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The model of the mind is based on the integration of Psyche and Soma: A state of mind is a state of body, and a state of body is a state of mind.
In Biodynamic Psychology, the model of the mind embraces the entire field of experience: cognitive, emotional, sensory and imaginal. Mind encompasses the personal, relational, transpersonal and spiritual realms.
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organism: the way into psychotherapy with Berit Heir Bunkan, from Oslo.
In this lovely conversation with 87 years old psychotherapist Berit Heir Bunkan from Norway during the European Congress in Athens, 2016, we discuss about different ways to get into the body mysteries as for example through the 3 diaphragms, look at it, learn and like:
” Is the orgasm reflex a myth? “
In this dialogue Ebba Boyesen and Rubens Kignel talk about the “orgasm reflex” an experience of the psychoanalyst Wilhelm Reich.
Ebba Boyesen and the psycho-orgastic work talking with Rubens Kignel
In this video I talk with Ebba Boyesen about the psycho-orgastic work, don’t loose it.
Connecting body, mind and soul
Originally published in The Psychotherapist
Promotion of Health and Biodynamic Psychotherapy
Originally published in The Psychotherapist
Levels of Consciousness and Contact in Biodynamic Psychotherapy
Originally published in The Psychotherapist
Transformative Moments: Short Stories from the Biodynamic Psychotherapy Room Pt. 1
Biodynamic massage (Southwell, 1982) is an integral part of biodynamic psychotherapy (Boyesen 1980, 1981, 2001; Heller 2012; Lewin & Gablier, 2013; Southwell, Selles, Tanguay, & Steinberg, 2014; Southwell, 1998), which allows psychotherapeutic work within the framework of the body. The name ‘biodynamic massage’ encompasses fourteen different methods of touch. Almost all the touch methods can be performed at different levels of the body - the level of bones, the periosteum, the deep and superficial muscles, the fascia, which contain the muscles, the subcutaneous tissues, and the different levels of energy. A biodynamic psychotherapist is often guided by a stethoscope (either electronic or ordinary) whilst carrying out biodynamic massage (Southwell, unpublished; Stauffer, 2005, unpublished, 2010; van Heel, 2014); the stethoscope is utilized for listening to the digestive system’s sounds (also known in this context as the psycho-peristalsis) (Boyesen, M -L. & Boyesen, G. 1978). This makes it possible to obtain immediate feedback from the body about the level of accuracy, quality, and attunement of the touch applied. The experience of touch must be modulated by context and internal state (Ellingsen et al., 2016). The digestive system is more active when there is stronger activity of the parasympathetic nervous system, a branch of the autonomic nervous system (Guyton & Hall 2011). This subsequently creates greater activity of the vagus nerve - the tenth cranial nerve of the parasympathetic nervous system – meaning that stimulation that increases psycho-peristalsis results in non-invasive vagal nerve stimulation. "The parasympathetic innervation of the gut by the vagus nerve provides sensory information to the brain, enabling gut activity to influence emotions" (Gómez-Pinilla 2008, Mayer 2011). Invasive vagal nerve stimulation (VNS) has an influence on cognition and emotion and has become a routinely approved procedure for the treatment of refractory partial onset seizures and chronic (i.e. not acute) resistant depression (G.mez-Pinilla 2008). Another method for carrying out non-invasive vagus nerve stimulation is transcutaneous vagal nerve stimulation (tVNS), which in healthy humans reduces the activity of the sympathetic nervous system. In this way the treatment ameliorates many conditions which present with higher activity of the sympathetic nervous system such as stress, heart failure, tinnitus, obesity, and Alzheimer's disease (Clancy et al, 2014). These findings demonstrate some of the hidden potential of Biodynamic Massage as part ofBiodynamic Psychotherapy, since it can non invasively cause stimulate of the vagus nerve. This stimulation plays a big part in the movement towards health (salutogenesis), developing independent wellbeing and an organic self-regulation process (Boyesen & Freudl 2015). The biodynamic therapist also receives feedback from the client’s body through objective observations (Bunkan et al 2004, Friis et al 2002) of the body’s posture (Bunkan et al 1998, 2010, Heller 2012 chapter 13) , breathing (Bunkan et al 1991, 1999, Friis et al 2012) , solidity of muscles (hypertonic, hypotenuse, and isotonic) (Johnsen 1973) , the muscles’ capacity for mobility (Bunkan et al 2001, Kva et al2011) , and the skin (for example, skin colour, temperature and sweating). In addition, the biodynamic therapist obtains information from objective observations of the sensations, feelings and emotions that arise and subside in their own body. So the biodynamic therapist is guided in real-time not only through technique, but also via feedback from the client’s autonomous nervous system, objective feedback from the client’s body, as well as what the client volunteers about his/her body and intuition. Here, I define intuition as an impulse arising from within the self to perform one action or another. We need to differentiate between intuition and the actions of psychological defense mechanisms like projective identification and re-enactment. Over time, the biodynamic therapist learns to integrate all that information with the entire history known to him about the client, including events of trauma and adverse events that occurred during the client’s life. That is how adjustment occurs between the intention and the client’s neurodevelopmental process. Every patient is an entire book (Rako & Mazer, 1980) , a distinctive and pulsing new fabric. All theoretical knowledge is solely theoretical when the therapist starts working with a client: it must be discarded in favour of the direct experience of processes unfolding here and now. The therapist has to respond in an attuned fashion to the living phenomena of this particular client, in this particular relationship, in this moment of now, without any agenda or predisposition. The only constant in living phenomena is change (Inspired by Vipassana meditation course) , and the therapist must be attuned to a change taking place in themselves and in the client at every moment, and in the relationship to the levels of awareness and arousal in the framework of the client’s body and the therapist’s body. The delicate fabric woven in the field of relations is formed of countless items, including the therapeutic relations. Dynamic items change constantly; therefore, biodynamic assessment systems are grounded on evaluating the changes occurring (Southwell, 2014) , not only on a static snapshot of the client’s condition. What defines the quality of the work are our bodies, our awareness to our body – that of the client and of the therapist – in addition to mental processes, intention and attention. In the living phenomena called human, the landscapes of the mind and the landscapes of the body are one concurrent phenomenon. In the reality of a human, it is impossible to separate between them, only for the therapeutic discourse, which ensues after action. As Wilhelm Reich stressed, "the point that the unconscious does not exist in a psychological space that is independent of one's bodily reality, but is intimately connected to a somatic or energetic substratum" (Boyesen & Freudl, 2015, p. 582). And so, to understand biodynamic therapy as a whole, and biodynamic massage particularly, we have to understand and investigate the human as a living phenomenon, as it is happening now, in real-time. As biodynamic psychotherapists, our job is not to save or rescue. Our job is to promote and support changes in the person as pulsating living phenomena, as our client wishes. The client can be viewed as a system that has the capacity for self-organization and selfleadership. Psychotherapy is a healing profession and the healer is the client. A good biodynamic psychotherapist will support the client in healing themselves (Tanguay, 2014). LILY: A CLINICAL CASE STUDY This article was written following a review weekend with students of biodynamic psychotherapy, concluding their first year of studies. During that weekend, they worked under their own observation and that of three trainers. Lily and Roy are both students (not their real names). I’m unfamiliar with Lily’s life-story in detail. To conceal Lily’s identity and to fine-tune certain points, I have used her story with those of other clients to create a single figure who demonstrates what needs to be demonstrated. THERAPY Roy worked with Lily using a mixture of touch methods in different parts of Lily’s body, applying the ethical rules customary in the method. He chose to begin working with Lily’s shoulders because they were so painful; he evoted over half an hour to her shoulders. He used elements of ‘basic touch massage’ mainly at the muscle level, and combined it with elements deriving from ‘lifting and stretching biorelease assage’. Once he felt he had finished, he worked with ‘energy distribution massage’ on her legs. Lily said she was satisfied that he reached the soles of her feet, and that the therapy had een beneficial for her and that felt she had received what she needed from it. In biodynamic psychology we work according to an important principle stating that what the client feels is always correct, and we do not undermine the client’s sensations and emotions. "The basic therapeutic attitude is this: the method can betray the client, but the client can never betray the method" (Boyesen & Freudl, 2015, p. 584). We follow the client and trust the process because the client is a self-organized system possessing the capacity to reorganize itself with self-leadership. Otherwise, the client would not have come to us in the first place, and every other following session. POST-THERAPY FEEDBACK In the discussion that developed afterward, the question came up whether it’s worth combining different touch methods in the same therapy session. The usual recommendation is in principle to use a single technique with a particular sequence in one session. The discussion created an excellent option for taking an in-depth look at one reason why biodynamic massage constitutes non-verbal psychotherapy. Roy remarked that he works differently in each part of the body, in terms of the type of touch he uses and how much time he devotes to each place, but he gives the same quality of touch everywhere. He asked if it can be beneficial working in the same way with identical kinds of touch, time, and quality even if the different places in the body feel completely different - both to the client and the therapist. Before I discuss this important question and suggest another major perspective, I’ll note again that in Lily’s case she felt fine with the mix and match, and the client is always right regarding her feelings. As I mentioned before "The basic therapeutic attitude is this: the method can betray the client, but the client can never betray the method" (Boyesen & Freudl, 2015, p. 584). In addition, the context of this treatment was a single massage session, a oneoff session during a review weekend. So an analysis of the options that I list below isn’t necessarily relevant to this context. Rather, my intention is to discuss psychotherapeutic possibilities and considerations that can be offered from another perspective, and to weigh the advantages of this therapy with the same kind of touch, over the whole body, taking more or less the same time. THEORETICAL DISCUSSION Had Lily come to me for therapy, I would have asked myself several questions. Her shoulders were painful – I wondered whether they were bearing the load that other parts of her body were not sharing. Though Lily’s build seems thin and fragile, her shoulders look broad and strong. They have been painful for a long time, a matter of weeks perhaps: they are warm to the touch, and have marked muscle tension (hypertonus). The soles of her feet are cold and her leg muscles are flaccid (hypotonus) relative to them. Lily also retains tension within her body, in her internal organs. Lately, her digestive system released large amounts of tension, expressed in diarrhea and stomach ache: that tension had been retained in her body for many years. Recently Lily suffered strong bladder pain. She suffered the pain in her bladder for a few months and despite different kinds of medical investigation no medical reason was found explaining her pain. She twice received empiric antibiotic treatment, which seemed to have little effect. The pain in her bladder was so intense that she had to stay home and missed two days of study, even though she really wanted to attend the class. The previous weekend, Lily had also suffered a severe migraine that again prevented her from attending a class session. During several previous sessions, Lily had said that her back was painful. The day before Roy gave her therapy, she shared with us during her morning check-in that many of her pains in the digestive system and bladder had disappeared, she had also suffered all her life from anxiety, she now felt more empowered and her anxiety had decreasedsignificantly. She shared with us, with a somewhat frozen expression, that she had come for training because it was a question of either coming to learn or get older; the felt sense of her statement seemed to some group members like 'to learn or to die'. It is noteworthy that Lily is an intelligent, sociable and sensitive woman. She has academic training and has lived with her partner for many years. She has a stable and supportive relation with him, and they have children together. ASSUMPTION: THE CONFLICT IS RETAINED WITHIN THE BODY AND MIND Lily’s body appears to represent a significant conflict, possibly more than one conflict. If we look at the global picture, we can assume that the various pains retained within Lily’s body represent different parts of Lily, parts that do not communicate with each other. Her shoulders want to come to therapy because they are painful, but her bladder and sometimes also her head want to stay home. The shoulders are bearing a heroic burden while her hips and legs—physiologically constructed to assume heavy burdens together—do not participate, and don’t help her to carry the burden. In physiological terms we see that Lily’s implicit procedural memory is actively commanding her shoulder muscles to clench; even though conscious explicit parts of Lily feel intolerable pain and want to release her shoulders because the pain is unbearable. WHAT IS LILY'S PROCEDURAL MEMORY? Lili's memory, like every human's memory construct from different parts. Memory is now understood to be a collection of mental abilities that depend on several systems within the brain. … A memory system is a way for the brain to process information that will be available for use at a later time. Different memory systems depend on different neuroanatomical structures. Some systems are associated with conscious awareness (explicit) and can be consciously recalled (declarative), whereas others are expressed by a change in behavior (implicit) and are typically unconscious (nondeclarative)” (Budson & Price, 2005, p. 692). Procedural memory refers to the ability to learn things such as behaviour (Budson & Price, 2005) - in this case: to clench her shoulder muscles on the unconscious level. She has no insight into why she has been doing it for such a long period of time. She can not explain it as her procedural memory is non-declarative and the reason for the original behavior can't be consciously recall. DOES IT MEAN SHE HAS A “SHORT” MUSCLES IN HER SHOULDERS? It is important to acknowledge that people usually don’t really have “short” muscles, they have tense over-contracted hypertonic muscles and under-contracted hypotonic muscles. Most of the people who come to us, if they should (god forbid) die, the muscles will relax and their posture will change and improve (my apologies for the rough description). Most people, usually have no structural abnormalities, no bony or muscular deformation. This means that in order to keep a “short” muscle short, the brain actively and unconsciously has to repeatedly send messages to the muscle to contract. It does this for 24 hours a day, 7 days a week, for years on end. Furthermore, when the brain gets the information from the muscles via interoreceptors - called proprioreceptors (which are called alpha [α] spindles) - that this is the level of contraction of these particular muscles, it still translates this as good essential contraction, despite the fact that some other interoreceptors send the brain messages of pain and will ‘scream’ at the conscious part of the person “this is a terriblypainful contraction”. The brain’s un-coordinated and un-integrated activity happens because of the person’s implicit procedural memory. It is a fundamentally automatic learned skill and it is a real concrete reality, not an imaginative process. This presents us with a question: why does the brain keep this mismatched and un-coordinated painful activity of the brain-mind-body? It always has very good reasons to do so. We know that the total human system functions energetically as an economic system. It will do (or not do) something only if it is somehow “cheaper” economically. This means that somehow, there is an advantage to the system at that particular moment to choose to carry out an action like over-contraction of a muscle even though it is painful. Most of the time, this advantage is not logical to the conscious SELF because the conscious SELF does not have access to most of the information available to the total system that we are. LILY Returning to my previous assumption that different parts of Lily want her to do completely different things, it’s perhaps unsurprising that ultimately she gets a migraine and her head ‘explodes’. Perhaps it’s because her head can’t decide which of her parts is right. Which part should she listen to and act according to? Each part of her body retains a different aspect of Lily’s desires, and each part represents a different aspect of the conflict she’s experiencing. But we don’t know what the conflict is because she experiences it unconsciously and is unaware of it. When I give each part of Lily’s body a specific, different therapy, I’m using the reparative model of the therapeutic relationship (Clarkson & Wilson, 2003) regarding each part of her body separately. But at the same time, I don’t relate to a split or conflict/retained within her. Even if it helped Lily to receive a different type of therapy for each body part, any outcome benefits would only be temporary because I didn’t relate to Lily as a single system, as one organism unable to work together and solve the conflict. I had to support the reorganizing of her entire body as an organism that can heal itself because it has selfleadership. In that simple physiological reality of Lily’s body, only one person can release Lily’s painful, tense muscles - Lily herself. Her mind must find a way into the labyrinth of the complex human brain towards the non-implicit unconscious procedural memory, render its content conscious and explicit, and find a way to change something within the procedure before storing the procedure once more. I can only suggest possibilities. It goes without saying that in this kind of therapy I also didn’t address two very important emotions that Lily shared with us. The first, the conscious one, is the anxiety she has suffered for years. She says that now she suffers less - but it did not disappear . The second feeling – less explicitly articulated and crucially important—is trapped in her sentence and the frozen expression that accompanied it when she said why she came for training. For her, as she said, it was “coming to learn or growing older" a sentence that some people picked up as "dying”. Is despair also trapped in there? Or another emotion? It’s a dramatic sentence that requires attuned attention. And we are obligated to remember that the emotions trapped there are the reason why she is here now, on Roy’s treatment table, because this emotion brought her to training. The fact is we don’t know anything that Lily herself has said about how those emotions exist within her. Any emotion is a collection of phenomena taking place in Lily’s body. Emotions do not occur in the human brain as a phenomenon that’s detached from the body but are experienced as a physical phenomenon of sensations in certain places in Lily’s human body. There are questions we must ask Lily herself. How does she know that what she’s experiencing is anxiety? What does she feel it in her body? Butterflies in her stomach? Is her heart racing? Does she have a sense of pressure in her chest, and difficulty breathing? Does she feel as if she’s choking, and the words won’t leave her throat? Perhaps she has a general sensation of weakness in her limbs? Maybe she feels frozen, immobilized? And perhaps she’s experiencing anxiety in another way that I haven’t listed. These are the critical questions we must ask Lily, and a no less critical question is – which emotions are trapped in that sentence “coming to learn or growing older". We need to examine with Lily how those emotions emerged in her body, how she identified what she was sensing and feeling. Even if Lily was satisfied with the treatment she received, which is indisputable, it’s important that we realize consciously that we have collaborated with the split, the lack of communication, and the lack of integration. And furthermore, that we didn’t necessarily relate to all Lily’s emotions during the treatment. NEGATIVE TRANSFERENCE AND POSITIVE TRANSFERENCE We have to be aware that when we work with different parts of the body and use various approaches, there is a risk that a more negative transference might develop. Sometimes, chiefly when there is a split, we observe that the different parts of the body can develop a sort of ‘envy’ towards the other parts that are being treated. We try to avoid that sort of negative transference because it’s hard for the client to receive such a powerful and intimate touch from someone towards whom they has negative transference. And so, particularly because of the strong degree of intimacy that this relationship calls for – a relationship that permits touch - we are interested in fostering positive transference. It allows us to work beyond the defense mechanisms, to enable a secure attachment, and to support the construction of important mental structures. Later on, I discuss the importance of developing a secure attachment. EQUANIMITY AS A WAY FOR INTEGRATION What then could happen differently if, during therapy I suggest a treatment that’s identical in terms of the type and quality of touch, and the time needed, for every part of Lily’s body? Identical treatment throughout her body could suggest to Lily - in a non-verbal way - a novel idea. A novel idea in which all the different parts of her body are my ‘clients’, and each one is important to exactly the same extent. Even in parts that are ‘screaming’ with pain, like Lily’s shoulders, even those that won’t let her shoulders rest, even those immobilized by cold, like the soles of her feet, and even those that still haven’t learnt to communicate, and those whose existence Lily may still be unaware of. Every part of our body has sensation. Where there is sensation, there is life. And where there is life, there is change. In fact, change is the only phenomenon that is permanent, not only in all living phenomena. The clearest evidence of this is seen in the sensations we feel in our bodies, which always arise and subside. Our ability as an organism to develop inner integration and inner communication between the different parts plays a critical role in developing awareness to the various sensations, to change, and to the life pulsating within us. Separated parts that do not communicate cannot help an organism to function effectively as a system. Their beauty is that they are part of an overall array. A simple example: what is beautiful hair? Hair is beautiful only when it’s part of the organism. But if you find a single hair on your dinner plate, you wouldn’t find it beautiful. A hair isn’t part of the organism when it’s out of context, it is not beautiful, it has disintegrated and lost its beauty. So, if I suggest to Lily in a non-verbal way, through touch, that all parts of her have the same degree of importance, like a mother loves all her children equally even if they’re all very different from each other, I’m proposing something new. That all of the parts can, metaphorically, sit side-by-side at a round table like King Arthur’s table. They can have a conversation and perhaps this can encourage them to hold an inner discourse that leads to collaboration. That was the breakthrough idea that King Arthur suggested: though he was King and had supreme power, his knights, whose task was to fight and govern the country together with him, could all talk equally around the table, and influence how the country was run. There’s a possibility that if this sort of discourse happens, and the mode of operation becomes absolute, Lily’s head wouldn’t have to explode with pain in order to decide what to do. This approach is also backed mathematically by findings of game theory. The mathematics of game theory demonstrates clearly that collaborating is the most effective method for all participants in the game to move ahead. In the long run everyone gets more, and enjoys the results: even if there’s a risk that they may have to compromise, in the long-run the compromise pays off. This is one of the deeper significances of integration. In this kind of integration, every part is important and communication between them is vital. Integration is like a fruit salad in which we can still recognise each fruit - the strawberry, apple, and banana. All of them combined create a fruit salad, unlike a smoothie. All of the parts and systems that form the finished organism, are a single system functioning together. Together, it can attain the most effective results. More cooperation and collaboration create greater coherence. It is a gestalt in which the whole is more than the sum of its parts. The change isn’t effected by me as a therapist, but by Lily herself. My role is to invite all the parts of her body to a roundtable discussion – it’s an invitation to function more coherently as a single organism, as a communicating whole. Not everyone responds similarly, of course, but if we don’t suggest it, we’ll never know what new places could develop when we propose identical therapy for all parts of the body. BACK TO LILY We know from the literature that, in general, people who suffer prolonged anxiety underwent past traumatic psychological incidents or adverse events. The implication is that we need to examine this possibility with Lily. It’s almost certain that the split that her body presents and her continuing anxiety need to be viewed against that backdrop. Although Lily at this stage, she hasn’t yet shared her past with me, which is common at the start of therapy, it’s important that I assume that something happened in her past that brought her to the current situation. Like other clients, Lily didn’t come to us out of nowhere but from the reality and experiences that formed and shaped her, and brought her to where she is, the way she is, today. My assumption is that Lily experienced something in childhood, something probably frightening that she only survived and remained sane by clenching her shoulders and fixing her body in its present condition. It was a normal reaction to an abnormal situation. If she underwent those experiences frequently, her body was no longer able to relax its muscles; it simply stayed that way, like in the story of Reich’s experiment. Wilhelm Reich’s experiment with an amoeba Wilhelm Reich, the father of Western physical psychotherapy, was a physician and scientist in his approach—he performed many experiments. The story says that one of his experiments was on an amoeba, an organism consisting of a single cell and a membrane. It moves by extending it pseudopods, which resemble arms, to make basic swimming movements, engulf food particles and bring them into the organism. This organism is constantly in movement of some kind, and as long as it moves, it is alive. As I said previously, change (expressed here in movement) is the only phenomenon that is permanent and distinctive, particularly in living organisms. Reich observed the amoeba under a microscope and decided to perform an experiment on it: he pricked the amoeba once without damaging its membrane and observed its reaction. He saw that it seemed to contract, freeze momentarily and stop moving. After a while, the amoeba recovered. Its behavior showed nothing to indicate it had been pricked. But, when it was pricked several times, although the membrane wasn’t damaged, it remained clenched and didn’t resume moving. Finally, because it no longer moved, it could not engulf food and died. A SIMILAR PROCESS IN THE BODY Similarly, that is what happens to muscles: after they contract many times into a specific position, they often stay contracted and are not released. The contraction and the inner split become fixed, because of a recurring action which became a procedure, and automatic process control by implicit automatic procedural memory. This is the disregulated way in which Lily survived her childhood. This is how she temporarily solved the insoluble problems that she had to deal with. It was the best way she could use at that time, when her needs were not met properly and the terrifying experiences recurred constantly. And regrettably - despite the frightening incidents that happened to her, and even though they no longer happen and there are good prospects she will never have to confront the reality which she did in the past, she doesn’t have to clench her muscles today - she still cannot release her muscles and reconnect the parts that have split away. All of this, because the reason and the process are reinforced in her memory as an unconscious process. SAFETY AND SECURE ATTACHMENT Now, during therapy, I can propose something new. As well as equanimity, I can propose another novel idea – that it’s safe now. I suggest it both verbally and nonverbally, particularly through touch. When I perform touch correctly, it helps by activating the hormonal systems to create oxytocin, and the parasympathetic nervous system is activated via vagal nerve stimulation. When they are jointly activated, this in turn activates the social engagement system. It’s an opportunity to examine the option that perhaps now, this moment is safe. Perhaps now she can release her muscles, let the tension go. It’s an invitation to negotiate, to re-examine conditions and options, to let something new happen. Another way of widening the sphere of confidence is by identical treatment over the entire body. Like this, the contact is systematic and identical, and it allows prediction; when a client anticipates touch, it helps her or him to be more relaxed. A basic condition for negotiating is Lily’s ability to develop the capacity to observe the sensations in her body as if it’s one unit. Sometimes this is only possible by presenting Lily to equanimity, as an organism aspiring to function harmoniously and integratively. In the following stage, she has to make sense of the various processes unfolding within her. During the process, it’s vital that she’s in a safe, nonjudgmental setting, and then we can negotiate and check new options at the ‘round table’. By addressing all parts of the body equally, equanimity can be a good method, enabling physical and mental integration. SUMMARY As yet, I do not know Lily well enough. I don’t know what in her history taught her shoulders and back to be tensed to the point of pain, to be so fearful. But what I do know is that it’s Lily alone who can find the winding, convoluted path in her brain towards the procedural memory that guides her motor region to continue clenching her shoulder and back muscles, despite the intense pain. Only Lily can extract that procedure, bring it to consciousness in her brain’s frontal area, and reexamine if there’s something else that she, as a whole organism, can do for herself to diminish her pain and live her life. And so we have to open the door to negotiations and integration, verbal and non-verbal alike and this is the therapist’s role. From that respective, equanimity is likely to be the path worth taking. Dr. Elya Steinberg, MD, is Co-Director of the Centre for Biodynamic Psychotherapy (London School of Biodynamic Psychotherapy). She is a medical doctor and biodynamic psychotherapist who integrates body-psychotherapy, Gerda Boyesen methods and bioenergy with psychological trauma work, martial arts, conventional allopathic medicine and complementary medicine. She interweaves alternative and conventional approaches to allow a person to grow as a holistic complex and improve their well-being. In partnership with Gerhard Payrhuber she facilitates the group 'Attending to the Silence’ for second and third generation Shoah survivors, perpetrators and bystanders.
How can we evaluate the subjective and objective aspects of effectiveness in the therapeutic alliance?Fundamental limitations to current scientific writing about therapeutic processes
Somatic Psychotherapy Today | Summer 2017 | Volume 7, Number 2 | page 39 In this article, I propose that there are fundamental limitations to current scientific mainstream methods of writing about therapeutic processes that in fact hinder our ability to both write about our therapeutic process and to learn from other clinicians’ and researchers’ writings. In my view, these limitations may partially be compensated for by allowing creative writing, poetry and other forms of art to be the major part of a case study, where the objective measures must be integrated into the subjective frame of writing. Creative writing conveys its truth by acknowledging the intense subjective complexity originating from sensations and emotions accompanying the actual objective memory. Therefore, describing only the client and therapist’s narrative itself or material that is only observable by external senses, heavily compromises the quality of the therapeutic process. By therapeutic process, I am including all interactions that a person has concerning any aspects of their health, whether with a medical doctor, therapist, psychotherapist, body-psychotherapist, psychologist, physiotherapist etc. In this article, for simplicity I will call all those from whom the person seeks support the Therapist and the seeker a Client rather than a patient. In some other places, when I think that the important aspect of the experience is simply human and is not dependent in a particular function or the differentiation between therapist and client I use Person or Participants. These fundamental limitations to current scientific mainstream methods of writing about therapeutic processes prevent full understanding of the quality of the therapeutic encounter and create a situation whereby the writing is potentially disloyal to the personal truth of the participants. For example, the measure of wellbeing, pleasant/ unpleasant or pain/ no-pain are clearly an individual perception and sensation. Those reflexive individual perceptions of wellbeing, pleasure and pain are complex multidimensional experiences that have defied our understanding for centuries. The reflexive awareness of those qualities of human consciousness, i.e. sensations, emotions and feelings, originate from the internal visceral aspects of the body (Damasio, 1999b, 2013). Still most case studies do not reflect on those important internal embodied experiences of the self of any of the two participants. At the end of the day, the efficacy of therapeutic intervention can be judged mainly by the clients only and deeply embedded in their inner motivation and their perception of themselves in their internal world, which is based on the maps of our visceral function as well as the external world. I will discuss these limitations from the point of view of Protagora’s (fl 5th C BCE) dictum “Of all things the measure is man” . . . I will do so without getting into dialectic argument, which could be essential in cases of cognitive dissonance and Equilibrium of Destructiveness. I will discuss these latter ones elsewhere. However, when we look at phenomena from the point of view “Of all things the measure is man” (DK8ob1), we must look at the ‘dual-aspect monism’ (Solms & Turnbul 2005) viewpoint. The monism claims that body and mind are one rather than accepting Descartes’ dualistic point of view that body and mind are made of different fundamental basic components. In addition, this one ‘thing’ can be perceived by two valid ways. Those two ways to perceive this one ‘thing’, objectively and subjectively are both measured by man, and I will elaborate on the question of how can we interweave those two valid ways of perception by man while reporting on the therapeutic encounter. I suggest that this way would be more accurate and could possibly support not just more fruitful communication between scientists and clinicians but also help stepping forward answering Searle’s question (Searle 1995a p62) ‘How does the brain get over the hump from electro-chemistry to feeling?’ A mixed method study of writing that interweaves objective and subjective phenomena may potentially offer more information necessary to investigate therapeutic processes from a ‘dualaspect monism’ (Solms & Turnbul, 2005) perspective that claims the body and mind are one, and we have two ways to perceive it: objectively and subjectively. The immense magnitude of information brings us to a crucial limitation—the need to choose from an infinite number of details that create the web of phenomena, which details do we discuss in a particular article? We usually strive to choose the details that express and present to us an important quality of the therapeutic process. One fractal picture from multifractal scaling information in motion or a particular emergent property. The process of choosing the particular facts that we intend to present in an article is always biased by many factors, for example: the researcher and the editor’s personal life and capacity to perceive phenomena; the wider social construct and ecological, economic and political situations. These biases compromise even further the writer’s capacity to present the quality of the therapeutic encounter. An example is presented by the enormous gap between conventional medicine and Chinese medicine. Both disciplines are successful systematic methods used to assess the health of a person and to suggest a course of improving the health of the client . However, each discipline chooses to consider a different group of facts and details from the infinite number available. Hence, they have no common language for communication. Sadly, this gap exists not just between Eastern and Western philosophy, but also between different Western disciplines such as medicine and psychology and even between different methods of psychotherapy such as cognitive-behaviour, psychoanalysis and body psychotherapy. One of the major challenges I observe arising from this lack of common language is a disrespect and a form of competition between the disciplines and therapists, each one claiming that it holds the absolute truth and the best way to attain human health. It has become a hidden power game rather than a collective effort to best serve the client’s needs. With these basic thoughts about our human incapacity to be objective, I let go of the idea of trying to be ‘objective’. I believe that there is a danger inherent in the attempt to be objective about the therapeutic encounter that is often the result of coincidental historic circumstances, or an arbitrary difference of opinion at the time of creation that does not provide the dynamic stability required for the processes and issues present in the therapeutic encounter. Many of the conclusions that claim to be objective tend to become ogmatic ideas or authoritarian politicalidentities that are no longer examined by thetherapist, as though they were mathematical axioms not capable of being excluded. It is par for the course that differences of opinion and questions about objectivity and subjectivity will always exist, and there is a question as to whether it is truly possible to utilise them without coercion and without even the slightest hint of violence. With that, it is well to recognize that expression of the experience is born of the desire to know the truth, and the intention is to protect the public from moral negligence. Hence, in this article I allow the flow of information to emerge from me in a process of creative writing, trusting the process rather than any premeditative preconception of how it is supposed to be written. There is more than one way to approach gaps in communication when we present the quality of the therapeutic encounter. Here I would like to explore ways to bridge scientific thinking and human experience . Scientific classical thinking is the thought process that is traditionally supposed to help us find objective truth. However, scientific thinking brings dualistic thinking into life in the form of an absolute ‘truth’ or absolute ‘non-truth’. It has a very little space for the spectrum of differences and relativity. Life is composed of infinite subjective and objective experiences. These infinite possibilities comprise personal truth. Originally, science evolved to explain human experience rather than the other way around. I think this leads to confusion. Many people look to science to validate their experience. However, their experience does not need external scientific validation to present accurately personal truth. It is for science to ask the questions how and why a particular truth is experienced as it is. It may be a truth that science cannot explain all subjective human experience, however it does not give it the moral right to belittle experience that it not yet explained. This means that in this article, first and most importantly, it is subjective human experience that will be presented as subjective personal truth, using creative writing in which I embed objective scientific findings that can explain some of the infinite possibilities of human reality. Some scientists may dismiss the creative writing as “almost literature” as did a reviewer of one of my articles. They may dismiss it, rather than looking at the interesting phenomena of how and why the particular flow of interactions gave rise to poetic writing and in which way this particular way of writing makes the reader feel surrounded by the flow of interaction inside the web of phenomena and connected to the real experience, rather than disengaged from it. In psychotherapy and some other disciplines, creative writing can bridge some of these gaps in communication. Poetry and creative writing may emerge from within the therapeutic process as phenomena in the client, the therapist, the supervisor or all three people and serve as a: “coherent narrative that does not betray personal truth”. They emanate from the “embodiment of psychic matter” of material such as indescribable, unbearable pain, enormous pleasure or praise for virtue. Subjective experiences that the human mind cannot comprehend completely by using the scientific vocabulary, which essentially lacks an appropriate narrative. Creative writing serves as part of a necessary process enabling us to assimilate the experiences. It works especially well where the incomprehensible traumatic experience feels compromised by any form of intellectual analysis. Creative writing conveys the truth by acknowledging the intense subjective complexity originating from sensations and emotions accompanying the actual objective memory. Therefore, describing only the client and therapist’s narrative itself or material that is only observable by external senses, compromises the quality of the therapeutic process. Yet, I am left with the most malignant questions that I struggle with. Therapists - whether medical doctors, sychotherapists, body psychotherapists, psychologists, physiotherapists etc. - read and write ‘case studies’ to be able to learn from each other and from other therapists’ experiences as “the greatest obstacle to discovery is not ignorance, it is the illusion of knowledge” (Boorstein, 1984). How can we be more effective if we will not do so? In the field of ‘manmade’ trauma, we oftentimes write about people who are highly traumatized, most of whom have been betrayed by the people who they should naturally be able to trust the most. People who have risen from the graveyards of an abusive childhood and neglected life, when they were treated as objects to satisfy the desires of others. Regardless, they have managed to build new lives as positive contributors to society, and possess special qualities that arise in a person when they need to survive resistance and oppression. They develop their strength against all odds and despite the conditions. They are resilient. They survive in conditions and environments that we, as therapists, may not be able to survive with our sanity intact. These people hold within themselves screams of pain juxtaposed with roars of victory. When I/we write about them in an objective manner, reducing their full manifestation as human beings, as subjects, do we not retraumatize them? Re-enact their original trauma in a malignant parallel process? Treat them as objects again? Do I/we reduce, intellectualize and rationalize their pain and agony, because as therapists I/we are not able to deal with their live full embodied pain? Do these clients and patients feel seen by me/us? Do I/we really see them and support them by telling their ‘objective’ story rather than their subjective story, to help them, and maybe also ourselves and future generations? or do I/we betray them somehow inside of that energetic quantum field by making them an object rather than a subject? This leads me to what I see as the Fundamental limitations to current scientific mainstream methods of writing about therapeutic processes(1) The first limitation is that in many of the current mainstream methods of writing about therapeutic processes, most of the processes encountered are measured by outcomes and notby process. This happens regardless of the fact that the quality of the outcome stems from the process. A dynamic process embedded in a complex dynamic matrix. Allan N. Schore (2002) writes, “The essential task of the first year of human life is the creation of a secure attachment bond of emotional communication between the infant and the primary caregiver. To enter into this communication, the mother must be psychobiologically attuned to the dynamic crescendos and decrescendos of the infant’s bodily based internal states of autonomic arousal” (pg. 9). Therapists, similar to the mother, wishing to offer a secure attachment bond in the therapeutic encounter also “must be psychobiologically attuned to the dynamic crescendos and decrescendos of the” client’s “bodily based internal states of autonomic arousal”. This a dynamic process that needs to be reflected upon with language that echoes on the deeply subjective dynamic crescendos and decrescendos of bodily based internal states of autonomic arousal. (2) The second limitation, which we can see as one of the extensions of the first one, is that the quality of the therapeutic process can’t be simply defined as an absolute measure. The existence of the quality of therapeutic encounter is dependent on multiple factors. For instance, Norcross suggests common factors that work in psychotherapy such as: alliance between therapist and client, cohesion in group therapy, empathy, listening, collecting client feedback, goal consensus, collaboration, positive regard, positive support and more. He also suggests factors that do not work in sychotherapy, such as some styles of confrontations, frequent interpretations, negative processes, assumptions, therapist’s centricity and early ruptures in the relationship. However, around 40% of the factors are unexplained therapeutic variance. Those, in my opinion, cannot be defined as they stem from the quality of the dynamic harmonious flow of interaction insidethe web of phenomena. When you have ‘quality’ in the room, you recognise when it is absent from the room. It is measured by subjective human experience and defined by the felt sense and capacity to appreciate ‘quality’. We can’t analyse this quality using rational systems of order. We can express the impact of the quality on the participants using creative writing or art, but we cannot describe it with scientific vocabulary. We can no more catch the flow of interaction than we can catch water in our hands. We need to relate the dynamic patterns of flow of the interaction, to the quality of the motion of a movie, rather than to separate pictures. (3) To explain this limitation, I will borrow a concept that originates in quantum physics: the uncertainty principle of Heisenberg. The uncertainty principle of Heisenberg determines that we cannot be certain about the accurate value of some pairs of variables, even not with the most accurate instruments. The best way to describe it is by using the following equations. In classical mathematic we say that 5X4-4X5=0. Meaning that the variables A and B are exchangeable. AXB –BXA=0. However, according to the uncertainty principle of Heisenberg, some pairs of variables that describe the way these elementary particles behave are not exchangeable, meaning: AXB-BXA≠0 One of these pairs is momentum and location. This means that if you know everything about the momentum of an elementary particle, then you cannot know its accurate location. If you know all about the location of an elementary particle, you do not know its accurate momentum. Momentum is a term that defines the direction and intensity of the movement of a particle. Now I will use the principle as a metaphor to explain my biodynamic perspective of therapeutic encounter. If I take a camera and take a picture of a moment in therapeutic encounter, it will give me an accurate location of the client and therapist at that moment. The picture provides me with a static location. I can gather maximum data on that phenomenological moment and ideally include everything that is captured in that moment, subjectively and objectively, by both participants and the observer of the moment. I could possibly write a paper on just that particular moment. In addition, we will gain information that enables us to diagnose the client with one of the known diagnostic methods such as DSM or ICD, which methodologically are based on sum of static pictures of the client. However, informative as that moment can be, it will provide no information about the momentum of the client and therapist I could take a video camera and record a movie. This movie might provide me with a full account of the dynamic flow of interaction, the ways of change and directions that appear in the client and therapist. Ideally, I could capture the objective and subjective dynamic complex phenomena. A particular location will become a vague phenomenon when I have clear information about the dynamic process of the flow of changes and interaction: How are the client and therapist moving nearer each other or further apart? What are the parallel changes in heart rate and heart rate variability of the client and therapist and how does this relate to the subject of conversation or silence in the room? The Biodynamic diagnostic system is essentially based on that information, information about the momentum that in the participants and inbetween the participants and in-between the participants and surroundings. A therapeutic process has clusters of information that are organized in reiterative and partially overlapping patterns and present the idea of a fractal experience. The fractal experience is crucial in the understanding of the ‘location’ of the participants in the therapeutic process. However, a fractal is still a static picture that give rise to the exhibition of multifractal scaling information in motion and unpredictable dynamic emergent properties. That dynamic motion would be crucial in the understanding of the ‘momentum’ of the participants in the therapeutic process. This kind of information cannot be expressed using words that describe the static picture. Nevertheless, it can be partially expressed by the subjective flow of creative writing. (4) The forth is that not all processes are alike and the individual match between Client - Method- Process -Therapist is crucial for a successful process that will result in a successful outcome. For example, in medicine, the process includes far more than the particular prescribed medication. The interweaved processes will determine for example whether his particular client will use the prescribed medication, follow what the doctor thinks is the ‘correct procedure’ or take the advice given. Some of the most popular research methods that scientific writings are based on the Randomized Control Study (RCT) protocol. In RCT, the researchers intentionally exclude the individual match; therefore, they can never capture some of the crucial essence of the therapeutic encounter. ( 5) The fifth limitation stems from the fact that the client and the therapist are part of the vast web of phenomena of the therapeutic process, which is an open, dynamic, complex system. This process is taking place beyond verbal content and observable measures. Traditionally, there are two main sources of relatively neglected information that needs to be taken into consideration methodologically: (5a) nonverbal information and (5b) non-observable information. Various aspects of non-verbal information are already considered by some researchers in developmental psychology such as Edward Tronick and Colwyn Travarthen, but not enough has taken place within the therapeutic encounter. (5a) Non-verbal information can be observed by watching systematically. For example, we can watch : micro-movement, macro-movement, patterns of breathing, motility and posture,dynamic changes in the colour and moisture of the skin, the music (i.e. the harmonious and disharmonious, the tune, tone of voice, accentuation, the pitch, the intensity etc.), the ‘dance’ of the participants in relationship to each other and gestures accompanying the lyrics (the words). 5b) Non-observable information contains vast reservoirs of informative aspects. I will mention three of them here: (5bi ) First are all the internal milieu, composed of a variety sensations, emotions, thoughts, psycho-neuro-immuno-endocrinological changes and the interlinked dynamics of the way they emerge. This can be partially observed during a session just by the trained participant who is able to use their own body as a measure in the resonance between the participants, for example via touch. (5bii ) The second aspect is historical (personal history and general history), social, ethnic, political and ecological that create a combination of dynamic realities. Prior learning experiences give rise to the particular perception in context and time of the therapeutic encounter, which includes the haptic communication. (5biii ) Third and no less important, it is hardly discussed in the literature: What are the people in the room choosing not to say? What are their reasons for conscious withholding? Furthermore, what happens to the participants in-between the sessions? And how can we evaluate the subjective and objective aspects of effectiveness in the therapeutic alliance? Evaluating the subjective and objective aspects of effectiveness in the therapeutic alliance In 2007, I was asked by the director of Confer to present and demonstrate how Porges’ Polyvagal theory is relevant for a clinical setting. I began that presentation by quoting the Israeli riter Yochi Brandes (Kings III, 2008): “Stories are a more efficient weapon than swords. The swords can only kill those who stand before them, in contrast to that, the stories determine who will live and who will die in later generations too.” That sentence followed a presentation of the story of one and a half hours of work I did with a person who had not moved for over two hours before I entered the room. It was a process of supporting a survivor of extreme abuse and torture (SRA; Survivor of Ritual Abuse) who suffered from Dissociative Identity Disorder (DID) in freeing himself from a voodoo death state. I presented that case a few times afterwards and called it “Voodoo Death, Dissociative Identity Disorder (DID) and Biodynamic Psychotherapy”. I unfolded the multi-layered phenomenology of the complexity of the subjective human experience of Biodynamic Body Psychotherapist at a micro-analytical level. I employed analysis from a variety of viewpoints originating from different theories and mythoughts were woven into the story as it unfolded. I followed the story from the perspectives of ontological and epistemological research as participatory (therapist), drawing together the professionalism with the direct authentic and Hursselic personal level. I reflected here not only on viewing external conditions - as done by the naturalists - but also on viewing the internal conditions and thoughts that cannot easily be measured, and by the inclusion of another spectator. My intention was to describe the complex processes of co-adaptation and co-regulation. I am doubtful as to whether I can properly describe and deal with such complex processes using only one sense, and whether they can be represented correctly by offering up a long catalogue of objective facts. For this reason, I broadened the viewpoint as far as possible to create a holistic web that includes body and soul as one, the story, Biodynamic Psychology, attachment theory, trauma work, and neuroscience. I still remember how the sense of real terror that enveloped the client spilled out into the huge conference room as I invited them to feel the story. At that time, it was not just a sterile case study about trauma; at that time, it was about a palpable person who had experienced trauma who then entered the room for the audience to have the direct experience and process with them. When Porges read the 40-page story he said an essential sentence to me— “I visceralised the patient.” Porges understood the accuracy that we gain when we describe the subjective qualitative aspects of the clinical material. Those subjective qualitative are body based and represent the internal map of the functions of the viscera. It gives rise to our consciousness. (Damasio, 1999, 2013; Solms & Turnbull, 2005). This background state of consciousness represents the most basic embodiment of the SELF. It is full of meaning and feelings. It does not just represent the self it also provides the reflexive content that tell you your situation in your life. I believe that we need a new scientific language that can enable us to feel the story and fully understand the client by re-experiencing, on a mini-scale, what the client and therapist really felt subjectively. I will share a few paragraphs from that story with you that has been published in the 2015 Biodynamic body-psychotherapy conference book, to show how poetic writing enabled me to dive into the personal subjective qualitative aspects of the clinical material. To enable the capture of the subjective qualitative aspects of the clinical material of this case, all was data, all mattered, beginning with the name. For example, I chose to call it “Voodoo Death,Dissociative Identity Disorder (DID) andBiodynamic Psychotherapy” rather than any of the other, more sterile options such as:Catalepsy, DID and Biodynamic Psychotherapy Catalepsy: a general term for an immobile position which is constantly maintained Catatonic rigidity, DID and Biodynamic Psychotherapy Catatonic rigidity: the voluntary assumption of a rigid posture held against all efforts at initiating movement Catatonic posturing, DID and Biodynamic Psychotherapy Catatonic posturing: the voluntary assumption of an inappropriate or bizarre posture, generally maintained for a long period of time ‘Death feigning behaviour’, DID and Biodynamic Psychotherapy - the less dramatic name used by physiologists for the voodoo death state I chose that particular name because it allows the real experience of the client to enter the conference auditorium. This is not my story; this was the client’s life story and it was what the client believed they had experienced. I felt that I had no right to reduce it. The story continues with one of my first observations when I entered the room and described the external phenomena I saw and my internal experience: “An Asian man sat, with a pale chiselled profile and dark hair. … lthough his body was present in the room I could feel the forceful absence of his social presence. I could see no trace of social behaviour or social communication in him. Clearly, he shared no intention, no feeling in our company”. At that moment, I experienced my thoughts as “distant”, which was already an embodiment of the dissociative experience I felt while I resonated with him. “I wondered, on one hand, what had caused this person to come to a halt, and on the other hand, what was the unique and selective adaptation process, conscious and unconscious, which had enabled him to choose a path of therapy and thus hope.” I started to remember Porges’ presentation at a trauma conference in Boston, saw the slides of that presentation in my mind. This was followed by the realization that I was using my own favorite defense mechanisms of intellectualization and rationalization so as not to feel him, as it was almost too much to bear. I regulated myself emotionally and physiologically, returned to feeling the mute person and continued to absorb and sense the experience of being with them (the client and two psychoanalysts) in the room, seeing and asking myself: “…Could the stone mask testify to the fact that he had already seen the felled head of Medusa and there was no somersault of the reaction?” I felt in my body and soul that moment when his despair and my despair became one. Acknowledging this despair enabled me to move forwards, and I felt that a new sensation regarding the musicality of the attachment process entered my consciousness. “I had the feeling that some synchronized sounds were present in the intersubjective space much like a voice calling out in the desert allowing the last bastions of hope for the lost.” When I concluded that I had seen all there was to see from the outside and gone through all my thinking and theory, I allowed myself to feel the full vegetative identification with him using mirror neurones and adaptive oscillation in the quantum field of the therapeutic space, to enable the full embodied somatic resonance and the sensations of counter-transference. “I was fully aware that the longer I stood in the room, the greater my feeling of a nameless sense of dread, which filled me from head to toe, as if the frozen intensity of the man in front of me was absorbed in my own body. My mouth was dry.” As I had no idea “what to do?” I started more consciously using ‘Dual Awareness’ in addition to the vegetative identification and analysis as a parallel process. “I sat and listened with my entire body, the 'material me' Sherrington, 1900). My ears seemed to have blocked themselves. This silence was the sound of terror, and I was listening to it and myself while all my other senses became more acute as the sensations were seemingly amplified through my body… A whispering fear rose inside me, engulfing me with a feeling of desperate solitude making the distance between myself and the others feel endless and unbridgeable” A memory of a sentence “fear cuts deeper than swords” sprang in me. I felt the impact of his horror in me “the impact of which no amount of training could prepare me for.” The experience of feeling like an invisible swordwas cutting into my own flesh led me to internal analysis in the 'present moment', connecting to my own trauma when I felt similar feelings and sensations in myself in my past. These led me to take a course of action of attuned intervention. That action was based on my Biodynamic working hypothesis about the essential need for self-regulation and my internal analysis gave me the entry point to understanding that I needed to find a way to touch and that touch might reconnect him to life. “I needed to reach out to the man. I needed to touch him and find a simultaneously (Byers, 1976, p60) shared rhythmic foundation (Mary Catherine, 1979) which would enable turn taking..” I was starting to negotiate a lifeline. “In a gentle voice that matched the volume, rhythm and prosody of the Clinical director and Therapist’s voices, I asked his permission. Did he blink his eyelids? A quick glance in the Therapist’s direction confirmed he had.” I again went through an internal process in negotiating the lifeline. “I quickly calculated the risks. At this moment, anything was possible, and I had to prepare for any eventuality, from gentle consolation to violent attack. For these, not only was there need for a victim in the cult, but also a priest. The emaciated bony hand of this cult survivor sitting opposite me might be contaminated with blood.” I had to regulate my fear as this was not counter -transference; this was a real risk. Externally, I took action as I had to get consent and permission to touch his hand but also to protect myself. Then, “I picked up a shiny, light coloured cushion and placed it on my lap. I spoke forgotten words, which suddenly came forth from the painful place inside me.” We negotiated the touch, then I gently placed his hand on the pillow and stroked his hand softly at a very particular rhythm and intensity, listening careful to the appearance of peristalsis. To feel real hope, we needed to feel life inside of us. Psycho-peristalsis could enable the internal transition of movement from paralysis to action. “I returned to silence, listening with my fingers, and then I heard the voice I had longed to hear emanating from his intestine. A gentle rumble, like the hesitant purr of a cat bathing in the sun’s rays, was very clear. Peristalsis, referred to in biodynamic psychology as psycho-peristalsis. My ears, accustomed to hearing these voices, sharpened, alerted. These involuntary gut responses, the sounds of which were increasing, sounded to my ears like the roar of an experienced surfer who forces himself to conquer a stormy wave and whose triumphant bellow echoes from its crest.” The intervention with appropriate touch came from my deep embodied resonance with him, and it looked like a good idea as the emerging data from scientific literature shows that appropriate touch starts a cascade effect throughout the systems of the body. Touch influences higher cognitive centres, enhancing body awareness and embodiment through proprioception (Berlucchi & Aglioti, 2010; Craig 2002, 2009). Gentle and pleasant touch acts via C-tactile afferents to influence affective and reward centres in the brain, which most likely activates the placebo effect (e.g. Benedetti, et al., 2011; Dunbar, 2010,), but which more importantly activates C-tactile afferent fibres in the skin that stimulate the client’s insula and begin the release of oxytocin. This activates theinsula and enables some sense of body ownership to reappear, due to the combination of oxytocin and the activation of the myelinated parasympathetic branch of the autonomic nervous system. Therapeutic touch is also likely to promote the release of endogenous opiates (endorphins) as well as oxytocin and arginine vasopressin, which has analgesic properties to help dealing with the emotional pain and influences social bonding (Dunbar, 2010; Sauro& Greenberg 2005). After the lifeline was established, the client moved and stood up on his feet. It felt like a triumph of the sympathetic branch of the autonomic nervous system; the client came out of his voodoo death state. This session unfolded as a combination of aspects from Biodynamic Massage in Vegetotherapy. Vegetotherapy is a method that began with Wilhelm Reich and which was further developed by Ola Rackner and Gerda Boyesen, the goal of vegetotherapy is to enable the activation of the identity of the self by being open to the infinite possibilities of the subjective experience. It is one of the major methods by which Biodynamic psychotherapists work, and which starts through embodied listening to the internal and external communicative musicality, including the vegetative internal signals (vegetative meaning autonomic nervous system signals). This sentence from Sherlock Holmes in The Sign of the Four (1890) sprang up in my mind: “How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?” Elya Steinberg, MD, is Co-Director of the Centre for Biodynamic Psychotherapy (London School of Biodynamic Psychotherapy). She is a medical doctor and biodynamic psychotherapist who integrates body-psychotherapy, Gerda Boyesen methods and bioenergy with psychological trauma work, martial arts, conventional allopathic medicine and complementary medicine. She interweaves alternative and conventional approaches to allow a person to grow as a holistic complex and improve their well-being. In partnership with Gerhard Payrhuber she facilitates the group 'Attending to the Silence’ for second and third generation Shoah survivors, perpetrators and bystanders.
Psycho-Peristalsis in the Shared Body
Reprinted with permission from Somatic Psychotherapy Today | Fall 2016 | Volume 6, Number 3 |
Connecting to the 'Primary Couple Personality': Couples Therapy with Body Psychotherapy
Reprinted with permission from Somatic Psychotherapy Today, fall 2015, volume 5, number 4, page 68
Therapeutic Insights into Infant Massage
Reprinted with permission from Somatic Psychotherapy Today, 2015, volume 5, number 1
Trans-generational and Inter-generational Trauma
First published as a chapter in: C. Young (Ed.) (2014), The Body in Relationship, (pp. 35-42). Galashiels: Body Psychotherapy Publications. Introduction Trans-generational trauma represents a form of trauma that has been transferred from the generation of survivors who have experienced (or witnessed) the catastrophe or atrocities directly. This could be a natural trauma (like an earthquake or tsunami), or a man-made one (such as the Holocaust, or the genocidal wars in the Balkans and Rwanda). It is also possible to examine the "trans-generational' transmission of trauma in a wider perspective, as trauma passed through the relationship of ancestors and descendants as well as the parent-child couple. `Intergenerational' transmission of trauma is that which is passed on through the relationship between parents and children: "The intergenerational trauma and trans-generational trauma interact with each other and will produce another quality of the trans-generational phenomenon" (Payrhuber, 2011, p. 27). There is also a strong body of evidence in the literature that the phenomenon transmits in utero, and post-natally as a pre-verbal experience. The literature also shows that the most devastating impacts develop as a result of the man-made historical traumas inflicted upon communities and individuals. Nowadays, we are aware that trauma can be passed down to the second and further generations of the offspring of the survivors via a complex and interconnected set of post-traumatic stress disorder (PTSD) mechanisms. The traumatic traces, 'like a child's footprint in wet cement', are often preserved for generations' (Felitti, 2010) and become `The Hidden Epidemic' that can disturb health.
Biodynamic Psychology: Healing through the wisdom of the body
Article from: Positive Health, July 2006 Biodynamic Therapy was developed by the Norwegian psychotherapist, clinical psychologist and physiotherapist Gerda Boyesen (1922-2005). who lived and taught in London, where she died last December after an (extraordinary rich and fulfilled life. It is a great joy for me to be part of the Biodynamic community and I highly appreciate the opportunity to share some of my insights into one of the most important psychotherapeutic techniques today: a technique that uses the treasure of body's wisdom, a technique that reaches far beyond Iwords to find healing, where pure verbal therapy gets to its end. THE BEGINNINGS Wilhelm Reich, student of Sigmund Freud. was first to understand and introduce the importance of body and ouch into psychotherapy. He laid the foundation for modern body psychotherapy. Gerda Boyesen was one of the econd generation's pioneers. She was already studying psychology, when she started to work with Ola Raknes, ne of Reich's close students in Norway. To fully understand the body and its anatomy, she additionally traineds a physiotherapist, where she got in touch with a very effective neuromuscular massage technique/, which came the basis of Gerda Boyesen's 'Deep Draining', and the foundation of 'Biodynamic Massage' (see below).The term Biodynamic refers to the concept of life energy flowing naturally in a healthy body. This flow of energy s either supported or disturbed by our personal life experiences. The more it becomes disturbed, the less healthy Iivell feel in our physical and psychological existence. Our life story is inscribed in our bodies. The way we kievelop our posture, the tonus of our muscles, the curves of the spine, the form of a toe, the shape of a face are -611 connected with the happy and the less happy experiences in our lives. THE PRIMARY PERSONALITY — TRUE EXPRESSION OF SELF Biodynamic Psychology believes that every human being has a whole & complete inner core remaining naffected by life's turbulences, called the Primary Personality. Its counterpart though, the Secondary ersonality. feeds on all life's experiences, which make us suppress or distort our primary impulses of true self xpression. Thus, over time, the way we present ourselves to the world is formed and crystallizes in a person's ypical character and body posture2.ere is a simple explanation of this process: Let's assume something frightening happens to a child. Its primary eaction would be either to scream, cry or run away out of fear: to hit, kick or shout out of anger: or maybe at the nd of the experience to reach out for its mother out of the need for comfort. The urge to express these feelings s not only psychological, but is a very physical, mostly instinctual reaction in the vegetative system. It can be described as a movement of fluid (or 'life energy') in the body. If the expression gets blocked, the fluid will not issolve and cause waste in mind and body. Tension builds up in the muscles to hold back the physical xpression. On the emotional level the child will feel frustrated, confused, unworthy. helpless...and in deep tress. This physical an emotional tension remains in and affects the vegetative system long after the original rge has subsided and been forgotten. If this process is repetitive armouring happens. Armouring means that a ertain muscle or a group of muscles become so stuck in their expressions that a chronic blockage arises. Reich as mainly talking about muscular armouring, meaning the skeletal muscles, whereas Gerda Boyesen found that e armouring is also happening on the even deeper level of the visceral, the muscles of the guts. The guts. she round out, are deeply involved in a person's self regulation of stress and conflict (see below 'psychoperistalsis'). We learn to suppress the urge to express ourselves from early age on, because in individual families and in ociety generally, the spontaneous expression of certain feelings is not welcomed. There may be prohibitions, isapproval, punishments or even more serious traumatic experiences like physical violence and sexual abuse to ake us repress or restrict the instinctual responses. BODY WISDOM AND THE BIODYNAMIC HEALING PROCESS A certain amount of stress and conflict though is quite natural to human life. And true it is that the human body land psyche has got an inbuilt self healing and self regulating ability, which can deal with this limited amount very well. Once the limit is stepped over self regulation stops working properly and a blockage starts to establish. The good news is that the Primary Personality even though it can be heavily covered by many layers, it is never destroyed. With few exceptions most people have healthy aspects with a good, flowing contact to the Primary. these aspects might be hidden away, but they are in a way just waiting to be rediscovered. So they will easily be ccessible for a client and provide a positive force and source of strength.Subtle impulses are incessantly sent ut from the core to brain and body carrying healing wisdom in form of what physical movement, what sound, or hat other expression or action is necessary in order to release and rebalance the stuck energy of that person in is moment. One of the aims of Biodynamic Body Psychotherapy is to help the client to regain awareness of ese subtle impulses 'impinging from within' and learn to trust and follow their guidance towards the enfolding of e self. Biodynamic Body Psychotherapy disposes over a wide range of techniques to work through a person's layers of armouring, in respect of the person's pace and in a gentle allowing way. In this path the client will most certainly meet his/her resistance. It is one of the fundamental beliefs of iodynamic Psychotherapy that resistance needs and deserves respect, and its attitude towards it is one of pen, loving inquisitiveness and understanding: why is that resistance there? What is/was its job? What does it eed to let go? Once valued for its aims and purposes linked to the past, the resistance will soften up and allow ing seduced to give way to more appropriate behaviour for that person's life now. Because blockages manifest on the vegetative and therefore subconscious level an essential part of the therapy works beyond words, in direct contact with life energy (hence its name 'vegetotherapy'). We can be mentally very aware of an issue, but as long as it is not cleared out of the body's system. it will most certainly continue to give.
Transformative Moments: Short Stories from the Biodynamic Psychotherapy Room Pt. 2
TOUCH AND BETRAYAL From an object-subject relationship point of view, we should never underestimate how challenging it might be for a body-mind system that has been betrayed by humans to trust humans again—to trust the object ‘human’ and to authentically experience that this subject is safe.It is especially important to explore the complexity of touch and the right touch for people who have undergone traumas of physical, sexual or emotional abuse in their family, when, in fact, inside the family somebody manipulates their most basic attachment needs, where love was demonstrated manipulatively in order to abuse the child as an object for the fulfillment of the perverse fantasies of the adult who was supposed to protect him. These people, who were born into an evil cradle, are the most wounded people in our society. They have never experienced safe touch or have experienced it partially from a friend of the family who was, at the time, a bystander to the abuse, and there are mixed together the touch and the sense of betrayal that occur in the conspiracy of silence. These people especially need, as a part of the overall psychotherapeutic experience, a space in which they can experience safe touch here and now inside the therapeutic alliance with a secure and safe attachment figure. They need a space in which they can learn to develop themselves ways to cope with the complexity of touch for them. Many of them suffer from intensive somatic sensory flashbacks that often emerge every second while attempting intimate touch. They learn in themselves the ability to enjoy the right touch here and now, to develop tools such as dual awareness during the somatic-sensory flashbacks in order to enable them to experience pleasure and joy. When their normal desire for another body, for skin-to-skin contact becomes a reality, instead of enjoying it they suffer from unexpected outbursts of somatic sensory flashbacks that push them into responses of hyper-arousal, such as fight and flight or hypo-arousal such as freezing and dissociation, which do not enable the development of intimacy and deep interpersonal relations. As long as psychotherapists refrain from practical observation of the complexity of touch in the therapy room and continue to maintain the dissociative dualism of Descartes' split between body and mind, they are, in essence, collaborators in the conspiracy of silence, in which there is refraining from looking into the most painful and realistic places in the individual's life. It takes courage to look at the profound emotions and painful, hidden, complex landscapes of the human being that can emerge with physical touch. Working with touch enables fuller integration of those parts of a person that were discarded as part of the taboo and restoration of the capacity for pleasure, happiness and physiological and emotional well-being. ANOTHER EXAMPLE OF A THERAPEUTIC PROCESS – WITH RONIT Ronit has permitted me to describe some of her story, using an assumed name. To conceal Ronit’s identity I have changed details. She came to me for treatment because she felt isolated, and her attempts to create new relationships with people failed. Somehow, each new relationship ended abruptly, and she couldn’t understand why it was happening. When I asked Ronit how she feels physically, she says that frequently her legs hurt her for no apparent reason, and she has suffered fromtonsillitis since childhood. After she left home, things improved, but she still suffers recurring tonsillitis the year-round. She is a light sleeper, frequently finds it hard to fall asleep, and is woken by any sound in the house. RONIT’S HISTORY Ronit was an abused child. She was hit, cursed, shouted at, and humiliated on a daily basis throughout her childhood until she left home at 20. It seemed that everything could trigger off the slaps and shouts: a broken cup, a spilt drop of milk. Everything, she felt, would end by her being hit. As a little girl, Ronit didn’t understand why she was getting slapped. Over time she learned that her father had principles. Whenever she complied with his principles - not sitting at the table with her feet on the chair, or not losing her key - she wasn’t hit, and could look after herself. But her mother was unpredictable. She flew into unpredictable attacks of rage. She hit Ronit, shouted at and humiliated her. She said terrible things that Ronit can’t remember. Any given moment was dangerous, and her mother even attacked her at night after Ronit had apparently gone to sleep. Once her mother stabbed Ronit’s sister, who managed to jump aside at the last minute, avoiding injury to her spine. Sometimes the blows lasted a very long time, and were often so powerful that Ronit lost consciousness. Her plastic descriptions of regaining consciousness on the floor after one such attack filled the treatment room. Ronit learned to live like a little hunted animal, always prepared for the next unexpected violent attack. When she grew up, she started to run out of the house until her mother cooled off. At night she made a point of falling asleep only after she heard the ordinary sounds of her parents sleeping. If there was a movement anywhere in the house, even the slightest one, she would wake up, open her eyes, ready to jump. From the outside, she appeared whole, but inside everything was shattered and broken from the blows and the verbal violence. PHYSICAL THERAPY, AND THE LINKS BETWEEN RONIT’S CURRENT CONDITION AND HER HISTORY Each treatment session included a biodynamic massage, usually the same method on the whole of Ronit’s body. During the treatment, we learned that her leg muscles hurt because, as a child, she always had to be ready to run and escape her parents, who often launched their angry attacks and hit her for no clear reason. To evade, them she was always ready to run. When she was older she jumped out of the living-room window of their ground-floor flat, or run to the toilet or to the little shed attached to the kitchen. Then she locked herself in and waited until their fury calmed down and it was safe to come out. Danger lurked at every given moment. She was always ready to jump, even at night and now, after so many years of being ready to run, just in case, she’s exhausted. She wants to rest, and her legs hurt. Perhaps she can rest now? Ronit has built a safe life for herself. For several years she has been in a relationship with a stable, sensitive partner who has never hit her. But inwardly she can’t free herself from the habits that saved her life and sanity. She always has an escape-plan; she’s always ready to run. Examining her past also explained her sleeping problems. For years she lived like a hunted animal, around the clock. But maybe now there is no ‘lion’ pursuing her? Even though consciously Ronit knows there isn’t any lion, and it’s probably not going to happen today, her body still doesn’t know it. The tension, the readiness for ‘flight and fly’ was in her implicit procedural memory for years. It’s an unconscious procedure over which she lacks conscious control. I invited Ronit to check some other possibilities, by means of touch. Possibilities in which we can at least put the tension on a shelf, close at hand, an arm’s length away. And only if she has to run in the future, if a lion really does turn up, she can take the anxiety back and run far away with it, like she did as a child. This defense mechanism saved her life. I didn’t want to take away those lifesaving defense mechanisms from Ronit, like her readiness to run because every time her legs became less and less tense, she suffered appalling anxiety attacks. And then we had to negotiate, while still respecting her defense mechanism, following the biodynamic principle of ‘making friends with the resistance’. Meanwhile, for just least a few minutes, maybe she can rest because there’s no lion in the room now. As an adult, she has been able to create a safe atmosphere for herself, has found safe people who will never hit her like people used to. Now she can rest and elax. This process required considerable non-verbal negotiations. THE CLIENT IS ACTIVE, NOT PASSIVE We must remember that biodynamic massage is in no way a situation in which the client is passive and receives a massage, and the therapist is the active one. To an outside observer of a therapy session, it may seem like that, but it’s incorrect. Just because a person isn’t physically moving, it doesn’t mean that he is inactive. For someone who experienced what Ronit did, the ostensibly simple state of lying on a treatment table without moving and relearning how to relax and rest - such a basic action, which people who didn’t have traumas like hers don’t think about twice – is for Ronit, a novel idea. For Ronit to let herself rest, even for just a single wonderful moment, she has to work Ronit learned to live like a little hunted animal, always prepared for the next unexpected violent attack. intensively within herself. To learn to differentiate between past and present, between the present and the future. This work took Ronit years of weekly therapy, sometimes even twice-weekly. When she began the process, she didn’t understand what was happening to her; all she knew was that she had difficulties in interpersonal relations. But it’s clear that because she was constantly ready to run, she couldn’t really be available in the ‘here and now’ for a relation with the person she’s with. TIME It took time for Ronit’s unconscious memories to became conscious ones. It took time to position all those dramatic events on a chronological timeline. Ronit had to physically change structures in her brain, like the hippocampus. The hippocampus does not develop appropriately in multiple situations of stress like those that she experienced, and without proper development,there is significantly less ability to place historical events along a chronological timeline. And then, in a roundtable discussion – between the brain that sees that the existing reality, the ‘here and now’, is safe, and parts that are afraid to rest - Ronit’s legs, can ‘sit’ at the round table, talk and negotiate, and let Ronit rest – and for more than just a few minutes. Initially, each minute depended on discussing and negotiating until – through new neuropathways that most probably started to emerge, new possibilities were laid down in Ronit’s brain. Their inherent option was that it had become possible to rest, before the next race begins. Each minute was a major achievement. Secretly, at home, behind a locked door, Ronit started to occasionally rest for longer periods. Resting when someone else was present required a very long drawn-out process, which she sometimes thought was impossible. However, she learned it from her direct experience. And now if she stays in one place long enough, she may be able to successfully build relations with other people. RONIT CRIES Ronit would at first cry in absolute silence, without making a sound. Tears trickled and flowed down her cheeks. Her nose dripped and even when she blew her nose, she did it with impressive silence. Not the smallest sound. Sometimes the pain in the room, in that space between us, was so immense that my eyes would also silently weep. Once I asked her how she learned to cry silently. As a child, she told me, when her mother hit her, if she made a noise and cried or screamed with pain, her mother completely lost it; she would hit even more violently, and shout at her to stop making a noise. Because according to her mum, Ronit was to blame for everything, she didn’t even have the right to make sounds of pain. And that’s how she learned to cry soundlessly. I asked if there was anything soft in her mother, that might help her grasp the pain she had caused her daughter. Dry-eyed and with a bitter voice, Ronit replied that her mother’s only soft place was her pillow. After her mother would hit Ronit, sometimes she ran to her mother’s bed, and scream and shout into the pillow. Often she cried like that for a long time, but her mother never came. I worked with Ronit in many sessions, using different kinds of biodynamic massage to help develop her throat, and allow her to emit sounds, slowly, through prolonged negotiations with all parts of the body. It was a process that sometimes both of us felt would be endless. And only after I promised her that my room is soundproofed and the neighbors wouldn’t come and hit her, she allowed her voice and weeping to emerge from her vocal chords. At first they were choking sounds, but gradually she let out the screams of anguish that her body had held in for so long. THE GATES BROKE OPEN She was left without pain in her chest, and without an inflamed throat. And for years afterwards, Ronit never suffered from a sore throat. Perfect rest I worked with Ronit for many years, and each session included biodynamic massage. And she became able, sometimes, to rest completely. Genuine rest. An island of calm within her. A place where Ronit could stop running. At night she still sometimes wakes up if there are sounds in the house. But now she soothes that little girl in her, the little hunted animal inside her, and goes back to sleep. Now she can stay in one place, form relationships with people, and can talk and express herself fully. HEALING So who healed Ronit of her painful legs, her recurring tonsillitis? It wasn’t me, the therapist – it was Ronit herself. It was Ronit who made the appointments. Ronit who came to every appointment. It was Ronit who walked cautiously along on the slippery wooden path in my garden, as she approached my clinic. She paid for our sessions. I only did the work when she came for the psychotherapy session. But it was Ronit who took the scalpel and opened the wounds of the past, let the pus flow out until, one after the other, her scars became clean and dry. She drinks to the full the few tiny drops of love she received as child, drinks thirstily and constantly. Fences off every moment of insanity. Every injury. Every knife and scissors that stabbed her or her sister. Fences off Arranges them in rows that are too many to count, like rows of tombstones Feels, senses, observes, processes, and - since she could never make sense of the moments of her mother’s rages - She fences off whatever she could To detach herself and remind herself that it’s all in the past She survived the worst of all, None of this will happen again. Now her world is formed the way she chooses. And me? I only helped I only supported with equanimity In every part of her In every part In all the particles In all the shattered fragments I supported them all equally Because they are all my clients Until gradually, ultimately they were integrated into a single whole I only did the best I could, without neglecting any part of the body and mind To support the change Because change is the only constant, as I wrote before Psychotherapy is a healing profession, and the healer is the client And the therapist's position which I followed here is known in Biodynamic Psychotherapy as the 'midwife position'. A NOTE ON THE DURATION OF THERAPY Occasionally people ask me how long biodynamic therapy takes, and I always reply, according to the client’s need. I’d like to enlarge on this point. People like Ronit who underwent innumerable traumatic and adverse events know there’s no magic wand. No shortcuts. The client must work over a long period to develop his or her full inner human potential - only self-work in a prolonged, fundamental process that can enable the changes that human biology and physiology require to experience the world from a different point of view. A fundamental process takes time. Sometimes more years than the number during which the damage occurred; it may take years of renewed growth. During that process, not only are forgotten pains reopened, but also the options for experiencing inner happiness and satisfaction. Nurturing the ability for selfmanagement, for designing your life with your own hands. I cannot state categorically if the decision to embark on therapy is worthwhile for a specific person, nor how long it will take. It’s a personal decision. What I can say, is that for me personally the investment was worthwhile, because I feel that I succeeded in fulfilling myself and my life. Going to therapy is a courageous personal decision that can yield a host of benefits for someone choosing that course. The time that’s needed is dictated by the personal process of each and every individual. My role is to support that person, to listen to his or her self and out of that direct experience to identify the appropriate period of time, but not to work out of blind belief in me, or an intellectual decision, or external conceptual understanding about therapy’s duration. Dr. Elya Steinberg, MD, is Co-Director of the Centre for Biodynamic Psychotherapy (London School of Biodynamic Psychotherapy). She is a medical doctor and biodynamic psychotherapist who integrates body-psychotherapy, Gerda Boyesen methods and bioenergy with psychological trauma work, martial arts, conventional allopathic medicine and complementary medicine. She interweaves alternative and conventional approaches to allow a person to grow as a holistic complex and improve their well-being. In partnership with Gerhard Payrhuber she facilitates the group 'Attending to the Silence’ for second and third generation Shoah survivors, perpetrators and bystanders.
The Gerda Boyesen Method: Biodynamic Therapy
From "Innovative Therapy in Britain" Chapter 9 - Pages 179 - 201. Edited by John Rowan and Windy Dryden, Open University Press, 1988
BIODYNAMIC MASSAGE CLINIC
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Centre for Biodynamic Body Psychotherapy