The Body Speaks

Christine Caldwell

Your client comes in for his weekly appointment, dejected, and relates the story of his week. Monday, his father sent him a cruel email, accusing his son of a lack of respect, lack of spine, lack of attention. On top of that, work was stressful this week, and the real kicker happened on Friday, when he had to go to the hospital for chest pains, sure he was having a heart attack. The doctors found nothing wrong, but it scared and embarrassed him.

You see his slumped posture, the tension around his eyes, and you immediately link the chest pain to the email. Of course they are related. You see it even if your client doesn't. But what do you do about it? Is helping the client to come to an understanding of the physical and psychological link between his heart and his father enough? Or does the heart itself need your mutual attention?

Another client arrives that afternoon, and as she describes a dream where she is stuck in traffic, she rubs her fingers on her temples, grimacing. It occurs to you that this gesture is part of the emergent story, part of the signaling of the unconscious, a kind of physically enacted image. How do you include this gesture into your explorations of the dream?

As verbally oriented therapists we have been trained to see words as deeply significant, as profound and mysterious emanations from the personal and perhaps collective conscious and unconscious realms. A clients ‘choice of words can say everything about their struggles and hurts. Voice tone and volume, the pacing and rhythm of their words often reveal conflicts and ambivalences between conscious thought and unconscious motive. Posture and gesture have been identified as part and parcel of the clients inter and intrapersonal processing. We all appreciate this, as we experience this concordance in our own lives as well. But while most of us have been schooled in these obvious liaisons between the body and the mind, we have likely not been adequately trained to do something about it.

Another way to appreciate this therapeutic dilemma we may be encountering is to use the now-popular metaphor of the brain. All events that influence us do so because our senses register them, and pass on this registry to the central nervous system (CNS). The CNS can be seen as first a filter, then a categorizer, and finally an organizer towards action. Perhaps reflection occurs before the action, perhaps not.

Consciousness is metabolically expensive, so we try to shunt as many events as possible into less expensive autonomic functioning. That's the filtering process. Partly we do this via genetics. We can say that genetic programming is simply an action that has been so successful for so many of our ancestors that we can afford to do it completely automatically, as an inherited package. I don't have to learn to secrete hormones, to consciously manage my peristalsis. Luckily, how to do it is a gift from my progenitors.

Another way we minimize the proverbial gas-hog of consciousness is to learn things. Learning and memory, in many ways interchangeable terms, allow us to commit events to networks in the brain that store them. Upon subsequent similar occurrences we retrieve the stored memories and act according to them, saving the energy we would have to expend if this were a novel event.

The unconscious is a physical as well as psychological phenomenon. As you read this sentence, you are doing many, many things that you are not keeping track of. If we had to keep track of each breath, of every beat of our heart, every enzyme level, we would be utterly and completely conscious and likely not able to do anything but sit still and manage our interior landscape. It's doubtful we would be recognizably human, as we haven't even begun to deal with the need to pay attention to the outside world.

On the level of the brain, there is no distinction between the body and the mind. It all parses out into levels of functioning. Does a sensation get routed only through the brain stem to the autonomic nervous system (ANS), where some quiet gland will respond, without conscious fanfare or emotional stirrings? Will a sensation make it to the limbic system, where it will be compared to stored events, sifted through emotional and factual memories, and whipped back to the ANS where we will feel the strong urge to panic and run? Or will it be un-urgent enough to be escorted through the gate of that midbrain and make it all the way to the neocortex, where we can actually consciously reflect on what we want to do? Clearly, what we typically think of as the mind is only the tip of the great iceberg of Self, and that Self is first and foremost a body.

Our clients come to therapy with all these levels of functioning in tow. Over the past decade the trauma field, as well as brain research has helped us to appreciate how poignant a truth this is. Defensiveness is a physical event first, a raising of the hands to ward off, a tension in the shoulders, and only later enrolls rationalization, denial, projection. Dissociation begins as a scrambling of the usually smooth sequence of events between sensation and corresponding action. How then, as therapists largely trained to work from the tip of the iceberg, do we work with the whole person? The answer lies in conscious attention and action, repairative moments that occur right there in the room.

Consciousness has long been the engine driving therapeutic change. In therapy we bear the expense of it so we can call up automatized material and tinker with it in the service of a more perfect union with ourselves and others. What we now know is that we need to help the whole being of the client to wake up, to bear the cost of consciousness. We attend both to sensation as well as thought, and to the physical rumbles of emotion as well as their cognitive explanations. We move our bodies as a way to move our whole being to a new place, and hopefully this new place will be graceful and efficient enough that we will automatize it, internalize it.

•  When to deal with the bottom up first

•  Become interested in non-verbal language – treat it as just as relevant as verbal – the client signals via nonverbal means

•  Know how to help a client manage their arousal – breath, movement, imagery, contact functions, touch (via sensory preferences)

•  Don't be afraid to let the client consciously pay attention to the hand they have put on their heart. Ask that hand to talk to that heart, and the heart to respond. ie, explore the physical actions that signal significant material

•  Appreciate the physical nature of attunement & therapeutic relationship, and appreciate somatic transference & countertransference

•  Organize your interventions around the realities of the sensorimotor process – ask a client to track their present moment sensations as well as historic ones. Study, right there in your office, how the sensations gets routed, and how this routing may be causing the client to suffer.

As your client talks about his father's email last week, he unconsciously rubs his heart with the fingertips of his left hand. You note this, and reflect it back to him. He nods. You ask him to go ahead and rub his chest very consciously