A missing dimension of mental health care
Peter Wilberg New Gnosis Publications www.newgnosis.co.uk Behind your thoughts and feelings my brother, there stands a mighty ruler, an unknown sage – whose name is Self. In your body he dwells. He is your body. CONTENTS
Psychiatric services concentrate primarily on the symptomology,
neurophysiology, and pharmacotherapy of mental illness. Counselling and psychotherapy offer ‘talking therapies’ focused on the client’s mental-emotional states. Social work concerns itself with the provision of managed social care for the mentally ill. Approaches to mental illness which concentrate either on mental-emotional states or on brain chemistry, however, tend both to encourage a lack of sensitivity to the somatic dimensions of the client’s experience of mental illness. In soma-psychology the term ‘somatic’ does not refer to the physical body, but to the client’s own inwardly felt body, in particular their felt bodily sense of dis-ease or distress and their felt bodily sense of self – or lack of it. The central hypothesis advanced by soma-psychology is that pharmacotherapy and psychotherapy are effective only to the degree to which they not only alter the client’s mental state or mood but deepen their felt bodily sense of self and of inner connectedness to others. Unfortunately both psychopharmacology and counselling or psychotherapy can also have the very opposite effect. Pharmaco-therapeutic treatment may numb rather than deepen the client’s bodily sense of self and of inner connectedness to others. Counselling and psychotherapy, cognitive therapy and emotional empathy can all become a substitute for deep somatic receptivity and ‘resonance’.
When the mentally disturbed or distressed turn to mental
health professionals, they are not just seeking medical diagnosis and treatment and/or emotional empathy and support. They are looking for someone capable of fully receiving them as ‘some-body’. By this I mean someone sensitive enough to resonate with those felt bodily dimensions of their lived experience that are so difficult to communicate in words. Not finding professionals with sufficient soma-sensitivity to ‘resonate’ with an individual’s inwardly sensed body, the client may feel no choice but to continue to communicate their felt dis-ease or ‘pathos’ through their own psychiatric, somatic or social ‘pathology’.
The theoretical framework of soma-psychology offers a
relational model of psychopathology, in line with leading edge trends in Relational Psychoanalysis. The ‘primary relation’ addressed however, is the individual’s relation to their own felt body and bodily sense of self. Different recognised psychiatric disorders are understood not as mental or emotional disorder, not as expressions of physical brain or body dysfunctions but as distortions in the individual’s relation to their own felt body.
In many current forms of mental health treatment the meaning of a
client’s pathology is sought in a hypothetical ‘cause’ or represented in the concepts, categories and constructs of a specific theoretical model. In contrast, the theory of soma-sensitivity follows the work of Eugene Gendlin in acknowledging that meaning or sense is something that can be
directly felt and sensed in a bodily way – and that the felt bodily sense we have of a client’s problem can provide a deeper foundation for intellectual insight and sensitive response than any pre-established ‘body’ of theoretical concepts, diagnostic categories, or therapeutic techniques. It complements Gendlin’s understanding of “bodily sensing” or “felt sense” by showing their relation to the sensed body and felt self – the ‘inner body’ and ‘inner self’ of the individual.
Like the training methods developed by Gendlin, the
evidence-base of soma-sensitivity training is research into the principal factors which facilitate genuine therapeutic change in any relationship, professional or personal. Gendlin’s groundbreaking work on the importance of bodily sensing in psychotherapy arose from research into the distinguishing characteristics of those clients who, independently of the nature of their own presenting problem and the particular approach of the practitioner, were able to benefit from therapy. His conclusion was that such clients were naturally able to use bodily sensing to (a) feel for words with which to express otherwise murky or unclear aspects of their experience, and (b) check out whether their own or other people’s verbal articulation of a problem was in resonance with their direct somatic experience of it. From this insight arose a new basic principle of therapeutic practice, a principle which provided at the same time an important new way of evaluating the efficacy of therapeutic interventions in situ.
“Moment by moment, after anything a person says or does,
one must attend to the effect it has on what is directly experienced. Does a given statement, interpretation, cognitive restructuring or any symbolic expression bring a step of change in how the problem is concretely, somatically experienced?…If there was no effect, we can discard what was said or done.”
‘Focusing’ is the name Gendlin gave to a set of simple but
highly effective methods which could help precisely those clients who had difficulty benefiting from therapy. The techniques of Focusing concentrate on helping the client – or any individual — to feel their feelings in a direct bodily way. This in turn enables them to sense whether their words or actions are in resonance with their own immediate somatic sense of their own situation or state of being.
Soma-sensitivity training draws from Gendlin’s method of
Focusing but shifts its focus from exploring the factors which enable clients to benefit from therapy, to the factors which enable therapists and counsellors to be successful — irrespective of the particular approach they adopt. Rather than examining and comparing the different models and methods, strategies and skills, processes and procedures which different schools of therapy employ, it concentrates on the dimensions of awareness that make individual therapists successful – in particular their own bodily self-awareness and sensitivity to the body of the client. The practical focus of soma-psychology is not on the client’s ‘pathology’ and its ‘causes’ but on the soma-sensitivity of the mental health professional — their
sensitivity to the felt body and bodily self of the client. Soma-sensitivity training for mental health professionals has already been shown to bring rapid benefits in their work with individuals suffering from psychoses, personality and anxiety disorders, and depression. Its aim is to cultivate the therapist’s ability to use ‘bodily sensing’ to (a) check out the efficacy of their own therapeutic interventions, (b) to become more sensitive to somatic dimensions of the client’s self-experience, and (c) use their own felt body to resonate with and transform the client’s inner bodily sense of self.
As Gendlin has pointed out, ‘therapy’ itself is best understood
not as some ‘thing’ that one person is trained to ‘give’ to another, but as a process — one that can either be facilitated or hindered in any relationship, including the ‘therapeutic relationship’. The therapeutic value of soma-sensitivity comes from its focus on the relational significance of ‘bodily sensing’. Like Focusing, its benefits aren’t restricted to the sphere of counselling and psychotherapy but can be experienced in all human relationships. More specifically, soma-sensitivity training is relevant to the relationships between all types of mental health professionals and their clients. It offers a valuable new form of complementary training and continued professional development for all those working in the mental health field — one that not only has its own direct therapeutic value, but also offers important new theoretical insights into the very meaning of ‘mental’ illness.
Training in soma-sensitivity is not a substitute for established
bodies of professional knowledge. What it provides is a way of preventing the latter from being mechanically applied — helping the individual mental health professional to ground the concepts and techniques they apply in bodily sensing and to cultivate their own somatic sensitivity to the client. Only in this way can particular approaches to the treatment of mental disorders cease to be reliant on a set of pre-established ‘processes’ and ‘procedures’, ‘skills’ and ‘strategies’. For if the incidence of somatic symptomology, drug abuse, violence and wilful bodily self-harm in the client population can tell us anything, it is that such ‘difficult’ clients refuse to be reduced to a set of disembodied cognitive processes or behaviours.
The Principles of Soma-psychology
Soma-psychology differentiates itself from other forms of
body-oriented psychotherapy or ‘bodywork therapy’ by clearly distinguishing the individual’s physical body from their own inwardly sensed body or ‘felt body’. It recognises the inwardly sensed body as an independent ‘inner body’ in its own right. Used as a medium of psychotherapy, soma-sensitivity is a form of inner bodywork in the most literal sense. Inner bodywork is the use of the therapist’s own inner body to feel and transform the client’s inner bodily sense of self, and to deepen the client’s inner bodily sense of connectedness to others. The basic principles of soma-psychology can be summed up as follows:
1. The less aware we are of our body as a whole, the less aware we are of
our self as a whole. The more aware we are of our bodies, the more aware we are of ourselves.
2. The inwardly sensed body or inner body is our link to our inwardly
sensed self or inner self, and to the inwardly sensed body and self of others.
3. Inner body awareness is awareness of an inner body. The inner body is
a body of awareness — the bodily shape and tone of an individual’s self-awareness.
4. Each individual’s physical body language has a more or less limited
alphabet of movements, facial expressions and vocal tones.
5. The more restricted an individual’s body language is, the less able they
are to embody their own inner body states.
6. Inner body states that cannot be fully embodied find expression as
mental-emotional states or somatic symptoms.
7. Emotions are motions of awareness in the inner body. Feeling ‘low’ or
‘down’ for example, is a motion of awareness toward the lower region of the inner body.
8. The mind is itself a layer of the inwardly sensed body, a language skin
or “ego skin” which functions as an internal mirror reflecting inner body states.
9. Psychological metaphors such as ‘closed off’, ‘thin-skinned’, ‘hard to
stomach’, ‘cold-hearted’, ‘hurt’ etc. are literal references to inner body states.
10. Our own inwardly sensed body and self is a medium of inner-body
resonance with the inner bodily states of others and their inner bodily sense of self.
Soma-psychology transcends the artificial separation of
physical and ‘mental’ illness in somatic medicine and psychotherapy. Physical body functions such as respiration, digestion and metabolism are the expression of basic functions of our inner body – for example our capacity to inhale, digest and metabolise our awareness of the world and other people. Both physical and mental illness are the expression of inner body states. Physical illness is the expression of disturbed inner-body functions – the respiration, circulation, digestion and metabolism of awareness. So-called ‘mental’ illness is an expression of a disturbed relation to the inwardly sensed body and self. This disturbed relation however, is invariably felt both as a self state and as an inner body state. States of anxiety, depression, dissociation or depersonalisation for example are all felt in a bodily way and in this way affect the individual’s bodily sense of self. Specific psychiatric disorders such as schizophrenia, depression, bipolar disorder, borderline personality disorder express specific disturbances in the individual’s relation to their inner body and inner self. What is regarded in the West as the ‘disease’ of ‘depression’ for example, (a word with no equivalent in Japanese) can be understood as the expression of a culturally induced incapacity to actively depress awareness from the head and upper regions of the inwardly sensed body to the abdomen and lower body. For it is in this way that we reground and recentre our inner bodily self-awareness, restoring a healthy sense of what Winnicott called “psycho-somatic indwelling”. Schizophrenia, on the other hand, is the expression of a split between the inwardly sensed body or psyche-soma (Winnicott) and the inner space of our minds or mind-psyche. Soma-psychology has an intrinsic cultural and spiritual dimension. For as the Japanese philosopher Sato Tsuji pointed out: “It is the great error of Western philosophers that they always regard the human body intellectually, from the outside, as though it were not indissolubly a part of the active self.”
Viewed from the outside, self and body are both seen as
something bounded by our own skins, and separated from others by an empty space filled only by air. But there is a deep reason why the root meaning of the Greek word psyche and pneuma meant ‘breath’ and ‘wind’, and why the words ‘spirit’ and ‘respiration’ have a common derivation from the Latin spirare – to breath. For in what manner and at what point does the air we breathe in become a part of ‘us’ and ‘our’ body? And at what point or in what manner does the air we breathe out cease to be part of ‘us’ and ‘our’ body? The question cannot be answered except by suspending our ordinary notion of self and bodyhood. Our inner bodily sense of self has no physical boundaries but is an awareness that, like the air we inhale and exhale, also flows between us and the world. The deep connection between awareness and breathing was well recognised in the spiritual traditions of the East, where meditation meant centering both awareness and breathing in the abdomen rather than the chest. Individuals in our globalised Western culture, on the other hand, tend to be identified almost entirely with their heads and upper bodies. Not being grounded in
lower body awareness, individuals lack a sense of inner centeredness. Both their breathing and awareness are disconnected from the abdomen, that abode of the soul which in Japanese culture has always been understood as both the physical and spiritual centre of gravity of the human being. In Greek culture the word soma originally referred simply to a lifeless corpse devoid of psyche or ‘life-breath’. Only later did the word soma come to refer to the living body of the human being, and the word psyche to its sensed interiority or ‘soul-space’. Today the very term psychology has become a contradiction in terms, referring to a ‘science’ in which soul or psyche has no place, or in which it is identified with the mind or brain. Its connection with the individual’s inwardly sensed body is completely ignored. Only in the work of Winnicott do we find a recognition that mental health has to do with the psyche-soma as opposed to the mind-psyche — our capacity to dwell and feel at home not just in the mind-space of our heads but the inner ‘soul space’ of our bodies.
Soma-Sensitivity and Somatic Resonance
What body is it with which we feel ‘warmer’ or ‘cooler’,
‘closer’ or more ‘distant’ to someone – independently of our physical temperature and physical distance from them? What body are we referring to when we speak of being ‘touched’ by someone without any physical contact, of moving ‘closer’ to them or ‘distancing’ ourselves from them, of feeling ‘uplifted’ or ‘carried away’? Are these phrases merely emotional metaphors derived from motions in physical space, or are the emotions themselves expressions of basic motions of awareness belonging to an inner body of awareness – that ‘soul body’ which Winnicott referred to as the psyche-soma, and Jung as the ‘subtle body’? What body and what organs are we referring to when we speak of someone being ‘warm-hearted’ or ‘heartless’, ‘thick-skinned’ or ‘thin-skinned’, ‘stable’ or ‘unstable’, ‘balanced’ or ‘imbalanced’, ‘solid’ or ‘mercurial’, ‘stable’ or ‘volatile’? Are we simply using organic or bodily ‘metaphors’ to describe disembodied mental or emotional states? Or are we describing felt inner body states?
The practice of soma-psychology is dependent on the
practitioner’s own soma-sensitivity and their capacity for somatic resonance. This is the capacity to resonate with another person’s mental-emotional states and ‘feelings’ in a bodily way, as felt states and motions of their inner bodily self-awareness. Again it must be emphasised that when we speak of someone feeling ‘fragmented’, ‘frozen’ in panic, ‘hollow’ or ‘empty’ inside, walled in ‘up to the neck’, ‘volatile’ or about to ‘burst’ etc. these are not simply emotional metaphors but literal expressions of felt inner body states. These felt states are also field states of awareness which can be sensed as states of our own inner bodies through somatic field resonance. When we see someone hunched up or
laid back, smiling or frowning, laughing or crying, then their posture or facial and voice expression not only gives outer form to an inner tone of feeling, it also induces a similar feeling tone in us through somatic field resonance. Somatic field resonance is a resonance of outward form (morphe) and inner feeling tone. In this sense it is the essence of what biologist Rupert Sheldrake has called ‘morphic resonance’. The whole art of the soma-psychologist lies in their ability to use their outward sensitivity to the body of the patient to resonate with their inner body – with the felt tone and texture, shape and substantiality, lightness and darkness, density or diffuseness, spaciousness or narrowness of another person’s own inwardly sensed body. Inner body states may be conveyed not only by the body language of the other but by the inner resonances of their verbal language. In particular,it is of great importance for the soma-psychologist to listen for significant somatic metaphors used by a patient, and to resonate with the inner body states that may constitute the literal inner sense of these metaphors.
The Resonant Healing Process
Soma-psychology understands therapy as a resonant healing process from soma-sensitivity to the words and body language of the patient to somatic resonance with their inner body. Somatic field resonance in turn is what facilitates a transformative response on the part of the practitioner.
The resonant healing process: 1. Soma-sensitivity 2. Somatic resonance 3. Transformative response
What I call healing resonation is the capacity of the
practitioner to (a) sense and resonate with the patient’s felt bodily sense of dis-ease, (b) transform their own inner body state from one of dis-ease to one of ease, and (c) use somatic field-resonance to effect a felt transformation in the inner body state of the patient. The practitioner for example, may find themselves outwardly sensing and then inwardly resonating with a quality of frozen immobility in the inner body of the patient. Only by first resonating with this sense of ‘frozen immobility’ – feeling it in their own inner body — can the practitioner begin to gradually transform their own inner body state from one of ‘frozen immobility’ to one of ‘warm fluidity’ or ‘fluid warmth’ in contrast to the frozen immobility. The key word is ‘gradual’. For it is only through establishing
and staying in resonance with the patient’s inner body that the practitioner can (a) use their own transformative response to exert a resonant healing effect on the client’s dis-ease (b) sense the degreeto which their own transformative response is exerting such an effect. If it is not having sufficient effect then the resonant healing process must be either renewed or intensified at one or the other stage, for example by renewing somatic resonance with the patient’s felt dis-ease, or gaining a new and different somatic sense of it. Central to the art of healing resonation is the practitioner’s awareness of the dyadic field of awareness between practitioner and patient. If the practitioner is successful in resonating with the patient’s felt dis-ease this resonance will be experienced by both patient and practitioner as a shift in the felt quality of the dyadic field. The practitioner’s resonance with a particular quality of the patient’s felt sense of dis-ease will automatically amplify the patient’s own inner bodily awareness of it. At the same time it will automatically intensify the field-resonance between practitioner and patient in a way that is felt by both.
Medicine and Soma-psychology
In what relation do psychotherapists and ‘mental health’
professionals stand to the medical model of illness, and in particular to the medical treatment of somatic symptoms? The question is a politically charged one, because the professional boundary between somatic medicine and psychotherapy is one closely guarded by the medical establishment. Many mental health professionals also still defer to medical authority and the medical model, at least when it comes to so-called physical illness. This is something of a paradox given that:
1. the majority of patients present to their local physicians with problems
seen as ‘psychosomatic’ by the medical profession itself.
2. most physicians completely lack the professional training and skills to
sense and resonate with the psychological dimensions of somatic disease (eg. the ‘loss of heart’ that may be experienced and expressed through physical heart symptoms).
Psychotherapists and mental health professionals of course,
tend not to be sought out by patients who see their symptoms as purely somatic, and their ‘illness’ as something purely physical. Soma-psychology, on the other hand, recognises not only a hidden psychological dimension to somatic symptoms and physical illness but a hidden somatic dimension to so-called psychological symptoms and ‘mental’ illness. Many people recognise that the division between psychotherapy and somatic medicine, mental and physical health, is an artificial one, maintained only by its institutionalisation. Until now however, there has
existed no framework of thought that truly transcends the artificial separation of ‘mind’ and ‘body’, ‘psyche’ and ‘soma’ – not only in theory but in therapeutic practice. Soma-psychology provides such a framework, acknowledging as it does that the ‘soul’ or ‘psyche’ has its own independent bodily dimension and exists as an independent inner body in its own right – the psyche-soma. The theoretical principles of soma-psychology resonation therefore provide keys to a fundamentally new understanding of ‘psychosomatics’. Similarly, the practice of soma-sensitivity, somatic resonance and healing offer keys to a fundamentally new approach to both psychotherapy, somatic medicine and ‘somatic psychotherapy’.
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