Indespensible survival guide for Psychotherapy Treatment

New Therapist Indispensable survival guide for the thinking psychotherapist

September/October 2012

The Body Edition

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Features 6

Body of Evidence: The head-to-toe history of body use in psychotherapy

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Every body needs some body

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MANAGING EDITORS Lee-ann Domoney Sue Spencer

CONTRIBUTING EDITORS Dylan Evans Graham Lindegger Jacqui de Mare Julie Manegold Tim Barry Tom Strong Kelly Quayle Robert Langs Simone Descoins Robert Waska

Jack Lee Rosenburg, Lisa Loustaunau and Frederic Lowen on body-based psychotherapy

CONTRIBUTIONS Submissions for inclusion in New Therapist are welcomed.

New Therapist reserves the right to edit or exclude any submission. Names and identifying information of all individuals mentioned in case material have been changed to protect their identities. The views expressed herein do not necessarily represent those of New Therapist, its publishers or distributors.

Minding the body:

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Feeling and sensations— what they offer us

By Trish Bartley

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EDITOR John Söderlund

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Drug watch

New Therapist (ISSN 1605-4458) is a professional resource published by New Therapist Trust every second month and distributed to psychotherapists around the world.

Research From the therapist's chair

Copyright © New Therapist 2012. All rights reserved. No part of this publication may be reproduced or disseminated by any means whatsoever without the prior permission of the publishers.

A publication of New Therapist Trust.

Drug watch Creatine boosts effectiveness of antidepressants for women

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ndesired effects of drugs can sometimes be attributed to nocebo effects, according to researchers at the Technical University of Munich. The findings appeared in the journal Deutsches Ärzteblatt International in July, 2012.

Nocebo effects are the adverse events that occur during sham treatment and/or as a result of negative expectations.

Nocebo responses can, for instance, be brought about by unintended negative suggestion on the part of doctors or nurses, e.g., when informing the patient about the possible complications of a proposed treatment.

The mechanisms behind this phenomenon are—as with placebo effects—learning by Pavlovian conditioning and reaction to induced expectations.

While the positive counterpart—the placebo effect—has been intensively studied in recent years, the scientific literature contains few studies on nocebo phenomena, the researchers note.

The researchers say that the consequences for clinical practice are that doctors may find themselves in an ethical dilemma between their obligation to tell the patient about the possible side effects of a treatment and their duty to minimize the risk of a medical intervention and thus to avoid triggering nocebo effects.

One possible strategy to solve this dilemma, suggested by the authors, is to emphasize the tolerability of therapeutic measures. Another option, with the patient's permission, would be to desist from discussing undesired effects during the patient briefing.

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 against depression is not precisely known, but the authors of the study suggest that the pro-energetic effect of creatine supplementation, including the making of more phosphocreatine, may contribute to the earlier and greater response to antidepressants.

The eight-week study comprised 52 South Korean women with major depressive disorder between the ages of 19 and 65. All the women took the antidepressant Lexapro (escitalopram) during the trial.

Twenty-five of the women received creatine with the Lexapro and 27 were given a placebo. Neither the study participants nor the researchers knew who received creatine or placebo.

The study showed that depressed participants who augmented their daily antidepressant with 5 grams of creatine responded twice as fast and experienced remission of the illness at twice the rate of women who took the antidepressant alone. There were no significant adverse side effects associated with creatine.

The researchers hold that their findings are significant because antidepressants typically don’t start to work until four to six weeks. They also note that creatine under a doctor’s supervision could provide a relatively inexpensive way for women who haven’t responded well to SSRI (selective serotonin reuptake inhibitor) antidepressants to improve their treatment outcomes.

“If we can get people to feel better more quickly, they’re more likely to stay with treatment and, ultimately, have better outcomes,” said senior author of the study Perry F. Renshaw.

The researchers say that future research efforts will test creatine supplements in men and women as well as individuals of different nationalities.

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Research

Believing in a mind-body connection linked to better health

Sleep deprivation linked to hunger and weight gain

he more individuals perceive their minds and bodies to be distinct entities, the less likely they will be to engage in behaviors that protect their bodies, according to researchers at the University of Cologne, Germany. The findings appeared in Psychological Science, a journal of the Association for Psychological Science in July, 2012.

The researchers note that many people are philosophical dualists—believing that the brain and the mind are two separate entities. Their findings showed that people primed with dualist beliefs had more reckless attitudes toward health and exercise, and also preferred (and ate) a less healthy diet than those who were primed with physicalist beliefs.

Furthermore, they found that the relationship also worked in the other direction. People who were primed with unhealthy behaviors—such as pictures of unhealthy food—reported a stronger dualistic belief than participants who were primed with healthy behaviors.

Specifically, these findings suggest that dualistic beliefs decrease the likelihood of engaging in healthy behavior.

Evidence of a bidirectional relationship further suggests that metaphysical beliefs, such as beliefs in mind-body dualism, may serve as cognitive tools for coping with threatening or harmful situations.

The researchers say that the fact that the simple priming procedures used in their studies had an immediate impact on health-related attitudes and behavior suggests that these procedures may eventually have profound implications for real-life problems. Interventions that reduce dualistic beliefs through priming could be one way to help promote healthier—or less self-damaging—behaviors in at-risk populations.

leep habits affect body weight by influencing an individual’s caloric intake and energy expenditure, according to researchers at the Society for the Study of Ingestive Behaviour. The findings appeared in PsychCentral in July, 2012.

The authors of the study observed the effect of short-term sleep deprivation on hunger as well as on physical activity and energy used by the body.

The researchers monitored the physical activity of participants by attaching acceleration detection devices to each of their wrists. They also monitored participants’ energy levels using indirect calorimetry—a method that estimates how much heat is produced by a person as they use oxygen.

The researchers found that participants who slept less had higher traces Ghrelin (or what they term the “hunger hormone) in their blood. Those who slept for shorter periods also moved around less.

Results also showed that after staying awake for one complete night, the amount of energy used by the body when resting was significantly reduced among participants.

The researchers say that their findings suggest that when individuals are sleep-deprived they are likely to eat more calories because they are hungrier.

This alone might cause them to gain weight over time. Sleep loss also means we burn off fewer calories, which adds to the risk of gaining weight and developing type-II diabetes.

The researchers conclude by saying that although much is still to be learned about the correct sleep dose for obesity and diabetes, the available research results clearly supports the notion that sleep is involved in the balance between the amount of calories we eat and the amount we use up through activity and metabolism.

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New Therapist September/October 2012

Research Fathers’ rejection can have particularly adverse effects on children

Snacking linked to brain activity and self-control

study by researchers at the University of Connecticut shows that while mothers have unique social and emotional bonds with their children, a father’s love contributes as much—if not more—to a child’s development. The findings appeared in the journal Personality and Social Psychology Review in June, 2012.

The researchers analysed the power of parental rejection and acceptance in shaping our personalities as children and into adulthood.

In a review of 36 international studies that involved more than 10,000 participants, the researchers discovered that parental rejection causes children to feel more anxious and insecure, as well as more hostile and aggressive toward others.

“Children and adults everywhere—regardless of differences in race, culture, and gender—tend to respond in exactly the same way when they perceived themselves to be rejected by their caregivers and other attachment figures,” said co-author of the study Ronald Rohner.

The authors of the study found that the pain of rejection—especially when it occurs over a long period of time in childhood—tends to linger into adulthood, making it more difficult for adults who were rejected as children to form secure and trusting relationships with their intimate partners.

Rohner notes that prior studies have shown that the same parts of the brain are activated when people feel rejected as are activated when they experience physical pain.

“Unlike physical pain, however, people can psychologically relive the emotional pain of rejection over and over for years,” Rohner said.

The results showed that while children and adults often experience more or less the same level of acceptance or rejection from each parent, the influence of one parent’s rejection—often the father’s—can be much greater than the other’s.

Researchers at the International Father Acceptance Rejection Project explain that children and young adults are likely to pay more attention to whichever parent they perceive to have higher interpersonal power or prestige.

So if a child perceives her father as having higher prestige, he may be more influential in her life than the child’s mother.

Rohner notes that fatherly love is critical to a person’s development. The importance of a father’s love should help motivate many men to become more involved in nurturing child care.

ood consumption and BMI (Body Mass Index) are linked to both brain activity and self-control, according to researchers at the Universities of Exeter, Cardiff, Bristol, and Bangor. The study appeared in the journal NeuroImage in July, 2012.

The authors of the study found that individuals’ brain 'reward centre' responses to pictures of food predicted how much they subsequently ate. This had a greater effect on the amount they ate than their conscious feelings of hunger or how much they wanted the food.

A strong brain response was also associated with increased weight (BMI), but only in individuals reporting low levels of self-control. For those reporting high levels of self-control a stronger brain response to food was related to a lower BMI. The researchers note that their study adds to mounting evidence that overeating and increased weight are linked, in part, to a region of the brain associated with motivation and reward, called the nucleus accumbens.

Responses in this brain region have been shown to predict weight gain in healthy weight and obese individuals. The current study adds to this by showing that this is independent of conscious feelings of hunger, and that self-control also plays a key role.

The study comprised 25 young healthy females with BMI’s ranging from 17-30. The researchers elected to observe female participants as they typically exhibit stronger responses to food-related cues than men. This is due to hormonal changes during the menstrual cycle.

All participants were taking the monophasic combined oral contraceptive pill.

Participants had not eaten for at least six hours. They were given a bowl containing 150 g of potato chips to eat at the end of the study.

The researchers used MRI scanning to detect the participants' brain activity while they were shown images of household objects, and food that varied in desirability and calorific content. After scanning, participants rated the food images for desirability and rated their levels of hunger and food craving.

Lead author of the study Natalia Lawrence of the University of Exeter says, "Our research suggests why some individuals are more likely to overeat and put on weight than others when confronted with frequent images of snacks and treats. Food images, such as those used in advertising, cause direct increases in activity in brain 'reward areas' in some individuals but not in others. If those sensitive individuals also struggle with self-control, which may be partly innate, they are more likely to be overweight."

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Body of evidence

Body of Evidence: An overview of body use in psychotherapy

By Kelly Quayle

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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 and body are not neatly distinct from one another. To a large extent, the focus of traditional psychotherapy is in working with one’s thoughts and beliefs. The old adage of psychotherapy as the ‘talking cure’ priveleges verbal communication to the sine qua

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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 the body in not only expressing mental trauma or imbalance, but also as a tool for therapeutic change and for tracking the progress of clients. This overview will cover the work of some leading writers and psychotherapists in this evolving area of psychotherapy.

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Understanding the body in mental illness: From hysteria to conversion disorders Hysteria is an obsolete medical term that is still used colloquially to refer to a state of extreme fear or emotion and the resultant irrational behaviour. The term was originally employed to describe women who acted irrationally due to a supposed disturbance of the uterus, and dates back as far back as Hippocrates.

The notion of hysteria was revived through the influence of Freud’s theories about hysterical conversions, which no doubt influenced the current thinking, namely that people may have physical manifestations of psychological distress as an unconscious way of repressing, expressing and coping with it.

In modern psychological thought the term hysteria is no longer considered a diagnostic category, although physical manifestations of psychological conditions can be diagnosed as somatoform and dissociative disorders. A somatoform disorder is characterised by physical symptoms that have no identifiable physical causes. These symptoms usually mimic real diseases or injuries. Such disorders include conversion disorder, body dysmorphic disorder and somatization disorder.

Dissociative disorders are psychological disorders that involve dissociation or interruption in aspects of consciousness, including identity and memory.

These types of disorders include dissociative fugue, dissociative identity disorder and dissociative amnesia.

Routinely, the body is considered when diagnosing mental imbalance and psychologists are trained to assess a client’s vegetative functioning, take into account their general physical functioning and observe non-verbal behaviours. But many psychotherapists and branches of psychotherapy are attempting to recognise the body not simply as a diagnostic agent, but as a living source of intelligence, information and change.

Clarifying ‘body in psychotherapy’ versus other disciplines Although, by definition, most psychotherapeutic approaches involving the body have a holistic understanding and work towards some form of body/mind integration, there are considerable differences in terms of technique, therapeutic stance and the role of the therapeutic relationship in the process. It is important to distinguish the various forms of body therapy from psychotherapy that integrates body work into its understanding and treatment techniques. Body healers may, for instance, use some form of massage or physical exercises, work simply to improve physical well-being and see inner balance and psychological benefits as indirect results. Other approaches, such as martial arts or cranio-sacral therapy, go further and aim to involve the client more pro-actively in increasing inner awareness and healing the body-mind split.

But psychotherapy with a ‘body’ focus is distinct from the above in that it always works from and within the client’s subjective reality, which includes an awareness of the different levels of body, emotion and mind that shape this reality. The understanding and use of the body in psychotherapy probably stands in most stark contrast to other body therapies in its conception of the therapeutic relationship. Although a holistic model of the client is common to all approaches involving the body, most non-psychotherapeutic body therapies tend to rely on a quasi-medical ‘expert’ relationship between patient and healer. Within the psychotherapeutic realm, no one specific technique is considered therapeutic in itself, but only as an integral part of a therapeutic relationship.

Conceptualising the body in psychotherapy on a continuum The therapeutic approaches that incorporate the body in psychotherapy may be depicted along a continuum. On the one end, predominantly verbal therapies pay little or no attention to the body. On this extreme, the spoken word dominates the therapeutic interaction and in the verbal interventions, there is little or no reference to body aspects. However, even on this end of the continuum, nonverbal interactions have an important and unavoidable impact on practice. Therapists and client are never just ‘talking’, they are always bodies interacting. Further along the continuum, there are therapies that display increasing body-orientedness. There may still be a focus on verbal interventions, but the body is recognised as an explicit source of information. And moving further along the continuum, there are approaches that are sometimes called “body therapy”. Major methods here are working with movement, nonverbal expressions and direct touch. These are the focus of this overview.

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History of the body in psychotherapy: From the 1900’s to the present A brief, incomplete history of the body therapies is depicted below, followed by a fuller description of some of the theorists that have contributed to the developments in this field. zz Freud, early 1900’s: The grandfather of modern psychotherapy was clear that the ego is first and foremost a ‘body-ego’ (certainly a statement integrating body and mind) and, for a while, assumed that some day psychoanalysis would be grounded in physiology and biology. His early conceptualisation of libido within a framework of homeostasis is much more aligned with biology and physics than with psychology, and there was a strong subversive impetus to liberate the body’s energies. From early on, Freud used a wide variety of techniques, including massage.

Later in his professional life he veered more towards seeing the body as representing the dangerously dominant force of the instincts which had to be kept in check by an increasingly conscious mind. zz Reich, from 1920: Reich was probably the first psychoanalyst to give significant impetus to Freud’s early ideas about the body and libido. He eventually became the pioneer of a school of thought known generically as body psychotherapy, although he began with an approach he labelled ‘vegetotherapy’. Reich recognised that all neurotic symptoms also have a physiological and physical aspect and that the body is closely linked to the psychological process. His central understanding was that body and mind interact dynamically with, and mirror, each other. If the mind forms a conclusion, the body has a reaction. Tension in physical form is connected to a mental state and releasing it has a freeing effect on the mind.

Reich’s concept of ‘character armour’— habitual and chronic fixed relational positions—

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captures both the defensive and self-protective aspects of ‘repression’ which have long been a cornerstone of analytic theory. Reich called his way of working with the body ‘vegetotherapy’, which he considered ‘character-analysis in the realm of the body’. For Reich, the therapeutic process is liable to remain bound by the linear world of mental understanding and insight unless the underlying ‘body armour’ is addressed—the body is just as effective and necessary an arena for change as is the mind. zz Neo-reichian theories, originating from Reich’s work, which focus on somatic healing and consider the mind-body interrelations and connectivity in order to heal the whole person.

Various techniques are utilized, including breath, physical touch and movement. Known generically as ‘body psychotherapy’, contributors to this line of work include Georg Groddeck and Sandor Ferenczi, whilst Alfred Adler and C.J. Jung and others contributed to its development through their concern with the distribution of psychic energy within the body and the relationship between body and mind. Specific therapies that emerged from within these developments include (cited in Eiden, 1999): {{ Bioenergetic Analysis developed by Alexander Lowen, who emphasised the importance of ‘grounding’—being in strong contact with the ground through feet and legs. {{ Core energetics: Developed by John Pierrakos.

It emphasised the bridge between psychology and spirituality. {{ Biodynamic psychology: Developed by Gerda Boyesen. She theorized that the dismantling of psychological stress is also connected with the digestive system. {{ The Chiron approach was founded by Bernd Eiden and Jochen Lude in the early 1980s and emphasises an integral-relational approach to therapeutic healing.

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Other 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 psychotherapy: For many years, the realm of implicit nonverbal communications and bodilybased affective states was largely ignored by mainstream psychoanalysis. The result was a traditionally strong bias in favour of explicit, verbal, cognitive mechanisms (Schore, 1994).

However, advances in our understanding of the psychology and biology of bodily-based emotional states and neuropsychoanalytic concepts that bypass the Cartesian error, along with the developmental psychoanalytic discoveries of how affect regulating attachment experiences positively and negatively impact evolving structure, are being incorporated into more complex clinical models of the psychopathegenesis and treatment of brain/ mind/body disorders.

Until recently, body psychotherapy progressed independently, and somewhat apart from, contemporary psychoanalysis.

This field has focussed more intensely on the somatic expressions of psychobiological trauma, especially trauma and affect dysregulation that occur in the histories of severe self pathologies.

But the body psychotherapists appear increasingly to be adopting an interdisciplinary perspective (Schore 2002).

Pat Ogden and her colleagues are a prominent source of neurobiologically, psychodynamically, and developmentally informed clinical models in the expanding world of somatically-focussed psychotherapy.

Dubbed the sensorimotor approach, it builds

on traditional psychotherapeutic understandings, but includes the body as central in the therapeutic field of awareness and employs a set of observational skills, theories, and interventions not usually practiced in psychodynamic psychotherapy.

Ogden argues that therapy is the context in which we work with the wisdom of the body in an attempt to integrate sensations, images, feelings and thoughts that constitute ongoing experience.

The experience of trauma is recognised as being significantly body-based. Sensorimotor approaches recognises and use this to allow the therapist to open up the client’s non-verbal world and make it available for integration and processing. By being aware of how a client stands, sits, walks, talks or gestures, the therapist can hypothesise about these bodily gestures and client and therapist can learn what these might be communicating.

The therapist also attends to the way in which bodily organisation reflects competence and wellbeing. Techniques may include the inculcation of deep and regular breathing, relaxation, physical flexibility and physical alignment.

The sensorimotor therapist is concerned with “top-down” management skills, such as clarifying meaning, formulating a new narrative, and working with emotional experience, as well as with “bottom-up” interventions that address the repetitive, unbidden, physical sensations, movement inhibitions, and somatosensory intrusions of unresolved trauma (Ogden, Pain & Fisher, 2006). Such an integrative approach attempts to help clients experience a reorganised sense of self.

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Features zz Mindfulness-based psychotherapies, eg. the Hakomi Method: In the last decade mindfulness has become increasingly popular within many branches of psychotherapy, based on the growing recognition that the ancient mindfulness teachings can reduce stress and contribute to the healing process for a wide-range of difficulties (KabatZinn, 2005). Within mindfulness, the somatic realm is not only deeply tied into all our emotional and mental processes, but it reflects them precisely, allowing the uncovering of fundamental issues and memories that give rise to them (Marlock & Weiss, 2006, in Weiss, 2009)). Mindfulness encourages ways of becoming more ‘aware’ or more conscious of bodily processes. Patients are usually encouraged to sense, feel and observe their bodies at great length.

Body psychotherapist Ron Kurtz pioneered the integration of mindfulness into psychodynamic therapy in the 1970’s. In his approach, The Hakomi Method, the therapist constantly monitors and helps to regulate the state of consciousness of the client. In the course of a successful Hakomi process, there is an expanding sense of mindfulness and the core of the process usually takes place in this state. As an experiential process, the therapist is radically nondirective in order not to interfere with mindfulness. This shifts the focus of the therapist from a ‘thinking’ to an ‘observing’ mode. When completely in tune with mindfulness, the therapist will manifest a state of being that Kurtz calls ‘a loving presence’ (Martin, 2007). The mindful approach requires a fundamental shift in attitude that is hard to fathom for those schooled in traditional ways of Western psychotherapy (Weiss 2007).

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zz Post-modern contributions (Tom Andersen and Jaakko Seikkula):The late Tom Andersen, a well-respected Norwegian therapist who co-developed a form of therapy known as ‘collaborative therapy’ and Jaakko Seikkula, a renowned Finnish psychotherapist and academic who borrowed from this approach and successfully developed social network based practices in psychiatry, brought about an increasing recognition of the dialogical and ‘embodied’ nature of therapy.

Andersen observed the work of physiotherapists who worked intuitively with a person’s body to effect change and he drew forth many observations to apply to his therapy with clients. He stated that therapy must be like a ‘pain producing hand’ in the sense that a therapist’s words must be unusual enough to incite change in the client. He also observed that a good therapist is guided by his or her client’s signs, which are often very subtle ones, and from this his ‘slow’ way of working evolved. Tom Anderson’s approach to therapy highlighted the importance of a responsive and embodied contact with an others expressions and following these moving’ expressions wherever they might lead (Shotter, 2007).

Jaako Seikkula developed Open Dialogue, a group therapy method in which ‘team members’ bring new words that offer an alternative language to those of symptoms and problem behaviours. Network members are encouraged to sustain intense painful emotions of sadness, helplessness, and hopelessness as a multi-voiced picture of the event evolves. A dialogical process is a necessary condition for making this possible.

To support diaological process, team members attend to how feelings are expressed by the many voices of the body: tears in the eye, constriction in the throat, changes in posture, and facial expression. Team members are sensitive to how the body may be so emotionally strained while speaking of extremely difficult issues as to inhibit speaking further, and they respond compassionately to draw forth words at such moments. “The experiences that had been stored in the body’s memory as symptoms are “vaporised” into words” (Seikkula & Trimble, 2005, p. 468). In this approach, dialogue is not just a form of communication, but a way of engaging with others in a way that forms minds. ‘Mind’ is not seen as an independent element of human psychological structure, but an ongoing process from one second to another between living (embodied) persons.

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Towards an integration: Drawing from the concepts and practices of ‘body’ psychotherapies

The body perceived from outside

It is clear that body psychotherapies do not emanate from a common theoretical base. Support for body work is found in different theoretical models: psychodynamic theories, including Reichian and non-Reichian theories, humanistic and existential psychology, transpersonal psychology, and behaviour therapy. Despite the number of specific models and therapies that incorporate the body into psychotherapy, Leijjsen (2006) suggests that a psychotherapist wanting to validate the body in psychotherapy can work with one or a combination of these aspects of the body, which might include the body perceived from outside, the body in action in movement and other nonverbal expressions, and the body in physical contact with another body, usually by touch. These are outlined below, with practical illustrations of how these techniques might be used in the therapy context.

A person’s facial expressions, body postures, gestures, breathing, even voice quality, sighing and laughing, are commonly used by the therapist to aid insight. People also have a natural tendency towards mimicking the posture, gestures, facial expressions of the people they are looking at, referred to as empathic attunement. Research shows that mirroring of bodily positions and an unconscious synchronisation of actions between people helps to develop and maintain rapport and relatedness (Cooper, 2001 in Leijssen, 2006).

The nonverbal communication may complement the client’s narrative or even reveal something different from the spoken narrative of which client may not be conscious. An awareness and reflection on the non-verbal communication of the client can bring greater awareness and insight to the issue being discussed. For instance, a client may verbally express that they are no longer affected by an experience from their past, but the therapist may observe the client holding her hands across her abdomen and this might cue the therapist to note that she is trying to protect herself from something that she is not verbally expressing.

However, sometimes clients may be confused when the therapist draws attention to physical components of their communication or feel intruded upon and thus therapists would ideally move the client along such observations or interpretations only at a pace that does not disrupt the therapeutic process, particularly when dealing with the results of trauma (Rothschild, 2002).

The body sensed from inside The body as sensed from inside, the experiencing body, relies on the premises that what is most essential can be experienced in the body. This is a visceral process, rooted in emotional experience, with cognitive activity as secondary. The inclusion of the simple invitation to pay attention to the body as sensed from inside can enhance each method of therapy without changing it very much (Gendlin, 2003 in Leijjsen, 2006). The therapist may ask: “Wait a moment, can you check inside, in your body, what you are feeling there?” If this bodily source is not too alien for the client, the symbols arrived at from that place will deepen the therapy by accessing the emotional material on more than just the cognitive level.

In the interaction with the client, the therapist can also rely on his or her body orienting sense, which some might call ‘somatic countertransference’. In their research on therapists’ experiences of empathy, Greenberh and Rushanskiu-Rosenberg (2002) investigated therapists’ internal process while being empathic.

Therapists reported often using their own bodily responses as tools to finding the most accurate connection with the client’s experience and as feedback for the accuracy of the interaction. A therapist might notice that they have a physical sensation mirroring the client’s experience. This might be felt as a shiver down the spine or a feeling of excitement; or as a body resonance that recognises the pain of the client. The therapist can even verbalise their own bodily experience with comments, such as “I notice that my heart beats faster when you talk about that.”

There are also many benefits to experiencing the body from the inside, such as increased self-awareness, a capacity for less impulsive or automatic behavioural responses to feelings and delaying automatic behaviour, and the attendant calming, relaxing and grounding effects that follow from these.

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Features The body perceived in action: Movement In this step of validating the body, the therapist pays more explicit attention to kinaesthetic, movementrelated experiences and also may also experiment with guiding the client to new movements and body postures.

The therapist might, for instance, ask the client to exaggerate a movement to increase its emotional salience and to bring the client in contact with something that is further away from awareness. Or the therapist might introduce small steps of experiential learning and invite the client to experiment with active behavioural expression. For example, a client reporting that he is “fed-up” with doing something and hunches his shoulders as he says it might be invited to exaggerate the moment in his body posture, or alternatively he might be encouraged to explore the opposite body position.

The therapist may also modulate body posture or movement that are unusual for a client in order to help the client achieve a recognition of alternate bodily experiences and explore new possibilities. For instance, a dependent person who ‘holds on’ to others and has difficulty standing on her own legs might be encouraged to plant her feet firmly on the ground. Movement exercises and experiements can also activate muscle functioning and create bodily flexibility, creating the possibility of new awareness and new experiences. However, Leijjsen (2006) cautions against the pitfalls of working with the body in action in the sense that the therapist may take too much control, or see himself or herself as the agent of change.

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The body in physical contact: Touch How touch is experienced is often subjective. The same sensory stimulus, like a tap on the shoulder, might be seen as an encouragement by one person and a reprimand by another. Touch crosses a body border and there is, inevitably, a correspondingly heightened sensitivity and intimacy involved in the act of touch. For these reasons, it is hardly surprising that touch has been been considered a controversial and usually undesirable practice in ethical codes that guide the practice of therapy. Where it has been used in therapy, touch might extend from a handshake in almost exclusively verbal therapy to intensive bodywork at the other end of the touch continuum.

While making physical contact with clients is indeed a ‘touchy’ topic amongst therapists, a survey of members of the American Academy of Psychotherapists (Tirnauer et al, 1996 in Leijjsen, 2006), indicated that only 13% “never touch” their clients. Ethical fears of touch are typically centred around a fear that physical contact may lead to exploitative or sexual interactions. Therapeutically, there is also a fear that touch may create transference issues and/ or retraumatisation when misuse of touch was part of the client’s original trauma. Leijssen (2006) suggests that acknowledging these concerns doesn’t imply that touch has to be problematic in therapy.

One way of framing touch in therapy is that, when used appropriately, it is a genuine expression of personto-person relating, and a strategic means of providing nurturance and support. Touch is clearly a more intrusive technique, but Leijjsen (2006) argues that touch, used appropriately, can provide a physical holding or containment of the client in trouble. Take the example of a trauma therapist, working with survivors of political torture, who used kind and gentle touch to help them ‘come back into their bodies’ (Bingham Hull, 1997, p.6 in Leijjsen, 2006). Touch in these instances would appear to assist the traumatised individual to move beyond a layer of fear that ‘freezes’ their ability to benefit from other interventions. As a guide, therapists are encouraged to ask permission and state the intention behind touch before making contact. Touch should also only be employed once the therapeutic relationship is well established and should always be congruent for the therapist and feel comfortable and appropriate to the client. Neither the therapist nor patient should experience the touch as a demand, nor as an expression of intimacy beyond that felt on an emotional level (Kertay & Reviere, 1993).

New Therapist September/October 2012

Features

Body of evidence Women's 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.

References

The body in action: Nonverbal forms of self expression This way of validating the body is an extension of movements in more nonverbal actions. The therapist may introduce expressive arts (dance, drawing, painting, sculpting, music, sound) as an alternate path for exploration and communication. In the consulting rooms of Carl Jung for example, people danced, sang, acted, mimed, played musical instruments, painted, modelled with clay (McNeely, 1987, p.39).

In this way of validating the body, it is important to remind the client that performing visibly is not essential—these methods are used to increase self-insight.

Nonverbal expressions can also replace or supplement words when talk fails to produce results. What is creative is often therapeutic (Adzema, 1985; Kahn, 1985 in Leijssen, 2006).

Andersen, T. (1997) Researching clienttherapist relationships: a collaborative study for informing therapy. Journal of Systemic Therapies, 16(2), pp 125-133.

Eiden, B. 1999. The History of Body Psychotherapy—An Overview. This article was written in January 1999 for 'Counselling news—the voice of counselling training'—a magazine published by CSCT. Greenberg, L.S., Rushanski-Rosenberg, R. (2002). Therapist’s Experience of Empathy. In J.C. Watson, R.N. Goldman, & M.S. Warner (Eds.), Client-Centered and Experiential Psychotherapy in the 21st Century: Advances in theory, research and practice (pp. 168- 181). Ross-on Wye: PCCS Books.

Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. New York: Hyperion.

Kertay, L., & Reviere, S. L. (1993).

The use of touch in psychotherapy: Theoretical and ethical considerations.

Psychotherapy: Theory, Research, and Practice, 30(1), 32-40.

Leijssen, M (2006). Validation of the Body in Psychotherapy. Journal of Humanistic Psychology. 46, 2, 126-146.

Maines, Rachel P. (1998). The Technology of Orgasm: "Hysteria", the Vibrator, and

Rothschild, B. (2002). Body psychotherapy without touch: applications for trauma therapy. In T. Staunton (Ed.), Body Psychotherapy (pp. 101-115). New York: Brunner- Routledge.

Seikkula, J (2008). Inner and outer voices in the present moment of family and network therapy. Journal of Family Therapy. 30: 478-491.

Seikkula, J. and Trimble, D. (2005).

Healing elements of therapeutic conversation: Dialogue as an embodiment of love. Family Process. 44: 461-475.

Schore, A.N. (2002). The right brain as the neurobiological substratum of Freud's dynamic unconscious. In D. Scharff (Ed.), The psychoanalytic century: Freud’s legacy for the future. (pp. 61- 88). New York: Other Press.

Shotter, J. (2007). Not to forget Tom Andersen’s way of being Tom Anderson: the importance of what ‘just happens’ to us. Draft of paper delivered at The 12th International Meeting on the Treatment of Psychosis, Lithuania, September, 2007.

Weiss, J. (2009). The use of mindfulness in psychodynamic and body oriented psychotherapy. Body, Movement and Dance in Psychotherapy, Vol. 4, No. 1, April 2009, 5-16.

About the author Kelly Quayle is a psychologist in private practice in Pietermaritzburg, South Africa, and a contributing editor to New Therapist.

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Every body needs some body

Every body needs some body An interview featuring Jack Lee Rosenburg, Lisa Loustaunau and Frederic Lowen

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Every body needs some body

“Everybody needs somebody to love”

Frederic Lowen

- Song by Bert Berns, Solomon Burke and Jerry Wexler, which first charted in 1964.

L

et’s face it: Our most archetypal attachment scripts are predicated upon a fundamental urge to fulfil the longing of every body for some body to love.

Our bodies are, whether we like it or not, the vehicle of expression for a great deal of what we feel, think and confront in our daily psychic life. So maybe we psychotherapists should just get over ourselves and our obsession with the talking cure. Could we contemplate that the bodily cure might be just as powerful and important a route to healing?

We asked three prominent body therapy practitioners and writers to back us up on this body check for overly talkative shrinks. This is what Frederic Lowen, Lisa Loustnaunau and Jack Lee Rosenberg had to say.

Frederic Lowen, son of Alexander Lowen, M.D., is Executive Director of The Alexander Lowen Foundation.

With long term and extensive experience in Bioenergetics, Bioenergetic therapy, workshop and training attendance since 1966, Fred seeks to expand the visiblity, appreciation, and use of Bioenergetics.

Fred lives in Vermont, USA with his wife and daughter.

Lisa Loustaunau 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. www.LisaLoustaunau.com

Jack Lee Rosenberg Dr. Jack Lee Rosenberg is internationally recognized as a pioneer for his innovative approach to body psychotherapy, human sexuality, and couples counseling. He is founder of the Integrative Body Psychotherapy Institutes. He has conducted workshops at the Esalen Institute for more than twentyeight years. The author of Total Orgasm, Body, Self and Soul, and The Intimate Couple, he is in private practice in Los Angeles.

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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.

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Lisa Loustaunau:

Frederic Lowen:

Working with the body opens an entirely new dimension in the treatment room, providing a wealth of material that could take months or years to access through verbal therapy alone. Words just as easily hide or alter the truth as reveal it and, as we know, most communication is non-verbal.

I am always struck by the depth of feelings and experience that my work with the body elicits which the client could not verbally or consciously communicate previously.

This is much more than body language, which reveals the truth of the moment.

The practice of body psychotherapy goes far beyond body language in that the body communicates the story of a lifetime and offers a direct channel to experience past and present.

When I look at a client's body I see the story of a life journey. It is a moving and vulnerable experience to receive the uniqueness of a human being in this way.

The body speaks to me about their history, their patterns of relating, their gifts and strengths and innate potential, as well as of their primary defenses and repetitive limiting life-patterns, which will be important to challenge in therapy. The body gives me the direction of the work. Working physically opens deeply held or denied feelings which, when integrated, expand the individuals awareness of who they really are. The body tells the truth without all the embellishments and smoke screens that the ego mind at times constructs.

Body work offers me a way to open the door to new or different energetic and emotional experiences. They happen right there in session. We aren’t figuring out what they feel or what they should do about this or that. The feelings emerge from within the body and are felt right there. It is very immediate and very powerful when clients experience themselves having feelings they didn’t know they had or were able to tolerate and having them freely and honestly.

I engage the person physically to effect a transformation that occurs on every level of being—psychologically, energetically, emotionally, mentally and spiritually. It is a powerfully healing expansion.

The client’s conscious mind is an unreliable source of usable information. Irrational behaviors, emotions, thoughts, beliefs, and attitudes are justified, defended, rationalized, and/or denied by the conscious “rational” mind. So, the value and usability of verbal communication is limited. A client’s “truth” must be discerned from the motivations of a client’s words, not from the words themselves. Talk therapy is like a mental chess game in which, too often, the patient is better than the therapist. Driven by a desperate need to maintain “control,” present an image, or to perpetuate a relatively comfortable, seemingly safe homeostasis despite the complaint/symptom, patients present all manner of resistances; some hardened to the point that talk therapy is virtually impotent.

In Bioenergetic Analysis, the body is the focus of the therapeutic work. Like the annual rings of a tree, the traumatic experiences of the individual are recorded in the body.

Originating in psychoanalysis, and developed from the work of Freud’s student Wilhelm Reich, Bioenergetic Analysis examines character and personality in terms of the energetic processes of the body. An individual’s energy is expressed psychologically in thoughts, beliefs, and (motivations for) behavior, and physically and physiologically in form, structure, and movement. The self comprises both, as well as the psychological unconscious and the autonomous physiology. Like two faces of a coin, each face may be radically different, and neither face is the whole coin.

To an experienced Bioenergeticist, the body is an expression of a person’s self. Unlike the mind’s rational verbal exchange, the body does not lie to the knowledgeable, aware therapist. All of us in the developed world, to varying degrees, have been restricted in fully expressing our feelings and our selves. To a point, this is necessary for social cohesion. But when our feelings and the expression of those feelings are rejected, suppressed, humiliated, threatened or denied, especially in childhood, the energy of those feelings becomes “frozen” into structure, subsequently restricting the motility of our bodies.

This frozen structure and the quality of expression: the inability to express, or inappropriateness of expression, are the elements used in Bioenergetic Analysis diagnostically and directly in treatment, hugely leveraging the value of verbal communications in uncovering and integrating trauma, and relieving the conflict between conscious and unconscious energies.

In addition to improving integration of conscious and unconscious, and mind and body, body work enhances physical and physiological health.

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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 countertransference, 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.

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Every body needs some body

Jack Lee Rosenburg:

Lisa Loustaunau:

We cannot access the deeper holding patterns of the body/mind. IBP breath work is used to change the balance between the sympathetic and the parasympathetic nervous systems, allowing a sense of wellbeing to unfold in the client's body/mind. There are certain emotions that cannot be known by the mind alone: such as love, trust, erotic sexuality.

We cannot access holding patterns stored in the body without some form of manipulation of the body. Therefore we must use a number of techniques for working using minimal physical contact and yet still opening or releasing fixed muscular patterns held throughout the clients’ body.

Verbal communication alone does not access early, emotional, relational limbic memory upon which our foundation is built. And yet, it is vital to get to the roots of holding patterns for healing. Also, when the body is tight, particularly in the chest, it shuts down access to the energetic feeling of love, causing love to remain a less satisfying mental construct or idea. This is a particular problem between parents and their children.

Simply talking doesn’t reopen the body to core self agency functions.

Without this opening clients remain disassociated from core experience and just learn more effective coping strategies rather than accessing their authenticity. Most profoundly, the awakening of the body allows the emotional heart to feel and connect with others. It also allows access to deeper wisdom. If we remain in our heads talking, life remains flat. Awakening the energy of the body brings deeper, truer emotions, essence of being and meaning.

Emotions available without grounding in the body are usually re-enactments of old archaic emotional injuries and are impervious to change.

We cannot access verbally what the unconscious intends to disown.

In body psychotherapy we see the unconscious not as a vague psychological sphere but as located in areas of the body where energy is being managed or blocked. In Core Energetics we see energy and consciousness as unified, so if you repress energy you repress consciousness.

If you block pain, you block pleasure.

How this happens in the body is through the formation of what is known as armoring, set patterns of muscular holding.

A tight jaw prevents us from crying or expressing our anger, vacant eyes caused by chronic tension in the intra-ocular muscles protects us from the intimacy of contact. These are some examples of how our unique pattern of armor serves to protect us from particular feelings or experience. Armor (often called blocks) develops as a process over time as a result of repetitive significant experiences during critical formational periods in early life that the psyche was not able to handle. Better said, the armor in the body is the way the psyche handled the developmental frustrations.

What is significant is that the same armoring which originally served an adaptive purpose—protecting us from knowing and feeling what would have been too painful to fully experience at the time—keeps us living and acting as if those early realities continue, and thus we find ourselves repeating certain patterns over and over. These patterns contain what in Core Energetics we call an “image,” a fixed belief.

Let me give you an example of an “image.” Someone who was deeply frustrated around needs may develop an image that goes “if I allow myself to need then I will be disappointed, if I don’t need then I can’t be disappointed.”

In this case closing off consciousness of real needs would become the solution to the frustration. This may never have been formulated as a distinct thought, the wound having been experienced before this thinking was possible. It would however be revealed in the body. You can see it in a sunken chest that takes in little breath, (refusing the energy and sustenance), and in de-energized arms that have difficulty reaching out toward what is wanted or needed. The body having formed itself in such a way as to literally close itself off from needing too much by a contraction of the receptive centers in the front of the body.

The experience of embodiment, the way a person feels and breathes and inhabits their body, needs to be changed in order to really transform a life issue. It is impossible to challenge the physical component of the defense with words alone.

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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.

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Jack Lee Rosenburg: We use limited touch.

The more the therapist touches the client during a body session, the greater the possibility to set up a possible problem, particularly a dysfunctional or misunderstood transference relationship with the client. The client can begin to feel dependent on the therapist for functions the client needs to develop such as wellbeing and problem solving. The client can feel inundated and/or touched inappropriately, especially if the client has been abused.

Yet, touch is very important for the wellbeing of human beings. Sometimes we hold a patient’s hand to help the client not feel alone. If touch feels like too much for the client we may use a strap or rope held both by the therapist and client. This can also be helpful to help a client make contact and remain present. We teach selfrelease techniques rather than touch so clients will feel self empowered.

We often hold the clients wrist pulse. This is a very sensitive process.

It places the therapist in contact with the very soul of the client and the client feels equally touched, known and connected.

NT: Do you think that the real value of body work is in diagnosis, in treatment, or in both?

Lisa Loustaunau: The value is in both. We have already established that diagnostically the body imparts a wealth of information about our history, how primary needs were handled during developmental stages, patterns of relating, challenges, as well as character strengths and gifts.This is all discernible by carefully observation or sensing of the body, not only its shape, but how it moves, how energy flows, posture, where energy is blocked etc.

All these blocks affect our vitality, our emotional and physical wellbeing and our ability to love.

The same blocks that were created as an attempt to avoid pain also diminish our pleasure and our life force. Every block is essentially a NO to life.

For me the goal of treatment is to support the client to reconnect with the fullness of their energy so they can walk in the world as they really are. Working through the blocks that keep us limited or stuck requires energy—at least as much as it took to create them. I believe the best way to mobilize and harness energy for this transformative process is by working with the body. Clients that have done a lot of work on themselves are often struck by the power and directness of this work. It takes more than just thought, or observation, or mindfulness to change the way we inhabit ourselves and walk in the world. Core Energetics is a very powerful process, physically, emotionally and spiritually. Dr. John Pierrakos, founder of Core Energetics, who is now deceased, always said that all our blocks and defenses were blocks to the heart.

For me the real value of body work is that it opens our hearts.

Jack Lee Rosenburg: You must have an accurate diagnosis in order to have a competent treatment plan. Both are needed.

When a clients sits and talks with us, they tend to talk about rather superficial issues, such as “he said . . or she did . . .” And they have little deep insight. If we awaken and open the body, whatever memories, thoughts, sensations, emotions, images that are most relevant to work on inevitably come to the surface. The depth of insight that becomes available along with the corrective experience of the therapist/witness 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.

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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.

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NT: Would you agree that psychotherapists tend to shy away from body work and, if so, why do you believe this is the case?

Frederic Lowen:

Jack Lee Rosenburg:

Aside from a lack of knowledge of body psychotherapy, therapists struggle with a modern society that is not supportive of the work. The values of the body are antithetical and are in opposition to the power objectives of the status quo.

Wilhelm Reich studied and wrote extensively on what he called the “emotional plague.” Subsequent to his inter-personal psychiatric work during and following his years with Freud, Reich turned his attention to understanding the sociological forces that determine collective behavior.

In my understanding, the cumulative dysfunction in individuals is reflected in the social mores, laws, and policies of society. Disconnected from the reality and grounding of their bodies and true undistorted feelings, and thereby from nature, individuals and populations are subject to any seductive or threatening force applied to their ego.

The “mind-body split,” which I contend is widespread, is the fundamental cause of a world torn asunder by the pursuit of the “ego values” of wealth, power, security and status, aka greed.

It serves the purpose (function) of the powerful and wealthy to stimulate the population’s pursuit of the “ego values.” The reason for this is simple: the pursuit of ego values is unfulfilling, thereby stimulating consumption.

These forces, and the understandable fascination we have with our ability to think, reason, build, and create, have converged to present the human race with its greatest challenge: how to employ our intellect to bring miracles to life without losing our humanity. With god-like technological powers, and an ability to accumulate “more money than god,” where is the humility to recognize we are not “masters of the universe?”

The humility is missing because it is a “body value,” not an ego value. Like vulnerability, empathy, and love, humility is just another talking point for the ego. In reality the body values are unfelt and in-operative in the pursuit of wealth, power, security and image projection.

The lack of body work in therapy is just one of myriad ways the modern status quo maintains its control and restrictions on our imaginations, creativity, and life. Modern psychiatry is an extreme example of how a profession has betrayed its patients’ interests in favor of the pharmaceutical and financial companies.

The psychiatrist knows precisely which drugs to match to which symptoms while minimizing legal liability, regardless of “sideeffects” or patient history.

To introduce bodywork into therapy is to go against the entire trend of our ego-charged narcissistic culture. Yet, body work is clearly an under-utilized, effective resource for psychotherapy. As said about us Americans: we will always do the right thing, but only after trying everything else. In psychotherapy, body work is the right thing.

Although bodywork is becoming more mainstream, we agree that most therapists do shy away. This may be due to differing issues. For some it is simply because they have no experience as to the profound results and have not developed techniques. Others may feel uncomfortable with the level of exposure to emotions, old traumas, intimacy and mutual attunement that arises with somatic awakening.

Still others may relate more to a purely intellectual stance and regard somatic psychotherapy as unconventional.

There is a lot more available to deal with in working with the body.

Working mind and body together makes the client more vulnerable and allows the therapist more access.

This means that the therapist must be well trained to not inadvertently take advantage of this.

Therapists may shy away from working with bodywork because they do not know how to deal with transference and how to work without being physically invasive to the client. This is a major way in which psychotherapists get into trouble. The more access therapists have, the more they must have completed their own embodied personal work. When a client is awakened and integrated somatically, they have access to a sense of truth. They are more aware of the therapist’s authenticity. This may be intimidating to the therapist. This is especially true if the therapist is not grounded in a positive foundation for a sense of self, wellbeing and constancy. Without this, the client is emotionally and energetically left alone. Empathetic attunement and boundaries become limited.

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Every body needs some body

NT: Would you agree that psychotherapists tend to shy away from body work and, if so, why do you believe this is the case?

NT: Are there body work ideas or practices that you might recommend for psychotherapists to incorporate into their own work?

Lisa Loustaunau:

Lisa Loustaunau:

Most mainstream psychotherapy has reflected the cultural split between mind and body where the body has been considered secondary to the mind—the primary object of interest and the territory to be examined in sessions.

Reich’s visionary work with the body and energy were discounted for decades in the aftermath of his political and legal imbroglios. I remember learning about Reich’s theories as a psychology student when they were only briefly mentioned and somewhat disparagingly at that. Even now I sometimes hear from practitioner trainees concurrently enrolled in graduate programs that very little if any consideration is given to Reich’s contributions. The body is still not considered or it is underconsidered in mainstream psych programs. Training in body psychotherapy remains the purview of specialized institutes in very few locations around the world which train therapists to work with the body.

Add to this double whammy of cultural touch-a-phobia and the extraordinary litigiousness of our society, in the US at least, and it’s no wonder that psychotherapists are going to shy away from working with the body. Psychotherapists trained in traditional settings here are told to, under no circumstances, touch a client or they may face a potential lawsuit.

So essentially body psychotherapy is still considered an unconventional or “alternative” therapy, one that fortunately is gaining in leaps and bounds thanks in part to the work that has emerged from the field of neurobiology in the past 10—15 years (with its funding) substantiating so much of what body psychotherapists have known and been doing for years. Every day more therapists are becoming curious about how we work and are paying more attention to the body in their sessions, even if in limited ways. Reich must be smiling (at least about this).

I would suggest experimenting with two things.

First, hold an intention to shift more of your focus to the clients body throughout the session. Hold a space of curiosity and open yourself to take in as much as you can. Notice what stands out, being careful not to label what you see. A big mistake I hear therapists make is to say things like “I sense sadness in your chest.” Do not interpret or put any experience or feeling onto the client. For example, if you notice your client is barely filling their chest with breath, you can ask if they notice what is happening in their chest. Have them describe what they are noticing physically. A client might say “my chest is barely moving, I don’t seem to be breathing, I feel a weight on my chest.” Ask the client to just keep doing exactly what they are doing, without changing anything, to just stay with themselves and notice what it is like for them when they... (fill in whatever they are doing).

After a while, ask again what they are aware of.

Keep inviting the client into a deeper awareness of their body. Whatever information is offered you can be explored. This is a simple body intervention that does not require that you be specifically trained in body psychotherapy and supports the growth of a client's perception of their energy and embodiment.

The second recommendation is that in session the therapist pay particular attention to their body.

Be curious about any tension in your body and its location. How is your energy being affected by the client? What parts of your body do you feel particularly connected to? More importantly, what areas are you NOT feeling? As a supervisor I notice how most therapists are terrified of feeling their pelvis in session. They cut off their vitality and block their energy for fear of having sexual feelings. Therapists need all of their energy in the session and to trust their containment. If we are cutting off our body we are not fully showing up for our clients. It’s wonderful material to take to supervision.

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Every body needs some body

Frederic Lowen:

Jack Lee Rosenburg:

Are there body work ideas or practices that you might recommend for psychotherapists to incorporate into their own work?

In body-psychotherapy, the most essential step for a practitioner is to gain some understanding of the truth of their own body. Body-psychotherapy is subjective by nature, and therapists absolutely need to be able to correlate their clients’ subjective experience with their own.

If a client is restricted in their breathing, a therapist cannot evaluate the restriction, or the cause of the restriction, unless the therapist has at least some awareness of his own limitations, restrictions, and causes.

Similarly, if a therapist has low energy, and is most comfortable discussing, analyzing, and interpreting, they will be unable to see the lack of grounding in their patients, and will be unable to guide them towards better grounding and connection.

So the first step is to gain body self-awareness.

This is best done either in a group workshop setting where direct body work is the focus, or spending some therapy time with an experienced body-psychotherapist.

Many years ago I asked Dad what he thought the essential qualities of a good psychotherapist are. He replied: you need to know a lot, you need to know a lot about yourself, and humility.

1. Learn breath work to lessen stress and to change balance between the sympathetic and parasympathetic nervous systems. This can bring about a sense of well being in the body as a foundation for therapy.

2. Learn to work with somatic boundary exercises with clients rather than talk about them. The exercises can inform clients of unconscious selfboundaries and support authentic boundaries with others.

3. Develop good mental health practices that can be taught to clients. Create a positive personal supportive family home life. Know your own sexuality so your longings are not acted out with clients. Make sure that you are awakened to limbic energy within so that you can attune with another and retain boundaries.

4. Learn the Sustaining Constancy Series exercises for your own wellbeing. Then you can teach the series to clients. Learn to provide homework for clients so that the therapeutic process continues from session to session. (Download Sustaining Constancy Series handouts online at: http://www. newtherapist.com/Resources/SCSHANDOUT.pdf) 5. Teach your clients to use a journal to track their wellbeing. The IBP Steps Out of Fragmentation, Use of a journal and the emptying out exercise will help.

6. For those already working with the body, the use of the ball and strap for opening fixed muscular patterns of the pelvis for grounding, constancy and empowerment, is very effective. This system of breath and movement, combined with weighted balls, does not require touching and can be done at home as an ongoing practice.

Further reading Lowen, A., Lowen L. and Skalecki, W. (2003) The Way to Vibrant Health: A Manual of Bioenergetic Exercises.

Bioenergetics Press. http://www.lowenfoundation.org

Would you like to run workshops with new mothers/parents?

If you are a mental health professional with an interest in providing pre-structured workshops to new parents and caregivers. you are invited to apply to become a licensed Babies in Mind practitioner.

Jenny Perkel, clinical psychologist and Email: jenny@perkel.co.za

author of Babies in Mind, has designed a series of workshops that aim to optimize the mental health—both present and future—of infants, as well as to improve the psychological wellbeing of their parents.

Babies in Mind practitioners are licensed to run the series of 10 Babies in Mind workshops with mothers, fathers or caregivers. The license

includes a training manual that contains the guidelines, layout and content of all 10 workshops, together with additional reading material for participants. This manual, together with the book, Babies in Mind, serves as the basis for the workshops.

For more information contact Jenny Perkel at: Tel: +27 (0)21 461 9153 Web: www.babiesinmind.co.za

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Minding the body

Minding the body Feelings and sensations— what they offer us

By Trish Bartley

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New Therapist September/October 2012

Features ‘The tragedy for too many of us is not that our lives are too short but that we take so long before we start to live them.’

-Williams et al., 2007

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on Kabat-Zinn, who developed Mindfulness-Based Stress Reduction (Kabat-Zinn, 1990) often quotes James Joyce, who famously wrote about Mr. Duffy…. who “lived a short distance from his body”. This seems to be true of most of us!

We live and breathe in these bodies. One day this body will die and the ‘I’, as we know it, will cease. And yet what Jon KabatZinn is pointing towards is the fact that we are so rarely present in this body. There are so few times each day that the mind and the body come together. The body might be here, but the mind is generally off somewhere else. Most of us live most of the time in our heads— thinking. We rush from place to place—from task to task. We are so busy and as a result, we miss so much of our lives.

In this article, I will suggest some ways of coming back to the body—of recapturing more of the moments in our lives. This needs a certain commitment to practice— but we find, quite soon, that there is some tangible benefit. With a kindly and curious intention, this ‘simple’ business of coming back to the body has a steadying and balancing effect. The mind seems to calm down—and we start to slow down, and are able to appreciate things a bit more.

We will explore this ‘coming back’, with some simple short exercises. Mindfulness practice is relevant to everyone, whether dealing with the general ups and downs of normal living, or facing particular challenging circumstances. With this in mind, we will read about people facing

Minding the body

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There are so few times each day that the mind and the body come together.

The body might be here, but the mind is generally off somewhere else.

serious illness who found practices that helped them.

We will then look at the way the body offers us clues to upcoming ‘edges’, if we are sufficiently aware.

By noticing and exploring physical sensations, as they arise, we can find different ways of relating to the mind. We find that the body can function a bit like a barometer for us, pointing to upcoming emotional ‘weather’. This offers an opportunity to respond to what is arising, rather than move into our usual knee-jerk reactions.

This article is written for you as individuals first and therapists second. I see it as vital for us to practice what we teach. Any other way will not work. We need to learn to practice awareness for ourselves—before we can be skillful in guiding others to practice this for themselves. This article is written in the service of inviting you, the reader, to try out these approaches, hoping that they will be of use to you. Later, you may decide to share them with those with whom you work.

Learning To Live Again As well as offering us more choice with what we find difficult in our lives, the practice of being mindful offers us ways of learning to appreciate, feel more alive and be more present to our world. We may well find we are more creative

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when we slow down to life. We discover the capacity to be open and compassionate. In essence, we may learn to love our lives again— to find joy and contentment in the simple things.

Susan, 35, and single parent of two young children, always appeared cheerful. Even when diagnosed with incurable cancer, she moved into treatment with extraordinary courage and energy. At the end, she was told that it had been so successful that she had a good chance of cure. Almost immediately, she felt herself going to pieces. She became irritable, angry, distressed and terribly anxious.

Over the 8 weeks of her mindfulness course, she learnt about the benefit of coming back to her body. She found ways of relating to sensations of fear and panic with kindness instead of judgment. At the end of the course, she was still experiencing anxiety, but she now had tools that helped her relate to it differently. She found this changed things considerably. At the last class, she described climbing to the top of a mountain with her children, feeling such pleasure that they had made it together. It was a lovely metaphor for what they had been through.

Coming Back To The Body It seems that we only give attention to the body when we get ill or hurt ourselves—and even then, our

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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 two meditation teachers talking from being with our bodies as they 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 I teach my students’, retorts the invariably accompanied by as benefitting a wide range of younger teacher. ‘Ah’, says the judging thoughts and anxious people with all sorts of physical wise old teacher, ‘but when my pre-occupation. Our focus is more and mental health conditions. students stand, they know they are directed at getting rid of the pain Most significantly of all, it has 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 they walk, they know they are ‘…Although turning your skillful in our lives. walking’. attention towards your pain may So in order to develop this art So there we have it. Inviting you seem scary, people on our courses of being present now, let us start now to practice this for yourself, if often say that it’s a tremendous with something straightforward. 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

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However, most of us are a long way from being with our bodies as they are. We seem fixated on changing them for the better. We want to keep looking young, so we buy creams and potions to slow down ageing. We go on endless diets. We even consider cosmetic surgery—all in the interests of improving the appearance of the body. How might it be to practice being present with the body just as it is, in this moment? What might that offer?

Interestingly, there is ongoing research looking into the effects of mindfulness on cellular ageing and much else. Mindfulness-based Cognitive Therapy has been shown to halve the risk of relapse in those who have had three of more episodes of depression (Segal et al.,

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Feet on the floor practice 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 placing your attention down to your feet, and exploring sensations of contact in your toes, as if this was the first time that you have ever felt your toes in contact with the floor... then after a while, moving to the soles of the feet...and then your heels... feeling your feet held by the solidity of the floor beneath you... staying with this and exploring these sensations for a moment.

Then, if you would like to, moving your attention to the contact of your body with the chair... maybe feeling your sit bones connecting with the seat of the chair… noticing how this feels to you… not thinking about it, but just sensing it directly as best you can.

Finally, bringing awareness to the weight of you going down onto the floor through your feet, and through your buttocks onto the chair– held and supported by the ground beneath you. Perhaps asking yourself, ‘What am I aware of right now’?

New Therapist September/October 2012

Features In this simple practice, we are deliberately becoming curious about the sensations of contact. Over time, we find that coming back to the body with curiosity, as if for the first time (every time), we slow down. What is happening here?

Most of the time, the mind and body almost seem to function independently. The body might be sitting without any particularly noticeable sensations—however the mind is off planning dinner, or thinking about what someone said to us yesterday, or just vaguely spacing out.

Once we start becoming more aware of our present physical experience, we discover that we are often on ‘automatic’. We might be eating a meal, whilst vaguely planning something for tomorrow—or driving the car, but not really aware of the countryside we are passing. Whilst this is quite normal, it also lays us open to potential problems. For when the mind is ‘free-floating’, we are at the mercy of habits of mind that have built up over a lifetime. We are then more likely to be influenced by personal history or past trauma.

Like background traffic noise that we screen out and are barely aware of, these patterns of mind influence our actions, affecting the mood. Being on ‘automatic’ may be normal, but it limits our choices.

We tend to react to what happens in predictable ways, invariably adding 'extra' to the event, with an overlay of negative or critical thoughts. This tends to keep us stuck in grooves of difficulty that echo back to the past, and resonate forward into the future.

Jennifer, an experienced mindfulness teacher was leading a large graduate class of people who had all attended 8-week mindfulness-based courses.

In the room was a woman who was obviously going through treatment for

Minding the body cancer. Jennifer made the point that for some people—in the moment—the appearance of a damp patch on the wall might be worse than having cancer. Some of the group looked shocked and turned to look at the woman with cancer to see how she was reacting. She nodded her head and, laughing, volunteered the comment that she had a particularly house-proud friend, for whom noticing a damp patch would be a major drama!

When we practice being present with our experience, we uncover qualities of compassion and kindness both for ourselves and others. This is not separate from the practice of being present. It is integral to it. Recent research showed increases in self-compassion to be one of the key ways that Mindfulness-Based Cognitive Therapy for Depression has its beneficial effects (Kuyken, 2010)

The point that the teacher was making was not that having cancer is a breeze, but that we all have the capacity—in the moment—to react way out of proportion to an event if certain personal patterns are triggered. By learning to regularly ‘come back’ to the body and the breath, we can start to wake up out of automatic, notice the reactive patterns as they arise and regain the opportunity to be more present to our experience.

Coming to the Breath

Anne had a teenage son, Alan, who had a rare and incurable illness. She nursed him at home whenever possible.

This put a huge strain on her and her family, and Anne knew that she was close to breaking point.

She was referred to a mindfulness course and met Jane, a mindfulness teacher. Neither of them felt that this was a good time for Anne to attend the course, as she was so troubled.

So they decided that Anne would go and practice ‘Feet on the Floor’ for a few weeks, to see how she got on.

Anne returned saying the practice had definitely helped and she was keen to learn more.

Later, on the course, she was given a little thread bracelet with a red bead on it as an aide to help her remember to ‘come back’. Anne’s group was told of rural South African mothers caring for their young with Aids, who were also wearing these threads. Anne was heard to comment ‘I don’t feel so alone’. (www.thoughtonathread.co.uk)

This is another practice which is important in signposting us back into the body. It offers us an anchor to come back to—and a way of exploring detailed sensations, deep in the body.

Coming to the breath practice 1. ‘ Feeling your feet on the floor—weight going down— and noticing your spine rising out of the pelvis up through the back—height going up’.

2. ‘Then becoming aware of the fact that you are breathing...

Letting the breath breathe itself—not interfering with it in any way... Simply feeling the sensations of the breath, deep in the body… as it breathes in and breathes out.’

3. ‘If at any point, you notice that your mind has wandered away from the breath... distracted by a thought or a sound, remembering that this is not a problem—it is what minds do... and as soon as you realize that you have wandered away, gently coming back to the anchor of the breath... and to the sensations of the breath breathing in and breathing out’.

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Features We can do this practice for a few moments, or a minute or two—and find ways to remember to come back to the breath during the day.

Indeed, we can create our own practices to suit us, whatever we are doing. Here are some ideas: zz Standing with my feet on the ground, pausing and noticing, and coming to the breath. zz Feeling the water on my back in the shower and smelling the soap. How am I right now? zz Getting into bed and deliberately feeling the bedclothes touching me zz Eating mindfully—really seeing, smelling and tasting my food. zz Going for a walk and ‘being there’ for each footfall.

We can also build in reminders and routines to help us remember to practice. Cultivating clear intention is key to this.

Turning Towards Once we have learnt to regularly come back to the body, and begun to notice when we have been on ‘automatic pilot’, we can then start to look at what happens when our ‘buttons get pressed’—or when things start to ‘amp up’ a bit.

So unpicking this a little—it is worth noting that every experience we have results in pleasant, unpleasant or neutral feelings (when things are neither pleasant nor unpleasant). What happens next is important.

We generally want to hold onto the experiences that feel pleasant.

We want more of them. We want them to last longer, or repeat again and again. Sensations in the body are likely to be ones of warmth, openness, lightness, flow and ease.

We usually pull away from things that result in unpleasant

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feelings. We try to avoid them.

We tense against them. Sensations in the body might be constricted, painful, agitated, hot and tight.

Thoughts in the mind can move towards blame, judgment, and rumination—adding a lot extra to what is already unpleasant.

Neutral feelings and experiences will usually not be noticed at all—and when they are, they turn into something else, pleasant or unpleasant.

We can readily appreciate the consequences of the ways we tend to react to unpleasant events. This is the picture of stress, distress, or worse. What is trickier is to appreciate what unfolds when we try to hold onto pleasant feelings.

Perhaps it might help to draw this out with a fairly trivial example.

I’m in my favorite coffee shop and am delighted to notice that there is carrot cake today. Ordering some, I start eating it with relish, and almost immediately think about whether to have a second piece.

In that moment of wanting more, and thinking about getting more, I am no longer enjoying the taste of the cake. In fact I may well finish the cake, without actually tasting much more than the first mouthful! The pleasant experience triggers wanting more, and soon there is just ‘wanting’, which is not pleasant. Eating is an obvious example, but there are many others that bombard us every day. We may discover that ‘wanting’ is as much, or more, of a problem to us than ‘not wanting’.

A short practice called ‘The Physical Barometer’ (Bartley, 2012) allows us to become aware of these feelings that can, in extreme, move into obsessive craving or strong aversion.

If you have ever seen someone consulting a old fashioned barometer, you will know that you need to gently tap on the glass

front to see if the needle moves up or down and by how much. From this, it may be possible to forecast upcoming weather. We can use our bodies in a similar way to give us sensitive information about the emotional ‘weather’ arising for us.

Here is how you do this:

The physical barometer 1. Determine some part of the body—preferably in the trunk—such as the chest area or the abdomen or somewhere between the two—that for you is especially sensitive to stress and difficulty. Place your hand there.

2. Once you have found the place, it can become your ‘physical barometer’. Tuning into it regularly, you may notice different sensations at different times. When you are under pressure, feeling anxious, or frustrated, you may notice sensations of tension, tightness, shakiness, or discomfort. The intensity of these sensations varies, depending on the level of your difficulty.

3. As you get used to practicing this, you can become aware of quite subtle sensations that may signal that something is brewing for you, long before you are consciously aware of this. Being curious about these sensations moment by moment, without attempting to change them, means you can respond to what is arising quite differently— perhaps with more choice and kindness.

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If this practice interests you, you might want to try it several times a day, as a way of developing the habit of tuning into the body. It helps to hook the practice onto an existing activity—such as boiling the kettle, or starting the car—in order to remember it better.

The Physical Barometer enables us to catch things early, before the ‘weather’ has really dug in. The practice also helps us to notice and appreciate all those pleasant little moments that are so easily overlooked in our busyness.

By practicing in this way, feelings and sensations in the body become allies in helping us relate more gently to the reactivity of the mind. In time, we become more able to respond more skillfully to the ups and downs in life. We discover we have choices and this can offer us some wonderful moments of freedom and wellbeing.

discover for ourselves a rich vein of present experience that simply asks us to be here—and in that moment allows us to open and be more kind to ourselves and the world.

In Conclusion Mary Oliver offers us wise advice in her poem ‘The Summer Day’: ‘let the animal of your body love what it loves’. (Oliver, 1992) In our brief exploration of being present to the connection between body and mind, we have been discovering how to move closer to the body and how helpfully the mind responds when we do.

Although it requires a certain effort, it is not so difficult. Simple practices such as ‘Feet on the Floor’ and ‘Coming to the Breath’ invite us to come back to the present. The body offers us a way of doing that – for it changes less quickly than the mind.

The body resonates with feelings in parallel with the nuances of the mind—whether these are pleasant or unpleasant. Investigating this for ourselves, we find a potential to interrupt the triggers that bind us.

With diligence and practice, we can

‘The present is the only time any of us have to be alive, to learn, to heal – indeed, to love’.

-Kabat-Zinn, 1990 With my thanks to Jody Mardula from the Centre for Mindfulness, Research and Practice, Bangor University, Wales.

References Bartley, T. (2012). Mindfulness-Based Cognitive Therapy for Cancer: Gently Turning Towards. Oxford: Wiley Blackwell Burch, V., (2008). Living Well with Pain and Illness: The mindful way to free yourself from suffering. London: Piatkus Kabat-Zinn, J., (1990) Full Catastrophe Living: Using the Wisdom of your Body and Mind to Face Stress, Pain and Illness. New York: Delta Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, et al. (2010) How does mindfulness-based Cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105-1112 Oliver, M. (1992). New and Selected Poems. Boston: Beacon Press.

Segal, Z.V., Williams, J.M.G., Teasdale, J.D., (2002) Mindfulness-Based Cognitive Therapy for Depression: A new approach to preventing relapse. New York: Guilford Press.

Williams, J.M.G., Teasdale, J.D., Segal, Z.V., & Kabat-Zinn, J., (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York: Guilford Press.

Williams, M., and Penman, D., (2011) Mindfulness: a practical guide to finding peace in a frantic world. London: Piatkus.

Trish Bartley has been teaching mindfulness and leading mindfulness-based training for over 12 years. She has considerable experience in introducing mindfulness to the general public and is also involved in training health professionals to teach mindfulness-based approaches. She has a background in development and has led training processes in South Africa since 1997. She now specializes in working with people with cancer and other life-threatening diseases. She has developed an intervention known as Mindfulness-Based Cognitive Therapy for Cancer, based on the “classical”, 8-week mindfulness course that has been clinically tried and tested with people with cancer over more than 10 years.

She works mostly in the UK and leads workshops and retreats internationally. Trish is the author of Holding Up the Sky: Love Power and Learning in the Development of a Community (2003) and of Mindfulness Based Cognitive Therapy for Cancer: Gently Turning Towards (2012).

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From the therapist's chair

Lost and found The evolution and eventual reversal of borderline dynamics as demonstrated in one patient’s life narrative

By Robert Waska

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New Therapist July/August 2012

From the therapist's chair Abstract

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ontinuing the ongoing story of a long term patient in psychoanalytic treatment, the author highlights points in this patient’s development where the borderline or paranoidschizoid experience seemed to have solidified. At the same time, there were critical moments of internalization and identification that either helped to balance the more persecutory perspective or added an element of idealization. In illustrating these points, the author shows how the Kleinian approach considers the ongoing relationship between external and internal and how the intra-psychic elements of attachment and phantasy are shaped by projective identification processes. The point of this ongoing column is to highlight the therapeutic nature of allowing the patient to tell his story and to have an unique chance to hear from the patient their own view of their life, the evolution of their pathology, and the way external life imprints upon internal life just as internal phantasy shapes the experience of external life.

We left off with the patient living in Africa. He was about nine years old and feeling a volatile mix of feelings about himself, his family, and the world around him.John’s family moved to Africa in the middle of a local civil war. The nation was divided and the government’s military was killing the opposing tribe. Therefore, there were armed gunman at checkpoints on the street, tanks rolling down the block, and an occasional killing in the neighborhood. It is interesting that from ages six to ten, John lived in the very bleak, dangerous, and difficult political climates of Rumania and Africa but never much reacted to them as such. One could say he was just being blind, as kids often are, but it was more that his internal struggles were so strong, and easily matched the ominous and strange nature of his outside environment, that he in fact remembered these experiences as often being interesting and exciting. Indeed, John found Nigeria to be the best place he had lived up to then. He loved exploring the area on his bicycle, hiking in the nearby jungle, and essentially playing spy or explorer in an unknown land.

One example of John’s inner struggles involved a memory of a Boy Scout meeting in which the Scouts were being instructed on how to tell the height of a tree by the length of its shadow. John said he had absolutely no idea what the instructor meant and was mystified by the whole discussion. He said, “I felt scared, stupid, and very anxious. So, I thought I should just act like I understood because it felt like it would be worse to admit my ignorance. Part of it was me not understanding the math concept. But, most of it was about me feeling alienated, strange, and nervous around these other people and desperately trying to blend in. It was this terrible sense of over there is them and over here is me. We are so separate and different. I wanted to escape but I had to stay and pretend.”

Here, we see the phantasy of possible persecution or punishment for not knowing and needing help overshadowing the less intense reality of simply not getting the math problem and needing to ask for help. This type of severe anxiety and internal conflict can create learning difficulties for some individuals, as well as relational problems, as it did for John. In other words, troubles in the internal world can block any external growth and, for borderline patients, the external world often looks identical to the internal world without any hint of as-if quality.

On the other hand, John felt more positive and enjoyed things in ways he hadn’t before. Building model airplanes became a passion and he dabbled in developing a small neighborhood newspaper made with a toy printing kit. He loved swimming at the local country club where he bought British comic books whenever he could, ate fries with vinegar in the English tradition, and spent his allowance on strange candies from a local vendor. John said, “I loved the Smarties, the English equivalent of M&Ms, but much bigger. I loved the roll of Trebor Mints, the strongest mint you ever tasted!” All this made him feel happy and excited. However there were elements of rebellion and protest that creep in as well. John also began experimenting with smoking cigarettes, readily available to anyone at the roadside stands.

Despite some more positive experiences while living in Africa, John continued to feel like a stranger in a strange land. He didn’t have any friends to speak of, although he did spend time with one boy in the neighborhood. They played with toy soldiers and rode bikes.

In general, however, John felt apart. He was beaten up several times at school and started to feel different than the other kids. He said, “I felt like they were the enemy, so I kept my distance.”

When John looks back on his

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From the therapist's chair When bad objects or ambivalent objects are internalized, the ego will attack itself. Depression, self mutilation, and suicide are some of the results in patients who seek revenge upon their internal objects with whom they have identified.

parents during this and other times, he feels they were not very involved with his emotional life, but certainly made sure he had all his material needs met. He told me, “My mother said my father felt so guilty about dragging me around the world that he would buy me anything I asked for. As a child, I had the feeling that when I tried to express myself honestly, my parents would either make fun of me in telling me I was cute, dismiss me, or just plain not understand me.”

John expressed this experience of neglect with various angry and desperate reactions. Just like he did in Jamaica, he would destroy his favorite toys. Since the toys had come from his parents, it was a way to lash out at them but also punish himself. When bad objects or ambivalent objects are internalized, the ego will attack itself. Depression, self mutilation, and suicide are some of the results in patients who seek revenge upon their internal objects with whom they have identified.

John ran away for much of one day, after leaving a letter outlining his grievances. When he came back at the end of the day, “my parents thought it was cute and teased me”.

John said, “I was showing them my feelings through my actions, but they didn’t get the message.”

It was during his time in Africa that John developed an interest in music. This started with him listening to some of his parent’s records. But, he also found other

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records and seemed to cultivate a real hodgepodge of tastes that reflected the mixed and complicated feelings he had. So, John enjoyed the hipster sound of Bobby Darin, the basic rock and roll of the Beatles, the childish fun of Snoppy and the Red Baron, the late sixties craze of short lived bands like Paul Revere and the Raiders and the Monkees, and darker songs by bands singing about the Vietnam war and the massacres America was responsible for. Fifth and sixth grade was a time when all these angry, fun-loving, immature, and sophisticated feelings began to fuse together.

One of the most idyllic memories John has of his time in Africa was a safari trip the family took one year. They traveled to Kenya and began a two week loop that took them through several enormous game reserves, across plains, and up Mount Kilimanjaro. They would spend the day locating and observing every type of wild animal one can image: elephants, rhinos, hippos, antelopes, cheetahs, monkeys, giraffes, birds, and alligators. They took a canoe down the Nile river, slept in a tent near Dr. Leaky’s famous excavation site, sat around a campfire listening to the nearby elephants moving about, laughed with local tribal members, bottle-fed an orphaned zebra, parked next to a pride of lions, and walked among thousands of bright flamingos feeding at a lake. For years, John fantasized about returning to Africa to become a park ranger, New Therapist July/August 2012

defending the animals from poachers and helping the underprivileged people. He said, “Mostly, I picture helping the animals. That is more comfortable than dealing with people.” The idea of protecting and saving the endangered seemed to be a way of reaching out to help in the way he wished someone would have done for him.

As we follow John’s narrative, over and over we find the same basic elements of loss, mistrust, idealization followed by emotional distress, and a jagged and distorted method of experiencing the world due to primitive projective identification dynamics. His reliance on splitting and projective identification left John feeling the world was populated by evil poachers and helpless baby animals, both camouflaged images of disturbed and disturbing aspects of himself and his internalized objects.

Grinberg (1968) notes how borderline and other primitive patients are prone to acting out in search of, and in reaction to, the perceived lack of a containing object that can sustain their separation anxiety, grief, guilt, and loss. I would add that this acting out is not just part of a searching out for the lost object but an angry retribution and revenge as well, for the perceived abandonment and betrayal. So, the containing object, the ideal good object, even if found, is never enough and always at fault. This creates a persecutory cycle of paranoid phantasies and unbearable guilt in which the lost object is now purposely neglectful and absent and the patient is always hungry and always has blood on their hands. This brings back the most fundamental and terrible infantile state of mind, of when absence was intolerable and the missing object was no longer a good object temporarily absent, but a persecutory non-object cruelly missing and permanently gone, yet forever haunting the empty, hungry, and

From the therapist's chair desperate child’s mind and heart.

The search for, and the disappointment in, the needed and desired object of nourishment created more and more anger, despair, and acting out as John was in his teens and older. In his younger years, most of these painful dynamics were internal but later in his life they became more external as well.

Steiner (1992) and other Kleinians have noted the early, more immature stage of the depressive position in which the patient has great difficulty tolerating and accepting the loss of the needed object. This was certainly the case with John. In order to cope, he relied on splitting, denial, manic defenses, or narcissistic (Rosenfeld 198) and pathological organizations (Steiner 1990) that defended him against paranoid collapse. However, these were very fragile psychological retreats (Steiner 1993) that easily broke down into more borderline states of mind with persecutory and primitive depressive conflicts taking over. This is similar to Quinodoz’s (1996) concept of untamed solitude as well as Palacio Espasa’s (2002) idea of the more para-psychotic and para-depressive phantasies of catastrophic, irreparable, and lifedeadening or life-draining states of loss. Only when the patient is able and willing to face, tolerate and integrate the actual and/or imagined betrayal, traumatic loss, and perceived rejection, can they move towards the more mature stage of the depressive position where forgiveness, hope, and a livable future exist.

Grinberg (1977) has described how many borderline patients have experienced, either in phantasy and/ or with actual external caregivers, traumatic separation and loss.

This has usually been based in the infantile experience of a mother who has not been able or willing to receive, contain, or modify the infant’s unorganized inner conflicts.

This idea of Grinberg’s, based on Bion’s container concept (Bion 1962), has been elaborated upon by other Kleinians and examined as a fundamental psychic state of mind in which the infant feels helpless in the face of loss, abandonment, or rejection by the object, leaving the infant in a blank emotional void and an internal sense of meaninglessness.

This Kleinian description of the complex dynamics that can evolve and rule a person’s psychology seems to fit with the conscious and unconscious experiences John relayed to me over and over again.

One of the ways the infantile ego copes with this difficult psychological situation is the internalization of a harsh and rejecting object and an identification with that object. This results in a turning of the despair, demand, and anger towards the self and the formation of a primitive and sadistic superego state. Grinberg (1964) describes how the primitive and sadistic superego attacks any growth and learning as well as creating a state of unbearable persecutory guilt and consequent acting out (Grinberg 1968).

So, it was very difficult for John to seek and find knowledge about the world, himself, or others that was different than the flawed state of mind he held in which separation, suffocation, control, loss, betrayal, rage and severe guilt all ruled the land.

Understanding of Borderline Disorders, in Borderline Personality Disorders: The Concept, the Syndrome, the Patient, edited by Peter Hartocollis, IUP, New York, Pg. 123-141 Palacio Espasa, F (2002). Considerations on Depressive Conflict and its Different Levels of Intensity: Implications for Technique.

International Journal of Psycho-Analysis 83: (4) 825-836 Quinodoz, J (1996). The Sense of Solitude in the Psychoanalytic Encounter.

International Journal of Psycho-Analysis 77: 481-496 Rosenfeld, H (1987). Impasse and Interpretation: Therapeutic and antitherapeutic factors in the psychoanalytic treatment of psychotic, borderline, and neurotic patients. New Library of Psychoanalysis Vol 1 318 pages London: Tavistock Steiner, J (1990). Pathological Organizations as Obstacles to Mourning: The Role of Unbearable Guilt. International Journal of Psychoanalysis, 71:87-94 Steiner, J (1992). The Equilibrium Between the Paranoid-Schizoid and the Depressive Positions. In: Clinical Lectures on Klein and Bion, New Library of Psychoanalysis 14: 46-58 Steiner, J. (1993) Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Borderline Patients, Routledge

References Bion, W (1962) Learning from Experience, Basic Books, New York Grinberg, L (1964), Two Kinds of Guilt—their Relations with Normal and Pathological Aspects of Mourning, International Journal of Psychoanalysis, 45:366-371 Grinberg, L (1968). On Acting out and its Role in the Psychoanalytic Process.

International Journal of Psycho-Analysis 49: 171-178 Grinberg, L (1977) An Approach to the

Robert Waska MFT, PhD is a 1999 graduate of the Institute for Psychoanalytic Studies, an International Psychoanalytical Association affiliate organization.He conducts a fulltime private psychoanalytic practice for individuals and couples in San Francisco and Marin County, California.

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Book reviews

The first

Keynote speakers

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: www.luthandoclinic.co.za or contact Ethelwyn Rebelo on: Email: ethelwyn@live.co.za

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Tel: 011 933 8834 New Therapist September/October 2012

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