Body Psychotherapy has a long tradition of creativity and innovation. While many theories have historically looked at the human psyche as a co-ordination of bodily, mental, and relational factors, this assumption has rarely been consistently applied and detailed as it is in the Body Psychotherapies. Academic approaches to communication distinguish verbal- and nonverbal- communication. We consider that an organism communicates with other organisms through millions of exchanged items. Verbal exchange is just one aspect of the flow of communicated information (1). As mentioned there is also a whole literature about the psychophysiological basis of affects (2).
[A] Methods involving the use of Touch
The use of touch in psychotherapy is one such innovation. The zeitgest of our times has made the culture fearful of touch as this has been seen as either primarily sexual or else overly nurturing in nature. It has been often felt that the use of touch might bring up prohibitively powerful transferential issues. As Body Psychotherapies began to explore the use of touch, however, they began to discover that touch can be as complex a language of communication as verbal diaglogue. Also, the intention of the person who uses touch is an essential component - for example Ilana Rubenfeld talks about "the listening hand" (Rubenfeld Synergy - Appendix 32). The parts of the brain engaged in the use of touch are larger than just the cortex and include the limbic system and other more primitive non-cortical structures. Thus, It is felt that using touch allows the therapist to communicate with the whole person whereas verbal therapy only allows contact with the cortical, language dominated aspects - though of course other things happen as a result. Body Psychotherapy has brought touch out of the closet and into the treatment room.
The use of touch is supported by recent research that shows that empathic touch in infancy is critical to the development of healthy body image. (ref: Harlow & Harlow, opp cit) Other research, shows that primitive brain structures e.g. the amygdala can be damaged in early trauma. () Traditional verbal therapies may not be as successful in impacting these structures as techniques that can bypass the cortex and access the limbic system. Body Psychotherapies are pioneers in this regard. Even the hypnotherapies which come closer to contacting the whole person (viz. Erickson) still rely primarily on cortical functions such as visual imagery. These are certainly impactful but the Body Psychotherapies go much further in this regard.
[B] Historical Perspectives
Most schools of Body Psychotherapy are suggesting that they take into account many different channels of communication. Only some of these include touch. We are suggesting that this point of view allows us to include and develop previous assumptions proposed by "verbal psychotherapies" such as those created at the beginning of the 20th century. We are also suggesting that earlier psychotherapeutic "verbal approaches" restricted their approach to their patients because taking into account all forms of communication - verbal and non-verbal - was too complex a task at that time. Freud for example began by taking as much as possible into account, using sometimes hypnosis and massage, and attempting to formulate a psycho-physiologic model for psychotherapy. As students came to see him he increasingly focused on verbal information, yet still included many emotional and bodily phenomena in the realm of unconscious communication.
When Reich became a psychoanalyst, Freud strongly encouraged him to create a psycho-physiological model. He sent the young Alexander (creator of psycho-somatic psychotherapy) to Reich for a didactic psychoanalysis. Reich was also one of Freud's main trainer for several years. However when political reasons (in 1933) reinforced conflictual positions between Freud and Reich, the body and emotional linkage was relegated even more into the background where it has stayed for most Body Psychotherapies. However over the last 30 years this has been changing very fast, through numerous different channels. The main European one of these was the pupils of Ola Raknes in Norway and the work of David Boadella in Britain. In America, John Pierrakos, Myron Sharaf, Alexander Lowen, Charles Kelley, the Orgonomists and others continued Reich's work, but they were aided by the growth of Humanistic Psychology in the 1960's around Esalen and similar centres. The new wave of psychotherapies that generated out of this movement include Fritz Perls' Gestalt Psychotherapy, Eric Berne's Transactional Analysis, Janov's Primal Psychotherapy, and so forth.
Reich created a whole range of techniques based on the psycho-somatic hypothesis (also found in current relaxation and yoga techniques) that the mind moves the body, and the body moves the mind. Thus arm muscles may become chronically tense as a child clenches his fists to repress his impulse of punching his father. But then, later in psychotherapy, massaging these same tense muscles may help a patient to contact his repressed anger against his father. (3) Reich was no specialist of body techniques. But some of his pupils were. Thus Alexander Lowen included tools from gymnastics, Gerda Boyesen tools from massage and physiotherapy, Keleman tools from Zen Buddhism, Lisbeth Marcher tools from psycho-motoricity (4), (see Appendix 1, Heller M.) Other Body Psychotherapies have developed from non-Reichian origins: for example Ilana Rubenfeld (Rubenfeld Synergy, see Appendix 32) synthesised The Alexander Technique and Feldenkrais methods (both somatic disciplines involving use of touch and exercises) with Gestalt Psychotherapy and Ericksonian hypnotherapy. Al Pesso used psychodrama and movement with Gestalt psychotherapy to create his 'Pesso Boyen System Psychomotor' type of Body Psychotherapy (see Appendix 5 and Appendix 31).
[C] Interactive Approaches
In the meantime, other Body Psychotherapists have trained in Psychoanalysis, systemic therapies, Gestalt, Transactional Analysis, and Jungian psychotherapy. The methods today at our disposal have thus developed in mainly two directions:
(A) Body Psychotherapy has developed increasingly refined methods to contact the interface between mind and body.
(B) Body Psychotherapy has connected links between their findings and most other psychotherapies. EABP authors such as Martin Aalberse, George Downing, Anne Fraisse, Michael Heller, Jerome Liss, Lisbeth Marcher, Bernhard Maul have recently been contributing to the already existing body of literature on these subjects.
Jerome Liss appends an article specially written for this submission on this particular question (see Appendix 26). It goes into the detail of the way in which Body Psychotherapists work, relating this to psychological theory and methods of treatment.
Lennart Ollars has also done some significant research work which is appended (see Appendix 27).
(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.
(3) Mann W.E.: Orgone, Reich & Eros. New York: Simon and Schuster, 1993.
(4) Wehowsky A.: Energy in Somatic Psychotherapy. Energy & Character, vol. 29, n.2,1998. pp. 68 - 78.
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In order to be considered a Body Psychotherapy, any approach must implicitly include verbal communication. In Body Psychotherapy we work with the whole person and we are, as humans, language based creatures. It would be, therefore, impossible to exclude verbal interaction from being highly significant in Body-Psychotherapy sessions. We are primarily psychotherapists and a significant part of our work and of therapists-client exchange is in the verbal channels. However, and this is where we differ from many other psychotherapies, we are perhaps equally more interested in bodily phenomena and other non-verbal sources of information and communications.
Much of Wilhelm Reich's early work on Character Analysis (first published in 1933) (1) starts from the premise that people embody their neuroses, and this embodiment will provide much of the resistance to verbal analytical work and the neurosis will not clear until the physical embodiment has been dealt with. The early work of Alexander Lowen (2), refined and added to these concepts of Character Analysis through observations of the morphology, the postures, the interplay of tonus (hypotonic and hypertonic musculature), psychological states and psychosomatic symptoms and the theme is further developed in Stanley Keleman's Emotional Anatomy and other works (3). Gerda Boyesen has done much work on the tonicity of muscles and how, through psychotherapeutic massage interwoven with verbal psychotherapy, these reflect the inner psychological processes and how these can be resolved through the process of Body Psychotherapy (4). Ilana Rubenfeld and Al Pesso (as mentioned earlier) both utilise Gestalt psychotherapy techniques extensively as well as working in parallel with the body, either directly with touch, or with a focussed awareness on what is happening in the body. These are all significant non-verbal sources of information.
Michael Heller has done research in conjunction with the University of Geneva which shows there are over a million possible non-verbal exchanges of information in a single psychotherapy session of any sort (5) and Dr Alfred Pritz states that about 80% of our communication system is non-verbal (Appendix 35).
David Boadella's article on the "Embodiment in the therapeutic relationship" (6) "introduces the rich field of non-verbal communication to psychotherapists of all persuasions, since every client will bring many important messages in this form, and every therapist, consciously or unconsciously, will likewise convey a great deal to his client through somatic signals." (7) This evidence comes from EAP's official journal - The International Journal of Psychotherapy.
However, our methods clearly include both verbal and non-verbal processes. A caveat should be issued here: There are those psychotherapists and/or psychiatrists who claim that they can solve psychological problems only by touching. These approaches cannot be properly recognised as body-psychotherapists by the EABP. We require a clear and proper grounding in the whole field of psychotherapy, as indicated in our Training Standards (Appendix 33).
To sum up, the human organism uses several channels of communication. Each has specific functions. Some Body-Psychotherapists claim that some aspects of deeper and perhaps repressed human feelings can only be recontacted through touch or smell - and there is some evidence from research to support this. But for the same reasons some aspects of the human mind can only be contacted through verbal exchanges. Given the complexities of human interaction, we do not see how a therapist can evaluate the impact of his interaction without the use of language. Finally verbal exchange is necessary to spell out and regulate the specifics (relational, transferential, contractual, ethical, financial, etc) of the therapeutic setting. This is an important aspect of the therapeutic contract that any Body-Psychotherapist has with their clients. Jerome Liss also explores this whole question in much greater depth (see Appendix 25).
(1) Reich, Wilhelm: Character Analysis: Farrar, Strauss & Giroux, NY, 1972.
(2) Appendix 3
(3) Appendix 4
(4) Appendix 8
(5) Appendix 1
(6) Boadella, David: Embodiment in the Therapeutic Relationship: International Journal of Psychotherapy, Vol 2, No 1, 1997 pp 31-45, which formed a main speech at the First Congress of the World Council of Psychotherapy, Vienna July 1996.
(7) Quote from the Abstract to the above article.
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The various Body Psychotherapy approaches have all delineated their rationales for treatment / intervention. So we cannot give a definitive EABP answer to this question but much is provided throughout the references given. In addition, we require the training schools to teach their students the theory, rationale for intervention and similar issues and this is very clearly stated in our Training Standards (Appendix 33). These are being adopted by all Body Psychotherapy training organisations that are going through the EABP accreditation process in The FORUM for Body Psychotherapy Organisations. The relevant sections are:
Section 4a: That Training Schools in Body-Psychotherapy need to conform with the general standards of professional training in psychotherapy and include a good awareness of such core components in their syllabus' (or make provisions for their trainees to have access to such modules) and teach them in relationship to any general theory of Body-Psychotherapy and also to their specific theory of Body-Psychotherapy.These primarily include elements of Theory: background; (epistemology, anthropology, sociology, scientific theory, etc.): general and specific theories of psychotherapy (human development; sexuality; history of psycho- therapy; purpose, possibilities and limitations; psychopathology; psychotherapeutic process etc.) and theory of practice (theory & methods of intervention; transference & counter-transference; assessment & diagnosis; indications & contra-indications; research methods; prognosis & evaluations etc.)
Section 4b: A General Theory of Body-Psychotherapy should be taught by all Training Organisations and should include a fundamental awareness of the EABP definition of Body-Psychotherapy; a history of Body-Psychotherapy and an awareness (or even experience of) other types of Body-Psychotherapy; a perspective on psychotherapy that includes a healing or curative approach as well as a personal developmental approach; goals of self-regularisation and empowerment for the client; and a basic awareness of how body-energy moves in and shapes the body
(1) That a Training School must be clear about the theoretical basis that is specific to it's particular methodology in Body-Psychotherapy and where and how it differs from or is similar to other Body-Psychotherapy theories and where it is the same as or different from other training organisations with similar theoretical bases.
(2) That there should be a coherence and a cohesion of theory and practice and of philosophy and literature which is demonstratable.
(3) That any significant variations from the norm in the balance of theory, method and practice in the training programme need to be justifiable.
(4) That there needs to have been some basic research into the validity and efficacy of this method and that this is communicated to the trainees.
The primary motivation of nearly all of the Body Psychotherapy methods mentioned in this submission is to help the clients to work towards a greater sense of self-regulation and self-determination for themselves. With these parameters comes greater autonomy, self-assurance, empowerment, freedom, self-realisation and similar concepts. The psychotherapist is therefore seen as a facilitator of the client's process, and the therapeutic relationship as one that is working together for the welfare of the client. It is primarily not a doctor-patient relationship: a well person curing a sick one through their greater skills and knowledge; though these elements are often implicit and present. However the psychotherapist is seen as much as someone who has experienced similar traumas as someone who is immune or inexperienced: the concept of the psychotherapist as a "wounded healer" is fairly prevalent. The psychotherapist has had to have had a significant amount of their own personal therapy and have experienced a significant length of therapy in the method of Body Psychotherapy which they are practising. This is evidenced in the EABP Membership Conditions (Appendix 34).
Most of Body Psychotherapy is practised in private sessions or in privately organised group sessions. There are a few Body Psychotherapists working in medical clinics. Many Body Psychotherapists would work cooperatively with doctors or other practitioners, and it has been shown that the most efficacious method of treatment in psychotherapy is a combination of appropriate medication and psychotherapy. Body Psychotherapists work co-operatively with other practitioners towards constructive change in the client.
Most Body Psychotherapy schools of thought would agree that the factors that provoke or maintain the client's illness or suffering are as a result of an initial trauma, series of traumas or from an impoverished early emotional life. Most of the approaches see these traumas as having become embodied in some way and the rationale behaind the treatment stems from this. Coming to terms with these is usually seen as primary. Whilst past history cannot be changed, emotional reactions to the historical events and the client's feelings about themselves that result from this history, can be altered significantly. (For just one example, see the description of a PBSP session in Appendix 31 ) However there has to be a willingness to work cooperatively with the psychotherapist on one's acknowledged issues. Clients with severe personality disorders and high levels of paranoia significantly exclude themselves from such a voluntary relationship.
In addition, most of the Body Psychotherapies hold the belief that intervention on a somatic level, either through massage, body awareness exercises, touch, breathwork etc. can have an impact on emotional, spritiual and cognitive aspects of the person. They also commonly believe that for lasting change to occur, verbal processing must accompany the somatic intervention.
Evidence regarding effectiveness of such interventions may be seen in many of the clinical case histories (see Appendix 6). Jerome Liss has also written an article which shows 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. This goes into the sort of detail about the Body Psychotherapist's awareness of anatomical and physiological functioning which is perhaps essential to a true understanding of the effect and limitations of Body Psychotherapy treatments (see Appendix 24 ).
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Body Psychotherapy has very strong and clear strategies for helping clients, especially with awareness about their bodies and the interactions of the mind-body associations. Nearly every Body-Psychotherapy modality has it's own particular area of awareness (e.g. Biodynamic Psychology - one particular modality - focusses on the action of the "psychoperistalsis" and the 'digestion' of emotions as a psychosomatic function of the alimentary canal. With the balance of the autonomic nervous system being better regulated through various massage techniques and with appropriate information, the client is led into this new area of awareness about their bodies and their emotional reactions). This distinguishes it from other different Body Psychotherapies. Another example is the Rubenfeld Synergy® Method which focuses on helping clients develop congruence between verbalization and somatic response.
Similarily every EABP practitioner situates him/her self differently in the actual web of the differing methods of psychotherapy. Most of the time these combine some form of a classical school of psychotherapeutic theory with some more bodily techniques. Thus most Body Psychotherapists have some experience in at least one of the following schools: Psychoanalytic, Jungian, Gestalt, Transactional Analysis, and various Systemic schools. There is similarly a web of more strictly Body Psychotherapeutic methods in which each Body Psychotherapist situates him/herself. For example, many touch during sessions, some never touch. Some use massage, some bioenergetic postural work, some use relaxation techniques, some look for deep regressive techniques (e.g. vegeto-therapy or primal scream), some prefer more body awareness techniques like Feldenkrais. Finally most practitioners who have started a school of Body Psychotherapy have had some training in more of purely bodily therapeutic techniques such as: gymnastics (Lowen), Scandinavian massage (Gerda Boyesen), far-east martial arts (Keleman), Californian massage (Downing), Feldenkreis & Alexander Technique (Rubenfeld), etc.
Thus Body Psychotherapy covers many different ways of working, and the realm in which a Body Psychotherapist needs to situate her/him self is entirely original. Some landscapes are common to most psychotherapy; some are common only to certain areas of psychotherapy; others are common to most Body Psychotherapists; some areas define a given school of Body Psychotherapy. Current research modulates classical forms of Body Psychotherapy: for example, only a very few techniques can be used with all patients. Some methods are mostly for over-armoured patients (e.g. Gerda Boyesen's Deep Draining massage), others are contra-indicated for certain patients (i.e. Peter Levine (1) (like many others) shows that deep regression is contra-indicated when one works with patients suffering from post-traumatic diseases). There are significant dangers of hyper- or hypo-ventilation for Body Psychotherapies that encourage deep breathing. Most of these areas are basically known about by most Body Psychotherapists.
One classical area involves undoing the physiological and somatic blocks that have "somatised" the trauma and reinforce the neurosis. Many of the Body Psychotherapy techniques have well developed strategies for undoing these blocks with different types of clients, and many of these strategies are sequential. These strategies help the client reorganise their emotional and psychological viewpoints in conjunction with their stance and posture, their muscle tonus, their proprioception, subsequently their emotions, and finally their potential actions and abilities.
Much of this work is described in the following: Wilhelm Reich's Character Analysis; Alexander Lowen's Bioenergetics; Stanley Keleman's work; Gerda & MonaLisa Boyesen's Collected Papers; David Boadella's Lifestreams and in many articles by him and others in Energy & Character; Arnie Mindel's Dreambody andWorking with the Dreaming Body; Joe Goodbread's The Dreambody Toolkit; Charles & Erika Kelley's Radix; Malcolm Brown's Organismic Psychotherapy; Lisbeth Marcher's work on Bodynamics; Ron Kurtz' Body Centered Psychotherapy about Hakomi; Al Pesso's Pesso Boyden System PsychoMotor; and there are many more variations and developments of these. Within these various methods there are a wide divergence of methods. All of the above mentioned have their own clearly defined strategies for working with clients. These are varied and are well described in their various books and articles about their work (see EABP Bibliography of Body-Psychotherapy and opp cit.).
(1) Levine P. A. & Frederick A. 1997: Waking the Tiger.Berkeley: North Atlantic Books.