Personally Professional Reflections of a Somatic Psychotherapist

Personally Professional Reflections of a Somatic Psychotherapist
Published in PSYCHOTHERAPY IN AUSTRALIA . VOL 8 NO2 FEBRUARY 2002

Somatic Psychotherapy has evolved from one of its early incarnations in Australia as ‘Biodynamic’ therapy, to a wide range of therapeutic styles that utilize bodily states in relationship. ALISON BALL, there at the beginning, recounts some of the developments she has seen, and concludes that this earlier training experience has led her to reject the psychoanalytic principle that frustration of the patient is the way forward for all patients.

It is now seventeen years since I began training in Somatic Psychotherapy. At that time, the name `Somatic Psychotherapist’ had not been invented and instead, we called ourselves
`Bio-dynamic Therapists’. Our teachers had been trained by Gerda Boyesen at the Boyesen Institute for Biodynamic Psychology in London. Such a name did at times lead to a lot of confusion along the lines of whether or not we grew potatoes! The grounds for confusion were extended further as we learnt to talk about Reich’s ‘character-analytic vegetotherapy’, in reference to therapeutic work that embraced both the psychic and the somatic apparatus.

The therapeutic approach developed by Gerda Boysen was termed `biodynamic psychology’ because it incorporated the individual’s `life energy’. This was based on the belief that the individual is comprised of more than just `character’ or `personality’ and that the many and unique ways in which we hold our bodies, and allow the energy to move in our bodies, determines, and is determined, by our character or personality. That mind and body are a duality. You cannot work with one without the other.

As I thumb back through books and material from my training, Clover Southwell (1982, p. 41)) helps me with her definition of biodynamic psychology:

I came to training in somatic psychotherapy by way of my early experiences as a `mature age’ graduate of social work, working in a marriage, individual and family counselling agency. Perhaps I was led there by what I noticed was happening with my own `life energy’. While I found the work fascinating, I felt frustrated and knew that I needed more skills to work with some clients. I had a very strong bodily feeling that I was stuck in my chair and, having learnt some of a T.A./ Gestalt approach, I found myself with the desire to physically move out of my chair to work more actively. Then a colleague did a short massage course that helped her to feel freer in her work and I thought `This is for me!’ … (when I was brave enough!) It took me another four years to even make enquiries and when I did I found out about the first three year training in somatic psychotherapy to be offered in Melbourne.

At the interview I remember talking about a strong bodily sense of being stuck in a cot, of not being able to get out and feeling too afraid to do anything. Whether this was an actual bodily memory or metaphoric, I have never discovered, but I do know that fear ruled my life as a child and I have conscious memories of being so fearful that I could hardly move. As a five-year-old I attended a paediatrician for years because I stumbled when I walked. Then, as an eight-year old, I developed Rheumatic Fever and again I could not move one foot in front of the other.

So began my involvement in the training offered in Melbourne, (a concurrent training was running in Sydney). After those three years the trainers and my peers formed the Australian Association of Somatic Psychotherapists. There have been many training courses since that time, some which have been conducted privately by some of our members.

Over the years the training of somatic psychotherapists has developed considerably and now incorporates more theory and psychoanalytic thinking; primarily object relations, self-psychology and inter-subjectivity. Amongst our members and associates there is a wide and individual variation in the ways we have developed our clinical practices, but our most essential and common identity is that of `psychotherapist’. We all have, from our training and experience, varying degrees of knowledge about the body and bodywork and this forms the basis and background for how we work. The theories and practices regarding the body and ways of working directly with it came mostly through Wilhelm Reich, Gerda Boyesen, Alexander Lowen, Stanley Keleman and David Boadella. We have learned to bring that body knowledge into the transference/ countertransference relationship. Some in our association already had a prior background in social work, psychology, psychiatry, nursing, natural therapies, Radix, Alexander technique or massage.

Touch for therapeutic purposes can be a legitimate part of the practice of members of our Association, and so our ethical code recognizes this and holds our members to account. For some, actual hands-on work with the body through touch, holding, or more formal ways is incorporated into the work, but others choose never to work hands-on. The great thing about having such a provision in our Code of Ethics is that it means touch and touching can be spoken about openly. It seems to me, after years of practise, that the prime danger in using touch as a legitimate therapeutic tool comes about when the fact of doing so cannot be spoken about; not only with the client but in supervision or between colleagues. Work with touch however, remains the most controversial aspect of the ways in which a somatic psychotherapist might work, even amongst members of our association.

In the training we were taught `body reading’ with a focus on the different ways in which character manifests in the body or, as Reich called it, the `body armour’. Much of this came from the work of Wilhelm Reich and Alexander Lowen, a student and analysand of Reich’s between 1940 to 1952. Lowen explains `armouring’ as referring to `… the total pattern of chronic muscular tensions in the body. They are defined as an armour because they serve to protect an individual against painful and threatening emotional experiences. They shield him from dangerous impulses within his own personality as well as from attacks by others’. (1983: p.13)

We learnt about `character types’ such as `masochistic’, ,rigid’, `schizoid’, `psychopathic’ and `oral,’ and the ways in which we `embody’ these. We became absorbed in the many ways in which an individual could regulate their anxieties and needs and how this would be expressed in the body through chronic muscular holding, temperature, fluid in the tissues and the breath.

The belief in this work and the purpose of it was based on Reich’s idea that working directly on the body itself gave direct access to the unconscious. Reich believed that when therapy was based solely on verbal interpretation many clients could completely avoid making progress or would be dismissed as `unanalysable’. He also believed that the main purpose of therapy was to unleash the libido but this idea was never really taken on by the proponents of somatic psychotherapy in Australia. In the early trainings we were taught various ways of working directly on this character and muscular armouring at both a physical and emotional level. We learned Gerda Boyesen’s Biodynamic massage, Lowen’s Bioenergetic exercises and a technique called Vegetotherapy. Reich used the term `vegetative’ to describe the intricacies of the autonomic nervous system responses of the body. Reich probably worked mostly with massage while our vegetotherapy, was more gentle and respecting of the client. Individuals could become more aware of, or less frightened and dismissive of, their bodily sensations and breath patterns.

The massage encompassed a range of approaches and could be used to `harmonise’ and `contain’ the energy of an individual who is in a `provoked’ state or, at the other extreme, help an individual whose body is so armoured they are unable to feel what is going on inside. Gerda Boysen’s teacher, Ola Raknes, had observed that when people are being massaged, chronic holding in their muscles and tissues begins to be released and an increase in peristalitic activity can be observed, so we learned to use a stethoscope to listen to the peristaltic changes. Peristalsis, Boyesen believed was not only about digestion of food, but also about emotional `digestion’.

`Bioenergetic exercises’ were designed to place stress on the chronic muscular holding in the body. For example, if you lean back over a chair enormous stress comes to bear on any muscular holding in the diaphragm, and allows release of the breath with accompanying `discharge’ of tension. Care needed to be taken that the individual worked within the techniques that were `right’ for their character type. Stress exercises were great for individuals who had `rigid’ character types, but were not so effective on other `types’.In vegetotherapy, the client is encouraged to lie down and simply tune into their bodily sensations and tensions. The therapist sits nearby, only touching by request.

The client is encouraged to follow or perhaps exaggerate a sense or feeling; say, the knot in their gut, the agitation in a leg or foot. Or they may ask for their hand held or to have a hand support their neck.They might decide to make the agitated leg movement bigger and this may develop into a sense of needing to kick or to stomp. They might choose to follow an urge to speak, to shout, to scream, or they may cry very deeply. Sometimes the client might simply choose to enjoy the sensation of just being tuned into their body, or to talk quietly about what was in their mind or what they had become aware of.

Our understanding was that the body holds a `cellular’ memory from which we can learn about past experiences if we are prepared to take notice of present aches, pains, or tensions in various parts of the body. The aches and tensions in the body are, like symptoms, necessary way-stations on the road to being able to deal with life experiences at a psychic and emotional level. We are not forced to act something out at the somatic level if we can deal with it at a psychic level. Permission for the client to follow their body was preeminent and was based on a belief that the body could be trusted to lead them where they needed to go. We talked about `working close to the ego’, never forcing a client into experiences that they would be unable to integrate. Experience in the moment was what was valued, believing that this would lead people to trust and value themselves. They would develop a stronger sense of self and of their presence in the world.

Most of us who have been through this training have developed a rather taken-for-granted understanding of the body. We perhaps now employ it without conscious awareness in an almost automatic `reading’ of the character `type’ of a new client; in easily tuning into how a client is breathing, where and when the breath is held, the tension in particular parts of the body, whether the person is `present’ in their eyes, the smile that seems a little out of sync with what is being said, the held back tears, or the way a person sits in the chair. Over the years of working with clients this sort of understanding forms a background to the work. But by itself it is not the work and such knowledge can also be used in ways that are not helpful.

Much of this `body knowledge’ is a superficial, mechanistic knowledge that can de-humanise or be used judgmentally. Furthermore, the techniques we learned for working directly are simply that – techniques. Today I almost never employ any of those techniques when I am working with a cl ient. Not that I do not see them as valuable, but I simply do not want to use formal techniques. Some colleagues do to very good effect and I sometimes refer clients for bio-dynamic massage if it can be integrated into their therapy. In psychoanalytic terms this could be seen as a splitting of the transference and that may be so. However, the usefulness of massage can outweigh any disadvantages, with the prime requirement being that the meaning of this outside intervention can be thought about with the client.

Many clients come to a Somatic Psychotherapist with bodily symptoms because they assume that we are psychosomatic therapists and that we treat psychosomatic symptoms. Of course that happens and often symptoms are mitigated with the work, however that can be true for all psychotherapists and counsellors. When people are listened to and heard they often find great relief, both physically and emotionally. But symptoms are just that – symptoms. Although we may have the tools to bring about some physical relief we, like other psychotherapists, work within the therapeutic relationship to bring about lasting change at an intrapsychic and intersubjective level.

Recently 1 was asked to speak on a panel about the physical aspects of bulimia. I had to think whether I knew anything at all about bulimia, and then I realized that I have at least three clients who had now, or have had in the past, symptoms of bulimia – regular vomiting or other purging, obsessive exercising and so on. However, I never think in terms of treating them for their bulimia. I am working with a person; listening to them, endeavouring to help them deal with their anxieties and make sense of the way they live their life. People need their symptoms until such time as they feel safe enough, strong enough and cohesive enough not just to survive but to really live.

In recent years, members of our Association have been developing a more coherent theory for somatic psychotherapy. A difficulty with the earlier period was that it was largely built on personal experience and personalities, though Reich built his ideas and his practise on his psychoanalytic base, and Boyesen was both a psychologist and a physiotherapist. For many attracted to somatic therapy there was a strong resistance to theory. The culture of a bodymind split meant that theory was often written off as `intellectualizing’ and it was said that words could not be found for pre-verbal experience.

This is the struggle for the psychotherapist: how can we pay attention to concrete bodily experience, connect with it to bring it to consciousness, and move forward to find meaning in symbolic expression? If we only have the concrete experience then our psyches become overloaded and we are fated to have our bodies act out our anxieties and our fears in the form of illness or other symptomatic behaviour.

In recent years somatic psychotherapists have been interested in the burgeoning research into the brain, particularly as it is affected by trauma and the ways in which the early infant-caregiver environment affects emotional development. The major response to this research amongst our members is to say ‘Hurrah, now the “evidence based” researchers are catching up with what our work has always taken for granted.’ The new research, including the work of Fonagy, Greenspan, and Schore, has helped build a more secure theory base for our work.

I recently wrote a thesis, that became a short book, on the taboo on touch that has governed psychoanalytic thinking and practise (Ball, 2000). The fact that a psychotherapist might touch patients seemed to bring quite condescending responses from many in the psychoanalytic field. These responses seemed to stem not so much from the fact of touching itself, but from an assumption that if a psychotherapist acts in a supportive, nurturing, concrete way then that will preclude work at a deeper `uncovering level’. By entering into such a supportive role the therapist is seen as somehow avoiding anger and rage, or is satisfying their own need to be liked, or their desire to be experienced as a `better’ parent than the original parent. This is certainly a danger, but the alternative might be that some patients never get the kind of therapeutic relationship that enables them to stay in therapy, or to make use of what the therapist can offer.

For most psychotherapists it is better, for themselves and their patients, to have the safety of a firm boundary that prohibits touch. If in any doubt then don’t, is a very good maxim. Psychotherapy that involves holding or touching must not be entered into lightly or without thought. Training and the individual character of the therapist are critical. Physical touch can be extremely intrusive (as can unempathic psychoanalytic interpretations) but I no longer believe that frustration of the patient based on the conflict model of psychoanalysis is the way forward for all patients. Severe deprivation and/or trauma may require that the psychotherapist first enters into a much more supportive and nurturing role. This may be accomplished with most clients through verbal work alone in a secure and empathic setting but, for others, the deprivation and the concrete bodily touch starvation can only be helped through the concrete. Yes, it is an active form of ‘re-parenting’ but it has a legitimate place in psychotherapy. We ‘re-parent’ all the time simply by providing a listening ear and a consistent space, place and time. Drawing a distinction between these `provisions of the environment’ and an active role that may involve actual touch is, I think, a false dichotomy.

REFERENCES

Ball, A. (2000) Taboo or not taboo: Physical touch in the psychoanalytic literature. Melbourne. Psychoz Publications.

Fonagy, P (2001) Attachment Theory and Psychoanalysis, New York, Other Press.

Greenspan,S.(1997) Developmentally Based Psychotherapy, Madison. International Universities Press Inc.

Reich. W. (1972) Character Analysis. New York. Touchstone.

Schore, A. N. (1994) Affect Regulation and the Origin of Self. The Neurobiology of Emotional Development,New Jersey. Lawrence Erlbaum Associates.

Southwell, C.’Biodynamic massage as a therapeutic tool – with special reference to the biodynamic concept of equilibirum’ in Journal of Biodynamic Pychology, Number 3, Winter 1982.

Lowen, A. (1983) Bioenergetics. NewYork, Penguin.