Therapy in 3D: Lessons from Body Psychotherapy
Goodrich-Dunn, Barbara, Psychotherapy Networker
Therapy in 3D
Lessons from body psychotherapy
by Barbara Goodrich-Dunn
For many therapists, the world of somatic psychotherapy still has the somewhat exotic and bewildering quality of an undiscovered country, despite the fact that it's been around now for more than 80 years. In fact, while there are a wide range of approaches to somatic psychotherapy (see sidebar page 42), all with their own terminology and specialized methods, they all share the same core assumption: the body is inseparable from our feelings of ourselves and our experience of others. From a body-psychotherapy perspective, even talk therapists are still "feeling" their clients' bodies and emotions just below their conscious awareness.
So what makes the body psychotherapist's work any different from that of a more traditional talk therapist? The body psychotherapist is far more likely to make the ways clients move, stand, hold themselves, and breathe as important in the assessment of who they are and what they need as what they say about themselves. Beyond that, body psychotherapy typically involves bringing clients' bodies into their treatment in some way, usually through breathing, movement, vocalizing, or touch.
As therapists, we may not be aware of exactly how much our bodies are sensors of our clients' underlying reality and communicators of our own. I remember 30 years ago in my own training as a body psychotherapist the day that we were studying how emotional patterns underlie people's postures. At one point my teacher said to me, "You're really shy, aren't you? But you come across as aloof."
I was shocked. I didn't feel aloof; quite the opposite, I was desperate to connect.
"You look as though you're looking down your nose at people," she told me. Then she showed me. She cocked her head back and looked down at me from under her glasses. Suddenly, I got it. It was something I'd been doing all my life, mostly to look calm. But when I saw her "looking above it all," I saw why people might not approach me. From that moment, my head came down and I learned to look people in the eye in a different way. The seemingly simple matter of changing the angle of my head not only changed how people saw me, but how I saw them. By making level eye contact, I was able to actually make the connection I so wanted to make, rather than observing someone from "above." I seemed friendlier to other people, and other people seemed friendlier to me.
By focusing me on the immediate, physical dimensions of my experience, my trainer opened up new doors for me. This tiny, somatic intervention had gigantic effects. Heightening awareness of your own body experience, even in small ways, can be enormously beneficial. What follows explores just a bit of what body psychotherapy might have to teach talk therapists, even if they may think they have no interest whatsoever in applying any specialized somatic techniques in their practice.
Our ancient ancestors understood that our psychological experience is rooted in breathing. Both psyche and spirit have their origins in the Greek and Latin words for breath. These early cultures intuitively knew that, from birth, the way we breathe is a major part of how we manage our experience of sensation and emotion. Some times subtly, sometimes quite dramatically, changes in breathing patterns are one of the principal ways that our internal ecology adapts to the sudden demands of external situations. We breathe in distinctive ways when we feel fear, panic, excitement, sexuality, pleasure, love, anticipation, anger, and sadness. Think about the sharp intake of breath when we feel awe ("It took my breath away"), or the shallow, rapid breathing of fear ("I was breathless with fear"), or the feeling of suffocation when someone is too close to us ("I can't breathe around him").
This fundamental component in our biological design also gives psychotherapists a powerful tool for helping clients with their emotional, physical, energetic, and mental states. Teaching an anxious client to calm herself with her own breath offers far more than temporary relief; it also gives her control over the mental and physical vortex that anxiety creates. Such breath work is often more effective than words in demonstrating to a client her own capacity to relax herself.
By relaxing our bodies, the breath diminishes the arousal inherent in anxiety and the thoughts associated with that arousal. Focusing our attention on the here-and-now experience of breathing brings our minds back from the imagined future, where anxiety reigns. Once we're relaxed, we're able to work with the thoughts that fuel the anxiety.
One easy way to understand natural breathing is to look at a sleeping baby. Her entire body ripples with the movement of breathing that's calming and deep and slow. Her breath moves throughout both the chest and the belly. Inhalation is full and, just as important, exhalation is, too. In contrast, anxiety occurs when we can't take in enough breath or when we hold our breath and don't release it completely.
Deep, slow, rhythmic breathing also calms other types of arousal. Clients caught in anger or hysterical crying can, in many instances, calm down through breathing. By teaching clients to breathe deeply, we teach them to bring their nervous systems out of extreme alert and into a state of relaxed attention. Over time, clients are able to learn how this state of relaxed attention is actually safer than the hypervigilance of arousal.
We're designed to temporarily alter our breathing in response to inner and outer changes, but what's meant to be a temporary adaptation can become permanent and dysfunctional. When we're in a chronically distressing situation, or when we're overwhelmed with trauma, we may become conditioned to using the breath to numb ourselves and not experience our own emotional response. For example, if we learn to hold our breath so we won't feel the pain in our chests that comes from needing our unavailable mother, we may learn to hold our breath in other relationships to stifle the inner sensation of need. Holding our breath doesn't just decrease the painful sensation, but all sensation, including the fundamental sensation of having a body.
This is why so many clients come to us emotionally and spiritually anesthetized. They tell us: "I feel as though I'm wrapped in styrofoam," "My body feels like a block of wood," "I feel like I'm asleep," or "I just can't feel anything." In body psychotherapy, working with the breath is key to reestablishing physical and emotional sensation.
After a series of broken relationships with men, Carrie feels as if her heart is encased in lead. We talk for a while about her difficult relationship with her father and identify the similar patterns in her failed love relationships, but Carrie's heart is still leaden. Finally, I suggest that Carrie begin to breathe very slowly into her chest, increasing her breath in small increments. She begins to notice how tight her chest is. She wants to stop, but she doesn't, challenging the tightness by increasing her breath even more.
After a while, she says, "I think my chest is going to crack. I can feel these little lines of feeling in my chest." I ask whether she wants to keep going.
"Yes," she says "I can't stand this heaviness anymore." Her breath grows slower and stronger. Then she gasps. "Oh, my poor heart! It's so shrunken and sad." Carrie's breath is a little ragged, as if she'll cry, but she doesn't.
"What does your heart need?" I ask.
"It needs me to take care of it. I don't take care of it. I just give it away to anyone because I feel so needy." Her eyes are closed; her hand is on her chest, over her heart. She opens her eyes and looks at me as she continues to breathe. "I have to take care of my own heart. I've been doing it by not feeling anything, but feeling my hurt is better than having no heart."
Watching and listening to our clients' breathing lets us become aware of how they're managing their emotions in the present moment. Breathing is the music for their words and allows us to distinguish what rings true in what they're saying and what feels dissonant to us. When we hear the gasps, the sighs, the pressured speech, the whines, the changes in the tone of voice, we're listening to our clients' body-mind regulating their emotional life. And when we listen to our own voices, our own gasps, sighs, and changing tones, we're listening to our own bodies regulate themselves in the intersubjective sea in which we swim.
There's a continuous stream of messages that's happening in the background of our awareness that comes from the state of our bodies. It tells us whether we feel strong or weak, tense or relaxed, stable or unbalanced, and many other qualities that are physical and psychological. Yet clients often talk of feeling like a nobody and wanting to be somebody. It's no accident that the body is central to both of these expressions of identity. Identity is formed by more than concept, construct, or image. Identity is also based in our physical and emotional sensations, our flesh and bones. How we think about ourselves is connected to how we experience the distinctive quality of aliveness in our bodies.
Forest drags himself into my office and plops himself in the chair right next to the door with the exhaustion of a man who's just run the New York Marathon. He sprawls. Forest is so glued to that chair, he's lost in it.
I know Forest isn't exhausted from running a marathon. Forest never runs, and walks as little as possible. He always parks as close to the door as he can, to minimize the steps he has to take. He's always exhausted. Depression? Of course. Forest has been through a pharmacy's worth of antidepressants and he's on one now that's helping, quite a lot. But Forest's shoulders still droop. He still shuffles. He has trouble holding a job even though he's very intelligent.
Looking at Forest's body more closely reveals a lot more about his experience of himself. Forest's body isn't just depressed; he's collapsed. The muscles in his body are flaccid. He doesn't have enough muscle tone to really hold himself "up," either physically or psychologically. He collapses at every opportunity because his energy is so low and everything hurts. He doesn't just collapse in chairs; he can't finish what he starts.
Working with Forest cognitively succeeds only for a short time, despite his best efforts and mine. The sensations of weakness from his body are too powerful for the cognitive messages of good self-esteem to take hold. His body identity is rooted in weak, underdeveloped muscles that are held upright by patches of extreme tension, rather than tone. Although he's an adult, his body is more like that of a baby just before he learns to walk. From a body-psychotherapy point of view, developmentally, Forest is stuck, body and psyche, in the first 18 months of life.
The messages from his body are "I can't": "I can't keep going," "I can't keep up," "I need to collapse," "Everything hurts," "It's too much for me," "Everything's too hard," "I'm overwhelmed." Because Forest has lived with these messages for so long, he's drawn some conclusions about himself and the world--"I'm going to fail," "I can't take care of myself," "Life's too hard," "Everyone else can live their life but me," "Nothing works for me."
One of Forest's complaints is that he can't get anything he wants in life. My goal with Forest is to help him use his body more actively to generate more physical energy and challenge his chronic passivity. "The only thing permanent about behavior patterns," said the famous somatic theorist, Moshe Feldenkrais, "is our belief that they are so."
I ask Forest to reach out, which he does anemically, then quickly retracts his arms. They fall to his sides, lifelessly. I ask him to reach out again, very slowly this time. Forest does this, but protesting: "This is stupid. What good will this do?" Forest's arms seem to have no energy. "I can't do this," he says. "I'm tired." He's collapsing as his body always dictates.
Even in reaching, Forest doesn't fully extend his arms. I ask what would happen if he really extended his reach. He reaches out a fraction of an inch more. That fraction brings a small tremor to his arms that travels into his shoulders and chest. His face begins to change color and his voice becomes distressed. "What if I try?" he asks "What if I really reach for something, finally, and nothing happens? I'll have played my last card. What'll I have left?"
I ask him to remember times when he reached out and there was nothing. "I reached out to my mother when I was little," Forest says, "over and over. She didn't notice. She ignored it." His voice is getting louder with an angry, bitter tone. "I gave up. I wasn't going to humiliate myself one more time."
"So you decided to never reach for anything again?" I ask.
"That's right! That's right! Never! Never!" Forest's hands have spontaneously become fists. His face is red with anger. His entire body seems more alive with the emergence of feeling around this childhood vow. "And I never did."
The anger flows out of Forest's face and is replaced by sadness. After a few minutes I murmur, "Try reaching again."
"It doesn't feel so stupid. My arms feel stronger," says Forest. "I hadn't realized how much I was holding back. I thought things just didn't work."
Forest's body structure is still collapsed, but he's had a different experience of himself as strong, energized, and assertive. From this experience, we can begin the slow process of helping him build both psychological and physical tone, so that he can begin to actually feel himself as strong and assertive, rather than just telling himself he is.
How we hold our bodies--how tense we are, how loose we are--helps us manage our emotions, just like breathing does. When we look at how our clients stand, sit, gesture, and move, we're watching their emotional present. But our bodies also express our past; our habits of survival are written into curled shoulders, stiffened jaws, or inflated chests. When we look at our clients' bodies with awareness, we can begin to see their stories expressed in muscle and bone, and start to elicit their bodies' version of their tale.
Touch has long been associated with out-of-control sexuality and emotional dependence. As a result, it's been more or less exiled from many psychotherapists' offices. Yet touch and contact are basic to our experience of security, connection, separateness, and solidity. Almost all newborn mammals, including human beings, must have touch--and lots of it--simply to live. For a baby, touch is tantamount to life. We're now understanding how early touch, or lack of it, influences neurological development and biochemistry. Lack of touch and contact have a negative effect on attachment, self-concept, learning, moral development, and even motor development and coordination.
Touch is imbued with communication. Secure touch is a primary way our caretakers help us manage the overwhelming emotions of infancy. In the best of worlds, our mothers hold us when we're scared or hungry or angry. Much of our feeling of self-acceptance is based on the acceptance that came through our skin through our contact with our mothers and other caretakers. Early rejection, even if unintentional, also comes through our skin and other bodily senses.
For some clients, early touch and lack of touch formed an internal reality that can't be changed by words alone. Without the life-giving nurture that touch provides, these people live dried-out lives, deprived of bodies and caught in the isolation of their heads. Dissociation--the split between the head and the body--can result from the absence of touch, just as it does from abusive touch.
Flora has spent much of her life in dissociation. Although she leads what others might consider a functional life, she doesn't ever feel real, nor do others around her feel real to her. She knows cognitively that she and other people exist, but she just doesn't experience it physically. Her world is a mental construct through which she navigates somewhat efficiently, but with underlying fear and no satisfaction.
Flora and I have been working together for three years. When she leaves my office, she can't hold onto the experience of our relationship. She believes that outside of the session, she, literally, doesn't exist for me. Even when Flora sits directly in front of me, she isn't quite sure that I'm real or that she's real. Visually, I'm flat to her, like a two-dimensional photograph.
During one session, I ask Flora if she wants to hold my hands to feel that I'm here. First, she holds my hands. Then she asks me to hold hers and squeeze. She needs the pressure to actually feel the touch, otherwise, she must tell herself that that I'm touching her.
Flora is looking directly at me but she still doesn't feel herself or me enough. A shadow of fear crosses her face. "Can I touch your face?" she asks.
I've known Flora for a long time now and know what an important question this is. "Yes," I say.
Flora's hands come up to my face. They're shaking and trembling. She's not caressing me, but feeling my face, as a blind woman would. She's feeling the three dimensions of me, the flesh and blood of me, the reality of me. She feels my face, then my head, placing one hand on my forehead and one hand on the back of my head. She's feeling that I have volume, bringing together her visual perception of me and a tactile sense to let her know that I exist outside of her idea of me.
"Now I want you to touch my face," says Flora.
"Okay, but I want you to put your hands on my wrists so you can pull my hands back if at any time this feels uncomfortable or like it's too much for you. You can also tell me if you want me to stop, at any time, for any reason."
She puts her hands on my wrists and I firmly place my hands on her cheeks as I look at her. This isn't about affection; it's about Flora's need to feel her physical existence while she experiences my physical existence. I keep my hands firm as I touch her jaw, her forehead, the back of her head. Her breathing relaxes. She looks more present. "I can feel myself," she says. She sounds relieved rather than excited. "I felt you." Flora has felt the boundary between herself and an other.
For Flora, this was just a taste of coming into existence. After this initial break into touch, we repeated this many times, assuring her that both she and I existed. My touch on her face let her feel accepted by me and eventually began to help her develop an internal body sense of self-acceptance.
Touch isn't just nurturing and connective; it also creates a boundary between us. Our skin is the outer boundary of our being. Children who aren't well touched or well protected, or who are violated by touch, often fail to develop workable boundaries as adults, in part because they can't feel the simple boundaries of their bodies. If we can't feel our skin or the structure of muscle that protects our internal organs, we walk around feeling like raw, floating psyches without protection, defense, or definition.
Mary is trying to role-play telling her husband that she wants him to stop making fun of her, but she keeps losing energy when she imagines how angry he'll be. She has no way to sustain what she wants, because she feels like she has no protection in the front of her body. Her skin, she says, feels like cobwebs. "Someone could walk through me." So we try something different. I step in front of Mary with my back toward her and ask her to get very close, so that my back covers the front of her body. I ask her to put her arms around my waist for a moment to feel how thick my body is and to feel that this thickness is between her and her husband, protecting her. I ask her to put her head over my shoulder and talk to her husband again. After a moment, she begins to speak. Her voice is stronger, and she manages to get out what she wants to say. As I move away, I ask Mary what she feels in her body.
"I still feel your back protecting my front," she says. I ask her to consciously remember this body feeling, so that she can use it to help her when she needs a boundary.
Touch by the therapist isn't the only boundary builder. Having your client firmly touch her own skin and feel the definition of her body with her own hands can be the beginning of developing body boundaries. Encouraging awareness of what touches her skin, including clothes, shoes, air, and water, is another boundary builder.
Touch can humanize and ground the therapeutic relationship. The educated use of touch can remediate severe forms of abuse and neglect, and normalize the most basic of our human experiences--that of being in a body. Our willingness, as therapists, to touch our clients in safe and appropriate ways can help them begin to make a distinction that abuse and neglect may have erased: "good touch" vs "bad touch," safe vs unsafe, nurturing vs sexual.
Without training in the psychotherapeutic use of touch, extensive use of touch, such as holding, can backfire. But the conscious use of touch, grounded in the history of a client and the context of the therapeutic relationship, can be life-changing. Something as simple and human as touching a client's hand while she's crying or a touch on the shoulder when leaving can convey a feeling of acceptance of the client exactly as she is. When we include touch that's "care-full" and well considered in our verbal work, we can begin to foster a sense of self-acceptance in our clients that words alone might not achieve.
In a sense, all psychotherapy is body psychotherapy. Words affect the brains, the nervous system, the circulation, and the biochemistry of the people we work with, just as body psychotherapy influences and changes their ideas and concepts. While verbal and body psychotherapy approach the body-mind from opposite ends, they meet in the center of the person.
We're born to be at home in our bodies. But for all the reasons clients come to therapy, many lose that sense of a secure base along the way. Their bodies, designed to protect them, emotionally and physically, sometimes become alien and threatening territory to them. Body psychotherapy has evolved to help those who've spent years searching for home discover, as Dorothy did, home has been there all along. n
Barbara Goodrich-Dunn, B.F.S., has been a body-oriented counselor for 30 years. Coauthor of The Psychology of the Body , she's the codirector of the Washington Institute for Body Psychotherapy and one of the founders of the United States Association for Body Psychotherapy and the DC Area Guild of Body Psychotherapists. Address 8830 Cameron Street, #206, Silver Spring, MD 20910. E-mails to the author may be sent to firstname.lastname@example.org. Letters to the editor about this article may be e-mailed to email@example.com.…