Burns-Lundgren, E., Walker, M., 2008. The Body in Dialogue. Reformulation, Summer, pp.18-19.
The majority of approaches to psychotherapy could be defined as being focussed on cognitive processes and/or the underlying psychodynamics, and on both the conscious and unconscious manifestations of these in the therapeutic relationship. As CAT therapists, this is where we mostly work. During the workshop presentation at this year’s ACAT conference, our aim was to introduce participants to the notion of the ‘body in dialogue’, being aware of and listening to its communications and how they relate to the therapeutic endeavour.
Being aware of the verbal and non verbal dimensions of communication is only part of a much larger picture. In addition to the expressions the body makes, there are also energetic changes influencing our ‘feeling awareness’ of both self and other. Although there are competing explanations as to how the body ‘encodes’ or ‘represents’ our psychological life and our emotions, (Van der Kolk, 2007; Rothschild, 2000) it can be accepted that psychological and emotional experiences do have this ‘expression’ in the physical domain. Not to notice this is to be ignorant of information we have access to, if we pay attention to both the client’s and our own embodied responses to what is going on. Focussing-orientated psychotherapy (Gendlin, 1996), mindfulness training and meditation (Kabat-Zinn, 1990), and other methods help bring to awareness and ‘process’ body changes and so allow them to become a routine part of the therapy encounter.
This is by no means new. Freud used the concept of ‘Libido’ to describe ‘energy’ (Freud, 1923) and indeed, before he refined his approach, he was known to physically interact with patients, ‘pinching’, ‘pressing’ and ‘kneading’ to relieve pain or help them remember things. (Freud and Breuer, 1895) Later, Freud said that the ego “is first and foremost a bodily ego” (Freud, 1923). Other important theorists such as Willhelm Reich followed, and today we have an increasingly mainstream psychological paradigm known as ‘Body Therapy’ with techniques ranging from breathing and imaging to physical manipulation. Eye Movement Desensitisation and Reprocessing (EMDR) and ‘Energy Therapies’ such as Emotional Freedom Techniques (Mollon, 2005) are becoming increasingly ‘evidence based’ and are being linked to psychoanalytic and cognitive concepts (Shapiro, 2001; Mollon, 2008).
Our sense is that CAT is quite a ‘heady’ therapy, which powerfully works in the arena of verbal and visual communication and description. In contrast, relatively scant attention has been paid in CAT to the information the body holds and especially to what it might be telling us about our own and our patients’ RRs. It is there in CAT theory, but almost hidden in terms such as ‘evolutionary predispositions’, ‘temperamental factors’ and ‘physicality’. Ryle and Kerr (2002) talk about ‘neurobiological process’ in ‘developmental mediation and internalisation of experience’, and draw attention to the biological effects of trauma, deprivation, and stress.
Trevarthen (1979) has given us powerful filmed illustrations of our Bakhtinian dialogic nature, showing infants having what appears to be an innate intersubjectivity, from the moment of birth – and perhaps earlier. They seem perfectly able to communicate at this early stage, without the mixed blessings of language. At the Dublin International CAT conference (2006), Trevarthen also stressed the importance of emotion in brain development -- ‘The Passionate Brain’ – echoing findings by Allan Schore (1994, 2003) and others.
Stern similarly draws attention to our ‘implicit knowing’, how we learn inter-subjectively and preverbally what to expect from others and how to feel/be/deal with others. ‘Nature was wise not to introduce babies to symbolic language until after 18 months so they would have enough time to learn how the human world really works without the distraction and complication of words – but with the music of language.’ (Stern, 2004) It is the music and rhythm in communication that Trevarthen also identifies. Stern stresses the importance of careful attunement by early caregivers, as well as within the therapy relationship.
So what relevance does this have for undertaking CAT therapy and for the workshop we ran? What we wanted to do was to ‘flag up’ the importance of bodily information as part of the process of empathising with and understanding the person in front of us and with his/her ways of holding and managing him/herself emotionally and physically within relationships, i.e. Reciprocal Role Procedures. Shaw and other body therapists emphasize that empathy is a bodily phenomenon; the body as well as the brain and psyche help us understand the world. This applies as much to us as therapists, as it does to the people we work with. Shaw reminds us that ‘We are embodied beings who happen to be therapists’.
Shaw goes on to state that ‘by being aware of what our bodies are saying to us while working therapeutically, and with the ability to use this information in an overt manner, it is possible to contribute to the inter-subjective nature of therapy. Our embodied sense is a means of contributing to a therapeutic story that is co-constructed by client and therapist.’ (Shaw, 2003) And here we are straight into CAT territory of Collaboration, Accurate Description, and Dialogic Reformulation.
CAT therapeutic discourse, as well as that of other therapies, explores the ‘Explicit Agenda’ (Stern, 2004), which aims to make verbal and emotional sense of the person’s life story. From this (hopefully) jointly created narrative a sense of continuity is given to the client’s experience. The client sees how s/he learned to view these experiences and deal with them.
And at the heart of this sits the person’s bodily sense of themselves. Many of our patients lacked the opportunity, when they grew up, to learn to attune interpersonally to the full range of their physical, emotional and psychological states. Many had their reactions overridden or denied, some were even explicitly forbidden to talk about traumatic events. Their bodies are, however, likely still to retain the memories (Rothschild, 2000) and the messages connected with them. If we are searching for the full, unalloyed picture of a person’s reality, it is therefore at our peril that we overlook or ignore information that clients may not have the words to tell us about, but which is nevertheless there in the therapeutic encounter.
The ‘Implicit Agenda’ in therapy is how RRs are likely to be re-enacted between us, and how we can together find straightforward and non-judgmental ‘Accurate Descriptions’ of these interactions and also find new, safe ways of communicating about them. For example, the body might vividly show a ‘Controlling-Controlled’ RR in how it holds itself or ‘holds in’ emotions. A hunched posture may in an instant communicate a cowed, frightened/abused role, or a placating TPP. Calmly reflecting on these observations can crucially add to a new ‘Dialogue’ that may be internalised, and re-enacted, both intra- and interpersonally, by the client.
Many of us probably automatically note the client’s posture, asking questions about what we may observe. Noting this and our own feelings in order to understand a countertransferential (CT) phenomenon is not new (Sheard et al, 2000). However, how often do we explain away that headache, stomach discomfort, tense shoulder, sore throat, tight jaw etc? Of course, it could be embodied personal CT, but it could also be an embodied, elicited CT giving us important messages.
In the workshop we tried to use Yalom‘s exhortation that ‘All is Grist for the Here-and-Now Mill’ – ‘Use it, Use it, Use it’ (Yalom, 2001). And in the ‘Here-and-Now’ moment we as therapists are as ‘Active Participants’ as ever our collaborating patients/clients are. If we are to be able to follow and describe triggering events and the sequences these give rise to in an accurate manner, we need to be quite specific in our observations. We need to be familiar with our own emotional and bodily base-lines, in order to be able distinguish these from what may be invited responses from the other.
During the workshop we began by simply becoming present. This involves (either standing or sitting) simply stopping and noticing the breath. Where do you feel it enter, is it fast or slow, high in the chest or low in the stomach, continuous or broken? And as you breathe, can you become conscious of the feelings in your body? It is here that it can be useful to do a body scan (Kabbat-zinn, 1990) and ‘check in’ with yourself and properly become aware of your body.
We then stood up and did some basic warm up exercises with the aim of more consciously inhabiting our bodies and being aware of any tension as we move. We focussed on loosening our arms and relaxing our shoulders as we moved our weight from side to side, turning as we did so. Over the course of the hour, we periodically did more moving and Qigong (energy work) exercises from a set known as the ‘Eight pieces of silk brocade’ (Cohen, 1997). We then moved on to some sitting exercises that involved ‘bringing an emotion/client/situation to mind’ and simply noticing what arises in our feeling sense (physical and affect) and what this may be communicating to us. In this process it was crucial not to think in terms of doing things ‘right’ or ‘properly’ but simply to become aware of, note and accept what actually ‘was’.
Physically, we have to be ‘body aware’, in order then psychologically to ‘get out of the way’ and experience our own ‘bodymind’ (Ralson, 2006). And it doesn’t have to be complicated, as Marcus Aurelius told us long ago in his Meditations:
“People try to get away from it all – to the country, to the beach, to the mountains. You always wish that you could too. Which is idiotic: you can get away from it anytime you like. By going within. Nowhere you can go is more peaceful – more free of interruptions – than you own soul. Especially if you have other things to rely on. An instant’s recollection and there it is: complete tranquillity. And by tranquillity I mean a kind of harmony. So keep getting away form it all – like that. Renew yourself. But keep it brief and basic. A quick visit should be enough to ward off all <…> and send you back ready to face what awaits you.” Hayes (2004)
In the therapeutic endeavour we may not always encounter tranquillity within, but rather conflict and tension. But we can find out about these equally readily by ‘going within’, and we need the capacity for tranquil observation in order to face the challenges without. For those interested in taking this further, a formal meditation practice, Taichi and Qigong can be of help, as well as other methods of bodywork, most notably Yoga.
Cohen, K. (1997) The Way of Qigong: The art and science of Chinese Energy Healing. Bantam Books. Great Britain.
Freud, S. (1984) The Ego and the Id In Penguin Freud Library Vol 7. Harmondsworth: Penguin : pp339-407.
Freud, S & Breuer, J. (1895) Studies on Hysteria. In Penguin Freud Library Vol 3 Harmondsworth: Penguin 
Gendlin, E. (1996) Focusing Orientated Psychotherapy. The Guilford Press. London.
Hays, G. (2004) ‘Meditations’, Marcus Aurelius. New Translation by. Phoenix,
Kabbat-Zinn, J. (1990) Full Catastrophe Living: How to cope with stress, pain and illness sing mindfulness meditation. Piatkus. Great Britain.
Mollon, P. (2005) EMDR and the Energy Therapies. Karnac. London
Mollon, P. (2008) Psychoanalytic Energy Psychotherapy. Karnac. London.
Ralston, P. (2006) Zen Body-Being: An enlightened approach to physical skill, grace and power Frog, LTD. Berkely, California
Rothschild, B (2000) The Body Remembers: The Psychopathology of Trauma and Trauma Treatment. Norton. London.
Ryle, A. & Kerr, I.B (2002) Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester. Wiley.
Schore, A. (1994) Affect Regulation and the Origin of the Self. Norton. London
Schore, A. (2003) Affect Regulation and the Repair of the Self. Norton. London
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Sheard, T. Evans, J (2000) A CAT-derived one to three session intervention for repeated deliberate self harm: a description of the model and initial experience of trainee psychiatrists in using it. British Journal of Medical Psychology. 73. 179 -196
Shaw, R. (2003) The Embodied Psychotherapist. Brunner-Routledge. Great Britain
Stern, D. (2004) The Present Moment in Psychotherapy and Everyday Life. Norton. London
Trevarthen, C. (1979) Communication and cooperation in early infancy: A description of primary intersubjectivity; Development of interpersonal and cooperative understanding in infants. In M.M.Bullowa (Ed.), Before speech: the beginning of interpersonal communication. New York: Cambridge University Press
Van der Kolk, B. Mc Farlane, A. Weisaeth, L (Eds) ( 2007) Traumatic Stress: The effects of overwhelming experience on mind, body and society. Guilford Press. New York.
Yalom, I.D (2001) The Gift of Therapy, Piatkus. Great Britain.
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