What distinguishes Body Psychotherapy from massage



Getting In Touch:The Importance of the Somatic Therapies 2019 IMHCA Pamela D. Trice, PsyD, LCPC, LMTMarch 9, 2019Course Overview: Definitions, History, Core Concepts, Importance of Touch, Clinical Applications, Collaboration Practices Definitions: Body Psychotherapy: A distinct branch of psychotherapy in which the common underlying principle is the functional unity between the mind and body. This psychosomatic approach suggests that whenever we work with the body—we also work with the mind., therefore, changes in the body facilitate changes in the mind. What distinguishes Body Psychotherapy from massage is its approach to personal/psychological growth through increased body awareness more deeply felt emotions, and the synchronizing of body, emotions, and spirit through the use of various modalities. (experiential)Massage Therapy: The clinical application of touch to change the tone of muscle/soft tissue, increase range of motion, decrease stress, and improve circulation. CASE PRESENTATION (from Timms & Connors, p. 27) For example, Joan, a female client in her mid 40s (with a hx of sexual abuse by a male), accompanied a female friend to a restaurant for dinner. A man in the restaurant commented, “It’s nice to see two attractive young ladies out enjoying themselves.. I admire your style.” …The compliment threw Joan into an emotional tailspin, ruining the evening for her. She felt unsafe because she had been noticed and admired by a man. She cut dinner short, ran home, isolated herself the next week, and went on an eating binge…she felt shame and self-blame over her eating binge, feared that being touched in any way would be sexual, and was generally not well associated with her body. In response to being touched on her hand or arm, Joan felt only panic over her whole body, not the physical sensation of tactile pressure in one location. Bodywork and psychotherapy helped her discriminate the physical sensation of touch from the past emotions she had always associated with it. She learned to associate physical sensations to the parts of her body where they were objectively occurring…helped her experience touch as safe, nonsexual, and in a specific, limited location…she made the parallel association in psychotherapy that social situations which previously caused anxiety could be non-sexual, have nothing to do with past abuse, and be located in present-day, adult reality. “In sexual abuse, the body is involved: it is invaded, its value distorted; it is used, made into a vehicle for physical pain, unwanted or confusing sexual responses, or dissociative absence. In a sense, the survivor’s body, or at least the survivor’s comfort and ease with his or her body, was stolen. Since the body was integral to the trauma, it must be reintegrated into the healing process.” (Timms & Connors, p.9 )History of Body PsychotherapyI. Explanatory Models (EMs) of Illness: Arthur Kleinman's Patients and Healers in the Context of Culture (1980):“Explanatory models are the notions about an episode of sickness and its treatment that are employed by all those engaged in the clinical process. The interaction between the EMs of patients and practitioners is a central component of health care…they offer explanations of sickness and treatment to guide choices among available therapies/therapists and to cast personal and social meaning on the experience of sickness.” (Kleinman, p. 104-106)Example: Indigenous Healing Practices and Touch The Hands Feel It (1996) Edith Turner The Inupiat (above Arctic Circle) developed means of diagnosis and healing practices using their hands/touch when people became injured or illExample: Everyday Language: Many cultures express emotional distress in somatic/embodied terms. a. Pictographic language (eg. Chinese): symbols combine parts of the body with different emotions/experiences b. Spoken Language: Somatic Idiom: verbal phrase used to describe an emotional experience that makes reference to a bodily sensation: "I have butterflies in my stomach…" (anxiety) Existence of somatic idioms are linguistic acknowledgment that our emotions are not?simply cognitions, but are visceral/sensory experiencesExamples of somatic idioms:"That person rubs me the wrong way!"—(irritation) “I just want to jump out of my skin!” (anxiety)"My heart is broken.” "heart is heavy" (grief)"My blood is boiling!" (anger) II. Eastern Approaches/ ContributionsA. Chinese Medicine: Seeks to restore balance/harmonyYin/Yang; Chi/Qi; Meridians; Five Elements B. Ayurvedic MedicineChakras (Energy centers) -7 chakrasRoot, Sacral, Solar Plexus, Heart, Voice, Intuition, CrownChakras correspond to the large bundles of nerve plexusesIII. Western ContributionsWestern approaches to health/healing have traditionally given the greatest authority to the physician…(body viewed as "bad" and the mind "good")A. Sigmund Freud (1856-1939) Austrian Neurologist Interest in Hysteria and the Somataform Disorders:“…noted that in some way the energy of the mind-body unit was capable of being misdirected into bodily symptoms, in effect saying that a sick or disturbed body indicates a disturbed psyche that needs healing. This was not a popular message.” (McNeely, p 28). --body and body processes are the foundation of psychological states--the ego [sense of the self] is first and foremost a body ego --position of the body in psychoanalysis (lowered defenses) B. Wilhelm Reich (1897-1957) Austrian Psychiatrist/analyst “Father of Somatic Psychology"Concept of Character ArmorCharacter Analysis (1933)--"character armor" :physical manifestation of repressed emotions--specific to a person's history and pattern of holding their emotions--by definition is self-limiting due to "holding" energy--a healthy individual has no limitation/energy is not bound in tension--repression is a PHYSICAL phenomenon—not just a psychic one!--Freud maintained that our psychological defenses bind anxiety, Reich simply applied this binding to have the physical/somatic expression of muscular tension to "hold in"--certain “personalities” would present with certain patterns/ postures (body signature) Five Segments/Areas of Holding:Ocular, Oral, Thoracic, Abdominal, Pelvic"…They store different memories, emotions, issues, and traumas…energy blockages can distort affect, posture, movement in characteristic ways, and result in specific physical and emotional illnesses” (Caldwell, 1997)Distinct departure from traditional analytic practices--sat beside clients, touched their jaws, backs, necks to dissolve muscle tension/engage armor--patients to hold their breath to control/limit the expression of their feeling-- “orgasm reflex”: involuntary response of whole body (spontaneity vs. inhibition) surrender , but also fully connected/integrated with bodyC. Alexander Lowen – (1910-2008) and Bioenergetics--student of Reich from 1940-1952--his analysand from 1942-1945 “Freedom is the absence of inner restraint to the flow of feeling, grace is the expression of this flow in movement, while beauty is a manifestation of the inner harmony such a flow engenders…to go through life with a closed heart is like taking an ocean voyage locked in the hold of a ship. The meaning, the adventure, the excitement and the glory of living are beyond one’s vision and reach.” (Lowen, p.44)“…most people are unconscious of the bodily handicaps under which they labor—handicaps that have become second nature to them, part of their habitual way of being in the world. In effect most people go through life on a limited budget of energy and feeling.” (Lowen, p43)Bioenergetic Character StructuresSchizoid, Oral, Anti-Social, Masochistic, Rigid--each has a unique bioenergetic (emotional) "charge" --psychical traits due to high or low charge D. Expansion of Theorists and Modalities 1. Adjustment Models --chiropractic, physical therapists, massage therapists, etc.“...understands therapy as essentially a corrective treatment, which realigns the body—physically, energetically, or both—and thus indirectly brings the mind back into a healthy or desirable condition...”--limitation is that it assumes the practitioner knows what is best for the client and the right to apply this understanding, literally moving or manipulating the clients on a bodily level.--can “power through” defenses without honoring their necessity2. Trauma / Discharge Models--psychological traumas have been “locked” into the body “a foreign body” (splinter or parasite) that the psychic structure must adapt/shape itself around...the adaptation eventually causes restriction --healing occurs with the full and conscious expression (abreaction) of the held/locked emotions --PTSD is fundamentally incomplete physiological responses suspended in fear (not as much discharge) as to completion of cycle.3. Process Models --therapist allows the client's bodymind to guide the therapeutic work --follow the flow vs. attacking the defenses/resistances --”unwinding” bodymind will heal if given the space and support it needs --process will emerge with presenceE. Professional Organizations1. Graduate Schools/Programs in Somatic PsychologyCalifornia Institute of Integral StudiesPacifica Graduate Institute-Naropa University (Boulder, CO)2. Certifications/Licensures Bioenergetics (Alexander Lowen)Hakomi Body-Centered Psychotherapy (R. Kurtz)Rosen Method (Miriam Rosen)Somatic Experiencing (Peter Levine)Healing Touch (Janet Mentgen)CranioSacral Therapy (John Upledger)Rolfing “The Body is the Personality" (Ida Rolf)Somatic Education (Moshe Feldenkrais)Holotropic Breathwork (Stan Grof)Reiki, Shiatsu….Etc…..3. Professional Organizations/ConferencesEABP: European Association for Body Psychotherapy (1989)Website: : United States Association for Body Psychotherapy (1996)Website: 4. Research and JournalsInternational Body Psychotherapy JournalSomatic Psychotherapy Today Core Concepts of Body PsychotherapiesA. The Unity of the Bodymind– each human being is a unityThe bodymind is a continuous system/feedback loop rather than twoseparate parallel systems--any event that we encounter impacts the whole person.--dysfunction in any part impacts the whole “I both have a body and I am a body, and this intimate relation puts my body in a closer juxapostion with my immediate awareness than any other object that I can possibly contemplate. NO piece of laboratory equipment could ever put me closer to a form and its process of formation than can my direct perception of my own body.” (Juhan, p. 11)B. Body as Metaphor –"The Body does not lie."-our body expresses our story: culture, generation, gender, age, family of origin, vocation, trauma's experienced, etc.--Deb Shapiro's book: Your Body Knows Your Mind KEY: “…the tissue pattern that is present has been cultivated, practiced, and developed through time. It is an embodied history of the sensations, feelings, and expressions that the person has permitted. The tissue state that is developed forms the basis for the person’s identity, ability to express various emotions and literal feeling of him or herself.” (Grand, 1982) C. Energy "We are ALIVE!"All things in the universe are composed of energy, matter, and space.Humans are unique energy systems (meridians / chakras/nervous systems)We are in a constant state of energetic process/exchange within ourselves and with our environment.--nature of energy is to FLOW /STREAM / MOVE vs. being stagnated, collapsed, blocked, drained D. Movement is Essential to Life-- (heartbeat, lungs expanding, cells metabolizing)--there is a cyclical expansion and contraction pattern in the body (intake and outflow) when either movement predominates...the equilibrium is disturbed “Movement leads to better orientation in relation to our own body…meditation/motionless/isolation tanks cause us to begin to lose sense of our own boundaries…we do not feel our body as much at rest…get a clearer perception of it when it moves and when it comes in contact with other objects/others” (Juhan, p.187)“Culture strongly influences how we move…how much space they can take up, how much effort they can use, and how quick or slow they can move…how we move influences how we feel, and how we feel shapes how we move. And culture shapes both.” (Caldwell, C, 2004)E. Sensations are Information about our Experience--Sensation words: hot, cold, clammy, itchy, hard, soft, etc.--teach clients how to attend to their physical sensations“Our bodies are giving us every moment a wealth of information about forms and formation…they have so much to teach us about reality. We should under no circumstances ignore or degrade what they are telling us; rather, we should be focusing our earnest attention upon the “field of sensations” as least as much as we do upon the “world of reality.” (Juhan, p. 13)Grounding/ Grounded--being based in actual here-and-now moment (vs. past or future)--not in your head but present in totality of your being--opposite of dissociation (out of body) / numbing--feel your own weight/mass/power/space you own--often less anxiety (body is not holding itself UP)Sense of Self :--holds the essential, unarmored self--having a center/core is both a metaphorical idea and literal experience--why people believe they ARE what they FEEL about themselves F. Emotions are Embodied Energy“Sensations form the basis for emotions…and emotions, thought"--if you feel grounded, feel at peace (vs. anxiety—emotion)-- intrinsic nature of feelings to express themselves somatically and actively--non-expression requires repression/blocking/numbing (shut-down) “Emotions exist to regulate [inform] our inner state, but at the same time they help us to regulate our relationships. They exist both as intrapsychic and social phenomenon.” (Caldwell, C, 2004) G. “People carry their issues in their tissues.”--restricted movement, emotion, blocked energy, restricted breath, undermotivated, over-excitable, lethargic, etc....--becuase bodymind is a unity, we can “read the body”--Reich's “character armor”Marion Rosen (1914-2012) Physical Therapist 1. “The mind is very literal, while the body speaks the emotional truth…" (Rosen, p27) 2. "body reading gives more accurate information than what people say.” (Rosen, p 34) 3. “…where is the breath?..the breath speaks even if the person does not talk” (is what they say true (integrated) or just in their heads (aware cognitively) (Rosen ,p 37)4. …the muscles tell different stories, depending on their function diaphragm (fear, holding in), Glutes (tight, no sway) shoulder blades (no reaching out?)“Emotions that we could not handle at the time we originally experienced them are still alive in us, and can emerge any time we stop holding them down…” (Rosen, p 61-62)H. Interventions1. New Options“Change the body and you can change the mind.”Direct here-and-now experiences to promote integration2. Release Restrictions / Ground Deep tissue/ meridians / energy blockagesBreathwork - expansion and contractionMovement/ Stretching –vs. stuckness/deadnessManic Movement: promote grounding / stillness3. Support Unwinding: “Provide support: body lets go”--body is completely supported by a table / floor--if areas of tension / tightness/ limited range of motion,Issue is present4. Touch: support of client (emotionally/physically) to deep tissue manipulationI. Core Parallel Concepts/Processes to Psychotherapy The Ethics of Touch (Benjamin & Sohnen-Moe, p. 14) a. Client-Centered (every action serves client needs), b. Fiduciary Relationship (client interests above LMT)c. Structure (limited time, structured time, fees)d. Safety (emotionally and physically safe; privacy, draping),e. Power Differential (always exists and LMT responsibility to manage) knowledge/expertise,f. Transference in Body Psychotherapy touch/somatic work often evokes unresolved transference issues --many clients surprised/unprepared for high level of intimacy (physical, emotional and verbal), the vulnerability, that occurs --transference not to be avoided, (most LMTs do) but navigated/utilized Importance of Touch: The Significance of the SkinIntroduction: Touching: The Human Significance of the Skin (1971) Montague--In 1915, infant mortality rate in orphanages reached 99%--disease called ‘merasmus,” (Greek meaning: ‘wasting away,)’ …the largest single factor of its cause? …sparse staffing. Attendants could only clean and feed the infants and put them back into their solitary cribs Studies of mammal, monkey, ape and human behaviors all indicate:--touch is a basic behavioral need, much as breathing--when unmet, abnormal development/behaviors resultA. Chronological and Psychological "Mother of the Senses"--first sense to come into being—6th week--Skin and the brain develop from the same primitive cells. --Surface and innermost core spring from the same tissue--throughout life they function as a single unit …skin is the surface of the outer brain, …or the brain is the deepest layer of the skin. (Juhan, p.35) “So the skin….offers an excellent means of influencing internal processes. Its sensory pathways unite the surface and the interior of the organism, and its surface does not shield any more than it exposes…internal states of mind and physical health directly effect the skin. Transitory moods are reflected by paling, flushing, goose flesh, cold shivers, sweating. Chronic anxiety and exhaustion darken the area under the eyes…neurotic dispositions can render it nearly numb at one extreme, or excruciatingly sensitive at the other….But what about the other way around? Can conditions and sensations on the skin really have an equally potent effect on our organs, our circulation, our moods, our personalities? (Juhan, p.43) In a word… YES!B. Healthy Touch—What Does It Do? “…two major functions of our surface layer [skin]: On one hand, skin is a barrier, effectively containing within its envelope everything that is ourselves and sealing out everything that is not. On the other hand, it is an open window, through which our primary impressions of the world around us enter our consciousness and structure our experience.” (Juhan, p.21 ) 1. Attachment / Connecting with others -- skin is also our POINT OF CONTACT that creates a sense of "Us"/Belonging --Secure Attachment is based on predictability "person will be there" and appropriately responsive--first "somatic knowing" of someone" being there"is through touch/contact then translates to emotional/verbalDanger of Radical Individualism: “…Our bodies are not used to connect us with others, but as firm boundaries between us and ourselves. This distancing happens as the relationally-based functions of the body—perception, emotion, sexuality and implacement—are minimized and denied, crippling our ability to relate.” (Hall, p161-162)2. Formation of self/ Felt Sense of Self--touch helps create internal visceral experience of self -- our immune system recognizes that which is foreign to us…self from non-self As we select postural fixations and become more and more attached to them, their increasing familiarity begins to give us a comforting sensory and psychological stability, a constant norm to which we return as to a favorite jacket or an old friend. Indeed, my favorite fixed positions eventually cease to be something I am doing and become to a large degree who I am.” (Juhan, p. 220) 3. Awareness of Boundaries --touch provides an “Other” to Form own self Against “Boundaries separate [define] humans from their environment and from other humans. They are elusive yet personally discernable lines that distinguish you from everything and everyone around you. They define your personal space—the area you occupy which you appropriately feel is under your control.” (Benjamin & Sohnen-Moe, p 26)Categories of Boundaries (Benjamin & Sohnen-Moe,p. 28-31)Physical (space around a person—in front, behind, sides, etc) Emotional (our feeling self—and whether we self-disclose this or not)Intellectual (person’s thoughts, beliefs and opinions are part of one’s self/identity)Energetic (emotional/spiritual state) not easily understood or discussed--the energetic state of one person can influence another person Sexual (can include all the above boundaries) Boundary Types: (Benjamin & Sohnen-Moe,p. 30-34) (drawn from Salvador Minuchin’s work)-- boundaries on a continuum of permeable to rigid. The degree of permeability also represents vulnerability.” P.30Permeable: information and feelings flow easily in and out(hallmarks of empathy—you let the experience of another impact you)(danger—you let the experience of another define you)Semi-Permeable/Flexible: closeness or distanceflexible: allows you to adapt to unusual needs or circumstancesover-flexible: others may impede on your personal time/take advantageRigid: flow severely limited--thick boundary, firm and distinct…severely limits the flow in or out of the interaction.--to protect the Self Over-rigid: person is guarded /isolated from others“Each person faces innumerable boundary decisions each day…boundaries fluctuate because they are both idiosyncratic and contextual. They are idiosyncratic because they reflect each person’s likes, dislikes, cultural background, temperment, and history. They are contextual because they can change depending on the situation.” (Benjamin & Sohnen-Moe, p 27) 4. Emotional regulation --nervous system (skin and visceral)--touch can offer: comfort / grounding/ containment/ support--actually can calm/regulate the nervous system (reboot)--grounding by means of "stronger energy"Example: Child and parent KEY: Therefore, the absence of touch AND harmful/inappropriate touch have far reaching impact on: AttachmentThe formation of the self, Understanding of boundaries, Regulation of Emotion…and can therefore negatively impact our development and preparation for living.“… some of our ethical fears and prohibitions reveal our illiteracy about touch as an implicit language. In truth, few of us have been well touched. Our fears speak to the pervasive dysfunctions of touch that make us suspicious of covert nonverbal messages which may be embedded within it. They speak to the untold suffering that physical and sexual abuse, both touch dysfunctions, have visited upon so many and to the deep yearnings and disappointments that the lack of loving touch leaves in our lives…can we afford to remain touch illiterate…for patients who require a real reparative object relationship to rework harmful internalized objects, it could be argued that avoiding contact could reinact the physical neglect or rejection these patients experienced as children.” (LaPierre, 2003)C. Touch Anxiety in our Society:--Modern media most often displays touch as either romantic/sexual or violent.”(Benjamin & Sohnen-Moe, p 106)-- years of “hands off” indoctrination. --what to do if we just need comfort? --misinterpret the need for touch as sexual desire or hunger, or depression. (Benjamin & Sohnen-Moe, 106)--Generational and/or cultural --many therapists feel guilty/awkward about touching patients, even to provide support/containment and comfortD. History of Touch Prohibition in Therapy (see Fossage, 2000):1. Psychoanalysis emerged within a cultural context of repression 2. Association of physical contact with traditions of religion, magic, and hypnosis. 3. False Psychoanalytic Assumptions? Bodywork and Touch as Interventions (Touching: Body Therapy and Depth Psychology (1987)“Experienced body therapists know there is a very distinct line between touching a patient with intentions of their own gratification and touching a patient with intention of therapeutic intervention. It is the therapist's own familiarity with his or her own feelings and sensations that makes this distinction possible. The body therapist's most significant tools are personal body awareness as well as intuition and a clear ethical stance.” (McNeely, p 97). A. Four factors associated with how patients evaluated touch in tx:1. clarity regarding touch, sexual feelings, and boundaries (clear and unambiguous) stated on consent form 2. patient control in initiating and sustaining physical contact3. congruence of touch with the level of intimacy in the relationship and with patient’s issues4. patient perception that the physical contact is for his/her benefit (Fossage, 2000, citing Gelb) p. 30B. Distinguishing Between Intimacy, Sensuality, and Sexuality1. Intimacy: Some clients need to differentiate soothing/comforting/nurturing touch from sexuality “By definition, sex, touch, and intimacy are three distinct behaviors and experiences. The fact that they overlap at times is what creates confusion. Most people would concur that a good sexual relationship includes all three…but, a person who only feels intimacy with someone when sex is involved might start to believe that intimacy and sex are the same thing.” (Benjamin & Sohnen-Moe, p 105)2. Sensuality is different from Sexuality--sensual originally meant “connection with the senses as opposed to the intellect,” -- incorporates the awareness of bodily sensation-- experiencing pleasure in sensation and utilizing sensation to be more fully present in our bodies. --bodywork can be sensual without being sexual3. Awareness of Sexuality--yet working with the body, a client may be confronted with awareness of their sexuality --very natural part of the process of becoming conscious of the body-- the therapist (who manages his/ her own sexual energy) can observe/support the emergence of the client's sexuality without getting caught up in a sexual complexes, just as a healthy parent can encourage a child’s sexual development without [genital] participation.” (McNeely, p 75)“The bodyworker’s touch need not replicate the original traumatic touch (indeed should not). No reputable BW or Tx would ever touch or stimulate genital areas of clients. …the kinesthetic connection to the abuse was anchored in the body long before the abuser got to the genitals. The memory could be stored as a hand on the shoulder, hip, neck, etc…This phenomenon of locating emotional responses and memories in the body may be related to the concept of ‘state dependent memory.” Timms & Connors, p.34C. Specific Interventions Utilizing Touch (McNeely, p 67-68)1. Providing Contact: handshake2. Providing Affection: expressions of tenderness/ nurture/support--reparenting the body (stabilizing the body/nervous system)3. Providing containment/grounding:-- physically hold a client experiencing terror or deep grief by giving client enough “support” to stay and process through the pain of the experience4. Exploration and Amplification: bring focus 5. Mirroring an Other: to push or pull against, dance, scream, feel strength For those who have never had their assertiveness mirrored or supported6. De-armoring/softening: actively move against/bring attention to patient’s somatic defenses “Child analysts such as DW Winnicott contend that a child of any age who needs to be held affectionately is seeking a physical form of loving which was given naturally in the womb. In this model, it is not enough to be conscious of the early pain of deprivation, but it is necessary that early wounding be repaired. This may occur through reparenting physically and emotionally by touching and holding at a non-sexual level, as one would touch and hold a small child…so that the muscular armoring gives way to the free flow of energy into the deprived tissues of the body…” (McNeely, p 71)D. Summary Thoughts on Touch“Touch is a powerful form of communication. We cannot afford to eliminate a proufoundly important mode of communication from our healing profession. As with any form of communication, verbal and nonverbal, we can use it advantageously or not for facilitating understanding, communication and the analysis…as we expand our view of the possible meanings of touch beyond that of infantile wish or defense formulation, we will be able to understand better our analysands requests for touch…” (Fossage, 2000) p 41 E. Example/Model Major Components of Rosen Method1.Touch as an Opening: “Being allowed to touch someone is a privilege. That person is entrusting themselves to us, and we have the possibility to be with the person, undefended, open, and receptive. It is a growing experience for practitioners as well as for patients. Practitioners are replenished at the same time they are giving.” (Rosen, p. 20)2. Presence as Acceptance: “[Presence] has nothing to do with physical strength, but rather with emotional freedom. Practitioners who are able to recognize and allow their own feelings can pay full attention to clients. This results in the ability to accept themselves and patients as well…it is not so much what we to do patients, but who we are with them.” (Rosen, p 21)“Through our hands comes a declaration saying, ‘I am with you without asking anything in return. I am with you whoever you are.’” (Rosen, p22)3. The Role of Words : “Talk is used to help patients become aware of what is important and really true for them (reflecting their feelings and body movements/rigidity/breath)…more important is what we do not say and when we do not say anything. When patients have connected with some emotion and are in a process, practitioners are quiet. Even their hands become quiet.” (Rosen, p.23)4. Body Reading: “At this point, body reading gives more accurate information what people say.” (Rosen, p 34) --what areas are “held, rigid, overused, underdeveloped” “where is the breath?..the breath speaks even if the person does not talk” (is what they say true (integrated) or just in their heads (aware cognitively) (Rosen ,p 37)--the muscles tell different stories, depending on their function diaphragm (fear, holding in), Glutes (tight, no sway) shoulder blades (no reaching out?)Patterns of Tension: holding down (suppressing), holding on, holding together, holding back “Emotions that we could not handle at the time we originally experienced them are still alive in us, and can emerge any time we stop holding them down…” (Rosen, p 61-62)The diaphragm is the bridge between the conscious and the unconscious…p.62““When the diaphragm lets go all the way, it seems that people have surrendered to whatever is happening, and they feel so peaceful…In German we have the word, Gotteskind, which means you become a child of God. It describes this state where fear and uncertainity go away and a new space inside opens up for loving and acceptance of oneself and others.” (Rosen, 68)When the body relaxes, the muscles soften, lengthen, and widen and emotions surface..p62)Place of Somatic Work in Healing: “Corrective Somatic Experience”-Bodywork can bypass cognitive processes and address psychological defenses --provides the somatic process of integration of insight gained in talk tx"Bodywork cuts through a lot of junk in consciousness and gets right down to brass tacks quickly. The advantage to this is that the Self appears in a real relationship between two persons often improves rapidly. Loneliness—the special loneliness of the Self—not the ego—is relieved because two selves can communicate…When this area is entered consciously, immediate relief is occurs in many persons, especially those who are gifted in body communication. Just as there are thinking and feeling types, so there are people who communicate more completely through body contact than with ideas…" (Mindell, p. 167)A. Depression: Address Isolation and Teach Self-Care (vs. neglect)--People who are depressed are often isolated (turned inward), lack energy/will to connect, and have often “given up” on self-care-- common in people: emotional deprivation/neglect/non-responsiveness Bodywork can communicate:Contact can establish connection (bond) vs. isolationCare and concern on very basic/primary level to the client’s body---which communicates direct care to the SELF --Over time translates into self-worth--Individual internalizes this care—and they learn to care for themselves. B. Anxiety: Experience Grounding and Reset Overstimulation2 clinical presentations: fear itself / fear of feelings--People with anxiety disorders often feel like they want to "crawl out of their own skin" --nervous system is in overdrive/ extends beyond skin--all this information is going to the brain—overload of energy (racing thoughts)--or muscles held tight/tension "way to hold the self together"--tight muscles are experienced by the body as "weight" load bearingTranslates to emotionally trying to "bear up"--Bodywork helps to calm and soothe/calm the nervous system so thatIndividual can feel peace/rest in their own body“Soothing touch, whether it be applied to a ruffled cat, a crying infant, or a frightened child, has a universally recognized power to ameliorate the signs of distress. How can it be that we overlook its usefulness on the jangled adult as well? What is it that leads us to assume that the stressed child merely needs ‘comforting’ while the stressed adult needs ‘medicine?” It has been the thrust of this chapter to suggest that there is nothing ‘mere’ about tactile comforting, and there is no gulf between ‘medicine’ and simple contact.” (Juhan, p. 56 C. Sexual/Physical Abuse: Affirm (A-FIRM) Boundaries andIntroduce Safe/Comforting Touch "Your Body is not the problem—the aggressor was the problem."--but since the body itself was part of the trauma, it must also given time for healing“Being present in one’s body is a double-edged sword for survivors: on the one hand working through the body can stimulate trauma and evoke confusing or frightening feelings; on the other hand,,.it is this very ability to be present in one’s body that ultimately allows one to feel more grounded and thus safer and more in control.” (Benjamin & Sohnen-Moe,p. 216)--ALWAYS give clients permission to "disrobe to level of comfort" (able to work with clients fully clothed)--Survivors often have difficulty understanding even the concept of boundaries (may ask for an inappropriate treatment or be unable to request that a intervention stop because of feeling violated) so practitioners must titrate and regularly "check in" with clients--body may "hold in" as expression of "holding in" the secret of abuse--people are more likely to inhabit and enjoy their body if it can be experienced as safe, good, and able to protect itself.“As these positive sensations accumulate, the individual can begin to make new emotional and intellectual associations with his body as well; it can be trusted and used to the full extent of its possibilities, not just suspected and defended; it is the source of movement and pleasure, not just limitation and discomfort; it provides many kinds of sensory information upon which a wide variety of choices may be based, not just one or two sensations which trigger one or two inevitable responses.” (Juhan, p. 211)D. Dissociation/Numbing: Feeling and Connecting/Integration--Initially an effective way to cope with the overwhelming nature of trauma—it also prevents individuals from connecting with others and themselves.--Because all contact/feeling is avoided (phobic); no new, positive experiences are allowed to correct/reset negative ones However, being "out of touch" with their physical body causes an absence of psychic limitations (multiple parts—exponential splitting)Vs. acknowledgement of only ONE self Bodywork can assist these individuals in getting “back into their bodies” And integrating the split emotions/parts Client experience of "being put back together" – whole self“Just as pain brings dissociation, pleasure brings association. Since many survivors fear the pain involved in new, risk-taking experiences, they may adopt a passive lifestyle. Because fear of pain is stronger than pursuit of pleasure, they may be locked into this passivity…to feel and believe, ‘I can be touched without being hurt.’ And ‘I am not like the person who abused me: I can touch and not hurt others…’ are new insights that can change a client’s self image.” Timms & Connors, p.62-63E. Neglect/ Deprivation: Provision of Care/Nurture/Tending--some clients have had the experience of “…insufficient holding”—an insufficiency that occurs not as a traumatic moment but as an ongoing, chronic absence. --lack of holding/touch, (frame for psychological development), emotional growth cannot occur. Awareness of boundary/self--become overwhelmed by persecutory fears…unable to trust. --no feeling of grounding or attachment (Josselson, p. 35)Bodywork can provide safe, nurturing touch within a therapeutic framework. F. Eating Disorders : Befriending the Body--body is not bad/enemy--does not need to be punished/deprived--help disentangle embodied SHAME (flawed, untouchable, disgust)--body can be the recipient of care and nurture (food)Bodywork can allow a client to experience the somatic acceptance of their body. G. Self-Injury: Experience of Care vs. Self-harm--Some clients engage in harmful behaviors (cutting, burning, risk taking) --body/self has been linked with feelings of shame and “needs to be punished.” (attacks on the self) --attempts at emotional regulation (preventing dissociation)--rework these beliefs and actions by being confronted by the care of a practitioner. The incongruence (self-loathing vs. therapists care) can challenge and alter firmly held negative assumptions about the self.H. Restricted Emotional Expression / Body Armoring --Understand resistance first (reason for armoring) before softening--may utilize deep tissue techniques…but want to explore why body is chronically restricted in that areaSUMMARY:“…the therapist can induce new movements and new sensations to begin the selection and establishment of new patterns. If the individual tries to move in new ways on his own, his overwhelming tendency is to favor patterns of movement that feel normal to him…but [in bodywork] by remaining passive and allowing the therapist to create movements and sensations FOR him, the individual can begin to ‘get the feel’ for patterns of movement that may take laborious weeks and months for him to master on his own…Relaxation does not merely allow the bodyworker to move the client’s joints more freely for the moment; it considerably increases the suggestive potency of those freer movements; it creates a neutral ground where the information of new sensations can be introduced into a system normally locked into its old patterns, producing an actual experience of what it would be like to respond differently.” (Juhan, p.190) What Does Collaboration Look Like?A. Experience a Bodywork Session First--before you refer to someone—knowthem/ their work!---must be clear for yourself about the Bodyworker’s approach, boundary issues, ethics, and general sensitivity to clients--because touch/presence is so individual --you will better be able to explain to your clients what they may experience, and will open the door to deeper discussion about boundaries, feelings, sense of self…B. Teamwork! (but psychotherapist is PRIMARY therapist) --Bodyworker is adjunct/supportive therapist of psychotherapeutic process--client has 2 professionals for support/resources (prevents overdependency)--therapist has a built-in colleague/consultant on case--bodywork requires being verbally processed Require Signed Release Forms--release form for collaboration/ Body Awareness/ Touch Hx--prevents splitting“Since most survivors have trust issues and are accustomed to keeping secrets, both professionals must make very clear that the psychotherapist and bodyworker—with the clients written permission—will periodically discuss their collaboration on the client'streatment.” (Timms & Connors, p. 12) C. Awareness of Transference and Countertransference: --many clients experience bodywork as filling a need they didn't even know they have--can create a strong bond very quickly (much to surprise of psychotherapist)--Both must be aware of what they are able to uniquely offer to the client --psychotherapist can utilize transference issues brought up by bodyworkD. Assess Client Readiness for BodyworkClient has a solid therapeutic alliance with psychotherapist--some fluency in expressing feelings--the introduction of therapeutic bodywork in therapy often intensifies therapeutic issues (psychotherapist & therapeutic bodyworker determine together whether client is a candidate for bodywork)Client “plateau/stuck” in verbal therapy, yet knows there is more workClient reports increased awareness of bodily tension/discomfort without a known medical cause. Be Ready To: (or Bodyworker should in 1st session)Discuss Difference between Massage Tx and Bodywork(many clients have never had massage and/or need to understand the difference between therapeutic bodywork and massage)5. What is a Somatic Bodyworker --is often an LMT or certified in a specific modality --also has awareness of process of psychotherapy (done own work) AND--experiential knowledge of transference, countertransference, importance of maintaining boundaries, ethics, in Bodywork6. Describe typical session:Review PaperworkExplore any concerns/questionsExplain procedure to clientOne hour hands on session (first contact to final ground)Debrief / Next StepTx Reenter room, check in with client, offer water, schedule next session paymentE. Contraindications for Initial Referral to Bodywork--client in acute crisis --Clients who tend to regress (use tx as fix vs. growth)Is why the manner of working is ultimately so much more important than are particular procedures or techniques, more important than merely pushing tissues and structures back into the ‘right’ place. Even though structural changes are to be expected, the crux of the therapy is not material, but has to do with the sensory evocation of feeling states…” (Juhan, p. 275-6)Time for Q & AConclusion:Quote by Clarissa Pinkola Estes Women Who Run with the Wolves "The body uses its skin and deeper facia and flesh to record all that goes on around it. Like the Rosetta Stone, for those who know how to read it, the body is a living record of life given life taken, life hoped for, life healed. It is valued for its articulate ability to register immediate reaction, to feel profoundly, to sense ahead. The body is a multilingual being. It speaks through its color and temperature, the flush of recognition, the glow of love, the ash of pain, the heart of arousal, the coldness of non-conviction. It speaks through its constant tiny dance, sometimes swaying, sometimes a-jitter, sometimes trembling. It speaks through the leaping of the heart, the falling of the spirit, the pit at the center, and rising hope. The body remembers, the bones remember, the joints remember, even the little finger remembers. Memory is lodged in pictures and feelings in the cells themselves. Like a sponge filled with water, anywhere the flesh is pressed, wrung, and even touched lightly, a memory may flow out in a stream. To confuse the beauty and value of the body to anything less than magnificence is to force the body to live without its rightful spirit, its rightful form, its right to exultation." References: Benjamin, Ben & Sohnen-Moe, Cherie. (2004). The Ethics of Touch. Tuscon, AZ: SMA Incorporated.Caldwell, C, ed. (1997). Getting In Touch: the guide to new Body-Centered Therapies. Theosophical Publishing House, Wheaton, IL.Caldwell, C. (2004). The Cultural Body. Lecture given in Taipei, December 2004. Transcript available at: , Siri. (2011). Body of Thought. Scientific American Mind. (Jan/Feb. p. 38-45).Carroll, R. (2002). Why Psychosomatisation is Complex: Going beyond cause and effect. Lecture given at conference on February 6, 2002. Transcript can be found at:, J. (1994). The Body in recovery: Somatic Psychotherapy and the Self. Berkley, CA: Frog Books. Ellingsen, D-E. et al. (2016) The Neurobiology Shaping Affective Touch: Expectation, Motivation and Meaning in the Multisensory Context. Frontiers in Psychology (6) 1-16.Field, Tiffany. (1998). Massage Therapy Effects. American Psychologist, 53(12) 1270-1281.Fossage, J. (2000). The meanings of Touch in Psychoanalysis: A time for reassessment. Psychoanalytic Inquiry, vol 20 (1) 21-43.Grand, I. (1979). The Marvelous in the Real. The Journal of Biological Experience-Studies in the Life of the Body. Vol 1(2) 33-43.Grand, I. (1982). Of tissue states and thermostats: Clinical observations. The Journal of Somatic Expeirence. Vol 4(2) 106-119.Greene, E. & Goodrich-Dunn, B. (2014). The Psychology of the Body, 2nd ed. Philedelphia, PA: Lippencott, Williams, and Wilkins.Hart, S.; Field, T., et. Al. (2001). Anorexia Nervosa Symptoms are reduced by massage therapy. Eating Disorders (9) 289-299.Johnson, D. & Grand, I. (1998). The Body in Psychotherapy: Inquiries into Somatic Psychology. Berkely, CA: North Atlantic Books.Josselson, Ruthellen. (1996). The Space Between Us: Exploring the Dimensions of Human relationships. Thousand Oaks, CA: Sage Publications.Judith, Anodia. (2009) Eastern Body Western Mind. New Delhi: India. Alchemy Publishers.Juhan, Deane. (1987) Job’s Body: A Handbook for Bodywork. Barrytown, NY: Station Hill Press.Kleinman, Arthur. (1980). Patients and Healers in the Context of Culture: An exploration of the borderland between anthropology, medicine and psychiatry. Berkley, CA: UCA Press.LaPierre, A. From Felt-Sense to Felt-Self: Neuroaffective touch and the Relational Matrix. Haikomi Institute Forum, Volume 16-17, Summer 2006, 43-45.Levine, P. (1997) Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books.Lowen, A. (1975). Bioenergetics. New York: Penguin Books. McGlone, F., Wessberg, J. and Olausson H. (2014). Discriminative and Affective Touch: Sensing and Feeling. Neuron (82) 737-755.McIntosh, Nina. (1999) The Educated Heart. Memphis: TN: Decatur Bainbridge Press.McNeely, D. (1987). Touching: Body Therapy and Depth Psychology. Toronto, CANADA: Inner City Books.Mindell, Arnold. (1982). Dreambody: The Body's role in Revealing the Self. Boston, MA: Sigo.Montagu, Ashley. (1971). Touching: The human significance of the skin. Harper & Row: New York.Moyer, Christopher; Rounds, James & Hannum, James. (2004) A Meta-Analysis of Massage Therapy Research. Psychological Bulletin, 130(1) 3-18.Moyer, Christopher. Affective Massage Therapy (Editorial). International Journal of Therapeutic Massage and Bodywork, 1(2) 3-5.Rosen, Marion & Brenner, Susan. (2003). Rosen Method Bodywork: Accessing the Unconscious through Touch. Berkeley, CA: North Atlantic.Rosenberg, J. and rand, M. (1985). Body, self, and soul: Sustaining Integration. Atlanta, GA: Humanics Limited.Rothschild, B. (2000). The Body Remembers: The psychophysiology of trauma and trauma treatment. New York; Norton.Shapiro, Deb. (2006) Your Body Speaks Your Mind. Boulder, CO: Sounds True.Smith, E.; Clance, P.; and Imes, S. (1998). Touch in Psychotherapy: theory, research and practice. New York: Guildford.Timms, R. & Connors, P. (1992). Embodying Healing: Integrating Bodywork and Psychotherapy in Recovery from Childhood Sexual Abuse. Brandon, VT: Safer Society Press.Totten, Nick. (2011). Body Psychotherapy: An Introduction. Philedelphia,PA: Open University Press.Turner, Edith. (1996). The Hands Feel It: Healing and Spirit Presence among a Northern Alaskan People. DeKalb, IL: NIU Press.Upledger, J. & Vredevoogd, J. (1983). Craniosacral Therapy. Seattle, WA: Eastland Press.Van Der Kolk, Bessel. (2014). The Body Keeps the Score. New York, NY: Penguin.Young, C. (2005). About the Ethics of Professional Touch. Electronic version (PDF) at , O. (2007). Touch in Therapy and the Standard of Care in Psychotherapy and Counseling: Bringing clarity to Illusive Relationships. United States Association of Body Psychotherapists Journal (USABPJ), 6 (2) p. 61093. ................
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