In Europe, science is often taught in the universities by different faculties.1 Each faculty covers a specific way of studying and understanding the organization of the universe: mathematics, physics, chemistry, biology, psychology, anthropology, sociology, and so on. In the universities, there are also faculties that teach specific competencies, such as the faculties of medicine, law, theology, engineering, and so on. By beginning this book with a discussion on yoga, I wanted to define the development of the human being as a system that is animated by a set of mechanisms so disparate that it would be necessary to take courses taught in each faculty to be able to understand it. The list of courses taught in a faculty of medicine demonstrates this very well. The human is found at the intersection of almost all of the scientific disciplines and practices taught at the university. This is already evident to the yogi. For them, it was impossible to sustain an individual’s spiritual development without coordinating different methods that render it possible to make the body supple, reinforce the metabolic activity, stimulate mental activity, acquire a moral sense, and enter into communion with the global dynamics of nature.
Defining the intersection zone of the different bodies of knowledge necessary to create a science of the human is one of the biggest problems I faced when writing this book. One of the original features of body psychotherapy is the will to face this head-on, without worrying about the fact that there is no appropriate definition of such a combination of disciplines and without wanting to re-create a sort of scientific yoga. Body psychotherapy is not a psychotherapy to which an approach to the body is attached. It is a development of psychotherapy that intervenes in the way the psyche inserts itself into its organism.
Yogis admit that an organism forms a coordination of disparate systems that require distinct forms of intervention; they still believe that this disparity can be placed under the yoke of a central will that allows the organism to access the profoundly harmonious core of the human being. I ended this manual with a diametrically different view of the human being by speaking about what is being discovered in the studies on nonverbal communication. If in yoga, the disparity is mostly on the surface of human dynamics, it becomes possible to imagine that it is also situated in its depth. This second path is the one of a synthesis between psychology and biology that does not think that there is a central core within an organism. There are no simple solutions to the multiplicity of questions that arise out of the complexity of the organization of nature. There is not one dimension of the organism that creates more truth than another, for each mechanism of the organism approaches what surrounds it with a local competency that is particular to it. The body knows how to do things the mind cannot even imagine, and the organization of the mind is not always more reasonable than that of the organism. Staying attuned to what each dimension of the organism can bring about is therefore the beginning of wisdom; staying attuned to what each organism, each culture, and each institution can bring may lead to additional wisdom. But in every case, many traps await the practitioner who would like to discover which road to take. I agree with Piaget (1961; Piaget and Weil, 1951) when he hypothesized that the development of intelligence is related to a form of progressive decentering, of the multiplication of different points of view. Most of the schools of body psychotherapy oscillate between the vision proposed by the schools of yoga and those that are developed by the studies on nonverbal communication.
The goal of psychotherapy is to intervene on three types of dynamics:
In any event, today, it is admitted that these loci of intervention are multiple, even when one mostly takes the psychological dimension into account. There are conscious mechanisms, memories, perceptive modalities, diverse ways of coordinating the mind and the other dimensions of the organism, as well as a multitude of cultural and social mechanisms. Body psychotherapist are often interested in these three types of phenomena; but the first one, which focuses on how the psyche is integrated by organismic regulation systems, is manifestly the main focus of most body psychotherapists.
Another central axis of psychotherapy is to think that all biological dynamics are in continuous construction. This plasticity is limited by the properties of the organismic system, but these properties are there to guarantee a flexibility that is one of the characteristics of biological dynamics. A therapist needs to show his patients that this flexibility exists, even if it is limited, and that it is the lever that therapies attempt to exploit.
It has always been that therapy seeks forms of intervention that provide some relief in the relatively short term, even when the mechanisms on which the therapist intervenes are still not well understood. The patient’s suffering does not have the time to wait centuries until research can describe all of the mechanisms involved in the cause of these difficulties. On the other hand, every relevant scientific advance is certainly welcomed by psychotherapists and patients. Having said this, it is possible that a recent scientific formulation is unable to satisfy the needs of a therapy because the clinician sometimes perceives practical complexities indicating that the researchers will have to review their formulation in the near future.
The general idea in body psychotherapy is to find the means to sense that an individual needs to be approached from one point of view instead of another at a given moment, while admitting that several forms of interventions (but not all) can lead to constructive solutions. Some memories emerge only when conflicting thoughts are activated by a particular kind of touch, or while the patient associates on a dream; others would have emerged whatever the method used. Seeking what each modality allows one to discover is already part of self-discovery. There are other approaches, like Gestalt therapy, that also use a great diversity of interventions to explore how an individual constructs himself. This is a characteristic of all humanistic psychotherapies. They have all been influenced by Freud, Jung, phenomenology, and Reich. Body psychotherapists have techniques in their tool box that permit explicit intervention on the body such as I define it in this volume, but their approach cannot be limited to this possibility. That is why I have insisted so much on the idea that body psychotherapy, above all else, should be an organismic approach that necessarily includes tools developed in psychotherapy and in mind-body approaches.
As soon as a therapy becomes sensitive to the metabolic activity, it becomes sensitive to the quality of the air, nutrition, and the relationships within which an individual thrives and interacts. That is why the world of body psychotherapy has always been sensitive and open to the notion of an ecological system. A cell is comprehensible only in function of its immediate chemical ecology (this is described in biochemistry), the mind can only be understood if it is situated in its organismic environment (the subject of this volume), and the organism cannot be understood unless one understands how it inserts itself into the relational and cultural network (the ecology of the mind according to Gregory Bateson) that structures itself within an ecosystem, such as the biosphere. There is a central point in this. The psychotherapist is not insensitive to the fact that the mental dynamics are dependent on the support they receive from the economy (the need to have satisfying work), culture (sexual and parental morality), interactions between individuals (nonverbal communication), behavior (appropriate technical competence and the capacity to communicate), the body system (movement and massage), the hormonal system (antidepressants and neuroleptics), the affective dynamics (Vegetotherapy), and so on. In the end, what is important for the psychotherapist is how a person’s psyche integrates these multiple systems of necessary support. The therapist cannot require that a patient understand all of this, because neither the therapist nor a gathering of scientists are capable of understanding all of this. The patient needs representations, landmarks, and competencies that permit his psyche to function as constructively as possible in an environment he will never be able to understand. At the occasion of a massage in body psychotherapy, the psychotherapist helps the patient become more explicitly conscious of certain aspects of his relationship with his body. To know how to relax a muscle (this could be done by a physical therapist at another time) is not what is essential for the body psychotherapist. He wants to help the patient develop nonconscious and conscious mental modes of functioning that allow him to refine his perception of the body and be less afraid of interacting with his body from the point of view of his thoughts. The nonconscious mental know-how formed during these sessions can be supported by useful metaphors that allow the patient to find more comfort and efficiency in his organism and in his environment.
I have already described the System of the Dimensions of the Organism in the introduction of this work. This model can be used in different ways. In this book, I have related it to a certain number of positions on the rapport between dimensions within the human organism. I now summarize these issues.
I start with the idea that the universe is made up of interlocking open systems. An open system is composed of three basic elements:
The human organism would be such a system. It is made up of several open subsystems situated at different levels of matter (information exchange, physiology, cellular, chemical, physics, etc.); it can interact with several levels of matter in its environment (physical, chemical, biological, cultural, social, the natural system, etc.). We can imagine two set of quasi-independent causal chains:
In the first scenario, the interaction between subsystems does not mobilize organismic regulation systems, whereas in the second scenario the activity of one subsystem is included in the general organismic system, which has an impact on other organisms and their subsystems.
For example, we have seen that sitting on a chair most of the time may have a deep impact of the venous return mechanisms in the legs. In this case, the influence of the sitting behavior of the person may have an impact on the venous system that is relatively independent from the impact of sitting on behavioral and psychological dynamics. Similarly, the gestures of one individual can influence the dynamics of the brain of another person without influencing the global organismic regulation of these two organisms. Thus, the impact of a gesture on the brain of one individual may unleash a reflex reaction in the other that does not necessarily engage the mind.
One of the particularities of the systemic analysis used in this volume is to insist on the following factors:
In other words, a relative heterogeneity of the modes of functioning of the subsystems of a human organism or of a human society is the norm. Harmony and coherence are possible systemic states, but they are not required and are not always advantageous from the point of view of survival. The interfaces that coordinate the subsystems of an organism have developed in function of the laws of the evolution of the species and a particular organism (phylogenesis and ontogenesis). These interfaces are therefore also heterogeneous and only partially adapted to the subsystems that they coordinate. Here are a few examples of such interfaces:
In particular, I have proposed that the affects (instincts, moods, emotions, etc.) are interfaces that actively connect several dimension of the organism (metabolic, physiologic, bodily, behavioral, and mental). Such global interfaces seem to present more flaws than more local interfaces, like the ones that regulate the interaction between a muscle and a few nerves. Concretely, this implies that there are several mental, bodily, behavioral, physiological, and metabolic heterogeneous subsystems. To be explicit, there are, therefore, several heterogeneous psychological functions, and none of them are necessarily more adequate than another. Some are pertinent at certain moments and become dangerous for the survival of the organism in other contexts (e.g., the activation of stress). This explains that a thought can interact, through the intermediary of interfaces, with all the subsystems of the organism, but that it cannot control how these other subsystems are going to react to this impact. My anxieties may eventually unleash a stomach ulcer, but they do not know how this came about and what impact this ulcer will have on my organism and my thoughts. It is even possible that the interaction between ulcer and anxiety would be so indirect that it can be considered fortuitous. For example, my anxieties will create a mobilization of my organism that risk putting all of its weak points to the test. In one individual, anxiety may create an ulcer; in another, an increase in arterial tension; and in another, both. Thoughts do not necessarily master the impact that they inevitably have on the rest of the organism. The inverse is certainly also as true. An ulcer will not necessarily resonate with the mind the same way in different persons. The recognition of this complexity is defended in almost all the chapters of this volume.
A certain number of possibilities can be considered by the practitioner:
It is useful to speak of association between mechanisms because there are several modes of association possible:
In all three cases, there is an association between wanting to be alone and thinking of my father, but the underlying mechanisms can be completely different.
Therapy is generally considered to be an attempt to use a panoply of interventions more or less targeted, that have the goal of correcting painful modes of functioning that put the survival of an organism in danger. Most of these modes of intervention were initially created by empirical trial and error. Today, some are supported by the development of technology and experimental research. Psychotherapy aims at domains that are still poorly understood (mind, affects, interactive behaviors, social integration, representations of one’s identity, etc.).
Speaking about the epistemological status of a discipline, I take up Piaget’s analysis (1972a), according to which each approach claims to be able to propose a certain form of knowledge concerning an object of study. A form of knowledge is a way of observing, gathering observation, and theorizing about what is happening. It seems useful to me to end this book by identifying why the actual status of psychotherapy is problematic, and why I think this domain ought to at least strive toward a common scientific ethic of knowledge.
I broached this discussion in the third part of the introduction of this book when I distinguished between hypertheses and hypotheses. I called all of the theses that humanity generated, thanks to its imagination, hypertheses; hypotheses were the most economical theses given the available data. Only the hypotheses are considered scientific at a given moment. Certain hypertheses (God, cosmic energy, the big bang, etc.) may become hypotheses in the future.
I return to this distinction by taking up four forms of knowledge: speculative, clinical, empirical, and scientific.
The history that we know about how aspirin works allows us to illustrate the difference between clinical, empirical, and scientific research.
A vignette on the history of aspirin. Over time, clinical experience made it possible to establish that bark from the willow tree had known curative effects for thousands of years. In the nineteenth century, a scientific method in chemistry made it possible to demonstrate that the curative substance contained in willow bark was salicylic acid. This acid was subsequently synthesized, and became the aspirin sold by the Bayer Laboratories since 1899. A combination of clinical and empirical research was able to show that aspirin is often effective for certain problems (flu, headaches, etc.), but not in every case. Up until 1970, no one knew the underlying mechanisms that were activated by aspirin in a human organism. The beginning of a scientific understanding of the impact of aspirin began forty years ago, when researchers like John R. Vane (Nobel Prize in 1982) discovered that aspirin inhibits the production of prostaglandins and thromboxanes.
Today, all research blends these four forms of knowledge. Even in science, speculative research is an important source of inspiration. In the domain of therapy, the three first forms of research may try to get closer to the demands of science when they respect the following criteria:
A school of psychotherapy that follows these three criteria, as much as it is possible, follows the scientific ethical standards on the management of information. It is in the psychotherapist’s own interest, in the current political context, to understand this definition of scientific ethics pertaining to knowledge. Psychotherapists also need to understand that the institutions that legislate on health matters tend to present as scientific what is in fact simply empirical research. They often use, mistakenly, the prestigious term scientific for empirical findings. To be clear, when the institutions request that schools of psychotherapy scientifically validate their approach, they are, in fact, requiring empirically validated studies. This is problematic for psychotherapy schools that (a) often do not have the means to undertake rigorous empirical studies, while (b) they already have at their disposal clinical observations that are often more scientific then empirical studies. Institutions need to understand that empirical studies are a useful complement to clinical knowledge (based on case studies). These distinctions may help psychotherapy schools fight unreasonable demands from health institutions that defend certain positions for purely political and economic reasons. Clinical issues focus on the health of patients.
The data that the empirical methods produce in psychiatry are often based on partially reliable measures (questionnaires), and the statistics demonstrate relationships that are only partially reliable. These studies are therefore instructive, but in no way scientific. Here is a discussion of well-known empirical studies:
Therefore, we have on one side broad lines that can be derived from questionnaires answered by a large number of people; and from other quadrants, detailed clinical observations showing that the results obtained by an empirical method are interesting, instructive but suffer from lacunae at the level (a) of the measuring instruments and (b) of the reliability of the generalizations proposed by statistical methods. The clinician needs precise categories. So precise that he may lose himself in the nuances that haunt his perception. It is almost impossible to have a significant cohort of subjects that present all of these nuances. Scientific experimental research has financial and technical exigencies that cannot be incorporated into the institutions that occupy themselves with clinical research. The stakes that structure scientific research are different from those that structure clinical and empirical research. We have seen4 that very probably, the day when scientific research preoccupies itself with what the clinicians observe, it will use an unexpected approach to these phenomena. This unexpected aspect will be based on data that neither clinical research nor empirical research could collect. In some cases they could not even have imagined that such data existed, or that it could be connected to the phenomena they were studying. A scientific approach would therefore inevitable lead to a third form of approach to mental disorders.
For the moment, psychotherapy is focused on a clinical approach that integrates, in more or less strong doses, the three forms of knowledge identified (speculative, scientific, and empirical). The problematic status of the epistemological rigor of the psychotherapist seems to me to be partly due to the structure of the schools that prevail in this domain for the time being. The speculative inspiration of the charismatic “master” often has more weight than clinical, empirical, and scientific evidence. For example, a school may only include in its references the evidence that supports their speculative stance. On the other hand, the proliferation of schools is the only form of creativity that seems to be efficient in the field of psychotherapy.
The institutions responsible for the politics of health care may try to impose an ethic of knowledge that is as scientific as possible, but the forms of thinking that are useful in science lose most of their relevance in a clinical practice. Today, the general trend is to differentiate evidence based psychotherapies (e.g., cognitive and behavioral therapy) from clinically based psychotherapies (e.g., psychodynamic, Jungian, Gestalt and body psychotherapies). From the point of view of the practitioner, this distinction is often artificial, as cognitive therapists can be excellent clinicians.
The plan of this book is more easily understood at this point because, for the moment, the only true strength of the psychotherapist’s knowledge is the robustness of certain themes that support most approaches. Psychotherapists, in most of the schools, have pride in having constructed a unique imaginative and useful knowledge. But they also often have the impression of being the poor parents of the development of knowledge. In spite of a success that has influenced the development of mores in all the cultures and milieus in the world, the social support they have received is relatively weak. One of the causes of this weakness comes from the practitioners themselves. They often have little confidence in the value and originality of their knowledge, while having daily confirmation of the usefulness of their propositions with their patients. I have noticed that, trained in the necessary restricted perspective of one school, practitioners often lack the necessary general culture to recognize that their knowledge has been polished for thousands of years in numerous cultures. In spite of the variety of elaborated approaches, most of them rediscover a certain number of robust practices and concepts that are sadly often drowned in a bizarre conceptualization. This textbook has been written so that in the future, body psychotherapists will be able to face these issues with more confidence.
No one really knows how psychotherapy functions. To take up the metaphor of aspirin, psychotherapy is still at the stage where a clinical knowledge shows that willow bark is therapeutically useful. The few theories about what is therapeutic in psychotherapy are not even at the stage where we know that it is an acid in the bark that heals. Clinicians are only beginning to accept the support of empirical research that describes the circumstances in which psychotherapy is indubitably useful. The theories on the underlying mechanisms of psychotherapy are often closer to speculations than to scientific thought. It seems to me that the few theories on psychotherapy that do exist are more placebo theories created to reassure psychotherapists of their competence. They are not really convincing. The great trump card of psychotherapy is to have cleared a domain that will be approachable by more rigorous thinking tomorrow.
The actual situation of psychotherapy resembles that of physics in Galileo’s time. Galileo and his colleagues did not have the scientific proof to support their conviction that the Earth rotates around the sun. Galileo’s fight with the Church is therefore the battle of one who wants to have the freedom to presume what he wants; and also to have the time (we are talking of centuries) and the means to seek the proofs necessary to confirm or refute what he and his colleagues have thought about profoundly.5
I allow myself this historical digression because the psychotherapy of our time is currently undergoing the same sort of menace that Galileo faced. The enemy is no longer the Church but a sort of scientism sponsored by economic and political stakeholders (the marketplace of health) that want to eliminate clinically based psychotherapies from the marketplace and only support empirically based psychotherapies with the argument that they are more scientific. The reasons certain powerful movements want to eliminate clinically based psychotherapy from the realm of psychotherapy remain unclear to me, but this political and economic trend manifestly exists. The difficulties experienced by psychotherapists in finding the institutional means to demonstrate the value of their approach are similar to those encountered by the scientists of the Renaissance. I hope that in the future, clinical evidence will again be recognized as a necessary complement to empirical evidence.
Like Galileo, I respond that our approach is based on common sense, experience, and a robust tradition. When this enterprise encounters scientific works that deal with subjects that call out to them, psychotherapists often take enthusiastic interest in them. Mostly, research tends to demonstrate the soundness of the global hypotheses of the psychotherapeutic field, instead of invalidating them, while contributing important clarifications. This is truly the spirit of the Renaissance and the Enlightenment that animates psychotherapy.6
Today, it is impossible to know what will become of the domain of psychotherapy 100 years from now. The wager taken by the associations of body psychotherapy like the EABP and the USABP is that certain central theses in their domain, such as those I have tried to describe in this volume, will be part of the entire psychotherapeutic endeavor. My secret hope is that the domain will be, from now until then, transformed in such a way that the debate concerning the relationship between mind and organism, and mind and body, will have changed and will develop new issues that permit us to revisit everything that has been said with points of view we have not yet imagined. We will then be able to propose more efficient forms of support than what exists today. This implies that clinical, empirical, and scientific research continues to create a better understanding of the psychological dynamics that animate human organisms.
At the beginning of this book I promised that I would concentrate on the issues that have structured the field more than on my personal thoughts. However, I also warned the reader that psychotherapy is not a subject on which one can write and remain neutral. Although I have not written much on my personal thoughts, I have taken clear options on each subject, so that the reader who reads this book from beginning to end will notice that some positions are clearly mine. This is why I advised the reader to focus on the issues I raise and then look for personal answers.
Assens (Switzerland), October 2011