The model of the mind is based on the integration of Psyche and Soma: A state of mind is a state of body, and a state of body is a state of mind.
In Biodynamic Psychology, the model of the mind embraces the entire field of experience: cognitive, emotional, sensory and imaginal. Mind encompasses the personal, relational, transpersonal and spiritual realms.
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Carlien van Heel and Anat Ben Israel talking with Deveraj Sandberg
Jeremy Vine - By-Elections and Inherited Trauma - @BBCRadio2
organism: the way into psychotherapy with Berit Heir Bunkan, from Oslo.
In this lovely conversation with 87 years old psychotherapist Berit Heir Bunkan from Norway during the European Congress in Athens, 2016, we discuss about different ways to get into the body mysteries as for example through the 3 diaphragms, look at it, learn and like:
” Is the orgasm reflex a myth? “
In this dialogue Ebba Boyesen and Rubens Kignel talk about the “orgasm reflex” an experience of the psychoanalyst Wilhelm Reich.
Ebba Boyesen and the psycho-orgastic work talking with Rubens Kignel
In this video I talk with Ebba Boyesen about the psycho-orgastic work, don’t loose it.
Connecting body, mind and soul
Originally published in The Psychotherapist
Promotion of Health and Biodynamic Psychotherapy
Originally published in The Psychotherapist
Levels of Consciousness and Contact in Biodynamic Psychotherapy
Originally published in The Psychotherapist
Transformative Moments: Short Stories from the Biodynamic Psychotherapy Room Pt. 1
Biodynamic massage (Southwell, 1982) is an integral part of biodynamic psychotherapy (Boyesen 1980, 1981, 2001; Heller 2012; Lewin & Gablier, 2013; Southwell, Selles, Tanguay, & Steinberg, 2014; Southwell, 1998), which allows psychotherapeutic work within the framework of the body. The name ‘biodynamic massage’ encompasses fourteen different methods of touch. Almost all the touch methods can be performed at different levels of the body - the level of bones, the periosteum, the deep and superficial muscles, the fascia, which contain the muscles, the subcutaneous tissues, and the different levels of energy. A biodynamic psychotherapist is often guided by a stethoscope (either electronic or ordinary) whilst carrying out biodynamic massage (Southwell, unpublished; Stauffer, 2005, unpublished, 2010; van Heel, 2014); the stethoscope is utilized for listening to the digestive system’s sounds (also known in this context as the psycho-peristalsis) (Boyesen, M -L. & Boyesen, G. 1978). This makes it possible to obtain immediate feedback from the body about the level of accuracy, quality, and attunement of the touch applied. The experience of touch must be modulated by context and internal state (Ellingsen et al., 2016). The digestive system is more active when there is stronger activity of the parasympathetic nervous system, a branch of the autonomic nervous system (Guyton & Hall 2011). This subsequently creates greater activity of the vagus nerve - the tenth cranial nerve of the parasympathetic nervous system – meaning that stimulation that increases psycho-peristalsis results in non-invasive vagal nerve stimulation. "The parasympathetic innervation of the gut by the vagus nerve provides sensory information to the brain, enabling gut activity to influence emotions" (Gómez-Pinilla 2008, Mayer 2011). Invasive vagal nerve stimulation (VNS) has an influence on cognition and emotion and has become a routinely approved procedure for the treatment of refractory partial onset seizures and chronic (i.e. not acute) resistant depression (G.mez-Pinilla 2008). Another method for carrying out non-invasive vagus nerve stimulation is transcutaneous vagal nerve stimulation (tVNS), which in healthy humans reduces the activity of the sympathetic nervous system. In this way the treatment ameliorates many conditions which present with higher activity of the sympathetic nervous system such as stress, heart failure, tinnitus, obesity, and Alzheimer's disease (Clancy et al, 2014). These findings demonstrate some of the hidden potential of Biodynamic Massage as part ofBiodynamic Psychotherapy, since it can non invasively cause stimulate of the vagus nerve. This stimulation plays a big part in the movement towards health (salutogenesis), developing independent wellbeing and an organic self-regulation process (Boyesen & Freudl 2015). The biodynamic therapist also receives feedback from the client’s body through objective observations (Bunkan et al 2004, Friis et al 2002) of the body’s posture (Bunkan et al 1998, 2010, Heller 2012 chapter 13) , breathing (Bunkan et al 1991, 1999, Friis et al 2012) , solidity of muscles (hypertonic, hypotenuse, and isotonic) (Johnsen 1973) , the muscles’ capacity for mobility (Bunkan et al 2001, Kva et al2011) , and the skin (for example, skin colour, temperature and sweating). In addition, the biodynamic therapist obtains information from objective observations of the sensations, feelings and emotions that arise and subside in their own body. So the biodynamic therapist is guided in real-time not only through technique, but also via feedback from the client’s autonomous nervous system, objective feedback from the client’s body, as well as what the client volunteers about his/her body and intuition. Here, I define intuition as an impulse arising from within the self to perform one action or another. We need to differentiate between intuition and the actions of psychological defense mechanisms like projective identification and re-enactment. Over time, the biodynamic therapist learns to integrate all that information with the entire history known to him about the client, including events of trauma and adverse events that occurred during the client’s life. That is how adjustment occurs between the intention and the client’s neurodevelopmental process. Every patient is an entire book (Rako & Mazer, 1980) , a distinctive and pulsing new fabric. All theoretical knowledge is solely theoretical when the therapist starts working with a client: it must be discarded in favour of the direct experience of processes unfolding here and now. The therapist has to respond in an attuned fashion to the living phenomena of this particular client, in this particular relationship, in this moment of now, without any agenda or predisposition. The only constant in living phenomena is change (Inspired by Vipassana meditation course) , and the therapist must be attuned to a change taking place in themselves and in the client at every moment, and in the relationship to the levels of awareness and arousal in the framework of the client’s body and the therapist’s body. The delicate fabric woven in the field of relations is formed of countless items, including the therapeutic relations. Dynamic items change constantly; therefore, biodynamic assessment systems are grounded on evaluating the changes occurring (Southwell, 2014) , not only on a static snapshot of the client’s condition. What defines the quality of the work are our bodies, our awareness to our body – that of the client and of the therapist – in addition to mental processes, intention and attention. In the living phenomena called human, the landscapes of the mind and the landscapes of the body are one concurrent phenomenon. In the reality of a human, it is impossible to separate between them, only for the therapeutic discourse, which ensues after action. As Wilhelm Reich stressed, "the point that the unconscious does not exist in a psychological space that is independent of one's bodily reality, but is intimately connected to a somatic or energetic substratum" (Boyesen & Freudl, 2015, p. 582). And so, to understand biodynamic therapy as a whole, and biodynamic massage particularly, we have to understand and investigate the human as a living phenomenon, as it is happening now, in real-time. As biodynamic psychotherapists, our job is not to save or rescue. Our job is to promote and support changes in the person as pulsating living phenomena, as our client wishes. The client can be viewed as a system that has the capacity for self-organization and selfleadership. Psychotherapy is a healing profession and the healer is the client. A good biodynamic psychotherapist will support the client in healing themselves (Tanguay, 2014). LILY: A CLINICAL CASE STUDY This article was written following a review weekend with students of biodynamic psychotherapy, concluding their first year of studies. During that weekend, they worked under their own observation and that of three trainers. Lily and Roy are both students (not their real names). I’m unfamiliar with Lily’s life-story in detail. To conceal Lily’s identity and to fine-tune certain points, I have used her story with those of other clients to create a single figure who demonstrates what needs to be demonstrated. THERAPY Roy worked with Lily using a mixture of touch methods in different parts of Lily’s body, applying the ethical rules customary in the method. He chose to begin working with Lily’s shoulders because they were so painful; he evoted over half an hour to her shoulders. He used elements of ‘basic touch massage’ mainly at the muscle level, and combined it with elements deriving from ‘lifting and stretching biorelease assage’. Once he felt he had finished, he worked with ‘energy distribution massage’ on her legs. Lily said she was satisfied that he reached the soles of her feet, and that the therapy had een beneficial for her and that felt she had received what she needed from it. In biodynamic psychology we work according to an important principle stating that what the client feels is always correct, and we do not undermine the client’s sensations and emotions. "The basic therapeutic attitude is this: the method can betray the client, but the client can never betray the method" (Boyesen & Freudl, 2015, p. 584). We follow the client and trust the process because the client is a self-organized system possessing the capacity to reorganize itself with self-leadership. Otherwise, the client would not have come to us in the first place, and every other following session. POST-THERAPY FEEDBACK In the discussion that developed afterward, the question came up whether it’s worth combining different touch methods in the same therapy session. The usual recommendation is in principle to use a single technique with a particular sequence in one session. The discussion created an excellent option for taking an in-depth look at one reason why biodynamic massage constitutes non-verbal psychotherapy. Roy remarked that he works differently in each part of the body, in terms of the type of touch he uses and how much time he devotes to each place, but he gives the same quality of touch everywhere. He asked if it can be beneficial working in the same way with identical kinds of touch, time, and quality even if the different places in the body feel completely different - both to the client and the therapist. Before I discuss this important question and suggest another major perspective, I’ll note again that in Lily’s case she felt fine with the mix and match, and the client is always right regarding her feelings. As I mentioned before "The basic therapeutic attitude is this: the method can betray the client, but the client can never betray the method" (Boyesen & Freudl, 2015, p. 584). In addition, the context of this treatment was a single massage session, a oneoff session during a review weekend. So an analysis of the options that I list below isn’t necessarily relevant to this context. Rather, my intention is to discuss psychotherapeutic possibilities and considerations that can be offered from another perspective, and to weigh the advantages of this therapy with the same kind of touch, over the whole body, taking more or less the same time. THEORETICAL DISCUSSION Had Lily come to me for therapy, I would have asked myself several questions. Her shoulders were painful – I wondered whether they were bearing the load that other parts of her body were not sharing. Though Lily’s build seems thin and fragile, her shoulders look broad and strong. They have been painful for a long time, a matter of weeks perhaps: they are warm to the touch, and have marked muscle tension (hypertonus). The soles of her feet are cold and her leg muscles are flaccid (hypotonus) relative to them. Lily also retains tension within her body, in her internal organs. Lately, her digestive system released large amounts of tension, expressed in diarrhea and stomach ache: that tension had been retained in her body for many years. Recently Lily suffered strong bladder pain. She suffered the pain in her bladder for a few months and despite different kinds of medical investigation no medical reason was found explaining her pain. She twice received empiric antibiotic treatment, which seemed to have little effect. The pain in her bladder was so intense that she had to stay home and missed two days of study, even though she really wanted to attend the class. The previous weekend, Lily had also suffered a severe migraine that again prevented her from attending a class session. During several previous sessions, Lily had said that her back was painful. The day before Roy gave her therapy, she shared with us during her morning check-in that many of her pains in the digestive system and bladder had disappeared, she had also suffered all her life from anxiety, she now felt more empowered and her anxiety had decreasedsignificantly. She shared with us, with a somewhat frozen expression, that she had come for training because it was a question of either coming to learn or get older; the felt sense of her statement seemed to some group members like 'to learn or to die'. It is noteworthy that Lily is an intelligent, sociable and sensitive woman. She has academic training and has lived with her partner for many years. She has a stable and supportive relation with him, and they have children together. ASSUMPTION: THE CONFLICT IS RETAINED WITHIN THE BODY AND MIND Lily’s body appears to represent a significant conflict, possibly more than one conflict. If we look at the global picture, we can assume that the various pains retained within Lily’s body represent different parts of Lily, parts that do not communicate with each other. Her shoulders want to come to therapy because they are painful, but her bladder and sometimes also her head want to stay home. The shoulders are bearing a heroic burden while her hips and legs—physiologically constructed to assume heavy burdens together—do not participate, and don’t help her to carry the burden. In physiological terms we see that Lily’s implicit procedural memory is actively commanding her shoulder muscles to clench; even though conscious explicit parts of Lily feel intolerable pain and want to release her shoulders because the pain is unbearable. WHAT IS LILY'S PROCEDURAL MEMORY? Lili's memory, like every human's memory construct from different parts. Memory is now understood to be a collection of mental abilities that depend on several systems within the brain. … A memory system is a way for the brain to process information that will be available for use at a later time. Different memory systems depend on different neuroanatomical structures. Some systems are associated with conscious awareness (explicit) and can be consciously recalled (declarative), whereas others are expressed by a change in behavior (implicit) and are typically unconscious (nondeclarative)” (Budson & Price, 2005, p. 692). Procedural memory refers to the ability to learn things such as behaviour (Budson & Price, 2005) - in this case: to clench her shoulder muscles on the unconscious level. She has no insight into why she has been doing it for such a long period of time. She can not explain it as her procedural memory is non-declarative and the reason for the original behavior can't be consciously recall. DOES IT MEAN SHE HAS A “SHORT” MUSCLES IN HER SHOULDERS? It is important to acknowledge that people usually don’t really have “short” muscles, they have tense over-contracted hypertonic muscles and under-contracted hypotonic muscles. Most of the people who come to us, if they should (god forbid) die, the muscles will relax and their posture will change and improve (my apologies for the rough description). Most people, usually have no structural abnormalities, no bony or muscular deformation. This means that in order to keep a “short” muscle short, the brain actively and unconsciously has to repeatedly send messages to the muscle to contract. It does this for 24 hours a day, 7 days a week, for years on end. Furthermore, when the brain gets the information from the muscles via interoreceptors - called proprioreceptors (which are called alpha [α] spindles) - that this is the level of contraction of these particular muscles, it still translates this as good essential contraction, despite the fact that some other interoreceptors send the brain messages of pain and will ‘scream’ at the conscious part of the person “this is a terriblypainful contraction”. The brain’s un-coordinated and un-integrated activity happens because of the person’s implicit procedural memory. It is a fundamentally automatic learned skill and it is a real concrete reality, not an imaginative process. This presents us with a question: why does the brain keep this mismatched and un-coordinated painful activity of the brain-mind-body? It always has very good reasons to do so. We know that the total human system functions energetically as an economic system. It will do (or not do) something only if it is somehow “cheaper” economically. This means that somehow, there is an advantage to the system at that particular moment to choose to carry out an action like over-contraction of a muscle even though it is painful. Most of the time, this advantage is not logical to the conscious SELF because the conscious SELF does not have access to most of the information available to the total system that we are. LILY Returning to my previous assumption that different parts of Lily want her to do completely different things, it’s perhaps unsurprising that ultimately she gets a migraine and her head ‘explodes’. Perhaps it’s because her head can’t decide which of her parts is right. Which part should she listen to and act according to? Each part of her body retains a different aspect of Lily’s desires, and each part represents a different aspect of the conflict she’s experiencing. But we don’t know what the conflict is because she experiences it unconsciously and is unaware of it. When I give each part of Lily’s body a specific, different therapy, I’m using the reparative model of the therapeutic relationship (Clarkson & Wilson, 2003) regarding each part of her body separately. But at the same time, I don’t relate to a split or conflict/retained within her. Even if it helped Lily to receive a different type of therapy for each body part, any outcome benefits would only be temporary because I didn’t relate to Lily as a single system, as one organism unable to work together and solve the conflict. I had to support the reorganizing of her entire body as an organism that can heal itself because it has selfleadership. In that simple physiological reality of Lily’s body, only one person can release Lily’s painful, tense muscles - Lily herself. Her mind must find a way into the labyrinth of the complex human brain towards the non-implicit unconscious procedural memory, render its content conscious and explicit, and find a way to change something within the procedure before storing the procedure once more. I can only suggest possibilities. It goes without saying that in this kind of therapy I also didn’t address two very important emotions that Lily shared with us. The first, the conscious one, is the anxiety she has suffered for years. She says that now she suffers less - but it did not disappear . The second feeling – less explicitly articulated and crucially important—is trapped in her sentence and the frozen expression that accompanied it when she said why she came for training. For her, as she said, it was “coming to learn or growing older" a sentence that some people picked up as "dying”. Is despair also trapped in there? Or another emotion? It’s a dramatic sentence that requires attuned attention. And we are obligated to remember that the emotions trapped there are the reason why she is here now, on Roy’s treatment table, because this emotion brought her to training. The fact is we don’t know anything that Lily herself has said about how those emotions exist within her. Any emotion is a collection of phenomena taking place in Lily’s body. Emotions do not occur in the human brain as a phenomenon that’s detached from the body but are experienced as a physical phenomenon of sensations in certain places in Lily’s human body. There are questions we must ask Lily herself. How does she know that what she’s experiencing is anxiety? What does she feel it in her body? Butterflies in her stomach? Is her heart racing? Does she have a sense of pressure in her chest, and difficulty breathing? Does she feel as if she’s choking, and the words won’t leave her throat? Perhaps she has a general sensation of weakness in her limbs? Maybe she feels frozen, immobilized? And perhaps she’s experiencing anxiety in another way that I haven’t listed. These are the critical questions we must ask Lily, and a no less critical question is – which emotions are trapped in that sentence “coming to learn or growing older". We need to examine with Lily how those emotions emerged in her body, how she identified what she was sensing and feeling. Even if Lily was satisfied with the treatment she received, which is indisputable, it’s important that we realize consciously that we have collaborated with the split, the lack of communication, and the lack of integration. And furthermore, that we didn’t necessarily relate to all Lily’s emotions during the treatment. NEGATIVE TRANSFERENCE AND POSITIVE TRANSFERENCE We have to be aware that when we work with different parts of the body and use various approaches, there is a risk that a more negative transference might develop. Sometimes, chiefly when there is a split, we observe that the different parts of the body can develop a sort of ‘envy’ towards the other parts that are being treated. We try to avoid that sort of negative transference because it’s hard for the client to receive such a powerful and intimate touch from someone towards whom they has negative transference. And so, particularly because of the strong degree of intimacy that this relationship calls for – a relationship that permits touch - we are interested in fostering positive transference. It allows us to work beyond the defense mechanisms, to enable a secure attachment, and to support the construction of important mental structures. Later on, I discuss the importance of developing a secure attachment. EQUANIMITY AS A WAY FOR INTEGRATION What then could happen differently if, during therapy I suggest a treatment that’s identical in terms of the type and quality of touch, and the time needed, for every part of Lily’s body? Identical treatment throughout her body could suggest to Lily - in a non-verbal way - a novel idea. A novel idea in which all the different parts of her body are my ‘clients’, and each one is important to exactly the same extent. Even in parts that are ‘screaming’ with pain, like Lily’s shoulders, even those that won’t let her shoulders rest, even those immobilized by cold, like the soles of her feet, and even those that still haven’t learnt to communicate, and those whose existence Lily may still be unaware of. Every part of our body has sensation. Where there is sensation, there is life. And where there is life, there is change. In fact, change is the only phenomenon that is permanent, not only in all living phenomena. The clearest evidence of this is seen in the sensations we feel in our bodies, which always arise and subside. Our ability as an organism to develop inner integration and inner communication between the different parts plays a critical role in developing awareness to the various sensations, to change, and to the life pulsating within us. Separated parts that do not communicate cannot help an organism to function effectively as a system. Their beauty is that they are part of an overall array. A simple example: what is beautiful hair? Hair is beautiful only when it’s part of the organism. But if you find a single hair on your dinner plate, you wouldn’t find it beautiful. A hair isn’t part of the organism when it’s out of context, it is not beautiful, it has disintegrated and lost its beauty. So, if I suggest to Lily in a non-verbal way, through touch, that all parts of her have the same degree of importance, like a mother loves all her children equally even if they’re all very different from each other, I’m proposing something new. That all of the parts can, metaphorically, sit side-by-side at a round table like King Arthur’s table. They can have a conversation and perhaps this can encourage them to hold an inner discourse that leads to collaboration. That was the breakthrough idea that King Arthur suggested: though he was King and had supreme power, his knights, whose task was to fight and govern the country together with him, could all talk equally around the table, and influence how the country was run. There’s a possibility that if this sort of discourse happens, and the mode of operation becomes absolute, Lily’s head wouldn’t have to explode with pain in order to decide what to do. This approach is also backed mathematically by findings of game theory. The mathematics of game theory demonstrates clearly that collaborating is the most effective method for all participants in the game to move ahead. In the long run everyone gets more, and enjoys the results: even if there’s a risk that they may have to compromise, in the long-run the compromise pays off. This is one of the deeper significances of integration. In this kind of integration, every part is important and communication between them is vital. Integration is like a fruit salad in which we can still recognise each fruit - the strawberry, apple, and banana. All of them combined create a fruit salad, unlike a smoothie. All of the parts and systems that form the finished organism, are a single system functioning together. Together, it can attain the most effective results. More cooperation and collaboration create greater coherence. It is a gestalt in which the whole is more than the sum of its parts. The change isn’t effected by me as a therapist, but by Lily herself. My role is to invite all the parts of her body to a roundtable discussion – it’s an invitation to function more coherently as a single organism, as a communicating whole. Not everyone responds similarly, of course, but if we don’t suggest it, we’ll never know what new places could develop when we propose identical therapy for all parts of the body. BACK TO LILY We know from the literature that, in general, people who suffer prolonged anxiety underwent past traumatic psychological incidents or adverse events. The implication is that we need to examine this possibility with Lily. It’s almost certain that the split that her body presents and her continuing anxiety need to be viewed against that backdrop. Although Lily at this stage, she hasn’t yet shared her past with me, which is common at the start of therapy, it’s important that I assume that something happened in her past that brought her to the current situation. Like other clients, Lily didn’t come to us out of nowhere but from the reality and experiences that formed and shaped her, and brought her to where she is, the way she is, today. My assumption is that Lily experienced something in childhood, something probably frightening that she only survived and remained sane by clenching her shoulders and fixing her body in its present condition. It was a normal reaction to an abnormal situation. If she underwent those experiences frequently, her body was no longer able to relax its muscles; it simply stayed that way, like in the story of Reich’s experiment. Wilhelm Reich’s experiment with an amoeba Wilhelm Reich, the father of Western physical psychotherapy, was a physician and scientist in his approach—he performed many experiments. The story says that one of his experiments was on an amoeba, an organism consisting of a single cell and a membrane. It moves by extending it pseudopods, which resemble arms, to make basic swimming movements, engulf food particles and bring them into the organism. This organism is constantly in movement of some kind, and as long as it moves, it is alive. As I said previously, change (expressed here in movement) is the only phenomenon that is permanent and distinctive, particularly in living organisms. Reich observed the amoeba under a microscope and decided to perform an experiment on it: he pricked the amoeba once without damaging its membrane and observed its reaction. He saw that it seemed to contract, freeze momentarily and stop moving. After a while, the amoeba recovered. Its behavior showed nothing to indicate it had been pricked. But, when it was pricked several times, although the membrane wasn’t damaged, it remained clenched and didn’t resume moving. Finally, because it no longer moved, it could not engulf food and died. A SIMILAR PROCESS IN THE BODY Similarly, that is what happens to muscles: after they contract many times into a specific position, they often stay contracted and are not released. The contraction and the inner split become fixed, because of a recurring action which became a procedure, and automatic process control by implicit automatic procedural memory. This is the disregulated way in which Lily survived her childhood. This is how she temporarily solved the insoluble problems that she had to deal with. It was the best way she could use at that time, when her needs were not met properly and the terrifying experiences recurred constantly. And regrettably - despite the frightening incidents that happened to her, and even though they no longer happen and there are good prospects she will never have to confront the reality which she did in the past, she doesn’t have to clench her muscles today - she still cannot release her muscles and reconnect the parts that have split away. All of this, because the reason and the process are reinforced in her memory as an unconscious process. SAFETY AND SECURE ATTACHMENT Now, during therapy, I can propose something new. As well as equanimity, I can propose another novel idea – that it’s safe now. I suggest it both verbally and nonverbally, particularly through touch. When I perform touch correctly, it helps by activating the hormonal systems to create oxytocin, and the parasympathetic nervous system is activated via vagal nerve stimulation. When they are jointly activated, this in turn activates the social engagement system. It’s an opportunity to examine the option that perhaps now, this moment is safe. Perhaps now she can release her muscles, let the tension go. It’s an invitation to negotiate, to re-examine conditions and options, to let something new happen. Another way of widening the sphere of confidence is by identical treatment over the entire body. Like this, the contact is systematic and identical, and it allows prediction; when a client anticipates touch, it helps her or him to be more relaxed. A basic condition for negotiating is Lily’s ability to develop the capacity to observe the sensations in her body as if it’s one unit. Sometimes this is only possible by presenting Lily to equanimity, as an organism aspiring to function harmoniously and integratively. In the following stage, she has to make sense of the various processes unfolding within her. During the process, it’s vital that she’s in a safe, nonjudgmental setting, and then we can negotiate and check new options at the ‘round table’. By addressing all parts of the body equally, equanimity can be a good method, enabling physical and mental integration. SUMMARY As yet, I do not know Lily well enough. I don’t know what in her history taught her shoulders and back to be tensed to the point of pain, to be so fearful. But what I do know is that it’s Lily alone who can find the winding, convoluted path in her brain towards the procedural memory that guides her motor region to continue clenching her shoulder and back muscles, despite the intense pain. Only Lily can extract that procedure, bring it to consciousness in her brain’s frontal area, and reexamine if there’s something else that she, as a whole organism, can do for herself to diminish her pain and live her life. And so we have to open the door to negotiations and integration, verbal and non-verbal alike and this is the therapist’s role. From that respective, equanimity is likely to be the path worth taking. Dr. Elya Steinberg, MD, is Co-Director of the Centre for Biodynamic Psychotherapy (London School of Biodynamic Psychotherapy). She is a medical doctor and biodynamic psychotherapist who integrates body-psychotherapy, Gerda Boyesen methods and bioenergy with psychological trauma work, martial arts, conventional allopathic medicine and complementary medicine. She interweaves alternative and conventional approaches to allow a person to grow as a holistic complex and improve their well-being. In partnership with Gerhard Payrhuber she facilitates the group 'Attending to the Silence’ for second and third generation Shoah survivors, perpetrators and bystanders.
How can we evaluate the subjective and objective aspects of effectiveness in the therapeutic alliance?Fundamental limitations to current scientific writing about therapeutic processes
Somatic Psychotherapy Today | Summer 2017 | Volume 7, Number 2 | page 39 In this article, I propose that there are fundamental limitations to current scientific mainstream methods of writing about therapeutic processes that in fact hinder our ability to both write about our therapeutic process and to learn from other clinicians’ and researchers’ writings. In my view, these limitations may partially be compensated for by allowing creative writing, poetry and other forms of art to be the major part of a case study, where the objective measures must be integrated into the subjective frame of writing. Creative writing conveys its truth by acknowledging the intense subjective complexity originating from sensations and emotions accompanying the actual objective memory. Therefore, describing only the client and therapist’s narrative itself or material that is only observable by external senses, heavily compromises the quality of the therapeutic process. By therapeutic process, I am including all interactions that a person has concerning any aspects of their health, whether with a medical doctor, therapist, psychotherapist, body-psychotherapist, psychologist, physiotherapist etc. In this article, for simplicity I will call all those from whom the person seeks support the Therapist and the seeker a Client rather than a patient. In some other places, when I think that the important aspect of the experience is simply human and is not dependent in a particular function or the differentiation between therapist and client I use Person or Participants. These fundamental limitations to current scientific mainstream methods of writing about therapeutic processes prevent full understanding of the quality of the therapeutic encounter and create a situation whereby the writing is potentially disloyal to the personal truth of the participants. For example, the measure of wellbeing, pleasant/ unpleasant or pain/ no-pain are clearly an individual perception and sensation. Those reflexive individual perceptions of wellbeing, pleasure and pain are complex multidimensional experiences that have defied our understanding for centuries. The reflexive awareness of those qualities of human consciousness, i.e. sensations, emotions and feelings, originate from the internal visceral aspects of the body (Damasio, 1999b, 2013). Still most case studies do not reflect on those important internal embodied experiences of the self of any of the two participants. At the end of the day, the efficacy of therapeutic intervention can be judged mainly by the clients only and deeply embedded in their inner motivation and their perception of themselves in their internal world, which is based on the maps of our visceral function as well as the external world. I will discuss these limitations from the point of view of Protagora’s (fl 5th C BCE) dictum “Of all things the measure is man” . . . I will do so without getting into dialectic argument, which could be essential in cases of cognitive dissonance and Equilibrium of Destructiveness. I will discuss these latter ones elsewhere. However, when we look at phenomena from the point of view “Of all things the measure is man” (DK8ob1), we must look at the ‘dual-aspect monism’ (Solms & Turnbul 2005) viewpoint. The monism claims that body and mind are one rather than accepting Descartes’ dualistic point of view that body and mind are made of different fundamental basic components. In addition, this one ‘thing’ can be perceived by two valid ways. Those two ways to perceive this one ‘thing’, objectively and subjectively are both measured by man, and I will elaborate on the question of how can we interweave those two valid ways of perception by man while reporting on the therapeutic encounter. I suggest that this way would be more accurate and could possibly support not just more fruitful communication between scientists and clinicians but also help stepping forward answering Searle’s question (Searle 1995a p62) ‘How does the brain get over the hump from electro-chemistry to feeling?’ A mixed method study of writing that interweaves objective and subjective phenomena may potentially offer more information necessary to investigate therapeutic processes from a ‘dualaspect monism’ (Solms & Turnbul, 2005) perspective that claims the body and mind are one, and we have two ways to perceive it: objectively and subjectively. The immense magnitude of information brings us to a crucial limitation—the need to choose from an infinite number of details that create the web of phenomena, which details do we discuss in a particular article? We usually strive to choose the details that express and present to us an important quality of the therapeutic process. One fractal picture from multifractal scaling information in motion or a particular emergent property. The process of choosing the particular facts that we intend to present in an article is always biased by many factors, for example: the researcher and the editor’s personal life and capacity to perceive phenomena; the wider social construct and ecological, economic and political situations. These biases compromise even further the writer’s capacity to present the quality of the therapeutic encounter. An example is presented by the enormous gap between conventional medicine and Chinese medicine. Both disciplines are successful systematic methods used to assess the health of a person and to suggest a course of improving the health of the client . However, each discipline chooses to consider a different group of facts and details from the infinite number available. Hence, they have no common language for communication. Sadly, this gap exists not just between Eastern and Western philosophy, but also between different Western disciplines such as medicine and psychology and even between different methods of psychotherapy such as cognitive-behaviour, psychoanalysis and body psychotherapy. One of the major challenges I observe arising from this lack of common language is a disrespect and a form of competition between the disciplines and therapists, each one claiming that it holds the absolute truth and the best way to attain human health. It has become a hidden power game rather than a collective effort to best serve the client’s needs. With these basic thoughts about our human incapacity to be objective, I let go of the idea of trying to be ‘objective’. I believe that there is a danger inherent in the attempt to be objective about the therapeutic encounter that is often the result of coincidental historic circumstances, or an arbitrary difference of opinion at the time of creation that does not provide the dynamic stability required for the processes and issues present in the therapeutic encounter. Many of the conclusions that claim to be objective tend to become ogmatic ideas or authoritarian politicalidentities that are no longer examined by thetherapist, as though they were mathematical axioms not capable of being excluded. It is par for the course that differences of opinion and questions about objectivity and subjectivity will always exist, and there is a question as to whether it is truly possible to utilise them without coercion and without even the slightest hint of violence. With that, it is well to recognize that expression of the experience is born of the desire to know the truth, and the intention is to protect the public from moral negligence. Hence, in this article I allow the flow of information to emerge from me in a process of creative writing, trusting the process rather than any premeditative preconception of how it is supposed to be written. There is more than one way to approach gaps in communication when we present the quality of the therapeutic encounter. Here I would like to explore ways to bridge scientific thinking and human experience . Scientific classical thinking is the thought process that is traditionally supposed to help us find objective truth. However, scientific thinking brings dualistic thinking into life in the form of an absolute ‘truth’ or absolute ‘non-truth’. It has a very little space for the spectrum of differences and relativity. Life is composed of infinite subjective and objective experiences. These infinite possibilities comprise personal truth. Originally, science evolved to explain human experience rather than the other way around. I think this leads to confusion. Many people look to science to validate their experience. However, their experience does not need external scientific validation to present accurately personal truth. It is for science to ask the questions how and why a particular truth is experienced as it is. It may be a truth that science cannot explain all subjective human experience, however it does not give it the moral right to belittle experience that it not yet explained. This means that in this article, first and most importantly, it is subjective human experience that will be presented as subjective personal truth, using creative writing in which I embed objective scientific findings that can explain some of the infinite possibilities of human reality. Some scientists may dismiss the creative writing as “almost literature” as did a reviewer of one of my articles. They may dismiss it, rather than looking at the interesting phenomena of how and why the particular flow of interactions gave rise to poetic writing and in which way this particular way of writing makes the reader feel surrounded by the flow of interaction inside the web of phenomena and connected to the real experience, rather than disengaged from it. In psychotherapy and some other disciplines, creative writing can bridge some of these gaps in communication. Poetry and creative writing may emerge from within the therapeutic process as phenomena in the client, the therapist, the supervisor or all three people and serve as a: “coherent narrative that does not betray personal truth”. They emanate from the “embodiment of psychic matter” of material such as indescribable, unbearable pain, enormous pleasure or praise for virtue. Subjective experiences that the human mind cannot comprehend completely by using the scientific vocabulary, which essentially lacks an appropriate narrative. Creative writing serves as part of a necessary process enabling us to assimilate the experiences. It works especially well where the incomprehensible traumatic experience feels compromised by any form of intellectual analysis. Creative writing conveys the truth by acknowledging the intense subjective complexity originating from sensations and emotions accompanying the actual objective memory. Therefore, describing only the client and therapist’s narrative itself or material that is only observable by external senses, compromises the quality of the therapeutic process. Yet, I am left with the most malignant questions that I struggle with. Therapists - whether medical doctors, sychotherapists, body psychotherapists, psychologists, physiotherapists etc. - read and write ‘case studies’ to be able to learn from each other and from other therapists’ experiences as “the greatest obstacle to discovery is not ignorance, it is the illusion of knowledge” (Boorstein, 1984). How can we be more effective if we will not do so? In the field of ‘manmade’ trauma, we oftentimes write about people who are highly traumatized, most of whom have been betrayed by the people who they should naturally be able to trust the most. People who have risen from the graveyards of an abusive childhood and neglected life, when they were treated as objects to satisfy the desires of others. Regardless, they have managed to build new lives as positive contributors to society, and possess special qualities that arise in a person when they need to survive resistance and oppression. They develop their strength against all odds and despite the conditions. They are resilient. They survive in conditions and environments that we, as therapists, may not be able to survive with our sanity intact. These people hold within themselves screams of pain juxtaposed with roars of victory. When I/we write about them in an objective manner, reducing their full manifestation as human beings, as subjects, do we not retraumatize them? Re-enact their original trauma in a malignant parallel process? Treat them as objects again? Do I/we reduce, intellectualize and rationalize their pain and agony, because as therapists I/we are not able to deal with their live full embodied pain? Do these clients and patients feel seen by me/us? Do I/we really see them and support them by telling their ‘objective’ story rather than their subjective story, to help them, and maybe also ourselves and future generations? or do I/we betray them somehow inside of that energetic quantum field by making them an object rather than a subject? This leads me to what I see as the Fundamental limitations to current scientific mainstream methods of writing about therapeutic processes(1) The first limitation is that in many of the current mainstream methods of writing about therapeutic processes, most of the processes encountered are measured by outcomes and notby process. This happens regardless of the fact that the quality of the outcome stems from the process. A dynamic process embedded in a complex dynamic matrix. Allan N. Schore (2002) writes, “The essential task of the first year of human life is the creation of a secure attachment bond of emotional communication between the infant and the primary caregiver. To enter into this communication, the mother must be psychobiologically attuned to the dynamic crescendos and decrescendos of the infant’s bodily based internal states of autonomic arousal” (pg. 9). Therapists, similar to the mother, wishing to offer a secure attachment bond in the therapeutic encounter also “must be psychobiologically attuned to the dynamic crescendos and decrescendos of the” client’s “bodily based internal states of autonomic arousal”. This a dynamic process that needs to be reflected upon with language that echoes on the deeply subjective dynamic crescendos and decrescendos of bodily based internal states of autonomic arousal. (2) The second limitation, which we can see as one of the extensions of the first one, is that the quality of the therapeutic process can’t be simply defined as an absolute measure. The existence of the quality of therapeutic encounter is dependent on multiple factors. For instance, Norcross suggests common factors that work in psychotherapy such as: alliance between therapist and client, cohesion in group therapy, empathy, listening, collecting client feedback, goal consensus, collaboration, positive regard, positive support and more. He also suggests factors that do not work in sychotherapy, such as some styles of confrontations, frequent interpretations, negative processes, assumptions, therapist’s centricity and early ruptures in the relationship. However, around 40% of the factors are unexplained therapeutic variance. Those, in my opinion, cannot be defined as they stem from the quality of the dynamic harmonious flow of interaction insidethe web of phenomena. When you have ‘quality’ in the room, you recognise when it is absent from the room. It is measured by subjective human experience and defined by the felt sense and capacity to appreciate ‘quality’. We can’t analyse this quality using rational systems of order. We can express the impact of the quality on the participants using creative writing or art, but we cannot describe it with scientific vocabulary. We can no more catch the flow of interaction than we can catch water in our hands. We need to relate the dynamic patterns of flow of the interaction, to the quality of the motion of a movie, rather than to separate pictures. (3) To explain this limitation, I will borrow a concept that originates in quantum physics: the uncertainty principle of Heisenberg. The uncertainty principle of Heisenberg determines that we cannot be certain about the accurate value of some pairs of variables, even not with the most accurate instruments. The best way to describe it is by using the following equations. In classical mathematic we say that 5X4-4X5=0. Meaning that the variables A and B are exchangeable. AXB –BXA=0. However, according to the uncertainty principle of Heisenberg, some pairs of variables that describe the way these elementary particles behave are not exchangeable, meaning: AXB-BXA≠0 One of these pairs is momentum and location. This means that if you know everything about the momentum of an elementary particle, then you cannot know its accurate location. If you know all about the location of an elementary particle, you do not know its accurate momentum. Momentum is a term that defines the direction and intensity of the movement of a particle. Now I will use the principle as a metaphor to explain my biodynamic perspective of therapeutic encounter. If I take a camera and take a picture of a moment in therapeutic encounter, it will give me an accurate location of the client and therapist at that moment. The picture provides me with a static location. I can gather maximum data on that phenomenological moment and ideally include everything that is captured in that moment, subjectively and objectively, by both participants and the observer of the moment. I could possibly write a paper on just that particular moment. In addition, we will gain information that enables us to diagnose the client with one of the known diagnostic methods such as DSM or ICD, which methodologically are based on sum of static pictures of the client. However, informative as that moment can be, it will provide no information about the momentum of the client and therapist I could take a video camera and record a movie. This movie might provide me with a full account of the dynamic flow of interaction, the ways of change and directions that appear in the client and therapist. Ideally, I could capture the objective and subjective dynamic complex phenomena. A particular location will become a vague phenomenon when I have clear information about the dynamic process of the flow of changes and interaction: How are the client and therapist moving nearer each other or further apart? What are the parallel changes in heart rate and heart rate variability of the client and therapist and how does this relate to the subject of conversation or silence in the room? The Biodynamic diagnostic system is essentially based on that information, information about the momentum that in the participants and inbetween the participants and in-between the participants and surroundings. A therapeutic process has clusters of information that are organized in reiterative and partially overlapping patterns and present the idea of a fractal experience. The fractal experience is crucial in the understanding of the ‘location’ of the participants in the therapeutic process. However, a fractal is still a static picture that give rise to the exhibition of multifractal scaling information in motion and unpredictable dynamic emergent properties. That dynamic motion would be crucial in the understanding of the ‘momentum’ of the participants in the therapeutic process. This kind of information cannot be expressed using words that describe the static picture. Nevertheless, it can be partially expressed by the subjective flow of creative writing. (4) The forth is that not all processes are alike and the individual match between Client - Method- Process -Therapist is crucial for a successful process that will result in a successful outcome. For example, in medicine, the process includes far more than the particular prescribed medication. The interweaved processes will determine for example whether his particular client will use the prescribed medication, follow what the doctor thinks is the ‘correct procedure’ or take the advice given. Some of the most popular research methods that scientific writings are based on the Randomized Control Study (RCT) protocol. In RCT, the researchers intentionally exclude the individual match; therefore, they can never capture some of the crucial essence of the therapeutic encounter. ( 5) The fifth limitation stems from the fact that the client and the therapist are part of the vast web of phenomena of the therapeutic process, which is an open, dynamic, complex system. This process is taking place beyond verbal content and observable measures. Traditionally, there are two main sources of relatively neglected information that needs to be taken into consideration methodologically: (5a) nonverbal information and (5b) non-observable information. Various aspects of non-verbal information are already considered by some researchers in developmental psychology such as Edward Tronick and Colwyn Travarthen, but not enough has taken place within the therapeutic encounter. (5a) Non-verbal information can be observed by watching systematically. For example, we can watch : micro-movement, macro-movement, patterns of breathing, motility and posture,dynamic changes in the colour and moisture of the skin, the music (i.e. the harmonious and disharmonious, the tune, tone of voice, accentuation, the pitch, the intensity etc.), the ‘dance’ of the participants in relationship to each other and gestures accompanying the lyrics (the words). 5b) Non-observable information contains vast reservoirs of informative aspects. I will mention three of them here: (5bi ) First are all the internal milieu, composed of a variety sensations, emotions, thoughts, psycho-neuro-immuno-endocrinological changes and the interlinked dynamics of the way they emerge. This can be partially observed during a session just by the trained participant who is able to use their own body as a measure in the resonance between the participants, for example via touch. (5bii ) The second aspect is historical (personal history and general history), social, ethnic, political and ecological that create a combination of dynamic realities. Prior learning experiences give rise to the particular perception in context and time of the therapeutic encounter, which includes the haptic communication. (5biii ) Third and no less important, it is hardly discussed in the literature: What are the people in the room choosing not to say? What are their reasons for conscious withholding? Furthermore, what happens to the participants in-between the sessions? And how can we evaluate the subjective and objective aspects of effectiveness in the therapeutic alliance? Evaluating the subjective and objective aspects of effectiveness in the therapeutic alliance In 2007, I was asked by the director of Confer to present and demonstrate how Porges’ Polyvagal theory is relevant for a clinical setting. I began that presentation by quoting the Israeli riter Yochi Brandes (Kings III, 2008): “Stories are a more efficient weapon than swords. The swords can only kill those who stand before them, in contrast to that, the stories determine who will live and who will die in later generations too.” That sentence followed a presentation of the story of one and a half hours of work I did with a person who had not moved for over two hours before I entered the room. It was a process of supporting a survivor of extreme abuse and torture (SRA; Survivor of Ritual Abuse) who suffered from Dissociative Identity Disorder (DID) in freeing himself from a voodoo death state. I presented that case a few times afterwards and called it “Voodoo Death, Dissociative Identity Disorder (DID) and Biodynamic Psychotherapy”. I unfolded the multi-layered phenomenology of the complexity of the subjective human experience of Biodynamic Body Psychotherapist at a micro-analytical level. I employed analysis from a variety of viewpoints originating from different theories and mythoughts were woven into the story as it unfolded. I followed the story from the perspectives of ontological and epistemological research as participatory (therapist), drawing together the professionalism with the direct authentic and Hursselic personal level. I reflected here not only on viewing external conditions - as done by the naturalists - but also on viewing the internal conditions and thoughts that cannot easily be measured, and by the inclusion of another spectator. My intention was to describe the complex processes of co-adaptation and co-regulation. I am doubtful as to whether I can properly describe and deal with such complex processes using only one sense, and whether they can be represented correctly by offering up a long catalogue of objective facts. For this reason, I broadened the viewpoint as far as possible to create a holistic web that includes body and soul as one, the story, Biodynamic Psychology, attachment theory, trauma work, and neuroscience. I still remember how the sense of real terror that enveloped the client spilled out into the huge conference room as I invited them to feel the story. At that time, it was not just a sterile case study about trauma; at that time, it was about a palpable person who had experienced trauma who then entered the room for the audience to have the direct experience and process with them. When Porges read the 40-page story he said an essential sentence to me— “I visceralised the patient.” Porges understood the accuracy that we gain when we describe the subjective qualitative aspects of the clinical material. Those subjective qualitative are body based and represent the internal map of the functions of the viscera. It gives rise to our consciousness. (Damasio, 1999, 2013; Solms & Turnbull, 2005). This background state of consciousness represents the most basic embodiment of the SELF. It is full of meaning and feelings. It does not just represent the self it also provides the reflexive content that tell you your situation in your life. I believe that we need a new scientific language that can enable us to feel the story and fully understand the client by re-experiencing, on a mini-scale, what the client and therapist really felt subjectively. I will share a few paragraphs from that story with you that has been published in the 2015 Biodynamic body-psychotherapy conference book, to show how poetic writing enabled me to dive into the personal subjective qualitative aspects of the clinical material. To enable the capture of the subjective qualitative aspects of the clinical material of this case, all was data, all mattered, beginning with the name. For example, I chose to call it “Voodoo Death,Dissociative Identity Disorder (DID) andBiodynamic Psychotherapy” rather than any of the other, more sterile options such as:Catalepsy, DID and Biodynamic Psychotherapy Catalepsy: a general term for an immobile position which is constantly maintained Catatonic rigidity, DID and Biodynamic Psychotherapy Catatonic rigidity: the voluntary assumption of a rigid posture held against all efforts at initiating movement Catatonic posturing, DID and Biodynamic Psychotherapy Catatonic posturing: the voluntary assumption of an inappropriate or bizarre posture, generally maintained for a long period of time ‘Death feigning behaviour’, DID and Biodynamic Psychotherapy - the less dramatic name used by physiologists for the voodoo death state I chose that particular name because it allows the real experience of the client to enter the conference auditorium. This is not my story; this was the client’s life story and it was what the client believed they had experienced. I felt that I had no right to reduce it. The story continues with one of my first observations when I entered the room and described the external phenomena I saw and my internal experience: “An Asian man sat, with a pale chiselled profile and dark hair. … lthough his body was present in the room I could feel the forceful absence of his social presence. I could see no trace of social behaviour or social communication in him. Clearly, he shared no intention, no feeling in our company”. At that moment, I experienced my thoughts as “distant”, which was already an embodiment of the dissociative experience I felt while I resonated with him. “I wondered, on one hand, what had caused this person to come to a halt, and on the other hand, what was the unique and selective adaptation process, conscious and unconscious, which had enabled him to choose a path of therapy and thus hope.” I started to remember Porges’ presentation at a trauma conference in Boston, saw the slides of that presentation in my mind. This was followed by the realization that I was using my own favorite defense mechanisms of intellectualization and rationalization so as not to feel him, as it was almost too much to bear. I regulated myself emotionally and physiologically, returned to feeling the mute person and continued to absorb and sense the experience of being with them (the client and two psychoanalysts) in the room, seeing and asking myself: “…Could the stone mask testify to the fact that he had already seen the felled head of Medusa and there was no somersault of the reaction?” I felt in my body and soul that moment when his despair and my despair became one. Acknowledging this despair enabled me to move forwards, and I felt that a new sensation regarding the musicality of the attachment process entered my consciousness. “I had the feeling that some synchronized sounds were present in the intersubjective space much like a voice calling out in the desert allowing the last bastions of hope for the lost.” When I concluded that I had seen all there was to see from the outside and gone through all my thinking and theory, I allowed myself to feel the full vegetative identification with him using mirror neurones and adaptive oscillation in the quantum field of the therapeutic space, to enable the full embodied somatic resonance and the sensations of counter-transference. “I was fully aware that the longer I stood in the room, the greater my feeling of a nameless sense of dread, which filled me from head to toe, as if the frozen intensity of the man in front of me was absorbed in my own body. My mouth was dry.” As I had no idea “what to do?” I started more consciously using ‘Dual Awareness’ in addition to the vegetative identification and analysis as a parallel process. “I sat and listened with my entire body, the 'material me' Sherrington, 1900). My ears seemed to have blocked themselves. This silence was the sound of terror, and I was listening to it and myself while all my other senses became more acute as the sensations were seemingly amplified through my body… A whispering fear rose inside me, engulfing me with a feeling of desperate solitude making the distance between myself and the others feel endless and unbridgeable” A memory of a sentence “fear cuts deeper than swords” sprang in me. I felt the impact of his horror in me “the impact of which no amount of training could prepare me for.” The experience of feeling like an invisible swordwas cutting into my own flesh led me to internal analysis in the 'present moment', connecting to my own trauma when I felt similar feelings and sensations in myself in my past. These led me to take a course of action of attuned intervention. That action was based on my Biodynamic working hypothesis about the essential need for self-regulation and my internal analysis gave me the entry point to understanding that I needed to find a way to touch and that touch might reconnect him to life. “I needed to reach out to the man. I needed to touch him and find a simultaneously (Byers, 1976, p60) shared rhythmic foundation (Mary Catherine, 1979) which would enable turn taking..” I was starting to negotiate a lifeline. “In a gentle voice that matched the volume, rhythm and prosody of the Clinical director and Therapist’s voices, I asked his permission. Did he blink his eyelids? A quick glance in the Therapist’s direction confirmed he had.” I again went through an internal process in negotiating the lifeline. “I quickly calculated the risks. At this moment, anything was possible, and I had to prepare for any eventuality, from gentle consolation to violent attack. For these, not only was there need for a victim in the cult, but also a priest. The emaciated bony hand of this cult survivor sitting opposite me might be contaminated with blood.” I had to regulate my fear as this was not counter -transference; this was a real risk. Externally, I took action as I had to get consent and permission to touch his hand but also to protect myself. Then, “I picked up a shiny, light coloured cushion and placed it on my lap. I spoke forgotten words, which suddenly came forth from the painful place inside me.” We negotiated the touch, then I gently placed his hand on the pillow and stroked his hand softly at a very particular rhythm and intensity, listening careful to the appearance of peristalsis. To feel real hope, we needed to feel life inside of us. Psycho-peristalsis could enable the internal transition of movement from paralysis to action. “I returned to silence, listening with my fingers, and then I heard the voice I had longed to hear emanating from his intestine. A gentle rumble, like the hesitant purr of a cat bathing in the sun’s rays, was very clear. Peristalsis, referred to in biodynamic psychology as psycho-peristalsis. My ears, accustomed to hearing these voices, sharpened, alerted. These involuntary gut responses, the sounds of which were increasing, sounded to my ears like the roar of an experienced surfer who forces himself to conquer a stormy wave and whose triumphant bellow echoes from its crest.” The intervention with appropriate touch came from my deep embodied resonance with him, and it looked like a good idea as the emerging data from scientific literature shows that appropriate touch starts a cascade effect throughout the systems of the body. Touch influences higher cognitive centres, enhancing body awareness and embodiment through proprioception (Berlucchi & Aglioti, 2010; Craig 2002, 2009). Gentle and pleasant touch acts via C-tactile afferents to influence affective and reward centres in the brain, which most likely activates the placebo effect (e.g. Benedetti, et al., 2011; Dunbar, 2010,), but which more importantly activates C-tactile afferent fibres in the skin that stimulate the client’s insula and begin the release of oxytocin. This activates theinsula and enables some sense of body ownership to reappear, due to the combination of oxytocin and the activation of the myelinated parasympathetic branch of the autonomic nervous system. Therapeutic touch is also likely to promote the release of endogenous opiates (endorphins) as well as oxytocin and arginine vasopressin, which has analgesic properties to help dealing with the emotional pain and influences social bonding (Dunbar, 2010; Sauro& Greenberg 2005). After the lifeline was established, the client moved and stood up on his feet. It felt like a triumph of the sympathetic branch of the autonomic nervous system; the client came out of his voodoo death state. This session unfolded as a combination of aspects from Biodynamic Massage in Vegetotherapy. Vegetotherapy is a method that began with Wilhelm Reich and which was further developed by Ola Rackner and Gerda Boyesen, the goal of vegetotherapy is to enable the activation of the identity of the self by being open to the infinite possibilities of the subjective experience. It is one of the major methods by which Biodynamic psychotherapists work, and which starts through embodied listening to the internal and external communicative musicality, including the vegetative internal signals (vegetative meaning autonomic nervous system signals). This sentence from Sherlock Holmes in The Sign of the Four (1890) sprang up in my mind: “How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?” Elya Steinberg, MD, is Co-Director of the Centre for Biodynamic Psychotherapy (London School of Biodynamic Psychotherapy). She is a medical doctor and biodynamic psychotherapist who integrates body-psychotherapy, Gerda Boyesen methods and bioenergy with psychological trauma work, martial arts, conventional allopathic medicine and complementary medicine. She interweaves alternative and conventional approaches to allow a person to grow as a holistic complex and improve their well-being. In partnership with Gerhard Payrhuber she facilitates the group 'Attending to the Silence’ for second and third generation Shoah survivors, perpetrators and bystanders.
Psycho-Peristalsis in the Shared Body
Reprinted with permission from Somatic Psychotherapy Today | Fall 2016 | Volume 6, Number 3 | “Has it ever occurred to you that one hundred pianos all tuned to the same fork are automatically tuned to each other? They are of one accord by being tuned, not to each other, but to another standard to which each one must individually bow...” (A.W. Tozer, 1948) The Rainmaker This is a story about a rainmaker that Carl Jung allegedly told in every possible seminar (Jung & Douglas, 1931-35; Rolef Ben-Shahar, 2014): Once upon a time there was a Chinese village suffering a great draught. The village people thus sent for the rainmaker who lived in the farthest corner of China. As he arrived and the elders of the village gathered around him, the rainmaker merely asked for a place to stay in solitude. He was provided with a small hut, where he sat and meditated for three days while the entire village people impatiently awaited him. On the third day the rain started to come, and the rainmaker left his hut. Excited and grateful, the village elders gathered around him curiously. “What have you done?” they asked. “Nothing,” he replied. “But you have brought the rain after so many months of drought.” “I don’t know about that,” answered the rainmaker. “In the village I come from people live according to the ways of the Tao. We maintain the dynamic balance of Tao so people are sad and people are happy, babies are born and people die, the sun shines and the rain comes. When I arrived at this village I felt that I was totally off-balance. I couldn’t think straight or calm down. It has taken me three whole days to retrieve my inner balance." The Third Area In therapist-client interactions something new emerges. There is an ‘us’ and it requires us to relate and to speak to it in a new, inclusive language.Through this profound attention and attunement a new field emerges. In relational psychoanalysis and relational body psychotherapy, this field is called the intersubjective third or the analytic third. The concept of the third means a wide variety of things to different thinkers—it has been used to refer to anything one holds in mind that creates another point of reference outside the dyad (Aron 1999; Crastnopol 1999). Thomas Ogden (1994) used the term analytic third to describe an entity created by the two participants in the dyad.While Lacan saw the third as an energy that kept two people from collapsing—be it merging into oneness, eliminating differences, or creating a “twoness that splits the differences—the polarized opposition of a power struggle” (Benjamin, 2004. p.4). Winnicott, who pointed out that there is no baby without a mother, called the transitional space that is neither subjective reality nor objective reality ‘the third area of the psyche’, which is an integral part of the human experience. The third area is where we experience our fantasy and reality without the need to choose between them, similar to what we experience while playing a game (Winnicott, 1971).When two people are together a wider mind is created (Bateson, 1972), and talking in terms of ‘my stuff’, ‘your stuff’, ‘my body’ and ‘your body’ does have therapeutic value. But we believe it might also be beneficial to give attention to the field, the effectiveness of the affective laden relationship, which often has the use of an inclusive language "us".As trained Biodynamic psychotherapists, we integrate the curious phenomena of psychoperistalsis (PP), a core concept of Biodynamic work, into our clinical work: What if we could relate to PP in the same way the rainmaker related to a whole village? Psycho-Peristalsis (PP) More than 50 years ago, Gerda Boyesen, the founder of Biodynamic psychotherapy, believed that not only food gets digested in the digestive system but also emotions. She noticed rumbling noises in clients’ intestines and that those clients who had them during a Biodynamic massage recovered much quicker than those who did not. She called these noises psycho-peristalsis (PP) (Boyesen, 1979).Because unresolved emotional processes may leave clients in a constant state of sympathetic arousal resulting in dysregulation and high levels of stress hormones, Boyesen focused her work on self-regulation. She emphasized clients’ capacity to down-regulate on three levels, which are illustrated by the embryonic layers that are also represented by the three layers of the emotional human experience: the psychological level (ectoderm); the muscular level (mesoderm); and the vegetative level (endoderm), which is the involuntary part of the autonomic nervous system.Boyesen believed the most significant part of healing occurs at the involuntary unconscious level and that PP, which is controlled by the parasympathetic nervous system, plays a pivotal role in healing—she believed it was an actual healing mechanism situated in the gastrointestinal track that linked the psyche and the soma. According to Van-Heel (2015), “Peristaltic sounds can guide our work when we want to initiate parasympathetic activity and cleansing” (p.9).Psycho-peristalsis offers a therapeutic indicator of emotional digestion and a discharge of any energetic or emotional accumulation (Boyesen, 1983). Though originally used during Biodynamic massage, PP and its resultant sounds have also become an important source of information during our therapeutic interactions. PP typically occurs when a client, in any setting, gains a deep insight, has a strong emotional release, or is deeply connected to his primary personality or core.Boyesen believed every individual has an embedded capacity for healing and independent well-being. She emphasized the wisdom of the body and its energy to know its way in the deep, unconscious vegetative level. Traditionally, in the Biodynamic psychotherapy approach, the therapist was perceived as a midwife who focused solely on the client, allowing the client's process to organically unfold. It was very much a client centred approach where the client led his process, with the therapist attending as a skilled witness to facilitate a safe, compassionate space for this organic unfolding.Using a stethoscope, which is attached to the client's belly, the therapist listened to the client’s intestinal sounds as a form of biofeedback to track his inner whereabouts that indicated his level of self-regulation, safety, ‘ripeness’ in processing different layers of inner healing and more. The Biodynamic therapist was and always is aware of her own self-regulation, but it is not spoken within the therapeutic dialogue.Today, there is more emphasise on a relational Biodynamic process, and the therapist is even more attentive to her own PP and self-regulation as well as the client’s within the therapeutic process. And yet, the energetic resonance with the client, based on connection with the life force energy, which generates and sustains the therapeutic process, is far below interpersonal and transferiential levels (Southwell, 2007).In this article we offer our experiences working with PP within the intersubjective field, within the shared body, with curiosity: what potential benefits may arise by using PP in this way? Psycho-Peristalsis in the Field Vignette (Yael) Sylvie (nick name) was referred to me by an organization that deals with adults who were sexually abused in childhood. Sylvie is suffering from what I identified as PTSD. She decided, at age 40, to initiate therapy (her first time) after developing chronic pains and anxiety attacks. During our first sessions, Sylvie came and simply verbally ‘vomited’ her story—words spewed forth without any emotional connection. She dissociated every time she talked about the horror she had faced for 16 years. During those sessions, I offered few interventions. Sitting and listening to her ‘dead voice’ as she talked about horrific experiences, I felt my body moving as if between an icy-cold river and a searing bonfire. I felt the heat of the pain and the icy-cold anxiety waves in me. While connecting to the sensations in my body, I felt Sylvie’s deadness trying to connect to life through my body. The boundaries of my body and hers started to merge; my pain and hers became one. I would breathe through our pain. For weeks, while working with Sylvie and listening to her stories, I concentrated on my self-regulation. I found that touching my feet helped me down-regulate the extreme sensations I felt. I noticed that once my psycho-peristalsis started to open up, and thus down-regulate me, Sylvie slowed down and something in her started to ‘click’, to connect. The Therapist as Rainmaker Within the complex dyad, PP became a conscious yet mysterious voice that represented unconscious shared material. This material was then processed by the client, by myself and/or by our shared body. Being aware of the PP in the field helped me to also stay in contact with the depth of the intersubjective third.As mentioned, PP is directly linked to the unconscious aspects of the human experience and, therefore, to the complex dynamics within the therapist’s and client’s bodymind. “When we ‘feel into’ the relational body… through (also) the nervous system of our shared body” (Rolef BenShahar, 2011. p.4), it helps us in the embodiedsensing of our shared-body in the intersubjective field.What happens to me as a therapist on a vegetative level is part of “an affective, embodied dance” (Rolef Ben-Shahar, 2011. p.4) where my counter-transferiential sensations can not only bring more information to the surface about myself or client but can also be part of an actual therapeutic processing that occurs in the here and now. On occasion, as a therapist, we are holding and digesting for the client processes that he/she is not ready yet to process (the notion of Kohut’s ‘Self-object’ (Kohut, 1971). Vignette (Shlomit) George, (a made up name), is in his early 30s’. A few years before we started therapy, he went through a major emotional crisis, which he now recovers from. I know how important it is for him to be ‘strong’ and on top of life situations. Every soft emotion reminds him of the fragile emotional state he had experienced during his crisis; as a result, he is reluctant to meet these emotions, which to him seem like emotions of weakness and loss of control. As happened in many previous sessions, George shares in detail how frustrated he is with his partner’s behaviour and lifestyle. He is full of rage and blame. Following a few months of therapy, I am confident that George is now able to contain his emotions. In other circumstances I might have supported him expressing his rage, but at this moment, I am not saying anything, I am taking the time to feel what resonates in me. What I feel is not anger or rage. It is a deep sadness and longing in me. I find it hard to breathe, my heart is broken, and my body is collapsed in the chair. “How does your heart feel?” I ask following a sense in which I feel our fear of 'going there’. “Can you breathe into your heart?” George dares to breathe into his heart. I can see his posture gradually become softer and wider, and with this his eyes become softer and sad, reflecting the sensations and emotions I felt for him. From this place of merging George was now able to connect for the first time to his softer emotions. We both could breathe now and feel our longing and sadness together. We heard the sound of watery peristalsis coming from both of us; we exchanged peristalsis in our shared field, in a beautiful duet of the souls. I felt relieved and hopeful, as I sensed and knew that peristalsis occurred within the process of deep insight and healing. We know we know. It is now easier for George to recognize and say: “I need my partner to touch and kiss me when I feel this next time.”Dan Siegel says that in the process of psychotherapy a shared space with the therapist may be an essential component of the therapeutic process. As two individuals share the closely resonant reverberating interactions, that their mirror neurons systems make possible, what before may have been unbearable now becomes tolerable (Siegel, 2007). Psycho-Peristalsis as a Duet - Resonance Somatic resonance is a phenomenon in which bodies impact each other at a vibrational and energetic frequency. This process is supported by mirror neurons in the brain. It is a biological phenomenon that allows us to impact and be impacted. It includes concepts of empathy, attunement, intuition, and kinaesthetic sensing.The mirror neuron system is thought to be an essential aspect of the neural basis for empathy. By perceiving the expression of another individual, the brain is able to create within its own body an internal state that is thought to "resonate" with that of another person. It involves a change in physiologic, affective and intentional states within the observer and by the person being observed. Therapists own bodily shifts may serve as a gateway towards empathic insights into the state of another person. (Siegel, 2007)Somatic resonance is a mutual process, involving both parties. Just as two finely made violins will resonate to the same vibration when only one string is played, the embodied self of the therapist and client reverberate in a somatic duet. When we are attuned to our own psychoperistalsis, we may find out how it communicates with the vegetative system of our client, and how we are impacting and being impacted mutually, just as we may notice that when we take a deep breath it impacts the person next to us and he might inhale deeply even without paying attention or be conscious about it at all. “Therapeutic resonance can serve as a superb diagnostic tool, allowing us to feel into the relational field (wider self), picking up shown yet unspoken fragments of communication... This is an intersubjective crossroads where body psychotherapy, relational psychoanalysis, and shamanism meet” (Rolef Ben-Shahar, 2014, p.298). A basic premise in systematic thinking is that any changes we personally make in ourselves (as part of this wider field), may impact the entirety of a system and surely we influence each other (Keeney, 1983). Through this lens, we may look at psycho-peristalsis also as a duet or mutual dance that can occur between the therapist and client. Summary Psycho-peristalsis plays a significant role in the process of emotional healing— its value of cleansing and regulating. Our intention was to spark curiosity and offer the question: is it of value to use this central and powerful concept in the relational third field?From our experiences in the therapeutic setting, we believe that when we allow ourselves to be in the position of the rainmaker— to drop into the shared third area— magic happens. We have the opportunity to realize that we are able to be and to create, to influence and to be influenced, to transform others and dare to be transformed by them. Using psycho-peristalsis as a biofeedback system in the field invites both the therapist and the client into a duet of streaming and fluid that communicate on another level that connects us and moves through us. Shlomit Eliashar Shlomit is a UKCP registered body psychotherapist with an interest in relational approach. She draws on her experience of other therapeutic modalities such as mindfulness, imagery, brief therapy, trauma work, breath and energy work to create a unique compassionate, embodied approach. She enjoys practicing privately in North London and at Mind Hertfordshire and was a course coordinator at LSBP. A qualified school teacher, (B.Ed.), Shlomit interweaves her love for teaching and for wellbeing as a trainer and workshops facilitator. As a mother of two who was challenged by prenatal and post-natal experience, she went on to qualify as a Baby Massage teacher, and created a unique, attuned approach to promote Baby-Mother bonding and well-being, in groups and privately. Shlomit is a family mediator, offering a sensitive approach to resolve conflicts in families. Yael Shahar I’m an Israeli born woman. After living for more than 10 years in London, where I had my psychotherapy training, I moved back to Israel last year and nowadays my practice is based there. I graduated at the London school of Biodynamic Psychotherapy (LSBP) where began my journey into the field of psychotherapy. At 2012, after participating at the EABP conference in Cambridge, I was challenged by, what was then new to me, the relational body psychotherapy thinking. Since then, I further trained in Relational Body Psychotherapy (IMT). I had an additional training, based on attachment and Reciprocal Play Therapy (Mifne Centre) with infants and young children on the autistic spectrum. My work is very much influenced by those approaches and I keep exploring ways to combine them. In recent years my work is engaged around trauma and post-trauma issues. I work mainly with survivors of abuse, dissociation, sexuality and gender identity. References Aron, L. (1999). Clinical choices and the relational matrix. Psychoanalytic dialogues, 9: 1 -30.Tozer, A.W. (1948). The pursuit of God. USA: Christian PublicationsBateson, G. (1972). Steps to an ecology of mind. Chicago, IL: University of Chicago Press.Benjamin, J. (2004). Beyond doer and done to: An intersubjective view of thirdness. Psychoanalytic Quarterly, 73:5-46Boyesen, G. (1979) Between psyche and soma. (Training material at Boyesen’s Centre).Crastnopol, M. (1999). The analyst's professional self as a “third” influence on the dyad: When the analyst writes about the treatment. Psychoanalytic dialogues, 9: 445- 470.Jung, C. G. & Douglas, C. (1931-35). VisionsNotes on the seminar given in 1930-1934.Ogden, T. (1994). Subjects of analysis. Northvale, NJ: Aronson. Princeton, NJ: Princeton University Press, 1997.Keeney, B. (1983). Aesthetics of change. New York: The Guildford press.Kohut, H. (1971). The analysis of the self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorder. London: Hogarth Press.Rolef Ben-Shahar, A. (2011). Something old, something new, something borrowed, something blue: Individual selves and dyadic selves in relational body psychotherapy. The USA Body Psychotherapy Journal, 10(1), 58-67.Siegel, D. (2007). The Mindful Brain. New York: W.W. Norton & Company. Southwell, C. (2007). The biodynamic therapeutic presence. Training material, LSBP. London.Van-Heel, C. (2015). Psychoperistalsis and its significance in psychotherapy. Association of Biodynamic Massage Therapists AMBT Journal, 17(2).Winnicott, D.W. (1971). Playing and Reality. London: Routledge. Serebrenick-HaiKean, M., Cruz, M.E., & Verfaellie, M. (2015). Attention and implicit memory: priming induced benefits and costs have distinct attention requirements. Memory & Cognition, 43(2), 216-225.Krikorian, R., & Layton, B.S. (1998). Implicit memory in posttraumatic stress disorder with amnesia to the traumatic event. The Journal of Neuropsychiatry and Clinical Neuroscience. 10(3), 359-362.Levine, P. A. (1977). Accumulated stress, reserve capacity and disease. Ann Arbor, MI: University of California, Berkeley.Levine, P. A. (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. Berkeley, CA: North Atlantic Books.Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores Goodness. Berkeley, CA: North Atlantic Books. Levine, P. A. (2015). Trauma and memory: Brain and body in a search for the living past. Berkeley, CA: North Atlantic Books.Roediger, H. L., & McDermott, K. B. (1993). Implicit memory in normal human subjects. In F. Boller & J.Grafman (Eds.), Handbook of neuropsychology. 8, 63- 131. Amsterdam: Elsevier.Rolef Ben-Shahar, A. (2014). Touching the Relational Edge - Body Psychotherapy. London: Karnac.Schacter, D. L. (1987). Implicit memory: History and current status. Journal of Experimental Psychology: Learning, Memory, and Cognition. 13, 501-518.Serebrenick-Hai, G. (2015). Applying Somatic Experiencing® therapy in the treatment of Substanceabuse Addictions. Somatic Psychotherapy Today, 5(4), 102-105.Siegel, D. (2012). The developing mind: How relationships and the brain interact to shape who we are. New York, NY: Guilford Press.Southwell, C. (1988). The Gerda Boyesen Method. In J. Rowen and W. Dryden (Eds.). Innovative Therapy in Britain. Milton Keynes, UK: Open University Press.
Connecting to the 'Primary Couple Personality': Couples Therapy with Body Psychotherapy
Reprinted with permission from Somatic Psychotherapy Today, fall 2015, volume 5, number 4, page 68
Therapeutic Insights into Infant Massage
Reprinted with permission from Somatic Psychotherapy Today, 2015, volume 5, number 1 An unfaithful womb Like many parents, I fantasied about the mother I hoped to be. Unfortunately, as a young mother, I experienced the birth of a pre-term baby. The birthing process itself and the subsequent moments following are significant and prepare us to connect with the baby, but in the case of premature birth nothing is known, or expected. Nothing could prepare my daughter and me for the cognitive dissonance we experienced at her birth. I called my uterus the ‘unfaithful uterus’ that betrayed not only her, but also me. A plastic box and a medical team that undoubtedly saved her life were her external uterus.I was forbidden for weeks to hold my daughter. The only touch my daughter experienced during her first two months of life, besides cold, unpleasant, and at times painful medical handling was when we laid two heavy palms on her back through the incubator's holes. In fact, these small holes only enabled me to complete a few small roles. Not knowing if I should prepare myself for separation from her or surrender to falling in love with her deeper and deeper every day, my heart longed for my baby daughter.A month after her birth, I was allowed to hold her for ten minutes. In those brief moments, we became one entity. I smelled her, felt her breath on my hands, and heard the little sounds she made. We barely began to attune with one another when the medical staff tore her from my arms to return her to the beeping box with the slippery mattress. They thought it was safer there than in my arms. This confused my maternal instinct, which pushed me to hold and protect my vulnerable baby daughter without being able to do so. Though I understood the logic of this, I developed a deep sense of guilt that I felt for many years.Stern, Bruschweiler-Stern, and Freeland (1998) write that "of all obstacles that you encounter as a young mother, the understanding that your child is not perfectly healthy might be the most shocking.” They also note, "you are losing not only your ideal baby, but also, and more importantly, your freedom to predict the future of your baby and your family . . . This is a trauma that usually stops the time in orbit . . . At that moment, your past, full of hopes and fantasies of pregnancy, are deleted and becomes too painful to recall it" (pp. 166-167). Today, it is more acceptable to allow the mother to hold her premature baby via direct contact with her abdomen in a position called ‘kangaroo’. It was discovered that skin-to-skin contact significantly increased the weight of the new-born and his chances of survival (Field, Diego, and Hernandez-Reif, 2010). But what about the emotional benefits of such touch for premature babies in their adult life? I wonder how much thought there is about this in the scientific community. Healing touch, attunement, and regulation Preterm birth is a different, unusual, and extreme story, but even alternative birthing processes such as a water birth affects the infant. The baby completes his formation process in the first three months after birth, a period called the fourth trimester. "In order to survive this extreme transition it requires a container- an embodied wider mind, which could regulate and contain it" (Rolef BenShahar, 2014, pp 82- 83), an outer uterus where he receives food and is wrapped in touch and love, which will create a sense of familiar, comforting continuation. As Leboyer (noted as the father of water birth), writes in his book, "Loving Hands" (1977) : “Inside, the terrible ‘gnawing thing’ and remedy, the satisfaction . . . somewhere . . . outside. Inside and outside. Space is born. Inside, outside: two. That come together. Yes. But often so clumsily. Two . . . Forever. Oneness is lost” (p.13). Following my daughter's discharge from the hospital and during her first year of life, a sense of happiness accompanied me, coupled with anxiety that she would stop breathing. Although I nestled her in my arms for hours each day and followed her developmental and medical progress, I didn't know about infant massage and its importance in the motherinfant attachment relationship as well as the infant’s health (benefits cited include relaxation, better sleep patterns, aids digesting and waste elimination, balanced respiration and more)(retrieved from http:// www.infantmassageusa.org/learn-tomassage-your-baby/benefits-of-infant -massage/).Massaging the baby creates the opportunity for somatic memories of safety, contact, and love to be embedded in the baby’s body and in his soul. If we offer the baby skin-to-skin touch, soul-to-soul, our hearts will touch each other and touch will become a means to a profound meeting that is beyond words, similar to the intrauterine conditions.I experienced this healing touch as an adult client, and it inspired me to become a biodynamic psychotherapist. Working with clients, I feel and hear the children they have all been. I feel and hear their longing for an attuned parental presence and a touch that also touches the soul. Is it unavoidable to become adults carrying painful wounds stemming from a lack of such parental presence? What if the parent is made aware of the importance of attuned touch at the right time?From these wonderings, I also qualified as an infant massage teacher where I was introduced to one technique that was considered rewarding for the baby and his mother. The basic protocol I learned required the mother to make eye contact with her baby, who is lying at floor level, to stroke his whole body while fully clothed and to ask his permission with attention to his nonverbal cues, before undressing and massaging him. Oil is used and songs are sung to engage him. The baby's strong resistance is a contraindication.The protocol emphasized gentle and respectful attitudes toward the baby and taught topics related to feeding, sleeping, comforting, and important issues related to touch. While comprehensive in its approach, I think the training needed to offer a more attachment-based and emotion-driven learning process with emphasis on psycho -education.Motherhood can be bliss, but there can also be elements of loneliness, depression, anxiety, and longing for other adults' company. I noticed that mothers enrolled in the infant massage course had unmet needs of their own, many stemming from their own infancy. During the training, mothers socialized with one another while massaging their infants. The essential element, awareness and attunement to the child, was missed. The process did not stress this enough. Reinforcement for this idea can be found in the Emotional Cycle theory of Gerda Boyesen, who described every emotional event in a cycle consisting of three inseparable elements or levels happening simultaneously: the vegetative (involuntary system), the muscular (voluntary), and the psychological. When a stimulus occurs it creates an emotional charge in the sympathetic nervous system. Boyesen called the charge the upward phase of the cycle and red energy. This energy is produced in the stomach - the bottom end of the emotional canal - and surges up toward to the other end of it - the head. It is seeking expression through action or voice. As soon as this expression meets an empathetic object this emotional event can descend into the downward phase in the cycle and down-regulate through the parasympathetic nervous system toward digestion and homeostasis in the three levels of the emotional cycle simultaneously. Boyesen called it ‘blue energy’.Only when one feels safe and contained are they able to reach a state of equilibrium as should have been before the emotional event. Many of us find it difficult to complete the emotional cycle through all its levels, which results in emotional difficulties and physiological symptoms (Southwell, 1988).Biodynamic massage is a great way to teach the body directly to obtain regulation in all of these levels; it helps eliminate waste materials resulting from stress and getting stuck in connective tissue, leading to a feeling of relaxation and well-being. With hearing and seeing compassionate touch we encounter the emotion or stress on the body and mind, and invite the recipient to let go without imposing anything on them. Messages not being received in the cognitive system may now be absorbed non-verbally or unconsciously and can create an opportunity for a different kind of dialogue.I believe that considerable time and space should be devoted in meeting the mother's needs and teaching her self-regulation as well as dyadic regulation skills, which are essential elements in holding infants. Just as body psychotherapists are aiming to be completely attuned to their clients during a session, I think mothers who are attuned to their babies create positive experiences that will be imprinted into the consciousness of both the child and his mother.Biodynamic psychotherapist Alice Jacobus (1995) describes the stages of child development by flow of libido (the creative component of the life energy and not necessarily sex drive) of different ages in her paper, "Phases of Libido Circulation Development". At each stage the life energy is more strongly present in a specific area of the body: beginning with intra-uterus, then moving on to ocular, oral, anal etc. as well as more spiritual phases of development. At each stage a different developmental task needs to be completed. When the task is not successfully completed as a result of the child not being properly contained, the flow of libido is weakened and impairs further stages of development. His physical and mental health is damaged.According to these stages of development, in the weeks immediately after birth—the ocular phase—the life energy is concentrated around the eyes. The baby expects to receive loving eye contact from his mother, to feel accepted and loved by her. He is unaware that she is a separate person; they are one. The developmental task is to survive and to feel worthy of being.In tandem and soon after, until about 18 months, the oral phase occurs. The baby who was grounded by the umbilical cord and contained by the walls of the uterus loses its ability to ground. The energy is concentrated around the mouth but also begins to establish itself around the anus for the next developmental stage. It moves between these two poles. The mother mediates between Earth and baby; she is the grounding and the regulating figure in his life through her presence and contact. Her attuned touch during feeding and playing helps these two poles to unite (Jacobus, 1995).The infant grounds himself through the love of the one who gives him love through touch and holding (Boyesen, 1981). At this stage, he needs to feel supported, loved, and protected. Attuned touch plays a significant and vital role in a baby's life helping him gain resources for more optimal development and self-regulation. Jacobus (1995) writes, "The psychological and emotional qualities that the person gains from a satisfactorily oral development phase are optimism and trust" (p. 18).During a massage, a large amount of oxytocin is released in the baby and his mother to enhance their attachment process. And, when the massage is given from a place of attunement, it can help the baby feel safe and calm at a time when touch is its main means of communication. Through daily massage, the attuned mother gets to know her baby and responds to it with greater speed and accuracy, which increases her confidence in her role. "One should never forget how the baby's back had so much fun in the womb . . . This is why we must caress, we must rock babies. And, even better, massage their bodies that are so empty, so hungry ‘outside’. Feeding babies with touches, giving food to their skins and their backs, is just as important as filling their stomachs. It makes outside happy. Inside and outside satisfied . . . No more two. Oneness again. And peace.” (Leboyer, 1977, pp. 14-15) Leboyer writes about the thirst and hunger of the baby's body-mind and the embodied presence of his mother; his writings mirror the presence body psychotherapists hope to have at any session with every client. I would further say that body psychotherapists strive to be people with such presence in all areas of their lives as they bring this embodied presence to their personal life and any therapeutic setting. Therefore, to me, it seems important to emphasize the importance of an attuned, sensitive, and unconditionally loving presence when teaching infant massage.In the biodynamic theory, there is a strong emphasis on respecting defences, on working with, as opposed to on the client, taking into consideration his wishes and mood. Identifying non-verbal cues is an important skill for body psychotherapists because it helps us feel the clients’ moods, which resonate in our body. In a sense, there is not a big difference between an adult and a baby. Many clients refrain from expressing dissatisfaction with the way they have been touched either physically by their therapist if touch is part of the treatment protocol or via the therapeutic presence. They may even offer dishonest, flattering comments to the therapist for various reasons including fear of losing the relationship with the therapist. At the same time, they send non-verbal signals, sometimes hidden even from themselves. These signals may tell the truth about their feelings.When working with infant massage, I want to teach mothers how to tune into themselves as well as their infants and how to track their infants’ pleasure and connection and their distress and disconnect, and if necessary to stop the massage and hold the baby to contain him unconditionally, until he feels safe and calm.As with adults, babies vary from one another; therefore, it is likely that each one might need a particular touch of certain intention to suit them. I have also learned from some mothers that they felt uncomfortable and intrusive touching their babies according to the infant massage protocol and would have preferred other forms of touch to suit them. Therefore, the idea of a single massage sequence offered in the infant massage course to all babies and mothers is puzzling to me. Biodynamic massage offers various forms of touch, does not use oil thus can be done also over light clothing,As a body psychotherapist, I apply my understanding of biodynamic psychotherapy within the infant massage protocol. My work with infants and their mothers promotes a sensitive approach that accepts unconditionally the difference between one person and another; I adjust my treatment accordingly.During biodynamic massage, I touch the whole person—his experience of body, soul, energy and even history. I touch everything that makes up this marvellous entity called a person. I believe that biodynamic massage supports not only situations of stress and illness but also gives space for and promotes feelings of pleasure and joy of being alive and connected, as well as acceptance of our body with all its limitations and imperfections. I teach parents how to help their baby in his complex but basic, natural, and straightforward task to feel safe, wanted, and loved in the world, and allow him a space in which to connect with the joy and delight within. Additional, Unexpected Therapeutic Spaces: A Case Study Sarah is an orthodox, modern Jew, a busy and successful career woman, married with five children, including a three-month-old baby. A month ago, while crossing the road, a car hit her and her baby-buggy with great power that left her unconscious and with broken legs. Miraculously, the baby was unharmed; her eightyear-old daughter, who walked behind, survived and witnessed the whole ordeal.Sarah, who was discharged from a lengthy hospitalization, was on sick leave at home for an indefinite amount of time. An au pair cared for the smiley, joyous baby and obviously loved her very much. I arrived at Sarah’s house to teach her infant massage for four weekly sessions of two hours. Because she was confined to a wheelchair and in a cast, the massage took place on a table in the dining room and not at floor level as usual. During biodynamic massage, I touch the whole person—his experience of body, soul, energy and even history. I touch everything that makes up this marvellous entity called a person. She asked for the au pair to not be present during the lessons, sharing feelings that the au pair was taking over the care of the baby and not leaving her a space in which to function as a mother. She refrained from confronting her because she understood that the au pair acted in kindness, but it was obvious to me that she longed for things to return to normal. We created an alliance. Sarah found a role that allowed her to set a schedule for a daily massage that became a period of time set for just the baby and her. She felt valuable, with parental authority and efficacy; she was able to reconnect with her infant daughter.During another visit, she told me that her eight-yearold daughter clung to her and tried to massage her leg. Sarah resisted. She was strong and independent, impressive in her ability to deal with stress and crisis. It was important to her to be perceived as powerful enough to protect her family and receiving a massage from her daughter did not fit this image. I sensed that she felt disgust mixed with anxiety about being a patient of her daughter and dependent on her. Also, many orthodox Jews can have complex relationships with touch. The baby slept, and Sarah told me about a pain in her shoulders. I saw this as an invitation, and she was glad when I offered to massage her shoulders. A few minutes later she opened up even more and was able to be in contact with her need, small as it was, for support. Now she could connect to softer emotions, let go of some of the need to show it is business-as-usual and not be a hero for everyone.We discussed the trauma her daughter experienced as a witness to such a dreadful accident. I wondered if watching her mother massage her baby sister she felt the suppressed need of her mother for care and reached out to her. Or perhaps she was asking her mother, non-verbally, to massage her, too? I raised the possibility that traces of this trauma were still there, and she felt compassion toward her daughter. She understood her daughter's need for contact. She has now opened up to the idea of co-regulating through touch and understands how touch and contact with her older daughter may heal their trauma. Summary Infant massage, from a biodynamic perspective, offers a means to create a deep and significant meeting, through which I can reach various, exciting, and unpredictable therapeutic spaces. Rewarding as it may be, the standard infant massage protocol does not distinguish between one baby and another and does not give enough space to process and psychologically educate the mother.From my perspective, a biodynamic approach to infant massage emphasizes the idea of intention, attunement, regulation, and attachment, and it recognizes and supports well-being and developmental principles, and respects defenses. I believe there is a place to promote these important principles that will strengthen the relationship, connection, and understanding between parents and their baby. Such an approach gives me hope that children and their families will be able to acquire tools that will enable them a better and healthier new beginning. Shlomit Eliashar: I am a teacher (BEd), biodynamic body psychotherapist (UKCP) and a trainer, practicing in a private clinic and at Mind in north London and St Albans. As a mother of two and a qualified infant massage teacher, I am passionate about attuned touch and bonding, and about exploring ways in which to integrate psychotherapeutic approach with infant massage. References: Boyesen, M. L. (1981). The Infant and the alpha. Journal of Biodynamic Psychology, 2.Field, T. (2001). Touch. Cambridge, Massachusetts: Institute of Technology (MIT), UK.Field, T., Diego, M. & Hernandez-Reif, M. (2010). Preterm infant massage therapy research: A review. Infant Behavior and Development, 33(2), 115-124. doi:10.1016/ j.infbeh.2009.12.004Jacobus, A. (1995). Of Libido Circulation Development Phases, UK.Leboyer, F. (1977). Loving Hands. London: Collins.Rolef Ben-Shahar, A. (2014). Touching the Relational Edge. London, UK: Karnac.Southwell, C. (1988). The Gerda Boyesen Method. In J. Rowen and W. Dryden (Eds.). Innovative Therapy in Britain. Milton Keynes, UK: Open University Press.Stern, D., Bruschweiler-Sern, N., & Freeland, A. (1998). The Birth of a Mother: How the motherhood experience changes you forever. New York: Basic Books.
Biodynamic Psychology: Healing through the wisdom of the body
Article from: Positive Health, July 2006 Biodynamic Therapy was developed by the Norwegian Psychotherapist, Clinical Psychologist and Physiotherapist Gerda Boyesen (1922-2005), who lived and taught in London, where she died last December after an extraordinary rich and fulfilled life. It is a great joy for me to be part of the Biodynamic community, and I highly appreciate the opportunity to share some of my insights into one of the most important psychotherapeutic techniques today: a technique that uses the treasure of body's wisdom, a technique that reaches far beyond words to find healing, where pure verbal therapy gets to its end. The Beginnings Wilhelm Reich, student of Sigmund Freud, was the first to understand and introduce the importance of body and touch into psychotherapy. He laid the foundation for modern body psychotherapy. Gerda Boyesen was one of the second generation's pioneers. She was already studying psychology, when she started to work with Ola Raknes, one of Reich's close students in Norway. To fully understand the body and its anatomy, she additionally trained as a physiotherapist, where she got in touch with a very effective neuro-muscular massage technique, which became the basis of Boyesen's 'Deep Draining', and the foundation of 'Biodynamic Massage'. The term 'Biodynamic' refers to the concept of life energy flowing naturally in a healthy body. This flow of energy is either supported or disturbed by our personal life experiences. The more it becomes disturbed, the less healthy we'll feel in our physical and psychological existence. Our life story is inscribed in our bodies. The way we develop our posture, the tonus of our muscles, the curves of the spine, the form of a toe, the shape of a face are all connected with the happy and the less happy experiences in our lives. The Primary Personality – True Expression of Self Biodynamic Psychology believes that every human being has a whole and complete inner core remaining unaffected by life's turbulences, called the Primary Personality. Its counterpart though, the Secondary Personality, feeds on all life's experiences, which make us suppress or distort our primary impulses of true self-expression. Thus, over time, the way we present ourselves to the world is formed and crystallizes in a person's character and body posture. Here is a simple explanation of this process: Let's assume something frightening happens to a child. Its primary reaction would be either to scream, cry or run away out of fear; to hit, kick or shout out of anger; or maybe at the end of the experience to reach out for its mother out of the need for comfort. The urge to express these feelings is not only psychological, but is a very physical, mostly instinctual reaction in the vegetative system. It can be described as a movement of fluid (or 'life energy') in the body. If the expression gets blocked, the fluid will not dissolve and cause waste in mind and body. Tension builds up in the muscles to hold back the physical expression. On the emotional level the child will feel frustrated, confused, unworthy, helpless… and in deep stress. This physical and emotional tension remains in and affects the vegetative system long after the original urge has subsided and been forgotten. If this process is repetitive, armouring happens. Armouring means that a certain muscle or a group of muscles become so stuck in their expressions that a chronic blockage arises. Reich was mainly talking about muscular armouring, meaning the skeletal muscles, whereas Boyesen found that the armouring is also happening on the even deeper level of the visceral, the muscles of the guts. The guts, she found out, are deeply involved in a person's self-regulation of stress and conflict (see below 'psychoperistalsis'). We learn to suppress the urge to express ourselves from early age on, because in individual families and in society generally, the spontaneous expression of certain feelings is not welcomed. There may be prohibitions, disapproval, punishments or even more serious traumatic experiences, like physical violence and sexual abuse, to make us repress or restrict the instinctual responses. Body Wisdom and the Biodynamic Healing Process A certain amount of stress and conflict is quite natural to human life. And it is true that the human body and psyche has got an in-built self-healing and self-regulating ability, which can deal with this limited amount very well. Once the limit is stepped over, self-regulation stops working properly and a blockage starts to establish. The good news is that the Primary Personality, even though it can be heavily covered by many layers, is never destroyed. With few exceptions, most people have healthy aspects with a good, flowing contact to the Primary. These aspects might be hidden away, but they are in a way just waiting to be rediscovered. So they will easily be accessible for a client and provide a positive force and source of strength. Subtle impulses are incessantly sent out from the core to the brain and body, carrying healing wisdom in the form of what physical movement, what sound, or what other expression or action is necessary, in order to release and re-balance the stuck energy of that person in this moment. One of the aims of Biodynamic Body Psychotherapy is to help the client to regain awareness of these subtle impulses 'impinging from within', and learn to trust and follow their guidance towards the enfolding of the true self. Biodynamic Body Psychotherapy disposes over a wide range of techniques to work through a person's layers of armouring, in respect of the person's pace and in a gentle, allowing way.On this path the client will most certainly meet his/her resistance. It is one of the fundamental beliefs of Biodynamic Psychotherapy that resistance needs and deserves respect, and its attitude towards it is one of open, loving inquisitiveness and understanding: why is that resistance there? What is/was its job? What does it need to let go? Once valued for its aims and purposes, linked to the past, the resistance will soften and allow being seduced to give way to more appropriate behaviour for that person's life now. Because blockages manifest on the vegetative and, therefore, subconscious level, an essential part of the therapy works beyond words, in direct contact with life energy (hence its name 'vegetotherapy'). We can be mentally very aware of an issue, but as long as it is not cleared out of the body's system, it will most certainly continue to give us trouble. This process develops gently in the safe environment of the therapeutic setting before it integrates more and more into the person's outer life.Ultimately, the person's self-regulation will be restored and fully functional again, so that he/she will be able to deal with the minor disturbances of everyday life on his/her own. Harmony, health and a deeper feeling of pleasure in being alive usually emerge out of this process. The Spiritual Embrace of Biodynamic Body Psychotherapy Biodynamic Body Psychotherapy acknowledges the spiritual dimension of our existence. I feel the wish to emphasize how I personally work on this premise. I see Body Psychotherapy (among many other methods and ways) as a very powerful tool to learn as much as we can about the path and intention of our soul here on earth, and to nourish that sparkling star in our heart, which radiates love and a 'yes' for life. I see every blockage as a blessed obstacle with the potential to wake us up and guide us to merge with our Primary Personality, which is directly linked with the higher self. Wonderful moments full of awe happen, when a client experiences this contact: deep healing is taking place. There is no need for words; peace, harmony and love radiate naturally from that person and pervade every cell of his or her body as well as the direct environment. It is like witnessing a miracle in all its simple beauty. The limits of my work, and any kind of Psychotherapy, lie for my understanding within the boundaries of the spiritual blueprint of a person's life at this moment in time, and I see my work in service of this greater perspective. What to Expect in a Biodynamic Therapy Session Biodynamic therapy works in depth with the link between mind, body and spirit. The attitude of the therapist is one of cooperation with the client. Together they set out on the journey to explore and understand where the symptoms or issues the client brought to the sessions originate, and what the person needs to regain his or her balance. The therapist takes sides with the healthy core and supports the client in his or her ability to connect with that core and listen to its messages. Non-verbal language is used as a means of communicating between the conscious and subconscious, for example in exploring a spontaneous gesture or movement, expression of the eyes or the sound of the voice. Non-verbal therapeutic interventions are for example, specially devised massages, breath work, body awareness, regression therapy, vegetotherapy and emotional expression. Touch is part of biodynamic psychotherapy, but will only be used with the understanding and agreement of the client. Verbal psychotherapy is to a certain extent always part of the setting. At the beginning and the end of a session, the verbal part functions like a bridge between the day-to-day life and the therapy session, and often it is important for the client to verbalize her/his experiences from the session in order to integrate it fully in his/her life. There might be sessions when verbal psychotherapy is what the client needs in this moment of his/her process. But the Biodynamic therapist will be aware of the non-verbal language and thus read between the spoken words. Biodynamic Massage Biodynamic Massage works within the above outlined holistic perspective of body, mind and spirit. It can be part of the therapeutic journey, or it can be used as a treatment in its own right.How does it differ from other holistic/therapeutic forms of massage? Biodynamic Psychology knows and uses the techniques and effects of classical massage, as well as those of the more spiritually oriented new-age massage types, and very similar results can be expected: general improvement of the metabolism, balance of the respiratory system, reduction of stress and stress-related symptoms (headaches, insomnia), calming of the nervous system, easing of muscular tensions and related physical pains and aches (back, neck, shoulders), release of toxins and aura balance, to name just a few. But some essential aspects surpass the areas of common ground hugely and give biodynamic massage its unique character: the Biodynamic Therapist is trained to communicate through touch with the vegetative system in order to bring the stuck energy and tensions to a release. Boyesen discovered that the peristaltic sounds gave her a feedback about how the body, (always understood as in unity with the whole person), and mainly its vegetative system, responds to the touch of the therapist. This reaction can be different for every few inches of the body. The peristaltic sounds are part of the self-healing or self-regulating ability of the body and they indicate the digestion of emotional stress. This function of our intestines Boyesen called the 'psychoperistalsis'. The biodynamic therapist may use an electrical stethoscope to keep track of the sounds during the treatment. Biodynamic massage knows about the effect of touch: 'When we touch a body, we touch the whole person'. Every massage is, in a way, an intimate meeting. Even the simplest body contact touches at issues around closeness and distance, and massage tends to associate with the regressive moments and corresponding emotions in a person's life. A biodynamic therapist knows about this dynamic. She or he is also aware of the effects of transference and counter transference any situation of physical closeness may cause, and is able to deal with it professionally. Sometimes this process will not show on a conscious level of interaction or it will be very natural and easy, and sometimes it may induce the step from massage to psychotherapy. Deep Draining: Knowing about the delicate balance of traumatic and life affirmative tendencies of a person, Boyesen developed a series of massage sequences, especially designed to trick the guardians of the unconscious (resistance) in order to finally convince them of the safeness of pleasurable alternatives. The 'deep draining' is a very powerful technique, where the subtle communication between the therapist and the vegetative system of the client must be used with high expertise. It needs a minimum of eight to ten sessions with intervals of body psychotherapy to integrate the changes on all levels. Vegetative reactions such as diarrhoea, sweating, headaches, deep tiredness and so on, can occur and indicate the release of toxins on the physical level. For a biodynamic massage treatment the therapist may use a massage table or work on a mattress on the floor. For success of the treatment it is not necessary to work on bare skin; it is up to the client to decide if he/she wants to be touched directly on the skin or not. It is up to the therapist to decide the use of any oils or lotions for the treatment. Some massages follow a fixed structure, like the back massage, belly massage, exit massage (head, hands, feet) and all the 'deep draining' treatments. But many others follow the client's verbalized needs, the feedback of the peristaltic sounds and the therapist's intuition. Who can Benefit from Biodynamic Massage? Biodynamic massage is suitable for those looking for release of stress-related symptoms and other psycho-physiological conditions. Headaches, anxiety, insomnia, depression, arthritis, ME, etc, have been treated successfully; for those looking for a pleasurable relaxing massage; and for those wanting to increase their body awareness and wanting to embark on a journey of self-discovery through a body-centred approach. The 'deep draining' is suitable for those on the path of self- discovery, willing to commit for a certain time and looking for the combination of massage and psychotherapy. Biodynamic Group Therapy Group therapy, in contrast to the 1:1 setting relying on the relationship between client and therapist, offers a diversity of relationships similar to real life, optimal ground to explore different ways of contact with each other and the self. It creates the possibility to encounter immediate emotional reality and its effect on the body and mind in a continuous process. The participants find a deeper sense of their true nature and come to understand what is going on in their present lives in the light of their past experiences. Trust, openness and speaking out freely transforms the group into a safe and secure place, where it is OK to experiment with and share a newly found truth, or to try for the first time to speak up for yourself. Eventually fear and shame can be overcome and a deep loving understanding towards ourselves and each other arises. Beginning to know that 'I am OK the way I am!' is a truly wonderful and freeing experience. Notes 1. This was the method of Aadel Bulow Hansen, who had her own clinic in Norway. Bulow Hansens's massages – without her having any knowledge of Reich's theories – succeeded in melting the muscular armouring. Gerda Boyesen trained with her and part of the training was to receive the massages herself, which opened Boyesen's process to a level she hadn't been able to reach before.2. Even though there are other aspects involved in character formation, like genetic inheritance, character types have been and still are important for Body Psychotherapy.
Transformative Moments: Short Stories from the Biodynamic Psychotherapy Room Pt. 2
TOUCH AND BETRAYAL From an object-subject relationship point of view, we should never underestimate how challenging it might be for a body-mind system that has been betrayed by humans to trust humans again—to trust the object ‘human’ and to authentically experience that this subject is safe.It is especially important to explore the complexity of touch and the right touch for people who have undergone traumas of physical, sexual or emotional abuse in their family, when, in fact, inside the family somebody manipulates their most basic attachment needs, where love was demonstrated manipulatively in order to abuse the child as an object for the fulfillment of the perverse fantasies of the adult who was supposed to protect him. These people, who were born into an evil cradle, are the most wounded people in our society. They have never experienced safe touch or have experienced it partially from a friend of the family who was, at the time, a bystander to the abuse, and there are mixed together the touch and the sense of betrayal that occur in the conspiracy of silence. These people especially need, as a part of the overall psychotherapeutic experience, a space in which they can experience safe touch here and now inside the therapeutic alliance with a secure and safe attachment figure. They need a space in which they can learn to develop themselves ways to cope with the complexity of touch for them. Many of them suffer from intensive somatic sensory flashbacks that often emerge every second while attempting intimate touch. They learn in themselves the ability to enjoy the right touch here and now, to develop tools such as dual awareness during the somatic-sensory flashbacks in order to enable them to experience pleasure and joy. When their normal desire for another body, for skin-to-skin contact becomes a reality, instead of enjoying it they suffer from unexpected outbursts of somatic sensory flashbacks that push them into responses of hyper-arousal, such as fight and flight or hypo-arousal such as freezing and dissociation, which do not enable the development of intimacy and deep interpersonal relations. As long as psychotherapists refrain from practical observation of the complexity of touch in the therapy room and continue to maintain the dissociative dualism of Descartes' split between body and mind, they are, in essence, collaborators in the conspiracy of silence, in which there is refraining from looking into the most painful and realistic places in the individual's life. It takes courage to look at the profound emotions and painful, hidden, complex landscapes of the human being that can emerge with physical touch. Working with touch enables fuller integration of those parts of a person that were discarded as part of the taboo and restoration of the capacity for pleasure, happiness and physiological and emotional well-being. ANOTHER EXAMPLE OF A THERAPEUTIC PROCESS – WITH RONIT Ronit has permitted me to describe some of her story, using an assumed name. To conceal Ronit’s identity I have changed details. She came to me for treatment because she felt isolated, and her attempts to create new relationships with people failed. Somehow, each new relationship ended abruptly, and she couldn’t understand why it was happening. When I asked Ronit how she feels physically, she says that frequently her legs hurt her for no apparent reason, and she has suffered fromtonsillitis since childhood. After she left home, things improved, but she still suffers recurring tonsillitis the year-round. She is a light sleeper, frequently finds it hard to fall asleep, and is woken by any sound in the house. RONIT’S HISTORY Ronit was an abused child. She was hit, cursed, shouted at, and humiliated on a daily basis throughout her childhood until she left home at 20. It seemed that everything could trigger off the slaps and shouts: a broken cup, a spilt drop of milk. Everything, she felt, would end by her being hit. As a little girl, Ronit didn’t understand why she was getting slapped. Over time she learned that her father had principles. Whenever she complied with his principles - not sitting at the table with her feet on the chair, or not losing her key - she wasn’t hit, and could look after herself. But her mother was unpredictable. She flew into unpredictable attacks of rage. She hit Ronit, shouted at and humiliated her. She said terrible things that Ronit can’t remember. Any given moment was dangerous, and her mother even attacked her at night after Ronit had apparently gone to sleep. Once her mother stabbed Ronit’s sister, who managed to jump aside at the last minute, avoiding injury to her spine. Sometimes the blows lasted a very long time, and were often so powerful that Ronit lost consciousness. Her plastic descriptions of regaining consciousness on the floor after one such attack filled the treatment room. Ronit learned to live like a little hunted animal, always prepared for the next unexpected violent attack. When she grew up, she started to run out of the house until her mother cooled off. At night she made a point of falling asleep only after she heard the ordinary sounds of her parents sleeping. If there was a movement anywhere in the house, even the slightest one, she would wake up, open her eyes, ready to jump. From the outside, she appeared whole, but inside everything was shattered and broken from the blows and the verbal violence. PHYSICAL THERAPY, AND THE LINKS BETWEEN RONIT’S CURRENT CONDITION AND HER HISTORY Each treatment session included a biodynamic massage, usually the same method on the whole of Ronit’s body. During the treatment, we learned that her leg muscles hurt because, as a child, she always had to be ready to run and escape her parents, who often launched their angry attacks and hit her for no clear reason. To evade, them she was always ready to run. When she was older she jumped out of the living-room window of their ground-floor flat, or run to the toilet or to the little shed attached to the kitchen. Then she locked herself in and waited until their fury calmed down and it was safe to come out. Danger lurked at every given moment. She was always ready to jump, even at night and now, after so many years of being ready to run, just in case, she’s exhausted. She wants to rest, and her legs hurt. Perhaps she can rest now? Ronit has built a safe life for herself. For several years she has been in a relationship with a stable, sensitive partner who has never hit her. But inwardly she can’t free herself from the habits that saved her life and sanity. She always has an escape-plan; she’s always ready to run. Examining her past also explained her sleeping problems. For years she lived like a hunted animal, around the clock. But maybe now there is no ‘lion’ pursuing her? Even though consciously Ronit knows there isn’t any lion, and it’s probably not going to happen today, her body still doesn’t know it. The tension, the readiness for ‘flight and fly’ was in her implicit procedural memory for years. It’s an unconscious procedure over which she lacks conscious control. I invited Ronit to check some other possibilities, by means of touch. Possibilities in which we can at least put the tension on a shelf, close at hand, an arm’s length away. And only if she has to run in the future, if a lion really does turn up, she can take the anxiety back and run far away with it, like she did as a child. This defense mechanism saved her life. I didn’t want to take away those lifesaving defense mechanisms from Ronit, like her readiness to run because every time her legs became less and less tense, she suffered appalling anxiety attacks. And then we had to negotiate, while still respecting her defense mechanism, following the biodynamic principle of ‘making friends with the resistance’. Meanwhile, for just least a few minutes, maybe she can rest because there’s no lion in the room now. As an adult, she has been able to create a safe atmosphere for herself, has found safe people who will never hit her like people used to. Now she can rest and elax. This process required considerable non-verbal negotiations. THE CLIENT IS ACTIVE, NOT PASSIVE We must remember that biodynamic massage is in no way a situation in which the client is passive and receives a massage, and the therapist is the active one. To an outside observer of a therapy session, it may seem like that, but it’s incorrect. Just because a person isn’t physically moving, it doesn’t mean that he is inactive. For someone who experienced what Ronit did, the ostensibly simple state of lying on a treatment table without moving and relearning how to relax and rest - such a basic action, which people who didn’t have traumas like hers don’t think about twice – is for Ronit, a novel idea. For Ronit to let herself rest, even for just a single wonderful moment, she has to work Ronit learned to live like a little hunted animal, always prepared for the next unexpected violent attack. intensively within herself. To learn to differentiate between past and present, between the present and the future. This work took Ronit years of weekly therapy, sometimes even twice-weekly. When she began the process, she didn’t understand what was happening to her; all she knew was that she had difficulties in interpersonal relations. But it’s clear that because she was constantly ready to run, she couldn’t really be available in the ‘here and now’ for a relation with the person she’s with. TIME It took time for Ronit’s unconscious memories to became conscious ones. It took time to position all those dramatic events on a chronological timeline. Ronit had to physically change structures in her brain, like the hippocampus. The hippocampus does not develop appropriately in multiple situations of stress like those that she experienced, and without proper development,there is significantly less ability to place historical events along a chronological timeline. And then, in a roundtable discussion – between the brain that sees that the existing reality, the ‘here and now’, is safe, and parts that are afraid to rest - Ronit’s legs, can ‘sit’ at the round table, talk and negotiate, and let Ronit rest – and for more than just a few minutes. Initially, each minute depended on discussing and negotiating until – through new neuropathways that most probably started to emerge, new possibilities were laid down in Ronit’s brain. Their inherent option was that it had become possible to rest, before the next race begins. Each minute was a major achievement. Secretly, at home, behind a locked door, Ronit started to occasionally rest for longer periods. Resting when someone else was present required a very long drawn-out process, which she sometimes thought was impossible. However, she learned it from her direct experience. And now if she stays in one place long enough, she may be able to successfully build relations with other people. RONIT CRIES Ronit would at first cry in absolute silence, without making a sound. Tears trickled and flowed down her cheeks. Her nose dripped and even when she blew her nose, she did it with impressive silence. Not the smallest sound. Sometimes the pain in the room, in that space between us, was so immense that my eyes would also silently weep. Once I asked her how she learned to cry silently. As a child, she told me, when her mother hit her, if she made a noise and cried or screamed with pain, her mother completely lost it; she would hit even more violently, and shout at her to stop making a noise. Because according to her mum, Ronit was to blame for everything, she didn’t even have the right to make sounds of pain. And that’s how she learned to cry soundlessly. I asked if there was anything soft in her mother, that might help her grasp the pain she had caused her daughter. Dry-eyed and with a bitter voice, Ronit replied that her mother’s only soft place was her pillow. After her mother would hit Ronit, sometimes she ran to her mother’s bed, and scream and shout into the pillow. Often she cried like that for a long time, but her mother never came. I worked with Ronit in many sessions, using different kinds of biodynamic massage to help develop her throat, and allow her to emit sounds, slowly, through prolonged negotiations with all parts of the body. It was a process that sometimes both of us felt would be endless. And only after I promised her that my room is soundproofed and the neighbors wouldn’t come and hit her, she allowed her voice and weeping to emerge from her vocal chords. At first they were choking sounds, but gradually she let out the screams of anguish that her body had held in for so long. THE GATES BROKE OPEN She was left without pain in her chest, and without an inflamed throat. And for years afterwards, Ronit never suffered from a sore throat. Perfect rest I worked with Ronit for many years, and each session included biodynamic massage. And she became able, sometimes, to rest completely. Genuine rest. An island of calm within her. A place where Ronit could stop running. At night she still sometimes wakes up if there are sounds in the house. But now she soothes that little girl in her, the little hunted animal inside her, and goes back to sleep. Now she can stay in one place, form relationships with people, and can talk and express herself fully. HEALING So who healed Ronit of her painful legs, her recurring tonsillitis? It wasn’t me, the therapist – it was Ronit herself. It was Ronit who made the appointments. Ronit who came to every appointment. It was Ronit who walked cautiously along on the slippery wooden path in my garden, as she approached my clinic. She paid for our sessions. I only did the work when she came for the psychotherapy session. But it was Ronit who took the scalpel and opened the wounds of the past, let the pus flow out until, one after the other, her scars became clean and dry. She drinks to the full the few tiny drops of love she received as child, drinks thirstily and constantly. Fences off every moment of insanity. Every injury. Every knife and scissors that stabbed her or her sister. Fences off Arranges them in rows that are too many to count, like rows of tombstones Feels, senses, observes, processes, and - since she could never make sense of the moments of her mother’s rages - She fences off whatever she could To detach herself and remind herself that it’s all in the past She survived the worst of all, None of this will happen again. Now her world is formed the way she chooses. And me? I only helped I only supported with equanimity In every part of her In every part In all the particles In all the shattered fragments I supported them all equally Because they are all my clients Until gradually, ultimately they were integrated into a single whole I only did the best I could, without neglecting any part of the body and mind To support the change Because change is the only constant, as I wrote before Psychotherapy is a healing profession, and the healer is the client And the therapist's position which I followed here is known in Biodynamic Psychotherapy as the 'midwife position'. A NOTE ON THE DURATION OF THERAPY Occasionally people ask me how long biodynamic therapy takes, and I always reply, according to the client’s need. I’d like to enlarge on this point. People like Ronit who underwent innumerable traumatic and adverse events know there’s no magic wand. No shortcuts. The client must work over a long period to develop his or her full inner human potential - only self-work in a prolonged, fundamental process that can enable the changes that human biology and physiology require to experience the world from a different point of view. A fundamental process takes time. Sometimes more years than the number during which the damage occurred; it may take years of renewed growth. During that process, not only are forgotten pains reopened, but also the options for experiencing inner happiness and satisfaction. Nurturing the ability for selfmanagement, for designing your life with your own hands. I cannot state categorically if the decision to embark on therapy is worthwhile for a specific person, nor how long it will take. It’s a personal decision. What I can say, is that for me personally the investment was worthwhile, because I feel that I succeeded in fulfilling myself and my life. Going to therapy is a courageous personal decision that can yield a host of benefits for someone choosing that course. The time that’s needed is dictated by the personal process of each and every individual. My role is to support that person, to listen to his or her self and out of that direct experience to identify the appropriate period of time, but not to work out of blind belief in me, or an intellectual decision, or external conceptual understanding about therapy’s duration.
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Centre for Biodynamic Body Psychotherapy