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A study of how body oriented therapists use their body awareness as a relational tool in the therapeutic dyad.
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Therapist’s Body Awareness in the Client –Therapist Interactive Process
Barbara Karlsen
May, 2012
Submitted in partial satisfaction for the Somatic Counseling Psychology Program
requirements of a master’s degree in Body Psychotherapy
Naropa University
Boulder, Colorado, USA
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Title: Therapist’s Body Awareness in the Client –Therapist Interactive Process
Author: Barbara Karlsen
Abstract
Body psychotherapists focus not only on the client’s body in clinical practice, but their own
body as well (Field, 1989; Shaw, 2004; Stone, 2006). This moment-to-moment attention to
the somatic process emerging between therapist and client is an integral part of the affective
dynamics between the body psychotherapist and client, and forms a central part of the
therapeutic alliance. Attending to this inner “felt sense” (Gendlin, 1992) requires the body
psychotherapist to have a keen awareness of their bodily response, and to use their body in a
sensitized matter. Using a qualitative research design, three body psychotherapists were
interviewed to explore the role of their body awareness in the therapeutic relationship.
Results showed the therapist’s body awareness forms a distinct dimension of subtle
interaction within the therapeutic dyad and is used to perceive information about the client
and the therapeutic alliance. Results also show that clients learn from the therapist’s body
awareness, and the field of body psychotherapy gives client’s permission to feel and move
their bodies as part of the therapeutic process.
Keywords: attunement, body awareness, body psychotherapy,
implicit communication, non-verbal communication.
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Introduction
The role of the therapist’s body awareness in the therapeutic relationship is largely
unexplored and undefined. When the body in the therapeutic encounter is written about, it is
predominantly the client’s body that is the focus of attention, and there is little reference to
the therapist’s body while working in the therapeutic dyad (Shaw, 2004).
In a body psychotherapy session, the therapist has to be aware of and track “felt
changes” within their own body, while at the same time track and help to regulate the client’s
experience as a source of insight about their health and wellbeing (Aposhyan, 2004). This
moment-to-moment attention to the somatic process emerging between therapist and client
requires a particular type of attention that reaches beyond tracking body postures and
movements, and requires a subtle attention to internal states. The author considers the body
psychotherapist’s body awareness to be a key component of this subtle attention. This
qualitative research study is an attempt to explore and determine a therapeutically relevant
concept of body awareness and it’s therapeutic relevance for the body psychotherapist in the
therapeutic dyad.
This author defines body psychotherapist as a psychotherapist who is trained in
specific skills such as body, movement and sensorimotor tracking in the process of
psychotherapy. The author will define body awareness using a definition proposed by Bakal
(1999), “the ability to perceive, interpret, and act on the basis of internal bodily
sensations”(p. 78). In the therapeutic encounter, a body psychotherapist uses their sensorial
experience as a source of knowledge, and recognizes that body- to- body communication
between client and therapist is important (Appel-Oper, 2010; Field, 1989; Shaw, 2004; Stone
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2006; Tantia, 2011). The therapist tracks his or her own nonverbal body communication by
feeling into their body, and receives the patient’s nonverbal communications through their
inner “felt sense” of the other (Gendlin, 1992). This paper posits that attunement, resonance
and nonverbal communication are considered important therapeutic skills, and require that
the therapist develop a keen awareness and understanding of their own body (Aron, 1998;
Rumble, 2008;Wilkinson, 2010). The author wonders what is it about therapist’s body
awareness that is unique and how then can it be used to facilitate or even augment the
therapeutic relationship? Using data from three qualitative interviews with body
psychotherapists in the Boulder, Colorado area, key concepts and themes pertaining to the
therapist’s perception and understanding of their body awareness in the therapeutic dyad
were compiled. The questions were structured in a way to help the respondents reflect both
conceptually and experientially. The respondents were able to stray from the interview
questions in the way they needed to describe their personal experience. All interviews were
recorded, transcribed and coded. Relevant words, phrases or statements within the text were
selected and categorized into Codes. Dominant and repetitive categories from the Codes
were then reconfigured into Themes to capture the essence of participant’s key concepts
from their initial descriptions. Themes were then used to formulate theoretical constructs.
Research Literature
Literature on the therapist’s body awareness, and the therapist’s awareness of their bodily
experience as an additional source of information in the therapeutic dyad were reviewed.
While the bulk of research focuses on patient’s verbal and cognitive domains, there is limited
reference to the relevance of attending to the therapist’s or the client’s somatic experience
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during the therapeutic encounter (Boadella, 1997; Dosamantes- Beaudry, 1997; Kepner,
1993; Shaw, 2004). When therapist’s somatic reactions during therapy are mentioned, it is
mostly pertaining to the idea of somatic countertransference. Somatic Countertransfence is
“the effect on the therapist’s body of the patient, and the patient’s material” (Forester, 2007,
p. 129). It may be a somatic reaction to something about the patient that evokes the
therapist’s own material (Casement, 1985). For the purposes of this paper, this author feels
that classical psychotherapeutic terms like countertransference may be inadequate when
addressing the role of the therapist’s body awareness in the therapeutic alliance.
A thematic review of the literature was done to illuminate the therapist’s bodily
experience from a neurobiological and a phenomenological perspective, and the specific
processes that may account for the therapist’s body as an “organ of information” (Samuels,
1993, p. 33) and vehicle of “implicit communication” (Chused, 2007, p.879). Key concepts,
existing theories and major theorists were reviewed.
Right Hemisphere Implicit Processes in Psychotherapy
Recently neuroscience has added much to our understanding of the psychoneurobiological
mechanisms involved in nonverbal implicit communications (Schore, 2005). This knowledge
has expanded our view of what happens in the interactive process between client and
therapist. Right hemisphere implicit structures are associated with the nonverbal, symbolic
and unconscious components of neural processing as opposed to the more explicit conscious
processing of the left hemisphere (Happaney, Zelazo, & Stuss, 2004). Implicit
communication expressed in body movements, posture, gesture, facial expression, voice
inflection, and the rhythm and pitch of the spoken words is an ongoing process in any dyad,
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and can provide information about one another without explicit acknowledgement ever
occurring (Schore, 2011; Dorpat, 2001). This has been referred to as “implicit relational
knowing”- a noninterpretive mechanism of the change process that does not rely on words
(Lyons-Ruth, 1998; Schore, Stern et al., 1998). Infant researchers, focusing on the facial
expressions, gestures, and prosody of mother/infant pairs have recently emphasized implicit
processes, and automatic actions (Beebe, Knoblauch, Rustin, & Sorter, 2005). This ongoing
paradigm shift from the explicit, verbal, conscious, and analytic self to the non- verbal,
unconscious, corporeal implicit self is becoming increasingly well known within the
psychotherapy world and has great implications for the role of the therapist’s bodily presence
as an intervention in the therapeutic relationship (Schore, 2011).
Affect attunement is another right hemisphere implicit process that is considered a
crucial aspect of the therapist’s interaction with the client (Beebe and Lachmann 2002; Stern
et al; 1998; Tronick et al, 1998; Wilkinson, 2010). According to Wilkinson (2010, p. 45),
attunement is “being aware of and responsive to another.” Rumble (2010) posits, “the body
forms a distinct dimension of attunement which can be explored by paying careful attention
to body sensations” (p. 130). This bodily dimension of attunement might also be considered
attunement between bodies, where one body impacts another. In other words, the body is
there for both for the therapist and the client, and is a direct participant in the interaction
(Rumble, 2010).
Affect attunement requires the therapist to track and helps to modulate client arousal,
and forms a rhythmic background to the ongoing verbal exchange between client and
therapist (Beebe & Lachman 2002). A key theorist in this area, Wilkinson (2010) has
assembled many theoretical and scientific sources and makes a solid case for “right- brain,
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implicit intersubjective affective transactions”(p.65). She asserts, “attunement and embodied
empathetic engagement are crucial in transforming the client’s internal working
model”(Wilkinson, 2010, p. 33). A growing number of neuroscience researchers now
emphasize the need for giving attention to nonverbal variables such as tone, tempo, rhythm,
prosody as well as body signals in the therapists’ interaction with the client (Hutterer and
Liss, 2006; Porges, 2009a; Schore, 2005; Stern, 2004). Schore (2008b) stresses how much
more than words is involved in therapy, and endorses the view of Hutterer & Liss (2006)
who emphasize the need for nonverbal variables such as tone tempo, rhythm, prosody and
amplitude of speech as well as body signals to be considered as crucial aspects of the
therapist’s interaction with the patient. According to Behnke (1995), body awareness is a
right hemispheric function that helps us attend to our emotional, ongoing, bodily felt
experience and to differentiate it’s meaning further through words.
Relational Intersubjectivity and Mutual Co-creation
To posit the relational role of the body in psychotherapy, contemporary relational and
intersubjective theorists were reviewed. Relational psychoanalysis privileges the role of
“intersubjectivity” over subjectivity and objectivity (Mills, 2005). Intersubjectivity refers to a
condition of interpersonal interaction. In his critique of relational psychoanalysis, Mills
(2005) emphasizes “dyadic attachments, affective attunement, and mutual recognition over
the role of interpretation” (p.155). Mill’s view demonstrates a relational dynamic that equally
applies to the mother- infant dyad and the therapeutic encounter (Beebe & Lachmann, 2003).
To help provide a theoretical framework for viewing the relational and intersubjective nature
of therapy, infant researchers such as Beebe and Lachmann (2002), Schore (2004), Stern et
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al., (1998) and Tronick et al (1998) were reviewed. Their focus is on two bodies in
relationship whereby each partner impacts on each other. Of particular interest is their
concept of “affect attunement” which posits that affects (intense emotions) play an
intersubjective role in the early pre-verbal relationship between infant and caregiver (Stern,
1985). According to (McCluskey, 2005), the infant’s affective display is a powerful signal
that calls on the caregiver to respond. Interactive regulation flows in both directions on a
moment to moment basis so that each experiences influencing, as well as being influenced by
the other (Beebe &Lachmann, 1998). The dynamics of this call and response lies in the
ability of the caregiver to attune to and modulate affects within tolerable parameters (Mc
Cluskey, 2005).
Infant researchers with an object-relations perspective such as Winincott (1971),
Mahler, Pine and Bergman (1975), focused on the physical and emotional contribution of the
caregiver to the infant’s emotional development, and emphasized the role of the mother in
the acquisition of the infant’s sense of embodiment. The emotional resonance of the
caregiver with the infant’s somatic experience provides the child with a mirror that reinforces
and affirms his or her sense of embodied existence (Mahler, Pine &Bergman, 1975). Infant
researchers Beebe and Lachmann (2002), Schore (2004), Stern et al., (1998) and Tronick
(1998) contend that this view of nonverbal interaction as a coordinated state, is as relevant to
adult communication and the client /therapist interaction, as it is to mother infant
communication. In somatic psychotherapy practice, body-to-body interaction, nonverbal
interaction and affect attunement between therapist and client has always been an important
way of working in the therapeutic relationship (Gratton, 2010).
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Embodiment
Most of the emphasis in somatic psychology to date has focused on subjective experience
through the body rather than on embodied relationship (Dosamantes-Beaudry, 1997; Shaw,
2004). There is a prevailing attitude in body psychotherapy that the therapist’s physical
resonances, or reactions, such as subtle changes in postures, gestures, and movements are
mainly used for further information on the client (Joyce & Sills, 2001), or are viewed as
physical counter-transference (Soth, 2006). To provide a broader conceptual framework for
embodied phenomenon relevant to this discussion, this author will turn to Philosopher
Merleau- Ponty (1963). The importance of his work in constructing a broader notion of
embodiment is summed up by the following quote, “it is through my body that I understand
other people” (1963, p. 186). Embodiment from this approach can be used in conjunction
with intersubjective meaning; by providing what Gendlin (1981) might describe as inner “felt
sense” to the other’s posture, gestures and movements. In a process of moment-to-moment
body communication, therapist and client co-create an embodied field in which both relate
with and refer to one another (Apel-Opper, 2010). Just like the infant comes to know his or
her sense of embodiment through the caregiver’s handling (Winicott, 1971), “the somatic,
nonverbal intersubjective dialogue begun in infancy continues to be carried on automatically
and unconsciously into adulthood, even after the acquisition of verbal language”
(Dosamantes-Beaudry, 1997 p. 520).
Researchers Field (1989) and Shaw (2003) have investigated the therapist’s
phenomenological experience of their bodies to gain a deeper insight into the embodied
experience of the therapeutic encounter. The importance of their research has contributed
greatly to the theory of embodiment and in particular psychotherapist embodiment. A major
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theme to emerge from Shaw’s (2004) research is that “the therapist’s body is used as means
to monitor the psychotherapeutic process, and that knowledge of the therapeutic encounter
can be acquired somatically by psychotherapists”(p. 285). As Stone (2006) reports, “the
therapists body acts as a tuning fork to resonate with the client’s experience”(p. 109).
Methods and Participants
Participants included three licensed body psychotherapists in Boulder, Colorado. All three
psychotherapists who took part in this study were selected based on the fact that they had
been in private practice for at least ten years. This was considered an adequate amount of
time to have experienced working with a variety of clients, and to have developed a keen
sense of bodily awareness in therapy. Two out of the three participants belonged to a
professional organization such as the United States Association of Body Psychotherapy, and
all three participants completed a recognized body psychotherapy training program. The
sample for the study was comprised of two Caucasian women and one Caucasian man. Their
ages ranged from 49-55 years old. Two out of the three therapists identified themselves as
body psychotherapists and one therapist identified as a somatic psychotherapist.
Procedure
Five open-ended questions were asked by the researcher during the interview with the
intention of obtaining information the participant deemed pertinent from his/ her experience
of perceiving and using their body awareness in the therapeutic encounter. Five questions
were formulated prior to the interviews, and expanded upon both conceptually and
experientially in the interview process. Questions were asked in order to elicit concepts and
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personal experiences pertaining to how the therapist might describe, and report their body
awareness operating in the therapeutic encounter. The interviews were digitally recorded and
transcribed. Following the transcription of the interviews common quotes, words and phrases
within the text were selected through a first round of coding using an in vivo coding method.
The second round of coding led to themes arising from the in vivo coding using a descriptive
coding method. Care was taken to incorporate all relevant information as clients described
personal accounts of their body awareness while working with the client.
Results
Codes are listed in Table 1. Themes arising from codes are listed in Table 2.
Table 1: Codes
Interview Questions First Order Themes
1.a. What is your personal
definition of body
awareness?
“ an informed, full bodied experience”
“ a streaming of information through my senses that informs
me”
“ using my body to observe and listen with”
“ allowing myself to be affected”
“ attention to bodily sensations and perceptions”
1.b. How do you use it in
the therapeutic
relationship with a client?
“ my primary method of perception”
“ to notice how I am in relationship with my client “
“ moment to moment tracking of information on many levels”
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“ to notice changes occurring within me and in the client”
2.a. Does your body
awareness inform you or
signal you in the
therapeutic relationship
with a client?
“yes”
2.b. How? “ sensations and impulses moving in me”
“ activation, heat, discharge ”
“ feel responses in my body”
“ a lot of perceptions at once”
“ a bodily felt sense of something”
3.a. How would you
define body awareness?
“ a full bodied participation”
“ a field of potency within, between and beyond”
“ a body intelligence that is tracking and recording”
“ integration of emotion, thought and physical”
3.b. What does it involve? “attention”
“being fully present with”
“a deep listening within and without”
“connection”
“willingness to be affected”
4.a. What is your
perception of the client’s
“helps them to drop into their feelings”
“helps them to feel something they may not be feeling yet”
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response to your body
awareness in the session?
“gives them permission to feel”
“curiosity”
“gives them a body experience”
4.b. Do you feel that the
client learns from your
body awareness?
“Yes”
5.a. Has your body
awareness changed over
the course of your
professional career?
“Yes”
5.b. How? “deepened”
“it has become more sophisticated”
“I am able to access more”
“increased my capacity to be with intense feelings”
“more resourcing in myself”
6.a. Has this changed your
therapeutic relationship
with the client?
“Yes”
6.b. How? “much more accepting and relaxed with client”
“increased feeling within myself”
“much more present with myself and client”
“offers more possibility where client can go”
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“I am more aware”
Table 2: Themes Arising From Codes
Interview Questions Second Order Themes
1.a. What is your personal
definition of body
awareness?
Using my Sensory Experience to Observe, Listen and be
Affected by the Therapeutic Relationship
1.b. How do you use it in
the therapeutic
relationship with a client?
Tracking the Therapeutic Relationship
2.a. Does your body
awareness inform you or
signal you in the
therapeutic relationship
with a client?
Yes
2.b. How? Bodily Felt Sense
3.a. How would you
define body awareness?
(Author Discarded as too similar to other questions)
3.b. What does it involve? Presence that Facilitates Connection
4.a. What is your
perception of the client’s
response to your body
Permission to Feel Body and Emotions
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awareness in the session?
4.b. Do you feel that the
client learns from your
body awareness?
Yes
5.a. Has your body
awareness changed over
the course of your
professional career?
Yes
5.b. How? Deepened Capacity to Access More in the Therapeutic
Relationship
6.a. Has this changed your
therapeutic relationship
with the client?
Yes
6.b. How? Able to Discern and Accept Differences Between Self and
Client
Discussion
In this study the role of the therapist’s body awareness in the therapeutic process was
explored. According to the interviewees, the therapist’s body awareness involves more than
just moment-to-moment physiological tracking. It involves an active engagement. This is
seen through the therapist using his/her own body to perceive, facilitate and to be affected by
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the therapeutic encounter. All three participants mentioned body awareness as their “primary
mode of perception” in the therapeutic relationship.
A second theme to emerge includes body awareness as an educational experience
wherein the client is “given permission” to engage in their bodily states. This suggests that
mirroring and reflecting body states, and using statements such as “what does your body
want to do?” and “how does your body want to move?” gives clients more options/ways to
include their bodies in the therapeutic encounter. This has great implications for body
psychotherapy and in particular it’s use as an intervention in therapy that has to do with
bodily states involved in trauma.
The third theme to emerge from the data is that amount of time in the therapeutic
relationship appears to be a factor influencing the development and refinement of body
awareness. The data shows that over time, body awareness develops into “deeper contact”
that influences therapists perceived awareness, and capacity to tolerate a wide range of
affective and somatic experiences in the therapeutic process. All participants mentioned
being “more accepting of where the client was at” and “having the increased capacity to
refrain from action and to remain curious.” This increased capacity to contain has great
implications for the field of body psychotherapy and in particular the field of trauma therapy.
In reference to a current and relevant therapeutic concept of body awareness, this
researcher proposes the following; therapist body awareness is a subtle and distinct
dimension of ongoing somatic interaction, and the primary process of perceiving information
for the body psychotherapist in the therapeutic process. Based on the three themes that
emerged from the data, the therapist’s body awareness has a significant role in the
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therapeutic encounter and can be considered to be a vital affective, relational and somatic
intervention in the therapeutic process.
Limitations
Limitations of this study include a homogenous sample of participants in regards to
theoretical orientation, apparent personal identity and educational background. All three
participants were affiliated with the same community; with theoretical foundations in body –
based approaches to therapy. It was noted after the data collection that all three participants
were also affiliated with the same academic community, and had a similar educational
background. It was noted that participants interviewed had a lack of diversity and shared a
similar ethic and racial background. Also, only three interviews were conducted for the
study, which likely did not achieve data saturation.
Limitations within data collection and methods involved throwing out question # 3
because it was deemed to be similar to question #1, and did not derive any new data.
Personal biases of the researcher include a preference towards body- based therapies and a
conceptual framework that values body awareness.
Conclusion
Body psychotherapists use their body awareness as a crucial source of information and
agency in their clinical work. When attended to, the therapist’s body awareness can inform
the therapist, facilitate the therapeutic alliance, and help the client make sense of their bodily
experience.
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Body psychotherapy training has always emphasized the somatic component of both
the therapist and client’s experience in the therapeutic relationship. However this is only one
component of somatically –oriented psychotherapies. The clinical importance of the
therapist’s embodiment and ability to reflect on his or her sensory experience with acuity and
clarity is often underscored. As therapists how do we train and cultivate this capacity for
sensory acuity and depth of bodily awareness? It is important to distinguish between
therapists’ bodily awareness in the moment, and therapist’s ongoing relationship to his or her
bodily process and how this is helpful to the therapeutic process. A future study using more
participants could look at how body psychotherapists cultivate a personal sense of
embodiment- a concept of which body awareness is just one aspect, and what that requires.
One could also include and explore how the therapist feels this practice affects the depth of
exchange between the client and therapist. This study could also include the client’s
perspective of the therapeutic exchange and whether this had increased meaning for them as
well. This could provide the basis for further research into the notion of therapist
embodiment, what this involves, and how it can be addressed and cultivated in the training of
therapists.
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