The 15 Questions about the Scientific Validation of Body-Psychotherapy.

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1. Please provide evidence that your approach has clearly defined areas of enquiry, application, research, and practice.

[A] Definitions:

The published EABP Definition of Body-Psychotherapy is that:

"Body-Psychotherapy is a distinct branch of Psychotherapy, well within the main body of Psychotherapy, which has a long history, and a large body of literature and knowledge based upon a sound theoretical position.
It involves a different and explicit theory of mind-body functioning which takes into account the complexity of the intersections and interactions between the body and the mind. The common underlying assumption is that the body is the whole person and there is a functional unity between mind and body. The body does not merely mean the "soma" and that this is separate from the mind, the "psyche". Many other approaches in Psychotherapy touch on this area. Body-Psychotherapy considers this fundamental.
It involves a developmental model; a theory of personality; hypotheses as to the origins of disturbances and alterations, as well as a rich variety of diagnostic and therapeutic techniques used within the framework of the therapeutic relationship. There are many different and sometimes quite separate approaches within Body-Psychotherapy, as indeed there are in the other branches of Psychotherapy, as indeed there are in the other main branches of Psychotherapy.
Body-Psychotherapy is also a science, having developed over the last seventy years from the results of research in biology, anthropology, proxemics, ethology, neuro-physiology, developmental psychology, neonathology, perinatal studies and many more disciplines.
It exists as a specific therapeutic approach with a rich scientific basis on an explicit theory. There are also a wide variety of techniques used within Body-Psychotherapy and some of these are techniques used on the body involving touch, movement and breathing. There is therefore a link with some Body Therapies, Somatic techniques, and some complementary medical disciplines, but whilst these may also involve touch and movement, they are very distinct from Body-Psychotherapy.
Body-Psychotherapy recognises the continuity and the deep connections in which all psycho-corporal processes contribute, in equal fashion, to the organisation of the person. There is not a hierarchical relationship between mind and body, between psyche and soma. They are both functioning and interactive aspects of the whole."

The published EABP definition of the work of a Body-Psychotherapist (as voted on and accepted at 3rd Congress of EABP Lindau, Sept. 1991) is as follows:

"Directly or indirectly the body-psychotherapist works with the person as an essential embodiment of mental, emotional, social and spiritual life. He/she encourages both internal self-regulative processes and the accurate perception of external reality.
Through his/her work, the body-psychotherapist makes it possible for alienated aspects of the person to become conscious, acknowledged and integrated parts of the self.
In order to facilitate this transition from alienation to wholeness, the body-psychotherapist should have the following qualities:

[B] Enquiry
Our domain is that of psychotherapy and, within that, Body Psychotherapy. Within this realm we focus on how bodily phenomena can improve current psychotherapeutic techniques and understanding. By bodily phenomena we understand such phenomena as muscular activity, breathing, bodily posture, muscular tensions, non-verbal communications etc. We differentiate Body Psychotherapy from purely body techniques, such as massage and physiotherapy, by concentrating on the interactions between the client's mental representations and their bodily phenomena. One of our main focusses in Body-Psychotherapy is the psychosomatic integration of the individual - we therefore consider all aspects of the mind, the body, and (in some cases) the spirit (1).

Furthermore we also consider interactive processes; for example, how the musculoskeletal system interfaces and influences the emotional life of a person and vice versa; or how two organisms (client and therapist) co-ordinate their gestures and mental representations and react and counter-react.

[C] Application
In this light, we work with various types of clients: (i) psychiatric clients; (ii) borderline, traumatised and addictive clients; (iii) clients with psychosomatic symptoms; (iv) all types of psychoneurotic and characterological clients; (v) clients who are not mentally ill or in great distress, but wish to enhance life skills, relationships, communication skills, or psychosomatic functioning. Body Psychotherapies often have an educational component when the client wishes to understand the inter-relationship between their bodily feelings, emotions, symptoms etc. This is often the case in Body Psychotherapy training sessions and with specialised client groups such as performing artists, athletes, etc.

Other client populations include children, adolescents, people being released from hospital, accident and post-traumatic stress victims, recovering alcoholics and drug addicts and people with body image concerns such as eating disordered clients.

In all of these, Body Psychotherapeutic principles have been applied in a large number of case studies from different disciplines: (ref: Appendix 1). Our field of enquiry thus not only encompasses the normal domains of psychotherapy but is additionally defined by Body Psychotherapy principles in application.

[D] Research
As regards research, we have already discussed some aspects around this point. Active research in Body-Psychotherapy is being carried out in a number of different ways.

[1] The EABP Bibliography of Body-Psychotherapy is a major project in the process of being constructed. At the time of writing it is in the form of a database which contains 1200 entries. By September 1999 the database should have 2500 entries, as available material gets entered. We estimate that this Bibliography will eventually (within 5 years) include 5000 - 7500 entries. It includes tapes, films, and videos, and has entries in various foreign languages being the language of origin as as an English entry. About 600 of the entries are to be found in PsychLit, the electronic database for Psychotherapy. These entries range over 30 years with some even going back further. Articles in a foreign language have two entries; one in that language and one in English. There are key words to enable research and extensive abstracts about each entry. Some of the Appendices (attached) list published articles and books extracted from this Bibliography, and selected through the use of key words. The key words are indicated in the listing of the Appendix.

[2] Many of the training institutes and the centres of the different modalities have their own archives, primarily used for training, which include articles about their particular modalities, clinical case studies, training papers etc. Biosynthesis, Hakomi, Process Oriented Psychology, Biodynamic Psychology, Biodynamic, Pesso Boyden System Psychomotor and others all have such archives. There is increasing use of video tape of demonstration sessions and training sessions. (see J. Liss - Appendix 22 for use of this method)

[3] There are a number of published papers of research within the field of Body-Psychotherapy, (see Appendix 2 which lists items only currently on the EABP Bibliography). There are many other research projects extant. The Swiss National Association is currently sponsoring two research projects into Body Psychotherapy (click here) and another is currently being designed by Richard Blamauer.

[4] Richard Meyer has designed a scientific project, in which a Body Psychotherapy training institute (I.A.S.) have been contracted for research and are working with the University of Erlanden. This is evaluating the efficacy of psychotherapy, looking at 2000 cases, and they need to start with 3000, estimating a 20-30% drop-out. It starts on Jan 1st 1999 with new patients, randomly selected, who do a questionnaire at the beginning, after 6 months, at the end of therapy, and with a 1 year and a 5 year follow-up. There are 3 lengths of therapy: short-term (upto 25 sessions), medium term (25-80 sessions) and long-term (more than 80 sessions); and group and individual therapy will be evaluated. 4 to 5 international questionnaires are being evaluated. They will look at improvement, efficacy, symptoms, personality disorders, body-image etc. All schools are invited to contribute, as it is a multi-disciplinary study and there will be training to help fill in the questionnaires. There is a 4 year window in which to start. Some of the costs will be born by the Research Institute of the University of Würzberg; and participating institutes are asked to pay 100 DM per case. A minimum of 50 cases from several therapists will be needed to participate. Each school will need 100-150 cases before it can put in its own special questions to assess particularly specific aspects. The outcome studies will be published in 10 years time.

[5] There are also small scale studies in Germany done by the University of Erlangen-Nuremberg using some Functional Relaxation interventions in asthmatic patients compared with inhalers and a process study with fibromylosis patients which has just started and is led by Dr. med. Angela von Armin. The asthma study is by Thomas Loew (who also did a study on Functional Relaxation and irritable colons) and Karin Tritt, Psychologische Psychotherapeutin, and students in the Abt. für Psychosomatik & Psychotherapeutische Medizin,. For more information, please contact them here.
There is investigation of certain experimental findings to confirm aspects of theory quoted by David Boadella in his submission to EAP for Biosynthesis (e.g. prenatal conditioning, developmental psycho-biology, and non-verbal communication). Boadella also quotes that there are two outcome research projects about to commence; one initiated by the Median Klinik Bergieshübel, near Dresden (above) and the second being launched by the Bundesamt für Sozialversicherung in Switzerland.

[6] In addition we know that a number of other research projects (largely uncoordinated) do exist but do not currently have any specific details of these.

[E] Practice
The large part of Body Psychotherapy practice is with clients in an individual setting, in a private practice situation. There are some Body Psychotherapy training centres which have Body Psychotherapy clinics, where members of the public come in and are ascribed a therapist. Thereafter they will usually be seen by that person. There is also a Body Psychotherapy practiced in a group setting, either in a training situation, or with clients at a fairly low level of emotional or personal content, appropriate to the whole group. Most of the accounts of these types of practice are in the form of clinical studies of individuals. A small selection is included here (2). 

References:
(1)
Christian Scharfetter, a research professor of psychopathology at the University of Zürich, states that the field of enquiry is not limited to the normal and abnormal, but includes the transpersonal and supernormal aspects of the human being.
(2) Appendix 6

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2. Please provide evidence that your approach has demonstrated its claim to knowledge and competence within its field tradition of diagnosis/assessment and of treatment/intervention.

 

Our view from within Body-Psychotherapy is that all psychotherapies are primarily practical approaches to problems which urgently need a solution and which cannot be provided by methods determined ny experimental research. If experimental research could bring a solution to these problems, we feel that there would be no psychotherapy such as it exists today. Therefore we subscribe to the view that psychotherapy has developed as a mixture of intellectual theory and pragmatism which has been supported primarily by research in the form of case studies.

References:
(1)
Note: The editor (Dr. Peter Bolen, Schoenbrunnerstrasse 187, 1120 Vienna) is the founder of Arbeitskreis für Emotionale Reintegration, a Body Psychotherapy school in Austria with 10 members in the EABP, including the 1997-99 EABP President. This school is not yet recognised under the Austrian law on Psychotherapy as Body-Psychotherapy has been deemed to be "unscientific" by influential factions within the Austrian National Umbrella Organisation who 'advise' the Austrian Health Ministry.

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3. Please provide evidence that your approach has a clear and self-consistent theory of the human being, of the therapeutic relationship, and of health and illness.

Being an association or conglomeration of approaches, we do not have any singular theory. The need to create a self-consistent model of communication and mind, integrating representations and movements, is a standard discussion in academic and psychotherapeutic literature and within Body-Psychotherapy. Our contribution to this discussion is central and one that can not be summarised in a few lines. We will attempt to describe elements of theory consistent across models.

[A] The Human Being as an Energetic System
For centuries, all approaches of how bodily behaviour is actually experienced have used models involving a form of energy specific to life (3 & 4). This was true for Yoga, with martial arts, in Greek medicine etc.; it was still true when the young Freud created a psychosomatic model, and when Reich created his groundbreaking style of Body Psychotherapy. In the literature on Body Psychotherapy energetic models are still a hot issue. An important number of authors still believe that understanding how bodily behaviour is experienced requires models which contain and try to explain the concept of life energy (for example Boadella D., Boysen G., Lowen A., Keleman S.), while others (Downing G., Geissler P., Liss J.) (see 5) argue that life energy is not required to understand bodily and psychic experience. This issue involves not only models, but also paradigms (6). Between these two extreme positions others think that life energy models (e.g. acupuncture) are a metaphor which allows practitioners to work with global physiological reactions too complex to be studied by scientific means until today. For example, most psychologists are working on the assumption that emotions are associated to global physiological arousal patterns. Bits and pieces of such patterns have been studied, but the complete arousal system can not yet be studied (8).

Behind these theoretical issues, there are sensations repeatedly reported by patients that require at least some sort of working models. Most Body Psychotherapists will agree that they are familiar with these phenomena. Here are a few examples: Patients report having to little or to much energy. During grounding exercises they may report that a wave of heat, excitation, and aggressivity rises from the feet to the head, passing by the back. During relaxation they may report a flow going down from face to feet, passing by the chest. During cathartic experiences that lead to subsequent behavior change, clients often report unusual or emotionally meaningful bodily sensations such as trembling, heat, or cold. Psychotic patients talk of having to much energy in the head, report headaches, hyper-activity, and continuous compulsive thinking day and night.

[B] Body/Mind Holism
The most prevalent theory of the human being within Body Psychotherapy is akin to that of Humanistic Psychology, which sees the Cartesian split as fallacious and recognises that a human being is comprised of a synthesis of mind, body, and spirit. Thus the main emphasis is on the mind-body connection and methods that promote such unity. However we are also assuming, and this is not inconsistent, a realm of theories which can claim to be consistent with Spinoza's and Piaget's notion that the psyche is made of relations between an organism and it's environment. The relations are necessarily composed of numerous modules that simultaneously include

a) mental representations;
b) a physiological arousal;
c) a communicative impact; and
d) a response feed-back mechanism by which learning is acquired.

[C] Additional Assumptions and Aspects of the Therapeutic Relationship
The theoretical common ground of our Body Psychotherapy Association supposes that our members are very familiar with these aspects of mental life (e.g. emotions) that combine such elements. Added to which there are specific theories of the human being, of the personality, and of character structure that are central to each of the various Body Psychotherapies. Whilst these differ in their particulars, there are several consistent themes. There is the presumption that the human being (pre-birth) is essentially open, receptive, and untraumatised. The birth process, severe tensions prior to the birth, and subsequent traumas in early life can all start the armouring, defensive, and emotionally repressive process. Depending on the presence or absence of love, warmth & understanding in the surrounding environment, these traumas can be either naturally healed or re-inforced. Degrees of unresolved trauma are built-up and somatised. These form the eventual bases of any neuroses, psychological problems or disfunctional behaviour patterns found in the client. The therapeutic relationship attempts to help the client to undo these patterns.

With unconditional regard, respect for their process and good contact (emotional, physical etc) the Body Psychotherapist tries to provide an environment in which the client can being to let go of these defences. There is a presumption of a natural desire and innate ability to heal. There is also generally an assumption that intervention on a somatic level affects the psyche and vice versa and the various theories of Body Psychotherapy attempt to explain the details of these phenomena. The therapeutic relationship in Body Psychotherapy usually consists of supporting the client both verbally as well as in some form of somatic intervention. This dual way of working aids and abets the eventual somatic release that has to happen for the neuroses or original traumas and defence patterns to be completely overcome.

For a more detailed explanation within some particular Body-Psychotherapies, consult the Appendices. ((Bioenergetics Appendix 14; Hakomi Appendix 15; Biodynamic Psychology Appendix 16; Pesso Boyen System Psychomotor Appendix 31, Rubenfeld Synergy Appendix 32)

[D] Touch and other Non-verbal Communication
The use of touch and it's importance is also a fundamental facet of Body Psychotherapy theory that generally separates it from other theories of psychotherapy. The evidence on the effectiveness of touch is,at present, indirectly documented. That is, the domain is well documented by research, but not the effects during psychotherapy. For example, Hunter & Struve (7), or Bonnet & Millet (8), demonstrate that touch has a deep influence on psychophysiology, and how certain forms of touch have certain type of influences. The existence of the phenomena is therefore not debatable, although one can always improve the knowledge. However the influence of certain forms of touch on specific psychological dynamics has not yet been researched experimentally. Nevertheless, much clinical knowledge has been amassed among the Body Psychotherapies that use touch. Touch should only be used with great consciousness and awareness and we require of Body Psychotherapists that they must be particularly well trained and supervised in such interventions. Clear ethical guidelines have been developed and are implemented in our association.

We generally assume that any communicative act is produced by an inner psycho-physiological mechanism that has an impact on the psychophysiology of those that perceive that behaviour. This assumption is one of the common roots of (a) the transferential model proposed by psychoanalysis, and (b) the communicational model of systemic approaches. We are in contact with several laboratories that are demonstrating the relevance of this standpoint through studies on non-verbal communication. There have also been studies showing how the non-verbal behaviour of patients influences the therapeutic relationship. In such studies the involvement of bodily phenomena in psychotherapy is clearly described (7). We are in contact with several laboratories that are demonstrating the relevance of this standpoint through studies on non-verbal communication and David Boadella is currently writing a paper on this (Appendix 35).

[E] Biological Approaches
Biological models are consistent with and lend support to the Body Psychotherapy notion of body-mind unity. One example is found in suicide studies that show how a single type of behaviour is the coordination of many functions ranging from historical factors to individual biochemical processes. For example, findings of low levels of serotonin in the cerebrospinal fluids of suicide victims is a well replicated finding (9). In all these studies there is a clear relation between serotonin, management of agression, impulsivity, and suicidal behavior. Other studies are looking at how medication might strengthen the association between depression (a mood) and suicide (a behavior) (10).

The success of psychiatric medication as a psychotherapeutic approach strongly supports the relevance of the body-mind theory of mental health. The literature showing that behaviour physiology and biochemistry has a strong influence on psychopathology is in fact as old as psychiatry itself. It is enough to mention any manual of psychiatry, of physiology, of neurology to prove this point. Recent examples are research on stress models (Seyle), PTSD, and all medications based on substances such as neuropeptides, endorphins, serotonin, dopamine, etc.which are used to fabricate psychotropic drugs such as anti-depressants, neuroleptics, etc. Ross Buck has written a good introduction to this data (5). Stress literature is well discussed by Lazarus (6). The recent research of Candace Pert on neuropeptides and emotion and others in the field of psychoneuroimmunology also lends support to our theory of body-mind unity. Findings, for example, that the use of imagery and visualization can have a notable impact on the healing of burn victims (Rossi) is such an example as is the Simontown's work on the benefits of visualisation with cancer patients. Many of these researchers may not know of the significance Reich's work and that of Body Psychotherapy. Their formulations are not the same as Reich's. Nevertheless they have generated models showing that psychopathology is strongly related to physiological and biochemical phenomena, which is a basic assumption of the EABP.

This enormous literature clearly shows that from antibodies to hormones, from hormones to neurology, from neurology to moods, from moods to behaviour, from behaviour to the environment, from the communication to perception, and from perception back to biochemistry, there exists a complex web of relationships which influence the development of psychopathology. Most psychotherapies have developed knowing that the ideal therapy should involve this enormous system, but until now, none to our knowledge, has been able to propose methods which can explicitly manage the whole system. Each psychotherapy develops methods which act on some crucial aspects of a few matrices within this system, hoping that the whole system can thus be influenced. Body Psychotherapy attempts to expand the range of impact to include behavior, as well as the impact of behavior on a) physiology, b) moods, c) consciousness, d) communicative attitudes. The relevance of this focus is supported by all existing research we know of, the above being a few examples.

[F] Models of Health
Ethically and practically, we are against proposing any absolute criteria of health such as illumination, orgastic potency, perfect physical health, or erect bodily alignment as possible criteria for ending psychotherapy. We think that we share this with most other psychotherapies. The aim of Body Psychotherapy is mainly to relieve pain, distress, or incapacitating ways of regulating oneself. However, there are a number of models that describe the human being including variants of "normality"/health and illness, or more precisely, variants of personality structure and dynamics, including an understanding of defense mechanisms and methods of assessment and intervention from a Body Psychotherapy perspective. These theories also correlate in some way to developmental psychology in that they describe how different patterns of human functioning are developed through childhood. Alexander Lowen's work with Bioenergetics (12) is one example of this latter point; The Character Structure Development Model of Bodynamics is yet another (13 & 14).

However, irrespective of the type of neurosis, when it developed, how it developed or whatever, there is a general agreement that the client is the main determinant of the successful end of therapy. This means that (generally speaking) the final decision is based on the client's feelings about themself and that there has been a significant improvement in their condition. "Good enough" is a pragmatic concept. However along with this frequently goes a more in-depth consciousness of the client's history and it's impact; a more rounded acceptance of that history and it's main protagonistic components; often a betterment of familial relationships; greater job satisfaction; a greater feeling of empowerment and potential; more contact with their emotions and inner senses; and a stronger sense of self and self-confidence. The therapist might also be looking for a better self-image; a more erect posture; greater ability to relax, to cope appropriately with stress, and to display emotions appropriately; the client might look healthier and be taking ative steps towards a healthier life-style; their face and skin might be more energised; their voice might be stronger or less constrained; etc. There are many such indicators which vary with the type of Body Psychotherapy.

References:
(1) Birdwhistell, R. Introduction to Kinesics: An Annotation System for Analysis of Body Motion & Gesture. University of Louiseville, 1952 and Kinesics & Context. University of Philadelphia Press, 1970. etc. see references in Chpt 5 of The Body in Psychotherapy, Edward W.L. Smith (McFarland) 1985.
(2) e.g.

(3) Boadella D. 1991: Organism and organisation: The Place of Somatic Psychotherapy in Society. Energy & Character, vol. 22.
(4) Heller M. 1993: The Jellyfish, or the Reichian World of Gerda Boyesen. Energy & Character, vol. 24, n.2, pp. 1 - 27.
(5) Ross Buck 1988: Human Motivation and Emotion. New York: John Wiley & Sons.
(6) Lazarus R.S. 1991: Emotion and Adaptation. Oxford: Oxford University Press.
(7) - Bonnet M. & Millet Y. 1971: Manuel de physiologie: l'usage des kinèsithèrapeutes et des professions paramèdicales. Paris: Masson et Cie, Èditeurs.
(8) Hunter M. & Struve J. 1997: The Ethical Use of Touch in Psychotherapy. Thousand Oaks: Sage Publications.
(9) e.g.

- Golden R.N. & all. 1991: Serotonin, Suicide, and Agression: clinical studies. Journal of Clinical Psychiatry, vol. 52, n. 12, pp. 61 - 69.
- Jacobs B.L. 1991: Serotonin and behaviour: emphasis on motor control. Journal of Clinical Psychiatry, vol. 51, n. 12, December, pp. 17 - 23.
- Motto J. A. 1996: Clinical applications of biological aspects of suicide. Archives of Suicide Research, vol. 2, pp. 55 - 74.
- Stein D.J., Trestman R.L., Mitropoulou V., Coccaro E.F., Hollander E., Siever L.J. 1996: Impulsivity and serotoenergetic function in compulsive personality disorder. Journal of Neuropsychiatry and Clinical Neuroscience, vol. 8, n. 4, pp. 393 - 398.
- Zalman A. & al. 1991: Serotonin Uptake Inhibitors: Effects on Motivated Consummatory Behaviors. Journal of Clinical Psychiatry, vol. 52, n. 12, pp. 55 - 60.

(10) For example: Bronisch T. 1996: The relationship between suicidality and depression. Archives of Suicide Research, vol. 2, pp. 235 - 254.
(11) For example:

Ekman P. & Rosenberg E.L. 1997: What the Face Reveals. Oxford: Oxford University Press.
Guimon J. 1997: The Body in Psychotherapy. Basel: Karger.

(12) Alexander Lowen: Bioenergetics. 1975 Penguin Books
(13) Peter Bernhardt, Marianne Bentzen and Joel Isaacs: "Waking The Body Ego. Bodynamic Analysis: Lisbeth Marcher's Somatic Developmental Psychology. Part I: Core Concepts and Principles" Bodynamic Institute 1997
(14) Peter Bernhardt, Marianne Bentzen and Joel Isaacs: "Waking The Body Ego. Bodynamic Analysis: Lisbeth Marcher's Somatic Developmental Psychology. Part II:Psychomotor Development and Character Structure". Bodynamic Institute 1997.

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This page was last updated on 5th May 1999