Kitabı oku: «Things in The Body», sayfa 4
Somatopsychotherapy “Debuts”
Psychotherapy works with disorders. Disorders can be acute or chronic. Usually the patients come to the first appointment to the psychotherapist when chronic disorders have been supplemented with the acute ones and their life has become unbearable. What does the therapists do at the first meetings? They react to the patient’s acute disorders. What does they do next? They respond to the chronic disorders that the patient often does not realize.
The acute disorder can again occur in the patients when their fate is changing. In general, the probability of meeting an acute state at the beginning of psychotherapeutic contact is higher than in the future.
Why do I mention this well-known to every therapist fact? Because it is related to the topic of this chapter. At different phases of work with a patient, different ’approaches’ will be preferable, different ’debuts’ will be played.
From the actual
The general pattern is as follows: at the beginning of the appointment a patient is so full of different experiences that it is not necessary to look for them, they openly come out and it is easy to work with them. The patients can be quickly turned to talk about what they are experiencing. If they describe their body symptoms, such as ‘a stone in a soul’, it will only be necessary to specify if it is large or small, heavy, or light. If they mention the overloading of their forehead with restless thoughts, you can just ask: how many of them (thoughts) have accumulated there, whether they are large or small, what they are made of in their sensation, etc.
If the patient has previously conducted internal analytical work and managed to identify their condition, they declare fear, which limits their life, or jealousy, which drives them crazy, or resentment, which they do not know how to survive. It is also quite easy to turn their attention towards the description of the body sensations. «Where is your fear: in the head, in the chest, or in the stomach? Is it big, heavy, or light?». As soon as the first answers arrive, e.g. «My fear in my stomach, and it is big», you should immediately ask clarifying questions, e.g. «How many centimeters is it in diameter?», and thus lead the situation in the direction of identifying the plastic image of the experience, located on one of the levels of the body.
The usual dynamics of asking questions is as follows. Suppose that the patient complains to the severity in the chest, or finds there the feelings associated with the experience, which they manage to qualify as an offense. It is essential that the chest area is seen as problematic, concentrating all the sensations on itself.
Without any delay we specify:
«Is the heaviness in the chest big or small?
«Big,» the patient answers.
«How many kilos?» we continue to ask without any hesitation.
It can hardly be called a traditional way. As we have already mentioned, usually a doctor, after taking note of the symptoms, begins to establish a ‘nosology form’ thinking about the pills to prescribe to mitigate the painful manifestations. A psychologist embarks on a search for the psychological conflict that caused the disorder of the client. A healer immediately determines “the influence of an evil eye’ and starts to remove the ‘damage’. We have already talked about many options for the external use of the patient’s message. SPT also offers to continue asking questions and go into more detail about what has already been said. To make it easier for the patient to concentrate, you can offer them to close their eyes.
Closing the eyes, the patient responds:
«Ten kilos.»
«Ten kilos of what: gas? fluids? mass? wood? metal? stone? anything else? What does that feel like?»
«Stone.»
«What type?»
«Marble.»
«Shape?»
«Cube.»
«Size?»
«10 × 10 cm.»
Thus, we receive the initial information.
Please, note that we find out the characteristics of what is really felt. It is not a representation of something that does not exist.
So, in acute cases there are no problems with the beginning of the work, because the experience «strikes’ the energy circuit of a person or, rather, the contour of their feelings so much, that neither the patient nor the doctor finds it difficult to identify the «theme’ for work. The locus of experience also does not require long definition. The head «rips apart’ with the concerns, the chest is «pressed by resentment’, the fear «gathers all the power’ in one’s stomach, etc.
It is not so easy to determine the location of the «threshold’ and «sub-threshold’ experiences. In these cases, some tricks may be needed in order to find them and neutralize. Either it will be a subtle conversation, revealing the «zones of indifference’ of the patient, or something like what I want to describe as a special approach in the identification of hidden problems in the patient’s experience.
From the drawing
The beginning of ‘from the drawing’ is one of the favorites in my practice. The instruction to the patient is as follows: “Draw a symbolic figure of a person of squares, circles and triangles, the number of elements in the figure is 10”. If the patient has additional questions, it can be explained that the total number of elements that make up the figure is 10, but their quantitative ratio is arbitrary. It is advisable to draw without giving it much thought. It is possible to change the size of the squares, circles, triangles.
In some cases, I propose to color the figure and almost always to denote the age of the character. We will not consider the variety of options based on the constructive drawing of the person now. This is a separate topic. Let us examine only some cases of using this beginning. I was shown this test and some of the possibilities it offers by V. V. Libin15, to whom I am grateful.
The use of this test in somatopsychotherapy is different from Libin’s expert one, in which the quantitative ratio of geometric figures in the drawing is important to make the conclusion about the main problems of a patient and his personal style.
In our case, this task is used for a completely different purpose – therapeutic. The authors of the expert system recommend asking for five drawings of a human figure at once. In our ’therapeutic system’, this does not seem appropriate. The first drawing is the last one. It means that the state, genetically related to it, is immediately subjected to study.
Subsequent (post-therapeutic) products will be new, and again one picture will be enough to fix the change. I give importance to the age of the character (it is not practiced in the original test). I also use colors for this test.
Below there will be many specific examples of using the drawings. Now I would like to focus only on general issues.
The work with the drawings becomes relevant only after the obvious distortions in the patient’s condition are worked out. Psychotherapeutic communication goes into a new phase – the phase of cleaning the consciousness of ’polluting’ formations’ in a systematic mode. When the patient is generally calm and there are no other emergency topics for work today, then they get the task to draw a symbolic figure of a person of squares, circles, and triangles.
After the drawing is made and the age of the character is indicated, attention is transferred to the sensations in the body associated either with this drawing or (more often) with the age indicated near the drawing. «Where are the feelings associated with the age of N years? At the level of the head, chest, abdomen, or anywhere else?» As a rule, sensations are detected at the level of one of the mentioned zones and it turns out that they are associated with some experience, more often unpleasant, sometimes pleasant, but always significant.
When the first episode of work ends with the patient’s calmness, ’closing’ the old experience, an alternative, more productive response in such situations can be find. As soon as the cycle of work with a separate experience is completed, the same task can be given again – to draw a figure of a person from the already known elements. To give or not to give this task again depends on, firstly, whether the patient has enough strength to do another cycle of work, and secondly, on how much time is left till the end of the session. In case the patient is not tired and there is enough time left, work cycles can be repeated an unlimited number of times. Remarkably successful patients can work out up to 5—10 episodes per hour. But the general rule is one episode per a session.
I recommend paying attention to the description of this kind of work in the Chapter «The Case». There you can see the typical ’growing’ of person from session to session.
In conclusion, I would like to say that starting the recovery process with a constructive drawing of a human figure can help a lot in a systematic work through the patient’s problems during the psychotherapeutic communication. Using the drawings can help the patients to determine what was in the depths of their consciousness delaying their free development. They help to actualize the hidden experiences that seem to belong to the past, but, nevertheless, remain in the present and continue to have a negative impact on the patient’s life. It is difficult to overestimate the usefulness of drawings as an indicator of the patient’s condition when everything only outwardly looks normal.
In cases where the patient is experiencing significant anxiety and is clearly aware of their trouble, the use of drawings becomes unnecessary, even inappropriate. With all the sympathy for them, we must realize that they are the artificial means of obtaining material for the work.
Both in case of work from a conversation that reveals the actual experience, and in case of work from the drawing, the so-called ’principle of non-slipping’ works. The first mention of a significant experience is a sufficient reason to study it. Listening to the enumeration of the patient’s troubles is a useless exercise. To deal with their consequences is much more productive.
From the dream
The starting point for the work can also be a dream. Here is one example of the work “from a dream’ in more details, as no description of this kind is further expected.
The main idea is that any dream as a whole or its elements are provided with a specific charge or their combination. For every dream there is an equivalent in sensations at the level of the body. So, the question is: «Where is the feeling associated with this dream or the dream element?» For example, the patient’s respond is ’in the head’.
The dream of patient P. was determined by the experience of betrayal, and his feelings associated with it were in his back.
From heads to tails
Patient P. is twenty-eight years old. He is not married and lives with his mother. His father, abusing alcohol, died when he was fourteen. At the age of twenty-four he went through a difficult parting with his girlfriend who was waiting for him from to resign from the Navy. He gave up his Midshipman shoulder straps for her. But after his return from military service she decided to leave him. The patient took her statement about their break-up as a blow which caused much pain.
He tried to forget her. He started dating another girl he had been introduced to. Their relations were warm but without love, and their wedding did not take place. Because of that he was very upset, and everything began «to fall out of his hands’.
Being soft and deep by his character, he used to write poetry and paint in his youth. He was also interested in philosophy. But now he has not got any special interests. He complains about «lack of spirituality’ in his life. He says that he does not want to do anything. «There is no purpose in my life. I am waiting for some fairy godmother or social worker to come and help me rebuild myself. I am still a dime. But I was thrown from the heads to the tails,» P. sums up his sad story. Some time ago because of all that background he began to drink a lot of alcohol with his friends to ’feel better’. Once he was stabbed in the heart. Fortunately, the knife hit his rib. He explains psychological gain from such behavior by ’obtaining new information’. Those ’guys’ were the only real opportunity to share experiences.
The characters in his drawings are not all standard. In response to the proposal to continue drawing after the first one was made, he gave almost abstract compositions from the given standard elements: squares, circles and triangles. The third figure in this series was subsequently decoded (Fig. 1). It turned out that it echoes the dream, which was the starting point for one of the episodes of the work. It depicts a sprawled man. «Two holes in him, in and out.»
Fig. 1
The dream refers to the period of 1995, when he broke up with the second girlfriend and felt as if something was also broken inside him. «I fell down on a piece of rebar at the construction site and it punched me through.» Some of his dreams the patient perceived as prophetic, so he stopped diving from a high of 8—10 meters, as he used to do.
His dream was rather old, but since the patient mentioned it today, I suggested to ’check’ where he was at that moment: still on the rebar or had already got off it.
«I’ve got off.»
«Was the wound healed?»
«How many percent?» I often use this question in my work. Its undoubted advantage is that it is completely «safe’. In case, «the wound’ is a hundred percent healed, it makes sense, if not a hundred percent – it makes sense as well.
Clarifying the feeling, the patient found out that his wound was not actually healed yet.
«Is there something about her that won’t let it heal?»
«Yes.»
«What is it?»
«Rust.»
«Much or little?»
«Much.»
«What will you do with it?»
«I will throw it away.»
«Proceed!»
While cleaning his wound from the rust, P. noticed that inside it was full of pus, and outside it was covered with a crust.
«What is the diameter of the crust?»
With his hands he showed a circle of a small plate. There was a crust on his back, below the shoulder blades.
«Do you need it for something?»
«No. It keeps the pus from coming out. If I squeeze it from inside, it comes out only in drops.»
«What will you do with it?»
«Pry it off»
He did it.
«Where will you put the pus: in a bucket, in a hole, in a toilet bowl, or somewhere else?
«The pus is running down my back.»
«Has the wound started to heal?»
«Yes. But there are still white streaks of pus».
«How many percent is it healed?
«65.»
«Shall it go on healing?»
«I apply some healing ointment, a bandage, and cover myself with a warm blanket. I need some rest.»
By the end of our conversation, I asked again about the condition of his wound.
«It’s almost healed,» was his answer.
As a rule, back injuries appear because of betrayal («a knife in the back’). In the case of P., it was a piece of rebar. There are also can be other causes of problems in this zone – functional blocks in the vertebral-motor segments (displacement of the vertebrae). Below we will talk about the non-psychic factors involved in the formation of sensations.
From the story about the events
“Now that you have spoken so beautifully about the events that have occurred in your life, I would like you to continue and describe the feelings that you experience as a result.” It seems significant to me. The patients are invited to make a more complete description of their condition.
From the images
If a jealous woman is “driven crazy’ by imaginary scenes of her husband’s cheating (“I go crazy when I imagine her hands on his neck…") – one can ask what she feels when she sees these scenes. Where is the charge associated with her emotion: in the head, in the chest, in the stomach? Is it big or small? etc. There appear a “black funnel’ in the abdomen. The direct correlation between the brightness, proximity of images of significant persons and the size of internal formations existing in relation to them is obvious.
From complaining about other people
“My mother-in-law bothers me”, a young woman complains with tears in her eyes. “What do you feel?” This question immediately turns the conversation from a useless discussion about the nature of the mother-in-law to a discussion of her state that arises as a result. The poor daughter-in-law finds “iron weight’ in her chest (her resentment). Somatopsychotherapy is the option of working with the results of the experiences.
On orders from the outside
An irritable person says: “I have a feeling that the energies of some people, like tentacles, reach for me, and I feel bad.” At the same time, he jokes at himself: “A false psychic!” “What do these tentacles indicate in you? How are they related to you? Why are you visible to them?” It turns out that these “tentacles’ are the assistants in tracking his own charges.
You can worry less
Wives of alcoholics often have an upset contour of their own feelings. They persistently take care about their husbands, but not themselves. The moment when a poor woman is asked: “In what state do you solve your problems?” becomes a true revolution in the life of their families.
Such women should be suggested to check the state in which they try to solve their husbands’ problems considering them to be their own. It helps to switch to the discussion about themselves. For example, a woman is trying to help her husband to stop drinking alcohol and at the same time is experiencing anxiety. She can feel that her anxiety takes away 90% of her forces and makes her almost unviable.
«Should you be so much stressed to solve your husband’s problems, or can it be less?»
«Maybe less.»
«How many percent less?»
«I guess it can be a hundred percent less. Whether I’m worried or not doesn’t change anything.»
«Maybe you shouldn’t calm down because in that case you will do nothing and let events take their course. Should you?»
«I think, on the contrary, I will be able to do something worthwhile, only when I am calm.»
«Well, will you calm down right now?»
«Yes.»
«Calm down and watch how your sensations are distributed. We always talk about the reconciliation of proportions of what we spend our energy on.
The method “to add volume” to the therapy process
Primary care for a patient depends on what they attention are initially focused on. The work on the bodily level usually finds a greater response in those people who have got naturally good feeling of their body, the body of their consciousness. They describe their sensations as an important part of their experience without any stimulation from a psychotherapist.
The ability for such awareness of the problems is an indication for the bodily psychotherapy. However, somatopsychotherapy can be also highly effective with other forms of self-consciousness and, in any case, is recommended as an additional means of «giving volume’ to a therapeutic process. Somatopsychotherapy is a good way of activating self- awareness and working out the physical aspect of the problematic experience, regardless of whether it is the main approach to change the state of a person or an ancillary one.
No matter where to start
There are an unlimited number of ways to start the recovery process: from a posture, from intonation, from facial expressions etc. It always turns out, that such manifestations are found in the body structure.
Fine examples of the beginning from gait features and gestures of a person are given by Arnold Mindell (USA)16. He organizes the process of «amplification’ of the movement, which tends to manifest, but is hidden. It is on the «lunar’ but not on the «solar’ side of consciousness. The question of the process-oriented psychotherapy is: what are you doing when you are holding your leg in such a way? The answer is: I am preparing it for a fight! The SPT question is different: where is what makes you so tense to keep your right leg like that? The answer is: there is anger in the chest. Thus, the continuation of the work is different.
N. R. Cape (Brazil)17 offers to pay attention to the characteristics which a person uses to describe the others. His integral psychoanalysis is based on returning to a patient their statements-projections. The SPT interiorization is achieved in a different way. «Is there something that makes you choose such words? Is it at the level of your head, chest, abdomen? What do you feel when you say that?» We move from the projection to the state which is holding it. We talk in a «topographic’ manner, using the question «where?». From nouns and adjectives that are used by a person to define the others, we move to the essence of the «speaker’, to that part of their consciousness, which «invests’ such speech behavior.
Now we will not go into details of somatopsychotherapy «debuts. Let us agree with Jung, who noted that " … in case you want to determine the patient’s complexes, you can reach the center directly from any point of the circle… you can start with the letters of the Cyrillic alphabet, with meditation in front of a crystal ball, with a prayer wheel or a modern painting, or even with a casual conversation about a trifling event. In this sense, a dream is as effective as any other starting event.18»
It does not matter which of the rivers will bring us to the lake, and, in a sense, it does not matter what to start the recovering process with. What is important, is how to end it. According to V. N. Tsapkin, we are looking for the «invariant of options.» He noticed that the same mental content expresses itself through the absence of legs in the drawing of a person, made by the patients with clinical symptoms of astasia-abasia, as well as through their dreams, or their behaviors in a group.
In somatopsychotherapy this kind of invariant is the bodily-oriented structure of consciousness. Under other circumstances, a person expresses it in words in free associations (in the psychoanalytic model); projects on the inner screen in the form of «movie’, accompanied by sounds, smells, bodily sensations (in the NLP model); expresses behaviorally (in the procedural model). In a «somatopsychotherapeutic’ situation it appears as an object in the body of consciousness. It is like a book on the bookshelf that can be read, filmed, or performed dramatically (as in the above-mentioned models), but which is now stored in a potential state within its covers.
