Including the Body in Psychotherapy
Crawford with Hahn ©Copyright Linda K. Crawford, L.I.C.S.W. with Andrew H. Hahn, Psy.D.
INCLUDING THE BODY IN PSYCHOTHERAPY
A BEGINNING GUIDE FOR CLINICIANS
Currently in the world of clinicians, there is a subtle but clear shift of focus to the body in psychotherapy. For trauma oriented clinicians, this includes a broadening understanding of the neurobiology of trauma, but that arena is not the topic of this paper. That work is foundational and incomplete. It deepens our understanding of why the body is important, yet is does not give us ways to work with the body in a standard therapy session. Our intention is to give more traditionally trained clinicians a clear concise introduction to some basic practices and language for working with the body. This introduction is necessary, we believe, for becoming aware of the power that is available when the body is acknowledged in psychotherapy.
Including the body in psychotherapy is certainly not new. Many pioneers have developed methods of working with the powerful information held in people’s bodies. The bioenergetic work of Lowen and its shift to core energetics with Pierokas, the original body centered works of Reich and Feldenkreis, the talking to the body work of Mindell, Grove and Hahn, and the body-based psycholanalytic work of Semrad, are only a few. Their work, however, stayed relatively separate from mainstream clinical work. The intent of this paper is to bring together these two traditions in a way that will be useful to both.
Implicit in this shift is the assumption that during a session, treaters are self-aware and in their own bodies in a clear and grounded way and are comfortable directing clients to deepen into the awareness of their bodies. Often neither of these is true. In hopes of increasing these skills, this paper discusses five key areas:
1) What is body knowing
2) How to help therapists be in the body and why that is important.
3) How to help clients be in their own body and why this is important
4) Understanding that the body has its own truth.
5) How to talk to the body and why this is important.
WHAT IS BODY KNOWING?
There are two levels of body knowing. The first is often spoken of in phrases like “The body keeps the score,” or “Your biology is your biography”. This level of body knowing refers to a mechanistic recognition that all of your experience is engraved in your body. Phrases like “I just KNEW it was the truth,” I had a gut sense.” “I heard an inner ‘Yes’,” refer to the second level of body wisdom. This level has many names in Eastern traditions – prana, chi, ki or shakti. For our purposes, we call it our deepest intuitive knowing. Invariably people describe this knowing as a felt sense, a visceral sense, a deep knowing in their cells. These two levels of body knowing collapse into the combined form of body wisdom best stated in the phrase “The body never lies,” and acknowledging this deep body wisdom is a powerful way of working in therapy.
HOW TO HELP THERAPISTS BE IN THE BODY… AND WHY THIS IS IMPORTANT
In the rush of most modern practice settings, it is often easy to lose the vital connection between one’s self and one’s body. What follows is a simple practice that grounds and focuses a therapist. A few moments of clear intention to bring one’s attention to the room, the chair, one’s body against the chair, the breath, usually with a deep inhale and slowed exhale, go a long way in helping a therapist become body aware at the beginning of a session. It is easy to ground oneself by placing both feet on the floor, breathing in and out slowly again and bringing the awareness to the soles of the feet. It is helpful to lower one’s gaze and again inhale and exhale, taking a moment to notice the quieter, more organized connection to oneself and an increased awareness of the client. With only a little practice, these three breaths become automatic for the therapist and can easily be taught to most, if not all, clients. These moments enhance the quality of presence that is in and of itself healing and allow the therapist to be with their client much more deeply than a purely mental or thought-based approach might allow.
HOW TO HELP CLIENTS FOCUS IN THEIR BODY…AND WHY THIS IS IMPORTANT
Over the last several years, many clinicians have been EMDR trained. Part of the standard protocol asks the client, “Where do you feel that in your body?” This question and the concluding bodyscan have done much to orient clinicians to material as it is stored in the client’s body. It is both possible and useful to apply this principle during standard talking sessions by having clients bring their attention to their body sensations and working with that material, yet many clinicians are reluctant to make this bridge. For example, when we observe a client’s eyes moving upwards as if they are trying to figure something out, we can invite them to bring their attention back down, focusing on the body sensation that invariably will be present. Many therapists find that knowing what to do next without a standard protocol is unnerving, so they avoid this form of work. Yet learning simple guidelines to explore in this way is easy.
THE BODY HAS ITS OWN TRUTH
Every time we experience some kind of shock, it creates an imprint in our body. Sooner or later, this imprint leads to some kind of difficulties in our life. The difficulties get stored in our body as a discomfort and present themselves in our sessions as body sensations…a pain, queasiness, a heaviness, etc. Every body sensation can be likened to a living organism that is birthed in a particular moment and has its own developmental history–really a life of its own. In other words, each person is a community made up of many living identities that are in relationship to each other and to the person himself. In order to discover these identities and our relationship to them, we can let ourselves fully experience our body sensations and start talking with them as if they are respected members of our community, each with its own story that it has been waiting to tell. All we have to do is ask.
HOW TO TALK TO THE BODY… AND WHY THIS IS IMPORTANT
We talk directly to the body sensations to create a greater immediacy. It is more real. Since each body sensation has its own identity and history, each must be addressed with respect. There are several aspects of this dialogue that tend to make traditionally trained therapists uncomfortable. The first is that the therapist helps the client learn to address these sensations directly rather than talking about them. For example, around a sensation of stomach queasiness the therapist might help the client by saying something like, “Bring you awareness to the sensation. Now, begin to talk with this sensation…”Queasiness in Stomach, (modifiers are not used because this is this identity’s “proper name”-remember ‘Duke of Earl was never The Duke of Your Earl) what have you come to share with me?” They might also explore with questions like, “Queasiness in Stomach, who/what are you? Where are you beginning? What is happening?” The therapist can even invite the client to become the sensation.
As the client does this many responses are possible. It is here again, that many traditionally trained therapists balk. Many images, words, and other sensations may arise. It is important to know that anything that occurs is part of the session. Having ideas/hearing words in their head (auditory) visualizing the narrative like it was a movie (visual) or reliving it (kinesthetic) are all equally good and common ways that clients experience this part of the work. When a session includes kinesthetic experiencing, it is necessary to understand that it is the sensation that is remembering and bringing forward stored information. The client’s observing ego or witness within is able to hold perspective in these moments in a way that is very empowering.
Listening to and working with body sensations requires a level of receptivity to the literal levels of the client’s work that is greater than many other ways of working. For example, a client came in describing their depression as “I’m weighed down. I can’t move. I’m helpless and hopeless.” These were sensations located as literal information in the body. They are access points to a “story” which we define as a narrative and/or set of beliefs. Where some might consider these statements of a problem or a vulnerability, we consider them power points of information. Inviting the client to locate these sensations specifically and then begin the dialogue with them is the entrance to the work.
Many treaters place greater emphasis on linear narrative. Whatever comes up IS the story be it simple sensations, fragments of thought or history, odd bits of historical information or coherent literal narrative. Metaphor and interpretation may or may not show themselves in the process. Many therapists are challenged to stay as present and as literal as this method requires, but the rewards are great.
Attention to “clean language” is essential. Mirroring exactly the sensation’s words and descriptors allows its identity to continue to come forward. Often even well trained therapists will substitute synonyms or quite unconsciously dilute the client’s language. The phrases, “That’s right, and…” or “Yes, and…” are useful to keep a session moving forward and in no way change the client data while maintaining active connection as the client does their work. The client reports uncensored whatever the sensations have come to share. As witness to this unfolding, the therapist’s capacity for patience, pacing and acceptance of whatever the client finds is sometimes quite challenged in this method, but that is the core of the practitioner’s art.
The transformative power of awareness cannot be overstated. It is often the case that bringing consciousness to these power points of information and allowing them to share their stories will facilitate a client making great movement both in the session and beyond. This cohesion of talking and body therapy is a very powerful and manageable beginning for both therapist and client as they move in new territories.