APPENDIX 17 : The Need for Touch by Jerome Liss
Freudian theory sates that oral feeding is the infant's most crucial relationship to its mother. That is why the first period of life is called the "oral period." Freud did not study infants directly but based his findings on his work with adult patients. However, if we examine the experimental work of Harlow as presented in John Bowlby's Attachment and Loss,(1) we see that Freud was not correct. The infant's emotional life is not as much affected by periodic feeding as it is by the availability of touch. Harlow's experimental work is carried out with infant monkeys, but the results are applicable to the condition of the human infant. Harlow's general procedure is to provide infant monkeys with either a cloth model of a wire model of an adult monkey. Each adult model has a baby bottle attached to it, from which the infant monkey can feed. The difference between the cloth and wire models is that the cloth model feels better to touch while the wire model does not. Bowlby describes one experiment wherein eight infant monkeys were raised with both the cloth and wire model monkeys present. Four infant monkeys were fed on demand on the cloth model, and the other four were fed by the wire model. Harlow measure the time the infants spent on each model, and the results were striking: No matter which model provided the feeding, the infant monkeys spent most of their time on the cloth models. Specifically, the infants of both groups spent an average of fifteen hours a day clinging to the cloth model, while none of the infant monkeys spent more than an hour or two a day with the wire model. In fact, "some infants, whose food came from the wire model, managed to lean over and suck the teat whilst still maintaining a grip on the cloth model."(p.214) Thus, the need to have long periods of holding a soft object is greater than the need for oral feeding in terms of the time span. And what about holding and emotions?
Two further experiments deal with this question. In one experiment the infant monkey is brouyght up in the presence of a cloth mother that gives no feeding. When the infant is made frightened and alarmed, it at once seeks out and clings to the cloth mother. This behavior is analogous to monkeys in a natural setting, who will run and cling to the mother whenever alarmed. Furthermore, after the infant holds on to the cloth mother, it apparently becomes less afraid and may even begin to explore the object that was previously frightening. In marked contrast, the infant brought up with wire mother that has provided feedings will not seek out that mother when alarmed, but will remain, instead, frightened and immobile. Thus the feeding mother that gives no physical touch comfort will not be sought out for reassurance when the infant is frightened. The cloth mother, however, not only is sought out, but actually gives enough contact to subdue the fright, and the infant once more explores its environment, a natural transformation of emotions.
The same results are obtained when infant monkeys are placed in a strange test room with unfamiliar toys present. Quoting from Bowlby: "So long as its cloth model (for touch) is present, the young monkey explores the toys, using the model as a base to which to return from time to time. In the absence of the model, however (which means "no touch"), the infants would rush across the test room and throw themselves, face downward, clutching their heads and bodies and screaming their distress.. The presence of the wire mother (also "no touch") provided no more reassurance than no mother at all. Control tests on monkeys that from birth had known only a wire nursing mother revealed that even these infants showed no affection for her and obtained no comfort from her presence."(p.215)
Thus, touch-comfort is an important means for comforting the frightened child. Its absence leads to distress and desperation.(2)
The Need to Act When Faced With Stress:
The research of the famed physiologist, Henry Laborit, has shed light on the physical dynamics of inhibited action and on the unhappy consequences of prolonged inhibition, namely, emotional and psychosomatic illness.(3) To understand Prof. Laborit's hypothesis, let us first review some recent concepts in physiology. Two major neural pathways have been discovered which control active behavior: There is the median forebrain which governs pleasureable actions (grooming, courting, pursuing a weaker prey). The MFB creates an important link between the limbic system (MacLean's "emotional brain") and the hypothalamus, a regulator of visceral functions by means of the autonomic neervous system and body hormones. A second pathway governing behavior is the periventricular system (PVS), which creates the response of "fight or flight" when there is an environmental stress: an attacking animal, a sudden change in temperature, a sudden danger such a fire, etc. The pleasure system and the fight or flight system both lead the living creature to make an active response to the environment. Together they create the Action Activing System (AAS).
Prof. Laborit's work develops yet further this line of physiological research when he identifies a new subcortical neural tract that lies close to the pleasure (MFB) and fight-flight (PVS) systems. He discovered that stimulation of this newly discovered tract inhibits pleasure-seeking and fight-or-flight behavior and, in fact, inhibits all behavior; thus, this neuronal tract is called the action inhibition system (AIS). The AIS is meant to function in brief spurts. Its purpose is to help the living organism make an abrupt halt (like a car that must "stop on a dime") so that a non-functional or dangerous action can be cut short. This is necessary to prevent the animal from walking into the hands of the enemy. Nevertheless, the AIS becomes a cause for pathology when it becomes chronic, that is, when the inhibition is no longer a brief parenthesis between adaptive actions, but rather, when the inhibition stays put. Prof. Laborit's research shows the following results: An animal put into a situation of stress (cold, electric shock, etc.) and prevented from moving will show behavioral signs of "anguish." At the same time physiological measures indicate visceral malfunctions such as ulceration of the gastro-instestinal tract and increased arterial tension. Animals exposed to the same conditions of stress but allowed to move do NOT show such behavioral and physiological pathology. Thus, according to Prof. Laborit, the prolonged inhibition of action during situations of stress create the basis for psychological illness (neurosis and psychosis) as well as for psychosomatic illness.(4)
Once action inhibition becomes prolonged, physiological and psychological mechanisms can create a situation of self-reinforcement and the person enters into a vicious circle by which the state of action inhibition becomes more intense and more difficult to change. The outcome is a chronic state of depression. One physiological feedback loop that reinforces chronic inhibition is the following: Prof. Laborit discovered that inhibition when faced with stress increases the animal's level of corticosteroids and noradrenalin. (At the same time adrenalin becomes decreased.) The physiological vicious circle is that the increased quantity of corticosteroids flowing through the blood return to the limbic system-based AIS and reinforces its inhibitory action. This is an example of the "autonomous" action of "a semi-autonomous system that functions in inter-action with other such systems,"- a systems principle already described when referring to Prof. Max Pages' Thérapie et Complexité.
What are the more general consequences upon our health? The increase of corticosteroids means that proteins will be broken down for energy use (the creation of ATP, adenosine triphosphate) and new protein production will be inhibited. This is espeically deleterious for the immunological systems since it means a decrease of antibody production. The result is that we have a lowering of immunological protection against infectious diseases and also again the growth of mutant cancerous cells, which are normally destroyed by the healthy immunological system. This is one mechanism to explain the connection between disturbed emotions that are repressed (expressive inhibition) and psychosomatically- determined illnesses of infectious diseases and cancer. Another hormonal mechanism that Prof. Laborit studied was the increase of noradrenalin. This can cause increased vasoconstriction of the arteries, a physiological consequence of noradrenalin, and therefore create the basis for hypertension.(5)
At the same time the psychological consequences of behavioral inhibition are well known: Lack of initiative, passivity, isolation. This "behavioral incapacity" can create a sense of low self-esteem, and therefore the psychological state of the chronically inhibited person can create a feedback loop which reinforces yet further social inhibition and isolation. Thus, the Systems Model helps us understand how various physiological and psychological sub-systems -- the AIS, hormonal changes, behavioral inhibition, social isolation, negative self-esteem, etc. -- can all contribute to a vicious cycle that terminates in psychological and/or physical illness.
Body Psychotherapy thus has two "physical" processes to confront: the lack of holding and body touch, the lack of action. The Body Psychotherapy approach is therefore coherent, because it brings into play these two physical dynamics -- holding and action -- during the psychotherapy session.
1. Bowlby, John, Attachment and Loss, New York: Basic Books, 1969.
2. Liss, Jerome, Free to Feel,, Chapter 8, "Why Touch?", London, Wildhouse Pub., 1974, pp. 87-89.
3. Laborit, Henry, L'Inhibition d'Action, Paris, ed. Masson, 1979
4. Liss, Jerome, "The Systems Model, Applied to Bioenergetic Therapy, Psychology and Psychosomatic Medicine," Energy and Character, (Editor: David Boadella), Vol. 13, No. 2, August, 1982, pp. 12-28 and Vol. 14, No. 1, April, 1983, pp. 18-36.
5. Laborit, H., op. cit., see Chapter III, "Neuro-endocrine Correlations."
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APPENDIX 18 : A New Structure for Writing Up Case Studies on a Scientific Basis: A Proposal by Jerome Liss.
In "Group Methods in Biosystemic Therapy,"(5) a particular method is used to transmit the therapeutic approach of individual Body Psychotherapy conducted in the group setting. This is called "the two-column method." In the left hand column we read the blow-by-blow therapeutic transactions: Exactly what does the patient, (Giovanni), say and do, and exactly what does the therapist and group members say to illustrate the therapeutic response. The right-hand column contains the theoretical concepts that explain Giovanni's problem (in this example, rage against the unjust authority of the father who forces him to go to Church and denigrates him by comparing him in an unfavorable way to his younger brother), and then explain the reason for the therapist's particular intevention: a psychodramatic re-enacting of being forced to go to Church, with the group members supportive of Giovanni's affermation of his own authority against that of the father.
Why this particular "two-column method"? First, specific data of "what actually happens," the transactions described in the left-hand column, are differentiated from the theoretical concepts and interpretations presented in the right-hand column. That overcomes the usual confusion in case presentation whereby the "facts" of the therapeutic encounter are mixed with the "interpretations" that are called forth to explain those facts. (This follows the Hempelian model of science as the interplay between empirical data and higher level conceptualisation. As Prof. Hempel states, "A theoretical system without empirical observations is incapable of test and thus cannot constitute a theory of empirical phenomena. We shall say of its terms as well as of its concepts that they lack empirical import.) (6)
A second reason is that the reader is permitted to make an indendent judgment: Are the theoretical explanations sufficiently tied down to the observed facts? (In technical terms, are the concepts sufficiently "operational"?) In addition, is the conceptual umbrella adequate in terms of "covering" the majority of facts, or are there large gaps of unexplained facts? And does the reader agree that the given theoretical explanation (right-hand column) is the explanation he would give as well? Or can the reader conceive of alternative explanations, perhaps those concordant with his own therapeutic approach, that seem to him more appropriate? Therefore, the reader enters actively into the scientific adventure rather than remaining a passive observer to the writer's claims. (The same two-column method is used in the article, "The Self, the Impulse and the Other,"(7) and the case study in another article,(8) creates the same contiguity between blow-by-blow therapeutic interactions in a case study and interpretive concepts for each moment.)
Video Registration and Video Research:
To follow the same logic of "methods" that access the concrete verbal and non-verbal transactions that are the heart of Body Psychotherapy, we might mention the use of video registration. Although this is not yet widely used, we expect that its application will become more widespread in the future. The program of Body Psychotherapy Congresses has sometimes included the presentation of video films of therapeutic encounters. The film presented by Dr. Maurizio Stupiggia of Bologna was especially appreciated in its showing several years ago. The film of a therapeutic session shown by Dr. Will Davis at the EABP Body Psychotherapy Congress in Austria (1997) was also very much appreciated for the illustration of "the stroke dynamic" in physical-emotional impulses. At the Biosynthesis Congress in Palma, Majorca, in April, 1998, David Boadella showed a film of his therapeutic work in which energetic concepts were "directly seen" in the intense psychotherapeutic exchange. Another film, presented by Prof. Jerome Liss, entitled, "Father, I Want to See You!," illustrated a situation of a student in a training group who relived, first, the anguish of her father's death, when she was 13 years old, and then relived, with the group's assistance, positive memories of being picked up by her father, as well as other moments of his presence and of his affection for her, when she was 4 years old. In this way body therapists can actually "see and hear" what their colleagues are doing, an event that written summaries can never achieve, and the consequent discussion after a film permits more detailed reflection on therapeutic interventions. The use of video films creates a step forward in all scientific research, as will be pointed out subsequently when the research of Prof. Daniel Stern is mentioned. (see footnote)
Writing up Therapeutic Transactions Observed in Video Films
The use of video films presents another opportunity. How is it possible to obtain the detailed, blow-by-blow observations of a therapeutic encounter? The case examples presented by the two-column method (above) were obtained by means of the therapist first writing own the specific verbal transactions offered by the auditory tape-recordings of therapeutic sessions. But this leaves out the significant physical interplay between therapist and patient. In contrast, video film registration of a therapeutic sessions offers a more total picture of the therapeutic interaction. Although this work of writing it all down is very time-consuming, therapists are sometimes willing to undergo the necessary efforts, since the work creates greater precision of perspective. As an example, Prof. Liss' film, "Father, I Want to See You!" is written up with all verbal transactions and numerous non-verbal transactions specifically delineated. (Although the subject is speaking in Japanese, the translation, well realized, makes the film quite adequate for the listener to understand the movement within the therapeutic session, and thus it can serve as a teaching film.)
Using Designs to Present Theories and Compare Them With Alternatives:
It is interesting that Requirement No. 12, which we are now responding to, asks for an integration of approaches "that can be seen to share common ground." If we take this request literally, we want to have a picture of the common ground between different psychotherapeutic orientations. And, in fact, many researchers who apply systems thinking (Joel de Rosnay, Edgar Morin, C.H. Waddington (9) will supplement their verbal texts with designs (using boxes for concepts and two-directional arrows for interactions) so as to visually show the circular interactions, feedbacks, recursive loops and multiple levels that are integral to systems thinking. The article from which we are drawing this material, "Psychothérapie and Complexité," (10) at the end of the above cited quote, says, "See Design I," and a visual design is offered to repeat the essential points of the argument. In fact, the article uses four designs in order to show, on a visual basis, the structure of the verbal article.
Why is this point being emphasized? Systems theorists (who can also be Body Psychotherapists, psychoanalysts, Gestalt therapists as well as University professors and engineers) will often reccommend to their colleagues the use of visual designs to accompany their (verbal) arguments. This has the positive result of creating immediate clarity, permitting the complexity of the systems and sub-systems to be appreciated at a glance, and integrating diverse models that have similar structures. Thus, it is reccommended that researchers in the field of psychotherapy who search to develop the "common ground" among different orientations make use of the same cognitive tool and supplement their arguments with visual designs.
1. Liss, Jerome, "An Epistemological Protocol to Create a Scientific Psychology: The Application of Carl Hempel's Epistemological Program to Daniel Stern's Research," 1999, 39 pages. (submitted for publication, with the recommendation of Prof. Daniel Stern, to Devenir in France and to Human Evolution and Attachment in England).
2. Hempel, Carl, Fudamentals of Concept Formation in Empirical Science, International Encyclopedia of Unified Sciences, Vol. II, No. 7, Chicago, University of Chicago Press, 1952, p.21.
3. Liss, Jerome, "The Philosophy of Science and the Clinical Researcher: A Proposal for a New Scientific Psychology," published in Italian: "Filosofia della Scienza e la Ricerca Clinica: Una Proposta Per una Psicologia Scientifica Nuova," in Psicologia Clinica (ed. Prof. Mario Bertini, Université di Roma "La Sapienza"), Vol. 2, No. 2, May-August, 1983, pp. 143-163, and in La Psicoterapia del Corpo, (by Liss, Jerome and Boadella, David), Rome, Ed. Astrolabio, 1986, Chapter XIV.
4. Liss, Jerome, "An Epistemological Protocol...", op. cit., p. 35.
5. Liss, Jerome, "Group Methods in Biosystemic Therapy," Chapter 6, in La Terapia Biosistemica, (edited by Jerome Liss and Maurizio Stupiggia), Milan, ed. Franco Angeli, 1994.
6. Hempel, Carl, Fundamentals of Concept Formation," op. cit. p.39.
7. Liss, Jerome, "The Self, the Impulse and the Other, Three Models of Psychoanalysis," Energy and Character, (editor: David Boadella) Vol. 23, No. 2, Sept. 1992, pp. 75-85, and Vol. 24, No. 11, April, 1993, pp. 21-32.
8. Liss, Jerome, "The Boadella-Liss Model as a Scientific Project: The Observational Basis of Clinical Science," Energy and Character, Vol. 28, No. 1, May, 1997, pp. 21-29.
9. DeRosnay, Joel, Le Macroscope, Ed. Paris, Seuil, 1975. Morin, Edgar, La Methode: Vol. I, La Naature de la Nature, Vol. II, La Vie de la Vie, Paris, Ed. Seuil, 1977 and 1980. Waddington, C.H., Tools for Thought, London, Paladin, 1977.
10. Liss, Jerome, "Psychothérapie et Psychanalyse, La Complexité en Question," Le Journal des Psychologues, No. 119, Juillet-Aout, 1994.
Footnote: (Written permission by the subject is always obtained so that these films can be shown to professional audiences. An added protection for the subject is that a film is not shown in the country, or at least in the city, in which it was taken. Dr. Stupiggia's film, made in Italy, was shown in France. Prof. Liss' film, made in Japan, was shown in Spain.)
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APPENDIX 19 : Considerations Regarding the Criteria for a Science of Psychotherapy: by Jerome Liss
Requirement No. 12 raises the question, "What is scientific psychotherapy?" And, in more general terms, "What is science?," when we are dealing with the field of the complex human personality and the even more complex dimension of human relationships. For example, does science mean the traditional paradigm of creating experimental and matching control groups?
For several centures the scientific method has been identified with the use of the controlled laboratory experiment. The controlled laboratory experiment involves comparing two situations which are identical except for our adding the independent variable, "x", to the experimental group, but not to the control group. The difference between the outcome in the experimental and control groups, which we can call "y," is attributed to the presence of "x" in theexperimental group and its absence in the control group. In this sense, it is concluded that the persence of "x" causes the outcome "y", or "x" causes "y".
This very precise scientific procedure has been eminently useful for the rich development of the natural sciences during the past several hundred years. Nevertheless, the demand that clinical psychology and psychotherapy adhere to the same paradigm can create, in my opinion, serious drawbacks and has and can continue to significantly limit a truly scientific study in clinical psychology and psychotherapy when the subject of study is the human being.(1)
Perhaps "therapy outcome" studies can attempt to create experimental and control groups, if one were able to collect a sufficient number of patients for each group, but most of us have the ethical problem of "not giving therapy" to control groups, that is, to people needing therapy as much as those in the experimental groups. (If they did not have a similar need for therapy, they would not be suitable as "controls.") This can be overcome by comparing, in sufficiently large number, patients who undergo diverse types of psychotherapy, and comparing the differential outcomes. This was attempted, for example, in the famous study conducted at Stanford University by Lieberman, Yalom and Miles,(2) when eighteen groups using ten different approaches were evaluated (including Gestalt Therapy, Psychodrama, Psychoanalytically-oriented, Marathon groups, "non-verbal" and leaderless groups). The overall effect: "Seventy-five percent reported immediately afterward that the group had resulted in positive changes in themselves." (p.493) And, evidently, some groups gave better results than others. But was this due to the method? the quality of the leader? or the particular students in the group? Larger studies are needed, and also means to ascertain that the participants are sufficiently similar to one another in each of the groups, otherwise, there is no "control."
Nevertheless, such similarity among participants is not easy to ascertain and, some may declare, given the marked difference among human beings, such "control" is impossible. One interesting result was that "the most stimulating leaders were those who did not have a background as professional psychotherapists." Does that mean that all of our professional training is more deleterious than helpful?
A Scientific Paradigm for Clinical Psychology & Psychotherapy
Let us now turn to the scientific question, "How can we study process in psychotherapy?" In other words, how can we study what therapists are actually doing, and also their conscious reasons for doing what they think they are doing? This would be an appropriate focus for scientific clinical research. The question is, "What is our scientific paradigm for clinical research if we cannot apply the traditional scientific paradigm of experimental and control groups that has been used, with great success, in the natural sciences of chemistry and physics?"
One response to this is to refer to the paradigm of science proposed by Prof. Carl Hempel, known philosopher of science at the University of Princeton during the 1950's and member of the group (along with Rudolf Carnap, Charles Morris and Otto Neurath) that created the International Encyclopedia of Sciences.
Science Means Ideas Linked to Experience (3)
The fundamental principle of science is that it is a relationship between ideas and concrete experience. Prof. Hempel states, "Science is ultimately intended to systemize the data of our experience, and this is possible only if scientific principles -- that is, our theoretical constructions -- have a bearing upon, and thus are conceptually connected with, statements reporting what has been established by immediate experience."(p.21) To put it in a nutshell: When we base our ideas on concrete experiences, we have science. Without concrete experience, no science. Thus, to repeat our earlier critique: Scientific books and articles in psychology, especially clinical psychology, frequently present little or no evidence, that is, little or no reference to concrete experiences. Thus, they are not scientific. To be scientific, we must link ideas to experience. To cite our original source, Carl Hempel: "A theoretical system without empirical observations is incapable of test and thus cannot consistute a theory of empirical phenomena. We shall say of its terms as well as of its concepts that they lack empirical import."(4) (p.39)
This fundamental notion of science, linking empirical observations to theoretical concepts, permits a new perspective for the clinical psychologist or psychotherapist. It means that the clinician can use his own case studies, and even single sessions, in which there are unique and non-repeatable events, as the empirical basis of his scientific theorisation. But there is still a need for "rigor." This rigor is, first, in the adequacy of his registered empirical observations, then in the clear-cut connectedness of his first level ("operational") concepts, and then in his establishment of "scientific fruitfulness."
The "effort" of science in clinical psychology changes direction. At the moment of obtaining data, the "effort" of the clinicalresearcher (and, as can occur, the clinical therapist-researcher,) is channelled toward accurately registering all of the pertinent observations. This requires less effort over time, since it is not necessary to keep repeating the same experiment over and over as in traditional science. On the other hand, this approach requires a greater effort during the period of observing the registered data and compiling the results, which means either giving a description or else a quantitative analysis. Thus, to observe complex and non-repeatable events and then transmit the observations into a transmittable form requires new capacities on the part of the scientist.(5)
A more complete account of what is required in order to have adequate observational data and appropriate operational concepts is as follows:
Step 1: Link our ideas to observations:
1. Reduce our general concepts to more precise ideas that almost touch reality. This means to define our operational concepts.
2. Define the specific observations which we wish to make which correspond to our observational concepts.
3. Register observations from the "natural reality" we wish to study, or from the laboratory reality which attempts to approximate the "natural reality." Thus, for the clinician, the registered "natural reality" that we wish to study is the therapeutic encounter.
4. Create qualitative verbal descriptions and, when possible, quantitative compilations, using several observers when possible, of the reality we have registered.
5. Create a written presentation that offers concrete examples of our observations and of the quantitative data, when available, all presented in conjunction with the operational concepts that we are seeking to support.
6. Relate these operational concepts to higher order concepts and present the structure of the theoretical matrix.(6)
On 'Scientific Fruitfulness'
But this does not complete our requirements for a scientific psychology that is useful. Like studies of rats, we may be very exact in our observations and correct in our linking such observations to operational concepts (by means of "rules of correspondence"), but our studies may still be limited in value. How can we ascertain that our scientific work is "relevant and fruitful"? The above cited article discusses such questions in detail. Here is the conclusion:
Step II: Show that our work is relevant and fruitful:
1. Show new empirical studies that come from one's own work, as well as the from the work of colleagues, that contain observations that further support and deepen our conceptual explanations.
2. Indicate the new hypotheses and refinements of earlier hypotheses that emerge from these additional observational studies.
3. Interlace our operational concepts and higher order theoretical constructions with those presented by colleagues, indicating similarities, differences and overlaps.
4. Spell out the implications of the research observations and theoretical constructions for wider fields of study (the "scope") that are within our own branch of psychology, that can be cited from other fields of science, and that, at times, becomes integrated with (or, as Max Pages might say, becomes articulated with) other domains of human endeavor such as art and literature.(7)
From the perspective of this paradigm regarding clinical science, all schools of psychotherapy are just at the initial stage of their scientific development. Nevertheless, it is possible to consider what steps have already been taken, and what steps remain for the future.
Characterological Diagnostic Categories
Body Psychotherapy employs many concepts that come from psychoanalysis. For example, the psychoanalytic concepts of character- oral, schizoid, masochistic, psychopathic, hysterical and phallic (with variations regarding these categories) -- are employed by many body psychotherapists. Alexander Lowen's "Language of the Body" is a classical example of this bridge between psychoanalytically-derived concepts and observations of the physical body.
On the other hand, these diagnostic categories must be questioned in terms of the first criterion in "linking our ideas to observations":
1. Reduce our general concepts to more precise ideas that almost touch reality. This means to define our 'operational concepts.' Do these characterological diagnoses "almost touch reality"? If they did, then there would be little confusion or debate when a person is categorized as "hysteric" and not "psychopathic." And so on. But some psychotherapists find that agreement regarding diagnostic categories is not so easy to obtain.
Let us take the example, "The patient's assertiveness was filled with negative and destructive projections toward others. This was because of his schizoid reaction formation." But maybe his negative assertiveness was due to "psychopathic manipulation" or else represented a "phallic-narcissistic defense." Another example: A young woman shows imhibition and withdrawal. Is this a sign of "oral weakness," of her "masochistic holding back," or of her "hysterical flight"? We suggest that these categories are NOT operational because different therapist-observers will offer different interpretive conclusions for the same observed phenomenon. In other words, these are not "operational" categories, as required by science, because concepts and observations are not sufficietly linked.(8)
This is but one perspective. The point is that the scientific adventure in clinical psychology and psychotherapy is just at its beginning. Perhaps the main problem is connected to Guideline No. 3 (above) in the linking of ideas to observations: "Register observations from the reality we wish to study, that is, the clinical session." When clinical psychology particularly develops a better observational basis, it will be interesting, at that point, to see what concepts become most relevant. For example, it would not be surprising if Daniel Stern's concept of "attunement"(9) becomes an important category, not only for understanding the therapeutic session, but for evaluating personality and character. In this regard, we can remember that Stern's research, which produced the operational concept of 'attunement,' came from regarding video-registered sequences of mother-child interactions. This suggests, to some people, that the video study of psychotherapeutic sessions (as mentioned previously), will not be just an option for the scientific development of psychotherapy but, instead, will become an absolute necessity.
Mesodermal and Endodermal Emotions
As an alternative to the diagnostic categories developed by psychoanalysis, two clinical researchers in Body Psychotherapy, David Boadella and Jerome Liss, have developed an alternative scheme of classification which, in their opinion, is more "operational" because it is more "visible" than the psychoanalyatic concepts. Their thesis is that it is possible to "see" receptive emotions with soften, inward flexor movements and distinguish these from active emotions based on more vigorous outgoing movements. The soft emotions relate to Boadella's concept of "endodermal" structures and to Liss' concept of "parasympathetic" dynamics, while the active emotions relate to Boadella's concept of "mesodermal" structures and to Liss' concept of "sympathetic" dynamics. In the article, "Endodermal 'Receptive' Emotions and Mesodermal 'Active' Emotions, the Boadella-Liss Model as a Scientific Project,"(10) it is claimed that this classification paves the way for "observable (operational) concepts" that can guide the therapeutic process. A concrete therapeutic session is described that applies these concepts.
Body Psychotherapy, like many other forms of psychotherapy, derives a number of its fundamental concepts from the psychoanalytic tradition: the retrieval of the repressed is a central theme, among others.
One common ground of conceptualisation is the "experiential map" mentioned in No. 7. To repeat the point: The experiential maps developed by Gestalt Therapy (foreground and background of experience), Neurolinguistic Programming (visual, auditory and kinesthetic fields of experience), and Focusing (image, word and body sensation) are used by many body psychotherapists. The body psychotherapist differentiates the body domain (as suggested by George Downing) into position, gesture, movement and sensation.
1. Liss, Jerome, "The Philosophy of Science and the Clinical Researcher: A Proposal for a New Scientific Psychology," published in Italian: "Filosofia della Scienza e la Ricerca Clinica: Una Proposta Per una Psicologia Scientifica Nuova," in Psicologia Clinica (ed. Prof. Mario Bertini), Vol. 2, No. 2, May-August, 1983, pp. 143-163, and in La Psicoterapia del Corpo, (by Liss, Jerome and Boadella, David), Rome, Ed. Astrolabio, 1986, Chapter XIV.
2. Lieberman, M., Yalom, I. and Miles, M., "The Group Experience Project: A Comparison of Ten Encounter Technologies," in Blank, L., Gottsegen, G., and Gottsegen, M., Confrontation: Encounters in Self and Interpersonal Awareness, New York, Macmillan Pubs., 1971.
3. Liss, Jerome, "An Epistemological Protocol to Create a Scientific Psychology: The Application of Carl Hempel's Epistemological Program to Daniel Stern's Research," submitted for publication, with the recommendation of Prof. Daniel Stern, to Devenir, (Paris) and Attachment and Human Development, (London).
4. Hempel, Carl, Fundamentals of Concept Formation in Empirical Science, International Encyclopedia of Unified Sciences, Vol. II, No. 7, Chicago, Univ. of Chicago Press, 1952, p.39.
5. Liss, J. "The Philosophy of Science," op. cit., pp. 160-161.
6. Liss, J., "An Epistemological Protocol to Create a Scientific Psychology," op. cit., p.35.
7. Ibid, p. 35.
8. Liss, Jerome, "The Self, the Impulse and the Other," Energy and Character, Vol. 23, No. 2, Sept., 1992, pp. 75-85, and Vol. 24, No. 1, April, 1993, pp. 21-32.
9. Stern, Daniel, The Interpersonal World of the Child, New York, Basic Books, 1985, especially Chapters 6 and 7.
10. Liss, Jerome, "The Boadella-Liss Model as a Scientific Project: The Observational Basis of Clinical Science," Energy and Character, Vol. 28, No. 1, May, 1997, pp. 21-29
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APPENDIX 20 : Integrating Complexity by Jerome Liss
The common ground between Body Psychotherapy and psychoanalysis is explained quite fully in the recent book by Prof. Max Pages (University of Paris VII), Psychothérapie et Complexité.(1) (Psychotherapy and Complexity) The following material is taken from the review article concerning this book, "Psychothérapie et Psychoanalyse, La Complexité en Question."(2) When Prof. Pages talks about "complexity," he is referring to the Theory of Systems, since this model, used so frequently today for the social sciences, permits the integration of different models by showing how various functional sub-systems, at different "levels," create a dynamic interaction and, at the same time, demonstrate autonomous functions. "Psychothérapie et Complexité integrates two points of view, Freudian and Reichian, by proposing a model of several systems in interaction: the emotional system, the body system, the cognitive-evaluative ("discursive") system and the social-familial system." In other words, there is common ground, in Body Therapy and psychoanalysis, regarding these sub-systems. How does a total system with such complexity function? By means of "semi-autonomous sub-systems in interaction."
This means a change of logic. The traditional logic of psychoanalysis and of Body Psychotherapy, in the past, tended to place one single system at the center of functioning, while all other systems were considered secondary or derivative. Psychoanalysis, for example, searched to uncover the unconscious fantasy while Body Psychotherapy searched to uncover the emotion behind the body armour. This traditional epistemology of unilateral thinking claimed that a change in the central system will result in a change of the entire pathological structure. In contrast, the logic of interactive systems, more and more widely accepted today, proposes that a change could be initiated in any sub-system -- unconscious fantasy, unconscious emotion, bodily-rooted emotion -- but the therapeutic process must involve other pertinent sub-systems. This means that we must renounce the satisfaction of declaring, according to linear, unilateral thinking, "This is the single and only cause!" (Is this like renouncing the single God of monotheism?) Thus, to say that a pathological process is due to the dysfunctioning of a single system -- the fantasy, the emotion, the symbolisation, the communication -- as the different schools of psychotherapy might still sometimes show the tendancy to do, must be considered today as reductive and incomplete. The alternative? Sub-systems A and B (and then C and D and E) are in circular interaction, A reinforcing B and B, at the same time, reinforcing A.(3)
Spacial Models to 'See' Our Ideas
It is interesting that Requirement No. 12, which we are now responding to, asks for an integration of approaches "that can be seen to share common ground." If we take this request literally, we want to have a picture of the common ground between different psychotherapeutic orientations. And, in fact, many researchers who apply systems thinking (Joel de Rosnay(4), Edgar Morin,(5) C.H. Waddington(5A)) will supplement their verbal texts with designs (using boxes for concepts and two-directional arrows for interactions) so as to visually show the circular interactions, feedbacks, recursive loops and multiple levels that are integral to systems thinking.
The article from which we are drawing this material, "Psychothérapie et Complexité," at the end of the above cited quote, says, "See Design I," and a visual design is offered to repeat the essential points of the argument. In fact, the article uses four designs in order to show, on a visual basis, the structure of the verbal argument.
Why is this point being emphasized? Systems theorists (who can also be body therapists, psychoanalysts, Gestalt therapists as well as University professors and engineers) will often recommend to their colleagues the use of visual designs to accompany their (verbal) arguments. This has the positive result of creating immediate clarity, permitting the complexity of the systems and sub-systems to be appreciated at a glance, and integrating diverse models that have similar structures. Thus, it is reccommended that researchers in the field of psychotherapy who search to develop the "common ground" among different orientations make use of the same cognitive tool and supplement their arguments with visual designs.
Interaction Among 'Partially Autonomous' Sub-Systems
The central point of this article, based upon Prof. Pages' book, is to indicate the various pertinent sub-systems that are brought into interactive play during the psychotherapeutic process. The fact that each sub-system is linked to a particular orientation of psychotherapy shows the diverse contributions of these origins. But this does not mean that each orientation has a monopoly in the use of its particular sub-system of focused intervention. Just the opposite! All orientations can profit from the specific contributions made by other orientations and integrate such contributions in their own therapeutic armamentarium. (The following list is evidently a simplified scheme, since each psychotherapeutic orientation actually produces a series of interventional modes that overlap with other orientations. But the purpose here is to understand, on the one hand, the original contribution of each orientation and, on the other hand, the final complexity of therapeutic work that is open to all schools of psychotherapy.) Here are certain sub-systems that can create a dynamic of interaction with other sub-systems:
Seeing this vast array of sub-systems which can offer a focus for therapeutic intervention, it is no wonder that schools are prone, today, to integrate the concepts and methods of other schools, and that therapists themselves, after a specialized training in one school, will voluntarily go to another school (often for a more brief, two-year course) in order to expand their therapeutic competence. Furthermore, such "ecleticism" or, more appropriate, "integration of different approaches," is justified by an interesting "systems concept": Because systems will often return to an original equilibrium, (and therefore to a previous pathological state of equilibrium), it is often more fruitful to attempt to create systems changes by by a multiplicity of intervention at different sites of input (that is, to call into play different sub-systems), than to attempt to rely upon a single, massive change at one site of input.(7)
Therefore, the psychotherapist competent in several modalities of intervention, and able to change, with flexibility and subtlety, from one modality to another, will often obtain, according to this systemic principle, greater and more lasting changes than the therapist who is totally invested in a single approach.
1. Pages, Max, Psychothérapie et Complexité, Paris, Editions Hommes et Perspectives, 1993.
2. Liss, Jerome, "PsychothÈrapie et Psychanalyse: La Complexité en Question," Le Journal des Psychologues, No.19, Juillet-Aout, 1994, pp.45-48.
3. Ibid, pp. 45-46.
4. DeRosnay, Joel, Le Macroscope, Paris, Ed. Seuil, 1975.
5. Morin, Edgar, La Methode, Vol. I, La Nature de la Nature; Vol. II, La Vie de la Vie, Paris, Ed. Seuil, 1977 and 1980.
5A. Waddington, C.H., Tools for Thought, London, Paladin, 1977.
6. "Psychothérapie et Complexité," op. cit., p.47.
7. Emery, F.E., (editor) Systems Thinking, London, Penguin Books, 1969.
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APPENDIX 21 : From Traditional Single-Cause Thinking to Systemic Interactional Thinking by Jerome Liss
In the article, "The Self, the Impulse and the Other," certain reflections are offered that associate the traditional tendancy of "exclusivity and superiority" within various psychotherapeutic schools with the epistemological problem of "linear, uni-lateral thinking," that is, a form of conceptualisation and evaluation characteristic of the 19th century but which is now contradicted by Systems Thinking, a 20th century epistemological model.
One of the limits of the psychotherapeutic tradition is its tendancy to maintain the traditional epistemology of linear, single-cause thinking. In the early Freudian period, this was expressed by an exclusive search for "the unconscious motivation" of an act and, when it was discovered, to consider that "this was the only real reason" for the act to be carried out. Thus, psychoanalysis of the past, and some even today, might argue over which interpretation of unconscius motivation is 'correct', with the underlying epistemological model of evaluation, "Either you are right or I am right! And since I know that I am right, you must be wrong!"
The outcome is that many psychotherapeutic schools still try to prove, "We are right and the others are in error." Such schools, within and among different orientations, might engage in a type of "in-fighting." Our point of view is that a certain competition is stimulating, but this goes overboard when one school claims to have the exclusive truth. (An example: Arthur Janov's claim, "Primal Therapy is the only cure for the neuroses," illustrates this same epistemological error.)
Thus, the debate among schools becomes negative (and sometimes even destructive) when a particular school claims, "We represent the FUNDAMENTAL method of psychotherapy and the ONLY valid method of treatment." This is as fruitless as the debate, "Which came first, the chicken or the egg?" Thus, different psychoanalytic schools may argue (treating the specific argument of the article), "Which is the fundamental dynamic of the personality and of therapeutic intervention: the Impulse, the Self or the Object Relationship? This model of single causality is reinforced by an analysis of psychopathology that claims that the disturbance of the entire personality structure is due to one single cause: THE nuclear complex,
THE unconscious fantasy, THE original trauma, THE birth trauma, THE primordial scene, THE anxio-genetic mother, THE absent father, THE genetic predisposition, etc. This epistemological attitude that seeks to search a single reason for all psychopathology might remind us of our Judeo-Christian heritage that preaches to us, "The Fall of Man was due to his First Sin."(1)
What are the alternatives to the linear single-causal modes of thinking that create such prejudice and closure among schools? The Systems Model shows that causality is interactive, not uni-lateral. In Requirement No. 12, we will show how Systems Theory encourages us to delineate the multiplicity of "semi-autonomous sub-systems in interaction" that create a common ground for all psychotherapeutic orientations. In this we we can integrate the contributions of specific psychotherapeutic orientations into a larger whole, avoiding negative (and worse, scornful and superior) comparisons and favoring a collaborative attitude of mutual respect and exchange among the diverse orientations.
Concepts and Models are Not 'True,' But Only 'More or Less Supported' by Facts
Another help for over-coming exclusivity and prejudice is the scientific model offered by Carl Hempel.(2) (Described in Requirements 9, 12 and 15) Once we understand that "ideas," "concepts," "models" and "orientations" are all "emergent cognitive structures" that derive their support from concrete observations and facts, we can understand that the evaluative terms, "truth," "absolutely correct", "totally right," "this is the 'only' solution," are epistemological biases coming from simplified and reductive thinking. Hempel's epistemological paradigm that declares, "Science is a constant moving between empirical observations and operational concepts associated by rules of correspondence" reminds us that the ideas, models and concepts that guide our therapeutic work can only be "more or less supported" by the factual evidence and never declared "absolutely right". Correspondingly, alternative models and concepts emanating from other schools can never be declared, "absolutely wrong," but only, "less supported, or even contradicted, by the evidence we have at hand." And even when we have evidence to contradict the validity of another school's therapeutic options, members of that other school will surely draw upon the complex phenomena of reality to produce evidence that their own orientation is "highly supported" and that it is our own school which is contradicted by the facts (meaning, the facts that 'they' have called upon as pertinent evidence). Therefore, the competition among theories, according to the Hempel model, can become vigorous, and also productive, as each orientation calls upon observations that support its own modality of thinking and functioning, and suggests, at times, evidence that contradicts the postulates of alternative schools. But such "wars in science" must be guided by epistemological restraint. Noone is absolutely right. Noone has access to a unique, omnipresent truth. But in this scientific duel, schools have the opportunity to refine their concepts, bring them closer to observable reality (see the paradigm described in Requirement 12 of linking observations to operational concepts), and discover further empirical evidence that can support their conceptual theses. (References for these considerations are given in other sections.)
To conclude, the "critical reflections" offered in Requirement 12, in which the question of "What is science for clinical psychology and psychotherapy?" is posed, indicate that we are just at the beginning of the scientific adventure. More detailed descriptions of case histories, side-by-side with clinical interpretations (for example, the "two-column method" described in that section), is one suggestion for deepening the scientific roots of clinical psychology & psychotherapy. Another suggestion is to use video-televised sequences as the basis of the "empirical" registrations that can then give forth productive conceptualisation. Still another is to use spacial 'Systems designs' when explaining conceptual models and comparing them to models offered by other schools. The article, "An Epistemological Protocol to Create a Scientific Psychology: The Application of Carl Hempel's Epistemological Program to Daniel Stern's Research,"(3) presents these and other considerations in greater detail.
1. Liss, Jerome, "The Self, the Impulse and the Other," Energy and Character, Vol. 23, No. 2, Sept., 1992, pp. 75-85, and Vol. 24, No. 1, April, 1993, pp. 21-32.
2. Hempel, Carl, Fundamentals of Concept Formation in Empirical Science, International Encyclopedia of Unified Sciences, Vol. II, No. 7, Chicago, Univ. of Chicago Press, 1952, p.39.
3. Liss, Jerome, "An Epistemological Protocol to Create a Scientific Psychology: The Application of Carl Hempel's Epistemological Program to Daniel Stern's Research," submitted for publication, with the recommendation of Prof. Daniel Stern, to Devenir, (Paris) and Human Development and Attachment (London).
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APPENDIX 22 : The Need for Concrete Case Descriptions by Jerome Liss
This is a challenging demand, it seems, for all schools of psychotherapy, given that the main model of all psychotherapeutic work, Sigmund Freud, after his earlier works- Studies on Hysteria and The Analysis of Dreams- wrote many theoretical papers that were theoretical treatises (or, as he called them, "theoretical sketches") without little (or, sometimes, almost no) case observation that could give observational support to the theoretical models. And, unfortunately, many followers in all branches of psychotherapy have done likewise, giving theoretical definitions of their work, sometimes in obtruse language, without methodical support from concrete case studies; or, sometimes, giving no evidence of their work, but offering an analysis of psychopathology based on their unseen work. The works of Lacan take this tendancy to the extreme; it is a challenge for anyone to understand even his theoretical model, no less find concrete case material that can support and elucidate his overly abstract concepts.
The point of this critical analysis is to demonstrate that many psychotherapeutic orientations need more specific methods for communicating their "fields of study," meaning concrete case material, and for delineating their treatment approaches.
What "method" is adequate in the field of psychotherapy? This question is faced in the article, "The Philosophy of Science and the Clinical Researcher: A Proposal for a New Scientific Psychology."(1) This article proposes that the traditional scientific paradigm, the laboratory experiment, is not an appropriate methodology for clinical psychology, a field in which unique, unrepeatable events involving the complex human personality represent the primary field of inquiry. (This point will be further developed in questions 12 and 15, that deal with the dilemma of how clinical psychology can progress to become a scientific discipline.) The upshot of this argument is that the most rigorous of all methods, the scientific method, requires the registration and communication of concrete case material, in order to justify the notion that clinical psychology or psychotherapy is scientific.
A New Structure for Writing Up Case Studies on a Scientific Basis, A Proposal
In "Group Methods in Biosystemic Therapy,"(2) a particular method is used to transmit the therapeutic approach of individual Body Psychotherapy conducted in the group setting. This is called "the two-column method." In the left hand column we read the blow-by-blow therapeutic transactions: Exactly what does the patient, Giovanni, say and do, and exactly what does the therapist and group members say to illustrate the therapeutic response. The right-hand column contains the theoretical concepts that explain Giovanni's problem (in this example, rage against the unjust authority of the father who forces him to go to Church and denigrates him by comparing him in an unfavorable way to his younger brother), and then explain the reason for the therapist's particular intevention: a psychodramatic re-enacting of being forced to go to Church, with the group members supportive of Giovanni's affermation of his own authority against that of the father.
Why this particular "two-column method"? First, specific data of "what actually happens," the transactions described in the left-hand column, are differentiated from the theoretical concepts and interpretations presented in the right-hand column. That overcomes the usual confusion in case presentation whereby the "facts" of the therapeutic encounter are mixed with the "interpretations" that are called forth to explain those facts. (This follows the Hempelian model of science as the interplay between empirical data and higher level conceptualisation. As Prof. Hempel states, "A theoretical system without empirical observations is incapable of test and thus cannot constitute a theory of empirical phenomena. We shall say of its terms as well as of its concepts that they lack empirical import.)(3)
A second reason is that the reader is permitted to make an indendent judgment: Are the theoretical explanations sufficiently tied down to the observed facts? (In technical terms, are the concepts sufficiently "operational"?) In addition, is the conceptual umbrella adequate in terms of "covering" the majority of facts, or are there large gaps of unexplained facts? And does the reader agree that the given theoretical explanation (right-hand column) is the explanation he would give as well? Or can the reader conceive of alternative explanations, perhaps those concordant with his own therapeutic approach, that seem to him more appropriate? Therefore, the reader enters actively into the scientific adventure rather than remaining a passive observer to the writer's claims. (The same two-column method is used in the article, "The Self, the Impulse and the Other,"(4) and the case study in another article,(5) creates the same contiguity between blow-by-blow therapeutic interactions in a case study and interpretive concepts for each moment.)
Going Beyond Words in Case Supervision
Another important method for transmitting knowledge in Body Psychotherapy is through case supervision based upon "the re-enactment of the therapeutic encounter." Such "reproduction of the reality, verbal and physical," is more important for Body Therapy than for verbally-based therapies, since the therapeutic interventions in Body Therapy must be "seen" as well as "heard." (It may be argued that verbally-oriented psychotherapies might also profit from this re-enactment method for case supervision since the traditional method of recounting, in third person terms, what happened during the therapeutic encounter, does not capture the non-verbal qualities of voice intonation, facial expression, postural change and "attunement" factors which can significantly influence the therapeutic outcome.) One specific approach to this "reproduction of reality" is described in the article, "Lo Psicoteatro Terapeutico,"(6) which presents a method that encourages spontaneous intervention of other people present (other trainees in the supervision group) for generating alternative approaches when the therapist is exploring a particular therapeutic dilemma. Once again, the logic remains the same as in the two-column method for writing up case histories: We must find ways to access the concrete reality rather than depend upon verbal formulations that cannot embody the physical interactions that are specific and essential to the Body Psychotherapy orientation.
Video Registration and Video Research
To follow the same logic of "methods" that access the concrete verbal and non-verbal transactions that are the heart of Body Psychotherapy, we might mention the use of video registration. Although this is not yet widely used, we expect that its application will become more widespread in the future. The program of Body Psychotherapy Congresses has sometimes included the presentation of video films of therapeutic encounters. The film presented by Dr. Maurizio Stupiggia of Bologna was especially appreciated in its showing several years ago. The film of a therapeutic session shown by Dr. Will Davis at the Body Therapy Congress in Austria (1997) was also very much appreciated for the illustration of "the stroke dynamic" in physical-emotional impulses. At the Biosynthesis Congress in Palma, Majorca, in April, 1998, David Boadella showed a film of his therapeutic work in which energetic concepts were "directly seen" in the intense psychotherapeutic exchange. Another film, presented by Prof. Jerome Liss, entitled, "Father, I Want to See You!," illustrated a situation of a student in a Training Group who relived, first, the anguish of her father's death, when she was 13 years old, and then relived, with the group's assistance, positive memories of being picked up by her father, as well as other moments of his presence and of his affection for her, when she was 4 years old. (Written permission by the Subject is always obtained so that these films can be shown to professional audiences. An added protection for the Subject is that a film is not shown in the country, or at least in the city, in which it was taken. Dr. Stupiggia's film, made in Italy, was shown in France. Prof. Liss' film, made in Japan, was shown in Spain.) In this way body therapists can actually "see and hear" what their colleagues are doing, an event that written summaries can never achieve, and the consequent discussion after a film permits more detailed reflection on therapeutic interventions.
The use of video films creates a step forward in all scientific research, as will be pointed out subsequently when the research of Prof. Daniel Stern is mentioned. It might be noted that Dr. Maurizio Stupiggia (of Bologna, Italy), a body psychotherapist in the avant-garde in the use of video films, has the video camera always on (so long as the patient agrees), so that the initial feeling of shame or discomfort, on the part of both patient and therapist, is overcome with the camera's habitual presence. The Biosystemic School of Therapy created a Video Congress in 1994 in which films of body psychotherapy, psychodrama, child play therapy and dance therapy were presented to an audience of eighty professionals.
The use of video films presents another opportunity. How is it possible to obtain the detaialed, blow-by-blow observations of a therapeutic encounter? The case examples presented by the two-colum method (above) were obtained by means of the therapist writing down the specific verbal transactions offered by the auditory tape-recordings of therapeutic sessions. But this leaves out the significant physical interplay between therapist and patient. In contrast, video film registration of a therapeutic sessions offers a more total picture of the therapeutic interaction. Although this work of writing it all down is time-consuming, therapists are sometimes willing to undergo the necessary efforts, since the work creates both greater precision and time for reflection. As an example, Prof. Liss' film, "Father, I Want to See You!" is written up with all verbal transactions and numerous non-verbal transactions specifically delineated. (Althugh the Subject is speaking in Japanese, the traduction, well realized, makes the film quite adequate for the listener to understand the movement within the therapeutic session, and thus it can serve as a teaching film.) (The manuscript is available to other professionals when a signed contract of confidentiality is sent to Prof. Liss.)
In these examples we are presenting methodologies that are not yet widely used. But, as mentioned, scientific advance within schools and between schoools of diverse therapeutic approaches will encourage the growth of these and many other specific methods.
1. Liss, Jerome, "The Philosophy of Science and the Clinical Researcher: A Proposal for a New Scientific Psychology," published in Italian: "Filosofia della Scienza e la Ricerca Clinica: Una Proposta Per una Psicologia Scientifica Nuova," in Psicologia Clinica (ed. Prof. Mario Bertini, Université di Roma "La Sapienza"), Vol. 2, No. 2, May-August, 1983, pp. 143-163, and in La Psicoterapia del Corpo, (by Liss, Jerome and Boadella, David), Rome, Ed. Astrolabio, 1986, Chapter XIV.
2. Liss, Jerome, "Group Methods in Biosystemic Therapy," Chapter 6, in La Terapia Biosistemica, (edited by Jerome Liss and Maurizio Stupiggia), Milan, Ed. Franco Angeli, 1994.
3. Hempel, Carl, Fundamentals of Concept Formation in Empirical Science, International Encyclopedia of Unified Sciences, Vol. II, No. 7, Chicago, Univ. of Chicago Press, 1952, p.39.
4. Liss, Jerome, "The Self, the Impulse and the Other," Energy and Character, Vol. 23, No. 2, Sept., 1992, pp. 75-85, and Vol. 24, No. 1, April, 1993, pp. 21-32.
5. Liss, Jerome, "The Boadella-Liss Model as a Scientific Project: The Observational Basis of Clinical Science," Energy and Character, Vol. 28, No. 1, May, 1997, pp. 21-29.
6. Cristofori, Stefano, "Lo Psicoteatro Terapeutico," in La Terapia Biosistemica, op. cit., Chapter 8, pp. 175-191.
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APPENDIX 23 : Answer to Question 8 by Jerome Liss
This question is epistemologically correct according to the scientific paradigm presented by Prof. Carl Hempel, Philospher of Science, and author of Fundamentals of Concept Formation in Empirical Sciences.(1) Prof. Hempel says that one criterion for the usefulness of a science is its capacity, both observationally and conceptually, to enter into "fruitful connection" with the scientific projects of colleagues who are making investigations and developing theoretical constructions within the same area and similar areas.
In response to question 7, we have already described how Body Psychotherapy integrates experiential maps and the consequent therapeutic strategies that are characteristic of Psychoanalysis, Gestalt Therapy and Neurolinguistic Programming.
In addition, it was pointed out in response to question 11 that Body Psychotherapy methods can be integrated with other therapeutic orientations. For this reason, Body Psychotherapy Schools often offer abbreviated courses (usually two years) open to therapists trained in other psychotherapeutic orientations.
What other evidence do we have for a fruitful dialogue between the Body Psychotherapy orientations and other psychotherapeutic orientations?
The book, Analyse Transactionelle et Bio-Energie,(1A) written by two psychotherapists, Jean-Michel Fourcade and Vincent Lenhardt, who have integrated both methods into a unitary approach, shows how the various concepts of Transactional Analysis -parent-adult-child positions, life scenario, rackets, cross communication, etc.- can be explored with greater emotional intensity by integrating specific Body Psychotherapy methods.
Alexander Lowen's classical work, The Language of the Body, integrates basic psychoanalytic diagnostic concepts of "character" - oral, schizoid, masochistic, psychopathic, hysteric, and phallic, based on the notion of infantile periods of fixation -with acute observations of the observable physical dynamics that underly these character structures.
Jean Ambrosi's work, L'Analyse Psycho-Energetique,2 integrates concepts of psychoanalysis with methodological tools that are derived from both Gestalt Therapy and Body Therapy.
Body Psychotherapy and therapy for sexual difficulties are presented as integrated approaches in various works.(3)
In Energy and Charcter (editor: David Boadella), published for almost thirty years on a regular basis, numerous articles treat an integration between Body Psychotherapy and other therapeutic orientations. Especially frequent are the articles that integrate Body Psychotherapy with Objects Relation theory and, more recently, with theories of Traumatic Neurosis.
In Free to Feel,(4) we find an integration between Body Therapy methods (bringing out feelings by direct physical expression) and Encounter Group methods.
In La Terapia Biosistemica,(5) Dr. Roberto Giommi offers an integration between Body Psychotherapy and the "Holding Method" developed by M. Welch and M. Zappella and used for the treatment of autistic children.
In the same book, the chapter by Dr. Stefano Cristofori, "L'Energia Entra in Scena, Lo Psicoteatro Terapeutico,(6) we find the desription of the Psicoteatro method, which represents an integration between Body Psychotherapy (the Biosystemic approach) and Psychodrama.
Body Psychotherapy methods have been applied to the Co-Counselling Method developed by Harvey Jackins (7) and also to Self-Help Groups. This is presented in the book, Insieme per Vincere L'Infelicité, Superare le Crisi con la Collaborazione Reciproca and i Gruppi di Auto-Aiuto.(8) (Together to Resolve Unhappiness: Overcome Crises with Reciprocal Collaboration and Self-Help Groups.)
An integration between Body Psychotherapy and Jungian Psychology can be found in The Shadow and the Body in Theory and Practice, The Clinical Applicatins of the Theories of C.G Jung and Malcolm Brown.,(9) by Catherine Brown,
The Self, The Impulse and the Other
One example (among many) of the dialogue between Body Psychotherapy and psychoanalysis, can be found in "The Self, the Impulse and the Other."(10) This work presents to Body Psychotherapists the essential aspects of three psychoanalytic models and suggests their relevance to work in body psychcotherapy. "The Self" refers to self concepts within various psychoanalytic schools: the concept of self-esteem developed by Edith Jacobsen, the concept of self autonomy developed by Margaret Mahler, and the concept of "functional capacities of the self" developed by Heinz Hartman.(11)
"The Impulse" refers to psychanalytic schools that emphasize the emotional dynamics of psychoanalytic work, such as Sigmund Freud(12) and Melanie Klein.(12A) In passing, Melanie Klein's concept of the introject is one of the important "borrowings" of Body Psychotherapy depth theory.(13)
"The Other" refers to psychoanalytic orientations that emphasize the Self-Other relation, especially the English School of Object Relationships (W.R. Fairbairn, Harry Guntip and D.W. Winnicott).(14)
To push forward the dialogue between Body Psychotherapy and psychoanalysis, this article poses the question of how to evaluate "the competition" between these three models. Is one model correct and the other two models incorrect? The falsity of this type of evaluation is outlined by referring to Systems Theory.(15)
"Today's thinking in the social sciences and in biology has undergone an epistemological change: from the single-linear-causality model to the multiple-causality-and circularity model now known as 'systems thinking.'" Systems thinking allows us to integrate different conceptual models. More specifically, each model refers to certain observations and excludes other observations, building up its theoretical concepts within the specific terrain of its observational focus. Therefore, "Self, Impulse and Other" refers to models that emphasize different aspects of the patient's existence; the Self aspects of self-esteem, self-autonomy and functional systems of the self; the Impulse aspects of emotions and introjected figures; and Other aspects of the relationship with other people in the world, where the issues of trust, loyalty and cooperation are dominant. Thus, all models have their potential use. In fact, this article shows the analogy between these three specific psychoanalytic models and the structure of language:
These three theoretical models -- Self, Impulse and Object Relationship- correspond to the three fundamental elements of language: The Self is the noun, the "I", the Impulse is the verb, the feeling and the action, the Object Relationship is just that, the object of the phrase, that which my "I" relates itself to through the dynamic of the verb. We can imagine that language formed this particular structure of noun-verb-object since this reduces to the most fundamental form the terms that are essential to represent all phrases of our experience: action, memory, plans, feelings, beliefs, intuitions, analyses, etc.(p.80)
Thus, Body Psychotherapists are encouraged to integrate all three models into their work and avoid the useless competition, "Which model is the correct one?"
To indicate the usefulness of the Three-Model Theory derived from psychoanalysis for both the body therapy and the psychoanalyst, the article concludes with two case studies: The first is a case study of body psychotherapy in which "hard stomach feelings" are related to the introjects of the mother and the father, and the second is an analysis of three case histories presented by psychoanalyst Joyce McDdougall in her book, Theaters of the Mind.(16)
A Body Psychotherapy Contribution: "The Expressive Apparatus"
One other point: "Dialogue" among psychotherapeutic orientations means a two-way process whereby each orientation can profit from the other. So far we have mentioned how Body Psychotherapy can integrate psychoanalytic concepts (in this case, the Three Models of Psychoanalysis). But this article also suggests that the Self-Concept of psychoanalysis can be enriched by an additional concept emanating from Body Psychotherapy, that is, the concept of "the expressive apparatus."
The "expressive apparatus" refers to automatic mechanisms of gesture, posture, voice intonation, facial expression, style of movement and action. and so on. A traditional position (coming from unilateral, non-systemic causal thinking) claims that every expressive moement surges from a hidden motivation; thus, when someone speaks with hard metallic tones in his voice, the traditional (unilater) position offers the following interpretation: this person's voice reveals his hidden aggressivity. Or if the person frequently shifts his gaze upward and to the side, giving an impression of a superior attitude, it is interpreted that this reveals an unconscious feeling of superiority. But close study by Body Psychotherapists shows the following phenomenon: There is often a gap betwen a person's motivation (conscious and unconscious) and the impact he or she exerts (through his "expressive apparatus") upon others: Those upward turning eyes may be due to fear and avoidence, rather than to superiority and contempt. Those eyes that shift from side to side may be due to confusion regarding one's own identity rather than to suspicion regarding the Other's intentions, as usually interpeted by the observer. Those lips that are firmly closed may represent a feeling, "What I say won't interest you," rather than (as interpreted by an outsider), "I won't give you a single word of my opinion. You don't deserve it!" In other words, there is often a difference between the non-verbal "analogic" message seen by the others and the inner emotion perceived by Oneself. Outer appearance and inner reality may be at odds with one another when we are dealing with non-verbal communication. Sometimes our intuition regarding the emotion behind the expression is correct and the person will deny our intuition because the emotion, as Freud points out, is disavowed and relegated to the unconscious. But the therapeutic work of the Body Psychotherapist has frequently produced examples where both ordinary intuition and psychoanalytic interpretation of what lies behind a person's non-verbal expressions are actually incorrect.(pp.78-79)
Thus, in the two-way dialogue between Body Psychotherapists and Psychoanalysts, a Body Psychotherapst, integrating the various "self concepts" offered by psychoanalysis, may contribute by suggesting that the addition of the concept, "the expressive apparatus," can help understand non-verbal behavior. The point is that if the non-verbal behavior seems to indicate a particular emotion or motivation, such an intuition may not be necessarily correct. The "expressive apparatus" is, as Systems Theory suggests, a "semi autonomous functional system" which has some connection to other systems, such as emotional and motivational systems, but which also has its own dynamic. To explain this point further, the example of depressive behavior is brought up.
A common example is a person who has been depressed for a long time. Such a person may continue to show an expressive style called "depressive comportment": eyes turned down, head lowered, shoulders hunched, spine curved, a certain slowing of movements or even immobilisation, and voice tones that are weak and without color. In general, these expressive characteristics were worse when the depression was full-blown and then markedly diminished during the resolution of the depressive emotions. Nonetheless, a residual of the depressive comportment might remain in the person's expressive style.(p.79)
We may ask ourselves at this point, "How can a functional comportment remain while its emotional and motivational dynamics have been resolved and are therefore no longer prersent?" The response is that behavioral and gestural comportment, called "the expressive apparatus," is a semi-autonomous functional system (a Systems Theory concept). How is this justified? Let us remember that behavior and expression are not only determined by the motor cortex (conscious intention), but have underlying dynamics determined by subcortical nuclei: the basal ganglia, the tegmentum, the red nucleus and the cerebellum, among others. Thus, these "out of consciousness" subcortical nuclei can continue to elicit a particular form of expression, like depressive comportment, even when limbic system (emotional) determinants of that comportment are removed.
This analysis suggests that the patient, even though finding his emotional problems are relatively resolved, can have "residual comportmental problems" due to the on-going and autonomous function of the "expressive apparatus" that will create interpersonal rejection and re-stimulate the original emotional problem:
The problem is that this style of personal expression - a residual of depressive comportment - can induce in other people a feeling of irritation or outward rejection through lack of interest. In other words, there will be rejection. Thus, the patient lives within a paradox: He has resolved his 'inner emotions' of depresion, but his 'character style' retains a sufficient residual of the depressive comportment so that people are induced to reject him once again and restimulate the downhill depressive spiral: "I act depressed, they reject me, I feel worthless, I become even more depressed and will be rejected once again."
Thus, the resolution of the negative emotional pattern also requires a resolution of the behavior and non-verbal expressive pattern that stimulate the negative reactions of others.(p.80)
The consequence of this analysis is that the body psychotherapist can have a special role, especially with depressed and anxious patients, of encouraging a change of behavior and non-verbal expression that corresponds to the "positive shift" (E. Genlin) toward new emotions, attitudes, cognitive concepts and perspectives, that their joint psychological work is aiming to achieve.
Through specific actions of "vitalisation," "mobilisation," "free movement," "opening the eyes," "making loud sounds," "accelerating the speech pattern," which may either be part of a warm-up period in psychotherapy or else part of the emotional work itself, the depressive comportment style is modified into an "open and vitalizing interactive style of behavior" that brings the patient into positive contact with other people.(p.81)
Evidently, this is just one example of how the body therapist can complete the emotional work by encouraging expressive styles coherent with his positive intentions. For example, the chronically anxious patient who has upset others by his disturbing feelings may be encouraged to communicate with calm and emotional-stabilizing non-verbal dynamics, etc.
The point is that the Body Therapy contribution of the "expressive apparatus" as a functional concept for assisting personality change can be of interest to other therapeutic orientations, as the two-way dialogue between therapeutic approaches brings benefits to everyone open to such exchanges.
Scientific Fruitfulness Based on Integration With Other Fields of Scientific Research
Scientific support for a psychotherapeutic orientation not only comes from its interlacing with other methods having similar goals, that is, with other psychotherapeutic orientations, but also comes from the integration of a method with other fields of research. This epistemological point is made by Carl Hempel when he proposes that scientific fruitfulness is also connected to "scope,"(17) that is, the connection of a scientific project with other fields of scientific inquiry.
An Example of How Body Psychotherapy is Enlarging its Scope
One of the most important developments in Body Psychotherapy in recent years is its connection with the scientific work of Prof. Daniel Stern.(18) Prof. Stern has studied mother-child interactions by use of video films. His conclusion is that a healthy mother-child relationship is based on "attunement", that is, a correspondence in physical non-verbal expression (between mother and child, but perhaps appropriate for other moments of life), which contains similarities in "rhythm, intensity and shape."(p.158) Many Body Therapists were already practicing "attunement" with their patients because of the intuitive sense that this both helps the therapeutic relationship, creating a sense of trust, and also encourages a free expression of feelings. The research of Prof. Stern has changed this intuition into a scientific fact. Different writings by Body Psychotherapists have shown an appreciation of this new connection(19),(20) and it is expected that more studies will elaborate yet further this fruitful scientific connection. It may be noted that Prof. Stern was invited by Dr. Luciano Rispoli to give the plenary talk at the Italian Congress of Body Psychotherapy held in Catania (Italy) in 1994.
Body Therapy Integrates Various Physiological Models
As already noted, Body Psychotherapy takes a great interest in scientific advances in physiology and neurophysiology, integrating new discoveries with its own conceptual framework. The application of the scientific work of Prof. Ernst Gellhorn, regarding the alternative interplay between the sympathetic and parasympathetic components of the autonomic nervous system, has already been noted. Also mentioned is the application of Prof. Henry Laborit's concept of prolonged action inhibition (or paralysis, immobilisation), the prolonged functioning of the subcortical AIS which connects limbic functions to the hypothalamus, and the emotional and psychosomatic disturbances which are the outcome. Also mentioned previously is the MacLean model of the Triune Brain, explaining the use of of body mobilisation methods which attempt to integrate the three levels of the brain.
Another work in physiology that has been of use to many Body Psychotherapists is Ernest Rossi's The Psychobiology of Psychophysical Healing.(21) His clarification of how the limbic system influenced hypothalamus controls important physiological processes is a step forward in showing the dynamics of psychosomatic processes. More specifically, the limbic system is the "seat of emotions," as MacLean points out. Its main ouput is toward the hypothalamus. Therefore, even subtle emotional changes (limbic system) can cause alterations of the hypothalamus. And what functioning does the hypothalamus control? The autonomic nervous system, hormonal secretion, the immunological system and the basal ganglia motor system.(p.40) Thus the mysterious bridge between "psyche" and "soma" is being explored, with Body Therapists applying these concepts to their clinical work.(22) The implication of Rossi's work is that emotional disturbance needs to be faced and resolved; otherwise, the patient is in danger, when the disturbance is prolonged, of undergoing psychophysical alterations that can result in physical illness.
1. Hempel, Carl, Fudamentals of Concept Formation in Empirical Science, International Encyclopedia of Unified Sciences, Vol. II, No. 7, Chicago, University of Chicago Press, 1952, p.28.
1A. Fourcade, Jean-Michel and Lenhardt, Vincent, Analyse Tranactionelle et Bio-Energie, Paris, ed. Jean-Pierre Delarge, 1981.
2. Ambrosi, Jean, L'Analyse Psycho-Energetique, Paris, Retz, 1979.
3. Liss, Jerome, "La Bioenergetica e la Terapia sulla Sessualité," Sessuologia, Aprile, 1979.
4. Liss, Jerome, Free to Feel, Finding Your Way Through the New Therapies, New York, Praeger Press, 1974, especially Chapter 13, "Are You Ready to Encounter?", pp. 146-159.
5. Liss, Jerome and Stupiggia, Maurizio (editors), La Terapia Biosistemica, Milan, Ed. Franco Angeli, 1994,- esp. Chapter 4 by Dr. Roberto Giommi, "Mi Abbracci Se Piango? Il Contatto," pp.79-93.
6. Ibid, Chapter 8, "L'Energia Entra in Scena, Lo Psicoteatro Terapeutico," by Dr. Stefano Cristofori, pp.175-191.
7. Jackins, Harvey, The Human Side of Human Beings: The Theory of Reevaluation Counselling, Seattle, Washington, Rational Island Press, 1965.
8. Liss, Jerome, Insieme Per Vincere L'Infelicité, Superare le Crisi con la Collaborazione Reciproca and i Gruppi di Auto-Aiuto, Milan, ed. Franco Angeli, 1996.
9. Brown, Catherine, The Shadow and the Body in Theory and Practice: The Clinical Application of the Theories of C.G. Jung and Malcolm Brown, M.A. Thesis for Antioch University, 1989.
10. Liss, Jerome, "The Self, the Impulse and the Other, Three Models of Psychoanalysis," Energy and Character, (ed: David Boadella) Vol. 23, No. 2, Sept. 1992, pp. 75-85, and Vol. 24, No. 11, April, 1993, pp.21-32.
11. Hartmann, Heinz, Ego Psychology and the Problem of Adaptation, New York, International Universities Press, 1958.
12. Freud, Sigmund, The Ego and the Id, in The Complete Works of Sigmund Freud, Vol. 19, London, Hogarth Press, 1927.
13. Klein, Melanie, Envy and Gratitude (and Other Works), 1946-1963, London, Hogarth Press, 1975.
14. On Object Relations Theory: Fairbairn, W.R., Psychoanalytic Studies of the Personality, London, Tavistock-Routledge Pubs., 1952 (1986). Guntrip, Harry, Schizoid Phenomena, Object Relations and the Self, London, Hogarth Press, 1968. Winnicott, D.W., Maturational Processes and the Facilitating Environment, London, Hogarth Press, 1965.
15. Systems Theory: Bertalanffy, Ludwig, A Systems View of Man, Boulder, Colo., Westview Press, 1981
Gray, William, Duhl, F.D. and Rizzo, N. (editors) General Systems Theory and Psychiatry, Boston, Little, Brown and Co., 1969.
DeRosnay, Joel, Le Macroscope, Ed. Paris, Seuil, 1975.
Morin, Edgar, La Methode: Vol. I, La Naature de la Nature, Vol. II, La Vie de la Vie, Paris, Ed. Seuil, 1977 and 1980.
16. McDougall, Joyce, Theaters of the Mind, New York, Basic Books, 1985. (Originally published as Theatres du Je, Paris, Gallimard, 1982.)
17. Hempel, Carl, op. cit., p. 46.
18. Stern, Daniel, The Interpersonal World of the Child, New York, Basic Books, 1985, especially Chapters 6 and 7.
19. Stupiggia, Maurizio, Chapter II, "L'Empatia," (Empathy), pp.41-63, in La Terapia Corporea (already cited). Because there is no Italian word for "attunement," Dr. Stupiggia has relabeled this concept, "body empathy."
20. Liss, Jerome, "An Epistemological Protocol to Create a Scientific Psychology: The Application of Carl Hempel's Epistemological Program to Daniel Stern's Research," 1999, 39 pages. (submitted for publication, with the recommendation of Prof. Daniel Stern, to Devenir in France and to Human Evolution and Attachment in England).
21. Rossi, Ernest, La Psicobiologia della Guarigione Psicofisica, Rome, Ed. Astrolabio, 1987.
22. See, in regard to how neurophysiological concepts are used to explain pathological conditions, the article, "Dall'Emozione al Cancro, Le Ipotesi Recenti sul Rapport tra Emozioni e Insorgenze Tumorale," ("From Emotion to Cancer, Recent Hypotheses Regarding the Relationship Between Emotions and Tumor Formation," by Jerome Liss, in Riza Psicosomatica, No. 68, October, 1986.
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APPENDIX 24 : Answer to Question 7 by Jerome Liss
Before we discuss "strategies for a new organisation of experience and behavior," we must discuss our "maps" of experience and behavior. Once we understand the terrain outlined by our maps, we can clarify our various strategies.
Maps of Experience
Body Psychotherapy has no qualms to borrow maps and strategies from other psychotherapeutic orientations, and it is hoped that all forms of psychotherapy maintain this openness in regard to alternative orientations. We will focus upon "maps of experience." Psychoanalysis speaks of 'consciousness' and the 'unconscious.'(1) Body Psychotherapy, like psychoanalysis, recognizes the dynamic of "experiences repressed from consciousness" and the need to permit the re-emergence into consciousness of these repressed experiences.
Gestalt Therapy creates a map of experience based upon the central figure, in the focus of consciousness, and upon the peripheral ground, which is in the periphery of experience.(2) (This may have some analogy with the psychoanalytic notion of the 'pre-conscious.') The strategy is to permit relevant peripheral experiences emerge into the foreground of consciousness. This is also a goal within Body Psychotherapy.
A more specific map comes from Neurolinguistic Programming (NLP).(3) In this case the experiential field is comprised of three primary components: visual, auditive and kinesthetic. More specifically, in our inner world we can notice three main dimensions: visual images, auditory (verbal) thoughts and body experiences.
George Downing (4) correctly notices the insufficiency of this map for the Body Psychotherapist and suggest to differentiate still further the kinesthetic body component of experience into four more specific dimensions: position, gesture, sensation and movement.
An experiential map very similar to that of NLP is that presented by Eugene Gendlin in his book, Focusing.(4A) Gendlin defines three primary dimensions of experience: image, word and body sensation. He suggests a method of subtle introspection in which a person first concentrates on the body sensation, then finds an image congruent with this body sensation, and concludes with a word that describes the image. Focusing on all three components at the same time can produce a "shift" of the body sensation, diminishing the negativity of the initial experience and permitting, with repetition of the procedure, an emergence of the positive experiential potential. Not only is the map interesting, but the particular method used to "reintegrate" the three dimensions -- sensation, image and words -- supports the notion that problematic emotions are connected to a splitting among dimensions of inner experience, and this introspective-meditative method encourages their being reunited.
Whatever map is used, the consequence is the same: The therapeutic strategy is to bring into the foreground of experience emotions, thoughts, images and body sensations that are outside of this foreground. So long as these experiences are not conscious, they are not integrated within the personality, and therefore the personality is 'limited,' 'divided,' 'fragmented,' or 'driven by unconscious forces' and therefore 'out of control.' The psychoanalysts claim that this work is to help 'the return of the repressed.' The Gestalt Therapists claim that this work to "to make experience complete." Whatever dynamic is hypothesized, the goal is to help the personality become more complete and integrated. It is also assumed that negative, destructive, uncontrolled and unadaptive behavior (including depressive immobility) will emerge spontaneously when the unconscious and non-conscious forces are brought into the light of consciousness.
Non-Conscious Physiological Processes that Underlie Emotions
Body Psychotherapy uses these maps and adds another essential point, specific to this orientation: There are "non-conscious" physiological processes that underlie our emotional difficulties and these physiological processes must be transformed at the same time that our emotions and cognitive processes undergo positive transformation. Such "non-conscious" processes are not equal to the Freudian unconscious because they cannot become conscious. More specifically, the dynamics of the limbic system, considered "the emotional brain" by Paul MacLean,(5) and all brain processes below this subcortical level -- the hypothalamus (for sympathetic-parasympathetic control and immunological functions), the basal ganglia (for motor action), the pons and medulla (vitality centers for breath and blood circulation), the vagus nerve (for input of visceral organ stimulation), the cerebellum (for motor coordination) -- are all brain centers that participate in our experiential and behavioral life, but their functioning is not supported by the structural complexity that is characteristic of the cerebral cortex, and therefore, their functions cannot enter the ordinary realms of consciousness. Nevertheless, the psychological work of Body Psychotherapy must influence these non-conscious physiological centers in order to succeed in transforming the non-healthy or suffering person toward his or her positive potential.
But it is not only the brain that contains our non-conscious physiological functions. The entire somatic body also is involved. Some aspects of the somatic body can enter consciousness: visual-auditory-olfatory sensory organs, skin sensations, muscle proprioception, etc. But "lower levels" of somatic functioning can never really find access to consciousness: vasoconstriction, glandular secretions, digestive processes such as peristalsis, hormonal levels, etc. Of equal importance, intracellular processes that have great effect upon total organismic functioning are always outside of the realm of consciousness and will always remains so: protein production in the ribosomes, mitochondria functions with the production of adenosine triphosphate, lisosome functions, and so on.
Organic medicine is cognisant of these non-conscious physiological processes. Accordingly, the administration of bonzodiazepines is given in order to influence limbic system functioning, probably at the level of the hippocampus. The use of mono-amine oxidase anti-depressives is to influence intracellular re-uptake of neuroepinephrine at the cellular synapse.
Body Psychotherapy proposes, therefore, an "organically-rooted" therapy which influences non-conscious body processes that are outside of the realms of consciousness. For example, consciously controlled actions such increasing the respiration, creating intensified arm and leg gestural expressions, receiving firm holding contact, and so on, represent the top conscious layer of psychophysical processes that penetrate into the domain of the physiological unconscious. Verbally-based psychotherapies can claim that their particular use of language - free association, dream analysis, direct talk - can also penetrate into the non-conscious physiological terrain. Nevertheless, the Body Psychotherapy approach, by using specific body methods in conjunction with language, gives a greater guarantee that such non-conscious physiological processes will be mobilised and transformed in correspondence with the conscious psychological processes.
Maps Come from Methods
Thus, the "map" of Body Psychotherapy, while integrating maps from other approaches, adds additional maps relevant to its methodology. (We must note the epistemological relationship between method and map: If a psychoanalysis relies upon verbal language, his map of conscious and non-conscious experience will focus upon domains influenced by his tool. Thus, for example, the Lacanian School of psychoanalysis brings the notion of language to its limit, suggesting that "the unconscious is structured like a language." Psychodrama suggests, in its map, that there exists "a hunger for action," and expressive action is, indeed, one of its chief therapeutic tools. Thus, Body Psychotherapy will call upon physiological maps that other schools will not find pertinent because the methodological tools of Body Psychotherapy includes modalities that can directly influence these non-conscious physiological processes.)
The Triune Brain
One psychophysiological map of great importance is called "the Triune Brain." Paul MacLean(6) proposes that we can better understand the complexity and contradictions of human behavior by returning to the evolutionary origins of the brain: The lowest brain levels, which he calls the "reptilian brain," consist of the brain stem, the pons and the inferior mesencephalon. It is in these areas that our vital functions of breath, blood circulation and automatic behavior are determined. The next level is called the "mammalian brain," which means the diencephalon, and it is here that the limbic system (also called the "emotional brain", and originally described as a circular circuit in 1935 by Papez) is located, determining our emotions of rage, fear, anxiety, fight-and-flight behavior, inhibition of action (H. Laborit) and our relationships of attachment and caring. The highest level, the neo-cortex, is the "human brain," and this is what characterizes man with his capacity for symbolic functions, speech, mathematical calculation, future projection, and so on.
By understooding these separate brain levels, we can hypothesize how splitting and contradiction of functions can lead to emotional turmoil and disruptive behavior.(7) For example, the separation between cortical and limbic functions can explain how our conscious and rational thoughts lead us in one direction while our emotional disposition leads us into an opposite direction. Another example: By understanding that our vital functions of breath and blood circulation are determined by the lower reptilian brain, we can better understand how conscious thoughts related to higher cortical functions bear little influence upon these vital functions, and this can lead to the depressive position.
The therapeutic implication is clear: The Body Psychotherapist seeks to "mobilise", "dynamise" or "involve" lower brain functions in order to integrate symbolic and verbal thought (neo-cortex), emotions (limbic system) and vital functions (brain stem). The specific methods of body mobilisation -- deeper breathing, intensified gestural expression, firm holding or other vigorous touch methods -- are justified according to the MacLean model of the Triune Brain.
The Organic Word
A specific example of how language functions and body mobilisation can be integrated is described in the article, "Key Words for Unlocking the Unconscious."(8) This article suggests that the Body Psychotherapist can sometimes ask the patient to repeat Key Words and Key Phrases with an upward spiralling intensity until the whole body is vigorously involved in the Key Word expression. This particular body method (or strategy) is called, metaphorically, "jumping the rock." This metaphor is used because in this article the psychotherapeutic process is considered analogous to a person crossing a river by stepping from rock to rock.
"Jumping on the Rock"
"Jumping on the Rock" means intensifying the emotional work by merely repeating the Key Word or key phrase. "I feel stuck!" Therapist and Patient (together): "Stuck! Stuck! Stuck!" Said with increasing loudness.
An even more incisive "directional question" offered by the therapist is the phrase, "Can you show it with your whole body?" The tone of the phrase is as important as its content, as is the case for all directional indications that seek to make Key Words and phrases shiver and vibrate in their fresh, red-blooded vitality, or else in their delicateness and vulnerability.(p.85)
Let us see how this particular strategy of "making the word organic" is supported by reference to Paul MacLean's neurological map of the Triune Brain.
Some Neurological Considerations:
Language processes are most clearly related to neurological functions around Broca's area in the cerebral cortex, as numerous studies have verified for more than a century.(9) But we know that a neurological center does not "contain" all aspects of a function like a car that contains all parts of its engine under the hood. The brain is a vast network and its genius comes from the vast interrelationship among all its parts.
This "network" model of the brain permits us to speculate as to how Key Words and phrases reveal a special emotional charge. And our hypothesis? That the Key Word, related to Broca area functioning, has important but dormant connections with brain areas especially concerned with emotion: the hippocampus and the amygdala, two important sub-cortical centers that constitute a part of the limbic system, also known as the "emotional brain." The hippocampus, which is the site of benzodiazepine action (which is a tranquillizer that acts against anxiety) is also intimately connected to the temporal lobe, the important "memory storage" sector of the brain. But connections between the higher up cortical Broca's area and the lower down hippocampus-temporal lobe region are not of high density. Neuronal messages between these two areas must pass through the entorhinal cortex and the cingular gyrus, two subcortical structures that function as a filter. Therefore, a language pattern can have some relationship to an emotional state, but the two functions are not always intimately related.
Therefore, how can we enhance the connection between the cortical Broca language area and the sub-cortical limbic system emotions?
From clinical experience, we find that repeating Key Words and phrases, increasing the sound intensity, permitting different "emotionally expressive" intonations of the sound, and adding to this our full body power using our arms, legs, trunk and facial expressions, all seem to "wake up" the dormant connections between emotion and language. We can imagine that these integrated body-vocal expressions, repeated and intensified, awaken a great number of brain neurons and also their somatic connections (muscular, visceral, hormonal, etc.), profiting thereby from a somatic "recharging" feedback to the discharging brain neurons. Thus, our work stirs up countless central-brain / periphral-somatic circuits firing together in positive feedback loops. Perhaps more can be said about which neural pathways and centers constitute these particular feedback loops. But for our purposes, it is sufficient to imagine a general schema of the brain functioning at a multiplicity of levels: the conscious cortex, the emotional centers of the limbic system, and the lower vitality centers, to follow Paul MacLean's scheme of the Three-Level Brain.(10) The Key Word repetition and verbal associations awaken cortical association areas,(11) while the "whole body intensification" awakens lower brain vitality centers. Thus, the emotional brain limbic system receives cortical inputs from above and vitality center inputs from below,(12) all of which catalyzes limbic-based emotional intensification and transformation. (p.88)
From the Exploration of the Problem to the Creation of the Solution:
Up to this point, we have shown how certain experiential maps are common to several psychotherapeutic orientations, thereby justifying certain verbal-emotional strategies, while other psycho-physical experiential maps (especially the MacLean Triune Brain model) justify strategies that are specific to Body Psychotherapy.
One final map used by some Body Psychotherapists is based on the following consideration: Freud suggested that psychoanalysis is somewhat like a sculpture chipping away at a rock until the hidden form becomes revealed. This means that the process of uncovering the unconscious (revealing the hidden form) is sufficient for releasing inhibited and pent-up behaviors that are more adequate and functional than the neurotic behaviors that were previously driven by unconscious forces. Many Body Psychotherapists adhere to this hypothesis.
On the other hand, if we put into doubt this "spontaneous emergence" of adequate behavior due to the uncovering of unconscious forces, we can ask ourselves, "How can we guarantee, or at least make more highly favorable, the emergence of positive behaviors, attitudes and perspectives after the unconscious forces of denied emotions -- fear, anger, humiliation, retaliation, sexual need, etc. -- are brought to light?"
What can justify this doubt? First, there is a frequently quoted phrase regarding people's disappointment with psychotherapy: "Now I understand my problems. But nothing has changed." Thus, the exploration and understanding of our problems does not automatically mean that we have found the emotional and behavioral solution.
When an emotional problem is acute and recent, such as an acute depressive reaction, or a newly emergent anxiety reaction, or a traumatic neurosis due to a specific and recent event, we can then imagine that the work of resolving the negative emotion can release positive forces of emotion, positive perspective and adaptive behavior that were already present. But many patients that we see today have problems that began in infancy and that interfered with developmental processes throughout their life, for example, deep characterological problems, so-called borderline patients, chronically depressed or chronically acting-out patients, and so on. In such situations, the positive potential of loving feelings, affirmative and positive communication, the capacity to create initiatives in social settings, and the capacity to use free time in a creative way, were never developed. Therefore, the resolving of anguish, depression and chronic anger is not sufficient for permitting the emergence of these new behavioral, cognitive and emotional potentials. That means "another step" is needed in the psychotherapeutic process, and this second step may be called, "Solution Work." This concept and method is described in the article, "From Problem to Solution: Guiding Emotional Work with Deepening Followed by Construction."(18)
One origin of the concept of "Solution Work" comes from the work of Franz Alexander and the notion of "the emotional corrective experience."(19) This means that the patient also needs to go through some kind of positive emotional experience in order to overcome the negative experiences of the past. Another origin of the concept of "Solution Work" comes from Albert Pesso's proposal of "positive re-parenting."(20) After the emotional work of confronting the negative parental figures, the patient is asked to choose group members who represent "positive parents" and then receives the words, holding and other parental gestures that were missing in his experience of chronic infantile privation.
The upshot of this analysis is a significant change of therapeutic strategy. From psychotherapy seen as the elaboration and emergence of repressed and traumatic emotional experiences, we now have psychotherapy as a "two-step" strategy: l) Explore (and, when necessary, allow to deepen) the feelings of distress -- rage, hurt, fear, pain, shame, etc. -- until there is real relief, and then 2) create "solutions" or "constructions" where by the patient's positive forces become liberated.
Live Out the Concrete Solution During the Therapeutic Session
And how does Solution Work actually occur? The goal is to make the positive intention a specific, conrete action. That is called "the next step." Solution work requires a constant effort to make concrete the "next step" proposal: What, exactly how, in what way, when, with whom? And to be absolutely concrete: "Can you imagine it step by step?" Or else: "Can we do it here together?" (This becomes a mime or a psychodrama.) The therapist might note down this "next step" positive action in his notebook in order to remember to ask the patient during the following session - if the patient is agreed to this approach - (though not necessarily at the beginning of the following session), whether the positive step had been taken and what was the outcome and, were the step not taken, what was the feeling evoked.
Solution work is usually introduced by the therapist first asking permission to introduce this phase of work. This is important because if the patient feels that the exploration and elaboration of difficult emotions is not finished, in other words, that the experience of "relief" of emotional distress has not yet been reached, then the Solution Work is premature.
"Now that you are feeling better, is it the moment to consider the changes you would like to make in your daily life?" In general, the question is formulated in a more specific way and tied down to the theme of the preceding work. For example, "Recognizing this rage at the constant disattention and neglect of your parents, is it possible now to think about how you receive attention and caring, and give it as well, in your life with your present family?" Or, for example, if the problem we are facing has been a feeling of depression linked to a constant sense of failure, with memories of inconclusive starts and unhappy endings reinforcing the negative spiral, the question might be, "Where can we start to build patterns of success in your present life? What is the smallest step possible that you can imagine for creating a new action that you won't sabotage and that would fulfill your inner promise?" The work here is to create daily life patterns where an inner promise is acted upon with success rather than renounced at the last minute as "too difficult" and thereby reinforcing the tendancy toward self-sabotage.(pp.42-43)
In summary, Freud's behavioral-emotional map proposed that the psychotherapist removes the blocks of repressed, disowned emotions and this releases the patient's potential to carry out new and adaptive behavioral-emotional capacities. Many therapists of all schools adhere to this map and therapeutic strategy.
An alternative strategy that is here proposed is that a second phase of psychotherapeutic work, called Solution Work, is needed: Solution Work prepares the patient to realize concrete acts in reality by actually practicing such concrete acts (psychodrama or mime), or else by imagining the "next step" actions with such concreteness that the new potential is actually re-lived during the psychotherapeutic session.
1. Freud, Sigmund, Inhibition, Symptoms and Anxiety, (1924) from The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XX, London, Hogarth Press.
2. Perls, F., Hefferline, R. and Goodman, P., Gestalt Therapy: Excitement and Growth in the Human Personality, New York, Julian Press, 1969.
3. Bandler, Richard and Grinder, John, Frogs Into Princes, Neurolinguistic Programming, Moab, Utah, Real People Press, 1979.
4. Downing, George, The Word and the Body, published in German, Italian and Swedish: Korper und Wort in Psychotherapie, Ed. Kosel; Il Corpo e la Parola, Ed. Astrolabio; Kroppen och Ordet, Ed. Natur och Kultur.
4A. Gendlin, Eugene, Focusing, New York, Everest House, 1978.
5. MacLean, Paul, "Una Mente Formata da Tre Menti: L'Educazione del Cervello Tripartito," in Oliverio, Alberto (a cura di): Cervello e Comportamento, Rome, Newton Compton, 1981.
6. MacLean Paul, A Triune Concept of the Brain and Behavior, Toronto, Toronto University Press, 1973.
7. Liss, Jerome, "Il Cervello Tripartito nella Medicina, nel Mito e nella Fenomenologia," in Il Corpo in Psicoterapia, (Atti del XVI Congresso Congiunto CISSPAT-ICSAT, a cura di Luigi Peresson, Ed. CISSPAT, 1991, PP. 73-86.)
8. Liss, Jerome, "Key Words for Unlocking Our Unconscious," in Energy and Character, (editor: David Boadella) Vol. 29, No. 2, Dec., 1998, pp. 79-93.
9. MacLean, Paul, "Psychosomatic Disease and the Visceral Brain, Recent Developments Bearing on the Papez Theory of Emotions," Psychosomatic Medicine, 1948, Vol. 11, pp. 338-353.
16. For an exposition of how stress disrupts cortical association functions, and how the resumption of cortical association area interaction can help return the person to a state of equilibrium, see the interesting research based on EEG studies by Quarti, C. and Renaud, J., Neurophysiologie de la Douleur, Paris, Hermann, 1972.
17. Visceral inputs reach the limbic system by a tortuous route: Starting with the vagus nerve, the visceral sensory input enters the brain at the level of the Solitary Nucleus, then climbs up the pons through a series of short fibers to reach the trigeminal region and central gray matter, and from there the message is relayed further upward to the limbic system. This once again indicates "indirect connections" that need to be reinforced, such as by Key Word repetition and intensification, in order to integrate visceral emotional input with emotional experience. See Nauta, Walle, "The Central Visceromotor System: A General Survey," (pp. 21-39) in Hockman, Charles H. (Editor), Limbic system Mechanisms and Autonomic Functions, Springfield, Ill., Charles C. Thomas Pub., 1972.
18. Liss, Jerome, "From Problem to Solution: Guiding Emotional Work with Deepening Followed by Construction," in Energy and Character, (editor: David Boadella) Vol. 29, No. 11, June, 1998, pp.40-46.
19. Alexander, Franz, Psychosomatic Medicine, New York, W.W. Norton Pub., 1950)
20. Albert Pesso, "The Effects of Pre- and Peri-Natal Trauma," Energy and Character, Vol. 22, No. 1, April, 1991.
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APPENDIX 25 : Focusing on the Non-Verbal Expression by Jerome Liss
While the psychoanalysts, Sigmund Freud and Ferenczi, both showed an awareness, in certain periods, of the bodily dimensions of emotional repression and the return to consciousness of repressed emotions, it was Wilhelm Reich who paved the way for the specific focus on the body as both a means of diagnosis and Psychotherap eutic treatment. In the following example we can notice how Reich described the physical expression (or non-verbal behavior) that underlay the emotional difficulties of the patient:
The general impression the patient made was characterized by his uncertain movements: he walked with a forced stride so that his gait was somewhat clumsy. His posture was not erect but expressed submissiveness, as if he were being constantly on guard. His facial expression was empty and meant nothing in particular. The skin of his face was somewhat shiny, drawn taut, and looked like a mask. His forehead looked 'flat.' His mouth was small, tight and hardly moved when he spoke; his lips were thin as if pressed together. The eyes were expressionless.(1)
The Body Psychotherapist does not have a monopoly within the domain of non-verbal behavior. Almost all Psychotherapist, whatever the orientation, will look at the patient in order to decipher the patient's underlying emotional state. Thus the organic psychiatrist who gives anti-depressive medicine will notice whether the patient's facial expression shows a fixed frown with down-cast eyes and retarded expressive movements. The far-away stare of the schizophrenic patient is universally recognized, as is the inappropriate smile of the hebephrenic patient or the muscular immobility of the catatonic patient.
On the other hand, the Body Psychotherapist is in a privileged position. His focus upon the bodily dynamics of emotional experience brings him to observe, with greater precision and constancy, the various non-verbal manifestations of emotions and their transitions. The following is a description of the non-verbal aspects of emotions that are frequently seen during the emotional intensification phase of Body Psychotherapy:
And the significance of these physical manifestaions? These are clinical signs that support the idea that the patient is undergoing a profound emotion. These are not manifestations that can be brought on intentionally through the voluntary muscular system. Rather, they are manifestations of deep emotions that appear when the client feels trust in the Psychotherapist and can "let himself go" without the inhibition of fear or shame.(2A) Such observations also bring up new questions which have not yet been resolved:
An important question which the Body Psychotherapist can pose to the experimental physiologist: How can we account for these important manifestations of emotional expression: shaking, trembling, clonic movements? What actually happens during the process of crying? What produces the emotional release and subsequent calm? And how can we understand the sensations of vibration and warmth?(3)
Focusing on the Verbal Process
Let us now turn to the question of verbalisation in Body Psychotherapy. Just as there are great variations in body-oriented techniques among Body Psychotherapist, there is also a great variation in the way language is used. For example, some Body Psychotherapist divide the verbalisation period from the emotionally-oriented body work while other Psychotherapist work simultaneously on both levels. In both cases, nevertheless, there is a respect for the power of language and, at the same time, an awareness that language can be abused: intellectualisation, rationalisation, skirting around a theme, meandering, and so on. Here is what David Boadella says:
On Embodied Language
Words can fool us, deform our experience, even lie, and yet we need language in order to arrive at the solution of our problems. Many people search for a refuge in the body or search for a truth that they cannot find with simple words. But the body without the significance of language can easily become just another object. While there is the danger of the "verbal defense" in psychoanalysis and in verbal Psychotherapy, when the words are too far removed from the body, there is likewise the danger, in a type of Body Psychotherapy that has not integrated verbal language into the emotional work, for the emergence of the "body defense."(4)
Therefore, one of the goals of Body Psychotherapy is to search for a new form of language which is "embodied," that is, in which the physical processes that underlie the emotional experience enter into the voice intonation and spoken words of the patient. We might call such embodied language "organic language," meaning that organic processes of the body are integrated with the verbal expression. This often means to integrate breathing with verbal expression, but it can also inspire Body Psychotherapist to use a mixture of direct contact on the thorax along with intensified non-verbal expression involving the arms, legs, face and body position, since such ancillary movements often accompany verbal expression on a spontaneous basis. The goal, in summary, is to overcome the process of splitting, called intellectualized verbal expression, and create the conditions for embodied emotional expression.
On Verbal Content
In regard to the question of verbal content, that is, what words are actually said, the interventions of many Body Psychotherapist are similar to those of verbal Psychotherapist: "What comes to mind?"-(free association) "What is the feeling that comes up?"-(orientation toward emotion) "Does this remind you of any other situations?"-(memory evocation) And so on.
Another specific intervention that alters the patient's specific language is one that is frequently used by Gestalt Psychotherapists, Psychodramatists, Transactional Analysts and other Psychotherapists with diverse orientations: Direct talk! Thus, when the patient refers his emotion to a particular figure -- example, "I felt afraid of my father!,"- the psychotherapist can suggest 'direct talk.' Psychotherapist: "Is it possible to say that phrase, 'I'm afraid of you, Father,' as if your father was right here in front of you?" Such 'direct talk' seems to have an effect of mobilizing the feelings that occurred in the original event and therefore helps that part of the Psychotherap eutic process that is searching to explore feelings that have been suppressed. The Body Psychotherapist might add, "Can you say that phrase with your whole body?", or, "Can you intensify that shaking of both arms while you say that phrase?" These interventions and countless others help the patient live his language with deeper integration of his physical and emotional body.
It is important to understand that such Body Psychotherapy interventions cannot be judged "right" or "wrong." "Right" or "wrong" is only applicable when we are in extreme circumstances and an action can become damaging. Our criterion for evaluation for these interventions and all others is made according to the model, "advantages" and "disadvantages." For example, the above Body Psychotherapy interventions have an advantage of intensifying the body components, and sometimes even the emotional currents, that underlie verbal language. But the disadvantage is that the Psychotherapist has interrupted the patient's autonomy in the free association process. On the other hand, if the patient's autonomy in free association is strictly observed, a disembodied form of intellectualized language can predominate and so the patient may fail to contact the buried feelings which the psychotherapeutic work is seeking to unearth.
The point of this reflection is to overcome "right-wrong" evaluations which lead to competition and misunderstandings among psychotherapeutic orientations, and to appreciate, instead, that every orientation has some advantages over others, because of its specificity, and, at the same time, some disadvantages in regard to other orientations, once again, because of that same specificity.
Words That Come from the Body:
Certain words and phrases of our normal vocabulary come from the body. "What does my 'heart' tell me," means "What is my true feeling?" While all Psychotherapists can use this poetry of mind-body verbal expression, the Body Psychotherapist will become especially competent in this domain, given that such poetic language creates a two-way bridge which both increases the psychological significance of body parts and, at the same time, gives "flesh and bones" to verbal statements.
Here is a series of examples of "poetic language that comes from the body":
Thus the power of our language becomes intensified, more dramatic, sometimes even poetic, when we use "body words" as metaphors in our ordinary speech.
Although the above phrases are in English, each language has particular phrases which demonstrate this poetic quality. In Italian, for example, there is a phrase, "Tu puoi spallaggiarmi?" 'Spallaggiare' comes from "spalle," that is, shoulders. Literally, this means, "Can you 'shoulder' me?" The significance is, "Can you support me?" Such embodied language is an effective tool for communication, whether used by the Psychotherapist or the patient. There are many such examples in every language. Body language is universally used.
The Identification Method
Another alteration from normal language that is used by some Body Psychotherapists (though the method is not exclusive to Body Psychotherapy) is called "the identification method." In this method, the psychotherapist offers his idea by saying it from the patient's point of view. Here are two examples:
Of course there are other aspects of this technique that are too detailed to explain fully here: ask permission; check if the identification if correct; ask for modifications or repetitions, etc. The point is that verbal language in Body Psychotherapy, as in other psychotherapeutic orientations, can be changed. In this case the goal is for the patient to feel more acutely the psychotherapist's empathy and for the psychotherapist's words to be integrated immediately within the patient's exploration of his feeling impulses.
Key Words for Unlocking the Unconscious
All psychotherapists develop a special sensitivity, especially over time, to specific elements of their patient's language: metaphors, interjections, imagery, etc. In the Body Psychotherapy orientation, the specific words that carry the greatest feeling charge, on the part of the patient, are called "the key words."
What is the "Key Word"?
The Key Word or key phrase means the "hot" word or "hot" phrase. They are coloured red, for passion, or black, for despair, or white and yellow for hope and radiance, or orange for the taste of sweet oranges. Technically, the Key Word and key phrase refer to those special words embedded within the patient's verbal communications that carry a special emotional charge and that reveal an important aspect of the patient's experience. Everytime we hear a key word, we can (effectively) see lights blinking, vibrations shimmering and flesh needing to tremble: emotion, charge, impulse and force! Or else we see the flower petals of vulnerability. Some examples:
Which Key Word will the Psychotherapist pick up? Clinical intuition and experience will lead the clinician to a very rapid decision: Lonely if he wants to favor, for the moment, the deepening of vulnerable and hurt feelings, Not a damned word! if he senses it is preferable, at that moment, to deepen and elaborate the sympathetic anger.(1) Whatever the decision, it is often the Key Word that will unlatch the lock.
One last point: Not everyone will agree, in a particular case, as to which word (or phrase, or part of the phrase) represents the Key Word. But that is fine. We can never know for sure the inner life of our patient, or client, or, for that matter, of anyone, aside from oneself, as R.D. Laing so poignantly points out in The Politics of Experience.(6) So we must acknowledge that every intuition we make, when attempting to select from the patient's total statement the most pungent Key Words, remains, epistemologically speaking, a hypothesis, not a truth.(7)
Once the psychotherapist is aware of the "key word," (and most psychotherapists are aware of this factor on an intuitive basis), s/he can use it in several ways: 1. Just make a mental note of its presence. 2. Repeat the key word, with or without "directional words." (Example: "In what situation does that 'panic' (key word) especially come up?"). 3. Ask the client to repeat the key word or phrase to explore and/or deepen its emotional impact. All these are interventions possible for a psychotherapist of any orientation.
The Body Psychotherapist can also explore the present and potential body components of the Key Word (or Key Phrase). Present body component: What do you feel in your body as you say, 'panic'?" Potential body component: "Can you create an expression with your whole body that expresses that feeling of 'panic'?"
The point of delineating these alternative interventions around the "Key Word" (or Key Phrase) is to highlight the fact that Body Psychotherapy, which has a specificity in comparison to other psychotherapeutic orientations, by mobilizing expressive body forces and using, at times, body contact, does not neglect the domain of "verbal intervention", but rather, like all psychotherapies, respects the importance of language. The psychotherapist, therefore, searches ways to develop an interpersonal verbal language that can transmit the psychotherapist's intuitive empathy while encouraging the patient to explore, with minimal interference, his inner world.
1. Reich, Wilhelm, Character Analysis, New York, Farrar, Straus & Giroux Pubs., 1949, p. 299
2. Liss, Jerome, "The Systems Model Applied to Bioenergetic Psychotherapy, Psychology and Psychosomatic Medicine," in Energy and Character, Vol 13, No. 2, August, 1982, pp.12-28, and Vol.14, No.1, April, 1983, pp.18-36
2A. Ibid, p. 18.
3. Ibid, p.19.
4. Boadella, David, in Chapter 11, "Energy and Language," in La Psicoterapia del Corpo, (by Boadella, D. and Liss, J.), Rome, ed. Astrolabio, 1986, p.156.
5. Liss, Jerome, "The Identification Method: An Innovation in Psychotherapeutic Language that Favors the Growing Impulse and Diminishes Interpersonal Defensiveness," in Energy and Character, (Editor: David Boadell) Vol. 27, No. 2, October, 1996, p. 47.
6. Laing, R.D., The Politics of Experience, London, Penguin Books, 1969.
7. Op. cit., p. 47.
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APPENDIX 26 : Emotions and the Body by Jerome Liss
Body Psychotherapy uses a series of methods that directly influence body processes. But before describing these specific methods and their rationale, it must be noted that this is a form of "psychotherapy," and therefore the diverse types of psychological intervention that characterize other psychotherapeutic approaches are also integrated in the Body Psychotherapy modalities. In consequence, Body Psychotherapy integrates the use of language, fantasies, mental free association, exploration of dreams, reevaluation of cognitive perspectives, retrieval of traumatic memories, etc. Relationship issues of trust, personal openness and reciprocal respect are brought to light. Self issues of self-esteem and self-acceptance, independence and inter-dependence, self respect and security, are another issue for psychological exploration.
The specific contribution of Body Psychotherapy is, first, to understand the various conscious and non-conscious body processes that can underly all these psychological dimensions and, second, profiting from this understanding, include direct body interventions, along with other types of psychological work, that can catalyze the psychological changes that represent the psychotherapeutic goal.
There is overwhelming evidence that biological processes influence all psychological functions. The fact that tranquillizing drugs can calm disturbing emotions, that psychedelic drugs can distort perception and cognitive processes, that physical disturbances like viral infections, intoxication, or prolonged exposure to cold can also disturb cognitive and emotional states, that normal variations of physical states, such as menstrual periods, intense fatigue, or drinking two glasses of wine can influence, for better or for worse, the psychological disposition of the person, all support the causal relationship between physiological processes and the consequential impact on emotional-cognitive-behavioral psychological states.
But our epistemological grounding must be clear: The causal chain is NOT unilateral. Systems theory has shown us to be wary, when dealing with any complex organic system, and especially, when dealing with the most complex organic system -- the psychological/physiological human system -- to avoid the simplification of unilateral causality. In other words, as much as physiological processes can influence psychological states, so psychological dynamics - thoughts, emotions, fantasies, behaviors - can influence, in their turn, physiological processes.
Therefore, Body Psychotherapy is NOT gymnastics, massage, respiration exercises, or any other specific body modality which seeks to influence, in a unilateral mode, the person's psycho-physical well-being. Body Psychotherapy keeps alive the mind-body interaction! Therefore, physically-based interventions (which we will describe in a moment) are studied for their direct cognitive-emotional (psychological) impact, while psychological interventions are brought into play, simulataneous with or in alternance with the physiological interventions; thus we have TWO input modaliaties for Body Psychotherapy, the physical and the psychological. To forget this essential point is to neglect the essential contribution of Body Psychotherapy, since the modality of intervention is both body and mind. The consequence of these interventions is to influence body and mind in their partially autonomous and partially integrated functioning.
Mind and Body, A Systems Interaction
How is it possibile, from a logical point of view, to postulate both autonomous and integrated functionings? Systems Theory(1) teaches us that we can have, within complex systems, "semi-automous sub-systems in interaction." This means that we can have sub-systems that are both partially autonomous and partially interdependent. Here are several examples of such physiological sub-systems: hormonal, respiratory, circulatory, muscle tone, muscle action, digestive, immunological, etc. And now for examples of psychological sub-systems: visual and auditory perception, touch and proprioceptive perception, cognitive-verbal, fantasy-imaginitive, memory retrieval, future projection, emotional, intuitive, etc. The meaning of this double dynamic - partially autonomous and partially independent - is that such sub-systems must be cultivated and encouraged to grow, on the one hand, as specific functions (with specific dominant brain areas underlying their functioning) and, on the other hand, as systems interactive with other psychological and physiological subsystems in order to overcome the "splitting of functions" and encourage the emergence of the integrated personality.
In practical terms this means that the Body Psychotherapist, while bringing into play various body modalities, remains attuned to the psychological realm: What are you feeling? What is the thought that comes to mind? Is there a specific image now? Does this connect to a memory? Does someone come to mind? In what situation? What do you feel like expressing? Is there now a desire to do something? What is the wish? These are just some of the psychological questions that the therapist verbalizes or silently asks himself, while in the midst of a body-focused intervention.
There are various ways of categorizing the Body Psychotherapist's body interventions. The following is just one scheme:
1. What are you conscious of in your body? (awareness)
2. Can you touch that particular part of your body? (touch)
3. Can you make a movement or expression that uses that body part? (expression)
Thus, awareness, touch and expression are the main modalities of body intervention. Each of these modalities may vary in intensity: soft, moderate and intense. Thus, various schools of Body Psychotherapy, while using a complex series of body modalities, will sometimes focus on one or another, with the intensity varying as well. As an example, Biodynamic Psychology (the Boyesen method) has developed specific soft touch methods which are then monitored by the therapist listening to the patient's peristalitic movements with a stethescope. (Blocked peristalsis is linked to emotional repression. The renewal of peristaltic movements means that somatic-emotional processes are becoming unblocked.) At the other end of the scale, the Bioenergetic Analysis method (Alexander Lowen) as well as the Biosystemic Therapy method (Jerome Liss) favor intensified expressions that can, at times, spiral upwards into emotional explosions.
But no school maintains a rigid position. Therefore, even when a Body Psychotherapy school is more known for a single approach, the reality is that almost all schools remain "open" and permit students to explore a panorama of body interventions. In this way the student, once he becomes a Body Psychotherapist, usually shows a predeliction for forms of body psychotherapeutic work that are concordant with his personality rather than just copying the models offered by the school.
The point is that any body intervention, even the most minimal, can have consequences that influence the psychological level of exploration. Examples: "As you tap your fore-finger on your knee, can you recount what comes to mind?" (physical micro-movment, psychological free association) "You just made a sigh with your breathing. If you can make the same sigh, perhaps a certain attitude comes to mind." (repetition of a specific type of breath, what attitude does it express) "You just raised your shoulders when you said, 'I don't know.' If you keep your shoulders raised, does a certain feeling come up?" (micro-expression, feeling)
Here is a citation on respiratory techniques offered by Dr. George Downing:
A client might be instructed to breathe for three or four minutes using a certain particular breath-movement in his abdomen. And then for a few minutes using another particular breath-movement in his chest. In a more elaborate version there might even be several minutes where he alternates between the two movements, switching from the one to the other with each new breath cycle. The patient will soon discover his respiratory pattern re-structured, temporarily, in some interesting way. His lower ribs, to take just one example, might be delicatelty fanning out with more movement and with a new sensitivity along the sides of the torso.
Where is the breath more constricted, where more free? What is its tempo, its volume, its co-ordination (abdominal movement integrated with chest movement), its degree of fluidity (jerkiness vs. smoothness), its degree of differentiation (fine movement vs. wooden movement)? What takes place during the transition from inhalation to exhalation? What during the transition from exhalation to inhalation?(2)
In these citations we have examples of how the Body Psychotherapist looks carefully and intervenes with subtlety. In fact, Dr. Downing develops our consciousness of "What are we doing?" when he presents the difference between "external" interventions and "internal" interventions. "External" interventions are when we introduce a new stimulus: asking the client to breath, encouraging movement, suggesting a change of physical position, etc. Example: "There's that clenching of your teeth again, can you feel it?... Could you try clenching them the tiniest bit tighter, and see what you experience while you do that?" Dr. Downing's section on "microexpression" helps us understand how minimal, and yet important, our active interventions can become. For example, the therapist can encourage a "microexpression" by asking the patient who is feeling anger to show the feeling through a) the movement of a shaking fist, or b) (still smaller) the hand creating the fist and or c) (still smaller) to imagine the hand creating the fist. .Schumacher's dictum, "Smaller is better," need not be a rigid rule, but it is clear that the psychotherapist's use of a "minimal" intervention helps the patient encounter psychological material that he can more easily assimilate and, at the same time, shows greater respect for the patient's autonomous capacities.
And "internal" interventions? We can thank the Gestalt tradition, which Dr. Downing includes within his therapeutic background, for helping us focus on "the here and now" without introducing any new factor. But WHICH here and now? Dr. Downing helps us become attentive to the slightest changes in our wording and the significant consequences derived from each formulation. "What comes to mind?" is different from "What is the thought?," and this is different from "What is the feeling?", and still different are: "What is the image?" and "What is that sensation saying?" In other words slightly different questions encourage attention to different experiential fields, and the art of therapy is to intuit which field is most ripe for harvesting as well as which field must be cultivated for producing its fruit at a later time.(3) These examples are meant to show how physical and psychological exploration are integrated in Body Psychotherapy.
Understanding the Body in Emotions
What does this mean for "the theory of psychotherapy"? Most approaches claim that psychotherapy is a means for the person to discover his whole personality. It is assumed that a change in a single part of the personality - the unravelling of unconscious processes understood by "insight" (psychoanalysis), the re-evaluation of perspective (cognitive), the canalisation of impulses into appropriate action (behavior), etc. - will inevitably exert an impact on the ever-present body. That is true. But the specific modality of Body Psychotherapy focuses upon those dimensions of the body that are repressed, inhibited, de-vitalized or chaotic, in order to ascertain that the development of the "whole personality" does not neglect the bodily dimension. Is this a "new" understanding of human nature, or is it the unearthing of a very old understanding of human nature that is found, for example, in such eternal dictums like, "Healthy body, healthy mind!" Perhaps what is "new", for our particular civilisation, is that bodily signs of emotions - trembling, shaking, tearfulness, vibrations, sudden movements and so on - are not regarded as signs of emotional pathology, but the very opposite! A 12-year old girl was given tranquillizing medicine because she cried everyday in the classroom. (Her parents were recently divorced.) But her crying was an essential part of the emotional repair work necessary to overcome the grief of her parents' separation. So is this actually "new understanding" of how the body functions in emotions, or is it a return to ancient knowledge suppressed by certain attitudes of our current civilisation?
Another consequence of Body Psychotherapy intervention techniques: A psychotherapist need not be a Body Psychotherapist to profit from the bodily dimension of his clinical work. It is easy to imagine how a Gestalt Therapist will profit from intensified movements, how a Psychodramatist will encourage, at certain moments, total body expression, how a verbally-oriented therapist will ask for "where in the body" the feeling exists and suggest a small movement or amplified respiration from that area, how a cognitive-comportamental therapist will ask whether a facial expression is coherent with the mental idea, and so on. Therefore, any psychotherapist can incorporate several subtle body-oriented techniques in his or her therapeutic armamentarium in order to facilitate the work of psychological exploration. In fact, many Body Psychotherapy schools recognize this "borrowing" among psychotherapeutic orientations and give explicit abbreviated courses (usually for two years) for therapists already trained in alternative modalities who wish to integrate a part of the wisdom and efficacy of Body Psychotherapy within their own area of competence.
1. For Systems Theory: Liss, Jerome, "The Systems Model Applied to Bioenergetic Therapy, Psychology and Psychosomatic Medicine," Energy and Character, Vol. 13, No. 2, August, 1982, pp.12-28, and Vol. 14, No. 1, April, 1983, pp.18-36.
Von Bertalanffy, Ludwig, A Systems View of Man, Boulder, Colo., Westview Press, 1981.
Gray, William, Duhl, F.D. and Rizzo, N. (editors), General Systems Theory and Psychiatry, Boston, Little, Brown and Co., 1969.
An exceptional presentation of Systems Theory is found in the book by Joel de Rosnay, Le Macroscope, Paris, Ed. Seuil, 1975.
2. Downing, George, The Word and the Body, published in German, Italian and Swedish: Korper und Wort in Psychotherapie, Ed. Kosel; Il Corpo e la Parola, Ed. Astrolabio; Kroppen och Ordet, Ed. Natur och Kultur.
3. Liss, Jerome, Book Review: The Body and the Word, in Energy and Character (Editor: David Boadella), Vol. 28, No. 2, Nov. 1997, pp.86-88.
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