Bodies In Treatment

The Unspoken Dimension

Frances Sommer Anderson, Frances Sommer Anderson

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136823060
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

Bodies in Treatment is a challenging volume that brings into conceptual focus an "unspoken dimension" of clinical work - the body and nonverbal communication - that has long occupied the shadowy realm of tacit knowledge. By bringing visceral, sensory, and imagistic modes of emotional processing to the forefront, Editor Frances Sommer Anderson and the contributors to this original collection expand the domain of psychodynamic engagement. Working at the leading edge of psychoanalytic theory and practice, and in the forefront of the integrative psychotherapy movement, Anderson has created a collaborative project that stimulates interdisciplinary dialogue on the developmental neurobiology of attachment, the micro-processing of interchanges between the infant and caregiver, the neuroscience of emotional processing and trauma, body-focused talking treatments for trauma, and research in cognitive science.Enlightened by experiencing body-based treatments for thirty years, Andersonreflects on the powerful impact of these interventions, recounting attempts to integrate her somatically-informed discoveries into the "talking" frame. Reaching further, her contributors present richly informative accounts of how experiences in body-based modalities can be creatively integrated into a psychoanalytic framework of treatment. Readers are introduced to specialized modalities, such as craniosacral therapy and polarity therapy, as well as to the adjunctive use of yoga, the effectiveness of which can be grounded neurophysiologically. Somatic interventions are discussed in terms of the extent to which they can promote depth-psychological change outside the psychoanalytic consulting room as well as how they can enrich the relational process in psychodynamic treatment. The final sections of Bodies in Treatment explore the range of ways in which patients' and therapists' bodies engage, sustain, and contain the dynamics of treatment.

1
At a Loss for Words and Feelings

A Psychoanalyst Reflects on Experiencing Bodywork

Frances Sommer Anderson

It was peony season last year when I committed to write this chapter. It is peony season again, as I struggle to finish. Monday’s tightly compressed buds, the size of pink cotton balls, have become Thursday’s 13-inch, effusive, exuberant, multilayered wonders, and they’re still expanding. Last year, I was in a full-bloom self-state while planning this book. As soon as I tried to use words to describe ineffable, imagistic experiences in bodywork, I tightened into an apprehensive, defiant, compressed-bud state: I was afraid I could not convey what I needed to in narrative form. It seemed like an overwhelming project, and I discovered that I did not want to work so hard. All year, I have felt like one of those oppositional buds that never opens. You know the ones I mean: They have such potential. You can wait forever but they never open. I felt as if I would never open. But I did. What I wrote during the year was self-conscious and stilted, too studious, dead. What helped me open was taking in the beauty and wonder of the peonies, staying with the feelings they evoked, and starting to write from that place.

I have a highly conflictual relationship with words compared with my relationship with imagistic mentation (Fosshage, 1997). I respond readily to color, texture, form, movement, facial expression, and posture and to the pitch, volume, rhythm, inflection, and intonation of spoken language. I grew up in a family who did not graduate from high school. They had native intelligence and abundant common sense but a limited vocabulary and only rudimentary grammar. They seldom put thoughts and feelings into words. I remember a lot of silence: Most family communication was through what was not said—through facial expression, gesture, and posture. When they did speak, I relied on intonation and inflection to discern what they really meant. I knew more than I could ever articulate, and I longed for the words to capture and convey my experiences.

I was, and still am, in awe of and envy people who seem to be able to articulate concepts and feelings effortlessly, fluidly, eloquently. I experience an unbridgeable gap between my interoceptive, proprioceptive, and kinesthetic experience and what I can convey about those aspects of experience in words. Often I cannot find the links between what Bucci (1997, 2001, 2003, this volume) calls the subsymbolic mode of experience and verbal and nonverbal symbolic representations of those experiences. (I often use visceral to refer to what she calls the subsymbolic mode.) Despite many years of formal education and evidence of mastery in some areas, I still feel at a loss when I confront dense, highly conceptual verbal and quantitative material. In contrast, when I meet someone for the first time or consult with a new patient, I “know” a lot immediately, even though I cannot always articulate what I “know” in my body. I rely heavily on subsymbolic and nonverbal symbolic modes of processing as an analyst and often find it difficult to articulate the complexity of my awareness in discussions with colleagues and when writing.

I resonated recently with a New York Times article, “Being Joan Didion” by Campbell Robertson (2006), in which he discusses the ways Ms. Didion and actress Vanessa Redgrave are collaborating on Ms. Redgrave’s role as Joan Didion in a play based on Ms. Didion’s book, The Year of Magical Thinking. The book is a gripping account of the impact of the sudden death of her husband, concurrent with the life-threatening illness of their only child. He quotes Ms. Redgrave, ”I’m thinking about a lot of things in a lot of different ways…. I don’t like to put it into words.” Ms. Didion supplied, “It freezes it” (p. E2). David Hare, the British playwright who will write the script, contrasts Ms. Redgrave and Ms. Didion as follows: Ms. Redgrave “is the most emotionally expressive actor about a certain kind of extreme feeling…. And one of Joan’s extraordinary qualities is this glacially perfect prose which contains fantastic feeling underneath a formal surface” (p. E2). There’s my challenge—I wish to be emotionally expressive about extreme feeling in glacially perfect prose.

My difficulties in the realm of verbal communication, discovered in my personal analysis and in my treatment of people in pain, together with my discoveries about personal trauma through bodywork modalities, are the sources of my passion for integrating verbal symbolic, nonverbal symbolic, and subsymbolic modes of processing. Writing from my perspective as a psychoanalyst reflecting on 30 years of experiencing body-based treatments, I hope to illustrate how I discovered experience that is difficult to represent in words but that I symbolized in images and eventually integrated into my biographical narrative. I also attempt here to identify conditions that can facilitate accessing feelings when the narrative lacks a connection with the subsymbolic realm. Finally, I wish to convey what I have learned about the advantages and limitations of verbal and nonverbal modes of treatment and how we can build bridges between self-states elicited in each.

The Beginning of My Quest

What began as an intellectual, academic pursuit became a passionate personal journey, fueled by each discovery I made along the way. My quest began in 1975, after I had finished my dissertation, received my doctoral degree, and completed my clinical psychology internship. I joined the psychology staff at my internship site—Rusk Institute of Rehabilitation Medicine at NYU Medical Center—diagnosing and treating children and adults with progressive neuromuscular diseases and doing research on sexuality and neuromuscular disease (Anderson, Bardach, & Goodgold, 1979). I have elsewhere described the impact of working as an analytically oriented clinician in physical rehabilitation medicine, where the material body dominates the physical environment and is the focus of one’s work every day (Anderson & Gold, 2003).

Eager to learn, I began studying in a private group with a psychologist, Camilla Kemple. She was renowned for diagnostic acumen and a creative approach to the interpretation of projective techniques—figure drawings and the Rorschach, among others. Having studied with Flanders Dunbar, a prominent figure in the field of psychosomatic medicine, Camilla had developed distinctive ideas about the relationship between mind and body, psychosomatic medicine, and how the Wechsler scales and projective tests could be used to detect difficulties in these areas. I had serendipitously found in Camilla someone from whom I could learn more about the mindbody connection, an interest dating back to my first undergraduate course in psychology. I first heard about “bodywork” from Camilla. She knew a seasoned Alexander teacher, and I, who had always been a very serious academic student, was ready to learn in a completely different modality. Thus, in 1976 I began to experience bodywork out of intellectual curiosity.

I chose to begin Alexander lessons without doing research on the technique; I relied only on Camilla’s descriptions. I wanted to enter from a place of curiosity, open to discovery, not from my “head.” Being goal oriented and practical, however, I found myself justifying the lessons: I knew that the Alexander technique focused on improving one’s posture, so I decided that I needed to correct my posture. That is where the trouble, and the unanticipated discoveries, began.

What was wrong with my posture? All I knew was that as far back as I could remember, Aunt Sadie had made harsh criticisms of it, such as, “What’s wrong with you? Hold your shoulders up.” Or, “Don’t slouch. You look like your daddy when you do that.” I continue to deal with the emotional reverberations of her critical voice, still audible within and capable of making me cringe as I write this. Having learned to avoid further castigation from her by being compliant, I never considered asking her to explain what she meant. Being precociously resourceful, I determined that I should lift my shoulders straight up to my ears. I hoped that would correct my problem, please Aunt Sadie, and literally get her off my back. Well, no matter how hard I tried to be perfect in order to avoid her criticism and to get her approval, my shoulders did me in. I just couldn’t remember to “hold them up” every single moment.

Thus, I brought my “poor posture” and “slumping shoulders” to my Alexander teacher, Patricia, fully intending to correct it. The sessions were about an hour long, and I was fully clothed. My first discovery was that, unlike my teacher, I was impatient with the painstakingly slow pace at which we worked. I had always taken pride in being diligent and patient. The body awareness Patricia required was very subtle and precise. Two thirds of each one-hour session was spent standing, turning, and bending, very slowly, with keen attention to doing it correctly. I quickly suppressed my feeling that this exercise was very tedious, boring, and, to my surprise, infuriating. I was angry that I had to be so conscious of every movement—what happened to spontaneous movement? What about the majority of people who never heard of Alexander lessons and seemed to be just fine without them?

The last part of the session, I lay on my back on a massage table, fully clothed, with my head off the table, supported only by my teacher’s hands. This posture was absolutely wonderful. I had never experienced anything like it. Her supporting my head was blissfully soothing. For about 3 years, I went for a class once a week, enduring the first part in order to get to the second part so that I could experience her holding my head. I had no idea why that was so important, and I never asked for the rationale for that part of the lesson.

I made two discoveries about myself that I had not yet made in my talking treatment: 1) I was very impatient and silently furious about having to work hard, in contrast to my conscious pride in being able to endure and persevere without complaint no matter what I had to do, and 2) it was very important for me to let go, to allow myself to be held, to be soothed: I hadn’t been aware of wishing for or needing that. These self-states, accessed first through “hands-on” body treatment, would prove to be fundamental in my process of integration and self-healing, to echo Krystal (1988). Neither my analyst nor I understood the significance of these self-states.

Treating Pain, Finding Myself

In 1979, I began working with a physiatrist, John E. Sarno, MD, at Rusk Institute, NYU Medical Center, treating people with chronic musculoskeletal pain. He was the only mainstream physician who recognized, from a psychoanalytic perspective, the role of emotions in creating and curing pain (Sarno, 1991, 1998, 2006). I have written a detailed case presentation of my treatment of Ellen, a patient referred by Dr. Sarno (Anderson, 1998).

My patients were exquisitely attuned to pain sensations in their bodies. Before long, I became aware of my own somatic sensations. I had hardly noticed them before, or I had paid scant attention to them if I did. Family and cultural norms had constrained and devalued bodily experience. I grew up on a working farm in the South, where we used our bodies for manual labor to make a living. We gave little thought to taking care of the body, except to feed it properly and to rest so that we could work. We had no concept of soothing the body, nor a concept of pleasure or leisure. My family also required Fundamentalist religious training, in which I was taught that the body was to be used to work and to do good deeds. I had much to learn about the body.

In the pioneering years of collaborating with Dr. Sarno, we treated people who had usually been suffering with pain for years. Many had had numerous unsuccessful medical procedures, including surgeries and injections. They had come to him as a last resort, placing great faith in and pressure on all of us who treated them. In the rehabilitation medicine field, they were thought of as “difficult,” even “untreatable,” except by the use of cognitive behavioral techniques to “manage,” not cure, the pain. That attitude prevails today, even though Dr. Sarno’s approach has gained national and international attention. My patients were not easily soothed; it was difficult to get them to talk about anything but their bodily pain, and they usually could not speak easily about their emotions. I was fascinated with the challenge of helping them but had no idea how much I had in common with them and how profoundly I would be affected by working with them.

As I worked with my pain patients, I began to feel that I needed a different kind of bodywork. Perhaps the Alexander technique had helped my posture, but more important were my discoveries that I hated working tediously at correcting my posture and that I craved the time I spent on the table “letting go.” I was eager to learn more about letting go through hands-on bodywork and in the talking situation.

What do I mean by letting go, recommended in many kinds of bodywork and meditation? Let me return to Monday’s peony buds. If you don’t know peonies, imagine a tight new rosebud. Can you locate within yourself the visceral experience of the tightly compressed buds? Here I use visceral to refer to sensory information from the internal organs of the body that reaches the brain by way of the spinal cord and to refer to our verbal concept of “gut feeling.” A technical term for this awareness is interoception. What do you sense in your body when you try to find that closed, compressed-bud selfstate? Imagine the tightly compressed bud and notice what happens in your body. I call that the OPPOSITE of letting go. Now, imagine Thursday’s 13-inch peonies, or a voluptuous rose, and notice what you feel in your body. What sensations, images, feelings, and thoughts arise when you try to access your peony/rose-in-full-bloom self-state? I call this a form of letting go, or opening up—a process that took my peonies about a week.

The “open” state that happens when we “let go” comprises cognitive, emotional, imagistic, and visceral elements difficult to convey precisely in words. Another image of letting go is to imagine holding a small rubber ball that will fit in the palm of your hand so that you can wrap your thumb and fingers around it. Imagine squeezing that ball very tightly, as tightly as you can, and notice all sensations, images, feelings, and thoughts that arise as you “hold on” very tightly. Now imagine suddenly letting go of the ball, suddenly releasing it—I call that letting go. What do you feel in your hand and in the rest of your body now that you have “let go”? Can you express in words what you feel in your body?

In 1979, I knew that my pain patients could not let go. And working with them forced me—allowed me—to discover that letting go was difficult for me also. Continuing to seek methods of experiencing feelings I could not access in talking treatment alone, I worked with a woman, Samantha, trained as a psychomotor therapist, focusing on how the body moves. I hoped to be able to discover how I could feel free to move and also understand what psychological processes interfered with moving freely. I also hoped that moving freely would generalize to feeling free to move cognitively and emotionally as well.

As I had anticipated, the work with Samantha was much more active than the Alexander lessons had been. It involved a lot of stretching and breath awareness while I was fully clothed. Some of it was done standing and some lying on the floor. I loved my teacher— she was warm, had a great sense of humor and a lovely voice, and was remarkably patient. I felt good being in her physical presence. I was ama...