Using Our Bodies to Get to the Heart of the Matter
by: Mary Sykes Wylie
A brilliant, thirty-something architect named Frank went to see Minnesota psychologist Patrick Dougherty because he'd never been able to sustain a successful, lasting relationship. Charming and voluble, he talked nonstop about his work, his social life, his multiple affairs, what he thought about art, architecture, music, politics, and the general state of the world. Several times during the first two sessions, Dougherty--who makes use of qigong breathing techniques in his clinical work--asked Frank to slow down and focus on his breath. In response, Frank would groan melodramatically, roll his eyes, take a couple of loud, stagey mock-breaths, and then skip right back to his (admittedly entertaining) monologue. Finally, a bit exasperated himself, Dougherty insisted, "Frank! Can't you just stop talking for a minute, relax, and breathe deeply?"
Frank stopped, shrugged, took one deep breath, and then screamed at Dougherty, "I don't want to fucking breathe! Don't you get it? I don't want to fucking breathe because I hate my life!"
To pause, breathe deeply, and pay attention to how it felt--nothing more dramatic than that--was enough to make Frank feel at the core of his being the extent of his anguish and loneliness. "Our clients come into therapy because they don't like the experience of themselves they're having, and they're fighting it," says Dougherty. Breathing deeply means being present to your experience and letting go of what you're holding onto." But even such a presumably innocuous bit of "bodywork" can have surprising power, making people aware of hidden emotional pain that weeks of talk therapy might not uncover. Too much power for Frank, apparently. The mere prospect of slowing down for 20 seconds and paying attention to his own body and pent-up misery was so threatening that he bolted, never returning for another session.
At first glance, Frank's reaction seems more than a little over the top. What is it about breathing, just breathing, that might cause somebody to flip out? But what Dougherty and thousands of other therapists have been discovering--or rediscovering--during the past few years, is that enlisting the body's resources in psychotherapy, even in the gentlest, most decorous, and least intimidating way possible, can have a dramatic impact on the therapeutic experience. Many are claiming that when approached skillfully and judiciously, the client's body can be, to update Freud's famous pronouncement about dreams, the "royal road to the unconscious"--a way to bring forth and immediately engage deep emotional issues that might never fully surface in plain talk therapy.
At Two with the Body
We're not, to say the least, a culture at home with the body. From early on, we're taught to regard all that stuff below our heads (forgetting that our heads and their contents are part of our bodies, too) as somehow distinct from our real selves, the "I" and "me" hovering invisibly just behind our eyes. For many of us, the idea that our entire experience of the world and what we make of it, the way we think and feel and act, all of what we call ourselves "happens" in the very tissues and fluids of our bodies seems bizarre, impossible, almost scandalous. We seem to think of our bodies as an odd sort of property--perhaps an interior, jungly, not particularly desirable quantity of real estate--that we inhabit uneasily, subject to the peculiarities of its climate, its inconvenient rhythms, its urgent necessities.
And yet, paradoxically, we're probably the most body-conscious society on earth, obsessed with how our bodies look, how they perform, how others perceive and judge them. We spend billions of dollars and as many hours trying to diet, exercise, buff, depilate, cosmeticize, and surgically enhance our bodies so they resemble the media icons of perfection constantly before our eyes. Many of us are health worrywarts, scrutinizing every food label like Talmudic scholars, adhering to Olympian exercise schedules, constantly inspecting our bodies for suspicious moles, bumps, and rashes, trying to self-diagnose unexplained twinges, aches, or tingling sensations, and wondering if perhaps we ought to go in for a whole-body MRI, "just in case." It would all be hilarious if it weren't also so sad.
But whether we're vigilant about our bodies to the point of lunacy or slothful, junk-food-noshing, cigarette-smoking, La-Z-Boy aficionados, we almost always judge our bodies harshly, when we don't ignore them entirely. They're never thin enough, young enough, fit enough, strong enough, graceful enough, shapely enough. And yet, for all this consuming attention to the external look of our bodies and the competence of their machinery, we often don't have a clue about what's going on inside our bodies, how we really feel beneath the surface of our skin.
Given the cultural climate in which it takes place, it's hardly surprising that the body has always had a kind of shadow presence in therapy--we're aware of what we think and feel about the way our bodies look in a bathing suit, about our sexual inadequacies, about the nausea we get before a work deadline. But few therapists ever ask their clients to report directly on their bodies' experience--"What do you feel in your body and where do you feel it?"--much less encourage them to express physically what they might be feeling. The opposite has always been more the case. "Where id was, there shall ego be," wrote Freud, shorthand for the belief that civilized society and individual mental health depend upon the rational mind interpreting, analyzing, and always keeping a safe distance from the uninhibited impulses of raw instinct. Even cognitive and behavioral therapists today, who've long since declared Freud and Freudianism anathema, still believe implicitly in the almost magical effects of purposeful conversation to bring order out of emotional chaos--the power of rational self-understanding to quell the irrational forces of despair, fear, rage, and aggression.
But this is changing, prompted in large part by developments in the headiest, most rarefied of scientific research domains. The work of psychoneuroimmunologists, oncologists, neurobiologists, cardiac experts, and other medical researchers has been demonstrating the body-mind connection for 30 years. Brain science and the advent of imaging technology have made it clear just how "embodied" the mind is. In addition, during that time, the entire society has been subject to a benign invasion of mind-body techniques from the East--yoga, tai chi, qigong, martial arts training (all staples of the local Y), not to mention a wide array of meditation practices.
Within the field of psychotherapy, trauma specialists have led the way in bringing a more direct focus on the body into treatment. The pioneering work of psychiatrist Bessel van der Kolk and others (see January/February 2004 Networker ) has highlighted the way that people experience the long-range effects of trauma as much in their bodies as in their minds--in their autonomic and immunological systems, their musculature, and the way they physically hold, move, and experience their bodies. Indeed, it's the very fact that both emotion and reasoning ability are held hostage by their body's continuing physical reaction to trauma--long after the traumatic event happens--that makes healing so hard for trauma survivors, no matter how much cognitive "insight" they have into their suffering. As a result, many trauma therapists have tried to make body awareness, breathing, relaxation, and grounding techniques as integral to the therapy as talk, and routinely prescribe yoga, tai chi, self-defense training, and aerobic exercise as important adjuncts to their clinical work.
Most talk therapists, however, have a long way to go before becoming as body-wise as their colleagues in the trauma field. For generations, therapists have been taught that focusing too much attention on the body would be too arousing, enticing, or frightening for clients--it would scare them off or confuse them or make them too dependent on the therapist. It might undermine the therapist's neutrality and ruin the transference--muddle the necessary therapeutic process whereby a client naturally projects feelings for his parents onto the therapist. "Traditionally, the level of psychological intimacy was so high in psychodynamic psychotherapy that adding body work involving touch would make the transference just too intense," says University of Minnesota psychology professor William Doherty.
But it wasn't just a concern for the client that kept therapists from bringing the body into their therapeutic work. Most people are at least a little frightened of their bodies and the untoward feelings that well up from their depths; frightened of what happens beneath the skin, beneath the veneer of reason and civilized behavior. According to Susan Aposhyan, author of Natural Intelligence: Body-Mind Integration and Human Development, therapists share our culture's general phobia against the body. "Like everybody else, we therapists are afraid to attune ourselves to our own body sensations because we're afraid of losing control of ourselves--that we'll get too angry or become sexual."
So what does it take for a therapist to move past the various obstacles to bringing mind and body together in the treatment room? Many of those who got into the body business, so to speak, did so because no matter how much expertise they acquired in various forms of talk therapy, or how technically successful their work, they were dissatisfied with the outcomes. The therapy "operation" succeeded, but the client still wasn't fully alive--even if not exactly dead, either. Patrick Dougherty, for example, reports that he'd been doing therapy for years, becoming an expert at insight-oriented psychodynamic therapy, family systems, chemical dependency work, but it rarely seemed to produce the kind of results he thought his clients deserved. "I could do terrific work with people, who'd come to understand everything about themselves. I could get them to experience cathartic responses in therapy, but still they'd be living pretty much the same kind of lives--the deep, inner change I hoped for just wasn't happening."
Gay Hendricks, author of more than 20 books on conscious relationships and personal growth, remembers that the first time he used what he now calls a "presencing" technique--a way to help people become fully present in the moment by becoming conscious of what their bodies are feeling--he was a frustrated talk therapist acting on a hunch. He noticed that the man in a couple he was working with, while angrily complaining about his wife's failings, kept unconsciously touching his chest near his heart. "His words were angry, his voice was angry, his gesticulations were angry," recalls Hendricks, "but after he'd touched his chest three or four times in the course of a minute, I had one of those moments of enlightenment. 'Underneath his anger, there's sadness or grief,' popped into my mind." Hendricks told the man what he was seeing: "I hear how angry you are about this, but you keep touching your chest and usually that's where I feel my sadness . Can you tell me what's going on in your chest?"
The man stopped mid-harangue, his face fell, and he teared up. He was desperately afraid, he mumbled, that his wife's coolness meant she didn't love him anymore. Within 10 seconds, says Hendricks, the energy totally shifted between the couple. Her tight-lipped expression softened, she looked directly at her husband for the first time in the session, and the stalemated therapy got off to a new start.
Once Hendricks had discovered the body, there was no keeping him down on the farm of talk-only therapy. He began to study and acquire training in different body psychotherapies, including Core Energetics, an intense, somatic approach drawn partly from the work of radical psychiatrist Wilhelm Reich (see sidebar on page 42), intended to unblock physical, emotional, and spiritual energy. Eventually, he decided that the Reichian therapies, with their emphasis on rigorous physical manipulation to break down muscular defenses, uninhibited physical expression--yelling, grunting, pushing, kicking, hitting punching bags--and explosive release, weren't well-suited to most middle-class, mainstream clients. "I wanted to create a more consumer-friendly system that could work for everybody--6-year-olds and 83-year-olds, lawyers and doctors and teachers." He began working with his wife, Kathlyn Hendricks, a dance and movement therapist, and together they developed an eclectic method of working that includes breathwork, movement, meditation, and coaching for couples in how to communicate and listen. Like many of what might be called the second, or even third, generation of somatically oriented therapists, Hendricks is less interested in dramatic catharsis that clears out the emotional sinuses than in a softer, gentler, but presumably more lasting, habit of mindful awareness--in which body and mind are deeply attuned to what's going on. The "Holy Grail" of therapy, Hendricks says, is helping clients become more fully present in the daily moment, to respond directly and immediately to what's happening in the here and now of ordinary life. It's an article of faith among many somatically oriented practitioners that the body knows more, knows it more directly, and expresses it more honestly than the often muddled, deceitful, and fearful mind. Rather than talking about problems, filtering them through the mind's stratagems of avoidance, clients are encouraged in one way or another to bodily inhabit and feel them, whereupon, it's often revealed that what they thought were the problems aren't really the problems at all
So Hendricks works at encouraging the body to "speak even louder" than it already is, amp up the volume of what it's trying to say, so its brain-deafened proprietor can hear it. For example, a couple walks into his office sullen and angry with each other, having had the same argument in the car that they've been having all week and probably for the preceding six months. The woman has a contemptuous, closed look on her face, and turns slightly away from her husband when she sits down. Her arms fold defensively. He has an angry, hostile look on his face, as he sits, shoulders hunched, glowering at her.
The Hendrickses begin by asking them if they're willing to resolve the issue "right now." Startled, the couple says yes. The Hendrickses then ask them to exaggerate as much as they can the postures and facial expressions they have. He should jut his jaw out even farther, glare at her even harder, bunch up his shoulders even more, and exaggerate as much as possible his threatening stance. She, meantime, should exaggerate as much as possible her expression of contempt, her slightly cowed, turned away posture, and make herself the complete incarnation of disgust and timidity. Once the two have worked themselves into the most extreme versions of their feelings that they can, they're asked to freeze in these positions, take a few deep, conscious, breaths, and concentrate on the emotions that come up. Amazingly, in both, something completely different boils up to the surface--they're both terrified of abandonment and so afraid the other will leave or cease their loving that they've shielded themselves in "safer" emotions of hostility and contempt. This joint realization makes them surprising, and surprised, allies in therapy--because they share the same fundamental emotions--and sets the clinical work on a new track entirely.
"Before my body-centered days," says Hendricks, "I would have tried to help them each relax, and both would get the chance to talk about their feelings and why they felt the way they did. Eventually, it might work--we might get to the same recognition of what really bothers them--but it would take forever. When you stop and focus on consciousness of your feelings, you can see and feel things you couldn't see and feel before."
Therapeutic skeptics still cite the possibility of stirring up intense transference and countertransference responses as a compelling reason not to use more body-oriented approaches. But therapists who work somatically maintain that transference and countertransference (the feelings and projections stirred up in the therapist by the client) are no bigger a problems for highly trained and skilled body psychotherapists than for well-trained talk therapists. "Transference problems happen in any therapy," counters Nancy Napier, a therapist in New York City, who uses Somatic Experiencing in her work. "What matters is how good the therapist is as a container of the client's emotion. We're always resonating with one another's nervous systems, like little radios, and if the therapist is uncomfortable with what the client is revealing, the client knows it right away. A therapist who gets defensive or scared in sessions will broadcast that to a client, no matter what method is used."
In fact, Napier suggests that somatically oriented work may help therapists avoid the guerrilla wars for dominance that sometimes simmer just beneath the surface of therapy. "In Somatic Experiencing, there are no control battles. When all you're trying to do is get clients to be more aware of their own bodies, it doesn't much matter what's going on in therapy--as long as they notice what they're feeling." Body-oriented practitioners even argue that clients may feel less defensive and reveal more when describing the state of their innards than when trying to verbally describe the various train wrecks in their lives. Even when a client doesn't want to tell the therapist what's going on in her body, says Napier, the therapist can simply ask her to "notice how it feels for you to make that choice not to tell me."
Other somatically trained therapists insist that learning how to track what's going on in both their own and their clients' bodies allows them to become more aware of countertransference reactions while they're still small clouds on the horizon, long before they have a chance to become violent thunderstorms. "A therapist who pays attention to her client's body state and her own is less likely to miss what's going on behind the words, and is better able to pick up signs of trouble in the session," says therapist Babette Rothschild, author of The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment.
For example, says Rothschild, consider a therapist who finds herself aware of feeling angry at the client--she notices a tightness in her chest and a feeling of heat at the back of her neck. Is she picking up angry vibes the client is unconsciously directing at her or is this anger a sign of something being triggered within her by the client that's related to her own life and quite irrelevant to the client? Either way, it's important to find out, so that therapy doesn't get sidetracked by the client's projections or her own. A therapist who pays attention to how she physically resonates (a favorite word among body-mind practitioners) with the client, who's aware of what's happening in both her and her clients' bodies, is less likely to be sandbagged by unexpected emotional firestorms in therapy.
It's an article of faith in these circles that therapists who do somatic work can't be remotely effective without having walked the walk themselves. "If we therapists aren't in our own bodies, there's no way we can do good work with anybody else's body," says Napier. "If we haven't done our own work, we can't be instruments of healing. This is true of all therapy, but it's particularly important in doing body-oriented work. Clinicians need to be very familiar with their own bodies before they can help somebody else become familiar with his or her body."
Working with the body requires, perhaps even more than talk therapy, a high degree of therapeutic consciousness and caution to control what's happening in the client. Verbalization tends to filter experience--simply changing the subject can help people regulate their levels of arousal. But physical experience can be more raw, more inherently arousing, as Patrick Dougherty's client ("I don't want to fucking breathe!") demonstrates. Therapists must tread carefully, says Babette Rothschild, so that therapy doesn't explode on them. "Provoking body systems, going beneath the verbal, can be very powerful, but it can also be very volatile," she says. "Therapies that work with body mechanisms can set processes in motion that, once activated, can be hard to shut down. You need skill and concentration and commitment in order to help clients regulate their own body systems."
For therapists who've spent entire careers firmly planted in their chairs, hardly giving a thought to their own or their clients' bodies, learning how to integrate some sort of body awareness into their work can be relatively simple. Unlike the early days of body psychotherapy, when massage tables were de rigeur for the intense, deep-muscle manipulation that was part and parcel of breaking down psychological defenses, today's body-mind practitioners don't have to use touch at all. In fact, "touch per se doesn't necessarily have anything to do with body psychotherapy," says Rothschild. "Nor does hugging clients or holding clients. Body psychotherapy has to do with the integration of body, mind, and emotion. If touch appears to be necessary to facilitate that integration, massage and manipulation can be part of body psychotherapy. But touch isn't essential for body psychotherapy to be effective."
How Far Do We Want To Go?
Therapists who want to bring a somatic element to their work, but aren't inclined to retool themselves and their techniques completely, can still enrich their therapy by learning how to better read their own and their clients' bodies, while never budging from their seats. A therapist listening to a client, particularly if the material is intense, can ground herself by becoming conscious of her own body--noticing whether her heart is beating faster than usual, whether her shoulders are tense or relaxed, whether she gets a sudden jab of anxiety in the gut. Does she feel antsy and restless or unaccountably sleepy? These "body scans" on herself will not only ground her, but help her tune into the client.
Similarly, therapists can pay close attention to body signals given by the client. Does a client seem to be holding her breath or sighing a lot? Does he become pale or get red in the face when certain subjects come up? How does she use her eyes--is she staring or afraid to look at the therapist? How does his voice sound? Is there an incongruity between his posture and tone of voice and his words? Does she slouch into the room and curl up defensively in the chair or stride in aggressively, as if she owned the place? All these are keys to clients' state of body, which may be far more accurate reflections of their state of mind than their words are.
Somatically inclined therapists claim that working with the body helps them get deeper into therapy more quickly, while working at a pace that feels slower and safer to the client. To allow a client to focus inside, the rhythm of therapy must slow down--making time for the client to sit quietly, breathe, and just notice the unfolding within. But these deceptively quiet moments can pack a real therapeutic punch.
A client Core Energetics therapist Mary Giuffra was seeing for his first session, for example, made what might be called a throwaway gesture--what looked almost like a mini-wave--while he talked in a desultory sort of way about his parents. Guiffra picked it up and asked him to do it again, but very slowly, deliberately, mindfully. Suddenly, he began crying and said, "I realize I have to say good-bye to my parents." In a flash, and at a level far deeper than cognitive knowing, it'd become viscerally clear to him that if he were to achieve independence in his life and career, it was imperative that he psychologically separate himself from his parents' domineering influence. He was unconsciously waving good-bye to them. "This was a critical insight for him and made it clear almost immediately what he needed to do in therapy, but I had no way of knowing ahead of time what his gesture meant or where it would lead," says Guiffra. "Working somatically, you get much deeper faster, but in a contained, deliberate way. Less is more, slow is faster in this work."
For all their enthusiasm about their work, however, body-mind therapists are keenly aware that a somatic approach doesn't work for every client. Some clients find it threatening to even talk about or focus on their own bodies, and would experience a therapist's attempt to get them to do that as deeply invasive. "People may get overenthusiastic about this kind of work and think it applies to everybody, but it doesn't," says Napier. "There are clients who seriously can't and don't want to deal with their bodies. They want to do their therapy entirely in the realm of ideas, and you would never want to press somatic therapy on them. People have a right to heal the way they want to heal."
Notwithstanding the appeal and promise of body-mind approaches and the fact that body psychotherapies of one sort or another have been around for decades, research into their effectiveness still lags well behind studies of other clinical methods. Psychologist John May, who teaches and practices Radix, a neo-Reichian approach, did a comprehensive review of empirical literature in 1998, researching body psychotherapy's effectiveness, and found only 20 studies, 15 of which showed beneficial results. (His review didn't include the copious research on EMDR or clinical studies of Focusing, a body-oriented process for deep self-awareness worked out by philosopher Eugene Gendlin in tandem with client-centered psychotherapy pioneer Carl Rogers in the 1960s.)
It seems inevitable that this situation will change. The trauma profession already has significant research in place demonstrating the key role played by the body, both in maintaining and healing from traumatic stress. Exercise, fish-oil supplements, light therapy, meditation, yoga, qigong, and various relaxation techniques--"body interventions" no less than psychotropic medications--are well known and scientifically validated approaches to reducing depression and anxiety. Furthermore, an explosion of knowledge in the neurosciences over the last 10 or 15 years indirectly buttresses the relevance of somatically informed psychotherapy. In numerous recent research coups, neuroscientists have shown just how integrated body and mind are, confirming in many hundreds of studies that our emotional life, our capacity to form relationships, our sense of ourselves, our creativity, and even our ability to make decisions are inseparable from the life of the body. Not surprisingly, the United States Association for Body Psychotherapy, the umbrella organization for the field, now actively promotes research and awards a cash prize every year to the most promising research study in the field. If somatically oriented work becomes more popular among clinicians, as seems likely, the research will no doubt eventually follow.
For years, the therapeutic legitimacy of body-oriented psycho-therapy was badly tarnished by overenthusiastic New Age practices during the 1970s, which led to uncontrolled regression, sexual orgies, flagrant ethical and professional violations, and a certain dogmatic anti-intellectualism. At one time, it seemed unlikely that many serious, mainstream psychotherapy practitioners would want to get into something so fringy. Now, body-oriented approaches are back, but in far gentler, more careful, thoughtful, and clinically knowledgeable manifestations. As a sign of just how far the social and clinical Zeitgeist has moved, far from seeming radical or bizarre, these approaches seem nonthreatening, sensible, even obvious. Why wouldn't a therapist want to use them?
Indeed, it appears that somatic approaches may become sufficiently ordinary and acceptable that the line between "body psychotherapy" and "talk psychotherapy" may one day disappear entirely. While the body-mind split in psychotherapy is "still alive and well," says William Doherty, he doesn't think it'll always be that way, particularly among younger clinicians who haven't yet gotten sucked into career trajectories in standard talk therapy. "I believe that, one day, bodywork and movement will be a normal adjunct to psychotherapy." John May agrees: "I think, one day, body psychotherapy will no longer be tenable as a separate entity. It's coming into mainstream practice now and, one day, will become a part of therapy." It's an irony of the body psychotherapy movement, he says, that it will have achieved its goals--bringing somatic work into general practice--and will itself, no doubt, disappear as a result.
Human relationships, and therapy itself, have often been described by psychotherapists as a kind of dance, but the metaphor seems more apt--and less metaphorical--when applied to body-mind approaches. When the body speaks, the language is both more immediate and more deeply felt, but also more elusive, more delicate, less amenable to the categories and formulations of reason and logic, than are words. And yet it is in and through this language of the body that we most fully and completely express our human being. The body enlivens the mind, the mind enables the body. There is no dance without both. Even in talk therapy, the stream of feeling coursing through the body probably speaks more loudly and often more truthfully than the mind, which often must struggle to understand this subtle, passionate, often incomprehensible but always meaningful, somatic language. "The wisdom of the body is so rich," says Mary Giuffra. "We go to school and learn and learn and learn, but the brilliance inside each person is truly amazing."Mary Sykes Wylie, Ph.D., is a senior editor of the Psychotherapy Networker. E-mails to the author may be sent to firstname.lastname@example.org. Letters to the Editor about this article may be sent to email@example.com.