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In the ongoing practice of psychotherapy clients and therapists exchange many words in the often frustrating attempt to make the therapeutic conversation come alive. In the midst of all the verbal communication what is often missing is the sense of both people being fully engaged and focused. Therapy can often too easily become reduced to people talking, communicating with words, and often ignoring the intense sense of life that can emerge when we tap into our immediate emotional and body-centered experience.

While many forms of communication take place outside of verbal dialogue, many therapists have little knowledge how to bring the nonverbal, present moment experience into their work. Yet, with a few basic principles and methods, many of them drawn from body-centered experiential psychotherapy called the Hakomi Method, therapists can help clients in a different way, which enhances both the intensity and the effectiveness of psychotherapy. (Kurtz, 1990).

The vast undercurrent of our experience is only partly and imperfectly reflected in verbal expressions. In fact, we communicate our inner states and our implicit beliefs in models of the world most clearly through nonverbal ways, which include gestures, postures, pace, tension or relaxation of our muscles, and other subtle somatic communications. To workText Box: New York Center for Somatic Psychotherapy & Trauma ResolutionText Box: Laurie F. Schwartz, L.M.H.C, M.S.Text Box: 1 Lincoln Plaza Suite 21J New York, New York 10023 with the present moment experience of clients, therapists need to learn how to be able to pay attention to these nonverbal signals. This can be difficult for many people who have been well trained to pay attention to the content of the client’s story. (Kepner, 1987).

As therapists we can notice and attend to the outward signs of internal experience. One way to accomplish this is to keep asking ourselves, “What is the client doing right now? How are they doing it? What experience are they having as they are doing this?” For instance the client could be looking down, moving in his seat, or perhaps being frozen and very dissociated. A client may be talking with great emotion or in a very cognitive, mental way. The client can be blaming, attacking, or defending herself. Each of these is an indicator of an internal experience as well as a set of beliefs and models of the world that underlie this client’s behavior. For example, later on in my paper when I discuss the case of Ingrid you will see that, very often, she is communicating, feels rushed and desperate inside, and she is talking but does not really want to rest or relax. Many times I interrupt the conversation just to get her to experience the internal experience of the outward manifestation of her behavior. I do this by having her slow down and contact sensations in the present moment, we call these ‘states of slowing down’ mindfulness

I am going to name a partial list of physical signals that a body-centered psychotherapist will track in helping the client explore their inner state.

1. Voice – How much or how little emotion is contained in somebody’s voice? Is the tone of their voice weak, loud, quiet, or strong?

2. Body – What’s the body’s position? How is the body in relationship to gravity? What images does the body evoke? Is the body grounded? Is it light? Is it constricted? How is the energy moving through the body? Is it flaccid or tight?

3. Movement – Are the client’s movements relaxed or active? Are their movements jerky or smooth, controlled or spontaneous?

4. Gestures – Does the client move or gesture? Is their gesture repetitive? What is the quality of the gesture? Is it gentle, aggressive, abrupt?

5. Posture – How is the client’s posture? Is it rigid, collapsed, threatening, over grounded, ready to spring into action, expressive

6. Eyes – Do the eyes look glazed? Do they lack luster or liveliness? Do they look scared, defiant, or threatening?

7. Muscle tension and relaxation – Noticing the patterns of tension and when they change. Is the client in touch with their breathing? Do they feel the ground beneath them or is most of their awareness above the neck?

8. Verbal pace and tonal quality – Is the client’s speech pace fast, slow, or does it vary? Is the tone of their voice harsh, even, melodic, monotone, or soft?

In body-centered psychotherapy as well as other modalities the therapist is paying attention to the client’s experience in the present moment. In contrast contacting, the act of reflecting back to the client their present experience, helps them shift their attention to the here-and-now and begin the process of deepening their awareness into their present moment experience. It also lets the client know that the therapist is connected with them; even simple contact statements can make the client feel deeply held and seen. This is a typical Rogerian approach that is used also in body-centered psychotherapy. Contacting is different from the process of mirroring back to the clients the content of what they say; it is the process of joining with their nonverbal communication and what it reveals about their unconscious processes. A contact statement lets a client know that you are aware of their internal world and you are noticing their communication on more than one level. This is an act of intimacy. For example, if a tear rolls down the client’s cheek, you might gently say, “Sad huh?” This has a different effect than saying “How are you feeling?” Psychotherapists are often trained to ask the clients questions about their experience as opposed to noticing what is actually unfolding in front of them in the present moment. Questions such as these, while they are staples of therapeutic interviewing, often do little to further the therapeutic alliance; they require the client to analyze what is going on and signals to them that we are either unconscious or we are inattentive. Why ask if they are already communicating to you nonverbally? By contrast when we reflect back their experience in the spirit of compassion, curiosity, and transparency clients typically feel more joined with and more attended too. These are some effective contact statements and the key features of a contact statement.

1. They are simple. If you speak in a complicated way you’ll engage more of the cognitive part of the client’s brain and then you will lose the experiential element.

2. They have a curious inquisitive tone. Since you are not trying to force your impressions or your agenda your statement indicates flexibility by the inflexion of your tone. You do not have an agenda and you are not trying to lead them into any technique.

3. They focus on how the client is behaving as well as what the client is saying. The qualities with which the person is talking, walking, shaking hands, or gestures provide important information on how the person is organized internally.

4. A contact statement supports whatever the experience is in the present moment.

5. The contact statement conveys the therapist’s curiosity, their acceptance, and their enthusiasm for the unfolding of the client’s experience

6. The contact statement is flexible rather than a question. (Kurtz, 1990).

Here are some examples of how a contact statement can be used to build therapeutic alliance. For example:

Posture: “You look like you’re ready to spring out of your seat” or “Ah, you’re looking down huh?”

Gestures: to a woman pushing her hand, “Seems like your hand is pushing something away.”

Verbal pacing: to someone who might be speaking very fast you might say “You’re feeling pretty rushed inside, pretty speeded up huh?”

Eyes: to someone who is looking down, “It’s hard to make contact when you say that?” For example in family therapy for someone who is not looking directly at the person in the room you could say “Hard to look at her when you say that huh?”

Dynamics of presence: “It seems like your energy level went when your family members’ went down.”

Quality of voice: “Seems like there’s a quality of anger or confusion in your voice when you say that.”

Verbal observations: “Seems like you end every few sentences with a question mark, are you aware of that?”

Hesitance: “You’re not saying much about this topic, sounds like it might be hard to talk about this, huh?”

A defensive maneuver: “I just noticed that you crossed your arms and you turned your head away, is there any way you might be holding back some feelings, huh?”

Some therapists seem to be concerned that when you name a client’s experience it deprives them of the opportunity to express it or name it themselves. I find that this is not really true, even reflecting on the content of what people say does not deprive them of the ability to talk about their lives. Very often it brings them more into the present moment and lets them know that you are fully paying attention to them. It gives them time to be with themselves.

Once you have noticed the physical aspects of your client’s experience and you have contacted it, the next step in this body-centered process of psychotherapy is to allow the experience to move or unfold toward core organizing material. When a client is immersed in her experience, she has the opportunity to bypass usual responses and defenses and cannot explore in a more visceral fashion these concepts and attitudes that underlie her perceptions, behaviors, and feelings. For this reason we move our therapy process from ordinary consciousness and external awareness into mindfulness and down into deepening more in the body. (Kurtz, 1990).

For example, if a client seems to be tightening her jaw when the husband is talking about his job the therapist might contact the feeling state by saying one or more of the following “Seems like you’re a little angry huh?”, “Looks like you are feeling frustrated huh?”, or “Your jaw seems like it is clenching huh?” This is to help immerse the client in the experience and you might then say to the client “Just let yourself stay with that anger, let’s just invite that feeling to be here.” You can then ask the client to explore some aspects of her experience. In this case you might say any of the following to the client “Notice where you feel the anger in your body,” “What words, images, or memories are there that go with this feeling of anger,” or “What is familiar about this feeling?”

As therapists many people often feel they are responsible for knowing what comes up next in the session or for interpreting the internal world of the client, but just like the skin has its own intrinsic knowledge of how to heal a cut, we also believe the psyche has an innate intelligence and, given the right conditions, it will unfold in the healing direction. We just need to assist clients by staying deep in their experience while it is unfolding. (Montague, 1969).

Mindfulness is a basic tool that helps the clients notice what is usually an unconscious level of their experience, something they might ignore, while teaching them how to explore their core beliefs and how their attitudes organize their world. This therapeutic device is a state of self observation in which the normal trance-like consciousness through which we perceive our lives is replaced by present centered awareness and attention. At the heart of mindfulness is a willingness to notice one’s present experience without judgment or without any effort or need to make a change. To induce mindfulness it’s crucial for the therapist to first slow down internally. You might then say to your client “Take a moment and turn your attention inside, you can begin to notice what comes up all on its own when you stay in the present moment.” Therapists can also say to their client “You might notice thoughts, feelings, sensations, images, impulses, or memories that come up in your body. Also, nothing may happen and that is all right.” We tend to give the client a menu so they know what their options are. Part of this process is educational and there is no pressure. We just ask the clients to notice what naturally arises when they do this and report what they discover back to us. You will notice that, with the clients I have chosen to discuss, I use this tool several times.

We consider people to people holographic. How people walk, talk, shake hands, or move are all holographic fragments of how they are psychologically organized in the larger arena of their lives. Through the process of mindfulness we really help the person stop what is an automatic habit pattern and start to focus inward in order to get more intimate and understand how their body is organized and what is going on below ordinary consciousness. Very often clients are interested because they feel alive and they are getting to experience themselves in a way that is different from a purely cognitive state. The possibilities for experiments and interventions using mindfulness are limitless. This tool is flexible, versatile, and can be implemented in any creative situation attempted by the therapist. Anything the client experiences can be studied in mindfulness and you can also bring in family members in mindfulness and help understand how the client is in relationship to the family system. (Kychtwald, 1977)

However, before a therapist can engage a client in mindfulness a safe psychological container must be created in the office while having nonviolent interventions. The therapist must ask the client to bring mindfulness into the focus so that the experience of their thoughts, actions, or feelings can be explored in a nonjudgmental, compassionate fashion. Working this way involves a certain commitment and a willingness to take responsibility for one’s life in that existential approach that Yalom speaks about. It requires that we come out from behind the protective cloaks of giving authority away and we proceed hand-in-hand with the clients on an adventure. This adventure is to help them unfold their whole conscious self.

Somatic Psychotherapy

For many therapists the world of somatic psychotherapy still has a somewhat bewildering quality, much like that of an undiscovered land, despite that it has been around for more then 80 years. There is a wide range of approaches to somatic psychotherapy, some of which I will define at the end of this paper. They all have their own terminology and specialized methods, and 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 work differently from more traditional talk therapy? The body-psychotherapist is far more likely to make a client move, stand, hold themselves, and breathe as important in the assessment of whom they are and what they need as much as what they say about themselves. You will notice in my sessions that many times I will ask the client to refer back to sensation, back to her body, because the deeper belief in somatic psychotherapy is that we need to connect with ourselves below pathology, which is at the “state of being,” this means being connected to our core selves through sensation with words coming later. Therefore a body-psychotherapist will typically bring their clients’ bodies into the treatment through sensation, the awareness of breath, the awareness of a gesture, or through touching. (Levine, 1997).

As therapist, we might not be aware of how much our bodies are sensors of our client’s underlying reality as well as communicators of our own reality. I remember 20 years ago when I was training as a body-psychotherapist, Ron Kurtz came over to me and he put his hands under my shoulders. Immediately I got in touch with the fear that I had been storing in my body that I was out of touch with. This one little movement and gesture under my shoulders was enough to show me the fear I was holding there. I was surprised and I was also grateful for this awareness. By focusing me on that immediate physical dimension of my armoring, my shoulders, Ron Kurtz opened me up to new doors for perception. This small somatic intervention also had other effects on me. It heightened my awareness of my own body’s experience. Such a small gesture was enormously beneficial.

Body Psychotherapy Methodology

Breathing

Our ancestors understood that our psychological experience is often rooted in breathing, both psyche and spirit have their origins in 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 or experience sensation and emotion. Sometimes subtly while other times quite dramatically, changes in breathing patterns are one of the principle ways that our internal ecology adapts to the sudden demands of the external situations we find ourselves in. For example, we breathe in distinctive ways when we feel fear, panic, excitement, pleasure, love, anticipation, anger, or sadness. Think about the sharp intake of breath when we feel awe and we say “ah, he took my breath away” or the shallow rapid breathing of fear when we say “I was breathless with fear,” or perhaps the feeling of suffocation when someone is too close to us and we say “I cannot breathe around this person.” (Pierrakos, 1987)

This fundamental component of our biological design can give a therapist 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 then temporary relief, it can also give her some control over the belief and the physical experience that anxiety creates. Sometimes breath-work can be more effective than talking in demonstrating to a client her own capacity to relax herself.

By relaxing our bodies the breath diminishes and the inherent arousal in anxiety, along with the thoughts that are associated with the arousal, relaxes. Focusing our attention on the here-and-now experience of breathing brings our mind back from the anticipated future where the anxiety reigns. Once we relax, we are able to work with the thoughts that fuel the feeling of anxiety. (Levine, 1997).

Body Identity

There is a continuous stream of messages occurring in the background of our awareness that comes from the physical and emotional state of our bodies. Our bodies tell us whether we feel strong or weak, tense or relaxed, stable or unbalanced, along with many other qualities that range from the physical to the psychological. Clients will often talk of feeling like a nobody and wanting to be a somebody. It is no accident that the body is central to both of these expressions of identity. Identity is formed by more than a concept, construct, or an image. It is also based in our physical and emotional sensations, our flesh and bones, and how we think about ourselves is also connected to how we experience the distinctive qualities of being alive in our bodies.

How we hold our bodies, how tense we are, or how loose we are helps us manage our emotions just like breathing does. When we observe how our clients stand, sit, gesture, or move, we are watching their emotional present. Our bodies are also expressing our past; our habits of survival are written into curled shoulders, stiffened jaws, or an inflated chest. When we look at our client’s body with awareness we can begin to see their story expressed in their muscles and bones and we can start to get in touch with their body’s version of their tale. (Kurtz, Prestera, 1976).

Touch

Touch has long been associated with sexuality and emotional dependency. As a result, it has been more or less exiled from many psychotherapist offices. Yet, touch and contact are basic to our experience of security, connection, separateness, and solidity. Almost all newborn mammals, including humans, must have touch, and lots of it, simply to live. For a baby, touch is tantamount to life. We are now understanding how early touch, or lack of it, influences the neurological development and the biochemistry. The lack of touch and contact has a negative effect on attachment, self-concept, learning moral development, and even motor development and coordination.

Touch is imbued with communication. Secure touch is the primary way adults help infants manage their overwhelming emotions. In the best of worlds mothers hold their children when they are scared, hungry, or angry. Much of our feeling of self acceptance is the result of the acceptance that came through our skin through our contact with our mothers and our other caretakers. Early rejection, even if unintentional, also comes through our skin and other bodily senses. (Montague, 1969).

For some clients, early touch and lack of touch formed an internal reality that cannot be changed by words alone. Freud defined trauma as a breach of the protective stimulus barrier leading to feelings of helplessness and overwhelm. Often clients who have suffered trauma have sensation and impulses frozen in their body and they are not fully alive in the present moment. Without the life-giving nourishment that touch provides many traumatized people live dried-out lives, deprived of bodies, and caught in the isolation of their heads. What we call dissociation, the split between the head and the body, often results from trauma and the absence of touch or abusive touch.

Touch is not just nurturing and connective, it also creates a boundary between people. This is illustrated in the demonstration sessions included at the end of this paper. Our skin is the outer boundary of our being. Children who are not well-touched, well-protected, or have been violated by touch often fail to develop workable boundaries as adults, in part because they cannot feel the simple boundaries of their bodies. If we cannot 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. The case I present will provide you with an example of how touch is used to help recreate a boundary. (Keleman, 1987).

Touch by the therapist is not the only boundary builder. You can have your client firmly touch her skin and feel the definition of her body with her own hands and that can be the beginning of developing body boundaries. Therapists can also encourage awareness through the items that touch the client’s skin including the clothes she wears, shoes, the air. The ground beneath her is another boundary builder. The contact achieved through touch can humanize and ground a therapeutic relationship. The educated use of this tool can alleviate severe forms of abuse and neglect, and normalize the most basic of our human experiences – that of being in a body. Our willingness, as therapist, to touch our client in safe and appropriate ways can help them begin to make distinctions that abuse and neglect may have erased: good touch versus bad touch, safe versus unsafe, nurturing touch versus sexual touch.

Extensive use of touch, such as holding, without the proper training in the psychotherapeutic use of this tool can backfire. But the conscious use of touch, grounded in the history of the client and the context of the therapeutic relationship, can be life-changing for the client. 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 the use of touch that is careful and well considered in our work, we can begin to foster the sense of self acceptance in our clients that words alone may not achieve. In both of the sessions I have included in this paper you will see how the clients are supported in touching themselves in the present moment through sensation and as their work continues I gradually introduce touch with their permission.

In a sense all psychotherapy does effect the body. Words effect the brain, the nervous system, the circulation, and the biochemistry of the people we work with, just as body psychotherapy influences and changes the ideas and concepts of people. While verbal and body-psychotherapy approach the body and mind from opposite ends, they both meet in the center of the person. Hopefully we are born to be at home in our bodies. For all the reasons clients come to therapy many have lost the sense of a secure foundation somewhere along their journey. Their bodies, originally designed to emotionally and physically protect them, have become alien and threatening territory, especially those who have been victims of trauma or abuse. Body-psychotherapy is evolving to help those who spent years searching for a home and to discover their basic home in the state of being, bonding, and belonging to themselves in the present moment.

Somatic Psychotherapeutic Definitions

Bioenergetic Analysis – Identified with psychiatrist Alexander Lowen, is one of the best known of the neo-Reichian psychotherapies. It works with exercises and new body positions designed to elicit buried emotional experiences. It may involve strong emotional expression, such as hitting, kicking, reaching, crying, and yelling aimed at educating the body and psyche to work together in processing emotion.

Core Energetics – Was founded by psychiatrist John Pierrakos. He originally worked with Lowen in developing bioenergetics, but split with him to bring a more spiritual dimension into his own body oriented approach.

Dance Therapy – First developed at St. Elizabeth’s Hospital in Washington, D.C., in the l940s, involves the psychotherapeutic use of movement to further emotional, cognitive, social, and physical integration. It’s long been accepted within the therapeutic mainstream, particularly in work with inpatient populations.

Pesso Boyden System Psychomotor Therapy – A highly structured psychotherapy that uses body movement developed by Albert Pesso and Diane Boyden Pesso. Clients are assisted in organizing scenes in which they can symbolically satisfy basic, developmental needs and create new experiences that can offset their traumatic histories.

Hakomi – Body-centered psychotherapy developed by Ronald Kurtz, seeks to heighten clients’ awareness of core patterns of emotional, cognitive, and somatic responses. Central to the Hakomi method are carefully designed “experiments,” which may involve listening to a statement, changing a position or posture, or working with gesture.

Integrative Body Psychotherapy – Developed by Jack Lee Rosenburg and Marjorie Rand, tracks interruptions to the somatic sense of self stemming from psychological, emotional, and relational patterns formed in the preverbal and precognitive stages of development. It integrates verbal and cognitive work with breathing, movement, and awareness of boundaries, grounding, and presence.

Rubenfeld Synergy – Was developed by Ilana Rubenfeld, who studied with Fritz Perls and Moishe Feldenkrais, the founder of Awareness Through Movement and Functional Integration. Rubenfeld Synergy flows between touch, gentle movement, dialogue, and humor. Work may take place on a table, standing, or sitting.

Sensorimotor Psychotherapy – Developed by Pat Ogden, strongly distinguishes between developmental issues and the treatment of trauma. Through movement and increasing the sensorimotor awareness, it helps clients learn to modulate their traumatic experience and increase their capacity for self-regulation.

Somatic Experiencing – Developed by Peter Levine, is partially based on the similarities between the regulatory systems of animals and humans in dealing with traumatic events. It teaches clients How to slowly and safely complete survival actions, interrupted at the time of trauma, as they learn to renegotiate their traumas rather than relive them.

References

1. Campbell, David. Touching Dialogue : A Somatic Psychotherapy for Self realization. New York: In Hand Books, 1989.

2. Dychtwald, Ken. Bodymind. New York: Pantheon Books, 1977

3. Johnson, Greg, and Ron Kurtz. Grace Unfolding: Psychotherapy in the Spirit of the Tao-Te Ching. New York: Bell Tower, 1991.

4. Keleman, Stanley. Living Your Dying. New York : Random House, 1974

5. – Your Body Speaks It’s Mind. New York: Gestalt Institute of Cleveland, 1987

6. Kepner, James. Body Process. New York: Gestalt Institute of Cleveland, 1987

7. Kurtz, Ron. Body-Centered Psychotherapy: The Hakomi Method. Mendocino, California: Life Rhythm, 1990

8. Kurtz, Ron, and Hector Prestera. The Body Reveals. New York, Harper and Row, 1976

9. Levine, Peter. Waking the Tiger: Healing Trauma Through the Body. North Atlantic Books, Berkely, California 1997.

10. Lowen, Alexander. The Betrayal of the Body. New York: Macmillan, 1967

11. Mindell, Arnold. Working with a Dreaming Body. Boston: Routledge and Kegan Paul, 1985

12. Montague, Ashley. Touching. New York: New York University Press, 1969

13. Pierrakos, John. Core Energetics. Mendocino, California: Life Rhythm, 1987

©Copyright 2009 by Laurie F. Schwartz, L.M.H.C, M.S. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Laurie and/or see her GoodTherapy.org Profile