of split-off feelings. Some clients who were not touched enough during early development have difficulty regulating their nervous system. Touch is very important for them until they are able to self-regulate and self-nurture. For others touch is difficult to tolerate, painful or invasive, so it is essential to explore touch as part of session work.Touch is our most primitive form of communication and how we receive it speaks volumes to our early holding environment.20 New Therapist September/October 2012
  • 21. Features Every body needs some bodyJack Lee Rosenburg: NT: Do you think that the real value of body work is in diagnosis, in treatment, or in both?We use limited touch.The more the therapisttouches the client duringa body session, thegreater the possibility Lisa Loustaunau:to set up a possibleproblem, particularly The value is in both. We have already established that diagnostically thea dysfunctional body imparts a wealth of information about our history, how primaryor misunderstood needs were handled during developmental stages, patterns of relating,transference relationship challenges, as well as character strengths and gifts.This is all discerniblewith the client. The by carefully observation or sensing of the body, not only its shape, butclient can begin to feel how it moves, how energy flows, posture, where energy is blocked etc.dependent on the therapist All these blocks affect our vitality, our emotional and physical well-for functions the client being and our ability to love.needs to develop such as The same blocks that were created as an attempt to avoid pain alsowellbeing and problem diminish our pleasure and our life force. Every block is essentially a NOsolving. The client can feel to life.inundated and/or touched For me the goal of treatment is to support the client to reconnectinappropriately, especially with the fullness of their energy so they can walk in the world as theyif the client has been really are. Working through the blocks that keep us limited or stuckabused. requires energy—at least as much as it took to create them. I believe the Yet, touch is very best way to mobilize and harness energy for this transformative processimportant for the is by working with the body. Clients that have done a lot of work onwellbeing of human themselves are often struck by the power and directness of this work. Itbeings. Sometimes we takes more than just thought, or observation, or mindfulness to changehold a patient’s hand to the way we inhabit ourselves and walk in the world. Core Energeticshelp the client not feel is a very powerful process, physically, emotionally and spiritually. Dr.alone. If touch feels like John Pierrakos, founder of Core Energetics, who is now deceased,too much for the client we always said that all our blocks and defenses were blocks to the heart.may use a strap or rope For me the real value of body work is that it opens our hearts.held both by the therapistand client. This can alsobe helpful to help a clientmake contact and remainpresent. We teach self-release techniques rather Jack Lee Rosenburg:than touch so clients willfeel self empowered. You must have an accurate diagnosis in order to have a competent We often hold the treatment plan. Both are needed.clients wrist pulse. This When a clients sits and talks with us, they tend to talk about ratheris a very sensitive process. superficial issues, such as “he said . . or she did . . .” And they have littleIt places the therapist in deep insight. If we awaken and open the body, whatever memories,contact with the very soul thoughts, sensations, emotions, images that are most relevant to workof the client and the client on inevitably come to the surface. The depth of insight that becomesfeels equally touched, available along with the corrective experience of the therapist/witnessknown and connected. leads to both a more genuine diagnosis that can be understood and worked with. With this opened awakening the results of treatment become embodied more reliably than with talk therapy alone. Indispensable survival guide for the thinking psychotherapist 21
  • 22. Features Every body needs some body NT: Do you think that the real value of body work is in diagnosis, in treatment, or in both? Frederic Lowen: In Bioenergetics, the value of body work is not only in diagnosis and treatment, but also as proof of therapeutic progress. In childhood, we are all subjected to the feelings, behaviors and words of our parents, both rational and irrational. As discussed above, when children’s feelings and expressions of feelings are suppressed, humiliated, threatened or denied, the energy of those feelings becomes “frozen” into the body structure in the form of contracted musculature. Just as an experienced woodsman can tell much of a tree’s history from the annual rings, an experienced Bioenergeticist can sense, see, hear, and feel a client’s energy “economy;” that is, their energy level and how they manage their energy: whether it is held, out-of control, totally controlled, split, or scattered. Additionally, the structure and form of the body is always telling. The alignment, posture and shape of one’s body speak volumes. A mis-alignment in legs, torso or neck and head, where one part of the body does not appear to match the rest of the body, may indicate a psychic conflict or a split in personality. The posture tells much of the quality of an individual’s contact with the ground, which mirrors one’s contact and connection with their environment, social and natural. It can also indicate the burden one carries, or the lack of maternal fulfillment, or the quality of one’s relationship with one’s father. In conjunction with the shape of the body, an attitude of superiority may be discerned, as the body exhibits a person who is “stuck” up, cutting themselves off from the fullness of life. Similarly, the facial mask many wear, a mask and pose adopted to protect the child from the anger or humiliation by a parent, becomes structured into the face as the automatic smile; or an irrational situation may create the knitted brow and angry countenance of a confused individual; or the jaw is thrust forward and rigidly held in defiance and determination; etc, etc, etc. Most basically, breathing is one of life’s most important functions. It is the autonomic function we have the most conscious control over, so it is a common starting point for both diagnosis and treatment. The fear and anger we have all experienced growing up, and the socialization of individuals within developed countries, has created widespread breathing disorders. Commonly these are not problematic, or even recognized until advanced age. However, they can be seen by a Bioenergeticist. Whether standing at ease, or in a Bioenergetic stress position, the quality and freedom of chest and abdominal movement in breathing tells us something of the fears, the energy, the spontaneity and the history of the person. Just as the inability to express feelings has been structured in the body, so too can those feelings be accessed by direct body work in treatment. Of course these feelings and memories need to be subsequently integrated into the personality. Body work focused on grounding, boundaries, and energy/feeling containment, enables deep integration in mind and body, thus completing the therapeutic process more effectively than verbal therapy alone. Finally, positive therapeutic progress can be visibly seen in a person’s body in changes in shape, form, demeanor, and enhanced aliveness.22 New Therapist September/October 2012
  • 23. Features Every body needs some bodyNT: Would you agree that psychotherapists tend to shy away from body work and, if so, whydo you believe this is the case?Frederic Lowen: Jack Lee Rosenburg:Aside from a lack of knowledge of body psychotherapy, Although bodywork is becomingtherapists struggle with a modern society that is not supportive more mainstream, we agree thatof the work. The values of the body are antithetical and are in most therapists do shy away. Thisopposition to the power objectives of the status quo. may be due to differing issues. For Wilhelm Reich studied and wrote extensively on what he some it is simply because they havecalled the “emotional plague.” Subsequent to his inter-personal no experience as to the profoundpsychiatric work during and following his years with Freud, results and have not developedReich turned his attention to understanding the sociological techniques. Others may feelforces that determine collective behavior. uncomfortable with the level of In my understanding, the cumulative dysfunction in exposure to emotions, old traumas,individuals is reflected in the social mores, laws, and policies of intimacy and mutual attunementsociety. Disconnected from the reality and grounding of their that arises with somatic awakening.bodies and true undistorted feelings, and thereby from nature, Still others may relate more toindividuals and populations are subject to any seductive or a purely intellectual stance andthreatening force applied to their ego. regard somatic psychotherapy as The “mind-body split,” which I contend is widespread, is the unconventional.fundamental cause of a world torn asunder by the pursuit of the There is a lot more available to“ego values” of wealth, power, security and status, aka greed. deal with in working with the body.It serves the purpose (function) of the powerful and wealthy Working mind and body togetherto stimulate the population’s pursuit of the “ego values.” The makes the client more vulnerablereason for this is simple: the pursuit of ego values is unfulfilling, and allows the therapist more access.thereby stimulating consumption. This means that the therapist must These forces, and the understandable fascination we have be well trained to not inadvertentlywith our ability to think, reason, build, and create, have take advantage of this.converged to present the human race with its greatest challenge: Therapists may shy away fromhow to employ our intellect to bring miracles to life without working with bodywork becauselosing our humanity. With god-like technological powers, and they do not know how to dealan ability to accumulate “more money than god,” where is the with transference and how to workhumility to recognize we are not “masters of the universe?” without being physically invasive The humility is missing because it is a “body value,” not an to the client. This is a major wayego value. Like vulnerability, empathy, and love, humility is just in which psychotherapists get intoanother talking point for the ego. In reality the body values are trouble. The more access therapistsunfelt and in-operative in the pursuit of wealth, power, security have, the more they must haveand image projection. completed their own embodied The lack of body work in therapy is just one of myriad ways personal work. When a client isthe modern status quo maintains its control and restrictions on awakened and integrated somatically,our imaginations, creativity, and life. Modern psychiatry is an they have access to a sense ofextreme example of how a profession has betrayed its patients’ truth. They are more aware of theinterests in favor of the pharmaceutical and financial companies. therapist’s authenticity. This may beThe psychiatrist knows precisely which drugs to match to which intimidating to the therapist. This issymptoms while minimizing legal liability, regardless of “side- especially true if the therapist is noteffects” or patient history. grounded in a positive foundation To introduce bodywork into therapy is to go against the for a sense of self, wellbeing andentire trend of our ego-charged narcissistic culture. Yet, constancy. Without this, the clientbody work is clearly an under-utilized, effective resource for is emotionally and energetically leftpsychotherapy. As said about us Americans: we will always alone. Empathetic attunement anddo the right thing, but only after trying everything else. In boundaries become limited.psychotherapy, body work is the right thing. Indispensable survival guide for the thinking psychotherapist 23
  • 24. Features Every body needs some body NT: Would you agree that NT: Are there body work ideas or psychotherapists tend to shy away practices that you might recommend for from body work and, if so, why do you psychotherapists to incorporate into their believe this is the case? own work? Lisa Loustaunau: Lisa Loustaunau: Most mainstream psychotherapy has reflected I would suggest experimenting with two things. the cultural split between mind and body First, hold an intention to shift more of your focus where the body has been considered secondary to the clients body throughout the session. Hold a to the mind—the primary object of interest space of curiosity and open yourself to take in as and the territory to be examined in sessions. much as you can. Notice what stands out, being Reich’s visionary work with the body careful not to label what you see. A big mistake I and energy were discounted for decades hear therapists make is to say things like “I sense in the aftermath of his political and legal sadness in your chest.” Do not interpret or put any imbroglios. I remember learning about Reich’s experience or feeling onto the client. For example, theories as a psychology student when they if you notice your client is barely filling their were only briefly mentioned and somewhat chest with breath, you can ask if they notice what disparagingly at that. Even now I sometimes is happening in their chest. Have them describe hear from practitioner trainees concurrently what they are noticing physically. A client might enrolled in graduate programs that very say “my chest is barely moving, I don’t seem to little if any consideration is given to Reich’s contributions. The body is still not considered be breathing, I feel a weight on my chest.” Ask or it is underconsidered in mainstream psych the client to just keep doing exactly what they programs. Training in body psychotherapy are doing, without changing anything, to just remains the purview of specialized institutes stay with themselves and notice what it is like for in very few locations around the world which them when they... (fill in whatever they are doing). train therapists to work with the body. After a while, ask again what they are aware of. Add to this double whammy of cultural Keep inviting the client into a deeper awareness of touch-a-phobia and the extraordinary their body. Whatever information is offered you litigiousness of our society, in the US at least, can be explored. This is a simple body intervention and it’s no wonder that psychotherapists that does not require that you be specifically are going to shy away from working with trained in body psychotherapy and supports the the body. Psychotherapists trained in growth of a clients perception of their energy and traditional settings here are told to, under no embodiment. circumstances, touch a client or they may face The second recommendation is that in session a potential lawsuit. the therapist pay particular attention to their body. So essentially body psychotherapy is still Be curious about any tension in your body and considered an unconventional or “alternative” its location. How is your energy being affected therapy, one that fortunately is gaining by the client? What parts of your body do you in leaps and bounds thanks in part to the feel particularly connected to? More importantly, work that has emerged from the field of what areas are you NOT feeling? As a supervisor I neurobiology in the past 10—15 years (with notice how most therapists are terrified of feeling its funding) substantiating so much of what their pelvis in session. They cut off their vitality body psychotherapists have known and been and block their energy for fear of having sexual doing for years. Every day more therapists are feelings. Therapists need all of their energy in the becoming curious about how we work and session and to trust their containment. If we are are paying more attention to the body in their cutting off our body we are not fully showing up sessions, even if in limited ways. Reich must for our clients. It’s wonderful material to take to be smiling (at least about this). supervision.24 New Therapist September/October 2012
  • 25. Features Every body needs some bodyFrederic Lowen: Jack Lee Rosenburg:Are there body work ideas or practices that 1. Learn breath work to lessen stress and toyou might recommend for psychotherapists to change balance between the sympathetic andincorporate into their own work? parasympathetic nervous systems. This can bring In body-psychotherapy, the most essential step about a sense of well being in the body as afor a practitioner is to gain some understanding of foundation for therapy.the truth of their own body. Body-psychotherapy 2. Learn to work with somatic boundary exercisesis subjective by nature, and therapists absolutely with clients rather than talk about them. Theneed to be able to correlate their clients’ subjective exercises can inform clients of unconscious self-experience with their own. boundaries and support authentic boundaries If a client is restricted in their breathing, a with others.therapist cannot evaluate the restriction, or the 3. Develop good mental health practices that cancause of the restriction, unless the therapist has be taught to clients. Create a positive personalat least some awareness of his own limitations, supportive family home life. Know your ownrestrictions, and causes. sexuality so your longings are not acted out with Similarly, if a therapist has low energy, and clients. Make sure that you are awakened tois most comfortable discussing, analyzing, and limbic energy within so that you can attune withinterpreting, they will be unable to see the lack another and retain boundaries.of grounding in their patients, and will be unableto guide them towards better grounding and 4. Learn the Sustaining Constancy Series exercisesconnection. for your own wellbeing. Then you can teach the So the first step is to gain body self-awareness. series to clients. Learn to provide homework forThis is best done either in a group workshop clients so that the therapeutic process continuessetting where direct body work is the focus, or from session to session. (Download Sustainingspending some therapy time with an experienced Constancy Series handouts online at: http://www.body-psychotherapist. Many years ago I asked Dad what he thought 5. Teach your clients to use a journal to track theirthe essential qualities of a good psychotherapist wellbeing. The IBP Steps Out of Fragmentation,are. He replied: you need to know a lot, you need Use of a journal and the emptying out exerciseto know a lot about yourself, and humility. will help. 6. For those already working with the body, the useFurther reading of the ball and strap for opening fixed muscular patterns of the pelvis for grounding, constancyLowen, A., Lowen L. and Skalecki, W. (2003) The Way and empowerment, is very effective. Thisto Vibrant Health: A Manual of Bioenergetic Exercises. system of breath and movement, combined withBioenergetics Press. weighted balls, does not require touching and can be done at home as an ongoing practice. Would you like to run workshops with new mothers/parents? If you are a mental author of Babies in Mind, has designed a series includes a training manual health professional of workshops that aim to optimize the mental that contains the guidelines, with an interest in health—both present and future—of infants, as layout and content of all 10 providing pre-structured well as to improve the psychological wellbeing workshops, together with additional reading workshops to new parents and caregivers. you of their parents. material for participants. This manual, together are invited to apply to become a licensed Babies in Mind practitioners are licensed to with the book, Babies in Mind, serves as the Babies in Mind practitioner. run the series of 10 Babies in Mind workshops basis for the workshops. Jenny Perkel, clinical psychologist and with mothers, fathers or caregivers. The license For more information contact Jenny Perkel at: Email: Tel: +27 (0)21 461 9153 Web: Indispensable survival guide for the thinking psychotherapist 25
  • 26. Features Minding the body Minding the body Feelings and sensations— what they offer us By Trish Bartley26 New Therapist September/October 2012
  • 27. Features Minding the body‘The tragedy for too many of us is not thatour lives are too short but that we take so ‘long before we start to live them.’-Williams et al., 2007 There are so few times each day thatJ on Kabat-Zinn, who developed the mind and the body come together. Mindfulness-Based Stress The body might be here, but the mind ’ Reduction (Kabat-Zinn, 1990) is generally off somewhere else.often quotes James Joyce, whofamously wrote about Mr. Duffy….who “lived a short distance fromhis body”. This seems to be true ofmost of us! serious illness who found practices when we slow down to life. We We live and breathe in these that helped them. discover the capacity to be openbodies. One day this body will We will then look at the way the and compassionate. In essence, wedie and the ‘I’, as we know it, will body offers us clues to upcoming may learn to love our lives again—cease. And yet what Jon Kabat- ‘edges’, if we are sufficiently aware. to find joy and contentment in theZinn is pointing towards is the fact By noticing and exploring physical simple things.that we are so rarely present in this sensations, as they arise, we canbody. There are so few times each find different ways of relating to Susan, 35, and single parent of twoday that the mind and the body the mind. We find that the body young children, always appearedcome together. The body might can function a bit like a barometer cheerful. Even when diagnosed withbe here, but the mind is generally for us, pointing to upcoming incurable cancer, she moved intooff somewhere else. Most of us live treatment with extraordinary courage emotional ‘weather’. This offers anmost of the time in our heads— and energy. At the end, she was told opportunity to respond to what isthinking. We rush from place to that it had been so successful that she arising, rather than move into ourplace—from task to task. We are had a good chance of cure. Almost usual knee-jerk busy and as a result, we miss so immediately, she felt herself going to This article is written for youmuch of our lives. pieces. She became irritable, angry, as individuals first and therapists In this article, I will suggest distressed and terribly anxious. second. I see it as vital for us tosome ways of coming back to the Over the 8 weeks of her practice what we teach. Any otherbody—of recapturing more of the mindfulness course, she learnt about way will not work. We need tomoments in our lives. This needs a the benefit of coming back to her learn to practice awareness forcertain commitment to practice— body. She found ways of relating to ourselves—before we can be skillfulbut we find, quite soon, that there sensations of fear and panic with in guiding others to practice thisis some tangible benefit. With a kindness instead of judgment. At for themselves. This article iskindly and curious intention, this the end of the course, she was still written in the service of inviting‘simple’ business of coming back experiencing anxiety, but she now you, the reader, to try out theseto the body has a steadying and had tools that helped her relate to it approaches, hoping that they willbalancing effect. The mind seems to differently. She found this changed be of use to you. Later, you maycalm down—and we start to slow things considerably. At the last class, decide to share them with thosedown, and are able to appreciate she described climbing to the top of a with whom you work.things a bit more. mountain with her children, feeling We will explore this ‘coming such pleasure that they had made itback’, with some simple short Learning To Live Again together. It was a lovely metaphor forexercises. Mindfulness practice what they had been through. As well as offering us more choiceis relevant to everyone, whether with what we find difficult indealing with the general upsand downs of normal living, or our lives, the practice of being Coming Back To The Body mindful offers us ways of learningfacing particular challenging to appreciate, feel more alive and It seems that we only give attentioncircumstances. With this in mind, be more present to our world. We to the body when we get ill or hurtwe will read about people facing may well find we are more creative ourselves—and even then, our Indispensable survival guide for the thinking psychotherapist 27
  • 28. Features Minding the body much thinking about sitting, but bringing direct sensate awareness‘ to the actual physical ‘experiencing’ of sitting. However, most of us are a long way There is a lovely old story of from being with our bodies as they two meditation teachers talking together. One is much older than are. We seem fixated on changing ’ the other. The younger one turns them for the better. to the older teacher to ask ‘How is it that your students do so much better than mine? What do you teach them?’ The older one replies that he teaches his students to practice sitting, and standing and attention is glancing, intermittent, 2002). Evidence shows mindfulness walking. ‘But that is exactly what invariably accompanied by as benefitting a wide range of I teach my students’, retorts the judging thoughts and anxious people with all sorts of physical younger teacher. ‘Ah’, says the pre-occupation. Our focus is more and mental health conditions. wise old teacher, ‘but when my directed at getting rid of the pain Most significantly of all, it has students stand, they know they are or illness than experiencing it. something to offer those of us who standing—and when they sit, they simply want to be happier and more know they are sitting—and when ‘…Although turning your skillful in our lives. they walk, they know they are attention towards your pain may So in order to develop this art walking’. seem scary, people on our courses of being present now, let us start So there we have it. Inviting you often say that it’s a tremendous with something straightforward. now to practice this for yourself, if relief. For those of us with Inviting you to bring your attention you would like to. chronic conditions, changing our to knowing that you are sitting relationship with them is often the here. The body has to be involved very best medicine’ in this ‘knowing’. We are not so - Burch, 2008 However, most of us are a long way from being with our bodies as they are. We seem fixated on changing Feet on the floor practice them for the better. We want to keep looking young, so we buy Taking a few moments to explore the contact of your feet on the floor— not needing to move your feet or adjust your position—but simply creams and potions to slow down placing your attention down to your feet, and exploring sensations of ageing. We go on endless diets. We contact in your toes, as if this was the first time that you have ever felt even consider cosmetic surgery—all your toes in contact with the floor... then after a while, moving to the in the interests of improving the soles of the feet...and then your heels... feeling your feet held by the appearance of the body. How might solidity of the floor beneath you... staying with this and exploring these it be to practice being present sensations for a moment. with the body just as it is, in this moment? What might that offer? Then, if you would like to, moving your attention to the contact of your Interestingly, there is ongoing body with the chair... maybe feeling your sit bones connecting with the research looking into the effects seat of the chair… noticing how this feels to you… not thinking about it, of mindfulness on cellular ageing but just sensing it directly as best you can. and much else. Mindfulness-based Cognitive Therapy has been shown Finally, bringing awareness to the weight of you going down onto the to halve the risk of relapse in floor through your feet, and through your buttocks onto the chair– held those who have had three of more and supported by the ground beneath you. Perhaps asking yourself, episodes of depression (Segal et al., ‘What am I aware of right now’?28 New Therapist September/October 2012
  • 29. Features Minding the bodyIn this simple practice, we are cancer. Jennifer made the point that When we practice being presentdeliberately becoming curious about for some people—in the moment—the with our experience, we uncoverthe sensations of contact. Over appearance of a damp patch on the qualities of compassion andtime, we find that coming back to wall might be worse than having kindness both for ourselves andthe body with curiosity, as if for cancer. Some of the group looked others. This is not separate fromthe first time (every time), we slow shocked and turned to look at the the practice of being present. Itdown. What is happening here? woman with cancer to see how she was is integral to it. Recent research Most of the time, the mind reacting. She nodded her head and, showed increases in self-compassionand body almost seem to function laughing, volunteered the comment to be one of the key ways thatindependently. The body might that she had a particularly house-proud Mindfulness-Based Cognitivebe sitting without any particularly friend, for whom noticing a damp Therapy for Depression has itsnoticeable sensations—however patch would be a major drama! beneficial effects (Kuyken, 2010)the mind is off planning dinner,or thinking about what someone The point that the teacher was Coming to the Breathsaid to us yesterday, or just vaguely making was not that having cancerspacing out. is a breeze, but that we all have This is another practice which is Once we start becoming more the capacity—in the moment—to important in signposting us backaware of our present physical react way out of proportion to an into the body. It offers us an anchorexperience, we discover that event if certain personal patterns are to come back to—and a way ofwe are often on ‘automatic’. We triggered. By learning to regularly exploring detailed sensations, deepmight be eating a meal, whilst ‘come back’ to the body and the in the body.vaguely planning something for breath, we can start to wake up outtomorrow—or driving the car, but of automatic, notice the reactivenot really aware of the countryside patterns as they arise and regain thewe are passing. Whilst this is quite opportunity to be more present to Coming to the breathnormal, it also lays us open to our experience. practicepotential problems. For when themind is ‘free-floating’, we are at the Anne had a teenage son, Alan, who 1. ‘Feeling your feet on themercy of habits of mind that have had a rare and incurable illness. She floor—weight going down—built up over a lifetime. We are nursed him at home whenever possible. and noticing your spine risingthen more likely to be influenced by This put a huge strain on her and her out of the pelvis up throughpersonal history or past trauma. family, and Anne knew that she was the back—height going up’. Like background traffic noise close to breaking point. 2. ‘Then becoming aware of thethat we screen out and are barely She was referred to a mindfulness fact that you are breathing...aware of, these patterns of mind course and met Jane, a mindfulness Letting the breath breatheinfluence our actions, affecting the teacher. Neither of them felt that this itself—not interfering with it in any way... Simply feelingmood. Being on ‘automatic’ may be was a good time for Anne to attend the sensations of the breath,normal, but it limits our choices. the course, as she was so troubled. deep in the body… as itWe tend to react to what happens in So they decided that Anne would go breathes in and breathes out.’predictable ways, invariably adding and practice ‘Feet on the Floor’ forextra to the event, with an overlay a few weeks, to see how she got on. 3. ‘If at any point, you notice that your mind has wanderedof negative or critical thoughts. This Anne returned saying the practice had away from the breath...tends to keep us stuck in grooves definitely helped and she was keen to distracted by a thought orof difficulty that echo back to the learn more. a sound, remembering thatpast, and resonate forward into the Later, on the course, she was given this is not a problem—itfuture. a little thread bracelet with a red bead is what minds do... and as on it as an aide to help her remember soon as you realize that youJennifer, an experienced mindfulness to ‘come back’. Anne’s group was told have wandered away, gentlyteacher was leading a large graduate of rural South African mothers caring coming back to the anchorclass of people who had all attended for their young with Aids, who were of the breath... and to the8-week mindfulness-based courses. also wearing these threads. Anne was sensations of the breathIn the room was a woman who was heard to comment ‘I don’t feel so alone’. breathing in and breathingobviously going through treatment for ( out’. Indispensable survival guide for the thinking psychotherapist 29
  • 30. Features Minding the body We can do this practice for a few feelings. We try to avoid them. front to see if the needle moves up moments, or a minute or two—and We tense against them. Sensations or down and by how much. From find ways to remember to come in the body might be constricted, this, it may be possible to forecast back to the breath during the day. painful, agitated, hot and tight. upcoming weather. We can use Indeed, we can create our own Thoughts in the mind can move our bodies in a similar way to give practices to suit us, whatever we are towards blame, judgment, and us sensitive information about the doing. Here are some ideas: rumination—adding a lot extra to emotional ‘weather’ arising for us. what is already unpleasant. Here is how you do this: zz Standing with my feet on the Neutral feelings and experiences ground, pausing and noticing, will usually not be noticed at and coming to the breath. all—and when they are, they turn The physical barometer zz Feeling the water on my back into something else, pleasant or in the shower and smelling the unpleasant. 1. Determine some part of soap. How am I right now? We can readily appreciate the the body—preferably in zz Getting into bed and deliberately consequences of the ways we tend the trunk—such as the feeling the bedclothes touching to react to unpleasant events. This chest area or the abdomen me is the picture of stress, distress, or somewhere between or worse. What is trickier is to the two—that for you is zz Eating mindfully—really seeing, appreciate what unfolds when we especially sensitive to stress smelling and tasting my food. try to hold onto pleasant feelings. and difficulty. Place your hand zz Going for a walk and ‘being Perhaps it might help to draw this there. there’ for each footfall. out with a fairly trivial example. 2. Once you have found the I’m in my favorite coffee shop place, it can become your We can also build in reminders and and am delighted to notice that ‘physical barometer’. Tuning routines to help us remember to there is carrot cake today. Ordering into it regularly, you may practice. Cultivating clear intention some, I start eating it with relish, notice different sensations is key to this. and almost immediately think about at different times. When you whether to have a second piece. are under pressure, feeling In that moment of wanting anxious, or frustrated, you Turning Towards may notice sensations of more, and thinking about getting more, I am no longer enjoying the tension, tightness, shakiness, Once we have learnt to regularly taste of the cake. In fact I may well or discomfort. The intensity come back to the body, and begun finish the cake, without actually of these sensations varies, to notice when we have been on depending on the level of ‘automatic pilot’, we can then start tasting much more than the first your difficulty. to look at what happens when our mouthful! The pleasant experience triggers wanting more, and soon 3. As you get used to practicing ‘buttons get pressed’—or when there is just ‘wanting’, which is this, you can become aware things start to ‘amp up’ a bit. not pleasant. Eating is an obvious of quite subtle sensations that So unpicking this a little—it is may signal that something is worth noting that every experience example, but there are many others brewing for you, long before we have results in pleasant, that bombard us every day. We may you are consciously aware unpleasant or neutral feelings (when discover that ‘wanting’ is as much, of this. Being curious about things are neither pleasant nor or more, of a problem to us than these sensations moment by unpleasant). What happens next is ‘not wanting’. moment, without attempting important. A short practice called ‘The to change them, means We generally want to hold onto Physical Barometer’ (Bartley, 2012) you can respond to what is the experiences that feel pleasant. allows us to become aware of these arising quite differently— We want more of them. We want feelings that can, in extreme, move perhaps with more choice and them to last longer, or repeat again into obsessive craving or strong kindness. and again. Sensations in the body aversion. are likely to be ones of warmth, If you have ever seen someone openness, lightness, flow and ease. consulting a old fashioned We usually pull away from barometer, you will know that you things that result in unpleasant need to gently tap on the glass30 New Therapist September/October 2012
  • 31. Features Minding the bodyIf this practice interests you, you discover for ourselves a rich vein ofmight want to try it several times a present experience that simply asksday, as a way of developing the habit us to be here—and in that momentof tuning into the body. It helps to allows us to open and be more kindhook the practice onto an existing to ourselves and the world.activity—such as boiling the kettle,or starting the car—in order to ‘The present is the only time any ofremember it better. us have to be alive, to learn, to heal The Physical Barometer enables – indeed, to love’.us to catch things early, before the -Kabat-Zinn, 1990‘weather’ has really dug in. Thepractice also helps us to notice With my thanks to Jody Mardula fromand appreciate all those pleasant the Centre for Mindfulness, Research and Practice, Bangor University, Wales.little moments that are so easilyoverlooked in our busyness. By practicing in this way, Referencesfeelings and sensations in the body Bartley, T. (2012). Mindfulness-Basedbecome allies in helping us relate Cognitive Therapy for Cancer: Gentlymore gently to the reactivity of the Turning Towards. Oxford: Wileymind. In time, we become more Blackwellable to respond more skillfullyto the ups and downs in life. We Burch, V., (2008). Living Well with Pain and Illness: The mindful way to free yourselfdiscover we have choices and from suffering. London: Piatkusthis can offer us some wonderfulmoments of freedom and well- Kabat-Zinn, J., (1990) Full Catastrophebeing. Living: Using the Wisdom of your Body and Mind to Face Stress, Pain and Illness. New Trish Bartley has been teaching York: Delta mindfulness and leadingIn Conclusion mindfulness-based training Kuyken, W., Watkins, E., Holden, E., for over 12 years. She hasMary Oliver offers us wise advice in White, K., Taylor, et al. (2010) How considerable experience in does mindfulness-based Cognitive introducing mindfulness to theher poem ‘The Summer Day’: therapy work? Behaviour Research and general public and is also involved ‘let the animal of your body love Therapy, 48(11), 1105-1112 in training health professionals what it loves’. (Oliver, 1992) to teach mindfulness-basedIn our brief exploration of being Oliver, M. (1992). New and Selected approaches. She has a backgroundpresent to the connection between Poems. Boston: Beacon Press. in development and has ledbody and mind, we have been training processes in South Africa Segal, Z.V., Williams, J.M.G., Teasdale,discovering how to move closer since 1997. She now specializes J.D., (2002) Mindfulness-Based Cognitive in working with people withto the body and how helpfully Therapy for Depression: A new approach to cancer and other life-threateningthe mind responds when we do. preventing relapse. New York: Guilford diseases. She has developedAlthough it requires a certain effort, Press. an intervention known asit is not so difficult. Simple practices Williams, J.M.G., Teasdale, J.D., Segal, Mindfulness-Based Cognitivesuch as ‘Feet on the Floor’ and Z.V., & Kabat-Zinn, J., (2007). The Therapy for Cancer, based on the‘Coming to the Breath’ invite us to mindful way through depression: Freeing “classical”, 8-week mindfulness yourself from chronic unhappiness. New course that has been clinicallycome back to the present. The body York: Guilford Press. tried and tested with people withoffers us a way of doing that – for it cancer over more than 10 years.changes less quickly than the mind. Williams, M., and Penman, D., (2011) She works mostly in the UK andThe body resonates with feelings Mindfulness: a practical guide to finding leads workshops and retreatsin parallel with the nuances of the peace in a frantic world. London: Piatkus. internationally. Trish is the authormind—whether these are pleasant of Holding Up the Sky: Love Poweror unpleasant. Investigating this and Learning in the Development of a Community (2003) and offor ourselves, we find a potential to Mindfulness Based Cognitiveinterrupt the triggers that bind us. Therapy for Cancer: Gently TurningWith diligence and practice, we can Towards (2012). Indispensable survival guide for the thinking psychotherapist 31
  • 32. From the therapists chair Lost and found The evolution and eventual reversal of borderline dynamics as demonstrated in one patient’s life narrative By Robert Waska32 New Therapist July/August 2012
  • 33. From the therapists chairAbstract We left off with the patient living in Here, we see the phantasy of Africa. He was about nine years old possible persecution or punishmentC ontinuing the and feeling a volatile mix of feelings for not knowing and needing help about himself, his family, and the overshadowing the less intense ongoing story of a world around him.John’s family reality of simply not getting the long term patient in moved to Africa in the middle math problem and needing to ask forpsychoanalytic treatment, of a local civil war. The nation help. This type of severe anxiety andthe author highlights was divided and the government’s internal conflict can create learning military was killing the opposing difficulties for some individuals, aspoints in this patient’s tribe. Therefore, there were armed well as relational problems, as it diddevelopment where the gunman at checkpoints on the for John. In other words, troublesborderline or paranoid- street, tanks rolling down the block, in the internal world can block anyschizoid experience seemed and an occasional killing in the external growth and, for borderline neighborhood. It is interesting that patients, the external world oftento have solidified. At the from ages six to ten, John lived in the looks identical to the internal worldsame time, there were critical very bleak, dangerous, and difficult without any hint of as-if quality.moments of internalization political climates of Rumania and On the other hand, John feltand identification that Africa but never much reacted to more positive and enjoyed things them as such. One could say he in ways he hadn’t before. Buildingeither helped to balance was just being blind, as kids often model airplanes became a passionthe more persecutory are, but it was more that his internal and he dabbled in developing a smallperspective or added an struggles were so strong, and easily neighborhood newspaper madeelement of idealization. In matched the ominous and strange with a toy printing kit. He loved nature of his outside environment, swimming at the local country clubillustrating these points, that he in fact remembered these where he bought British comic booksthe author shows how the experiences as often being interesting whenever he could, ate fries withKleinian approach considers and exciting. Indeed, John found vinegar in the English tradition,the ongoing relationship Nigeria to be the best place he had and spent his allowance on strange lived up to then. He loved exploring candies from a local vendor. Johnbetween external and the area on his bicycle, hiking in the said, “I loved the Smarties, theinternal and how the nearby jungle, and essentially playing English equivalent of M&Ms, butintra-psychic elements of spy or explorer in an unknown land. much bigger. I loved the roll ofattachment and phantasy One example of John’s inner Trebor Mints, the strongest mint struggles involved a memory of a you ever tasted!” All this made himare shaped by projective Boy Scout meeting in which the feel happy and excited. Howeveridentification processes. The Scouts were being instructed on there were elements of rebellion andpoint of this ongoing column how to tell the height of a tree by protest that creep in as well. Johnis to highlight the therapeutic the length of its shadow. John said also began experimenting with he had absolutely no idea what the smoking cigarettes, readily availablenature of allowing the instructor meant and was mystified to anyone at the roadside stands.patient to tell his story and by the whole discussion. He said, Despite some more positiveto have an unique chance to “I felt scared, stupid, and very experiences while living in Africa,hear from the patient their anxious. So, I thought I should John continued to feel like a stranger just act like I understood because in a strange land. He didn’t haveown view of their life, the it felt like it would be worse to any friends to speak of, although heevolution of their pathology, admit my ignorance. Part of it was did spend time with one boy in theand the way external life me not understanding the math neighborhood. They played with toyimprints upon internal life concept. But, most of it was about soldiers and rode bikes. me feeling alienated, strange, and In general, however, John feltjust as internal phantasy nervous around these other people apart. He was beaten up severalshapes the experience of and desperately trying to blend in. It times at school and started to feelexternal life. was this terrible sense of over there is different than the other kids. He them and over here is me. We are so said, “I felt like they were the enemy, separate and different. I wanted to so I kept my distance.” escape but I had to stay and pretend.” When John looks back on his Indispensable survival guide for the thinking psychotherapist 33
  • 34. From the therapists chair‘ defending the animals from poachers and helping the underprivileged When bad objects or ambivalent people. He said, “Mostly, I picture objects are internalized, the ego helping the animals. That is more will attack itself. Depression, self comfortable than dealing with people.” The idea of protecting and mutilation, and suicide are some saving the endangered seemed to be of the results in patients who seek a way of reaching out to help in the ’ revenge upon their internal objects way he wished someone would have done for him. with whom they have identified. As we follow John’s narrative, over and over we find the same basic elements of loss, mistrust, parents during this and other times, records and seemed to cultivate a real idealization followed by emotional he feels they were not very involved hodgepodge of tastes that reflected distress, and a jagged and distorted with his emotional life, but certainly the mixed and complicated feelings method of experiencing the made sure he had all his material he had. So, John enjoyed the hipster world due to primitive projective needs met. He told me, “My mother sound of Bobby Darin, the basic identification dynamics. His said my father felt so guilty about rock and roll of the Beatles, the reliance on splitting and projective dragging me around the world that childish fun of Snoppy and the Red identification left John feeling the he would buy me anything I asked Baron, the late sixties craze of short world was populated by evil poachers for. As a child, I had the feeling lived bands like Paul Revere and and helpless baby animals, both that when I tried to express myself the Raiders and the Monkees, and camouflaged images of disturbed honestly, my parents would either darker songs by bands singing about and disturbing aspects of himself make fun of me in telling me I was the Vietnam war and the massacres and his internalized objects. cute, dismiss me, or just plain not America was responsible for. Fifth Grinberg (1968) notes how understand me.” and sixth grade was a time when all borderline and other primitive John expressed this experience these angry, fun-loving, immature, patients are prone to acting out in of neglect with various angry and and sophisticated feelings began to search of, and in reaction to, the desperate reactions. Just like he fuse together. perceived lack of a containing object did in Jamaica, he would destroy One of the most idyllic memories that can sustain their separation his favorite toys. Since the toys John has of his time in Africa was anxiety, grief, guilt, and loss. I would had come from his parents, it a safari trip the family took one add that this acting out is not just was a way to lash out at them but year. They traveled to Kenya and part of a searching out for the lost also punish himself. When bad began a two week loop that took object but an angry retribution and objects or ambivalent objects are them through several enormous revenge as well, for the perceived internalized, the ego will attack game reserves, across plains, and up abandonment and betrayal. So, the itself. Depression, self mutilation, Mount Kilimanjaro. They would containing object, the ideal good and suicide are some of the results in spend the day locating and observing object, even if found, is never enough patients who seek revenge upon their every type of wild animal one can and always at fault. This creates internal objects with whom they image: elephants, rhinos, hippos, a persecutory cycle of paranoid have identified. antelopes, cheetahs, monkeys, phantasies and unbearable guilt John ran away for much of one giraffes, birds, and alligators. They in which the lost object is now day, after leaving a letter outlining took a canoe down the Nile river, purposely neglectful and absent his grievances. When he came back slept in a tent near Dr. Leaky’s and the patient is always hungry at the end of the day, “my parents famous excavation site, sat around and always has blood on their thought it was cute and teased me”. a campfire listening to the nearby hands. This brings back the most John said, “I was showing them my elephants moving about, laughed fundamental and terrible infantile feelings through my actions, but they with local tribal members, bottle-fed state of mind, of when absence didn’t get the message.” an orphaned zebra, parked next to was intolerable and the missing It was during his time in Africa a pride of lions, and walked among object was no longer a good object that John developed an interest thousands of bright flamingos temporarily absent, but a persecutory in music. This started with him feeding at a lake. For years, John non-object cruelly missing and listening to some of his parent’s fantasized about returning to permanently gone, yet forever records. But, he also found other Africa to become a park ranger, haunting the empty, hungry, and34 New Therapist July/August 2012
  • 35. From the therapists chairdesperate child’s mind and heart. This idea of Grinberg’s, based on Understanding of Borderline Disorders, in The search for, and the Bion’s container concept (Bion Borderline Personality Disorders: The Concept, the Syndrome, the Patient, edited by Peterdisappointment in, the needed 1962), has been elaborated upon by Hartocollis, IUP, New York, Pg. 123-141and desired object of nourishment other Kleinians and examined as acreated more and more anger, fundamental psychic state of mind Palacio Espasa, F (2002). Considerations ondespair, and acting out as John in which the infant feels helpless in Depressive Conflict and its Different Levels of Intensity: Implications for Technique.was in his teens and older. In his the face of loss, abandonment, or International Journal of Psycho-Analysis 83:younger years, most of these painful rejection by the object, leaving the (4) 825-836dynamics were internal but later in infant in a blank emotional void and Quinodoz, J (1996). The Sense ofhis life they became more external as an internal sense of meaninglessness. Solitude in the Psychoanalytic Encounter.well. This Kleinian description of the International Journal of Psycho-Analysis 77: Steiner (1992) and other complex dynamics that can evolve 481-496Kleinians have noted the early, more and rule a person’s psychology Rosenfeld, H (1987). Impasse andimmature stage of the depressive seems to fit with the conscious and Interpretation: Therapeutic and anti-position in which the patient has unconscious experiences John relayed therapeutic factors in the psychoanalyticgreat difficulty tolerating and to me over and over again. treatment of psychotic, borderline, and neuroticaccepting the loss of the needed One of the ways the infantile patients. New Library of Psychoanalysisobject. This was certainly the case ego copes with this difficult Vol 1 318 pages London: Tavistockwith John. In order to cope, he psychological situation is the Steiner, J (1990). Pathologicalrelied on splitting, denial, manic internalization of a harsh and Organizations as Obstacles to Mourning:defenses, or narcissistic (Rosenfeld rejecting object and an identification The Role of Unbearable Guilt. International198) and pathological organizations with that object. This results in a Journal of Psychoanalysis, 71:87-94(Steiner 1990) that defended him turning of the despair, demand, Steiner, J (1992). The Equilibrium Betweenagainst paranoid collapse. However, and anger towards the self and the the Paranoid-Schizoid and the Depressivethese were very fragile psychological formation of a primitive and sadistic Positions. In: Clinical Lectures on Klein and Bion, New Library of Psychoanalysis 14:retreats (Steiner 1993) that easily superego state. Grinberg (1964) 46-58broke down into more borderline describes how the primitive andstates of mind with persecutory and sadistic superego attacks any growth Steiner, J. (1993) Psychic Retreats:primitive depressive conflicts taking and learning as well as creating a Pathological Organizations in Psychotic, Neurotic and Borderline Patients, Routledgeover. This is similar to Quinodoz’s state of unbearable persecutory guilt(1996) concept of untamed solitude and consequent acting out (Grinbergas well as Palacio Espasa’s (2002) 1968).idea of the more para-psychotic So, it was very difficult for Johnand para-depressive phantasies of to seek and find knowledge aboutcatastrophic, irreparable, and life- the world, himself, or others thatdeadening or life-draining states was different than the flawed stateof loss. Only when the patient is of mind he held in which separation,able and willing to face, tolerate suffocation, control, loss, betrayal,and integrate the actual and/or rage and severe guilt all ruled theimagined betrayal, traumatic loss, land.and perceived rejection, can theymove towards the more mature stage Referencesof the depressive position whereforgiveness, hope, and a livable Bion, W (1962) Learning from Experience,future exist. Basic Books, New York Grinberg (1977) has described Grinberg, L (1964), Two Kinds ofhow many borderline patients have Guilt—their Relations with Normalexperienced, either in phantasy and/ and Pathological Aspects of Mourning,or with actual external caregivers, International Journal of Psychoanalysis, Robert Waska MFT, PhD is a 1999 graduate 45:366-371traumatic separation and loss. of the Institute for PsychoanalyticThis has usually been based in the Grinberg, L (1968). On Acting out and Studies, an International Psychoanalyticalinfantile experience of a mother its Role in the Psychoanalytic Process. Association affiliate organization.He International Journal of Psycho-Analysis 49: conducts a fulltime private psychoanalyticwho has not been able or willing practice for individuals and couples in 171-178to receive, contain, or modify the San Francisco and Marin County,infant’s unorganized inner conflicts. Grinberg, L (1977) An Approach to the California. Indispensable survival guide for the thinking psychotherapist 35
  • 36. Book reviews Keynote speakers The first Luthando (CHBAH Psychiatry) Prof Mark Solms Department/SACNA Neuropsychology Mr Brian Mallinson Prof Marilyn Lucas SYMPOSIUM WHEN: 19th-20th November, 2012 WHERE: Sunnyside Park Hotel, Princess of Wales Terrace, 2 York Road, Parktown, Johannesburg COST: R1,500 R1,000 (SACNA members) R500 (State employees) For more information on programme and registration, go to: or contact Ethelwyn Rebelo on: Email: Tel: 011 933 8834 Cell: 073 062 178936 New Therapist September/October 2012