The Embodied Psychotherapist

The Therapist's Body Story

Robert Shaw

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135452353
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

The therapist's body is a vital part of the therapeutic encounter, yet there is an inherent inadequacy in current psychotherapeutic discourse to describe the bodily phenomena. Until recently, for instance, the whole area of touch in psychotherapy has been given very little attention. The Embodied Psychotherapist uses accounts of therapists' own experiences to address this inadequacy in discourse, and provides strategies for incorporating these feelings into therapeutic work with clients. Drawing on these personal accounts, it also discusses the experiences that can be communicated to the therapist during the encounter.This description and exploration of how practitioners use their bodily feelings within the therapeutic encounter book will be valuable for all psychotherapists and counsellors.

Part 1 The body in psychotherapy

Part 1 is devoted to an exploration of how the body has been incorporated into psychotherapy. I begin with a historical overview and address issues such as mind body dualism, discussing how this has had a profound impact on how we as therapists approach the body, and the types of language we currently employ to describe bodily phenomena. This leads us to an exploration of how psychotherapeutic techniques of the body are acquired by therapists and opens up a debate on the importance of incorporating a knowledge of the body within psychotherapy training. In the final two chapters of Part 1 I suggest that there are alternative ways of looking at bodily phenomena; that the bodily feelings we experience as therapists can be framed within an embodiment perspective. I therefore spend some time discussing embodiment in Chapter 3 and suggest a novel means of interpreting our bodily feelings in the therapeutic encounter. Chapter 4 builds on these ideas and adds a further layer to the embodiment framework. I discuss the narrative movement and how therapy can be perceived as a joint storytelling venture, by both therapist and client. My suggestion is that our embodied experience as therapists can be incorporated into the therapeutic encounter, and we can use an embodied narrative approach to therapy.

Chapter 1 The psychotherapeutic body

I have been intrigued for some time by how the body has been perceived within psychotherapeutic culture. A question I have posed and attempted to answer in this chapter is: how has the body come to occupy such a peculiar space within psychotherapy? It is as if, as psychotherapists, we are not sure where to put the body, or even whose body to concentrate on: the client’s or the therapist’s. Bodies can be seen as fearful objects where certain taboos come into play—for example, the whole area of touching in psychotherapy is fraught with ambivalence, or even anxiety. In some sense the body becomes silent and is almost written out of psychotherapy as a dangerous ‘thing’. When it is written about, it is predominantly the client’s body that becomes the focus of attention; the therapist’s body is marginalised or seen as merely a receptacle for transferential phenomena. This chapter looks at these issues and the key debates around the body in psychotherapy. These are crucial areas to debate due to the centrality of psychotherapist embodiment within this book. I will begin with a historical overview of the body in psychotherapy which provides a context for the importance of addressing the body within the therapeutic encounter. There will be a critical discussion of the impact of mind body dualism on psychotherapeutic culture, and the difficulties of integrating bodily phenomena into psychotherapy. An example of this is provided by exploring the concept of somatisation. This is also a key concept, and its use within psychotherapy discourse is ambivalent. Indeed, it was the concept of somatisation that started my interest in the research presented in this book.

Other disciplines within the social sciences are also beginning to acknowledge the importance of the body, so at the end of this chapter I have included a brief overview of how sociology is addressing the bodily perspective.

Historical overview: the origins of mind-body dualism¹

The body is the tomb of the soul.

(Plato)

Before embarking on an overview of the body in psychotherapy it is important to provide a brief sketch of the meanings of the body within western culture, and the impact this has had on viewing the body as a separation of mind and body. I start with Plato (d. 347 BC), not as a means of privileging Greek knowledge but as a reasonable place to begin. I am not intending to marginalise other ways of looking at the body, such as eastern traditions which perceive the body as a physical manifestation of the mind (Capra 1975). Different cultures inscribe the body with different meanings. At this point I am deliberately looking at the western perspective of the body, since psychotherapy is a western cultural practice.

The ancient Greeks celebrated the human body, this being demonstrated by their art and literature, and by their organisation of the Olympic Games. However, as the founders of western philosophy they also began the intellectualisation of the mind-body split. Plato, in the quotation at the beginning of this section, sees the body as a captivating force, an armoured carapace locking in the soul. Also, in one of his dialogues, the Phaedo, (Hutchins 1952) he describes body and mind as fighting against each other in a constant struggle.

This image of the body is echoed in Roman times when Stoicism was a dominant philosophy of Seneca the younger (d. AD 65) who said:‘Nature has summoned our soul with the body as its cloak’ (Synnott 1993:10). Again, we see the body acting as some kind of concealer, an object to prevent seeing, a definite entity in its own right. Indeed, Seneca goes on:‘a high minded and sensible man divorces soul from body’ (Synnott 1993:10). Although ‘soul’ here does not necessarily mean ‘mind’, these quotations do emphasise that the body per se is somehow separate, somehow distanced, and are a clear demonstration of mind-body dualism.

The early Christians seemed to have difficulty in reconciling their bodies as part of themselves. St Paul, for example, said ‘Your body is the temple of the Holy Spirit’ (Synnott 1993:7), while Francis of Assisi believed that ‘We must hate our bodies with [their] vices and sins’ (Synnott, 1993:16). There is thus a confusing message that the body is something to be worshipped as it contains the Holy Spirit, but at the same time it is full of evil as demonstrated by desire. Bayer and Malone (1998) describe how early Christianity viewed the body as a site of sin and of weakness, and how St Augustine of Hippo (AD 354–30) insisted that pleasures of the body be denied. Badaracco (1997:108) also makes a link between illness and punishment, and links this to Christianity, which ‘considered the body as the origin of the sin of the flesh, and illness as a consequence of guilt’.

The body as a beautiful object was rediscovered in the Renaissance of the fourteenth century. Artists such as Botticelli, da Vinci and Michelangelo produced images glorifying the body. The body was something to be admired, adorned and enjoyed. However, as civility and refinement increased, so basic bodily instinctual behaviour was frowned upon. The body became distant and, as Synnott (1993:19) puts it, ‘New notions of civility began to privatize the body’.

Throughout this period, the mind is considered as higher, of greater worth, and the body as a vehicle for the mind. This was given credence by the work of René Descartes (1596– 1650), ‘the patriarch of Western philosophy’ (Boyne 1990:1) and by his famous statement, ‘Cogito ergo sum’ (‘I think therefore I am’). The view of the body as machine was given a philosophical meaning and, combined with the monumental work of Isaac Newton, the prevailing Cartesian attitude was that ‘the rules of mechanisms are the rules of nature’ (Synnott 1993:23). It was believed that everything could be reduced to its constituent parts, analysed and therefore understood, and the mind was that which was capable of this understanding. Modernity was born with the fundamental belief that mankind could at last, via scientific tools and reductionist philosophy, understand the universe. Mankind, of course, included the mind and that irritating encumbrance, the body.

Scientific knowledge increased during the eighteenth and nineteenth centuries, and scientific discourse was founded. It is still a powerful discourse today, with the entrenched belief that the mind is separate from the body. Sanitary science in the 1870s put the body in its place. An acknowledgement of the scientific dangers of human waste led to phobias of diseases from without affecting the body. Although advances in sanitary disposal undoubtedly helped to improve people’s health in general, they also established ‘a new anatomical space’ (Armstrong 1993). In the eyes of public health administration the body became political. However, during the nineteenth century certain cracks started to appear in this dualistic paradigm. Charles Darwin demonstrated that our bodies were still evolving, thus implying that ‘mind was dependent on body’ (Synnott 1993). Karl Marx suggested that, if a body can be viewed as a machine, it can become a disposable asset (Fox 1993; Synnott 1993), therefore pointing out that ‘body as machine’ can be used as a manipulative tool, and that power is knowledge. If that knowledge comes from a philosophical base of reductionism, then workers are units, units are machines and machines are expendable. He therefore exposed a cruel extrapolation of Cartesian thought. Later, in 1895, Freud’s studies on hysteria led him to see that psychological phenomena converted into physical symptoms (Freud 1905); in effect, he founded psychosomatic medicine. However, far from introducing the idea of an integrated system of medicine, Freud’s ideas became subsumed into general medical discourse. Medicine thus promoted the mind-body dualism by providing specialisms in mind and body. Medicine has taken control of our bodies and our minds: ‘The magic bullets work better and quicker than prayer’ (Synnott 1993: 28).

Mind-body dualism and psychotherapy

The problem of mind-body dualism is not only located within psychotherapeutic culture, but appears to be endemic within western culture (Bayer and Malone 1998). However, within psychotherapy it is worthwhile to trace the sources of this dualistic attitude. As McLeod (1997:15) notes: ‘All the pioneers of psychotherapy were scientifically trained doctors, and they brought with them into the new discipline of psychoanalysis a battery of medical procedures and principles’.

We see that the founders of psychoanalytic psychotherapy had a medical training (e.g. Freud, Jung, Reich, Adler, etc.). This is echoed in many other models of therapy. The founders also had a strong medical background—for example, Joseph Wolpe, who influenced the behaviour therapies, was a medical doctor and Albert Ellis, who founded cognitive behaviour therapy, had initially trained as a clinical psychologist (Prochaska and Norcross 1994). It is interesting to consider the absence of the body in much current psychotherapeutic theory. Perhaps, as the founders had such a grounding in medicine, the body was taken as a given; it was simply not worth mentioning. Clearly, their view of the body would be that as seen through a medical lens, and this therefore may be one of the reasons for the embedded nature of the mind-body split within psychotherapy culture. Medicine clearly focuses on the patient’s body; we can see that a history of the body within psychotherapy could also be considered to be a history of the client’s body. The therapist’s body is written out and almost absent in most of the literature, except in cases of issues like erotic countertransference or touch. Even then, somehow the therapist’s body is reacting to the client’s body. This in effect is another form of dualism: there is a client body separated from a client mind, and a therapist body separated from a therapist mind.

Clearly the body has been given much significance in psychotherapy—as Freud stated, ‘The ego is first and foremost a bodily ego’ (Freud 1923:364). Freud’s perspective on the body has been critiqued from a feminist standpoint and Bayer and Malone (1998:95) point out that for Freud ‘women’s bodies posed not only an impasse to full psychosexual development, at least insofar as development of the super-ego went, but also a mystery about femininity’. Yet, for psychotherapy there remains the issue of how to work with bodily phenomena, and how to make sense of such bodily information. One way of dealing with client’s bodies is via the use of touch, which has its own particular set of problems (see Chapter 2). However, Freud’s assertion about bodily ego led to a very important developmental implication—that ‘the lack of certain body sensations will limit ego development’ (Smith et al. 1998:5). I agree with Smith et al. that the importance of the idea of the body ego actually provides for a rationale for the use of touch in psychotherapy. However, when looking at the history of psychotherapy, it was not Freud who developed this idea but one on his students, Wilhelm Reich, who took the idea of the body seriously and developed a method of treating the body within a psychotherapeutic framework. He further developed Freud’s notion of libido and applied it to his observations of his clients’ bodies. Reich extended Freud’s theory of libido to the realm of body armour. Reich (1983, 1990) observed in his patients areas of rigidification within the soma; he termed this ‘body armour’ and suggested a mechanism for this process in that the ego assumes a definite form in the conflict between instinct (essentially libidinal need) and fear of punishment. He suggested that the ego becomes rigid. It is this rigidity that can be felt within the body, but this required touching his patients. Therefore, according to Reich, rigidified areas within the soma represent unconscious conflict. These areas of armouring can also be considered as an adaptive response to past or present events.

Reich provided a further rationale for his theory by suggesting that armouring reduces the capacity of the body to feel pleasure by blocking out libidinous urges. Reich’s observations led him to believe that areas of the body become numb by encapsulating the libidinal feeling into a site of muscular tension. Such areas of high muscular tone symbolise denied preconscious and unconscious feelings. It requires energy, physical and psychic, to maintain such tightness; in a sense these areas can be regarded as psychic defence mechanisms aimed at preventing the conflict becoming conscious (Reich 1983, 1990). Thus, armouring reduces the capacity to achieve libidinal pleasure by decreasing the body’s ability to feel, and that character armour ‘fulfils its function by absorbing and consuming vegetative energy’ (Reich 1990:339). Reich therefore advocated a system of therapy which involved touching patients and encouraging an awareness of body tensions.

There have been many developments of Reichian therapy (for a good review see West 1994). However, one of the criticisms of this way of working is that without the associated verbalisation of these somatic phenomena it is unlikely that a meaningful understanding of bodily phenomena will be achieved. Therefore, authors such as Frankl (1990, 1994) and McDougall (1989, 1993) advocate the use of some form of insightful talking therapy as an adjunct to body work.

The net effect of these techniques for addressing bodily phenomena is not the solving of mind-body dualism but a perpetuation of this dichotomy. In some way this apes the medical model from which the founders of psychotherapy came and in which physicians treat physical phenomena and psychiatrists treat mental phenomena. Also in the world of psychotherapy there are now particular models of body psychotherapy which are identified as using body techniques. However, the use of ‘body’ in their title emphasises the split from ‘mind’. Perhaps Reich was closer to addressing the mind-body split in psychotherapy when he advocated that all psychotherapy practitioners should undergo training in physiology and anatomy (Prochaska and Norcross 1994).

A good example of mind-body dualism within psychotherapy culture is the use of the term ‘somatisation’. This also highlights some of the difficulties of integrating bodily phenomena into psychotherapy. It is to this concept that I shall now turn.

Somatisation

…communicating personal problems through complaints about the body is the universal language of mankind.

(Szasz 1987:37)

The discussion of the concept of somatisation is important because of its use within the therapy world and because it is a notion frequently referred to by therapists. Somatisation is a medical term that is used to describe bodily pain which does not appear to have a medically clear physical cause. A simple definition of somatisation is provided by Kellner (see Rodin 1991:367): ‘the presence of somatic symptoms in the absence of organic disease’. An example of how the term is currently in operation in the medical world is given by Servanschreiber et al. (2000:1423): ‘Somatisation is the experiencing of physical symptoms in response to emotional distress. It is a common and costly disorder that is frustrating to patients and physicians’.

Somatisation is included in the generic term ‘somatoform disorders’ which appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) published by the American Psychiatric Association (1995). This is a comprehensive classification of mental disorders which has become an invaluable tool in assessing patients for mental health problems. It is, therefore, a manual in widespread use, not only in the USA but also in the UK, and has become accepted currency within the health care professions dealing with mental disorders. However, it is of interest to note that classifications change; for example the passive aggressive personality disorder is present in DSM III (American Psychiatric Association 1987) but absent from DSM IV (1995). Drew Westen (2002) has also noted this absence from DSM IV, and wryly observed that a possible reason for this omission is that patients with this personality orientation did not fill out the relevant questionnaire, which could be construed as passive aggressive behaviour! The classification of mental disorders is therefore not immutable but subject to change, and it is interesting to speculate on who decides on this change and for what reason. However, for the purposes of this discussion, somatoform disorders are classified in the DSM IV. There are seven classifications, namely: somatisation disorder; undifferentiated somatoform disorder; conversion disorder; pain disorder; hypochondriasis; body dysmorphic disorder; and somatoform disorder not otherwise specified. A definition provided by the American Psychiatric Association (1995:457) is as follows:

The common feature of the Somatoform Disorders is the presence of physical symptoms that suggest a general medical condition (hence, the term somatoform) and are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder (eg Panic Disorder).

The term within medicine tends to be used in a pejorative manner as patients who have this ‘condition’ are viewed as not having an organic disease, and thereby in some sense not suffering from a ‘proper’ pathological condition. A demonstrable pathology can be classified, and then presumably treated by medical means; however, somatisation poses a problem for medicine as, if it cannot be classified within pathological parameters, the manner of treatment becomes problematic. Patients who regularly present with symptoms which can be described as somatisation are termed by the medical profession as ‘crocks, turkeys, hypochondriacs, the worried well, and the problem patients’ (Lipowski 1988:1361). Somatisation has thus come to be an accepted medical label for this group of patients. It is an a...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgements
• Introduction
• Part 1: The Body In Psychotherapy
• Part 2: Psychotherapists’ Body Narratives
• Part 3: The Embodied Psychotherapist