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The Integration of Focusing with Other Body-Centered Interventions

by Neil Friedman, Ph.D.

In the first volume of this Journal (The United States Association of Body-Psychotherapy Journal) several traditions in Body Psychotherapy were enumerated.. There is the thread that starts with Reich. There is the thread that starts with movement (e.g. the Pessos). There is the thread of Asian bodywork. And there is the thread of the synthesizers (e.g. Hakomi and Rubenfeld Synergy).

There is at least one further thread that deserves mention. This is the thread that comes out of phenomenological/existential philosophers such as Husserl, Heidegger, Kierkegaard, Merleau-Ponte and Sartre (Gendlin, 1973, pp. 317-319.) Although they are philosophers, there is now a psychological method that comes out of their work. That method is called Focusing.

Focusing is a way to make direct reference to one's bodily felt experiencing process (Gendlin, 1981). The person focusing closes his/her eyes. The guide directs the person's attention down into the trunk of the body where a felt sense of the issue being focused upon is allowed to form. Focusing gives one moment-to-moment experiencing of one's existence. Over thirty studies show that the ability to focus correlates with positive outcome in psychotherapy.( Hendricks,, 2002 )

But the body is not just an experiencing process. It is also muscles, arms, legs, feet firmly on the ground. As readers of this journal have seen, there are other approaches to the body besides Gendlin's, What happens when focusing is combined with interventions that come from these other body-centered approaches?

What do I mean by body-centered interventions?

Robert E. L. Smith, in his 1985 book, The Body in Psychotherapy quotes approvingly from Jung: "...psyche depends upon body and body depends on psyche." (vii) He goes on to say that "A major trend during the past fifteen years or so has been the bringing of the body into psychotherapy." (Smith, 1985, p.IV)

This trend has accelerated since the publication of Smith's book. Bioenergetics, gestalt, psychomotor, radix, Reichian orgonomy, and, most recently, hakomi--and the combining of these--are now, more than ever, one accepted part of the overall therapeutic landscape. I agree with Smith: "All of these approaches are of value, and not one of them is a complete system having a total perspective on psychopathology, growth, and learning" (1985, p. vii).

But, when these several approaches are integrated with focusing, then one has what I will call a vibrant and effective body-oriented, focusing-oriented, person-centered experiential therapy.

It is the task of this essay to describe such a therapy.

Notice that it is the combining of methods rather than a monogamous relationship to any one that is characteristic of this approach to therapy. The emphasis in the combining can vary. After introducing the concepts of "hard," "soft," and "expressive" body-centered techniques, Smith writes, "I do a body-oriented Gestalt therapy, integrating aspects of Reichian, neo-Reichian [hard], and other body-focused growth methods in the context of the therapist-patient relationship" (1985, p. vii). Whereas I would say I do a focusing-oriented/person-centered, experiential therapy integrating hard, soft, and expressive body techniques along with reflections of feeling, probing questions, feedback, interpretations, personal sharings, and statements of support and affirmation within the context of a Rogerian-like therapeutic relationship.

II

 

There is no universally agreed-upon categorization of body-oriented therapeutic methods. I like the classification introduced in Smith's book. He talks of "soft," "hard" and "expressive" body-centered techniques. I want to take them up in turn, define and describe several of them, and show some ways to combine them with focusing .

Of "soft" techniques, Smith writes that they "tend to be gentle and allowing rather than forcing... [they] tend to be subtle. The things which happen, such as increased body awareness, psychological regression, increased experience of emotion, and expression of emotion, do not happen as quickly or as dramatically [as with the other two categories]... the soft methods are safe...." (p. 115)

Hakomi probes, work with posture, touching, and work with the breath are examples of "soft" technique. See Table 1. Tables are based on material in Smith (1985)}

Table 1 -- Soft Technique

Characteristics: gentle and allowing

subtle

safe

may or may not include physical touch

Results: increased body awareness

psychological regression

increased experience of emotion

expression of emotion

contact, empathy, nourishment

access and deepening of inner experience

Examples: posture

touch

breathing

Rogerian listening

focusing

hakomi probes

guided inner experience

 

I want to illustrate the combining of focusing with (1) touch and (2) hakomi probes.

1. Focusing and Touch[1]

Focusing-oriented therapy that is body-centered grows naturally out of verbal focusing/listening therapy. It was Gene Gendlin's discovery that certain words, phrases, and images have an "experiential effect." When they are said by the client--or said back to the client by the therapist--they carry experiencing forward. The "talk therapist" tries to say such words. He directs his verbal articulations at the felt sense of the client. When his words "hit the mark," so to speak, verbal therapy moves forward.

It is only a small step to "hands on" body therapy. The link: Focusing involves the body. The felt sense is in the body. It is real. It is bodily felt. What distinguishes verbal focusing therapy from "just talking" (or "just imagery") is that it is bodily.

Since focusing is bodily, it makes sense that the focusing therapist would make use of body interventions.

For example, the "body-oriented focusing therapist" uses touch to:

  1. anchor the felt sense
  2. amplify the felt sense
  3. help the felt sense move, thereby facilitating a felt shift

Anchoring the felt sense: The client has identified a felt sense in her chest. "It's here," she says, pointing to her chest. With her permission, the therapist places her hand gently on the place the client has pointed to. This helps anchor the felt sense. It helps the client stay focused. The therapist's hand says, "Keep your attention right here."

Clients who are focusing do have difficulty in keeping their attention on the felt sense. They lose it. They wander. They get distracted. They talk about the weather. The therapist, by putting a hand on the felt sense, can help keep the client "on beam"--tuned into the felt sense.

Amplifying the felt sense: The therapist's touch also helps by increasing the "volume" of the felt sense. We all have energy. When the therapist touches the place where the felt sense is, she sends energy directly to it. This amplifies the felt sense.

For example, during focusing a client said he had a pressure in his stomach. The therapist asked if he could put his hand on the client's stomach. (Notice this "asking" way of introducing touch; focusing-oriented therapy is a very careful and client-respectful therapy.) The client said yes. The therapist placed his hand on the client's stomach, waited, and then asked, "What are you experiencing?" The client responded, "The pressure feels sharper, clearer. I can sense it better."

Helping the felt sense move (shift): The therapist can use her touch to help the felt sense move. When a felt shift comes at the end of a round of verbal focusing therapy, some way that the body has been carrying its troubles actually changes, shifts, moves. It seems miraculous, at first, that words, distal as they are, can do this. Not surprisingly, touch, properly applied, can do it, too.

For example, the client's felt sense was something pushing down on his chest. The word for it was "burdened." The therapist used his touch to "imitate" the felt sense. He pushed down--hard--on the client's chest. The client reported he felt some "give" inside. Then, as he continued to push, the therapist gave the client the instruction, "Let your body do what it wants to do." The client pushed back against the therapist--that is, against the external imitation of the felt sense. The therapist pushed back. The client got angry. The therapist and client were soon wrestling. The client threw the therapist (i.e. the burden) off. "That feels better," the client reported. A big shift had occurred. The client felt lighter, energized, exhilarated, clear. With the burden off he now "saw" that he needed to mobilize his anger under his depressed/burdened place. The insight had come after the shift, just as focusing theory would predict.

In sum, I am suggesting an addition to focusing therapy in the direction of touch and the body. The body-oriented therapist does everything that the verbal-oriented therapist does. He also uses his or her touch to help anchor, amplify, and move the felt sense.

2. Hakomi probes and Focusing

A second "soft" technique is the hakomi probe.

Hakomi purports to be a complete system of body-centered psychotherapy. (See Kurtz, 1994) It was begun by Ron Kurtz who was influenced by Al Pesso, Moshe Feldenkrais, and Eastern principles of non-violence and mindfulness. Turning away from the hard and forcing nature of his training in bioenergetics, Kurtz and his original trainees developed a body-centered therapy for the 90's--one that combines a background of Eastern teachings with a Rogerian respect for the person and powerful body-oriented interventions.

A hakomi probe is the kind of statement an ideal parent would make. For example, "You are perfectly welcome here... Your needs are OK... You are fine just the way you are... Everything is going to be all right...."

The hakomi therapist delivers the probe in a ritualized way. He gets the person into mindfulness, eyes closed, attention inside his own present experiencing. (This is very akin to focusing.) Then, he puts his hand on the client's chest, says his first name, and very slowly delivers the probe: "Al, you are perfectly welcome here...". He may repeat it--with the person's name--three times. Then he asks for the person to report his experience.

Here is how I combine focusing with a hakomi probe:

He has been talking about his distrust of people in general. The talking has started "off the top of his head" but has moved closer to feeling:

T: What are you feeling right now? Go inside. (invitation to focus) Let your attention come down into your body. See if there is a word, phrase, image, sound, or gesture for what's there.

C: It's funny. I'm feeling like I trust you!

T: Ha! A surprise. You trust me.

C: Yeah, but don't get cocky... I don't trust M, Z, or B! They aren't going to pull anything over on me.

T: Let's try something. (Client nods OK) Close your eyes. Breathe. Put your attention right here under the palm of my hand--is it OK if I put my hand here? (Client nods yes) Now, pay attention to what you experience when I say these words: Charlie, all people are your friends... Charlie, all people are your friends... Charlie, all people are your friends... Now, what happened?

C: (He had begun to cry on my second repetition of the probe.) I felt my longing to believe that. I know you've said things like that before. But I never really felt--I want to believe it! So just now I felt the wanting, the yearning... and also that I can't (sob)... I just can't.

T: Focus again. Be friendly to yourself. Ask yourself, "Why not? Why can't I believe it? Don't ask it judgmentally... but with real caring for yourself."

C: (deep sobbing) Because they [his parents] beat me too much, and they were the first ones. The first models weren't my friends. I can't get beyond that--yet.

T: You can't get beyond that--yet. ( listening )

C: Yes, but I did feel--there is some hope. It could shift.

Here is another example. I cannot overstate how valuable the combination of focusing and hakomi probes really is:

She has been talking about how she lives for others; how she doesn't take care of herself; how she is all worn out. The talk has been getting more and more feelingful.

T: Let's try something.

C: OK.

T: First, just go inside and see how you are right now (invitation to focus)

C: (closes her eyes, takes 30 seconds, tunes in to herself) I'm pretty OK, sort of feelingful, but calm, serene, even though I'm really feeling what I've been saying.

T: OK. Now keep your attention inside. If it's OK, I'm going to put my hand here on your chest (Client nods OK). Put your attention right under the palm of my hand and now just listen inside and report to me what happens when I say... Chris, your needs are OK... Chris, your needs are OK... Chris, your needs are OK.... What happened?

C: That was fantastic!

T: Yeah... but what happened?

C: I saw the house I grew up in. I saw my parents in separate rooms... away from each other. I saw my four brothers all involved in doing things... and I saw--no one had any time for me! I even went from room to room trying to make contact (she cries here), but no one stopped what they were doing; no one paid any attention--

T: To your needs.

C: Right! And they still don't. I go home and it is the same story. Damn! To this day. I'm invisible.

T: You live your life as if everyone were your family. (interpretation )

C: What do you mean?

T: As if your needs are unimportant to us all...

C: And, therefore, to myself! Damn. I'm going to change that.

T: You really have to, you know, or you are going to wear yourself out and ruin your health. (feedback, said lovingly)

C: (cries) I don't want to admit it--but you're right.

Notice that hakomi and focusing are quite similar. There is only a slight change in the energetic vibration of the session as one moves from focusing to a hakomi probe. They combine easily together and carry the session forward on a similar wavelength.38

As focusing itself is a "soft" technique, its combination with other "soft" techniques does not much change the overall feel of the session.

Our next examples of "hard" techniques will be quite different.

 

III

By "hard techniques" Smith refers to methods of body intervention which are neither subtle nor gentle. They may be, in fact, uncomfortable . They "tend to be dramatic in their releasing of blocked emotion and memories." They are of "high potency and therefore require considerable judgment and caution... if they are to be used in growthful.. rather than traumatic ways." (1985, chap. 9) They can contribute mightily to unblocking and disinhibiting. They are dramatic and their incorrect use can be traumatic. Thus, they need be applied with extra care.

Smith discusses hard techniques from Reichian, bioenergetic, and psychomotor therapy (see Table 2).

Table 2 -- Hard Technique

Characteristics: neither subtle nor gentle

can be uncomfortable

can be dramatic

high potency/high risk

force/pressure

use with care

Results: dramatic breakthroughs

release of blocked emotions/memories

disinhibition

resumption of flow

Examples: deep pressure on various muscles (Reich)

"limits structure" (Pesso)

mimicking "hard" feelings inside body (Focusing)

The flavor of hard technique--what it is like, what the client thinks of it, what it accomplishes--is most charmingly captured in this long excerpt from Orson Bean's Me And The Orgone. Bean describes his first session with Reichian therapist, Dr. Baker, who has just finished some opening chit-chat with him. I quote this at length as it beautifully captures the flavor of a kind of work that is not all that well known even inside the body therapy community:

Dr. Baker sat down behind his desk and indicated the chair in front of it for me.... "Well," he said, "take off your clothes and let's have a look at you." My eyes went glassy as I stood up and started to undress--"You can leave on your shorts and socks," said Baker, to my relief. I laid my clothes on the chair against the wall in a neat pile, hoping to get a gold star. "Lie down on the bed," said the doctor. "Yes, sure," said Willie the Robot, and did so. "Just breathe naturally," he said pulling a chair over to the bed and sitting down next to me. I fixed my eyes on a spot of water damage near the upper left-hand corner of Dr. Baker's window and breathed naturally. I thought: "What if I get an erection, or shit on his bed or vomit." The doctor was feeling the muscles (italics mine) around my jaw and neck. He found a tight cord in my neck, pressed it hard and kept on pressing it. It hurt like hell but Little Lord Jesus no crying he makes. "Did that hurt?" asked Dr. Baker.

"Well, a little," I said, not wanting to be any trouble.

"Only a little?" he said.

"Well, it hurt a lot," I said. "It hurt like hell."

"Why didn't you cry?"

"I'm a grown-up."

He began pinching the muscles in the soft part of my shoulders. I wanted to smash him in his sadistic face, put on my clothes and get the hell out of there. Instead I said "Ow." Then I said "That hurts."

"It doesn't sound as if it hurts," he said.

"Well, it does," I said, and managed an "Oooo, Oooo."

"Now breathe in and out deeply," he said and he placed the palm of one hand on my chest and pushed down hard on it with the other. The pain was substantial. "What if the bed breaks?" I thought. "What if my spine snaps or I suffocate?"

I breathed in and out for a while and then Baker found my ribs, and began probing and pressing.

I thought of Franchot Tone in the torture scene from Lives of a Bengal Lancer. I managed to let out a few pitiful cries which I hoped would break Baker's heart. He began to jab at my stomach, prodding here and there to find a tight little knotted muscle. I no longer worried about getting an erection, possibly ever, but the possibility of shitting on his bed loomed even larger. He moved downward, mercifully passing my jockey shorts. I don't know what I had expected him to do, measure my cock or something, and began to pinch and prod the muscles of my inner thighs. At that point I realized that the shoulders and the ribs and the stomach hadn't hurt at all. The pain was amazing, especially since it was an area I hadn't thought would ever hurt. Notwithstanding, my feeble vocal expressions were nothing that would have shamed Freddie Bartholomew.

"Turn over," said Baker. I did and he started at my neck and worked downwards with an unerring instinct for every tight, sore muscle. He pressed and kneaded and jabbed and if I were Franchot Tone I would have sold out the entire Thirty-first Lancers. "Turn back over again," said Dr. Baker and I did. "All right," he said, "I want you to breathe in and out as deeply as you can and at the same time roll your eyes around without moving your head. Try to look at all four walls, one at a time, and move your eyeballs as far from side to side as possible." I began to roll my eyes, feeling rather foolish but grateful that he was no longer tormenting my body. On and on my eyes rolled. "Keep breathing," said Baker. I began to feel a strange pleasurable feeling in my eyes like the sweet fuzziness that happens when you smoke a good stick of pot. The fuzziness began to spread through my face and head and then down into my body. "All right," said Baker. "Now I want you to continue breathing and do a bicycle kick on the bed with your legs." I began to raise my legs and bring them down rhythmically, striking the bed with my calves. My thighs began to ache and I wondered when he would say that I had done it long enough, but he didn't. On and on I went, until my legs were ready to drop off. Then, gradually, it didn't hurt anymore and that same sweet fuzzy sensation of pleasure began to spread through my whole body, only much stronger. I now felt as if a rhythm had taken over my kicking which had nothing to do with any effort on my part. I felt transported and in the grip of something larger than me. I was breathing more deeply than I ever had before and I felt the sensation of each breath all the way down past my lungs and into my pelvis. Gradually, I felt myself lifted right out of Baker's milk chocolate room and up into the spheres. I was breathing to an astral rhythm. Finally, I knew it was time to stop. I lay there for how many minutes I don't know and I heard his voice say, "How do you feel?"

"Wonderful," I said. "Is this always what happens?"

"More or less," he said. "I can see you on Tuesdays at two. Ideally I'd like to see you twice a week but I don't have the time and once a week is more than sufficient."

I stood up shakily and began to pull on my clothes. "I'm a bit dizzy," I said.

"You'll be all right," he said. "Just take it easy. Actually you're in pretty good shape. It shouldn't take too long."

We agreed on a price per hour, I finished dressing, shook his hand and walked out into the waiting room. A bald-headed man sat there reading Life magazine. He didn't look up. I wondered how long he had been there and if he had heard my noises in the other room. I walked out the door and down the hall. It seemed as if my feet barely touched the carpeted halls. I came out into the air and crossed the street into the park. I looked up into the sky over the East River. It was a deeper blue than any I had seen in my life, and there seemed to be little flickering pinpoints of light in it. I looked at the trees. They were a richer green than I had ever seen. It seemed as though all my senses were heightened. I was perceiving everything with greater clarity. I walked home feeling exhilarated and bursting with energy. That night I went to work at the theater and got through the show somehow. I didn't know if I was good or bad. I got home sometime after midnight and I knew there was no remote possibility of going to sleep. Far from settling down, the energy coursing through my body had increased as the night went on, moving rhythmically up and down from head to toe. There was no doubt in my mind that it was orgone energy or whatever the hell name anyone wished to give it. It was like nothing I had ever felt before and I knew that I had tapped into the strongest force in the world. I sat by my window on the river, watching the debris float by. I thought about life and people and kids and sex and my ex-wife and psychoanalysis and how in the name of God human beings had gotten themselves into the shape they were in and finally, about five-thirty in the morning, I fell asleep. (Bean, pp. 31-36)

Let me say right away that I don't have clients take off their clothes, and that the eye-rolling segment and bicycle kick segment are soft and expressive techniques rather than hard techniques. But most of the session is a good example of Reichian hard techniques. Notice both Bean's comments on what the client is saying to himself during the work (an equivalent of--what is this shit!), and how he feels after (an altered state of ecstatic consciousness). Both the client's inner comments on his experience of hard technique and the remarkable after-effects of hard technique need to be given careful, respectful, and due consideration. There can be no doubt that something very powerful has occurred here.

One might think that the combination of focusing and hard technique is unlikely. After all, Dr. Baker does not sound like a focusing therapist. He sounds like just the opposite, just the kind of therapy and therapist focusing is the antidote for!

Yet, empirically, it turns out that focusing and hard technique can be combined. This is surprising. Even with its philosophical opposite--violent, therapist-directed, pushing-- there can be combining. This is an important point.

If focusing work is the ground, the foundation upon which therapy sits, then a few moments of hard technique can be added to the mix.: The combination is very powerful. Consider these examples:

C: When I close my eyes and go inside I feel like throwing up. There is an image of a hand over my mouth, keeping me from speaking.

T: May I do that?

C: (surprised) What?

T: (matter-of-factly) Put my hand over your mouth. I'll try to do it like it is in the image. (Notice that I ask permission to initiate hard technique.) Let me know when I get it right, if you want to do it. Then, breathe... and let your body do whatever it wants to do. OK?

C: (a bit warily) OK.

T: (puts hand over client's mouth; adjusts force until C nods head "yes" as in "yes, that's it.")

C: (muffled)

T: Let your body do whatever it wants to do.

(At first C collapses. I keep my hand over her mouth. For about a minute she is rolled up in a fetal-like ball, and I am leaning over her with my hand over her mouth. She signals to stop. I take my hand away.)

C: It's moved. It's in my throat now, squeezing at me.

T: May I?

C: (gives me an "oh my God, this too?" look) Sure.

T puts his hand over her neck and squeezes--not as hard as he can, but hard enough. Suddenly she starts to stir and to fight. She grabs at my hand to pull it away from her neck, and I don't let her.

T: No you don't. Keep it in. I won't let you out. (By now we are in a violent tussle rolling around the room--this is in my private office, and it is rather large. We keep wrestling for a few minutes until she finally uses both her hands and all her force and pulls at my bracelet... and gets me to let go. We lay a few feet apart from each other. She is crying and laughing wildly. I am laughing.)

In exchange for a reduction in fee, this client wrote me two or three pages of her reflections on each session. Hence we have her own words about this interaction.

"The neck thing was interesting. Actually, I knew the block has been there for a very long time... on and off since I was about sixteen. Maybe even way before that.

"Interesting that when Neil held his hand hard over my mouth... I felt it familiar and bearable (on one level). If that is what you [her partner] want to do to me, why resist? And then as I tried to take his hand away... I really didn't! I thought about pushing it away, and it felt premature, like, I'm not ready. It is as if I don't want to come out mean and harsh and bad!... Some part of me at sixteen pulled back... the sexuality part... and became held in... and has been there all this time...

"And then when Neil started to press hard against my neck... it was different from my mouth. Ah ha! You want to squeeze the life out of me! That I will not take!

"That is when I pushed his hand away. Hard.

"So I'm willing to be shut up in a relationship, but not to give up my life. Interesting... I felt OK during the session. I'm ready to move, to get unstuck."

 

Here is another example of focusing and hard technique. Remember: much of the background of our sessions are focusing, listening, and other verbal methods. What I am highlighting, however, are some of the breakthrough sessions which may combine focusing with body-centered techniques.

This is another session that this client wrote up for me:

"2/21/89 -- When I went in I didn't know what I wanted to work on. Neil gave me focusing instructions. I wasn't anxious--which I've been feeling lately--but I could feel something pushing out--and being held from within at the same time.

"Feel that," said Neil. Definite bondage. And since it was being held from within, I knew I had everything to do with it. I felt it particularly in my legs! That was new. It had something to do with who I am and who I am not. A lot of weight on my legs...

"Neil sat on my legs. Hard. It felt normal. So I pushed him off (I'm glad I'm as big as he is!) Not really knowing why I did. Then I was suddenly sobbing and crying. Out of nowhere. This went on for maybe five minutes.

"After the tears, the insights: Like this is my facade, but I won't tolerate you really believing this is who I am. I mean the wanting to be liked. It isn't who I really am. Where does this whole thing about being liked really come from, and why is it so important to me? It is like a dead weight holding me down [on my legs] so I cannot move. I mean, it is an overwhelming factor in my relationship with the world.

"Near the very end of the session... my legs felt very different [felt shift]... I don't mean just from getting his weight off them... I mean from the inside. I started to get the feeling... maybe I am getting ready to move."

 

Another example of focusing and hard technique: This one comes from a group workshop. It is a seven-minute segment of work with a participant (This one has elements of hard and expressive technique, which we will take up next).

T: Go inside and see what is there. ( invitation to focus)

C: (after 30 seconds) I don't know if I can tell you.

T: You don't know if you can tell me. (Listening)

C: The image is so horrible... and I have it so often.

T: There is a horrible image there, one you have quite frequently. (Listening)

C: Yeah... OK... I see myself holding a knife and stabbing myself in the stomach with it. The feeling with the image is--disgust. But it is what I want to do.

T: Would you be willing to try something?

C: (looks at me warily) Maybe.

T: Make a fist like you are holding a knife in your hand. (C does this) Then let me grab you by the wrist. (She agrees) Now, you try to stab yourself, and I'll hold you back. I'll make sure you don't do it. [In hakomi terms, this is an example of "taking over"]

C: Are you sure you can keep me from doing it?

T: I'm sure... but we can try it for a minute so you'll see.

C: Let's try it.

We try it out. She struggles to "stab" herself. I am able to keep her from doing so. We stop.

C: OK, you can do it. I'm game.

T: See how you are inside right now.

C: Excited!

T: OK, whenever you are ready.

She tries to stab herself and I stop her. I also verbalize what I imagine are the voices she hears when she has this image: "I want to be dead. Life isn't worth it. I want out." I scream these words, and she throws herself more and more into the self-destructive effort. She pulls me all around the room... but she never "stabs" herself. Her face looks fiercely angry, and I hold her wrist very hard. After seven minutes the bell rings, and we fall to the ground--three-quarters of the way across the room--in a heap.

The rest of the morning she was very alive and present. She thanked me twice for the experience. I had never seen her so relaxed as I did later that day.

 

One more example. This, too, is from a group workshop. It is similar to the example I used in the focusing and touch section.

T: What is happening inside you? (invitation to focus)

C: There is all this tension... I'm carrying it on my neck and shoulders.

T: Can I be the tension?

C: What do you mean?

T: Get on your knees. (C does this) I'll get on your neck and shoulders with my hands leaning on you like the tension does.

C: Oh, I see, OK, why not?

I lean all my weight on the palms of my two hands digging into his neck and shoulders. At the same time I tell him to breathe and to let his body do whatever it wants. He is a little smaller than me, and I am feeling very powerful and energetic this morning. He starts to struggle and fight to get from under the pressure (me)... and I won't let him.

C: Wait a minute.

He takes off his glasses. Now he really goes at it. I'm yelling, "You can't get out from under me," and he's yelling, "I'll get you off me you son-of-a-bitch." We wrestle and roll around the floor... and just as he throws me off... I climb right back on--just as I imagine his pressure does. We are back at it again, maybe for five minutes altogether, and in the end we are laughing uncontrollably after he does, for good, throw me off.

C: My shoulders sure feel better!

T: How about you? How are you? How are you inside? (invitation to focus)

C: I feel exhilarated! I haven't had so much fun in years. And I feel relaxed--boy, do I put a lot of pressure on myself. But it is not there now. I really see how I do it to myself, and how I have to stop doing it to myself.

T: Will you?

C: Time will tell.

T: Yes. It always does.

We hug.

I want to repeat. I do not use hard techniques often. Focusing and listening are the staples of my therapy. But the care-full use of hard technique can really propel things forward. It is important that the therapist be very skillful with hard technique and that he be aware of its possibly traumatic effects.

 

 

IV

 

Smith says that "the essence of the expressive techniques is taking action, concrete musculoskeletal movement." He adds, "the action to be growthful, however, must carry symbolic meaning." (Smith, 1985, p. 135)

The expressive techniques, then, involve the client's taking symbolic action beyond the point of usual self-interruption. "The expressive work involves movement of energy into the musculoskeletal system... support is given to the patient's acting on what he or she is organismically experiencing as growthful or natural, rather than self-interrupting and continuing the old pattern of avoidance. The patient is invited and encouraged to act in spite of the voice of the toxic introject, to act in the face of catastrophic expectation." (Smith, ibid.)

Much psychotherapeutic expressive work is verbal, and Smith singles out the gestalt therapy literature for this (I would agree, and add the psychodramatic.) Smith makes the case forcefully for the need for body-oriented expressive work to really finish the unfinished business:

When there is self-interruption, there is some body part that has not been put to full use. There are an arm and fist that have not hit, a jaw that has not bitten, tear glands which have not secreted, a throat which has not screamed, a belly which has not chuckled, a pelvis which has not thrust... the expressive work... involves the reowning of the 'missing' body part. (Smith, p. 136)

Gene Gendlin explicitly acknowledges the need to combine focusing with expressive techniques:

Many events, especially in childhood, generate strong emotions and at the same time block their expression. If a child can cry, shake, and scream, it is sooner done with a painful event. But along with bad events children are usually also prohibited from expressing anything [that the parent or care-giver does not want to hear]. One meaning of 'completing' an incomplete experience is to let these long-missing expressive sequences happen. (Gendlin, 1991, p. 265)

Another kind of completion concerns the interaction: what one could not tell the original people, how one could not fight back. Incomplete interactions need to be completed... in therapy there needs to be room and welcome to cry the uncried tears, to sob, shake, or move to express old pain and fury in more than words. ( ibid.)

Therapy must involve more than focusing on inner data in reflective inner space. there also needs to be a movement outward, into interaction.... Moving out, rolling out [his words for expressive action] is an essential dimension of therapeutic change that is not provided by inward process dealing only with inner data." (Gendlin, ibid., p. 267)

However, I do not feel that he goes far enough in providing for this expressive rolling out. He says:

Cathartic therapists are right to tell other therapists not to stop expressive discharge, however, intense it may be... I welcome discharge when it has already come. The next question is whether it should be deliberately engendered.... On that question agreement is not so easy, and I am not sure of the way I have chosen.... I believe that catharsis should be an open, known, and included possibility. Beyond that I don't believe I should engender it. (italics mine) (Gendlin, 1991, p. 265-6)

My own experience both in private practice and group workshops is that clients often need a lot of encouragement and cheerleading in order to get into cathartic, expressive, or intense feeling work. The work is unusual. It breaks certain internalized taboos. ("Don't ever raise your voice at me; big boys don't cry; big girls don't hit.") In my experience, if the therapist really wants expressive work to happen, he has to lend it his energy and also find the way that helps each particular client into it. Simply mentioning that it exists as an option is not, in my experience, enough. The dice are too loaded against intense expressive emotional release. The therapist needs to "point" the client towards it.

Here are several examples in which focusing and expressive work are combined.

1. This is one of my all-time favorites. Both for aesthetic reasons and in terms of its overall effect it seems to me picture-perfect.

The context was a group workshop in which there are what we call "healing circles". Laury Rappaport was doing the overall timing of all the healing circles. I was leading one.

I had worked some earlier with this woman. She had made reference to a terrible trauma when she was eleven years old. Her mother had set fire to her favorite doll's clothes. She mentioned especially a Barbie's blue dress.

When she lay down on the mat she mumbled that she wanted to work on "the Barbie dress thing." I asked her to close her eyes and tell me what she felt (invitation to focus). She said, "apprehensive, scared, terrified."

I asked her to keep her eyes closed and, speaking in the present (gestalt) tell me the story of the doll dress.

She began: "I'm eleven years old. I'm sitting on the porch playing with my Barbies. My mother has just come home from the crazy hospital. She is upset about something. She sees my Barbies. My favorite has on a blue dress."

At this point, as she is talking, I signal to Laury, "bring over the old blue bataka that is falling apart and a box of matches." Laury doesn't know exactly what is going on, but she catches my drift and brings over the props.

Back to the story: "Mother is mad at me for some reason. She tells me she is going to get rid of my doll clothes." (The story is told with increasing agitation.) "I cry and beg her not to, but she grabs my Barbie and takes off the blue dress. Then she takes a match...."

At this point I have Laury stand above her with a lighted match about to touch the old blue bataka.

"And she sets fire to the blue dress."

At this point I instruct the woman to open her eyes and look straight up. At this moment Laury sets the bataka on fire.

The woman makes a piercing shriek that is heard throughout the workshop room, above the din of everyone else. She loses it. She is moaning and groaning, and moving all around, and I get down real close to her to keep her company. This goes on for five minutes. The group surrounds her lovingly but also gives her room as she screams, yells, punches, and kicks. Finally, as she seems to settle down I invite her to talk directly to her mother (Laury), who has been standing there the whole time.

"How could you have done that? Why were you so sick? I hadn't done anything bad (tears). That was my favorite dress. That Barbie was my real friend (sobs). You burned her favorite dress. What kind of a mad woman were you?"

She continues to cry for another five minutes, those old, ancient, forbidden tears; and then, by the time the bell rings, she is quiet, taking in the love from the group through a laying on of hands. Her face is transformed. She is glowing. I feel a very full contentment.

In a letter after the workshop she thanked us profusely and told us of the real life changes she made in the following week. They were many and included--buying herself a Barbie with a blue dress!

2. The second example also comes from a healing circle at a group workshop.

It was a men's workshop, and I had in my circle five men who had known each other for some time. Two were twins. They asked if they could take a turn together.

I said yes. They told me they wanted to re-enact their birth. (They were both quite "warmed-up" and had previously done considerable work individually and together in psychotherapy.)

I had them lay on a mattress and had a second mattress placed over them. The group held the second mattress in place--not forcefully--just enough for it to be womb-like.

They both must have been inside there about five minutes. There was no big noise--just little whimpering sounds. Then one (the older by five minutes) started to come out through an opening we gradually gave him at one end of the mattress. He cried, like a baby, and the group held him.

Then there were moans and movements and crying from inside. The other twin stayed in another five minutes and was very agitated, moving around, whimpering more. Finally, he too came out and was also helped by the group.

The twins lay there, side by side, held by a bunch of men.

I asked the second twin to focus and tell us what he had been experiencing when he was by himself in the womb.

He said one word-- "abandonment," and broke out crying. His twin held and embraced him, and we all cried. "I'm sorry. I didn't mean to leave you. I still loved you and I always have." The older twin said all this to the younger. They held each other, and there wasn't a dry eye in the circle. We all sang to them:

Like a ship in the harbor,

Like a father and child,

Like a light in the darkness,

I'll hold you awhile.

We'll rock on the water,

I'll cradle you deep

And hold you while angels

Sing you to sleep.

A beatific smile came over the face of the younger twin as the older stroked his beard, mustache, and thinning blonde hair. It was an unforgettable scene.

 

 

3. This one comes from my private practice:

He is in the midst of deciding to finally separate from his wife after several months of ambivalence. He is carrying a lot of rage. I invite him to place his wife's face on the pillow in front of him and take the bataka. I tell him to close his eyes and remember the last seven months of their marriage. "Just let the memories cross the screen of your awareness, one by one, whatever ones want to walk through." I notice that a few tears drop, and his hands enfold the bataka handle more forcefully. "When you feel ready, open your eyes, see Amanda's face on the pillow and let your body do whatever it wants to do." Soon he is beating up the pillow with gusto as I cheer him on. Days, weeks, months, years of anger, rage, and frustration come pouring out. After awhile he stops beating the pillow and collapses into long-suppressed tears.

When he has had enough time with the tears by himself, I move toward him gently and slowly and cuddle him. He puts his head in my lap and cries even more.

When the tears subside, I ask him to focus. We are both surprised by what he "sees." "I see the 1954 All-star Baseball game. My father and I are at it together. Gil McDougal has just made this wicked wonderful play at second base." He is smiling. "Where did that come from?" "Beats me--what is the feeling?" "Like, peaceful. (tears) Like I need to spend time with him and other men (more tears). Like I need to go to a baseball game." "Tomorrow is Opening Day." "Maybe I'll go to Fenway, play hookey from work...My wife never liked baseball."

By this time he is grinning from ear to ear, and it is time for the session to end.

 

Notice in these sessions how much and what variety of previously blocked emotion is released! I don't want you to think every such session is like this. It isn't. But when it is--there is little doubt that something very powerful has happened.

5. One more example from my private practice. This one allows me to at least allude to my work with focusing, expressive work, and couples. In my practice these days about three out of twenty sessions a week are with couples. I have a particular way I begin a first session with couples. After listening to each person talk for awhile about what has brought them to me, I ask them each to close their eyes, imagine their attention is like a searchlight, and first, just see how they each are inside. (This is the first step, of course, of focusing.) After they have done this, I ask for a nod of the head when they are ready to move on.

I wait until they are both ready. Then I ask them to hold their relationship in front of them, picture it, say their partner's name over and over--whatever will hold it in front of them -- and then I say, "And let your attention come down into your body and see what is the whole feel of the relationship for you... (invitation to focus) Let a word, phrase, image, sound, or gesture form that will match or act as a handle on the feeling inside... when you get a handle, say it back to yourself, check it against your body, see if it fits.... Take your time... you don't have to do it as quickly or slowly as your partner.... Give me a nod when you are finished."

When they have each nodded, I may ask them a further one or two focusing questions - "Ask the feeling--what's the crux of it? What makes it this way?" "Ask it--what does it need? What does it need to have happen?" Or I may simply say, "Now I want you to open your eyes, turn your chairs to face each other, and take turns--like sharer and witness--telling each other what you have just experienced."

This lesbian couple has come in because one member wants a child and the other does not. They have done the focusing and now are ready--more or less--to talk.

T: Decide who wants to talk first. Talk directly to your partner--unless you want for some reason, at some point, to talk to me. Then turn your chair so it is facing me. You two decide who goes first.

C1: (the one who wants a child) I saw us holding a baby girl... (tears) and the feeling was in the song lyric, "We Are Family." It was warm (more tears), warm in a way my family never was.

C2: (she looks flabbergasted) I saw us holding a baby girl, too. (C1 now looks shocked) And we were playing with her, and suddenly she wanted to go into your arms, and I felt left out--just like I always did growing up. I also heard the lyric, "We Are Family" in my head, and I saw - who was it?--The Staple Singers singing it?-- (none of us can remember who sings it!) But they all had their tongues sticking out at me (cries).

There is an embarrassment of riches here. Remember: It is just a first session. I decide to go for gestalt expressive work. That is, I focus, and see inside how to set up a gestalt expressive experiment.

T: OK. Let's bring that doll over from the corner of the room. I'm the doctor so I'll go get it. (laughter...I bring the doll over) Now I want you to each hold it and talk to it as if it were the baby you may or may not have.

C1: (tears throughout) I love you, my darling. You are the little girl I always wanted to be. I'll take good care of you. I'll never forget you. I'll never forsake you. We are all going to be family. (Gives the doll to C2)

C2: (can hardly hold her) You are going to come between us. If we have you, I'll be the outsider-- the father who stays down in the cellar watching TV. You'll prefer her to me... and you know what? ( this comes like a revelation to her)... I won't like you so much either. (She hands the doll to me.)

T: (to doll) Well, I guess we see where we stand at this point (C1 and C2 nod their heads in agreement). But don't worry. Remember: this isn't about you; it's about them. Now, this is just where we will all start. Let's keep an open mind--and open hearts--as to where we will end up.

I saw them for seven months, once a week. They never missed a session. This was in 1998.

Last month I got a postcard with a baby shower announcement from them.

 

Table 3 summarizes the characteristics of expressive work, its results, and a sampling of kinds of expressive work I make frequent use of, and where each comes from.

Table 3 -- Expressive Technique

Characteristics: symbolic action

use of arms and legs and other body parts

Results: finishing unfinished business

going beyond point of self-interruption

Examples: Gestalt: repetition; amplification; exaggeration; presentification; "let me feed you a sentence..."; "speak directly to_______.

Psychodrama: role-playing; re-creation of crucial scenes

Bioenergetics: "abandonment" stress position (this is expressive and hard)

Pesso: accommodation

 

V

 

I hope the last three sections have given you a feel for what body-centered focusing-oriented therapy is like as I practice it.

Please remember that these examples are illustrative, not exhaustive, and, obviously, I have chosen to share ones I feel particularly good about.

Not all the sessions are like these. I make mistakes. Things don't work. I can't get a handle on what is happening. People refuse to follow my invitations. People aren't sufficiently warmed up. There is reluctance. People just won't let themselves do it.

Therapy is not an unending string of successful, dramatic, and stirring interactions. If only it were!

 

Notes

1 This entire section follows closely the article, "Focusing and Bodywork," which I wrote with Laury Rappaport for the Focusing Connection. I want to acknowledge and thank Laury for her collaboration with me on this article.

References

Bean, O. ME AND THE ORGONE. New York: : St. Martin's Press, 1978.

Friedman, N. and Rapapport, Laury, "Focusing and Bodywork". The Focusing Connection, May, 1985 , Vol III, No. 2 pp.1-3.

Gendlin, E.T. "Experiential Psychotherapy " in Corsini (Ed.) CURRENT PSYCHOTHERAPIES. Itasca: F.E. Peacock, 1973.

Gendlin, E.T. FOCUSING. New York: Bantam Books, 1981.

Gendlin, E.T. "On Emotion in Therapy" in Safran and Greenberg (Eds.) EMOTION, THERAPY, AND CHANGE. New York; Guilford, 1991, pp. 255-279.

Gendlin, E.T. FOCUSING-ORIENTED PSYCHOTHERAPY. New York: Guilford, 1996.

Hendricks,, Marion. "Research Basis of Focusing-Oriented/ Experiential Therapy" in Cain, D. and Seeman, J. (Eds.) HANDBOOK OF RESEARCH AND PRACTICE IN HUMANISTIC PSYCHOTHERAPIES. APA, 2002.

Kurtz, R. BODY-CENTERED PSYCHOTHERAPY; THE HAKOMI METHOD. Mendocino: Life Rhythm, 1991.

Smith, R.E.L. THE BODY IN PSYCHOTHERAPY. North Carolina: McFarlane, 1985.

 

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