Kitabı oku: «Things in The Body», sayfa 3
Remarkable school
For me it was a remarkable schooling to observe and then participate in the practice of addressing the problems associated with alcohol abuse (and complex problems) according to the methodology of Croatian psychiatrist Vladimir Hudolin. I got acquainted with this approach (called ecologic, family, systemic) in Italy, where I was invited thanks to the inter-confessional cooperation of the Russian Orthodox and Roman Catholic churches.
The so-called operators consider themselves to be a facilitator of the process of staying sober and sees their task as so much doing something for the families, but rather to create conditions in which the families themselves, having problems associated with alcohol consumption, can do what will save them.
If an «active’ approach is used, the alcohol addicted patient is usually «coded’, «torpedoed’, if not sent for the «compulsory treatment’ to the institution of a prison type. The new program of the environmental approach sometimes suggests leaving such a patient alone and start the treatment by changing someone in their family.
The essential point is the «return of responsibility’ («recuperare la responsabilita» in Italian) to the members of the club (the community of families) for the process they are going through. Practically this is achieved in the following way: meeting, «chronicle’, support to absent participants (patronage), the preparation of tea and other things are conducted by the members of the club at a time. The operator only cares about the safety of the atmosphere in which all this is done. Developing the pooling of experiences and resources of club members, they ensure that forces are not wasted on talking about politics, football, etc., thus restricting the simple rules of life in this community of self-and mutual aid: to just talking about the present and to rely on their own collective experiences.
In contrast to the common methods of «healing in one day’ (such as the above mentioned «coding’ or «torpedoing’), this environmental approach gives much slower results, but is incomparably more reliable. The result of the club meetings is directed to the future, to the life of the descendants of the club members. This result is not limited to a period of 12 months or 5 years.
In connection with my participation in that Italian program, I thought of a «plant’ agronomic metaphor. What will the gardener take care of while planting beets in his garden? About the soil and light of course, but he will not try to grow it himself instead of a beetroot. Likewise, it is especially important to the doctors to understand the limitations of their competence and not to overdo it. In the end, the patients are saved by their own effort, not only by the activity of the doctor. This is my conclusion.
Get some rest!
The doctor can see the problems in the form of objects, like a psychic, or guess their location from the “weak signals’ or detect them by testing or infer their presence in many other ways not unlike famous detectives. On the other hand, psychocatalysis specialists will refrain from the open use of their “brilliant abilities’ and their trained “clinical machine’. During work sessions with patients, they will leave their knowledge and intuition out of the equation, trusting the abilities of the mentee. By answering questions, the patient develops the ability to visualize and can even find a path to enlightenment. Questioning is of crucial importance to the process of somatopsychotherapy.
Of course, this does not negate the importance of the training of an «assistant’. Both clinical and psychological preparation is extremely important. Understanding the human character, the peculiarities of nosology classification, the dynamics of experience significantly accelerates the therapy: the ability to ask relevant questions is a great art. However, trust in the patient’s ability to respond in any case remains truly relevant.
One of the components of the internal training of the questioner, including the key to their ability to withstand the intonation, to provide the choice of an answer to a patient, is the understanding that the patients are able to determine their own feelings. This is one of the postulates of therapy through questions about body sensations.
The research tool
The technique of the «objectification of feelings’ falls under the category of indirect methods. This means that it «includes’ the initiative of the patient and activates his ability to determine and change his state. The solving of this problem is based on the amazing, but usually unused human ability to self-diagnose their own condition as specific images of objects.
This process is called psychocatalysis, by analogy to a catalytic chemical process: there is a «substance’ that can change its state – a petrified emotion – and there is a psychotherapeutic influence (the catalyst) without which this process is difficult, slow or stuck. When they are combined, a «miracle’ occurs.
The patient’s attention is the main active element but is expedited by the catalytic effect of psychotherapist’s questions.
There are two main questions in the diagnostic phase: WHERE and WHAT.
“Obstetricians’
Socrates, with his “skill of midwife’, more than 2000 years ago showed the effectiveness of asking in a philosophical conversation: “People, when being asked right questions, decide themselves what is necessary…12». The discovery of the role of questions as “birth attendants’ is perhaps as significant in the field of interpersonal communication as the discovery of the wheel in technology.
The effectiveness of questioning, instead of stating, was noticed by many wonderful masters not only in philosophical circles but also by the medical «maieutic’. (The Socratic Method, also known as maieutic is a form of cooperative argumentative dialogue between individuals, based on asking and answering questions to stimulate critical thinking and to draw out ideas).
I mean not just ancient the Zen Buddhist teachers with their unanswerable questions («How does one-palm clap sound?»), or the Sufi sages, or Orthodox saints, who, by asking questions, revealed the «soul problems’ of their disciples, spiritual children, no worse than a surgeon with a scalpel reveals ulcers. I am also talking about the masters of psychotherapy.
It would be difficult to describe their work here. After all, even a benevolent silence, a willingness to encourage and to support the mental movement of a patient is also a kind of a question – silent and at the same time the deepest one. «Tell me anything you want.» When I talk about such silence, I mean the empathic acceptance of Carl Rogers, creating a space for safe expression of a client, or a «gap’, the willingness to patiently wait for the manifestations of a patient’s activity, of Arnold Mindell, as a fisherman waits for a bite13. A question creates an area of negative pressure that is ready to take into its form what it is waiting to be let out. The task of a psychotherapist is to model capacities for meaning.
Questions are a natural part of the life process
We are going to talk about the questions that people can ask their body, but I have no doubt that the body itself is able to ask questions. In particular, with the help of dreams. Wakefulness is the “answer’ to dreaming. The dream poses a problem and real life serves its solution. You can say the opposite: a dream is a response to wakefulness. The life itself is questions and answers.
Psychotherapy and somatopsychotherapy, as part of our life, does not invent anything unnatural, it does not deal with something artificial. It only cleanses and gives patronage to everything natural.
The terms «facilitation’ and «amplification’ are well known. I use the term «psychocatalysis’. The fact, that psychocatalysis applies to the inner body sensations, became an important opening of the Russian school of BEST by E. I. Zuev and the basis of the development of this «question’ therapy.
«Ask me questions,» a patient often says, dropping themselves into a therapist’s chair (as if surrendering»). Who will do it, how will it be done, and what for?
The Key question
We can say that each system of psychotherapy has its own key question. (This does not automatically mean that it works by questions – and yet…)
The question of clinical psychotherapy: dynamics of what constitutional genetic type manifests itself in the experiences and events of this person’s life?
The question of psychoanalysis: when, under what circumstances, what affection of Id and prohibition by Super-Ego encountered in Ego and provoked the complex?
The question of Jungian therapy: what kind of distortion in the conscious life of the patient makes their subconscious mind «to take measures to equalize the situation» and «what exactly should a person do to regulate their relationship with the unconscious?14»
The question of Gestalt therapy: what is the need of the body which makes the «figure’ now, what is the «background’, what prevents the Gestalt from «closing’, what unfinished actions prevent a person from living «here and now’?
The question of NLP: in what modalities and submodalities there is the information that affects a person, how they «manage’ to be upset or, on the contrary, spirited. And so on.
The SPT question
At the diagnostic phase of SPT, a charge that deranges the patient’s consciousness focusing the energy of the body on itself (the substance “heat-heaviness’) is found.
The question that helps to find to this «charge’ is usually very simple: where is the sensation associated with a particular episode of life, with a particular fragment of a dream, with a particular picture, which the patient drew on the instructions of the doctor? At the level of head, chest, abdomen, or anywhere else? Is it something big, small, light, or dark? What is it «made of’? And so on.
Below we will take a closer look at the options of talking to patients, depending on how they declare their problem.
In fact, SPT offers the patients to think about a simple thing: how are their sensations distributed when they solve this problem? Or simply: how are their sensations distributed? Is there anything that disturbs the optimal distribution of sensations in the body? Is anything missing to feel good?
Where does the heat in the arms and legs reach? Are there any uncomfortable sensations concentrated at the level of an area of the body?
I will allow myself a short historical excursus.
Do not wait for any hair to appear on a tortoise shell
Before somatopsychotherapy I had a few years of practice in clinical psychotherapy.
What are its obvious advantages? Firstly, it is the interest in the constitutional and genetic basis on which certain mental processes are developed. A clinical psychotherapist at the first stage of communication with a patient finds out the specific features of the mentality of the latter, and at the last stage they help a patient to see the world as a meeting of different forms of life, each of which has their own purpose. The ultimate achievement of successful clinical work is the patient’s inner peace and tranquility based on self-acceptance as a certain natural entity, endowed with their own character, accepting others as well! «Do not wait for any hair on the shell of a tortoise,» says Taoist wisdom, quite «clinical’ in its essence). This is a substantial part of the work of a clinical psychotherapist, but I would like to draw your attention to something else.
“Storytelling’
A clinical psychotherapist pays much attention to the baseline state in which the communication between a doctor and a patient takes place. Even the most correct messages can be received by the patients only when they have a free resource for this. The fact is that their resources are mostly spent on tension and neurotic experiences.
Johann Schultz is known to have researched and described the basic sensations that a person experiences in the process of relaxation. They were named «six exercises of autogenous training’. A pleasant heaviness and warmth fill up the body then turning into a pleasant lightness and freshness. The heart beats calmly and evenly. Breathing is free and even. The solar plexus emits warmth. The forehead is slightly cool.
The state of the patients when «pleasant warmth reaches their fingers and toes, and the roots of their hair’ is healing in itself. In clinical psychotherapy it is also the background for the patients to accept themselves, the situation and to adjust to a successful way out of difficulties.
It should be noted that sometimes this part of the work is not the second, but the first one: instead of talking to the patient in their «abnormal’ state, the therapist invites them to the session, which is called «learning auto-training’, «hypnosis’ or something else. Only after nonspecific calming in a cozy environment, under the influence of relaxing music, words of «comfort’ with the lulling intonation, and storytelling, the patient is «taken’ to more specific work.
The psychotherapeutic “swing’
At the early stage of my professional development my working combination was conversation plus relaxation. After discussing with the patients their important issues, I offered them to close their eyes and let the feelings to be distributed. Partly, that was the pre-system of the work I am describing now.
Conversation-relaxation-conversation – this rhythm began to seem more natural and important. It is a kind of a psychotherapeutic «swing’. The second part (hypnotic and auto-training) changed its tone in the process of «working out’ this practice. If, at first, I tried to imbue something to the patients at that phase (based on the material of the previous study of their problems), then later I refused to be directive and often offered just to observe the sensations after the conversation, to let them «lie down’.
The questioning observation: question without question
Offering patients to observe what happens after a usual empathic hearing often leads to surprising results. Patients connect to their body sensations, fall into a kind of trance, and undergo a series of transformations, often spontaneously describing the process that, in fact, is organized by psychocatalysis in somatopsychotherapy.
The stones of unease can be detected and disintegrated, sensations can move actively from one area of the body (overfilled) to another (devastated), completely new and optimized contours of sensations can be formed. The convalescents get into the new spaces, from which they come back renewed. It is like auto-training without instructions. Conciliation, calming down, and rebalancing occur spontaneously, in accordance with the «program’, which the body choses itself.
He sat down and began to describe
Recently, I was impressed by a kind of echo of my old “mute’ practice (mute, because it has a minimum number of questions with maximum confidence in own healing process of the body). This story is about the transformations that a twelve-year-old boy began to experience, as soon as he sat down on a chair and heard the words: “Close your eyes. Describe what you feel.”
The boy had a weakened immunity of unclear genesis. He had been suffering from furuncles for a long time. The last two months he was continuously treated for submandibular lymphadenitis (there was a crack in the corner of his mouth, through which he, apparently, got the infection). Two operations under general anesthesia were unsuccessful. He underwent a lot of bandaging, and there was constantly a tubule for drainage in his wound. Of course, he had to forget about going to school.
The boy was brought to me just after he had been bandaged once again. He sat down on a chair and fell into a special state of connection with attention to inner sensations – a kind of trance. He began to describe his sensations in detail without any instructions from me, except for the most general one: «Watch and describe.» The boy understood the main instruction perfectly, though it didn’t say: «Heal.»
The movement of sensations was very intense. The terrible heat was gathering in his chest and there was the feeling of a huge furuncle.
«Will you let him break through?»
«No.»
The boy felt as if he «put his hands in the oven’, then two dinosaurs were fighting in front of his eyes. Then, after a bright flash, everything disappeared.
First, his head «weighed 300 pounds’, then his legs did. Then «a worm slid on his hip and jumped out,» and «a turtle with a small shell, a long neck, big eyes and a silly smile made him laugh’. At last, being weightless, he began to «flip’ in the air.
«Count how many times.»
«Five.»
He began to «flip’ in the air again. This time he had ten «flips.»
A series of transformations, which lasted for about thirty minutes, ended with the formation of a sensation of even heat throughout his body, and the boy felt the opportunity to open his eyes.
A lump of cottage cheese
I was interested in following the outcome of his healing after that process of spontaneous self-regulation. I asked about the condition of the boy in a month. He was healed. Two months later I met him once more.
He maintained balance in his sensations. He enjoyed playing with his friend. «Everything is good. I can play and jump,» he said. Only a small crimson scar under his jaw reminded about his former problems.
«Scars adorn a man,» I remarked.
«I have got enough of them,» my little patient said proudly
The boy reproduced the dynamics of recovery: steady internal heat remained after our meeting. «We were going to take him to the regional center for a more massive operation, but the need for this somehow disappeared by itself. The wounds began to heal,» his mother added. We communicated with him on February 8th, and on March 8th he was already at school. Later his health was improving steadily. His relatives noticed that in he also became calmer.
At the end of my communication with the boy his aunt expressed a desire to talk with me about her problems. It was an indirect sign of recognition of the connection between the session and the recovery by the boy’s relatives. A large lump of fresh cottage cheese, which I brought to Moscow to my children, seemed to me a great reward for my modest question: «What do you feel?»
When you can let happen transformations like those, described by my little patient, nothing else is necessary.
In a few other cases, the challenge is to make the sensations flow. Such transformations are the essence of therapeutic achievements.
Do not talk
To tell the truth, sometimes I almost fall asleep when the patient tries to describe in detail the story of his suffering, not hurrying to work through it. It happens not only to me. In the “Technique and practice of psychoanalysis” Ralph Grinson especially considers such cases when a psychoanalyst accidentally falls asleep during a psychoanalysis session. He recommends not to blame the patient. I can cope with it even without pinching my own hand, but I do not tend to overestimate the effectiveness of this method of psychotherapeutic session and try to warn the patient about the uselessness of just listing the facts.
To avoid this, at the first mentioning of a significant event for the patients, which left a mark in their soul, I prefer to work through the consequent of their experiences, to verify the expediency of its storage, instead of being limited to a simple listing the imprints of events in their soul. I call it the non-slip principle.
Though it is possible to talk as well
However, I must note that there is no need to impose a rather closed, non-objective language of body sensations, when a person calls for an open conversation on existential topics and the balance of their state is not in doubt. Indications for SPT method are very wide, but not unlimited. It is the way to restore the resource of a person. It is needed in almost 100% of cases, but it is not the only thing that the patient may need. Thus, the psychotherapist is not obliged to use the methods of SPT always and everywhere.
We will continue to talk about situations where the balance of the human condition still raises doubts.
The ending – to the beginning
With the time, the phase of communication between the doctor and the patient, conventionally called the “relaxation phase’, became increasingly valuable. I learned to perceive it as a kind of goal, the culmination of the process of psychotherapy,
I once noticed that I was not at all inclined to talk to a patient. Of course, I mean «conversation of minds.» Taking into consideration the importance of the influence of affective charges on a patient’s thinking, I found out that it made sense to «talk to the boss’ (unconscious), in the words of M. Erickson, and not with subordinates (thoughts of conscious mind).
It was easier to find «the boss’ by the sensations in the patient’s body.
The direct appeal to the sensations from the very beginning of the work marked the opening of a unique opportunity to change the state directly, without talking (in the usual meaning of this word). The old formula «conversation – relaxation – conversation’ was replaced by a new one: «relaxation – conversation – relaxation’.
The idea, that the analysis of the patient’s circumstances was usually given an exaggerated value, began to strengthen. In fact, not these circumstances are so important, but how the patient «stands’ in them. It is important to help a person to take a different position in relation to the circumstances, to find another their state. The further is the matter of their own life.
The second phase became the first. Conversations began to start with the analysis of a condition, instead of a situation. Somatopsychotherapy is an exceptional care for the patient’s condition.
Separation of the concepts of “patient’s condition’ and “patient’s problem’
Often the conversation with the therapist flows into the area of discussion of the patient’s problems. I think this is a minimally productive approach. But firstly, let us define what there is besides the patient’s problems.
«The patient’s problem’ is what makes the body react. The perceived information about the situation inside or outside the body, deviates from the optimal. So, the persons consider the restoration of its optimality to be their vital task. This is the basis for their concern.
What is meant to solve the problem is the patient’s state. This is the life resource, the certain configuration of sensations in the body.
Perceptions of situations and responses to them vary widely. What is a difficult problem for one, is nothing for the other; when ones react with all their beings the others can stay completely indifferent. This observation makes you think about the initial state in which a person perceives the situation, evaluates it and forms a reaction to it. The constitutional and genetic factors, the early history of the individual and so on, play an important role in the formation of the patient’s state. It is important that by the time of the meeting with the psychotherapist, the result of the life of this particular person (with his genes, personal history and education) is presented in the form of a state with a certain configuration of internal sensations.
Temperature above 39 degrees
There is a number of situations when the patient’s condition itself (for example, tension) is a problem. As the temperature in case of inflammation goes above 39 degrees. The increase in temperature is natural, of course, but not to such an extent.
Entering the psychotherapeutic room, the patients do not always know what they did it for: in order to solve their problems, or to change their condition. (The third option is the question of how to constructively apply their condition to the problematic situations without changing it a lot). In fact, the problems of the patients are solved outside the therapeutic room. They come here to rate their state of mind in which they try solving the problems and to optimize it.
Psychocatalysis of body sensations is a method of changing the patients’ state and restoring their resources. It is not about solving their problems, unless, we consider the state of their health a special problem. In this case it is a «metaproblem’, the solution of which determines the solution of all other problems.
Separation of the concepts of “psychotherapy’ and “exchange of experience’
It is known that some psychotherapists, including the most authoritative, like M. Erickson or A. Alexeichik, did not shy away from acting as advisers to their patients. There is nothing unnatural in it: a wise person shares with the other one, who is not so wise, their life experience, possibilities, and the program of actions. Such advice of the psychotherapist is distinguished by the fact that it is given technically, “with the special approach’. The instructions remain in the patient’s mind until their full implementation… But it is not psychotherapy – it is an exchange of experience in solving different problems between the experienced and inexperienced persons. The same applies to psychological “problem’ counseling.
We are going to talk about psychotherapy, about helping to change the patient’s state. With such an approach the problems of life will go beyond the brackets. In the field of our study there will be only living beings themselves. The question will be only the following: in what state do they live? In what state do they solve their problems? One of the basic beliefs of the SPT is that it is good to solve problems when the one who solves them is a calm state – which is consistent with the position expressed by Freud: responsible decisions should be taken only after analysis.
The main concern of a somatopsychotherapist is to find what the patients’ resources, their energy, and their attention are being spent for. The work of a SPA therapist can be compared with the work of a prospector. The golden nuggets, that they extract, are the «petrified emotions.» The fact, that they look more like coal, should not be embarrassing. «Gold’, hidden in this ore, is the priceless energy of life, like human life itself is.
Not in blind
Activation of “moving sensations’, such as described in the case of the twelve-year-old boy, is quite common both in the states of “psychic genesis’ and somatic disorders. It is always surprising, delighting and reassuring when the body itself specifies and solves all the issues.
Typically, the sensations themselves are mostly «blind’. As for somatopsychotherapy, the control over this process is particularly important.
First and second level questions
To find out the characteristics of what is disturbing the somatopsychotherapist can go in two directions: the questions of so-called second level require more body energy for the implementation of the reaction, because the expected response is uncertain and creative. “Where is your fear?” – “In the belly”. “What does it feel like?” – “A jellyfish.”
The «first level’ questions are less energy-intensive, and the answers are more predictable. No wonder they are called guiding questions. «Where do you your feel fear: in the head, in the chest, in the stomach, or anywhere else? Is it something big or small, light or dark, heavy or light, dense or soft, or anything else?» You can ask about more details, bringing the questions to the «zero level.» «Does it weigh a hundred grams, two hundred, three hundred, five hundred, a kilo, more, less? Does it feel like gas, liquid, mass, stone, wood, metal, or anything else? Is it an object, a plant, an animal, or anything else?» The series of questions can be continued.
However, to go «below zero’, i.e. to assert something or to impose one’s intuition, is highly undesirable. Unfortunately, this principle is often violated. (And, of course, always with the best intentions!)
“A well working patient’
Being in the “working’ process, a patient begins to understand what is required. The questions become more concise. During one session, already by the third approach (“approach’ means a complete cycle of work; there can be several complete cycles during one session), a well-taught patient can quite “correctly’ answer “simple’ questions. Where are the sensations related to that age? (This refers to the age indicated in the figure in the drawing test). And the patient says, “In the head.” “What is there?” – “Dark heavy mass.” That means that the patient does not need specifying “tips’ such as: “Where are the sensations associated with the exact age: in the head, chest, abdomen, or anywhere else? Is it something big, small, light, or dark? What is it made of…?” anymore.
But even for such an «ideal’ patient some clarifying questions can be appropriate: «Is it in the forehead, in the back of the head, in the crown, or in the temples? How many grams is it? What is its size or volume?»
