§ It takes a good deal of experience for therapists to be able to distinguish between their “own” sensations and those that they are “picking up” from their clients. Analysts sometimes call this projective identification.
‖ Another way to learn is by watching the TV series Lie to Me.
a This is the basis for the method of acting taught by Konstantin Stanislavsky.
b I am not sure how much is due to the actual radiation of heat and how much is the result of somatic resonance.
c The legendary actor of the Peking Opera, Mei Lanfang, used hundreds of specific hand gestures to communicate several unspoken or subtextual emotional aspects of whichever character he was performing.
PART II
The Body as Storyteller: Below Your Mind
We use our minds not to discover facts but to hide them. One of the things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day.
—Antonio Damasio, The Feeling of What Happens
CHAPTER 8
In the Consulting Room
Case Examples
To acquire knowledge, one must study; but to acquire wisdom, one must observe.
—Marilyn vos Savant
You can observe a lot just by looking.
—Yogi Berra, catcher, New York Yankees (circa 1950s)
The therapist who is familiar with bodily feelings has a privileged window onto the primal life of the psyche and soul. No amount of talk alone can match this vantage point. Long before the advent of psychiatry, the French philosopher Pascal noted that “the body has its reasons that reason can not reason.” The Austrian Wittgenstein, in this same tradition, wrote that “the body is the best picture of the mind.” And the Australian F. M. Alexander, around the turn of the nineteenth century, made an extensive study of peoples’ postures and concluded, “When psychologists speak of the unconscious, it is the body that they are talking about.”
The current lack of the appreciation of the body in psychotherapy caused the analyst Musad Kahn96 to lament, “I have not come across any paper that discusses the contribution made to our knowledge and experience of a patient from our looking at him or her in their person as a body as against looking at merely the verbal material and affective responses in the analytic situation.”
Somatically oriented therapists provide their clients with carefully paced feedback in the form of invitations to explore their emerging bodily sensations. This feedback is based largely on the therapist’s ability to observe and track the postural, gestural, facial (emotional) and physiological shifts throughout a session in order to bring them into a client’s conscious awareness. This allows both client and therapist to uncover unconscious conflicts and traumas that are well beyond the reach of reason. Freud seems to have grasped this concept in his early work when he says, “The mind has forgotten, but the body has not—thankfully.” Yes, thankfully! Though Freud seems to have abandoned this premise, his student Wilhelm Reich spent his entire career studying how conflicts are lodged in the body. “When it comes to the consulting room,” he remarked, “there are really just two animals and two bodies.”97
In this chapter, I will use examples from my own cases to illustrate the principles outlined in Chapters 5 through 7. In the very beginning of session work, a client may not understand the therapist’s feedback about her unconscious attitudes. But as the client becomes more conscious of her sensations, she is able to use them to access innate resources and to deepen her capacity to “know” herself through the subtle promptings of her body. In the first case (Miriam), I introduce expressive, but hidden, body language. This case is relatively straightforward and demonstrates some basic body-oriented observational skills that therapists can utilize with their clients to facilitate their awakening and to enhance integration of their sensations, feelings, perceptions and meanings.
Miriam: In the Unspoken Language of the Body
Miriam enters the room, tentatively sits down, and folds her arms tight across her chest. This posture gives the impression of rigid self-protection. Of course, one may have many reasons for folding one’s arms: she could be comforting herself or even keeping herself warm. It is the overall context that tells the story. Miriam is agitated, pumping her crossed legs repeatedly. Her face is visibly constricted; her lips are thin and pulled tight. Miriam offers that she feels discontented and resentful about her marriage and work situation. She finds herself “in bad moods a lot” and frequently has trouble staying asleep at night. When she wakes up, it is often because of cramps in her belly and restlessness in her legs. She describes this intrusive experience by grumbling, “It’s like they kick at night and wake me up.” Her family doctor thinks that she may have “restless leg syndrome” or depression, and suggested an antidepressant medication. However, she first wants to try and “talk things out.”
Miriam’s body language reflects both her distress and her “resistance.” This resistance is there for a reason: it is the physical expression of how she is protecting herself. In part, Miriam is defending herself as though from an outside “attack.” However, she is protecting herself primarily from her disowned sensations and feelings. Resistance needs to be worked with gently and indirectly. Frontal confrontation is generally ill advised: to “attack” resistance directly is likely to intensify it or to break it down precipitously. Such a sudden demolition of a defense is likely to bring with it overwhelm, chaos and possible retraumatization.
Observing resistance at the bodily level allows the therapist to monitor the person’s developing capacity to befriend her sensations and feelings as the session progresses; and, thus, to assess the efficacy and intensity of various therapeutic interventions, both verbal and nonverbal. As the client begins to feel safe enough (through appropriate reflection, pacing and mirroring), she begins to feel she is seen and respected; and then, naturally, her guarding postures will gradually diminish. If the client, on the other hand, tries too hard to open up (for example, by divulging more about herself than she is physically and emotionally ready to), her body will reflect that by intensifying resistance or in non-congruent changes in her nonverbal and verbal behaviors. However, when a therapist can track the client’s burgeoning awareness and provide support in tracking her self-protective somatic mechanisms (without pushing into—or backing away from—them), the deeper levels of the body’s unconscious communication system begin to speak, both to the therapist and to the client.
While, initially, Miriam is not conscious of her protective posture of habitually holding her arms crossed, it is still a relatively voluntary gesture. As she feels safer and more confident, these unspoken narrations emerge as more spontaneous, rather than habitual, expressions. As she gains deeper access to fledgling feelings, core issues begin to surface, ready to be explored.
Miriam continues to talk about her difficulties at work and with her husband, Henry. Although these are the same problems she was struggling with a few minutes ago, this time there is more animation in her voice. She gestures with her arms, extending them slightly outward in front of herself. Her hands are nearly at right angles to her wrists, almost as though she were pushing something away. I make a similar movement with my arms so as to “mirror” her movements and help her to feel and trust her own (disowned) movements.*
I bring Miriam’s attention to her extending her arms and bending her wrists and suggest that she repeat the movements slowly. I ask her to try to focus on how her arms feel when she makes the movement, so that she gets a sense of how the movement feels physically from the inside. At first, she seems puzzled. After a few times, she pauses, smiles and says, “It feels like I’m pushing something away … no, more like holding something away … I need more space, that’s what it’s really like.” She sweeps her arms from in front
of herself and then off to both sides, creating a 180-degree range of free motion. She lets out a deep and spontaneous breath: “I don’t feel as suffocated, and my belly isn’t hurting like it was when we started.” She extends her arms, flexing her wrists again. This time she holds them out for several seconds, almost at arm’s length. “It’s the same problem … at work and with my husband, too.” She now places her hands gently on her thighs. “It’s so hard for me, I don’t know why but … I don’t feel like I have a right to do this … like I don’t have a right to my own space.”
I ask her if it’s more of a feeling or a thought. She pauses, giggles and replies, “Hah, I guess it’s really a thought.” Now there’s a deeper laughter.
By contacting her nonverbal bodily expression, Miriam is able to go beneath the veneer of her ruminative thoughts about Henry and her work, to explore freely the story her body is beginning to tell. With this emergent kinesthetic and proprioceptive awareness, she has begun to sense into the neuromuscular attitude that underlies her internal conflicts.
After settling into her bodily experience, Miriam starts to get wound up again. I observe her carotid pulse and notice an increase in her heart rate, along with pressured, rapid, shallow breathing. I ask her to put her questionings aside for a moment and place her focus back on her body. Relieved by this suggestion, she closes her eyes.
“I feel more solid now … like there’s more of me.”
When I ask her to try and identify where in her body she feels the solidity, she says, “I don’t know; I just feel that way.”
“Just take your time,” I suggest. “Don’t try too hard. Just settle inside your body and see what you begin to notice.”
Miriam closes her eyes. She seems a little confused and doesn’t speak for a minute or two. “Its mostly in my arms and legs … They feel like they have more substance … They feel more solid … I feel that way.”
At this point, Miriam initiates further, this time self-directed, exploration by closing her eyes without my suggestion. After a minute or two, her jaw begins to tremble almost imperceptibly. I wait to see if she will notice this on her own.
“I feel strange,” Miriam says, “kind of shaky inside … I don’t like this … It makes me feel kinda weird inside … like I’m getting out of control, like I’m not myself, like it’s not me.”
I reassure her by explaining that new sensations often feel uncomfortable and alien at first, and encourage her to “just let it happen … try to suspend labeling or judging sensations for a bit.” Miriam tells me that she’s feeling worse, even more uncomfortable. I acknowledge this but gently and firmly encourage her “to hang in a little bit longer,” to shift her attention to her arms and legs for a while—to the places in her body where she had been feeling rooted a short time ago.
“Huh, they don’t feel shaky … actually they feel strong … I feel my jaw shaking … That’s where I feel shaky … My legs feel solid.”
The juxtaposition of the empowering sensations of her arms and legs supports her ability to experience the “shaky” sensations associated with the weakness without being swallowed up by them. Her breathing is now deep, continuous and spontaneous. Her skin has a warm rosy glow, indicating that the social engagement system is starting to function, to come online.
I suggest that she slowly begin to open her eyes and look around.
“That’s funny,” she says. “Things seem a little clearer; the colors are brighter and … I think warmer, too. Actually, I feel a little warmer, and the trembling is less … or not so scary … It feels like I could go back inside now … Do you want me to do that?”
“That’s up to you,” I say, knowing how important the element of choice is. “What I can tell you, though, is that you are starting to be able to go inside yourself, and you seem less scared and helpless.”
She looks at me momentarily, but then averts her gaze downward to the floor. Slowly she looks upward, contacting my eyes. A single tear rolls down her cheek. “Yes that’s right, I don’t feel so scared … In some ways I feel a little excited … Yes I want to go on … It’s scary, but I think I can do it … I just need some help … your help.” More tears stream from her eyes. Her words stumble as she chokes: “It’s hard for me to ask … It feels emotional … I don’t think I have so much experience in asking for help.”
This acknowledgment lets me know that the social engagement system is operative, and that deeper exploration is possible. “Yes, I’m glad to give you support,” I respond. When I ask her if she has any ideas of what kind of support might be helpful, she responds that just to do what I’ve been doing is what she wants. I ask her to be more specific.
“I’m not sure,” she says. “Actually, I think it has to do with feeling that you’re here, here for me. When you give me feedback, that helps keep me in touch with what I feel … in a way with who I am.”
“When you say that,”—I see her face relax—“you seem to let go more deeply.” Miriam smiles, and I continue, “It’s different than a few minutes ago, when you spoke of not having had the experience of asking for help.”
“Yes,” she adds, “it’s really different to ask you for support in helping me to learn how to be there for myself … That way I don’t feel less than you, I feel more equal … I like that … I feel like if I didn’t want to do something that you suggested to do, I could tell you that now.” Without prompting, Miriam holds out her arms and hands again and sweeps them around in a horizontal semicircle. “Yes, these are my boundaries. I can set my limits—that feels good … and I can tell you what I need.”
We both smile. Miriam closes her eyes and sits quietly for several minutes. While it may seem simplistic, having the actual, kinesthetic, proprioceptive experience of being able to form and hold boundaries gives Miriam a significant physical experience that contradicts the pervasive sense of powerlessness that has driven her perception of the world. Rather than being folded defensively across her chest, her arms now lie resting on her legs—exemplifying a more open stance and a willingness to look inward.
Miriam continues, “First I started to feel the shaking again … It became more intense, but then it started to settle down on its own.” She is now beginning to self-regulate by moving through activation/deactivation cycles. “I felt some warmth starting in my belly and then spreading out in waves … That felt really good … I could even feel the warmth flowing into my hands and legs … but then my gut started to knot up. I started feeling a little sick, nauseous and queasy. I realized that I was thinking about Evan, my first husband. Actually, I saw a picture of him walking toward me. He was killed a month after we were married … I think that I never got over it … I couldn’t believe it happened … In a way I still don’t … I dream about Evan a lot. It’s always the same dream. He comes to me; I’m despondent. I ask him why he left me. He doesn’t answer me, but turns his back and walks away. I wake up wanting to cry, my throat is all tight, but I don’t want Henry to know. I feel so terrible; like there’s something wrong with me … I don’t want to cause him any pain.”
“Miriam, I’m going to ask you to say something and notice what happens inside when you say the words. But remember these are my words. They might not mean anything to you. I’m only asking you to try them out and then just to notice how your body responds. Try not to think too much about it; just do it. Does that feel OK to you?” I say this not because it is true (or false) but so that the person can observe the effect the sentence has on their body sensations and feelings.
She nods. “Yes, that’s OK. I’d like to do something about these feelings, these dreams, if I can.”
“Ok, here’s the sentence: ‘I don’t believe it happened; I don’t believe you’re really dead.’ ” The purpose of this is to bring into consciousness the direct body experience of denial so that it can be dealt with.
Miriam holds her breath and turns pale; her heart rate drops sharply, from about 80 to 60, indicating that the vagal immobility/shutdown system may have kic
ked in. “Are you OK, Miriam?” I ask.
“Yes … but my guts are queasy and tight … like a cold hard fist … I feel sick again … It’s worse this time … but I think that I can handle it. I’ll tell you if it’s too much.”
Wanting to reinforce her developing capacity to assess her capability to handle difficult sensations, I ask her, “What gives you that sense, Miriam, that you can handle it?”
“Well, mostly I feel it in my arms and legs again. They still feel strong now, even if they’re shaky.” With her eyes still closed, Miriam starts to tremble visibly.
“That’s OK,” I encourage. “Just try and be with it. Know that if you need to, you can open your eyes. OK if I place my foot next to yours?”†
“Yes, I would like that … Yes, that feels better.” The trembling increases in intensity; it settles, increases and settles several times. Miriam takes a deep spontaneous breath and then becomes still. She seems peaceful; the color of her hands and face indicates a significant rise in temperature. Sweat begins to break out on her forehead.
“How are you doing now, Miriam?”
“I feel really hot … like waves of heat burning me … It’s so intense, like nothing I’ve ever felt before; maybe once when I … was with … oh my god!”
“OK,” I offer, “just sit quietly; just let it settle.”
Tears start streaming as Miriam begins to cry softly. “It feels so deep. I couldn’t feel this before. It was just too much when he died. It’s different … I can feel the pain in my body and I won’t be destroyed … Actually the pain in my belly is completely gone … and it feels warm there … a soft kind of warm.” This is an example of linking islands of safety (see Step 2 in Chapter 5). The linking of resources starts with the sensations of strength and solidity in Miriam’s arms and legs as she is able to form boundaries. Then experiencing the visceral sensations of warmth and expansion gives her a developing sense of empowerment and of intact goodness. This “chaining” of resources allows her to gradually experience the sensations and feelings of paralysis and helplessness, which form the core of her traumatic experience. As she does this without being overwhelmed, time has in a sense moved ahead from the frozen past of denial into the present. In the following phase of the session, Miriam accesses the “unfinished business” of anger, loss and guilt. In moving from fixity to flow, she awakens her sensual aliveness.
In an Unspoken Voice Page 18