Self, other and the wider world
Gill Westland
In individual, depth, developmental psychotherapy the repair of early distressful relationships runs alongside profound moments of interconnection as universal states of consciousness are entered. Repair involves the re-patterning (re-organisation) of early traumatic and stressful relationships (early insecure attachments). These early relationships, where bonding has been problematic, form basic signature patterns of relating and ways of organisation. They are encoded in implicit memory and are out of our awareness. However, patterns of relating are revealed, for example, in breathing movements, which are specific to individuals (Andersen, 2007). These patterns are malleable and ‘Deep re-organization occurs through the deepening and expansion of relational capacity in the client (and the therapist)’ (Carroll, 2005, p. 90, author italics). Through embodied contact in the therapeutic relationship, both client and therapist may cultivate under-developed parts of themselves and jettison unhelpful ways of relating. Changes happen in the present moment with re-organisations of the biological systems of the body and are reflected in new signature postures, movements and breathing. Changes are also revealed in novel speech patterns, ways of thinking and expressing emotions. Changes occur in non -conscious, implicit parts of the individuals and are activated by present time physical, sensory and atmospheric experiences, in which the client-psychotherapist dyad join together in moments of meeting.
The non-conscious is to be differentiated from the unconscious. The non-conscious has never been explicitly known and forms implicit memory, which is non-verbal (Rustin, 2013). ‘Implicit knowing is nonconscious’ (Stern, 2004, p. 116). It manifests in tangible, physical ways. In contrast the unconscious was explicit and became repressed. Changes in people come about through shifts in non-conscious ways of being without any explicit knowledge of how the changes came about. From this viewpoint, change is possible without insight (cognitive understanding), analytical thinking, and verbalisations (Lyons-Ruth, 1998; Marks-Tarlow, 2012; Schore, 2011; von Peter, 2013). This does not exclude the possibility of change through insight, which is more widely discussed in the psychotherapy literature, but the inclusion of non-conscious ways of changing widens the scope of the discussion on how healing comes about.
Buddhist psychology and philosophy contribute to an understanding of how changes occur and underpin the perspective of this chapter. Awareness and mindfulness practices taken from Buddhist psychology and introduced into psychotherapy provide the vehicles within which to explore experiences. Exploration may have a selective focus on the self, the other, or the wider world, and open different states of being. Central to the change process is bringing awareness to the dynamics of therapeutic relating. It is through deep listening and bringing awareness to different dimensions of relating that profound transformation occurs.
When I trained as a body psychotherapist in the late 1970s it was common to hear ‘he’s in his head, he’s not in his body’, but theoretical discussions about precisely what this meant were limited. Significantly, the descriptions could be observed by the trained eye and had clinical relevance. The assumption was that many problems could be attributed to, and were characterised by, a lack of body awareness and ‘splits’ between parts of the body that felt alive and parts that felt dead, numb, or non-existent. An explanation about a particular experience was less important than having, for example, the experience of numbness. Following Reich (1945/1970, 1942/1983) body psychotherapy, along with other psychotherapies such as dance movement psychotherapy took non-dualism for granted (Payne, Warnecke, Karkou, and Westland, 2016). This perspective also saw life and energy synonymously (Reich, 1945/1970, 1942/1983), a viewpoint more consistent with Eastern philosophies than Western ones. Being in the body (being embodied) was a working assumption rooted in empirical work with clients. With it came views about human beings and whether they were merely existing or living vibrant, full lives. Current literature is exploring embodiment or the lack of it more systematically with clinical populations (for example, Fuchs and Schlimme, 2009; Martin, Koch, Hirjak, and Fuchs, 2016).
Being aware of the stream of arising subjective experiences in the body is being embodied. Knowledge of this process is cultivated by focussed awareness. It involves tracking thoughts, feelings and sensations with reference to how they are simultaneously experienced bodily. Any thought has an accompanying collection of physical sensations and emotions; emotions have an accompanying collection of muscle and postural changes, including changes in breathing rhythms. Being embodied is having the capacity for thinking, feeling and sensing at the same time. Through developmental arrests, and ‘insults to form’ (Keleman, 1985), including trauma, past and present, these functions become split from each other. Being embodied is a fluctuating process representing shifts in our level of consciousness (Clover Southwell, personal communication, 2014). Being in touch with the ‘felt-sense’ (Gendlin, 1981, 1996), ‘somatic body awareness’ (Fogel, 2009), and ‘somatic markers’ (Damasio, 1994) provides information for decision-making, links thinking with the feeling of something and is vital in relationships for effective communication. Furthermore, body awareness is important when a person is talking and attempting to express feelings authentically. Reich writes:
It is clear that language, in the process of word formation, depends on the perception of inner movements and organ sensations, and that words which describe emotional states render, in an immediate way, the corresponding expressive movements of living matter.
(Reich, 1945/1970, p. 361, original italics)
When Reich writes here about the ‘movements of living matter’, he is describing being in contact with the movements of life. Movement distinguishes the living from the dead. Following from this living in a body and inhabiting oneself (rather than having a body) means connecting with the movement of life itself. And so, to the extent that we are embodied, we are truly alive.
Imagine a man ‘in his head’, let’s call him Mark. He thinks, he talks, but he lacks awareness of his body. Sensitive observation of him shows that from the occipital region at the back of the head and from his neck down his body barely moves. He lacks vitality. He speaks in a monotonous tone without the contours of emotions being expressed in his voice. If Mark is asked about himself, he explains himself, but not an immediate experience of what it feels like to be him. Mark’s thinking is well developed, but he struggles to couple his thinking to his sensations and feelings. Nevertheless, he knows that he is lonely, anxious, somewhat depressed, and that he finds it difficult to relate to other human beings intimately and so prefers solitary pursuits. Mark has developed sensitive-analytic defences (Kurtz, 1990), also known as schizoid character structure/strategy (Lowen, 1958/1971; Reich, 1945/1970), which roughly correlates with Ainsworth’s insecure-avoidant attachment style (Ainsworth, Blehar, Waters, and Wall, 1978). These diagnostic models are useful for recognising and thinking about clients and how they relate in a general way. They do not describe immutable states and obviously, clients are more than their defence system. Mark’s style of relating protected him from experiencing inhospitable relationships early in his life, but also hinders the development of different aspects of himself, such as feeling and sensing. More importantly it obscures his fundamental sense of connection with life.
It is easy to think that Mark’s difficulties can be resolved simply by somehow lessening the grip of his protective ways of relating. A different approach, however, is for him to become aware of how he is engaging with feelings, thoughts, and sensations from moment to moment, when by himself, with others, and when engaged in all sorts of activities – eating, walking, sitting, exercising and so on. Awareness is non-verbal and is the physical felt-sense of something, not a description of it in words, although sounds, movements, art, poetry, and imagery can bring some sort of approximation to it. Within psychotherapy awareness has long been known to be transformative (Bugental, 1978; Maslow, 1973; Ogden, Minton, and Pain, 2006; Siegel, 2010).
Although the term awareness is often used interchangeably with mindfulness, ‘mindfulness directs us to the details of our experience, [while] awareness refers to the larger context, the space within which experience arises’ (Wegela, 2009, p. 58) and ‘mindfulness is paying precise attention in the present moment to whatever object we have chosen to observe’ (Wegela, 2014, p. 17). Both awareness and mindfulness are important for living life more fully. Meditation teacher Gunaratana writes:
Awareness allows us to see whether our actions spring from beneficial or harmful impulses . . . When we are mindful of the deep roots from which our thoughts, words and deeds grow, we have the opportunity to cultivate those that are beneficial and weed out those that are harmful.
(Gunaratana, 2012, p. 2)
Whilst Western science and philosophy have struggled with mind-body dualism, this is not the case in Eastern philosophy where the perspective is ‘of mind/body oneness’ and experiential practices taking precedence over theory (Watson, 2002, p. 187). These are ‘the foundation for methods of self-cultivation which affect, train, and transform the mind through the body’ (Watson, 2002, p. 187). This view sits easily within embodied psychotherapies. Not only does Buddhist philosophy give ways of thinking about human existence, but mindfulness and awareness practices provide tools for the clinician to cultivate disciplined attention to the details of relating. Embodied psychotherapies often draw on phenomenology (Merleau-Ponty, 1962) for their philosophical underpinnings (for example, Gallagher and Payne, 2015; Koch and Fischman, 2011; Payne et al., 2016). This can be valuable as phenomenology attempts to bridge the perceived dualities between mind/body, and man/world, but nevertheless, phenomenological investigation remains mostly an intellectual activity. Cognitive scientist, Varela, and his colleagues observe that current scientific investigation has ‘no direct, hands-on, pragmatic approach to experience with which to complement science’ and suggest meditation practice gives the possibility for ‘skilful and disciplined examination of experience’ (Varela, Thompson, and Rosch, 1993, p. xviii). They suggest a combination of mindfulness and awareness meditation practices to structure research experiences. These practices also have a role in psychotherapy and are familiar to body psychotherapies explicitly (Kurtz, 1990; Ogden et al., 2006; Weiss, 2009; Weiss, Johanson, and Monda, 2015; Westland, 2015) or implicitly (Boadella, 1987; Boyesen, 1980; Rosenberg, Rand, and Asay, 1985). In this sense psychotherapy may be seen as experiential research.
Returning to Mark, his therapeutic journey involves him gaining awareness of his ways of relating and qualities of being, rather than selecting some experiences over others and having set goals. Rather than trying to change him, the therapeutic stance is one of accepting him (and oneself) as he is. Mark’s psychotherapy might end once he becomes consistently less anxious and no longer depressed, but it might not, since body psychotherapy aspires to more than symptom or problem reduction. A central theme in body psychotherapy is the blossoming of latent potential (Boening, Southwell, and Westland, 2012). Southwell writes:
from conception onwards each individual has a unique and dynamic potential. This drives his physical growing into his particular human shape: it also drives his passage towards mental, personal, and spiritual fulfilment. We work in alliance with this dynamic inner pressure. . . The dynamic of our client’s potential is the motor of the therapy. Our therapeutic relationship is its containing membrane. We hold the vision of our client’s unrealised potential. For us, this is more significant than his pathology.
(Southwell, 2010, p. 11, author italics)
And Boadella adds:
The goal of therapy is to restore the person to a state of healthy pulsation in which the basic life activities are rhythmic, give pleasure, and work for enhanced contact with oneself and others.
(1988, p. 163)
Boyesen (1982) describes a person living from the ‘primary personality’ as in contact with life. This is nourishing and gives meaning to life. This contact with life is visible in people in their actions and general demeanour. She writes:
The Primary Personality has a natural joy in life, a basic security, stability and honesty. . . There is pleasure in work and in relaxation, a gentle euphoria and a mild intoxication in the pleasure of living. . . He or she is in touch with the instinctual self, the primitive and animalistic urges, yet this is integrated also with the transcendent. . .
(Boyesen, 1982, pp. 5–8)
In Mark’s case, his psychotherapist notices that he becomes most alive when he speaks of his passion for bird-watching; his eyes light up and his face shines. At those times she underscores this by asking him more and engaging in lively discussion about the plumage and habits of the birds that Mark had seen. The invitation to say more validates Mark’s pleasure and vitality and offers the possibility of him connecting with his experience in these moments.
The tendency of all life, including human life, is movement towards health. Life is self-directing, and healing is a self-organising, non-linear process (Capra, 1996; Maturana and Varela, 1987; Wilber, 1995). Many of those seeking psychotherapy will have experienced early traumatic events and relationships. Nevertheless, whether severely traumatised or not, there is always ‘an organic impulse to heal, which can be experienced phenomenologically and that moves towards increased complexity and wholeness’ (Johanson, 2014, p. 68).
Southwell tells us, ‘The dynamic updrift is the key to change in biodynamic therapy [body psychotherapy]’ (Southwell, 1988, p. 196). Fosha describes ‘transformance’, which sounds like Southwell’s ‘dynamic potential’ (Southwell, 1988). Transformance is, ‘. . . the overarching motivation for transformation that pulses within us. . . Innate dispositional tendencies toward growth, learning, healing, and self-righting are wired deep within our brains and press towards expression when circumstances are right’ (Fosha, 2009, p. 174).
The force of ‘unrealised potential’ is also described as primary impulse(s) or primary communications (Westland, 2015). If early relationships or the atmosphere of the family home is threatening, the primary impulse becomes overlaid and obscured by the ‘secondary personality’ (Southwell, 1988, p. 182). The acquired secondary personality is developed by the child to protect him or herself from unbearable feelings. This is secondary patterning or secondary communications (Boadella, 1987; Westland, 2015). The lack of movement in Mark’s body is an example of secondary patterning, his eyes lighting up, when talking about a bird’s primary impulse.
In spite of Mark’s secondary patterning, he already possesses everything for his independent well-being. The psychotherapeutic task is to foster conditions in which he, and clients generally, reconnect with life or ‘inherent health’. Inherent health is synonymous with ‘wisdom’, ‘core state’, ‘essential self’, ‘source’, and ‘essence’ (Boadella, 1988; Boyesen 1976; Kurtz, 1990; Maurer, 1993; Pierrakos, 1987; Rosenberg et al., 1985; Sills, 2009; Southwell, 1988). Wegela, uses the term ‘Brilliant Sanity’ and also informs us that the therapeutic task is ‘to help our clients connect, or reconnect, with their own worthiness, their brilliant sanity’ (Wegela, 2014, p. 5).
Psychotherapists must live from a place of embodied connection with life to help clients to connect with Brilliant Sanity. Being relatively embodied and relating through the body are fundamental. However, having a moving, flexible body such as that cultivated through dance or gymnastics does not equate with relating through the body. Embodied relating requires being grounded and centred in the body and using the physicality of the body as a reference point for staying in contact with reality. As the therapeutic relationship develops and different states of consciousness emerge, the task is to maintain an awareness of whatever is being experienced through referencing the bodily experience of it. Being aware involves slowing down the stream of experiences to capture subtlety and nuance. Maurer adds, ‘Slowness serves to help one concentrate, to increase one’s capacity to spiritually concentrate and to become fully attentive, preliminary to meeting one’s wholeness, one’s own essence’ (1993, p. 88). This invites wholeness in both client and psychotherapist and has implications for the training of psychotherapists and ongoing professional development.
The main way that psychotherapists learn embodied relating is through experiential training, including participating in one to one psychotherapy of the same modality that they will be practising. It should be experiential and process oriented. The training of humanistic psychotherapies, which include body psychotherapies and creative arts psychotherapies, has long privileged this sort of experiential learning. Experiential learning becomes embedded in the psychotherapist and is often not known explicitly, but emerges from the psychotherapist spontaneously, when the need arises. It cannot be acquired thorough textbooks and interactive technology. In experiential training something is tried out in an activity, such as a role play, a movement, a posture or different way of breathing and afterwards reflected on. Reflection means further experiencing and recasting of the first experience in the present, as what was experienced is spoken about. This deepens the experience and with it the learning. Meaning emerges through the experience rather than through analytical thought. So the term reflection here is not the same as mentalising as used psychoanalytically (for example, Fonagy, Gergely, Jurist, and Target, 2002). Experiential learning as a student psychotherapist approximates the way learning occurs in embodied psychotherapies. This style of training and clinical work is also described as ‘bottom up’ (Ogden et al., 2006). That is, it focusses on sensations and emotions and the physicality of these before the ‘top down’ processes of thinking and analysis.
Intuitive, spontaneous and creative interactions are also the stuff of this sort of training. Analyst Lomas writes. . . ‘a good training is one which allows and encourages students to trust, as far as possible, their own intuitive capacity, and to build on their own style of being with people rather than suppressing it and replacing it with a formula for behaviour imposed from without’ (Lomas, 1994, p. 136).
Marks-Tarlow explains, ‘In psychotherapy, we continually shuttle back and forth between the intuitive mode of the right hemisphere and the deliberative mode of the left one. . . it is the intuitive right side that integrates the whole’ (2012, pp. 17–18). Intuitions and spontaneous interactions can be seen as undisciplined and reckless and so ‘Intuitions have to be grounded in and experienced, through the body; otherwise they really can be wild and unhelpful’ (Westland, 2015, original italics).
When training is finished, continuing to relate through the body requires practice within and outside the consulting room. Maurer (1993) suggests psychotherapists help themselves to slow down by engaging in ‘relaxation exercises’ and ‘Eastern fighting techniques’ such as Aikido and Tai Chi. Additionally engagement with activities which nurture an ongoing relationship with body experience are essential. These could include dance, walking, meditation, and yoga. These practices help to keep essential therapeutic skills honed, but also help to prevent burn out.
Increasingly there is recognition that every therapeutic relationship is unique, with both client and psychotherapist bringing their personal histories, life experiences and predilections to it. Soth and Young observe:
There is not just one kind of therapeutic relating, but a pluralistic diversity of different and sometimes contradictory - ways of relating that all seem to ‘work’ at different times, in different situations, and with different therapists and clients, and all these therefore need to be acknowledged as valid, at least in principle.
(Soth and Young, 2015, p. xvii)
Relating through the body (embodied relating) requires a relatively more right brain way of relating, described by Schore (2012) as a right brain to right brain interactive approach. Schore elaborates:
At the most fundamental level, the work of psychotherapy is not defined by what the therapist explicitly, objectively does for the patient, or says to the patient. Rather the key mechanism is how to implicitly and subjectively be with the patient, especially during affectively stressful moments when the ‘going on being’ of the patient’s implicit self is dis-integrating in real time.
(Schore, 2011, pp. 94–95)
Within this style of psychotherapy there is a lot of scope for intuitive responses (Marks-Tarlow, 2012), since the psychotherapist does not have to understand something intellectually and consciously before responding. Schore explains ‘Much of the therapist’s knowledge that accumulates with clinical experience is implicit, operates at rapid, unconscious levels beneath levels of awareness, and is spontaneously expressed as clinical intuition’ (Schore, 2012, p. 7).
Nevertheless, while it is convenient to describe psychotherapy as right brain to right brain relating, as it offers a way of discussing ideas, in practice being with clients is more than one brain relating to another brain. Returning to a Buddhist perspective, being with the suffering of ourselves and others reminds us of the ‘inherent connectedness of all life’ (Sills, 2009, p. 2). Meditation teacher Thich Nhat Hanh uses the term ‘Interbeing’ to describe this fundamental interconnection. All human beings, all living creatures and the wider environment including forests, rivers, mountains and minerals are interconnected and ‘Interbe’ (Hanh, 1998). Intersubjectivity is therefore the natural condition (Fulton, 2014). Sills (2009) describes two axes of relating. The first is ‘Source – being – self’. In moments of stillness, in the present moment, universal connectedness (Source) can be entered. The second axis is ‘being – to – being’ and is interpersonal. Being-to-being relating is relating from beneath any defensive secondary patterning, that either client or therapist carry, and which may evoke reactive responses in either or both. The two axes co-exist and can melt into a profound sense of the interconnection of everything.
Awareness is always connected with something. Within psychotherapy attention can focus on different ‘objects’, as client and psychotherapist follow their co-arising curiosities. Objects of attention can be breath, body sensations, movements, sounds, smells, feelings, sights, touch, energy, atmospheres, others – loved ones, friends, acquaintances, difficult people, enemies, people in the wider world – nature, and inanimate objects. Any of these can be the portal for personal explorations and expanded states of awareness.
Gunaratana (2012) reminds us that the body and breathing are ever present and can be the starting place for self-awareness. By becoming more self-aware, the psychotherapist becomes more present to him or herself and creates a receptive field for Mark to enter. When Mark arrives, he will sense this welcome without necessarily registering it in his thinking. For Mark, the difference between thinking emotions and physically sensing them and gaining a different sense of self can be cultivated by asking questions about his experience. For example, ‘Let’s take a pause here, notice what you are sensing in your shoulders and chest. How would it be to move your shoulders a bit? How it that now?’ These sorts of questions are commonplace in body psychotherapies and are termed by Ogden (2009) as directed mindfulness.
For clients more traumatised than Mark, reflections on self-experience are often problematic. Those with a diagnosis of Borderline Personality Disorder (BPD), for example, have deficits in mindfulness and these are predictive in BPD pathology. Mindfulness, therefore, has a role in the treatment of BPD (Wupperman, Neumann, Whitman, and Axelrod, 2009). For some traumatised clients an internal focus on themselves whether on the body or a body part or their breathing is too exposing or threatening. These clients, as it were, live at some distance from themselves. An alternative inquiry is with objects in the room. ‘As you place your hand on the wall, notice if the wall feels cool, warm from the sunshine or cold’. A short-rein, matter of fact style of discussion is apt (Westland, 2015). This keeps a tight hold on the pace of relating, without silences, and keeps to an everyday level of consciousness, which reduces potential emotional overwhelm.
We are always connected with others, although we may not be aware of it. From a neuroscience perspective mirror neurons (Gallese, Fadiga, Fogassi, and Rizzolatti, 1996) let us resonate with others. They enables us to capture what is happening with clients beneath the spoken word. ‘ Somatic resonance is the direct experience of the client’s feelings, bodily sensations, and thinking. It is more than empathy’ (Westland, 2015, p. original italics). For the psychotherapist the task is to track changes in their physical, subjective internal state and read them both as information about themselves, but also the client. Shifting the focus of attention to the actual client sitting in front of the psychotherapist gives further visual information.
So again, taking Mark, as an example, if the therapist senses tightness in her shoulders, she might look at him and see the tension and lack of mobility in his shoulders. When Mark is asked about his experience of his shoulders he might respond ‘tense’. He might then be invited to explore further with questions such as, ‘What is the shape and texture of “tense”? What happens to the tension if you move a little?’ The psychotherapist might then notice her own changing experience of her shoulders.
Often clients will come to learn how to have contact with an internal focus on themselves and be able to sustain it as they are more focussed interpersonally. Clients tend to focus more on the other and loose connection with themselves or vice versa. Traumatised clients, for example, often have highly developed antennae for mood shifts in the other, but underdeveloped body awareness. Those more narcissistically inclined tend to focus on themselves, but do not connect with the other. As a way of addressing the focus on self – other dynamics a pertinent question at the right time is, ‘As I say that how do you experience that?’ This is quite a challenging question and probably not suitable for Mark until he becomes less fearful about such a direct focus.
Focussing attention on the wider world and taking a panoramic viewpoint involves relating to, and having awareness of, objects – the wall, the floor, the picture on the wall. It also includes the atmosphere in the room and relationships with others not present in the room – loved ones, friends, difficult people, and so on. Again whatever the focus, the question is to reflect on what arises. All of these reflections can give different senses of self.
Whilst it is helpful to become aware of all sorts of aspects of ourselves and our surroundings, Fulton reminds us that the relationship to experience is not raw experience itself (Fulton, 2014). However, from focussing on any one of these objects of attention, it is possible to slip into expanded awareness of the core state. Wegela writes:
When we are willing to be present, we tap into direct experience: that is experience that is not filtered through our thoughts, expectations, hopes and fears. Instead, we see, hear, taste, touch phenomena, and recognize thoughts and images in the mind without adding judgments or preferences. Things are just what they are. Putting nowness and direct experience together means being awake in the present moment.
(Wegela, 2009, p. 26)
Through embodied relating and bringing attention to different experiences gives clients and psychotherapists alike the means to live life more fully. Awareness and meditation practices are not so much about reducing symptoms such as anxiety, although that may happen, but open the way for surrendering into the core state. This is characterised by compassion, loving-kindness, joy and equanimity.
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