Every client who comes into my office has a body.  There are no exceptions.  Most sort of live in their body, some just visit now and again.  For some it is just a convenient vehicle to schlep around their minds.  For others it’s a place they call home.

I primarily see adults.  Every adult I see was once a child.  They bring their childhood experiences with them when they visit me.  Some share them with joy, some hide them assiduously.  Some want to hide them but can’t do so successfully.  Many play the game of hide-and-seek, showing me a part of themselves, then hiding and inviting me to find them.  The core adaptive strategies they developed as children that helped them survive their childhoods surface to show me how they were both hurt and rewarded.  Their history emerges in the present moment if I am attuned to them and know how to watch.

Like a Russian Matryoshka (nesting) doll with a smaller one inside, and another one inside it, and another and another, in each session my clients reveal parts of themselves with the hope that I will help them make sense of something they cannot understand or access, enhance their connection to themselves and others, and live a happier, more fulfilling life.  Most do not know what they need and don’t have the words to ask.  But their bodies reveal the truth of their experience and offer me clues of how to proceed.  Each session reflects an aspect of their internal life that they are challenged to share.

Many therapists don’t know how to listen to their clients’ somatic messages.  Most simply endure their clients bodies without knowing what to do with them, how to see them, how to understand the meaning of what they see, and how to respond helpfully.  I don’t really blame them, they were trained that way.  Most are trained to assess their client’s cognitive capacity and emotional distress, identify what is wrong, help them adjust and correct their distorted perceptions and thoughts.   Their clients’ somatic experience is not seen to be as significant as the narrative they share.

Somatic practices is the term that captures the broadest range of therapeutic interventions that include the body.  Listening to the language of the body orients us to what our clients are unable to express in words.   Holding their breath, constricting their diaphragm, showing micro-expressions of disgust, as well as postural displays of shame and anger are but a few somatic communications that tell their story.

While therapists may notice these non-verbal communications, many may not know how to bring them to conscious awareness, how to make their implicit content explicit in a way that increases their clients’ organization, coherence and range of resilience.

From a body psychotherapy perspective, interventions that reference the body are motivated by different concerns.  Sometimes we seek to increase our clients’ general somatic awareness.  Sometimes we bring attention to their body so they can realize that the sensations they are experiencing are temporary and changing, such as in the case of working with anxiety.  Sometimes we direct their attention to their body to consolidate and further solidify an insight or a new connection.

Some clients have limited access to sensations.  There are usually very good reasons why they are challenged to articulate their somatic experience.  Especially in the case of early childhood when the body is the target, be it due to abuse, neglect or medical procedures, they develop non-conscious strategies to adapt to the situation.  Some are body-based while others are identity-oriented.  What distinguishes body psychotherapists from body workers is that as body psychotherapists we are trained to address both the somatic patterns and the identity strategies.  We must remember that these adaptive strategies are invaluable resources of the past that have become hindrances in the present.

Somatic practices in general and body psychotherapy in particularly are effective for clients with both a distorted sense of identity and a dysregulated nervous system.  To address both somatic patterns and identity issues, body psychotherapists use both bottom-up and top-down interventions.  Bottom-up interventions move in the direction of neurophysiology to musculature to sensation to affect to cognition.  Top-down interventions move in the opposite direction:  from cognitive to affective to musculature to sensation to neurophysiology.  Identity-related issues are usually addressed in a top-down fashion while somatic issues start bottom-up.  These are not mutually exclusive and the art of body psychotherapy is to know when and how much to do in each direction.  Having clarity about what motivates each intervention is an essential aspect of these integrative practices and when done well they are intuitive and magical.

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