The Body in Psychotherapy: Creating Integration

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 people in a different way, which enhances both the intensity and the effectiveness of psychotherapy.

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 work with the present moment experience of an individual, 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 a person’s story.

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 person doing right now? How are they doing it? What experience are they having as they are doing this?” For instance, the person could be looking down, moving in his or her seat, or perhaps being frozen and very dissociated. A person may be talking with great emotion or in a very cognitive, mental way. The person can be blaming, attacking, or defending himself/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 person’s behavior. Many times, I need to interrupt a therapeutic conversation to get a person to experience the internal experience of the outward manifestation of their behavior. I do this by having them slow down and contact sensations in the present moment, we call these “states of slowing down” mindfulness.

A partial list of physical signals that a body-centered psychotherapist will track in helping a person explore his or her 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 person’s movements relaxed or active? Are their movements jerky or smooth, controlled or spontaneous?
4. Gestures: Does the person move or gesture? Is their gesture repetitive? What is the quality of the gesture? Is it gentle, aggressive, abrupt?
5. Posture: How is the person’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: Notice the patterns of tension and when he or she changes. Is the person in touch with their breathing? Does he or she feel the ground beneath them, or is most of their awareness above the neck?
8. Verbal pace and tonal quality: Is the person’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 an individual’s experience in the present moment. In contrast, contacting, the act of reflecting back to the person 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 person know that the therapist is connected with them; even simple contact statements can make the person 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 person 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 person 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 a person’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 person questions about their experience as opposed to noticing what is actually unfolding in front of him/her 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 individual 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, people typically feel more joined with and more attended, too.

Some 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 person’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 inflection 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 person is behaving as well as what the person is saying. The qualities with which the person is talking, walking, shaking hands, or gesturing 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 person’s experience.
6. The contact statement is flexible rather than a question.

Some examples of how a contact statement can be used to build therapeutic alliance:

1. Posture: “You look like you’re ready to spring out of your seat,” or, “Ah, you’re looking down, huh?”
2. Gestures: To a person pushing their hand, “Seems like your hand is pushing something away.”
3. Verbal pacing: To someone who might be speaking very fast, you might say, “You’re feeling pretty rushed inside, pretty sped up, huh?”
4. 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 him/her when you say that huh?”
5. Dynamics of presence: “It seems like your energy level went down when you talk about your family members’.”
6. Quality of voice: “Seems like there’s a quality of anger or confusion in your voice when you say that.”
7. Verbal observations: “Seems like you end every few sentences with a question mark; are you aware of that?”
8. Hesitance: “You’re not saying much about this topic. Sounds like it might be hard to talk about this, huh?”
9. 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?”

Some therapists seem to be concerned that when you name a person’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. 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 an individual’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 person is immersed in his or her experience, he/she has the opportunity to bypass usual responses and defenses. He or she can now explore, in a more visceral fashion, these concepts and attitudes that underlie his/her perceptions, behaviors, and feelings. For this reason, we move our therapy process from ordinary consciousness and external awareness, to mindfully deepening into the body.

For example, if a person seems to be tightening his/her jaw when their spouse is talking about his/her 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.” This is to help immerse the person in the experience, and you might then say, “Just let yourself stay with that anger, let’s just invite that feeling to be here.” You can then ask the person to explore some aspects of his or her experience. In this case you might say any of the following: “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 an individual; 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 people by staying deep in their experience while it is unfolding.

Mindfulness is a basic tool that helps the individual notice what is usually an unconscious level of their experience, something they might ignore, while teaching them how to explore their core beliefs and attitudes. 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 need to make a change.

To induce mindfulness, it’s crucial for the therapist to first slow down internally. You might then say to a person, “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, “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 person a menu so they know what their options are. Part of this process is educational and there is no pressure. We just ask the person to notice what naturally arises when he/she does this, and report what is discovered back to us.

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 help the person stop what is an automatic habit-pattern and start to focus inward. This allows a more intimate and understand how their body is organized and what is going on below ordinary consciousness. Often people are interested because they feel alive. 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 person experiences can be studied in mindfulness. You can also bring in family members, in mindfulness, to help understand how the person is, in relationship to the family system.

However, before a therapist can engage a person in mindfulness, a safe psychological container must be created, while having nonviolent interventions. The therapist must ask the person to bring mindfulness into 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 Irvin 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 individual on an adventure. This adventure is to help them unfold their whole conscious self.

Somatic Psychotherapeutic Definitions

Bioenergetic analysis: Identified with psychiatrist Alexander Lowen, it 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, DC, in the l940s, it 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. People 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: This body-centered psychotherapy developed by Ronald Kurtz seeks to heighten a person’s 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, it 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 people learn to modulate their traumatic experience and increase their capacity for self-regulation.

Somatic experiencing: Developed by Peter Levine, this is partially based on the similarities between the regulatory systems of animals and humans in dealing with traumatic events. It teaches people 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. (1989). Touching Dialogue : A Somatic Psychotherapy for Self realization. New York: In Hand Books.
2. Dychtwald, Ken. (1977). Bodymind. New York: Pantheon Books.
3. Johnson, Greg, and Ron Kurtz. (1991) Grace Unfolding: Psychotherapy in the Spirit of the Tao-Te Ching. New York: Bell Tower.
4. Keleman, Stanley. (1974). Living Your Dying. New York : Random House.
5. Your Body Speaks It’s Mind. (1987). New York: Gestalt Institute of Cleveland.
6. Kepner, James. (1987). Body Process. New York: Gestalt Institute of Cleveland.
7. Lowen, Alexander. (1967). The Betrayal of the Body. New York: Macmillan.
8. Mindell, Arnold. (1985). Working with a Dreaming Body. Boston: Routledge and Kegan Paul.
9. Montague, Ashley. (1969). Touching. New York: New York University Press.
10. Pierrakos, John. (1987) Core Energetics. Mendocino, California: Life Rhythm.

© Copyright 2009 by Laurie F. Schwartz. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

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