Kitabı oku: «Things in The Body», sayfa 2

Introduction

Every psychotherapist and practicing psychologist know about patients’ descriptions of their bodily sensations. There is no more or less noticeable experience that would not be accompanied by a burning of the chest, or a pain in the head, or compression in the abdomen.

Different attitude to the body sensations

In classical medicine, the body sensations are taken into account to clarify the diagnosis and monitor the dynamics.

Clinical psychotherapy calls them vegetative accompaniments of experiences.

In psychoanalysis, they serve as a material for the interpretation and construction of structures, where through somatic symptoms «the body reports the dominant idea of the «subconscious’. The subject of the searches is the idea underlying the formation of the symptom.

In the context of Jungian’s approach, there can also be situations in which patients indicate body sensations in the process of experiencing certain archetypal scenes, but these feelings rarely fall into the focus of attention. More importance is given to the semantic elaboration of the symbols.

Gestalt therapy pays more attention to body sensations to establish contact with them, to find out their «addressee’, if any, and to complete the unfinished deal associated with them.

Psychosynthesis does not exclude the use of body parts to establish mutually beneficial contact between them. In this case heart, brain, stomach, ears, personified as subpersonalities, can sort out their relationship, but this process does not have the nature of direct work with sensations.

Reichian body-oriented psychotherapy attaches great importance to the analysis of the «rings’ of tension at the level of the eyes, mouth, neck, chest, abdomen, pelvis, forming a «protective shell’ around the body, delaying the free flow of «bioenergy’, and considers its important task to work through the «muscle armor’. However, this approach works primarily with the surface of the body.

Erickson hypnotherapists use descriptions of body sensations to create a background of reliability in the process of «soft trance guidance’. Bodily sensations in this tradition are highly valued for their credibility. With their help, hypnotherapists often receive from their clients, a credit of trust, which a person is inclined to give to someone who has correctly described at least three components of his bodily experiences. An erickson hypnotist describes what a person feels with their body but… thinks about something else.

Here’s how body sensations are characterized from the point of view of neuro-linguistic programming: «Evaluative meta-feelings about other perceptions or representations, also called emotions, feelings, or visceral kinesthetic, which are presented in the chest and/or abdomen, or in the midline of the body. These feelings are not direct sensations/perceptions, but representations derived from other sensations/perceptions.²" «Other sensations/perceptions» – specifically visual, auditory and kinesthetic – are the main focus of attention in NLP.

The ontopsychology of Menegetti attaches great importance to the knowledge of the doctor’s own body sensations in the process of communication with the patient and the study of «semantic field’. However, in this case the appeal to the sensations is of an official nature.

The process-oriented psychotherapy of A. Mindell touches the sensations in the prosses of working with the «channels of perception’.

There are many reports of body sensations during sessions of holotropic breathing according to the methodology of S. Grof.

We can say that every serious school of psychotherapy somehow reacts to the fact of the presence of body sensations brought about from experiences, but almost none of the existing schools work directly with them, thus remaining within the indirect use of this phenomenon. I would like to name the way it is done as external.

Psychocatalysis of body sensations works with sensations directly, «internally’ using them.

Traditional Russian attitude to body sensations

As real force that significantly affects the health of our fellow citizens, this tradition does not exist. The interests of the social experiment, which our country went through, demanded special personal qualities from its participants. The inclination to introspection was not listed among them. Moreover, its manifestations were considered almost counter-revolutionary. “The battles for the harvest’ and other “battles’ for agriculture, industry and other fronts did not include any study of body sensations. That era put forward its heroes. However, their valor was not intended to be healthy for, but rather, to be useful to society.

One of my colleagues told me a story about a group of American feminists who arrived in Moscow during the perestroika period. Instead of giving a long explanation, I will just say that she invited them to a public bathhouse… When the feminists saw the women around them, they began to cry. They could vividly imagine how those Russian women must have mistreated themselves to end up with such deformed bodies. The Americans ladies were particularly shocked by the extent of their distorted joints.

I would like to mention something about the souls of the long-suffering Russian women! Indeed, no matter what, they are distinguished by their commitment to compassion and sacrifice. It would have been necessary to have a remarkable strength of character to withstand everything that our parents and grandparents had to endure. Though, it would have been prudent to add a culture of personal care and self-preservation to such character and experience of suffering; a culture of working through the consequences of the resentment experienced.

I hope that my scientific work will contribute to the formation of such culture.

Domestic “tradition’

This is an example of attitude to oneself, and to the signals of the body, at the household level. Fortunately, this does not mean that in “the domestic’ tradition there is no other attitude to the perceived.

The Orthodox Church, especially the Byzantine monastic tradition of Hesychasm (sacred silence), which was developed in the environment of Russian monasticism, offered to be very attentive to what was formed in the mind of a believer.

I was greatly impressed by the topographic structure of the descriptions of «mind preservation’ by the Christian ascetics. Long before the emergence of any psychotherapy, they described the phases of entering into a passionate state and their ways out of dead-end experiences. Those experiences often resembled plants and animals.

We know such expressions as «seeds’ or «roots’ of passion. In the V century the monk Neil of Sinai wrote about «the foxes that live in the soul of the vindictive, and the animals that hide in the indignant heart’ or «as the water is perturbed by a falling stone, so the heart of a man by a bad word.» «As the smoke from smoldering straw bothers the eyes, so the rancor bothers the mind during the prayer’³. These descriptions are more than just beautiful literary images, they are documentary evidence of the experience of internal work.

The image of perception of the soul and passion is found in the following excerpt by the monk Hesychius: «Distinctive in the old Testament, the high priest decoration (a pure gold plate on the chest, with the inscription: «Holiness to the Lord’, – ex. 28, 36) has a conversion of heart purity which inspires us «to heed the plate of our heart, so that, if it is black from sin, (if we can find it) we should hurry to clean it with our tears, repentance and prayer.⁴»

«From incessant prayer the air in our minds is pure of dark clouds and winds of evil spirits.⁵" The concepts of purity or blackening of the soul, the quality of the «mental air’ in us are important for us and will be repeatedly mentioned in the book.

Sinful thoughts «come to the door of the heart and, finding it is not protected by mind, one after the other comes in, each in its own time. When one of these […] thoughts, rising to the heart, enters it, then brings with it a whole swarm of impure thoughts and, thus darkens the mind and heart, irritates the body and attracts it to the shameful deeds.⁶" The «Swarm of impure thoughts’ is not just a comparison, it is a documentary description of what is happening.

“Objectification’ of sensations in psychotherapy

To continue the conversation about schools, dealing with sensations, the method of bioenergotherapy (BEST), developed by E. I. Zuyev (St. Petersburg) should be mentioned first. BEST, as no other manner of work, enables a person to transfer to the practitioner (the operator) the nuances of body sensations. The peculiarity of BEST is that in the process of massage, which is more than just the mechanical interaction between the practitioner and the patients (which, rather, should be called work on the movement of sensations in the body) the latter are asked “strange’ questions: about the consistency of movement in the body “sensations’, the color of the inner space and other characteristics of the “body scheme’. The patient, for example, reports that their head is filled during the manipulation. “With what?” – the operator asks. The patient: “Air (water, milk, resin, lead, etc.)”. The practitioner holds the shoulder blade and asks again: “What am I holding?” The response is: “A chicken”.

Zuyev’s followers gently call the evocation of those felt images to be the product of «illusions’, the «suggestive effect’. They use this curious feedback to adjust their operational efforts, as well as to divert the patient’s attention towards the process of performing manual therapy procedures. Representatives of the BEST school also suggest: «The immersion in figurative reality is an integral part of deep diagnosis, since the patient «gives’ those images that are embedded in the structures of the subconscious. The creative application of the knowledge of psychoanalysis has limitless possibilities here.⁷»

We can say that the psychocatalysis of body sensations is the development of BEST ideas in the direction of the psychotherapeutic usage of the ability of man to recognize the «schemes’ of a body.

Spontaneous detection of sensations

“A stone in soul’ is one of those images most often experienced by patients, but it’s not the only one. “Jellyfish’ or “octopuses’ of fear, sitting in the stomach and launching their “tentacles’ in all parts of the body. “Clouds’ of anxiety in the chest, forcing the patients to wring their hands and run around the room. A “mass’ of anxiety, bursting in the forehead, preventing them from sleeping. “Lumps’ of grievances in the chest, preventing them from breathing. “Balls of despair in the throat, squeezing tears from the eyes (“globus hystericus” in Latin). “Brain-eating snakes’ of doubt in the head and “steel plates’ of situation control in the back of the head, raising blood pressure to pre-stroke levels. “Lead shoulder straps’ of responsibility hanging on the shoulders, flattening the spine. Patients often describe their sensations in these terms.

The objectification of feelings in artistic speech

In everyday and poetic language and in proverbs, one can meet such expressions as: “my problems swell my head’, or “cats scratch my heart’. Joy is usually described as big, and grief as heavy. Doctors speak about the “neurasthenic helmet’, though it is not known how to get rid of it.

It is possible to give a lot of quotes from popular songs, for example:

«Don’t go to him, don’t go, he’s got a granite stone in his chest.»

Here is an example from a novel: «A young woman is standing in a dark and cold hallway, near a tepid stove, warming her hands, waiting to be called for dinner- and, having pursed her dried up lips, thinking… about what? About Rodion? It is all nonsense, that she has poisoned him, nonsense! But what if she really has poisoned him… my God! What must she feel? What tombstone is lying on her secretive soul!⁸»

There is no need to add to the list of excerpts because the reader will be able to recall such collocations, used to describe sensations in the body during the experience of various emotional states.

Snakes in the head is not a sign of schizophrenia

Being a student of the clinical school, I used to perceive the evidence of patients about their feelings as a part of the information needed to help establish the diagnosis and verify the effectiveness of the treatment. If patients told me about the “daggers in their backs’, “the devil on their shoulders’, “worms in their heads’, I thought about senesthopathy, and schizophrenia.

Today, while working through «a given’ energy structure rather than an innate genetic one, I often met the descriptions of «strange’ feelings experienced by my patients. For me, the style of such descriptions is important. It can be epileptoid-photographic, cycloid-colorful, or schizoid-abstruse, or organically flattened. Knowledge of the patient’s character remains essential, but no less important is the fact that there is practically nobody who is unable to describe what is felt. The body experience, (or «experiences of the body’) is a phenomenon which is quite natural to people of any constitutional and genetic type and culture.

Bodily experience, conscious or unconscious, is constantly presented in the normal human sensory system. The only real «strangeness’ of descriptions of body sensations in the somatopsychotherapeutic process, is that they are made in the form of describing objects, which was not done before. It will be discussed below.

Sometimes patients can be surprised by the nature of their perception when referring to their feelings. They even ask in embarrassment: «Do you have a lot of crazy people like me?» The perception of what is felt in images is not a sign of mental illness. On the contrary, the ability to perceive indicates mental health. If we talk about diseases, it turns out that «snakes in the head’ are more a sign of pre-stroke than schizophrenia.

During the observation of the object descriptions of experiences it was found that the results of self-examination of the body sensations can serve, firstly, to activate the processes of natural self-regulation in the body (through the inclusion of the feedback mechanism) and, secondly, to organize accelerated changes in the mental status of the patient through focusing on this process.

An overview of the work with sensations

If we talk about the main issue of psychotherapy, it is, in my opinion, as follows: to get quickly to the mental charge which is «knocking down the patient’s energy circuit’ and decide on what to do with it.

There are a number of approaches to solving this issue, e.g. psychoanalysis with its method of free associations and catharsis while understanding the «primal scene’; gestalt therapy, which aims to modify the expression of feelings through finding a «formula’ of constructive appeal to the «addressee’, etc.

SPT implements a specific approach. In the diagnosis, it suggests turning to body sensations, finding unresolved experiences by their «mass’ (the technique of «objectification of sensations’), and in the therapy – calming down without preconditions, (the technique of «zeroing’). The special issue is obtaining new experiences.

Phases of work with sensations

Diagnostic phase

1. “Where?” (Sensations, associated with the experience – at the level of head, chest, abdomen?)

2. «What?» (Is it something big or small? Light or dark? Heavy or lightweight? The image of what is it?)

Evaluation phase

1. Can it be bigger or smaller?

2. What parts of the body are «de-energized’?

3. Did it emerge recently or long ago?

4. Under what circumstances?

5. Was it brought from the outside or formed inside?

6. What condition does it correspond to?

7. Does it solve problems or complicate them?

8. Do you want to continue living with this feeling or do you want to part with it?

9. What percentage of your forces is concentrated on it?

10. Would these forces be useful for anything else?

11. Other issues

Therapeutic phase

1. Calming down

2. Suspending

3. Testing of “secondary formations’

4. Application of the forces to new areas of activity

Psychocatalysis of body sensations

The essence of the work can be described as follows: the sensation in the body, corresponding to a certain experience, is objectified from questions about how much it “weighs’, what “volume’ takes, is it “light’ or dark’? After that, a decision about this sensation is made. It is either preserved, “fed’, applied to life in an unchanged or modified form, or, on the contrary, a person chooses to calm down and observes the resorption of this sensation.

After a short conversation, a patient is invited to turn to inner sensation and determine its nature. Where is there an accumulation of heat sensations or gravity? Where, on the contrary, is there a lack of filling?

When the location of the experience is revealed, there is a discussion about the evaluation of this formation which has been subjectively felt inside the body.

If the feeling has a negative impact on the health and way of life of the patient, the therapist invites them to take a decision on this formation or somatic structure. The correct outcome of this part of the work is considered to calm the patients. It is accompanied by the observation of the process of resorption or «shrinkage’ of the specific formation.

At the end of this process, the diagnostic phase is repeated. The key question of this phase is: «What is left in the place of the previous structure?» As a rule, it is defined as something scanty in size, volume, weight, something like a dot or a speck. Then it is specified once again: «Do you need it for something?» If it is not necessary, the patients observe the cleansing of the body from the rest of the experience that has spoiled their condition. Usually it is done by absorption, evaporation, washing out, etc. In some cases, «the dot’ simply «flies away’.

The result of this part of the work is the restoration of the balance of sensations in the body. A program of actions for the future is formed based on this state. A new style of behavior is developed for a problem situation to meet what caused a failure in the patients’ condition.

A series of sessions to «clean’ consciousness leads to a new level of freedom for the patients to use their mental powers and to changes in their way of life.

Diagnostic phase

Patients first come to the doctor, not always knowing what to start with. One thing is obvious to them: they feel bad. What is this «bad’ about? How great are the number of the ways to further communication between two people, one of whom is a doctor and the other the patient? This choice of paths depends a lot on the doctor’s viewpoint.

The therapist’s viewpoint

“I’ve slipped away from Aesculapius…”

Let’s consider what usually happens when a person turns to the “classic’ doctor. “What are you complaining about?” The complaints are recounted. Anamnestic data is collected. Then an objective examination is carried out: percussion, auscultation, palpation, followed by instrumental and laboratory studies. The sum of the data allows evaluation of the state of certain organs and to put forward diagnostic hypotheses. Differential diagnosis involves the selection of the most likely conclusions from the list of possibilities. In the future, the diagnosis will be refined using “ex juvantibus’, which is a process of making an inference about disease causation from an observed response of the disease to a treatment. The activity of the doctor at the same time is quite large. The patient is enjoined to be “obedient’, “to bravely endure all the hardships of service.”

Thus, the diagnostician in this relationship is a doctor. Their research tool is their «clinical apparatus’ together with devices that are extensions of their senses. Their direction of examination is the state of organs and systems. The position of the patients is to endure everything, as it is all about their functional status (patient is in Latin – «patient’).

Psychiatrists still maintain the impartial study of the psychopathological phenomena, the definition of symptoms, syndromes and «nosology class’ of the disease.

«Well-collected anamnesis is half the diagnosis» – these traditions are inherited by clinical psychotherapy. On one hand, allowing the participation of the patient’s personality in determining their fate, but, on the other, not overestimating the role of psychological factors in the formation of the patient’s condition. (Excessive psychologization is referred to as false psychology). Clinical psychotherapy is interested in the peculiarities of the constitutional and genetic type of a patient. A therapist plays the role of a mentor or a teacher: «a patient’s job is to be ill and a therapist’s job is to study their illness and to prescribe proper medical procedures’.

Healers without any medical training copy the expert in a parodical way. They know everything for their client, they will tell him everything: what was, what is, what will be, who «did’ it to him. Their main instrument is their intuition. They are ready to answer almost all questions, as well as cure all diseases…

There is a clear difference between the content of professional and non-professional approaches, but they do have one thing in common. They give the patient the role of a mute participant. (By the way, not all applicants for help reject such a passive role. Among the clients there are a lot of undisguised supporters of such a position.)

The directive position of the doctor in relation to the patient was especially present in the initial stages of the formation of psychotherapy. Charcot and his school, Pierre Jean, French doctors Lebo and Bernheim were the researchers of the phenomena of suggestion. August Forel from Switzerland did a lot in the study of somnambulism and the phenomena of hysteria, followed by the discovery of the origins of affective symptoms, particularly hysteria by Breuer and Freud. However, their methods also suggested a greater activity of the doctor.

Dialectical method

Laying the foundations of “psychological’ psychotherapy, Freud made a remarkable move towards greater interaction with the patient in the identification, interpretation and subsequent processing of their condition. However, there were “remnants’ of the old “hypnotic’ period of development of psychotherapy: the patient passively lay on the couch, the analyst was separated from them.

Jung was much more inclined to the ’dialectical method’. «If I, as a psychotherapist, feel an authority towards the patient and, in accordance with this, claim to know something about their personality and be able to make the right conclusions about it, then I, thereby, sign my own non-criticality, because I find myself untenable in assessing the person opposing me.⁹»

Here is his description of the features of the «dialectical mode of action, i.e. the position avoiding any methods’:

«The therapist is no longer an active subject, but a witness of the individual development process. (…) The analyst here is not a superior, competent, judge and advisor, but a participant in the dialectical process as well as (now) the so-called patient. (…) In the relations «doctor-patient’, two mental systems are mutually correlated, and therefore any sufficiently deep penetration into the psychotherapeutic process will inevitably lead to the conclusion that due to the individual originality of the participants, the «doctor-patient’ attitude should be a dialectical process. (…) It is clear that more complex, spiritually higher standing natures cannot be helped with complacent advice, suggestions and attempts to appeal to a particular system. In such cases, the doctor is better to remove the armor of methods and theories and rely only on the fact that his personality is strong enough to serve the patient as a point of reference and support. At the same time, it is necessary to seriously weigh the probability that the patient’s personality may surpass the doctor in mind, spirituality, breadth and depth… in all such cases, the doctor should leave open the individual path of healing, and then the healing will not lead to a change in personality, but will coincide with the process of individuation, i.e. the patient will become who is in essence¹⁰».

On the North American continent, Carl Rogers and other humanist psychologists have proclaimed confidence in the client’s own abilities for personal growth.

Significant development of this principle is in the NLP, offering to refrain from meaningful instructions and limited only to formal.

Following the client’s process is a fundamental principle of process-oriented psychology.

The risk of affirmations

Reflecting on the danger of affirmations, and even more on suggestion (in particular, in the process of psychoanalysis), V. T. Kondrashenko and D. I. Donskoy note: “There are certain difficulties in the use of suggestion. One of them is that the patient gets used to this regressive form of support and uses it as a prosthesis. The second difficulty arises if the suggestion is used without its subsequent realization. In this case, the suggestion of the analyst is not analyzed and, as a result, the patient may develop a new neurotic symptom complex. Most often this happens when the interpretation is presented to the patient as a dogma.¹¹”

Thus, suggestion, struggling with one complex, can give rise to another.

To sum up the above, there is a tendency to increasingly trust the capabilities of a person undergoing treatment in determining the process of psychotherapy. The principle of interaction, rather than impact, is becoming clear. A two-way process occurs when two people come in contact, although one is called a therapist and the other is a patient. There is a search for a solution to the problem when combining efforts. To achieve success, the therapist does not need to play a Superman, all knowing and able to do everything for the patient.

A person is a self-organizing system with sufficient resources. All they may need is some assistance in the use of those resources. This is the principle of psychocatalysis which is contrary to the principles of doing something for the patient, whether interpreting their condition or the selecting more useful areas of activity for them.

Somatopsychotherapy (I will try to show) implements this principle to the greatest extent possible. The instrument of «doing’ are questions. But before we talk about them, we will pay attention to some more general problems related to the self-training of a psychotherapist.

Pitfalls

“The clinic drives a psychotherapist,” said prominent Russian therapist S. Konstorum. "…The philosophy of human life… directs the life of the therapist and forms the spirit of their therapy,” K. G. Jung stated with him in unison.

What can prevent us from the realization of these truly golden principles? There are probably reasons for possible failures in their implementation, depending on the patient, but we will analyze what depends on the therapist. «Physician, heal yourself first» (the Church. – Slavic) is a long-known principle. Before you start healing others, follow the advice of the Delphic Oracle «get to know yourself.» (And change yourself – A.E.)

The merit of the introduction of the principle of preliminary and parallel analysis of the analyst themselves belongs to Jung. The need for this was also recognized by Freud.

A somatopsychotherapist, no less than the psychoanalyst or the Gestalt therapist, needs to study their own state, to know the tendencies of their reaction and the nature of their character.

Tendencies of character

In accordance with your personal character: mainly schizoid, cycloid or epileptoid – you may need to track tendencies for: complication, self-admiration, domination and for commanding.

The presence of asthenic traits in the nature of the therapist can lead to the development of the patient’s parasitic traits.

Neurotic complexes

It is obvious that the psychotherapists’ own traumatic experience and the presence of their unresolved life issues can complicate the process of psychotherapy. It is discussed in detail in different literature, and I will not dwell on this further.

Cultural stereotypes

Having accepted the fact that psychotherapy is not an area of self-affirmation for the power-loving, nor an area of self-gratification for the sweet-loving. It is also neither an area where excessively smart people feed their pride (nor an area of self-torture for a “good’ one), nor indeed, a sphere for solving neurotic problems of the psychotherapist, let us pay attention to the following:

Even if we assume that a «perfectly balanced’ person, who has undergone a long personal psychoanalysis or other thorough therapy, is engaged as a psychotherapy practitioner, that is to say, this person is pure in the sense of the absence of any tendencies to solve their own psychological problems when in contact with the patient; this «ideal’ psychotherapist still risks falling into «activism’.

It is difficult for a doctor to trust the «uneducated’ mind of a patient. They are used to being an expert, a specialist. They know the terminology to denote the patient’s different states. They are competent to prescribe and cancel medications, discharge the patient to work or leave home. They are responsible for the life of the patients almost more than the patients themselves.

For the psychologist it is not easier to tune in to a trusting attitude towards the client. Although initially, they are more «consultative’ and can imagine that, as a specialist, they must be «smarter, stronger, more agile’ than their ward.

For me, falling into all these «traps’ as a result of being interested in my self-development of the «purity of doing’, it became important to track my characterological response, my own neurotic problems and tendencies, which had appeared in the course of my previous professional life.

Below are some examples of my self-analysis (in the manner of «somato-analysis’). I also mention some of the experiences that I have gained through participation in a special program.