Although we talked a lot in college about the "bio-psycho-social" approach to treatment, most of the focus was on the "psycho" and "social" components. In college I learned that, as a process, therapy is emotional, psychological, and interpersonal; there is nothing physical about it. There was a lot of discussion about emotions but never any mention of how emotions are actually experienced. I only later learned that at their core, emotions are physical experiences. They are literally felt on a physical level. And yet not once during my formal education and training was this discussed. Instead, we talked about emotions as if they exist in our minds.
Most of my patients are people who have experienced trauma in one form or another. It turns out that physical experience is especially important to the coneptualization of posttraumatic stress disorder and other trauma related syndromes. Most of my patients are plagued by intrusive memories of past trauma and have extreme physical reactions to anything associated with their traumatic experiences. Some of my patients have panic attacks, which are defined by a variety of unpleasant physical sensations to include heart palpitations, sweating, trembling, chest tightening, shortness of breath, nausea, dizziness, tingling, chills, etc. Almost all of my patients complain of being hyper-alert and physically unable to relax. So while my patients may come to me for help with psychological or emotional problems, their difficulties are also very physical in nature.
When exposed to a life-threatening event, we automatically enter "survival mode;" our brains instinctively activate the "fight or flight" response by stimulating the autonomic nervous system. This activation creates a number of physiological changes in the body. Some of these changes include increased heart and lung action, inhibition of stomach and upper intestinal tract so that digestion slows or stops, constriction or dilation of blood vessels, pupil dilation, relaxation of bladder, inhibition of salivation, increased blood flow to the muscles, increased muscle tension, and increased blood pressure. The purpose of the "fight or flight" response is to provide the body with increased strength and speed in preparation for fighting or fleeing. Once the fight or flight system is triggered, the body feels compelled to do one or the other - either fight or flee. If neither response is possible in a given situation, the fight or flight system becomes overwhelmed. The result, according to Herman, is that, "each component of the ordinary response to danger...tends to persist in an altered and exaggerated state long after the actual danger is over." This explains the physiological symptoms experienced by people with posttraumatic stress.
There is a growing body of research suggesting that unresolved physical reactions associated with trauma must be identified and experienced physically for healing to occur. This is particularly true for people who experience their physical sensations as intolerable and overwhelming. This describes a lot of my patients.
I would therefore like to incorporate aspects of physical experience into my work with patients on a regular basis. Thus far I have only managed to do this in a few small ways. When talking about emotions, for example, I ask patients to describe the physiological sensations associated with various feelings. Sometimes I ask patients to identify where in their bodies they feel a particular emotion. Patients frequently describe these requests as strange or odd. Most have never thought of emotions as phsycial sensations taking place in the body. I suspect this is the case not only for my patients but for most people in general.
I suspect there are a lot of people who are not particularly comfortable inside their bodies. How often do most of us tune in to our internal body sensations? We live in our bodies yet we rarely listen to them. Experience tells me this is particularly true for men, who are often socialized to believe that displays of emotion are not masculine.
To be honest, "body centered" psychotherapy has always seemed too "touchy feely" for my taste. I've heard colleagues describe it as "hokey" and "froo froo." Some clinicians don't see it as "real" therapy.
Every therapist has his or her own personal "style" of therapy. Whether or not we adopt an unfamiliar technique depends a lot on how well it fits with our pre-existing therapy style. We choose techniques that feel natural to us. It's easy, however, to become too comfortable. When a clinician considers a new technique the primary concern should be potential patient benefit. If a certain tool or technique might be useful we should try it, even if it makes us uncomfortable. And so, in the coming weeks I hope to step outside of my comfort zone a little bit. I'll let you know how it goes.