Bodies in Treatment: The Unspoken Dimension
Frances Sommer Anderson (editor)
The Analytical Press 2007 (Relational Perspectives Book Series)
pp273 £27.99 (Hardcover)
by Brigitta Mowat
Bodies in Treatment is a follow-up to Relational Perspectives of the Body (Analytic Press 1998) that introduced working with the body and emotions from a relational perspective. The central theme in this new book is the body in relation to trauma and it felt at times like reading a Body Psychotherapy book – especially the essay by Graham Bass who describes using a ‘hands on approach’ in a session with a client. Touching a patient in psychoanalysis is, at least in this book, no longer a taboo! The reader is introduced to a range of body-based treatments that are used either to complement or as an integral part of psychoanalytic treatment. This is a step- change, signifying a shift both from traditional psychoanalytic practice and from psychodynamic and humanistic approaches. Throughout the book we are introduced to an approach that does not favour verbal over non-verbal communication; furthermore, experiences in the non-verbal domain are seen as essential steps in the process of reintegration.
The editor gives a personal account of being at the receiving end of body-based treatments while undergoing psychoanalysis. Her remark that many of the body practitioners did not have sufficient interpersonal skills to work at a relational depth that, in her view, is necessary in trauma work, is food for thought. Nonetheless, treatments like the Alexander Technique, bioenergetic techniques combined with Kundalini yoga, biofeedback etc played an important part in her quest to uncover and integrate her traumatic experiences in a way that psychoanalysis was not able to do. It was her experience of the limitations of traditional psychoanalysis that motivated her to produce this book.
Part One explores ways of attending to ‘bodily experience’ that serve to support and strengthen a client’s bodily or ‘core’ self. William Cornell shows how this aspect of self can be strengthened in therapy: for example, he had a client mimic different characters from one of her own drawings she brought to a session. This enactment enabled her to grasp feelings and sensations which she had previously forbidden and which had therefore been out of her awareness. The acting of different characters awakened feelings that had been stored in her ‘implicit memory’. This vignette demonstrates the undoing of another common analytic taboo: getting a client to act as opposed to talking in a disconnected way. Wilma Bucci’s essay provides theoretical underpinning for this new way of working. She relates ‘the unspoken dimension’ to multiple code theory: for example she suggests that experiences are stored on symbolic and sub-symbolic levels and regards these as being on an equal footing rather than lower and higher brain functions. This non-hierarchical way of looking at experience seeks to use language that connects intuitive and visceral levels in contrast to traditional, rational ways of using language.
Part Two introduces the reader to body-oriented techniques such as Pat Ogden’s and Peter Levine’s trauma work, dance and authentic movement, yoga, cranio-sacral therapy, and polarity therapy. This part of the book is very useful for psychotherapists who are seeking to integrate a body-based therapy into their clinical work. Christopher Eldredge and Gilbert Cole present trauma work that concentrates on tracking body sensation, arguing that ‘memory, affect, and image arise from a deep somatic source, not a verbal or narrative source’ (p.80). They present five different techniques that can help a client to focus on bodily experience. Maria Paola Pacifici’s essay describes long-term analytic work with an anorexic young woman, where dance and movement was crucial in helping to enliven her depleted, lifeless body and enabled her to build a new authentic self. Patricia Gerbarg introduces a wealth of research on yoga in connection with trauma. The benefit of using Sudarshan Kriya Yoga (SKY) as an adjunct to psychoanalytic treatment is illustrated in her long-term work with a client who suffered from PTSD. She suggests that yoga could play a vital part in a therapeutic plan because:
‘therapeutic breakthroughs may be catalyzed, particularly in cases where trauma-related schemas have remained inaccessible to persistent psychoanalytic approaches.’ (p.143)
Continuing with trauma work, Graham Bass, as mentioned above, uses cranio-sacral therapy as a means of helping a client become aware of, and learn to integrate, traumatic experiences. He also says that the same form of bodily integration of dissociated affects can be facilitated in an attuned psychoanalytic setting; however, based on my personal experience of having received touch, as well as using touch as an integral part of my client work, this does not ring true and the question as to whether or not touch adds another dimension is an interesting debate. Helen Newman’s essay, the last in part two, introduces the reader to polarity therapy in conjunction with psychoanalysis. She works with the five elements: ether, air, fire, water and earth. Her clinical vignettes demonstrate how these elements can be applied to individuals’ histories: for example, ‘a person whose parents died during childhood might have suffered a blow to his earth element and the work may consequently centre on helping him to feel more grounded.
Part Three explores yet other ways into the ‘unspoken dimension’, paying attention to bodily experience in the form of movement, vocal rhythms and facial expressions. Steven Knoblauch describes a mutually transformative moment in a piece of client work which he calls the ‘tipping point’; by this he means a moment of unusual emotional intensity that marks a shift in consciousness – the equivalent to Daniel Stern’s concept of a ‘now moment’. Gianni and Susanna Nebbiosi focus their analytic work by observing clients’ rhythmic movement patterns. They found that miming a client’s postural pattern in a supervision context has helped them to encode and understand the non-verbal communication. This approach is based on contemporary parent-infant research and the recent discovery of mirror neurons in the brain.
‘Based on these studies, it appears that the sharing and communication of emotions takes place largely through our patients’ body movements, and this process is mainly relational.’ (p. 223)
Part Four outlines ways of bringing the body into therapeutic dialogue, and suggests that this approach challenges many mainstream methods. Jean Petrucelli advances the topic from a clinical perspective and raises awareness of the simple truth that we all have feelings about our physical body as well as our therapist’s body. This is often difficult to talk about and she suggests that:
‘By bringing a consciousness of the therapist’s body into the therapeutic dialogue, we have a chance to recognise how patients disown their bodies: their feelings of insecurity, shame, humiliation, self-hatred.’ (p. 242)
Adrienne Harris and Kathy Sinsheimer write on the topic of the analyst’s self-care. Both authors point out that listening to our clients’ emotional distresses and fantasies, often for several hours a day, may affect the practitioner’s emotional and physical health. They recommend that psychotherapists seek self-care in the form of peer support and/or find ways of nurturing their bodies in massage, yoga or writing.
Overall, I found Bodies in Treatment a well-written and well-structured book in which there is a good balance between theoretical concepts and clinical examples. The vignettes bring the often quite complex theories alive. The book’s main message is that, in order to promote integration and healing, trauma work needs to happen not only on a relational level, but also on a bodily level. The variety of body treatments that are explored in the context of psychoanalysis is at the cutting edge of integration. I wholeheartedly recommend this book to psychotherapists, educators and body-based health practitioners who seek to find effective ways of working with trauma.