I’ve been having lots of conversations with therapists looking to enroll in our Somatic Attachment Psychotherapy Training about working with the body in therapy. Lots of therapists identify that they in fact already do use the body in their clinical practices, by asking,
what’s happening in your body?
where do you notice that?
is there a sensation that tells you that?
and then what they share with me is that they often feel uncertain about what to do with that information, or how to take it beyond their initial question/intervention – of course, this is what we teach in SAP over the two years! These conversations inevitably beg the question, is that enough? Is it enough to have people identify what is happening in their body and then notice it, stay with it, watch it? My response is, enough for what? What is the purpose of drawing the client’s attention to their internal sensation or felt sense? What is the working theory, not only about why the therapist is inquiring about the body, but also inviting clients to stay with it? That’s the guiding question here, what is the purpose?
If the intention is to merely have people increase their capacity to be present, be with what is, and increase capacity to tolerate discomfort, then yes, the status quo of how people often use the body might be a worthwhile intervention, though perhaps not the best intervention, as most therapists, prior to somatic training, choose to include the body at a time when there is distress, intense emotion, or disconnection/disembodiment. (More on this later).
If the intention to help process and metabolize material in the system (relational and incident traumatic material), then no, just dropping in and noticing the sensation, and staying with it, particularly difficult or uncomfortable sensations, is not likely going to further the processing of the neurophysiological material or psyche reorganization, and if it does, it will be short-lived. What is likely though, is that simply focusing on the body during these times of arousal will move the system out of the processing window into high/hyper or low/hypo arousal as the dysregulation in the system creates more and more dysregulation. Alternatively, the client may continue to feel the sensation but not really garner further process or understanding from it – for example, the tightness remains tightness, so the intervention fizzles without any further clinical or embodied process unfolding.
In order to process (trauma, grief, loss, etc.), the work is to up and down regulate the autonomic nervous system along side the story. This is where BBP/SAP differs from other somatic dominant trainings – one of our guiding principles is that people need to tell their story, and be witnessed relationally, rather than just experience and process what is happening in their body, so working to re-organize the psyche and body in concert. When we invite the body into the clinical dialogue and process, we want to be able to work to help people to not only be present to what is happening within, but to the nuanced truths of the story that also help anchor and facilitate processing and internal re-organization, both of which are key to change.
Change is key to therapy. We know the body and psyche are wired together, and that trauma is held in the right (versus the left), so we understand as therapists how bringing the body into practice offers an effective way to attend to and process traumatic material (of all kinds) in order to regulate and process the physiological body and reorganize the psyche and internal working models, and ultimately bring forth a new narrative understanding of self and story.
For clinicians, working adeptly with the body necessitates a solid understanding of the Polyvagal Theory (Porges) (read, the Polyvagal made simple) and the Window of Tolerance (Siegal). These conceptual frameworks offer therapists a theoretical framework to guide the use of somatic interventions, rather than simply inserting them into the therapy. Further, I would suggest that correlating sensations and felt sense into this framework is necessary for therapists to have a sophisticated capacity to work with, and in the body.
If we circle back to these conversations I’m having about bringing the body into practice, it seems to me that what we are differentiating here is mindfulness and somatic processing. While there is overlap, they ultimately have different purposes. Mindfulness is a practice oriented towards increasing one’s capacity to be with what is. Somatic process has the intention to shift the internal state and process material. These are significant differences when thinking about the purpose of inviting the body into the clinical conversation. In this way, I want to underscore not only the difference between mindfulness and somatic therapy, but the difference in intention. Somatic therapy is used to process material. It may use mindful presence to attune and be with experience, but it at its core, it’s about shifting and processing—making it different, not learning to be with what is.
This fall I’ve been thinking a lot about the capacity to witness. I have been thinking about what supports it, what threatens it, what builds it, and for therapists, how we are called to witness the unbearable, the unspeakable, and at times, that which has not, and perhaps cannot, or cannot, at this time, be metabolized through the body and psyche of the people we sit with. This is the work we do in the clinical space. As therapists, we serve as witness, and in doing so, material that has been rendered unbearable, becomes tolerable enough to metabolize. Mucci (2018) speaks to this, “by taking in the pain of the other, and bearing witness to it, the other is enabled to retrieve those parts of his or her existence that seemed erased, dissociated, split and disconnected. This retrieval enables a transformation in the social connection, a sign of renewal, reconstitution, collective reparation, and rebirth” (Mucci, 2013 cited in Mucci, 2018, p. 176 – 177). Mucci speaks of this as rebirth as there is a return of vitality as the psyche integrates and the autonomic nervous system processes the life-threatening states held in the body, moving from hypo arousal or dorsal vagal into a stronger, dominant ventral vagal state.
But what happens when we as therapists are also called to witness horror and terror in the larger world, the one outside of our clinical space, and in response to it, we feel fear, despair or helplessness? How do we continue to do the work that we do, and what is called for, when we are taken to our knees by world events, when our clinical spaces are infiltrated with the happenings of the larger world? As an educator in Somatic Attachment Psychotherapy, I’m always thinking about, how do we become more and more robust, where do we lean, what do we lean into, what holds us, how do we maintain our witness when we stumble, and as we stand as witness for and with others, what do we need?
In this time and place in history, where we are inundated by geo-political chaos and disconcerting movements, both in our own small communities and around the world, I am aware of the toll it takes. I know that it taxes each of us as clinicians, even if we are able to shut out some of the bombardment of difficult news, it comes in through our practices, and of course impacts us energetically. I’ve been thinking about that in my own life, and in a broader way, the lives of the therapists I know.
I think about the work that we do. I am awash with memories, scraps of competing truths vying for primary remembering, primary knowing:
I remember that the body is “our primary text and starting point for knowledge” (Rountree, 2006, p. 98). This quiets me. I land.
I remember, “When we remain connected to our body knowledge, it will make it more difficult for the powers that be to control our minds” (Crawford, 1998, p. 57). I nod.
I remember, “A brain disconnected from the stomach, intestines, throat, heart, and other parts of our body isn’t only seriously impaired, it can be as deadly as the proverbial loose cannon” (Todd, 2001, p. 28). I nod.
I remember, “People who can’t trust their own body knowledge feel out of touch, have less tolerance for ambiguity, seek clearcut simple rules to determine their actions, tend to consider complex situations in simplistic terms, and are thus more likely to be swayed by “experts” and by naïve either/or arguments” (Todd, 2001, p. 24). I feel worry.
I remember, “reading the body as one would read a text, we used our lived experience as another valid and valued source of information and knowledge…” (Gustafson 1998, 52). I nod.
I return to remembering that the body is “our primary text and starting point for knowledge” (Rountree, 2006, p. 98). This quiets me. I land.
I come back to the truth that nothing remains static. Embodiment is an ever-shifting evolution. Paired with the body is the capacity to witness, to be present, to hear the testimony of the people we sit with, and to use my body and my regulation in the process, for the process. For me, this has been an ever evolving and expanding quest, and I hope that is for you too.
This past week has called me to dig deeper and steady myself as my perception of reality shifted, as did many peoples’, with the outcome of the US election. By happenstance, my weekly supervision group was the first clinical space I entered into after the US election. I am one of the two Canadians in the group, the others are American. We put aside our cases and we sat, we processed, we made sense, and most importantly we connected and stood as witness for one another.
Since then, I have needed to take time, to be with myself, and come back to what I know beyond this moment. I had to take a bird’s eye view of history, of humanity, and lean into the vastness of time, to remember that Rome wasn’t built in a day, nor did it fall in a day, and I had to find commonality of values with those that understand a way forward that is different from my own perspective. Remembering the goodness of people beyond their political leanings helped me remember how to connect across differences, even when the chasm feels vast. This was imperative, not finding it as a philosophical endeavor, but for myself, so I could find my ground again and stand, until the next time I stumble.
References:
Crawford, L. 1998. “Including the Body in Learning Processes.” In Proceedings of the 17thAnnual Conference of the Canadian Association for the Study of Adult Education, edited by Maurice Taylor, 57-60. Ottawa: University of Ottawa.
Gustafson, D. L. 1998. “Embodied Learning about Health and Healing. Canadian Women Studies 17 (4): 52-55.
Rountree, K. 2006. “Performing the Divine: Neo-pagan Pilgrimages and Embodiment at Sacred Sites. Body & Society 12 (4): 95-114.
Mucci, C. (2018). Psychoanalysis for a new humanism; Embodied testimony, connectedness, memory and forgiveness for a “persistence of the human”. International Forum of Psychoanalysis. 27:3, 176 – 187.
Todd, J. 2001. “Body Knowledge, Empathy and the Body Politic.” The Humanist (March/April): 23-28.