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Body Oriented
Psychotherapy
History, Methodologies, Ethical and Clinical Considerations
Submitted to:
Joyce Rowlands,
Registrar,
Transitional Council
College of Registered Psychotherapists
& Registered Mental Health Therapists
Submitted by: Canadian Humanistic and Transpersonal Association
January 11, 2010
Canadian Humanistic and Transpersonal Association
208 Carlton St., Toronto, Ontario M5A 2L1
www.chata.ca
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Table of Contents
1
Introduction
4
Survey of the Field
6
Jungian Psychology
8
Psychoenergetic Models
12
Psychophysical Enactment Techniques
13
Humanistic Existential Phenomenological Tradition
18
Transpersonal Psychology
19
Psychosomatic and Mind-Body Medicine
21
International Body Oriented Psychotherapy Associations
23
Therapeutic Uses of Touch
25
Ethical and Clinical Considerations in the Therapeutic Use of Touch
31
Notes
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BODY ORIENTED PSYCHOTHERAPY
INTRODUCTION
A bodily orientation and a psychosomatic awareness has been a part of psychotherapy
since its inception just over one hundred years ago. The psychodynamic, humanisticexistential and transpersonal traditions have all carried this theme. Beginning in the
1960’s and 70’s there was an explosion of North American and European interest in
new humanistic experiential psychotherapies such as encounter groups, Fritz Perls’
Gestalt therapy at Esalen, primal therapy, and psychoanalytic humanistic derivatives
such as bioenergetics, Ron Kurtz’s Hakomi, and others such as Pat Ogden’s
Sensorimotor psychotherapy. Some university psychology departments also began
focusing in these humanistic-existential-phenomenological areas that included a
somatic theme (such as University of West Georgia, Seattle University, Sonoma State
University). For this reason, somatic psychotherapy is generally thought of as a
humanistic modality, although there are accredited graduate schools in the USA that
grant degrees specifically in Somatic Psychology (such as California Institute of Integral
Studies, Naropa University, Saybrook Graduate School and Research Centre) and
many free standing training schools that graduate practitioners in specific modalities
(such as Bioenergetics, Reichian, Organismic, Gestalt).
Even though psychoanalysis never developed a body focused methodology, it
has shown a decidedly psychosomatic and psychoenergetic orientation. In addition, a
number of its practitioners have developed psychotherapy models in which direct work
on and with the body is significant in their methodology. Jungian psychology, arising
out of psychoanalysis and retaining key elements, is a significant carrier of a body
orientation. The main repository, however, of a thoroughgoing, integrated body
orientation and methodology is found in the humanistic, existential and transpersonal
traditions, with their general focus on the facilitation of a patient’s awareness of being an
embodied, experiencing subject. In addition there are a number of specific disciplines
from these traditions that utilize an extensive and intensive focus on the body as a
means of psychotherapy.
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Methodology varies across a spectrum from simple focused body awareness
techniques through expressive psychotherapy, movement/dance therapy and
psychodrama, to direct hands on approaches utilizing breathing, postural exercises and
massage techniques. These function in the service of both working with psychosomatic
psychodynamics and facilitating alive, energetic physical dynamism. Quite often in
body oriented psychotherapies, the focus on bodily experience is part of an overall
holistic and experiential theme i.e. a desire to facilitate fully alive, activated human
potential in each person so that the whole spectrum of their experiential range is
available to them (thoughts, images, feelings, emotions, intuition, sensation), positing
this as a goal of therapy and a definition of healthy human functioning. Thus, in these
traditions, the body is seen to reflect the psyche and, by working on it, the psyche is
affected in a unique way, not readily available by verbal and interpersonal techniques
i.e. the body orientation is fundamental and not incidental. The holistic theme in these
traditions then says that it is not just the psyche that is important, but the whole
organismic mind-body functioning. This is the attitude that informs a number of holistic
health modalities — where the mind body functional unit is seen as the focus of
psychodynamic and psychophysical techniques.
By examining historical developments in psychotherapy it can be seen that body
oriented psychotherapy is situated within the mainstream traditions of psychotherapy, in
the forms of psychoanalysis and the humanistic, existential and transpersonal traditions.
That psychoanalysis is an historical mainstream tradition is not debatable. Currently it
is somewhat in eclipse, though it remains a significantly active discipline, especially in
the forms of self psychology, relational psychoanalysis and various psychodynamic
psychology, that derive their fundamental construction from psychoanalysis. Jungian
psychologies, an analytic form that is historically based in psychoanalysis and still
shares, for example, the developmental and ego psychology positions, has been a
significant contributor to the evolution of body oriented psychotherapy.
The humanistic, existential and transpersonal traditions are not as widely known
in Ontario, but are, nevertheless, mainstream. Since its formalization as the “Third
Force” (to distinguish it from psychoanalysis and cognitive behavioural) in the 1960’s,
humanistic psychology has established itself via the Association for Humanistic
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Psychology and its peer reviewed journal, the Journal of Humanistic Psychology.
Similarly transpersonal psychology has been established via the Association for
Transpersonal Psychology and its peer reviewed journal, the Journal of Transpersonal
Psychology. Existential psychotherapy was originally part of psychoanalysis in the
1930’s and ‘40’s and eventually became part of humanistic psychology. Its
philosophical tradition extends back 150 years. America supports regionally accredited
training institutions in these traditions granting MA’s and PhD’s in theoretical and clinical
applications. There is a national advisory body (National Psychology Advisory
Association of the Association for Humanistic Psychology) that monitors and evaluates
these programs. In clinical psychology texts, psychiatric texts and reputable books
covering the field of psychotherapy these traditions are represented1 2 3 4 5. Both
humanistic and transpersonal psychology are recognized by the American
Psychological Association as APA Division 32 (Humanistic Psychology), also known as
the Society for Humanistic Psychology.
Thus, despite the fact that many body oriented psychotherapies have been
developed in the last fifty to sixty years, their origins date back to early twentieth century
psychology. In addition, a survey of the eclectic field of current body oriented
psychotherapies that have descended from these traditions shows that this is a
significant, viable, professional, ethical and coherent group of psychotherapies.
Body oriented psychotherapy has generally developed outside university
settings, but within a professional practice that has subsequently resulted in the
formulation of a psychotherapy model and method, which is then offered in training to
practitioners. Not many body oriented psychotherapists are psychiatrists or
psychologists, but this is true of psychotherapy in general, which is practiced by
psychotherapists, social workers, counsellors and ministers. In Ontario there are around
4000 unregulated psychotherapists who are currently going through the process of
becoming a regulated profession.
The most vexed questions in body oriented psychotherapies is touch. But if we
consider the specific and general guidelines for touch of a patient by any health care
practitioner and the extensive training regarding appropriate professional,
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psychodynamic ethics that any depth oriented psychotherapists should have, it is
possible to apply appropriate criteria and conditions to psychotherapeutic touch. The
evocation of transference and counter transference inherent to any depth oriented
psychotherapy complexifies the issue. But this is what training and supervision in
psychotherapy are meant to deal with. Thus the requirement for adequate training in
handling transference and counter transference issues is vital, as is ongoing supervision
of a body oriented psychotherapist. Both the United States and European Associations
for Body psychotherapy recognize this with well defined ethical guidelines.
It is also true that body oriented psychotherapy must be used judiciously and the
proper application of methodology and types of techniques varies according to
personality type. I will address this in detail later in this paper, but I would again like to
emphasize that training, clinical supervisions and ongoing continuing education are vital
for a therapist to be able to make diagnostic and prognostic judgments as to the efficacy
and specifics of appropriate body oriented techniques. Not all body oriented
methodologies involve actual touch.
SURVEY OF THE FIELD
Body oriented psychotherapy is a term covering a range of attitudes to, and
instrumental involvement of, the body in a psychotherapy process. I will cover the field
of body oriented psychotherapy under the following headings: Psychoanalysis; Jungian
Psychology; Psychoenergetic Models; Psychophysical Enactment Techniques;
Humanistic-Existential-Phenomenological Tradition; Transpersonal Psychology;
Psychosomatic and Mind-Body Medicine.
Psychoanalysis
The original psychosomatic formulation came from the psychoanalytic tradition in which
the body, (energetically, anatomically, physiologically) was seen as a ground for the
creation of psychic contents. Sigmund Freud developed his original drive theory based,
in part, on his neurophysiological background. Although it has been significantly
modified in modern psychoanalysis (in the forms of Self Psychology, Ego Psychology,
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Object Relations Theory) David Krueger MD, psychiatrist and psychoanalyst, still
postulates the development of the body self in the first two years of life (based on the
maternal relationship and developmental themes) as the basis for psychological self.6
Freud’s original views on the instinctual energy of the body as a basis for unconscious
drives has not been abandoned entirely. The tripartite (id, ego, superego) elaboration of
the drive theory is still present today, along side the more relational focused forms of
psychoanalysis. Although psychoanalysis as a method does not currently directly work
with the body, it has been responsible for bringing bodily drives and instincts into
psychological focus, as well as pointing to the persistence of infant bodily
preoccupations in adult life. Psychoanalysis also formulated psychosomatic models
that suggested a symbolic and causal link between mind and body. Thus, in the
foundation of the model of one of the mainstreams of twentieth century psychology we
have a basic irreducible orientation to the body.
In addition to Freud, psychoanalysts Sandor Ferenczi MD and Alfred Adler MD
focused on the importance of the body. Ferenczi took the role of good parent and
encouraged dramatization of memories while amplifying the interpersonal aspect of the
analytic procedure, thus becoming a forerunner for psychodrama.7 According to
Jacoby, Ferenci “was the first psychoanalyst to allow nearness, interaction and even
body contact with certain patients in regression”. He believed “they needed a kind of
‘maternal care’ from the analyst in order to relive emotional experiences of early
infancy.”8 This sensitivity to primary needs was taken up by Kohut, Winnicot & Balint,
whose idea of “benign regression” invokes the theme of a “psychic state of ‘primary
love’ in which there is ‘a sort of harmonious interpenetration mix up’ with the analyst and
the symbolic expression of this ‘primitive relationship in the analytic situation is often
some sort of physical contact with the analyst, the most frequent form of which is the
holding of the analyst’s hand or one of his fingers, touching the chair etc.’”9
Adler was originally attached to Freud’s biological approach and had an interest
in the body’s capacity to compensate for organic damage by adaptations in the
psychological sphere. According to McNeely, Adler’s attention to physical defects and
bodily expressions of character traits was an important contribution to the evolution of
body therapy, and she quotes him as saying “the bodily postures and attitudes always
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indicate the manner in which an individual approaches his goal”.10 McNeely goes on to
say “Adler’s detailed focus on expressive movement was an important source for the
development of psychosomatic medicine and the holistic approach”.11 Dance therapist
Liljan Espanek comments that Adler’s linking of organic function with the mind and
emotion is the first premise for successfully using the body to influence the two other
systems.12
George Grodeck MD is another early psychoanalyst who paid great attention to
the body, seeing for example “in illness a vital expression of the organism” similar to “his
manner of walking, ... facial expressions, movement of hands”. Grodeck spoke of the
body as “an analogous unconscious of other organs, cells, tissues etc.”13
Franz Alexander MD, a later psychoanalyst and author of “Psychosomatic
Medicine” combined the physiological and psychological perspectives in attempting to
define a relationship between personality characteristics, social conditions and physical
illness.
Jungian Psychology
According to McNeely psychoanalyst Carl Jung MD conceptualized libido as a general
life force of primarily psychic energy which is only partially sexual, thus differentiating
from Freud’s physiological grounding. “Yet his psychology has furnished a container in
which his followers have been able to develop many facets and directions including
body therapy and dance movement.”14 She quotes Whitmont as saying that in the
1920’s Jungians were doing breathing therapy.15
McNeely suggests that Jungian psychology has contributed to body oriented
psychotherapy according to the following: 16
1.
The Jungian concept of psychic energy having a “dense end which corresponds
to the most primordial instinctual level of biology” and that because of the focus
of wholeness as the main theme of individuation this must be taken into account.
Jung’s psychological interpretation of alchemical symbols and cosmology led him
to this conceptualization.
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2.
Jung’s psychology exhibited a preference for visual, auditory and kinesthetic
experiences, some of which would be enacted as dance based on active
imagination exercises. Whitmont and Kaufman write that “In Jung’s consulting
room people danced, sang, acted, mimed, played musical instruments, painted,
modelled with clay”.17
3.
In the Jungian concept of the psyche’s need for balance in the personality
typology, feeling and sensation functions must be incorporated into one’s
lifestyle, implying an essential role for bodily awareness.
4.
Despite his primary psychic orientation, Jung also spoke of the physiological
concomitants of psychological complexes and Mindell says, “biofeedback
researchers today credit him with the discovery of what they call ‘skin talk’”.18
5.
Jung insisted upon integration of body and spirit as a condition for the success of
the organismic drive to wholeness, which he called individuation. Nathan
Schwartz-Salant has underlined it thus: “Only when the spirit exists as a reality,
when psychic reality is a phrase with objective meaning — stemming from a
transformation of the psyche such that a feeling centre exists — then and only
then does a descent into the body lead to transformation and the experience of
the Somatic unconscious”.19
6.
Jung’s openness to consider Eastern thought and symbolism, such as the
concept of Kundalini and the chakra system of organization of a type of biological
energy that has psychological and spiritual implications, thus providing a model
of energetic psychosomatics.
McNeely reports that Jungian analyst Arnold Mindell PhD considers that the
unconscious “speaks” in the language of the body. 20 His principal focus is the
amplification and expression of the body’s involuntary signals in order to translate those
signals into healing images. Mindell writes in Dreambody that bodywork extends the
experiential dimension of dreams and generally increases the possibility for knowing the
unconscious.21 He also suggests that “the eyes, skin colour, lips, hand motion, body
posture, voice tone, all manifest the real personality”.22 He works using subtle
attunement by focusing intently on body gestures, postures and sensation to bridge the
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mind body gap through active imagination. McNeely also reports that Jungian analyst
E.C. Whitmont MD advocated the use of body awareness techniques to amplify dreams,
intensify affect and contact preverbal contents. In group settings he used forms of
bodily dramatic enactment similar to gestalt and psychodrama.23
Training in Jungian psychotherapy is available internationally. The original centre is
in Zurich, with additional locations in places such as London, New York, San Francisco,
Los Angeles and Toronto. In addition, Jungian thought and clinical practice has
significantly influenced Transpersonal Psychology which has training programs
throughout North America. There are at least five Jungian journals published
throughout the world, Spring being the original Zurich based publication, the Journal of
Analytic Psychology in London, the Jung Journal in San Franscisco and the Journal of
Jungian Theory and Practice in New York.
Psychoenergetic Models
Wilhelm Reich MD is the psychoanalyst who most focused on the body as a means of
psychotherapy. Writing in the 1920’s he spoke of body tension, posture and of
“character armoring and character resistance” 24, by which he meant chronic
physiological rigidities corresponding to emotional barriers against feeling excitement.
He advocated direct body contact work on the defensive musculature using breathing,
exercise and massage, calling this “vegeto therapeutic treatment”. By the 1940’s Reich
had coined the term “bioenergetic”, which his patient and student, Alexander Lowen
MD, came to use as the name of a form of body oriented psychotherapy that he
developed, along with John Pierrakos, who went on to develop his own version called
“core energetics”, which incorporated a spiritual element. This marked the beginning of
a trend in body oriented psychotherapies — that of speaking in energetic metaphors
using terms such as “charge”, “streaming”, “block”, “flow”, “pulsation”, “grounding”.
Many of the current varieties of body oriented psychotherapies employ this model and
the work of therapy includes a significant focus on this element. This functional
dynamism is said to show itself in such factors as level of vitality, skin color, body
posture, eye quality, voice tone, sense of contact, groundedness. Means of working
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with it include breathwork, postural exercises, stress positions, vocal expressions,
massage, dramatic enactment, guided visualization.
Lowen’s Bioenergetics has a significant psychodynamic focus, retaining the
psychodynamic typology of psychoanalytic character analysis (rigid, psychopathic, oral,
narcissistic, schizoid etc.) and extending it to include body characteristics.25 Lowen’s
Bioenergetics focuses toward grounded aliveness by the releasing of body blocks to
energetic flow, via the undoing of traumatic psychophysical personality distortions,
especially as manifest in muscular armoring, based on chronic tensions and rigidities.
Bioenergetics is one of the more widely practiced and established techniques of body
oriented psychotherapy.
John Pierrakos, MD, a contemporary of Lowen’s and student/patient of Reich,
initially worked with Lowen until he took a more spiritual direction in developing his
model and practice of core energetics. While accepting the bioenergetic
psychophysical characterological model, he says, “My experience with patients showed
the need to reach deeper than the functions of the body, the negative unconscious and
the analytic mind. To lead to true integration the healing work needed to centre on the
life affirming consciousness that is the human core. Excluding the person’s spirituality
from therapy came to seem like shearing the top off a pyramid”.26 In this Pierrakos
touches on themes central to the humanistic, existential and transpersonal traditions.
Pierrakos incorporated elements from the Eastern tradition of Kundalini yoga, which,
like Chinese acupuncture, sees the bioenergetic flow as being organized in a particular
way, focusing through seven centres at various levels of the trunk (similar to Reich’s
seven rings of muscular armoring). Each centre is said by Pierrakos to be associated
with specific psychological and spiritual characteristics.27
Hakomi, developed by Ron Kurtz and Hector Prestera, MD, uses similar
psychophysical typology to Lowen. They have, however related the psychodynamic
and bioenergetic model to the Chinese acupuncture system28 in their book, The Body
Reveals, which provides a very detailed examination of what various body parts can
show about personality, bioenergetics and psychodynamics.
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Methodologies such as Therapeutic Touch and EFT (Emotional Freedom Technique)
have evolved from this connection of psychosomatic energetics and acupuncture
meridians, newly represented in a professional association, the Canadian Association of
Integrative and Energy Therapies (CAIET). Research shows that these modalities are
particularly effective with trauma and PTSD. They do not usually involve direct body
contact. There is an annual Energy Psychology conference in Toronto put on by CAIET.
Training in Reichian and Neo Reichian psychotherapy is international, with centres
in New York, London, Denmark and other European centres. Training in Pierrakos
Core Energetics is available in several centres, including New York City, upstate New
York and Toronto. Currently, the International Institute for Bioenergetic Analysis (IIBA) is
based in Zurich, Switzerland. There are 1500 members in 57 societies, functioning in 8
languages (English, French, German, Italian, Polish, Portuguese, Russian and
Spanish). The two Federations (Europe and South America), the North American/New
Zealand region (NANZIBA), the Faculty community and the Italian group are run by the
membership. In Canada, there is an Atlantic Canada, Central Canada, Manitoba
Society, Southern Ontario Society and Western Canada Institute for Bioenergetic
Analysis, as well as the Societe Quebecoise d’Analyse Bioenergetique.
Malcolm Brown, PhD began his work in body oriented psychotherapy in 1964 as a
colleague of Lowen. Although designated a Neo-Reichian, thus acknowledging Reich’s
influence on his tradition, his sources of influence are diverse, including C.G. Jung, E.
Neuman (Jungian), A. Maslow (transpersonal), K. Goldstein (Gestalt), and C. Rogers
(humanistic/existential).29 This is somewhat typical of current body oriented
psychotherapies. Their background influences are diverse, but apart from Reich’s
original connection to psychoanalysis, they mainly fall within the existential and
transpersonal traditions, since these are quintessentially holistic and integrative with a
significant stated focus on embodied experience as a core theme and goal of
psychotherapy. Brown is particularly focused on spiritual issues in embodiment work
and also on appropriate challenge to ego defences. McNeely quotes from Brown’s
privately published writing. “Our body-centred energy-mobilization techniques are for us
exclusively intermediary in function, never ends in themselves. They mediate the
client’s awareness of his own neglected soul-powers and intuitive capacities for self
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evolution and self fulfillment. By placing our ... hands on those parts of the patient’s
body that are most likely to produce a widespread simultaneous dispersion of energy
flow into distant parts of the metabolism, we stand a good chance of safely challenging
the ego-defence network without over threatening and provoking it to assume a position
of defended vigilance.”30 Brown exemplifies a necessary ethical and professional theme
in body oriented psychotherapy — that of appropriate timing in a therapeutic process
and of appropriate level of stimulus in specific body work techniques employed with
different psychological types. Brown distinguishes between therapeutic nurturing touch
and more challenging touch, which he calls catalytic.31 Typically the former precedes
the latter in order to build trust and rapport. He concludes “... a therapist must exercise
considerable caution and restraint as he gradually facilitates the internal mobilization of
energy flow within a client’s organism”.32 McNeely quotes from a lecture by Brown in
which he posits “creative disintegrative regression” to be necessary to the healing
process. Brown says, “The challenge to all psychotherapy is to transform the regulative
system of the body away from the dominant cortico cerebral spinal circuits and toward
the self-regulative creative unconscious in vital centres below the cerebral cortex”.33
This could be considered a general aim of many body oriented psychotherapies in its
organismic based holism and spiritual orientation. Brown calls his approach organismic
psychotherapy. Since 1975 he and his wife have co-directed the European Institute of
Organismic Psychotherapy.
In the 1970’s, Pat Ogden developed Sensorimotor psychotherapy, a body-oriented
therapy that integrates verbal techniques with body-centered interventions, helping
clients connect their physical characteristic patterns and their psychological issues.
Research supports its claim to be an effective treatment for trauma, attachment and
developmental issues. Simple, body-oriented interventions help clients track, name and
safely explore trauma-related somatic activation, disturbed cognition and emotional
processing, then create new competencies and restore self esteem. Sensorimotor work
helps to bring implicit procedural memory into the realm of what can be cognitively
known, then help regulate dysfunction in the somatic experience. It helps with
assimilation of memory and the regulative of cognitive and affective processing. The
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Sensorimotor Psychotherapy Institute offered its first professional training course in the
early 1980’s.
Psychophysical Enactment Techniques
Another major body oriented psychotherapy tradition is Psychomotor Therapy, founded
by Albert Pesso and his wife Diane. According to McNeely this combines
psychodynamic, interpersonal and psychodramatic techniques, usually in group
sessions.34 The aim is to correct early negative experiences by dramatic enactment so
that a different outcome may be created. The goal is to be in touch with one’s potential
experientially, supported by the safety of the group. This quite often leads to spiritual
connections, as Pesso is significantly influenced by Jung. Like many Jungians (and
other body oriented psychotherapist) Pesso sees symptoms as energy and, in
themselves the beginning of healing. For example, according to McNeely, Mindell, a
Jungian psychologist, “considers pain and illness to be signposts from the unconscious
speaking in the language of the body. His principal focus is to encourage the
amplification and expression of the body’s involuntary signals in order to translate those
signals into healing images.”35 Pesso has an extensive workshop training program and
a course leading to certification as an Adjunct Psychomotor therapist.
Psychodrama, founded by Jacob Moreno, MD in 1921, is a method of
psychotherapy that involves the body in interpersonal enactment. It does not have a
bioenergetic orientation and does not involve bodywork techniques such as massage. It
is, however, very much focused on bodily expression of inner states and “is a method of
psychotherapy in which patients enact the relevant events of their lives instead of simply
talking about them. This involves exploring in actions not only historical events, but
more importantly, dimensions of psychological events not ordinarily addressed such as
unspoken thoughts, encounters with those not present, portrayals of fantasies of what
others might be feeling and thinking, envisioning future possibilities and many other
aspects of the phenomenology of human experience”.36 Psychodrama was founded at
St. Elizabeth’s Hospital where dance therapy also began. There are currently many
psychodrama training centres throughout North America (including Toronto) and Europe
with well defined and coordinated programmes leading to certification.
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Dance therapy is becoming an established psychotherapeutic modality in which the
body is used as an instrument to promote the differentiation and integration of inner
experiences. McNeely reports extensively on the use of dance therapy, particularly by
three American women (Mary Starks Whitehouse, Marian Chace and Trudi Schoop),
the latter two of whom developed their methods working with mental patients in hospital
settings. Whitehouse coined the term “authentic movement”. Joan Chodorow is a
Jungian analyst and dance therapist whose work is regarded as within the mainstream
of Jungian analysis, reflecting the importance accorded to authentic body movement as
a form of psychological expression within the Jungian tradition in general.37 The widely
published, Zurich trained, Toronto based, Jungian analyst Marion Woodman uses group
programmes to contain the body work aimed at establishing authentic movement. In
these sessions the major emphasis is on breath and dance, utilizing music, although
specific bodywork techniques may be used with appropriate patients.
Humanistic-Existential-Phenomenological Tradition
The humanistic-existential-phenomenological tradition in psychotherapy, called the
“Third Force” to distinguish it from the other two main streams of psychological thought
and practice (psychoanalysis and cognitive behavioral), has carried the most specific
and detailed bodily orientation of all three, in the tradition in general and in certain
specific disciplines within this tradition.
A central theme and goal of the humanistic-existential-phenomenological tradition is
the facilitation of a patient’s awareness of being an embodied experiencing subject. In
this tradition it is believed that all self-examination, personal growth and healing of
psychopathology proceeds from this starting point, which also informs the process of
therapy as a continuing ground and reference theme. This is mainly derived from the
holistic perspective which is part of the tradition. Urban puts it this way: “Thus despite
huge numbers of subsidiary elements that may comprise human beings and their
actions it is necessary to recognize that the person always functions as a unit and
operates as an integral whole”.38 He quotes Allport, Rogers, Adler and Murray in
support of this notion. Heidegger’s philosophy, “the source of a major portion of
contemporary existential thought and practice” according to May, locates the primary
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source of self knowledge within the embodied experiencing subject, as connoted by his
term for human existence, Dasein, meaning simply, “being there”.39
Humanistic, existential and phenomenological psychotherapy are each
established traditions, with accredited training institutions throughout North America
granting MA’s and PhD’s in both clinical and theoretical applications. The Consortium
of Diversified Psychology Programs (which includes virtually all of the accredited M.A.
and Ph.D. programs in humanistic, existential, or transpersonal psychology - CDPP web
page is at http://www.sonoma.edu/psychology/cdpp) monitors these institutions. The
Psychology Department of the State University of West Georgia publishes a Directory of
Graduate Programs in Humanistic-Transpersonal Psychology in North America. This
Directory is online at the web site for Old Saybrook II, at
http://www.westga.edu/~psydept/humanisticdirectory. Saybrook Graduate School and
Research Centre, California Institute of Integral Studies, Duquesne University, State
University of West Georgia, Seattle University and Sonoma State University are all
prominent accredited institutions granting MA’s and PhD’s in these fields. Santa
Barbara Graduate School, California Institute of Integral Studies, Naropa University and
Saybrook Graduate School and Research Centre offer specific post-graduate degrees
in the somatic psychology or mind-body medicine fields. In addition, a number of
specific disciplines have originated from within this model to become traditions in their
own right. Gestalt, Focused Expressive Psychotherapy, Rubenfeld Synergy Method,
Focusing, experiential psychotherapy, encounter and primal therapy are covered here.
Frederic Perls MD, a cofounder and popularizer of Gestalt psychotherapy, included
both an holistic and specific bodily focus in this model.40 The holistic theme, drawn from
Gestalt psychology, took the form of an “organismic” orientation, which drew specifically
on bodily experience and expressions, such as posture, hand movements, facial
expressions, the kinesthetic sense and awareness of physiological reactions, bringing
the patient into the “here and now” moment of self experience. In this Perls drew also
on Reich’s work, of whom he was a patient during 1931-32. Gestalt also promoted
physical expression (such as yelling and gesturing or pounding a mat) and a
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psychodramatic type of dramatic enactment, thus involving the body as a vehicle for self
expression and self awareness.
Subsequent gestaltists have continued and elaborated this bodily focus. Kepner
writes about this in detail, based on his teaching and work at the Gestalt Institute of
Cleveland. His themes include body experience as experience of self, the body and the
disowned self, the therapeutic use of touch and dealing with the person as a whole.
Kepner appropriately also delineates limitations for touch oriented body work with
certain diagnostic types.41
Les Greenberg, a graduate of the Gestalt Institute of Toronto and psychology
professor at York University, has co-developed a method called Focused Expressive
Psychotherapy (FEP) which includes a “motoric” element whose specific purpose is “to
involve the body’s sensory system in release of suppressed emotion” by “acting out
(e.g. hitting, kicking etc.; writing, drawing, colouring; use of the bataca [encounter bat]).”
He also specifies “non verbal” methodology “to put patients in heightened contact with
bodily reactions” by “breathing; clenched hands/teeth; voice energy; screams versus
whining; facial reactions”.42 In the preface it is stated that “This manual represents a
compilation of data and information obtained from more than sixty years of our
accumulated clinical experience, as well as a decade of conducting training in FEP at
the university graduate level.43 As would be hoped with such an evocative array of
techniques the authors define selections and contraindication criteria for this therapeutic
approach.44
Training in gestalt is offered throughout the world, with many centres in North
America and Europe, including Toronto, New York, Los Angeles, Cleveland and
Chicago. Their publications include the International Gestalt Journal, the British Gestalt
Journal and Gestalt!, an online journal.
The Rubenfeld Synergy Method combines the postural methods of F.M. Alexander
and Feldenkrais with gestalt awareness techniques and Eriksonian hypnotherapy, the
goal being “re-education of the nervous system, especially the motor cortex” 45 and to
correct “tensions and imbalances” in the “dynamic integration of body, mind, emotions
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and spirit”46. Certified synergists complete a three year training programme conducted
by Ilana Rubenfeld (the founder of the method) and faculty.
Gendlin’s47 body oriented psychotherapy called Focusing combines Heidegger’s
philosophy and Roger’s client centred approach. Gendlin’s technique involves a close
phenomenological following of the patient’s immediate experience, called “process” by
Gendlin, looking for the “border zone” of an emerging “felt sense”. He states that “a
direct sense of the border zone occurs bodily, as a physical somatic, sensation”.48 He
has written extensively on the techniques of following the unfolding of this bodily felt
sense and offers training at the Focusing Institute in Chicago. For his development of
experiential psychology, he was chosen by the Psychotherapy Division of the American
Psychological Association for their first “Distinguished Professional Psychologist” award.
A Canadian psychologist teaching at the University of Ottawa has written extensively
on experiential psychotherapy. Mahrer, in acknowledging his debt to Gestalt and
Gendlin, outlines a series of therapeutic operations starting from “attention-centredbodily experiencing” and ending with “being/behavior change”. 49 In doing this he
suggests that experiencing is carried forward by using more and more of the body in
greater and greater intensity of expression. “The body is to be the avenue of
experiencing”. This involves “kickings, hittings, cryings, dry heavings, twistings,
shakings, wrenchings... screams, yells... laughs.”50 Mahrer also states that “this therapy
is not for everyone” and goes on to delineate criteria51.
Encounter is a methodology arising out of the humanistic-existentialphenomenological tradition. It has foundations in communication theory and the
existential tradition. Both suggest a body orientation. Egan quotes many sources
“which relate body movements including gestures and facial expressions, to the process
of communication”.52 He goes on to elaborate on the use of physical contact in
encounter groups (as part of the general use of contractually defined exercised) such as
hand holding, hugging, pushing, falling, being picked up, containment (e.g. by a sheet).
These exercises are defined, negotiated and agreed upon in advance by all parties. An
important element in these exercises is the respect for boundaries. The ultimate control
of the exercises rests with each participant who may call a stop at any time. Egan goes
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on to say, “exercises should not be used indiscriminately... but should rather be
integrated with the task at hand” and “the choice and timing of an exercise is
important”.53
Primal therapy is a particularly bodily oriented psychotherapy that draws on both the
psychodynamic and existential traditions, as well as pre and peri natal psychology. The
existential focus on authenticity (incorporated into primal as an attempt to manifest the
“real self”) and the psychodynamic focus on reliving the traumatic past as a vehicle to
present psychological health, both call for this body orientation in the primal model. The
goal is an ever deepening sense of here and now self, mediated as embodied
experience. The facilitation of emotional expression by techniques of breathing,
posture, massage and containment exercises is part of a general focus on aliveness.
The primal model sees the psychodynamic self as being based on a bodily sense of self
originating in infancy, birth and intrauterine life. Support for this comes from
psychoanalysis, pre and peri natal psychology and transpersonal psychology. Freud
and the early psychoanalysts located the beginning of the development of a sense of
self at the Oedipal period. Later psychoanalysts (through Object Relations and Self
Psychology) have extended this back to infancy. Krueger goes so far as to say the
body and its evolving mental representations are the foundation of a sense of self and
suggests this beginning in the first few weeks of life. He quotes Lichtenberg as
describing “the concept of the body self as a compilation of the psychic experience of
body sensation, body functioning and body image”54. Clinical work in primal therapy and
research evidence in pre and perinatal psychology has suggested moving the temporal
location of the beginning of a historical sense of self back beyond infancy into birth and
intrauterine experience.55 Verny quotes extensive research evidence supporting this
position56. It is the incorporation of elements of pre and perinatal psychology into the
primal model which supports the primal focus on birth and intrauterine material as a
means of access to deeper levels of the adult psyche. The primal model suggests that
this is made available especially, perhaps even only, via body oriented techniques. The
primal model further suggests that full bodily mediated, egoically modulated access to
these deeper layers of the psyche is necessary to a mature sense of self and activated
human potential. It is also the position of the primal tradition that these deep bodily
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mediated experiences provide unique access to an individual’s spiritual potential, a goal
of both the humanistic-existential and transpersonal traditions.
Transpersonal Psychology
Transpersonal psychotherapy is a tradition that significantly focuses on the body as a
vehicle for personal growth and resolution of psychopathology. This reflects its
relationship to the humanistic-existential model in the shared focus on the facilitation of
a patient’s awareness of being an embodied experiencing subject as a therapeutic goal.
The transpersonal focus on spiritual and archetypal experiences is incorporated within
this embodied subject theme. The transpersonal tradition also provides an holistic,
organismic perspective in its focus on mind-body integration. An aspect of this is the
contextualizing of physical symptomatology as expressions of emerging self identity
which must be integrated into the process of what Jungians call individuation — the
developmental path toward wholeness, self actualization and fully activated human
potential.
The Institute of Transpersonal Psychology offers PhD’s which meet academic
requirements for state psychologist license, and MA’s which satisfy state degree
requirements for California marriage, family and child counsellor licensing57. The course
of studies includes body disciplines, drawing on the general field of mind body
integration, specific body oriented psychotherapy techniques and Eastern traditions. In
the Association for Transpersonal Psychology’s 1994-95 Listings of Schools and
Programs there are eighteen accredited institutions granting BA’s, MA’s and PhD’s in
Transpersonal Psychology. One of these (the California Institute of Integral Studies)
grants an MA in Somatic Psychology. The University of California, Irvine has a four
year full-time residency training for medical school graduates who wish to specialize in
psychiatry with an emphasis on transpersonal psychology. The four year psychiatric
residency programme at the University of California, San Francisco’s Langley Porter
Psychiatric Institute employs transpersonally oriented supervisors and mentors.
Holotrophic Breathwork developed by S. Grof MD is a specific transpersonal therapy
which utilizes an experiential body oriented approach.58 Through the use of breathing,
massage, and self arising physical expressions in conjunction with evocative music
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“sensory, biographical, perinatal and transpersonal realms of experience are
accessed”.59 The hyperventilation techniques initially particularly activates the sensory
apparatus, including body sensations and proprioceptive experience. The
characterological body armouring blocks that are brought into focus are worked with
using massage and posturing techniques so that deeper aspects of the psyche may be
accessed. These techniques facilitate a similar set of experiences to those in primal
therapy with a particular focus on spiritual and archetypal themes. Grof has significantly
contributed to the understanding of the psychophysical encoding of birth material
through his definition of the “four basic perinatal matrices”, including methods of working
with the bodily manifestations of these.
Psychosomatic and Mind-Body Medicine
Another broad area where body oriented psychotherapy is applicable is what might
generally be termed psychosomatic medicine, in which the mind and the body are seen
as self reflecting aspects of the human being as an organismic whole. Psychosomatic
medicine originally was a formulation of psychoanalysis, arising in part out of the focus
in psychoanalysis on the body as the ground for the creation of psychic contents
through drives and instincts, in part out of the observed relationship between bodily
behaviour and psychodynamics and in part out of the observations of the somatization
tendency in hysterical conversion reactions. As previously outlined in this paper, Freud,
Jung, Grodeck, Ferenzi, Adler and Alexander, amongst others, contributed to the
definition and evolution of this psychoanalytic psychosomatic model. Dunbar further
proposed in 1935 that various personality characteristics were associated with particular
psychosomatic disorders employing the idea of specificity.60 More recently, according to
Wittkower and Warnes, this “has increasingly given way to the psychosomatic
approach, i.e. to the psychological and psychosocial approach to anyone suffering from
any disorder”61 (i.e. physical disorder). However, although multicausality in
psychosomatic conditions is currently a prominent model, Paulley and Pelser show
contemporary support for specificity (of personality characteristics or profiles in relation
to psychosomatic expressions), preferring, however, the term typicality and suggesting
that coping mechanism style confers this typicality/specificity.62.
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Kellner surveys the field of theoretical and empirical studies on somatization (which
he defines as the presence of somatic symptoms in the absence of physical disease or
tissue damage, thus subsuming the categories of the DSM somatoform disorders) and
includes among possible aetological factors: depression; anxiety; hypochrondiasis;
hostility (especially repressed hostility); inhibition; repression and lack of confidence;
communication, defence and conflict resolution; and alexithymia.63 These are obviously
psychological characteristics. Thus theoretical and empirical studies on somatization
point to a psychosomatic model.
According to Goleman and Gurin, mind-body medicine tends to focus on the mind’s
capacity to influence quality of life, wellness and the course of physical disease itself. It
invokes evidence from stress studies, psychoneuroimmunology, the effects of emotions
and psychosocial conditions. 64 An interesting journal in this area is Advances in Mind
Body Medicine.65 It is a peer reviewed, well referenced, thoroughly clinical and
academic publication, with thematic issues such as “Is the Mind Part of the Immune
System” and “Can the Self Affect the Course of Cancer”. Mind body medicine employs
methods such as autogenic training, relaxation techniques, biofeedback, hypnosis,
social support, guided visualization, exercise and psychotherapy. Holistic medical
doctors are typically practitioners of mind body medicine, as are many GP
psychotherapists. Ontario GP Psychotherapist Bob James has written of the mind-body
connection using the term Bio Mind, which he suggests subconsciously “organises
events within and between all our living cells” by means of a decentralized field effect
and holistically reflects the self organizing, evolutionary theme in nature itself. 66
Behavioral medicine is an evolving discipline in which behavioural factors (including
psychological variables) are seen to influence somatic experience and disease states.
It is not psychodynamically oriented, placing particular relevance on empirical studies of
behavior and utilizing cognitive behavioral techniques. It has become part of the
curriculum in many medical schools, and teaching hospitals have established centres.
In psychosomatic, mind-body and behavioral medicine the potential applications of a
body oriented psychotherapy are broad. The establishment of proper selection criteria
for the appropriate range and intensity of bodily focus is crucial. This is an area that is
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at present underdeveloped, but the implications from the history, the theoretical models
and the clinical evidence point very strongly toward useful applications of body oriented
psychotherapeutic techniques.
INTERNATIONAL BODY ORIENTED PSYCHOTHERAPY ASSOCIATIONS
The professional profile of any modality of psychotherapy may be demonstrated by six
criteria: demonstrable historical roots in the field; substantial literature; training facilities
that offer diplomas and certificates or university degrees in the field; presence of peer
reviewed journals; professional associations and research that supports the modality’s
efficacy. This section will introduce two substantial professional associations, the
United States Association for Body Psychotherapy (USABP) and the European
Association for Body Oriented Psychotherapy (EABP).
In June 1996 the first US National Conference on Body Oriented Psychotherapy was
held in conjunction with the fourth International Congress of Psycho Corporeal
Therapies, providing a professional forum for North American and European
practitioners to meet. One hundred and fifty presenters from eighteen countries gave
workshops on over sixty modalities of body oriented psychotherapy. The program
provided continuing education credits for both physicians and psychologists.
Workshops included topics such as “The Role of Catharsis”, “Psychosomatics as
Experienced from an Art Therapy, Object Relations Perspectives”, “Sexuality and Body
Psychotherapy”. All the well established body oriented psychotherapies mentioned in
this paper were represented, alongside newer, evolving approaches. This conference
was the culmination of a five year process of discussion between many practitioners
and represents a desire to clarify commonalities and explore differences between the
extensive array of developing body oriented psychotherapy approaches.
The USABP, formed from this conference, has held regular conferences ever since.
The USABP defines body oriented psychotherapy as “a distinct branch of the main body
of psychotherapy with a long history and a large body of knowledge based upon a
sound theoretical position… (It) involves a developmental model, theory of personality,
hypotheses about the origins of psychological disturbances and alterations, as well as a
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rich variety of diagnostic and therapeutic techniques used within the framework of the
therapeutic relationship.” Techniques combined involve meditation, emotionally
expressive work such as kicking, making sounds, reaching, moving towards or away
from another, eye and body movement, breathing, touch (when appropriate and agreed
upon) etc.
The USABP was founded in 1996 following the first US National Conference on
Body Oriented Psychotherapy. Their peer reviewed journal is the USA Body
Psychotherapy Journal. Their stated mission is to: develop and promote standards in
providing body psychotherapy to the public; to promote access to quality body
psychotherapy for all persons; to be an influential, equal, and collaborative member of
the health care and education community; to be a source on issues and information
related to the field of body psychotherapy; to enhance the professional development
and personal growth of members; to encourage, develop, and provide a professional
community that is based on enlightened, collaborative, and collegial relationships. The
USABP provides online continuing education credits to members through their website,
with credits granted by the California Board of Behavioral Counselors (Approval no.
PCE 4095).
The EABP acts as an accrediting organization for European bodypsychotherapists. They have over 600 members in about 21 countries, mostly in
Europe, but also including the US, Canada, various South American countries and
Australia. They recognize about 45 training and professional organizations and 30
different approaches and techniques within the field, all of whom go through a process
of scientific validation. They have been accepted as a European Wide Accrediting
Organizational Member (EWAO) of the European Association of Psychotherapy (EAP)
and have a seat on their board and representation on the Training Standards
Committee. They have established the scientific validity of body psychotherapy with the
EAP, according to their criteria. They sponsor the EABP Bibliography of BodyPsychotherapy Project, now with over 3,500 entries. They also publish research
projects, produce a Handbook for Body Psychotherapy and hold conferences.
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THERAPEUTIC USES OF TOUCH
In body oriented psychotherapy the psychotherapeutic use of touch is widespread,
although there are a number of body oriented approaches that use other non touch
oriented body techniques such as simple directed awareness, exercises, dramatic
enactments (such as psychodrama) and movement (such as dance therapy). In this
context the term touch refers to a professionally and clinically motivated form of body
contact. Typically a practitioner’s hands would be used in this therapeutic activity but
occasionally other parts of the practitioner’s body may be used, such as forearm or
elbow. It is not to be understood in the manner of casual, socially mediated bodily
contact. The United States Association for Body Psychotherapy (USABP) and the
European Association for Body Psychotherapy (EABP) have developed precise and
extensive ethical guidelines for therapist’s use of touch within the practice of somatic
psychotherapy.
In gestalt and Jungian body work, bioenergetics, core energetics, Reichian, Neo
Reichian, primal, experiential and transpersonal psychotherapy (amongst others) touch
is central. It is usually done in the form of simple touch, massage, posturing or
psychophysical engagement.
Kepner, a gestalt therapist, suggests that
“through touch a therapist can directly demonstrate the existence of
bodily tension, position the client’s posture to illustrate new
possibilities, directly release muscular holding, encourage the client to
fill his or her bodily space with awareness, assist movement and so on.
In this way touch as a means to an end is used to facilitate
development of a client’s body-self through sensation, awareness,
movement and posture. Touch can also be an end in itself. Touching
and being touched are fundamental modes of human interaction. In
the human interactions of therapy, touch can result in the emergence
of unfinished business.. The use of touch by the therapist, in carefully
gradated and respectful ways, can be used to evoke and work through
this unfinished business.”67
“Unfinished business” is a gestalt term for problematic psychodynamic material that
remains undealt with. He further suggests that the appropriate therapeutic use of touch
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inherently and uniquely moves the patient toward an experience of “the unity of body
and self”.68 He also suggests that touch can be used to bring bodily resistance into
consciousness and “to invite the person’s awareness and breathing into a part of the
body that seems deadened and lifeless”.69
His perspective is that touch is a unique and potent form of psychotherapeutic
intervention. “Skilled touch can often communicate something about body process with
a specificity, directness and immediacy that would require lengthy verbal explanation”.70
McNeely, a Jungian, identifies three unique aspects of touch: (I) exploration and
amplification of bodily states by enactment, positioning, asserting movement and
directing attention; (ii) mirroring, in which the therapist actively joins with the patient in
exercises such as pushing or pulling; and (iii) de-armouring where the therapist actively
moves against the patient’s somatic defence system, through pressure that can range
from light touch to deep massage.71
Bioenergetics, core energetics, Reichian and Neo Reichian body work techniques
utilize posture, massage, breathing and grounding exercises. As noted earlier in this
paper, Brown distinguishes between nurturing and catalytic touch suggesting the latter
must follow based on sufficient prior use of the former. In these body oriented traditions,
touch is considered essential in diagnosing energy and tension patterns,
psychophysical defensive blocks and tissue structure in relation to character type. The
psychotherapeutic process itself involves extensive use of touch in working with the
bioenergetic, psychophysical and psychodynamic elements of the patient. This is
considered fundamental to these models of psychotherapy.
In regard to touch, Jacoby quotes Greene’s feminist Jungian critique of the
patriarchal background of the analytic and psychiatric establishment and its deficiency
“in the differentiated relationship to anima, the feminine and the body”. 72 She goes on to
delineate the “matriarchal” trend within psychoanalysis, started by Ferenczi and
elaborated into a tradition of sensitivity to primary needs through themes such as
Balint’s “primary object”, Winnicott’s “holding function” and Kohut’s injunction to reflect
the “gleam in the mother’s eye” through empathic mirroring. In psychoanalysis this
translates into only minimal body contact, while in Woodman’s Jungian approach it
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could mean more expressive, supportive touch and holding, and in primal therapy has
been developed into a reparenting model, where persistent infant bodily needs are
directly engaged.
McNeely delineates several issues in body need gratification via touch,73 including
providing contact (which Whitmont describes as a “channel of relatedness for contact
starved adults”74), affection (being careful to avoid sexualizing) and containment (e.g.
giving support to release of terror or grief that would otherwise not be possible because
of anxiety factors). She suggests the primary object of reparenting touch is healing of
mind body splits created by early damage to the body and psyche.75 She says that child
analysts, such as Winnicott, contend that a child of any age who needs to be held
affectionately is seeking a physical form of loving which is given naturally in the womb.76
She also says that in this model it is not enough to be conscious of the early pain of
deprivation, but is necessary that early wounding be repaired. She suggests “this may
occur through reparenting physically and emotionally by touching and holding at a pre
genital level, as one would touch and hold a small child”.77 Greene says “we have all
experienced how insight into a complex and its archetypal images is often not sufficient
to change the compulsive nature of an associated behaviour that has its roots in the
very structure of the body”.78
ETHICAL AND CLINICAL CONSIDERATIONS
IN THE THERAPEUTIC USE OF TOUCH
The Somatics and Wellness Community of the Association for Humanistic
Psychology gives the following ethical guidelines for the use of touch in body oriented
psychotherapy.79
1.
Get touch training;
2.
Take a history of affection, control, punishment, sexuality re receiving, giving,
witnessing touch;
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3.
Precontract for touch as a possibility in therapy, explain that it does not have to
be a part of therapy, and that it may be stopped at any time at patient’s
discretion. Poorly developed touch boundaries should be addressed as an issue
in itself before touch is utilized.
4.
When in doubt don’t touch and bring the question up as a clinical issue.
5.
Examine your own motivations for touch regarding your attention focus to ensure
that it is patient centred and in response.
6.
Pay attention to timing. Touching too soon may prevent an issue emerging.
Touching too late may reinforce old imprints of control or depriviation.
7.
Never touch a sexual area or an area the client considers private, noting cultural
differences in regard to privacy concerns.
8.
Trust your intuition but beware of projection, relying on training, experience and
integrity to know the difference.
9.
Use touch generously and sparingly. Therapists can be sources of nourishment
in patients’ lives while proactively and appropriately challenging patients to find
other sources for this.
Kepner addresses the issue of touch with these opening words. “Body oriented
work in general, and work that uses touch as a tool for intervention in particular, places
the client and therapist in a position of unusual closeness and intimacy... The physical
distance between the client and therapist is much less than the usual social distance
and requires the client to let down some of his or her reserve to allow the therapist in.
The therapist is potentially in a position of greater power and influence and the client is
potentially in a position of greater vulnerability and openness than the average
therapeutic encounter”.80
These issues increase the importance of a number of boundaries in body and touch
oriented psychotherapy, including the importance of therapists being aware of their own
needs. In this sense, it may be suggested that until a potential body oriented
psychotherapist has worked through any sexual dysfunction or confusion and deep,
unmet psychological needs they should not be doing bodywork. It should be possible to
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develop a set of criteria that would guide this judgement. The importance of a working
contract, which includes a clear channel for the patient to communicate limits, and
attention to transference/counter transference issues, especially in regard to
sexualization of the therapeutic situation, are also vital in regard to proper boundary
maintenance.
Respect for patient boundaries is an inherent part of any psychotherapeutic
situation. For some patients, touch based psychotherapy may never be appropriate.
For example, according to Kepner in paranoid disorders, schizophrenia and severe
forms of personality disorders such as borderline and dissociative, the fragile ego
structure may not be able to discriminate between therapeutic intent and
retraumatization.81 This is also true of any patients with severe abuse histories,
especially sexual abuse. According to Jacoby, the possibility of a delusional
transference is a contraindication because the analyst is not experienced “as if” he or
she were father, mother, etc., but is seen literally as one of these figures i.e. the
projection is concretized.82 Jacoby also cautions against feeding the addictive potential
in need gratification, for example through overly supportive reparenting body work. This
addictive tendency itself, however, may be a significant part of what needs to be worked
through, and thus body work may be simply what calls the issue into focus. In this,
Balint distinguishes between benign and malignant regression.83 In malignant
regression the patient aims at perpetual “gratification of instinctual cravings” whereas
the benign form serves basically to seek “the recognition of the existence... of the
patient’s own unique individuality”.
Primal therapy is particularly aware of this problem as part of the reparenting
element of touch-based body work. In this context regression to awareness and
expression of instinctual infant needs is seen often and expected. In fact, in primal
therapy, body oriented techniques are specifically used to evoke this material for
psychodynamic work. The reparenting theme focuses on completing the natural,
developmental movement toward maturity by receiving (amongst other things) “good
enough” (re)parenting. This requires significant verbal, ego oriented psychotherapy
work concurrent with the body work. The handling of possible malignant regressive
tendency then becomes a part of the therapeutic task i.e. the tendency to regress to an
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infantile need gratification posture and want to stay there is the actual subject of
therapy, and not just an impediment or absolute contraindication, depending on other
factors such as ego strength and psychological mindedness.
According to McNeely, one of the arguments raised against touch in psychotherapy
is that it complicates and overstimulates the transference.84 She herself does not
believe this to be true, and quotes Whitmont as saying “contrary to the usual
expectation, the inclusion of non verbal enactment does not complicate the transference
problems, but tends to help in working them out. It does so by clarifying, through direct
experience, the qualities of transference and counter transference. Mutual resistance
and their unconscious motives are brought into focus”.85 Kepner echoes this with his
suggestion that unconscious resistance may be brought into aware, owned and full
expression, thus bringing the patient into more contactful engagement with the
environment, promoting a capacity for separation, power and aggression.86
Primal therapy supports this view of the facilitative value of touch in psychotherapy,
suggesting that the uncovering of unconscious infantile preoccupations and needs is
particularly facilitated by body oriented psychotherapy. It further suggests that it is not
possible to fully address infantile preoccupations and needs by verbal techniques alone.
While it recognizes the need for verbal interactions oriented toward insight,
understanding, ego development, boundary negotiations and timing, it holds that, in
order for there to be full conscious explication of the tangled web of deep unmet infant
need, need denial, self deception, projection and acting out, a body orientation is
essential.
As in all psychotherapy, the quality of the therapeutic relationship is paramount in
the use of touch. This brings into focus issues such as empathy, trust and appropriate
timing. The quality of a patient’s social support system is also an important criterion.
Similarly, the therapist’s confidence in the patient’s ability to not misinterpret therapeutic
body contact and to respect therapeutic boundaries must play a part in determining
readiness for body work techniques. This suggests that a bodily intervention that may
not be appropriate early in the therapeutic relationship may become so once trust and
familiarity have been built between patient and therapist. In this sense, awareness of
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the psychodynamic and social readiness of a patient to handle material that touch may
evoke is vital. To evoke a suicidally depressed infant state in a patient with insufficient
social support or therapeutic bond, for example, is obviously inappropriate. Similarly, to
attempt to address sexually charged issues using body oriented techniques in a patient
with histrionic personality typology who is actively seductive is not appropriate.
According to Kepner, “Touch is not always a necessary, or even a desirable, part of
working with the body in therapy. Much can be done of a physical nature in therapy
without the use of touch: verbally directing the client’s attention to his or her body
process (e.g. breathing posture and subtle movements); instructing the client in various
exercises, movements or postures; asking the client to touch his or her own body as a
means of focusing attention and supporting body experience. With persons who cannot
tolerate the physical proximity of the therapist or for whom tactile contact is an
exceedingly foreign and frightening modality, much body oriented work can still be done
using the above methods.87 He goes on to say “Work with touch can, like body oriented
work in general, be thought of on a continuum. Just as I can use attention to body
process or breathing without doing any major experiment such as movement or
vigorous exercise, so too I can use touch in a brief and unobtrusive way that does not
involve extensive hands on application... and of course there are many clients with
whom I may never do any form of touching because the goals and issues with which
they are dealing do not require it.”88
We must also remember that attitudes to the body are characterological. So, for
example, the schizoid tendency to deny, and the anorexic tendency to control, the body
may, in themselves, be the subject of therapy. Similarly, cultural background may
encode typical rigidified attitudes to the body which may become the subject of therapy
for the individual. Body oriented techniques may be introduced to these patients when
timing is appropriate, noting boundary issues, therapeutic bond and ego skills as
significant qualifiers of this timing.
In regard to the issue of sexualizing in body oriented psychotherapy. The first and
last statement must be that, as in any form of psychotherapy, indeed as in any form of
relationship in the helping profession, sexual acting out is absolutely contraindicated,
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being harmful to the therapeutic relationship, the patient and the therapist. It is
imperative that this be clearly understood as a principle and that therapists, through
their own psychotherapeutic work, clear any sexual dysfunction, confusion and unmet
need. Ongoing supervision and peer contact is an important element in managing any
potential problems. Proper training in understanding both empirical and psychodynamic
aspects of sexuality is vital - for example, recognition of sexualizing of defences,
seductive gambits and the confusion of sexual and infant maternal bonding needs are
just some points at issue here.
McNeely, however, also points out that “While working with the body one is usually
confronted, at some point, with the sexual aspects of the patient”.89 This is also true of
any long term, deep change oriented psychotherapy, and of course for any client in
whom sexual function is a psychological issue. McNeely goes on to point out
“Awareness of sexuality becomes a very natural part of the process of becoming
conscious of the body; the therapist who is managing his or her own sexual energy well
can observe the emergence of sexuality in the patient without getting compulsively
caught up in his or her own sexual complexes, just as a healthy parent can encourage a
child’s sexual development without participation”.90
The issue of potential sexual acting out, as would be the case for any health
professional, needs to be addressed by the therapist’s personal therapy to ensure
personal maturity, training to ensure understanding of principles and integrity, and
supervision to maintain vigilance.
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NOTES
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