Body-Mind Psychotherapy: Principles, Techniques and Practical Applications
by Susan Aposhyan
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Embodiment is the moment to moment process by which human beings may allow our awareness to enhance the flow of thoughts, feelings, sensations, and energies through our bodily selves. Embodiment requires the creative ability to allow the life of the universe to move through our bodies, be colored by our unique perspective, and move back out into the world. Embodiment implies an unencumbered flow of life into us as food, air, liquid, sights, sounds, and more organized experiences. Embodiment also implies the elegant and creative integration of these inputs with the totality of our beings. Embodiment means that these inputs are thoroughly processed and sequenced out into our unique relationship with the world. The world comes in, we process it, and through the processing we find ourselves in a whole new relationship to the world. Embodiment, then, is a grounding and flowing relationship between ourselves and the rest of the world.
Embodiment is fundamental to most contemplative approaches to life. Buddhist meditation is seen as the synchronization of body and mind. From the simplest point of view, we might ask “Are my body and my mind in the same place at the same time?” I might be physically here, but my mind is halfway around the world, far into the future. This presents difficulties when we are unaware of this desynchronization, or we are so habituated to it that we are unable to “be present.”
Embodiment enters into the task of psychotherapy in many ways. For the client, as a member of our fragmented and dualistic culture, there is always some of aspect of every dilemma which is related to body-mind dualism. By recognizing the deeper, cultural roots of an individual problem, we might discover more fundamental ways to rectify it. We might also be simply relieved to see our personal issues from a larger perspective.
For the therapist, the more deeply the therapist embodies themselves and their place in the world, the more fully present he becomes for the client. In Natural Intelligence the idea that presence is a matter of degree is presented. How present are we in this moment in this body? How much of this body is actively available to respond to the present moment? What aspects of my whole being and body are dancing with the flow of information and energy that is coming into it? And, in terms of output, how much of the therapists’ being is available to understand, respond to, and facilitate the clients’ process? As the therapist’s own embodiment deepens, his understanding and skill in interacting with the client will simultaneously deepen as it draws from a wider range of resources.
To state all this simply: Embodiment is fundamental to the development of any aspect of a human being. Embodiment allows the psychotherapist to be present with understanding and skill. As a teacher and trainer of psychotherapists, I often observe myself clinically as I work with clients. I do this so that I can teach my students and trainees how to do what I do. While I can articulate various conceptual guidelines for my decisions, the quality with which I do things and the timing that I use often defy conceptualization. They just feel right. This ability to “feel” your way through the world and to integrate feelings and thoughts with elegance is a hallmark of embodiment. As I stressed in Natural Intelligence, I feel it is important to recognize that embodiment is a seemingly infinite process. It is infinitely possible to become more sensitive, more articulate, and more fluent in our abilities to listen to our bodies, express with our bodies, and process more energy more precisely. It saddens me when embodiment is reduced to a simple on/off switch, “Yes, I was in my body.”
Take a moment to rest into your body. Feel the sensations that move inside you. Allow your breath the freedom to come and go at its own rhythm. Open your mouth a bit to create this permission.
As you feel the sensations moving through you, recognize them as physiological events occurring within you. Every sensation is the result of the movement of your physiology. Within you are 75 trillion human cells, they are all rippling with constant physiological activity. Take a breath as you acknowledge all of that life moving within you.
In addition to our human cells, we have approximately ten times more nonhuman cells in each of our bodies. These primarily consist of bacteria. We are each an active biosphere. Again breathe with the awareness of the fullness of life inside you. We are biospheres in and of ourselves. And we exist within the biosphere of this planet. The atmosphere of the earth, the body of the earth, and the web of life within that create a womb-like space which supports the life of each creature on the plane. Feel all the life of the biosphere humming outside you. We are in the womb of the biosphere. Again take a breath and rest into an awareness of the fullness of life moving inside you and the fullness of life moving outside you. And these two systems of life are exchanging with each other. The life inside you is spilling out into the world, and the life outside you is entering you constantly, in many ways. With every breath, with every movement. What if you lived your life grounded in awareness of this flow of life?
The ability to sequence energy is an aspect of embodiment. In the nonhuman animal world, when an animal is startled or traumatized, they visibly shake off their response when the stimulus is over. With a mild startle, this may look like a shiver, a headshake, or a skin twitch. With a full-blown trauma, this may look like rolling, shaking, moaning, and bellowing. Through acculturation, adult humans learn to freeze around intense sensation and suppress our natural responses. When our sequencing responses are shut down, we can get stuck in the freezing phase of trauma. To resolve trauma, we must learn bit by bit to allow our trauma response to sequence through our bodies without maintaining the freezing phase. This can be accomplished by going slowly, learning about sensation and movement, and becoming comfortable with intensity. The key is to be able to stay present during the intensity.
The word catharsis is important in the history of psychotherapy. Webster’s defines the psychological meaning as, “Elimination of a complex by bringing it to consciousness and affording it expression.” This sounds mild enough, but the medical definition is “Purgation.” In clinical psychotherapy practice, catharsis has come to mean intense emotional reexperiencing. In trauma, if there is not sufficient ability to stay conscious, sequence this energy out of the body, and hold the intention of healing, a cathartic experience can be retraumatizing. When we originally experienced a trauma, it literally overwhelmed to us. We were unable to respond in a way that restored us to safety or well being. We did not have sufficient resources to respond effectively. The point of reexperiencing trauma clinically is to resolve it through effective response. To do this, we must first establish sufficient resources to respond. Then we must slowly renegotiate the trauma with the intention of resolving it through allowing our bodies to sequence the energy and to respond protectively and effectively. Peter Levine (1997) points out the need to proceed slowly and thereby titrate the traumatic response, dissolving it into restored autonomic flow. Titration involves the smallest amount of activation possible. When there is an intense cathartic release, this intensity may overwhelm and cause dissociation. Dissociative catharsis is retraumatizing. This possible danger has generalized into a fear of intense expression in general. However, this danger can be handled responsibly through systematic development of the client’s ability to sequence energy while monitoring for dissociation. Dissociation can be judged by many factors: eye contact, movement that sequences from the core all the way to the periphery, verbal contact, and the intention to heal. It is possible to express intense emotions and stay present and clear about the intention to heal. Here, the catharsis will be a healing experience. It is the responsibility of the therapist to assess if this is the case. It may be necessary to ask the client questions about their experience and intention to anchor in their ability to renegotiate intensity.
In a traumatic disorder, our neurological functioning is disrupted. In addition to resolving the central traumatic response, it may be necessary to reintegrate more peripheral functions. These might include basic autonomic regulation, such as digestion, cognition, and motor reflexes. In Denise’s case, she needed to reestablish a reflexive ability to defend with her arms. Other people may need to reestablish this with their voice (the ability to scream), or with their legs (kicking and running). In reestablishing these reflexes, it is necessary to monitor the client for neurological overwhelm. With more severe trauma it tends to take longer to be able to renegotiate these responses. The client’s ability to sequence energy, commitment to healing, and ability to stay present must be even stronger. The stronger the trauma response, the more easily it is reactivated. Michael’s story that follows is different from Denise’s in the severity of the trauma. He clearly suffered from post-traumatic stress disorder. His trauma was easily reactivated and therefore required greater care to renegotiate.
An example of Physiological Exploration:
The nervous system is vast structurally as well, and its definition is currently expanding. Traditionally, we have always included the brain and the spinal cord which together comprise the central nervous system, and the peripheral nervous system, comprised of both afferent and efferent nerves of the somatic and the autonomic branches of the nervous system. In addition, modern neurological research has discovered a plethora of neurological tissue in the gastro-intestinal tract: 100 million nerve cells, as well as supporting cells, and a complex circuitry of connections. This system is now dubbed the enteric brain or the “gut brain.” The gut brain can send and receive impulses, record experiences, and respond to emotions similar to the cranial brain. The gut brain and the cranial brain mutually affect each other. However, the gut brain can act independently. The gut brain is primarily involved in gut feelings and digestive processes.
Another less concrete area of neurological activity is the “mobile brain,” the network of chemical communication between all the cells of our body. Originally christened psychoneuroimmunology, the field studying the mobile brain has discovered that neuropeptides, the chemical analog of thought can be both produced and received by most kinds of cells in our body. Thus, most cells in our body can both generate and receive neuropeptides, the so-called information substances. As the field expands, Candace Pert, a neuroscientist, who is one of its leading proponents suggests that now we might need to call it “psychoneuro-gastro-dermo-cardio-endocrino-immunology.” This would acknowledge the participation of cells in all of these various systems. This cellular communication can change both our physiological processes and our psychological processes and often does so simultaneously. For example, the hormone oxytocin (also a neuropeptide) stimulates uterine contractions as well as playing a role in maternal behavior and long-term monogamy (Pert, 1997). To give the reader a better sense of the functioning of specific neuropeptides and their bodymind interface, the following information derived from Jaak Panksepp’s Affective Neuroscience lists primary neuropeptides and some of their basic behavioral functions (Panksepp, 1998, p.101). While this list tends to emphasize the behavioral functions and to a lesser degree the emotional functions, it only minimally acknowledges a few of the more basic physiological functions. Nonetheless, it can aid in a basic understanding of the range of peptide functioning.
- Substance P (Pain and Anger)
- Angiotensin (Thirst)
- Oxytocin (Social Processes, Female Sex, Orgasm, Maternal Behavior, Social Memory)
- ACTH (Stress, Attention)
- Insulin (Feeding, Energy Balance Regulation)
- Vasopressin (Male Sexual Arousal, Dominance, Social Memory)
- a-MSH (Attention/Camouflage)
- Bradykinin (Pain)
- B-Lipotropin (Opoid Precurser)
- CCK (Satiety, Panic, Sex)
- Prolactin (Maternal Motivation, Social Feelings)
- TRH (Arousal, Playfulness)
- VIP (Circadian Rhythm)
- LH-RH (Female Sexual Arousal)
- Bombesin (Satiety, Memory)
- Neurotension (Arousal, Seeking)
- Met- & Leu Enkephalin (Pain & Pleasure)
- B-Endorphin (Pain, Pleasure, Social Feelings)
- DSIP (Sleep, Stress)
- Dynorphin (Hunger)
- CRF (Stress, Panic, Anxiety)
- NPY (Feeding, Hunger)
- Galanine (Memory)
To provide a more detailed example of the physiological mechanisms related to peptides, peptide a-MSH disperses pigment physiologically. Pigment dispersal correlates to its attention and camouflaging function. As another example, Vasopressin aids in “retaining” both memory on a brain level and fluid in the kidneys. At this chemical level, physiology and emotion are truly inseparable. Obviously the chemical information systems is a fascinating interface. All of these peptides communicate directly from cell to cell, traveling within the body’s fluid circulatory system. They act without relying on the transmission of nerve impulses along fibers. In fact, Miles Herkenham, a neuroanatomist who collaborates with Dr. Pert, estimates that less than two per cent of what we have considered neurological activity actually occurs at the synapse from one nerve fiber to the next (Pert, 1997). Thus, an estimated ninety eight per cent of neurological functioning might occur within the mobile brain.
A Case Study Involving Trauma
Michael was an extremely intelligent, slight young man who came to therapy out of a desire to sustain the relationship he had just begun. He was determined to “do better,” than he had in past relationships. He had been in therapy off and on since he was a teen and his parents had divorced. He had vague visual memories of being anally abused by his father. He believed this began in infancy and continued intermittently until about age 2. He had always had these memories and had first discussed them in therapy as a teen. During this period he researched abuse, trauma, and the recovery process with the help of his therapist. Also with his therapist’s support, he shared his memories with his mother who intuitively felt that they might be true. She confirmed that his father was often home alone with him during that time as he worked in the evenings. When Michael was 2-1/2, his father had taken a job that kept him traveling much of the time. This was consistent with Michael’s sense that the abuse had occurred only at a very young age. All of this was put together during his stint in therapy in his teens. Much healing had taken place during this period of therapy, extraordinarily so for such a young boy.
Now Michael found himself in his first homosexual relationship with any potential for commitment. In the past he had gone through the motions of relationships with women. When they had gotten too close, he had increased his abuse of alcohol and marijuana. Through substance abuse and neglect of the relationship, he always managed to have these women reject him. When he began to experiment with relating to men, he felt more intensity, but was only able to be sexual when he was intoxicated. Donald, his current partner, was the first man with whom he had developed a friendship as well as a sexual intimacy. Donald and Michael both wanted a committed relationship, but Michael was very frightened. He felt that his fear stemmed from his early abuse. He stated that he “couldn’t stand being close to an erect penis without being high.” Michael felt that he had worked with his abuse as much as possible in verbal therapy and that to go further he needed to work on a body level. I asked him whether he had any images of what working with the body might look like for him. He said that he didn’t, except he hoped I wouldn’t make him pound on pillows. He said he had pounded on plenty of pillows, and he could do that for free. I asked him to think about his impulse to work on a body level and to allow that thought to develop fully in his imagination. I suggested he close his eyes and allow the thought to float around in his body. He squirmed a bit; I encouraged him to take a deep breath and stay with it a moment longer. His face flushed slightly; I asked, “So what are you feeling?” “My heart beating.” “Is that a good feeling or a bad one?” “At first it felt kind of good, I felt kind of excited to do this, and then it felt scary and like it was too much.”
I heard this as a parallel of how his relationship with Donald felt, exciting at first and then building toward reactivating his trauma. The challenge is always to learn to support the excitement and gather strength to move through the trauma. With that intention, I suggested, “So feel your heart again and look for some way that you can support it to stay with the excitement and not get overwhelmed.” His attention turned inward for a moment, and then he looked up, “I don’t know.” As he said this, he squirmed, sort of an impatient rock back and forth with his pelvis. I did the same movement and said, “Let’s take that squirming movement to be your body’s answer to the question. . . . So, maybe your lower body can help support you to stay with the excitement.” I avoided using the word pelvis, because I felt it might be somewhat reactivating. “Feel yourself seated on your cushion. Take a deep breath. Imagine your heart feeling really safe and supported from below.” This image definitely settled him down a bit, but it also seemed to quell his excitement. In order to reinvite his enthusiasm and also to move into safer territory, I said, “So Michael, I really heard how important this relationship with Donald is to you, and I believe that working slowly with yourself, you can make intimacy feel safer, bit by bit. So what’s the hardest part of relating to Donald?” As this first session proceeded, I asked questions about the relationship and as he answered, I coached him to take a deep breath and feel his support.
The next few sessions proceeded in a similar fashion. We did an educational piece on the pelvis: its importance as the base of the spine, how it is involved ideally in every movement, and how we are culturally indoctrinated with fear about the pelvis. This helped to disarm any superficial triggering that the word pelvis may have had. After this, I felt comfortable using that word, and Michael appeared to have no reaction. We processed the daily interactions between Donald and Michael, talked about the nuances of intimacy and the core feelings that intimacy flushes out. Throughout this period, we were touching into awareness of sensation, breath, and giving permission to his body to stand or shake in order to tolerate his sensations.
I understood this phase of our work as establishing trust and relationship between us, establishing awareness of his body and basic skills in supporting and moving energy through the body, and education in communication and relationship skills with Donald. While we discussed many aspects of their relationship, we were not talking about sex. At a certain point, I felt there was enough safety to ask how things were going sexually. I added the question of whether or not he felt comfortable talking about sex with me yet. “I don’t know. It’s going okay. It doesn’t seem that important. . . to either of us. We don’t do it very much. When it seems like it’s up, I slug down a couple of beers and just kind of get through it. . . . It’s okay.” “How does it feel talking about this now with me?” “It’s okay. I mean it’s kind of uncomfortable, but, it’s okay. I know we have to do it.” Michael’s voice seemed flat, his vocabulary limited; his eyes were downcast. “Tell me about why we have to do it.” He flipped into an intellectual mode, running through psychoanalytic theory. As he continued it got more feverish. “Whew,” I inserted into a gap, “that’s a lot of pressure. . . You sure you want to do this?” “Hell no,” he replied, “I don’t want to do it. I hate it. I hate the whole idea of sex.” “Slow down, breathe, feel what’s happening in your body right now.” He slumped down, breathed deeply a couple of times, and shook his arms a little bit. His eyes teared up. He looked at me, “What do we do now?” I smiled at him, “Let’s just be here together for a minute. . . . Michael, you’ve been working with yourself in a very sensitive way, so feel your body and your breath. . . . Find your support . . . Really take the time to connect to the wisest part of yourself . . . From this place, ask yourself the question, ‘What do I want right now? Where do I want to go from here?’”
Michael sat quietly with his eyes closed, breathing deeply. Finally he looked up, his eyes were misty, but strong and clear, “I’m not ready.” I acknowledged his ability to know that he wasn’t ready. Over the next couple of months we discussed what it would mean to get ready. This gave us an opportunity to talk about sex in a general, almost theoretical way, and to learn to be comfortable with each other. We discussed bringing Donald in when he was ready. During this period Michael’s relationship with his own body got stronger. He began doing breathwork regularly in our sessions and on his own, as well as reconnecting to riding his bicycle aerobically a couple of times a week.
When Michael felt ready, he and Donald talked about their sexuality and what they wanted. Donald shared more of his own fears and sexual issues. Together they developed a set of goals of what they wanted for their sexual relationship. High on Michael’s list were eliminating alcohol and making more eye contact. When the three of us met together, we focused on Michael’s goal to eliminate alcohol from their sexual encounters. Donald felt very open to that. We talked about alcohol as a means to overcome anxiety. I asked Michael to show Donald how he worked with this breath and pushing with his arms and legs to ground and redirect anxiety. I asked Michael how he would like Donald to support him if he had an anxiety attack while they were making love. They developed a plan. Michael would let Donald know whether he got anxious, and Donald would ask periodically how Michael was doing, as well. If Michael were anxious, Donald would hold his hand very firmly, look into his eyes, and say, “Do you want to breathe together?” They practiced that in my office together. I suggested that they talk some more together about both their histories and how that had affected their sexuality. We agreed to meet again together.
When we met again, we began a breathing routine Michael had created for himself in which he did deep knee bends and moved his arms as if doing the breast stroke while breathing deeply. I asked whether Michael wanted to lay down and breathe while Donald held his hand. They did this together while Donald told Michael that he loved him, that he wanted to be there for him if Michael needed him, and that he wanted him to feel safe with him. I asked Michael whether he was willing to imagine feeling safe with Donald. He said yes, smiled softly, and breathed more deeply. Then he began to whimper. This quickly escalated into full sobbing while Michael gripped Donald’s arm. Michael’s eyes were wide open. Afraid that he might be overwhelmed and dissociate, I leaned over into Michael’s field of vision. “Michael?” “Yes?” “Can you stay in your body?” “Yes.” “Feel your feet. . . . What’s your intention? (We had talked about the importance of maintaining a healing intention toward oneself.)” “I want to heal.” “Good. . . . Keep breathing.” I felt confident in his ability to stay present. He breathed more deeply with his crying. Under my direction he put his feet up on the wall. He began to grit his teeth and twist and turn. He seemed right on the edge of dissociating. I told him to use his feet. He began to pound the wall with his feet. I asked whether there were any words. He began yelling, “No, No, NO, NO.” I told him to use his hands. He began to pound the futon underneath him, yelling and stamping and pounding while he twisted and sobbed. I coached him to keep going, feel his body, feel what wants to happen next. He was able to make good clear eye contact with both Donald and myself. He struggled to his feet, flailing his arms and legs and screaming “No, I hate you. I hate you.” I kept saying “Stay in your body, feel what wants to happen next.” As a slight lull began to arise, I said, “Is he [meaning his father] still here?” Michael looked slightly to his right and nodded as he panted. I said, “Get him out of here. You get him out of here now.” Michael began yelling “Get out,” and charging the spot he had looked toward. I opened the windows, instructed Donald to breathe and take care of himself, asked Michael whether he was out yet, and encouraged him to get him all the way out. Finally Michael, sweating and panting, said, “Yeah, he’s out.” Big grin. “You did it,” I said, then looking at Donald, “He did it.” Donald looked slightly windstruck, but was smiling too. I told Michael to feel his body now and let it recuperate. He breathed and shook and stretched. I told Donald to do the same. Finally, Michael lay down again and began a soft gentle crying. Donald was right beside him, crying a bit himself, and touching him and kissing his head. Michael looked up at Donald, “Thank you.” He looked at me as well, “Thank you.” I said, “You are so welcome; I am so happy for you. You did great.” Michael cried some more. We talked a bit about taking it very easy this week. I asked him to call me the next day and let me know how he was doing, and we ended.
This was a great turning point in Michael’s life and in Michael and Donald’s relationship. Michael was able to integrate his movement through this traumatized part of himself. He remained stable in his life. They went through similar episodes on their own a few times, but the episodes died down in less than a month. Michael was able to achieve his goal of making love without alcohol. Michael and I continued our work together for about a year longer, and then Michael and Donald moved to a new city. I encouraged Michael to connect to a therapist in his new city and to be prepared to take care of himself if his trauma were reactivated in the future.