This is a revised version of the author’s Manuscript published in: Authentic Movement: Moving the Body, Moving the Self, and Being Moved. Edited by Patricia Pallaro .2007. Jessica Kingsley. Publisher. London and Philadelphia
PSYCHOTHERAPY AND AUTHENTIC MOVEMENT: WORKING WITH THE SOMATIC ASPECTS OF TRANSFERENCE, COUNTERTRANSFERENCE, AND DISSOCIATION
The Nature of the Work
The living body is the very possibility of contact, not just with others but with oneself–the very possibility of reflection, of thought, of knowledge. (Abrams, 1996, pp. 45-46).
One of my primary intentions as a psychotherapist is to value the subjectively lived body as an integral aspect of self, to bring that aspect of the self into psychological discourse. Through our bodily senses we perceive and experience the world and those who are most significant to us within it.
Attending to the bodily-felt experience of living can be significant in multiple ways in psychotherapy. Perhaps most obvious is the contribution this makes to healing the dualism of the culture by shifting the predominant emphasis on the mind to allow for a fuller experience of self. The implications of this are vast. Access to felt sensation can allow us to be with nuances of sensual life, pleasure, and pain whether within ourselves, in relation to others, or in relation to the natural world. Because of the profound importance of the body in infancy, early, and ongoing experiences of the self, the work of “refinding” or deepening bodily-felt experience can greatly contribute to work with developmental insults and the healing of trauma.
In the process of psychotherapy, one way I include the body is by simply attuning to and sustaining empathic inquiry of sensation and bodily-felt aspects of experience, just as I would with affective and cognitive processes. My somatic emphasis changes, at times dramatically, depending on the needs of my patient, just as it would for any other kind of intervention I might make. When working with preverbal states, attending to somatic experience may be the most direct avenue of accessing inner knowledge. Because of this it may seem logical to assume that the earlier the wounding, trauma, or developmental deficits the more apt I am to pay detailed attention to sensation, buy this is not always the case. In work with one individual many sessions may go by with little or no reference to sensation, only later to come into sharp focus for a time before dropping again into the background. With another (as will be shown in the case that follows), attention to sensation and physical states is of primary significance much of the time. Initially this shifting focus came primarily from my “feel” of an individual, their presentation, and what seemed effective.
Over time various sources have contributed to my understanding, many of which you will find in the chapters of this book. One is Daniel Stern’s infancy research concerning the formation of a sense of self. Stern’s view is that there are four different senses of self that emerge in development: the emergent self, the physical or core self, the subjective self, and the verbal self. Each of these is concerned with specific development capacities that contribute to domains of experience in interpersonal relatedness. These senses of self have a particularly sensitive period of development in infancy but continue to exist concurrently through the life span. At any point in the life cycle events may occur that are more situated within one domain than another. The domain of the sense of core or physical self, which coheres to allow for core relatedness, pertains to self-agency, self-coherence, self-affectivity, and self-history or continuity in time.
A crucial term here is a “sense of,” as distinct from “concept of” or “knowledge of ” or “awareness of” a self or other. The emphasis is on the palpable experiential realities of substance, action, sensation, affect, and time. Sense of self is not a cognitive construct. It is an experiential integration. This sense of a core self will be the foundation for all the more elaborate senses of the self to be added on later (Daniel Stern, 1985, p. 71).
Discovering the domain of self-experience most prevalent in a patient’s narrative can give a clue to the most salient way to attune with the patient’s experience, the way which most directly connects to affect. For instance, if a patient’s concern is about self-agency and she describes being ordered to “not move” or if she has experienced being “physically restrained,”then inquiries directed towards the physical experience of “moving” or “restraint” are likely to be good entryways into her narrative. Domains of experience come in and out of focus throughout life, thus the emphasis is on linking with the most prevalent domain rather than a specific developmental phase or stage (Stern, 1985). I want to again emphasize that the sense of physical/core self is always present; our experience is always situated within our bodies. Stern’s contribution calls us as psychotherapists to a special kind of listening and response. That is when a patient speaks from the domain of the core self, that we respond to that very bodily realm of being, in terms which match rather than in terms which interpret or overlay another kind of meaning.
In addition to this way of conceptualizing how and why to work somatically, there is more. For some, the kind of knowing that arises from a full-bodied awareness is like a balm for the soul: clear, direct and immediate. Body awareness and movement can be experienced as a source of imaginative process as well as deep centering as in meditation and ritual. In this way working with the body in psychotherapy can access sources of healing and creativity which are difficult to reach through verbal means alone.
In my work as a therapist I listen to the body as a significant source of wisdom. I listen and invite my patient to listen to her body as it speaks in symptom or movement. Similar perhaps to dreams, the body expresses a raw, elegant poetics. At times this wordless language is harsh and primitive, like the disturbing occurrence of heart problems, or the deeply upsetting quality of a recurring, gruesome, and murderous dream. In other pivotal moments of one’s life or work in therapy when dealing with some intense inner struggle, some strangely exquisite sensation reveals itself, like light falling into darkness, beckoning hope and encouraging the continued journey of entering the fullness of life. At times image, insights, and a new-found potential for relatedness accompany or arise from cultivating body awareness. Reciprocally, that awareness can awaken through insight, imagination and relationship.
Dolores
In the presentation that follows I attempt to highlight aspects of work with the body in the course of an eight-year psychotherapy with a woman who suffered considerable trauma and strife in her early life through physical, sexual, and emotional abuse. My intention is not to delineate the whole of our work together but to bring forward parts of her unfolding narrative and the attention and significance of attuning to her bodily-based experience. I will focus on how this pertains to dissociation, the capacity to self soothe, and somatic manifestations of the transference and countertransference.
Dolores’ healing journey began when she entered therapy while getting a divorce. Spurred on by her children’s strength and support and the then-budding women’s movement, she realized she didn’t have to suffer so and that there was more possible for her. She decided she would end her twenty-five-year marriage in which she felt stifled and devalued.
After two years of psychotherapy, she was referred to me because of my somatic approach. Dolores is a fifty-eight-year-old woman who is quite competent in the working world. She is an engineer, with an advanced degree which she obtained when her children were in their later school years. She holds a very responsible position in her company. Each year she is honored and has been frequently promoted. Dolores is the mother of three grown children, and grandmother to six. Previous to her work in therapy she could tolerate only very time-limited engagement with her relatives, though she loved them. She found others “nice” but preferred to be alone. She is the surviving member of her nuclear family. Her mother died when Dolores was nineteen. Both her sisters died within the last ten years; her father four years ago.
Dolores’ early life was colored by neglect, as well as physical, emotional, and sexual abuse. Her mother suffered from severe depressions and breakdowns, for which she was frequently hospitalized. The first occurred when Dolores was age three to five. She was hospitalized on and off at other times and again for another prolonged period during Dolores’ adolescence, from age fifteen to seventeen. When her mother was at home, she at times could be quite loving and nurturing. These memories were precious for Dolores and dearly protected within her psychic organization. For the first couple of years in her therapy she could only think and speak of her mother in a positive and idealized way. Over time she was able to talk about how her mother’s caring would often turn to hurt: an endearing cheek squeeze turned to a painful pinch; hair combed and washed suddenly pulled harshly. When intensely agitated, her mother might beat or slap Dolores. At other times the mother would become very withdrawn and sit in her chair in the living room for hours unto days.
Dolores’ father was an extremely narcissistic and sadistic man who humiliated, devalued, and hurt her and most others in every encounter Dolores recalls. He never handed her anything: he always threw things on the floor, be it a signed school report card or the infrequent birthday gift. Dolores lived in constant dread that she would be hit by a heavy object thrown at her in rage. Dolores knew the story of her father throwing her older sister across the room when she was just an infant. Dolores fell down two flights of stairs at age two. She feels that it could have been he who shoved her down. His dictum was that she was not to talk, actually not to make a sound. Not to speak of anything, never the past. The consequence of a rebellious smirk was being gagged by paper stuffed in her mouth, restricted, hit, and terrified. He drilled into her that she was ugly, stupid, and worthless. He never acknowledged her as his daughter. She felt that he seemed bent on annihilating her sense of self.
Dolores was sexually abused by her uncle at age six and constantly humiliated for her womanhood by her father. She was molested by two men outside the family.
By the time Dolores was a teen, when she passed by a mirror she would look to see if she was there. Dolores remembers her teen years as the worst time in her life. She recalls wanting to die. Throughout childhood she never believed she would live to be an adult.
Dolores seems to have survived her early years largely through dissociation and establishing an inner imaginal world with good parents and elaborate fantasies of being cared for. The bond she felt with her sister was of prime significance. She developed an incredible focus of attention in the things that drew her in school. By age nine she remembers being especially interested in earth science. She would spend hours creating experiments and months observing the outcomes. In retrospect she says that the sciences gave her such satisfaction in part because here she could find answers and reasons. All of this she detailed in perfect penmanship in a way that brought both soothing and order to her chaotic inner world.
The early phases of therapy were about establishing safety and containment, serving to allow her a voice where her story could be told, to help name and acknowledge the vast disavowed affective world. During this time she suffered with anxiety or panic most mornings as well as at other times when triggered by flashbacks, dreams, or other relational situations. At times she would enter my office in a somewhat dissociated state, not quite able to remember how she had traveled there. One day she arrived describing herself as being on automatic, a little clumsy, moving robot-like and feeling numb. “Take a minute to be with your breath, not trying to change it, just be with your breath as it is,” I suggested. “If slight adjustments occur spontaneously as a result of your attention, just allow for that. As you breathe, notice what if any awareness you have in your feet and legs.”
“I feel my feet. My legs I don’t feel much. I guess they feel kind of numb.”
“What do you notice in your feet?”
“Like pressure, the pressure I feel where my feet touch the floor.”
“Just let your breath support your awareness of your feet in contact with the floor and the sensation of numbness in your legs. For a moment join with that experience in your legs and feet…as if you were actively participating with that numbing and pressure.”
After a short pause I ask. “What do you notice?”
“Kinda numb and tight, my legs feel tight.”
“So your legs feel kinda tight too,” I mirror back, “and how do you experience your breath?”
“Yeah, tight, shallow and tight, it feels better to breathe deeper. Yeah my legs feel kinda tingly now.”
“Just stay with the sensations, just like that, letting it shift as it does, that’s just a natural process. Notice if any image, feelings, or memory arises.”
Gradually, like one awakening from sleep, she tells me, “Now I feel some pain there; I used to be hit there by the cat with nine tails.” She grimaces and I see her body rock a bit back and forth. I empathize with her and how hard it might be for her to come to see me given that in the past her experience with those who could help her had also been hurtful. We spend time exploring how and when this occurred in her early life.
“Notice the experience now in your body, the sensations, the slight movement, the feeling of your legs. Listen for what wants to happen now, just allow the sensations and any slight movement or rocking.”
She responds hesitantly, “The rocking, that feels good, it kinda lets the pain seep out.”
I reflect this back, giving plenty of time, and ask curiously, quietly, “What are the sensations ?”
“I feel my feet and legs and the pressure of the floor but it feels fuller, not just in one spot.”
In the following months, we worked slowly and gently to establish connection to her body and to bodily-felt sensation. We focused on developing awareness of breath and maintaining the awareness of sensation in her legs and feet, particularly the experience of connection of feet with the ground, commonly called grounding. As we did this, veils of dissociation lifted as she became able to acknowledge the abuse of the past. She gradually gained more and more physical presence.
“I’m aware of my getting from place to place,” she would say. “I used to ride the bus or walk and not really remember how I had gotten here. I moved like a robot on automatic. Now I’m aware of putting one foot in front of the other. It feels very good to feel myself like this, to feel like I’m moving myself.”
Dolores is making a direct statement here about her sense of agency a key attribute of a sense of core self (Stern, 1985).
***
Following is a story Dolores told and retold throughout her years in therapy. Each telling came with a shift in the intersubjective field between us and with a shift in relationship to her understanding and experience of herself. She first recounted this in the initial year of therapy.
“My sister Rebecca and I shared a bedroom. I would lie in my bed and with my fingers I would scratch and peel the paint on the wall. The patch of peeled paint on the wall was big, my sister would be so upset, I didn’t want to feel so upset.”
I see Dolores across from me. To me she looks wide-eyed and frozen in terror. I feel a panicky trembling in my belly which I did not have before. “I wonder if you were really scared,” I say gently and concerned.
“Yes. My sister would bang her head on the wall to get to sleep.” She added, “I don’t know how she could. I could never do that so I would peel the paint.”
The trembling in my belly and the panic lessen somewhat. “What was that like for you peeling and peeling?” I ask.
“I don’t know, I guess when I was peeling with my hands like that I wouldn’t think or feel, and it would help me to go to sleep.”
“What’s your inner experience as you talk to me?”
“Yeah, I guess I’m holding my breath. I don’t feel so good.”
“Holding your breath and feeling a little scared. No wonder, given what you’ve experienced in the past. I wonder if you feel uncertain as to how I may respond to you.”
“No, you’re always very gentle.”
“Mm. What’s it like inside holding your breath?”
“I feel tight in my chest, trapped.”
“Mm…it must have been so frightening for you to feel so alone with your fear and hurt, confused and uncertain what was happening.”
“My sister and I were there for each other but sometimes she was so upset. I didn’t want to upset her more.”
“Of course you wouldn’t want to upset her more and see her in pain. It sounds like you were very upset and scared also.”
“Yeah, I was scared. It was scary. ”
“I wonder who was there for you?” I ask.
“No one,” she says quietly.
“I can really understand how important it was for you to try not to be upset when your sister was, and it seems sad to me that at times you were so alone and overwhelmed with scary feelings.”
“Yeah. ” she says, a welling in her eye, breathing a little deeper.
I breathe deeper both in a mirroring response and in response to my own inner ease as she is able to integrate some of the powerful affect laden in the account. We sit quietly with her sadness. In time she says, “I feel better, my chest isn’t so tight.”
“You’re feeling a little easier, your chest not so tight… and your breath?”
“Yeah, my breath is a little deeper, I don’t have that trapped feeling.”
“Yes, breathing a little more, just experiencing that feeling of breathing a little easier.”
In some small but significant way I feel I have been let into her room, the room she describes as having been so isolated in and trapped. She recounts to me that she and Rebecca together would push the heavy chest of drawers against the door to keep out the terror, the unpredictable. Then Dolores would lie in her bed listening for and not wanting to hear the creaking wood stairs, footfalls, often her father’s, which could only mean the pain of being yelled at or being the target of some heavy object heaved in anger or the hinted-at but hard-to-hold possibility of sexual assault.
And so we worked slowly like this. By attending to my own felt sensation, inquiring into it, I feel on a visceral level some sense of what perhaps Dolores experienced. Through this embodied attunement I can more fully hold an empathic container for her terror. Initially, I thought of my somatic experiences with Dolores as part of a projective identification sequence. As I learned more about our intersubjective field, I came to think of my feelings, like these, as a kind of somatic attunement or resonance. I was experiencing with her what she could not name, experiences about which she was mute.
It is clear to me that there is much more for Dolores to integrate here. Yet clearly she is beginning to embody the previously disavowed affect, reestablishing coherence and continuity to her sense of self, particularly the core sense of self (Stern, 1985). She is initiating a pathway through the dissociation. At this time, I follow her lead and go on. I’m aware of not wanting to impose anything that could give rise to her again feeling her world overridden by another and trapped again, so I simply work to contain and track her responses and felt sensations. I want to aid her in building an underlying sense of support through her organism, to help her learn that she can feel sensations and find resolve through doing so.
I want her to learn that some nervous arousal can be safe to feel, that allowing sensations can aid in soothing the upset. Up to now these kinds of sensations have been feared because they have led to panic and signify that she is crazy. At this early point in therapy she needs me to be there as the soothing, self-regulating other. So many times in her early life she needed the kind of soothing normally experienced through holding and touch from a caregiver. It is in part these kinds of experiences that are eventually internalized within the individual’s own psychic structure, allowing one to soothe oneself when upset. I don’t touch or hold her literally. My intention is to create an environment in which she feels “held” emotionally and physically. I believe that by attending to the bodily felt sensations, these unmet needs that involve physical contact from another are more apt to be met than through affective attunement alone.
Through her work in therapy Dolores came to understand that in relationships she would inwardly try to assure herself that if she were not upset she could help the other maintain their inner cohesion. This was so important because seeing someone she loved falling apart was intensely painful and left Dolores even more emotionally alone than before. At times when her mother or sister was hospitalized, she felt completely abandoned. In other words, Dolores learned to regulate her own internal, affective states to maintain a bond with others. She realizes that the cost of this is a kind of loss of her own self-experience.
Given the enormous upset Dolores was continually confronted with, understandably she is fearful of her own ability to maintain inner cohesion. By inner cohesion here I mean to be consciously connected to her own subjective reality so as not to break down. One primary way Dolores protected herself in these overwhelming situations was through dissociation. The dissociation is lived in her body through muscular tightening that shuts off her felt sensation. Withdrawing from sensation did allow her some relief but it eventually resulted in an oscillating experience of numbness or free-floating anxiety or panic devoid of content. Her bodily states were necessarily cut off from the awareness of affect or cognition that could give them meaning. My focus was to ground her in and guide her through the detailed experience of the continual flux of sensation and breath linked to affect that could lead her out of the continuous recycling of numbing and panic. Over the course of therapy these threads were worked within the relational transference and countertransference interplay. Attuning to and expanding her bodily-felt experience was a continual thread, just like attunement to her affective states and our relational dynamics. In this way her bodily experience is an integral component in her reorganizing her sense of self.
***
In situations of abuse, the abused child’s body and emotional world havebeen so overridden by another that it interferes with her reality testing. She loses her inner ability to distinguish pleasure, pain, and desire and to trust her own perceptions and initiative. The need to acknowledge and affirm inner affective states is considered a crucial aspect of therapy (Davies and Frawley, 1994, p. 103). A somatic emphasis adds that as the child’s body—her core self and boundaries—have also been overridden, then working directly with sensation can be a significant contribution to the healing process. She has learned to disavow overwhelming affect and pain too difficult to integrate. This disavowal or dissociation is an experience lived in the body. This can manifest in various ways, such as withdrawal of muscular tone and feeling from the periphery of her body by chronic tightening inside, or by loss of tone in intrinsic muscles (collapse), or by tightening outer musculature in order to numb against the overwhelming energy of terror and rage. In the work of therapy, whatever the physical manifestation, attuning to bodily-felt experience can facilitate bringing cohesion to the shattered self states.
As one learns to tolerate sensation and accompanying affect, these can be integrated into self-experience. Gradually through this process one can build self-soothing capacities. Self-soothing can be understood as the ability to physically tolerate sensation and emotion, and to use the ever-changing flow of sensation and feeling—grounded in the breathing body—as a resource to process upset towards some tolerable inner state or the more hoped-for inner ease. The ability to regulate and soothe a spectrum of embodied states from mild upset to the constant recycling of hyper-arousal and its concomitant numbing response that is often present in those who have suffered trauma can herald healing relief. The cognitive recognition of this as an inner resource facilitates a much-needed sense of empowerment and agency (Davies, J.M., and Frawley, M. G. ,1994. Herman, Judith, M. D., 1992. Levine, Peter A., Fredrick, Ann, 1997).
In the early phase of therapy, Dolores participated in an Authentic Movement group that I co-led. Authentic Movement is a process which uses the bodily felt experiences of movement, stillness, impulse and sensation as a medium for active imagination in the tradition of the analytic psychology of C. G. Jung. This work was originated by Mary Whitehouse as a way to bring to bear the experience of the interplay of conscious and unconscious processes when grounded in the body and responsive movement. An essential element of this way of working is the experience of “the mover” and “the witness/therapist” and the intersubjective field which evolves between the two (Joan Chodorow, 1991). The therapist/witness consciously reflects on her own inner state, attentive to projection and various levels of identification in the countertransference, thus cultivating a nonjudgemental, non-interpretive attitude. This creates a unique kind of holding environment (Winicott, 1965) for in- depth explorations arising from the mover’s physical/core sense of self. Exploration periods are followed by writing, drawing, sculpting and or solely verbal sharing. The symbolic and verbal sharing allows the mover to articulate and delineate her self experience. The witness, deeply centered in her own felt experience, offers her witnessing in service of the mover. The witness’s responses can span across the dimensions of intimacy. The witness may be there as a self transformative other for the mover, at times simply receptive and non-intrusive or by offering responses such as ones which acknowledge the mover in being seen, attuned to, and affirmed. The witness may also respond from her own felt experience as it relates to the mover or her experience witnessing, this kind of sharing opens into the interpersonal dimension of intimacy (Shane, Shane, and Gales, 1997).
In these Authentic Movement group sessions Dolores’ movement work most often unfolded in such a way that she would find a comfortable spot for herself within the circle of other participants. She would sit and slowly rock, with her torso moving forward and back and her head bent towards her chest. At times her torso would describe tiny spirals and quiet tears would fall. Emerging from the movement, she would often draw an image of renewal: fresh life, like a daisy or a rain drop, that arose from a blackness in her child’s body or the home in which she grew up.
She spoke with some surprise about the permission she felt with us. She emphasized how important our witnessing presence was for her, especially in regard to her feelings of safety. Opening her eyes and having eye contact with a witness after moving, and at times during a movement period was paramount. She experienced a growing sureness about our reliability to be there, attentive to her. This contributed to further a development of her sense of object constancy. These experiences also allowed her to build on her capacity to self-soothe, both capacities having been disturbed early in her life. These developing capacities were a continuous focus throughout the therapy.
At times I was concerned that allowing her to uncover disturbing historical material, which often occurs in the work of Authentic Movement, would be too much for her fragile sense of self. I knew, however, that her earlier work with another therapist had primarily focused on shoring up her ego strengths. I intuitively felt a deep trust in the spontaneous moves of her own psyche towards healing. The work with her body both uncovered unconscious material and gave her more immediate strength in her sense of self in terms of presence and coherence.
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Dolores’ growing strength was furthered by her participation in an eight-day wilderness journey for women that I co-led. This journey was an opportunity to be in reverence with inner and outer life. We walked through the mountains cultivating attention to breath and sensory awareness, deepening our connection to the earth, ourselves, and each other. This contemplative attitude was also directed towards each woman’s inner world. We spent much of our time doing group work with dreams, individual life stories, and with the process of Authentic Movement, mentioned above (Whitehouse, 1995).The expedition itself was not one of surviving with nothing but self in the wild. We were well equipped with food, shelter, and horses to lighten our load.
Yet initially I was concerned that the level of physical rigor and challenge required would be too much for Dolores. If this were so, requiring that at some point she would have to leave, this would have involved an extremely complicated evacuation from a remote mountain range in Wyoming. Dolores’ intention was strong; she was enthused and certain she wanted to participate. This was a different attitude than what she expressed for other situations that involved anywhere near this amount of social interaction. I could see there was something extremely significant for her here, like a calling that comes from some faraway source that must be answered. In my assessment Dolores was clearly a woman with a good deal of inner strength. She had endured much suffering, and this had not broken her spirit nor her depth of compassion. She was intelligent and accessed this in her work. Yet she did not recognize these strengths within herself, she knew so little of herself; her predominant experience was anxiety. I believed that somewhere inside she knew she had this strength and she needed desperately to remember this part of herself. She needed to remember herself, her sense of wholeness within and the wholeness possible in the outer world. She needed to know she had this strength in order to do the difficult work in therapy that lay ahead. By participating on this wilderness expedition, these strengths would be called forth in an unshakable way. All of these parts of her character would be called on to complete the course, and she would be left with a tangible testimony to her experience. After several therapy hours exploring these issues, I felt a deep trust in her impulse and intent to heal through participating. Though I still felt there was some risk in terms of her physical capacities, we jointly came to agree on, and hold excitement about, her participation.
My and my co-leader’s role mainly focused on facilitating the inner work of the journey while a third woman assisted us by managing the details of logistics, living and traveling in the wilderness. Dolores and I also spoke at length about how it might be for her to change the context of our work together, what therapists refer to as the therapeutic frame. The amount of time we would spend together, the context and the relational dynamic would shift. Our discussions mostly centered on the shift from one on one relating to Dolores being one of many to whom I would be relating. We explored in depth her marked lack of concern about this especially as it revealed her lack of expectation and desire in relationship and her feelings of low self worth. We explored how she embodied this as diminished excitation and constriction as a way to protect herself from humiliation, criticism and rejection. We explored how her fears of being in the group hovered around similar dynamics as well as her hopes of having an opportunity to have new and positive experiences in relationships.
For Dolores this indeed was a time of empowerment—a time when she felt safe enough to enter the unknown. She reached to something she had always yearned for but did not believe she would be able to do in her life—to walk in the mountains, in the wilderness. As a child, the park near her house, especially the trees she found there, was where she had gone for soothing and nurturing. When her relations with the important others in her life were ambiguous at best and unpredictable, the living trees offered constancy and protection. Her inner world of imagination both protected her from overwhelming pain and disappointment with others and allowed her to preserve her connection to positive inner representations of others, sustaining her hope for positive caring relations. In childhood these fantasies intermingled with her relation to nature and nurtured positive experiences. Nature filled some of the gaps of inadequate caretaking. As an adult, to help her find her way out of her inner isolation, Dolores needed to have the experience of linking these archetypal energies to experiences in human relations.
On her solo, which was one full day spent alone in silence (the original plan for a two-day solo cut short by evidence of a mother bear and her cub in the solo area), she was moved to pay tribute and dialogue in a prayer-like way to the sky spirits and trees, masculine creative forces as she saw them. She connected to the earth in reverence, and the mother bear, both of which to her embodied the feminine spirit, nurturing, benevolent, and fiercely protective of their young. She felt moved by these connections, in a profound, spiritual way. “Who needs church?” she joked. Then, in a more serious voice, she told a story of being in her early teens, when she walked through the city, forlorn and desperate for connection and guidance. She tried the door of a church: it was locked. She tried the door to the synagogue: she was turned away for not being a member. The door to her spiritual longings shut within her that day and the cynic came forward. Now a door within opened. She felt welcomed by and linked to the creative force.
She was able to speak in a vulnerable way about how she felt protected, safe, and connected to me, the co-leader, and the group, humanizing the attributes she found in the archetypal world. Within the group interactions, closeness developed despite conflict. Anger and conflict arose, at times with resolution and at times without. It was consciously discussed and no violence precipitated from this; there was an atmosphere of collaboration rather than domination. The group dynamics did indeed offer her a new experience of relationship.
From here she could build upon resources she had found in childhood in relation to nature: what was moving to her was acknowledged and respected. This contributed to building an inner sense that trust and belonging in the world was possible, linking her to the felt sense of meaning that she was a significant breathing being equal in importance to the earth, spiders, bears and other people—a part of the living universe.
This pivotal experience continued to unfold in its meaning in her own walks in nature, and later, at times, when we spent the therapy hour in a natural setting doing Authentic Movement. Each time she walked in nature, even when struggling with inner turmoil, she “returned” sensing her own vitality stronger than before; she felt more certain of her own inner resources and linked to a sense of herself as part of a greater whole.
As we return to our senses, we gradually discover our sensory perceptions to be simply our part of a vast, interpenetrating webwork of perceptions and sensations borne by countless other bodies–supported, that is, not just by ourselves, but by icy streams tumbling down granite slopes, by owl wings and lichens, and by the unseen, imperturbable wind (Abrams, 1996, p. 65 ).
***
In the middle phase, four years into the therapy, one of the most significant transference enactments occurred upon my return from four months’ maternity leave. Dolores suffered intense fears of breakdown as we worked through her fear of me as the unpredictable hurtful other, as her mother had been upon her return from hospitalizations, and Dolores’ related intense abandonment anxiety. For several weeks we increased the frequency of therapy to five days a week. She also began to use an antidepressant, which was helpful in modulating the hyper-arousal and concomitant numbing phases of post-traumatic stress syndrome that returned during this period.
In a session several months following this, Dolores chose to do Authentic Movement. By now, she knows the process well: she sits on the floor of my therapy room and turns her focus inward, closing her eyes initially. I offer her a gentle guide to find entryway to this interior space. “As you turn your attention inward, notice your breath, letting it be just as it is, allowing for whatever shifts that naturally occur with your attention. Let your breath link you to your felt sensation. Follow your inner sense of what wants to happen in your body, impulses towards stillness or movement.”
Now I am silent, the witness/therapist, and she will spend the next ten or fifteen minutes attuning to her inner world. Linked to sensation and felt experience, she will respond to bodily-felt yearnings or impulses as well as images, memories, and feelings as they weave into her awareness. I hold a “free and protected space,” a “temenos” for her, in this process of using the body in active imagination (Kalff, D. M., 1980).
She sits on the floor then scoots herself towards the far wall of my office. She puts her head to the wall where an intricately hand-stitched quilt hangs. Now her hands touch the wall. She lies down the whole of her body close to the wall. Her hands scratch the fabric of the quilt.
I am sitting on the floor across the room, attentive as she moves in close to the wall. Then my attention lapses for a moment, my mind drifts. As I realize this, I bring myself back, but it takes effort to focus. As I reflect on my inner state I wonder why my witnessing attention lapsed, I was not preoccupied, but actually quite interested in being with Dolores. I think of how often Dolores was left alone and unattended to in her early life, and it occurs to me that perhaps this is what is being enacted between us: I am now the abandoning parent.
With this awareness my attention quickens. She is lying against the wall, her hands slowly scratching. I feel such an emptiness, then profound sadness. I recall the scene that Dolores described to me years ago of peeling the paint on the wall. I feel a deep maternal pull to hold her and let her cry. I sit quietly. Our agreed-upon time for the “movement” is nearing its end. Without me saying this she slowly sits up and her eyes find mine. For a brief moment we make a very focused eye contact and she announces that she is finished. We both move from the floor to our seats. She begins telling me of her movement experience.
Dolores retells the story that I had recalled. I ask her what she felt in her body as she lay close to the wall. She tells me that her stomach felt tight and she felt fear. I respond with empathy and her eyes tear. She now adds that sometimes her Mom, very upset, would come into her room in the night. She would sit on her bed. Sometimes she says her Mom would bang her
head on the wall too—”My Mom couldn’t go to sleep either.” Dolores’ quiet tears well up as we continue to hold between us her fear, confusion, and sadness in those times.
I ask her how it was for her when she looked at me as she sat up. She says in a childlike voice: “That felt very good. I know I am safe with you here.”
I contain the feelings I experienced witnessing, they serve to deepen my attunement with Dolores and offer me a path of empathic inquiry. Again I feel she has let me in the room. Her work in therapy has let her discover that she can be with her inner experience and reclaim parts of herself that have seemed too frightening to get near. She can now find some safety both inside herself and with me. The movement allows her to let me in with her to her sadness and pain. We both feel it, her pain here. Entering this memory in movement has allowed her to link the intense affect to memory, to be with the affect that up to now she has not borne. She can tolerate a bit more of her self state.
As a result of being and working with her pain and fears of abandonment, Dolores has a renewed certainty of my constancy and thus, her safety. She can trust me enough to reveal the depth of hurt and pain she felt when her mother abandoned her emotionally. Dolores’ mother, reacting to her own overwhelming pain in this way, had shattered Dolores’ sense of boundaries and hopes for safety. The trust she now sensed with me opened the way for her movement work to unfold. She entered a grieving state that went on for several weeks. Dolores says of the sadness and loss she feels about childhood:
“I feel a lot of pain, but I breath and it seeps out of me. I know it will pass and it does. But I don’t feel only panic like I used to. Sometimes I wake up and feel shaky. I do the grounding exercise you taught me, then the shakiness passes. I feel pain but not just anxiety. It seems that by experiencing the dark feelings that I used to always stay away from I now also feel joyful feelings.”
She goes on to speak of the joy, fullness, and ease she is finding in being with grandchildren and grandnieces and -nephews. I see significance in her timing as she shares her joys. Recounting her joy helps her both to restore her integrity as well as justify the hard work she is doing in therapy—it is worth it because she is able to enjoy more and more of life. She also needs me to hold and mirror these joyful experiences just as she needs me to acknowledge the painful ones.
Much of this middle phase of therapy was about mourning, brought on by my comings and goings in maternity leave and vacations, and the death of her sister that also occurred at this time. She was able to mourn her mother’s death and life’s possibilities lost. Her ability to have more social contact and truly enjoy it was evidence that she was integrating within herself a sense of trust she had learned from our relationship and extending it to others.
****
The next stage of therapy, which would last nearly two years, was punctuated by flashbacks, dreams, and intrusive imagery. In this phase dissociative phenomena were very prevalent within and between sessions. She would not remember content or process between us. Much of our focus was to handle her memories of sexual and physical abuse and to explore the ways she protected herself through dissociation and fragmentation. An essential aspect of our work was her reclamation and integration of her rage and sadistic impulses. This was a difficult time for both of us—a time when material would seemingly slap us in the face only to disappear again, leaving us both confused. Focusing on her somatic process and its manifestations in the transference became the guide through.
In this phase a narrative unfolded through her dreams that seemed to reveal her subjective experience of being hurt. As we inquired into the content and feeling of these dreams, a transference/countertransference enactment developed in which I was either the provoker of terror from whom she must flee or avoid, or alternately I was seen as the colluding mother who knew but did not respond.
For instance, on one occasion we had been talking about a disturbing memory, which had come forward through association to a dream, abruptly Dolores wanted to end before time. “hm, of course you can end anytime you want, but I wonder if we could talk about what’s going on?” I ask.
“Yes. O.K.”
“I feel a little like a door just shut on me, in a way that makes me wonder if you are wanting to get away from me,” I say.
“You don’t miss a beat. Yeah, I am.”
“I wonder what your inner experience is?”
“I feel like running.”
“Running is a very good way to protect yourself when you’re threatened. I wonder if you might be feeling threatened by me,” I respond.
“No, not of you, but of your questions. I get afraid and don’t know what might come up.”
“I can understand how my questions feel frightening and being with me as we talk in this way feels unpredictable.”
“Yes, it does. When I was with my father I could never talk, not say a word, not even breathe loudly. Once I let out a kinda sigh when he said not to talk. He started after me. I ran. I wasn’t very fast but I could get away. I would get to the bathroom and lock the door or I ‘d run out the front door.”
“No wonder you might want to run away from me, shut the door on me, on my questioning, when I provoke some of the fear and unpredictability you so often felt with your father. What happened once you were out the front door?” I ask.
“I would get to my bike and ride.”
“As you speak of running out and getting on your bike, what are the sensations in your body like?”
“My legs feel weak, not enough oxygen. I hold my breath and push to get more force,” she responds, almost like she’s guilty, doing it wrong.
“Yes, do let your breath gather and push down and give you the force you need. Push through into your legs, let that oxygen into your legs.” She is feeling her legs with her hands. “Yes, feel the strength in your legs.” I say.
After a time she says, “I feel better now the energy in my legs feels soothed. I remember I liked riding and riding.”
“Yeah, running and just riding and getting away. It’s such a natural and healthy response to being frightened. It seems that’s how you could protect yourself. I can imagine that you might have felt like you regained some of your integrity, your sense of freedom when you were riding like that. It seems it’s important to know you can protect yourself from me too, from my questions.”
“I feel safe with you. ”
“It seems like some part of you feels safe with me and the child part, the wounded part of you, gets scared and has feelings of wanting to run away.”
“Yeah, I think so.”
“I wonder if there are other feelings you’re aware of?
“I feel so much rage at my father. I could kill him,” she says.
The session is near its end. I empathize with her feelings and again wonder aloud if she might feel like she also wants to get rid of me, my questions. She responds shyly and affirmatively.
In the past I have explored with her what happened when she made her way to the bathroom. Running to the bathroom at times resulted in further abuse and at times it did not, but discussing any memory of getting to the bathroom was coupled with feelings of fear and entrapment. Any inquiry I might direct there would result in a return to her experiencing the post-traumatic syndrome cycling of numbness or dissociation and hyper-arousal. This response would occur either during a session or following. In the past this running/escape has been coupled with dissociation and fragmentation. She may have gotten away and felt some relief, but her fear was encapsulated and split off from consciousness. When the anxiety did return she would experience herself as weak and feel threatened by her vulnerability to the greatly-feared possibility of breakdown. These feelings only served to support an inner feeling of worthlessness. Essential now in refinding and valuing this natural arousal towards flight is allowing integration of the knowledge of the experience that precipitated the anxiety/arousal (here both the immediate situation with me and the understanding of how it happened in the past) and the corresponding integration of affect and memory (Levine and Fredrick, 1997; Herman, 1992).
The kind of fragmentation in her consciousness at these times seemed to me to be primarily associated to her core self and core relatedness, particularly the domain of self-coherence and agency. Perhaps this can also account for why interventions directed towards her sense of her physical experience of herself seem to have much more effect than interventions solely directed towards her verbal self (Stern, 1985).
Several months later Dolores was exploring her considerations about going off her medication, which she basically didn’t want to do but needed to talk through. The medication had, for the most part, been very helpful to her, though at times it seemed to me to support her tendencies to dissociate. For example, she generally felt better on the medication and usually was able to talk about how she attributed feeling better to both her work in therapy and the antidepressant. With the antidepressant, when she felt bad, she didn’t feel as bad, and when she felt good she could sustain it much longer. She felt she was able to understand more and have a new experience of herself.
Yet, if she suffered a flashback just before a session and was thrown into a dissociative state from the event, she could begin to work with it in that immediate session. In the next session, a couple of days later, she might be in a state where she felt numb or sleepy. She would have a hard time understanding this, given that her medication had not changed. She would dissociate from the terrified part of herself and only be able to consider her shifting experiences from a standpoint of the effects of the medication. She would not remember that the frightening event had happened or that she had had difficult feelings associated with it.
In this particular session we were discussing this dissociative process. As we spoke, she discovered that now that she generally felt so good, she was particularly frightened of losing that good feeling. It was hard for her to accept the reality that she could feel terror and pain again. She would push those feelings away, splitting them off from her conscious awareness. In so doing, this terrified part of her was unable to benefit from her courage and experience of working things through with me.
We continued the discussion and I began feeling extraordinarily sleepy, by now a more-than-familiar countertransference response of mine with Dolores. This time, I wonder aloud about my experience. She recalled how her previous two therapists had both complained of this, and one of them had actually fallen asleep in session. I felt somewhat desperate to not fall asleep as we spoke and asked her if she might want me to be sleepy right now.
“No,” she replied, “my mother would do this—she would sleep or be very sleepy when she was ill.”
From here came a deepening in her understanding of the relational dynamics with her mother that contributed to her lack of a sense of worth in her subjective experience or hope that she could be understood and considered by an other. This was extremely sensitive territory for her, yet it opened a way for her to be expressive and vulnerable in our relationship, sharing her feelings of gratitude and need for me.
As we furthered an appreciation of how splitting/dissociation had protected her from the terror she felt as a child in her relationship with both her father and mother, at one point I said, “How much care, holding and soothing that part of you must need.”
“If I can care for my adult self then certainly I can care for my child self,” she replied softly.
“What is your inner body experience now as you speak?” I ask curiously.
“It feels very relaxing, like a hug or a warm bed in winter. Safe and protected,” she replies in the childlike voice, so characteristic for her in these moments of regression.
“How good to feel safe,” I softly accentuate.
She replies, “Yes, with safety comes comfort, without safety there is no comfort.”
I am taken by her statement. Indeed this seems to me key to her healing, and I reflect this back to her: “With safety comes comfort.”
The reality of her therapy was that there was a continuous spiraling, looping back around to a place she’d been to before, but each return was to a slightly different rung on the spiral, with a feeling that a safety net had to be woven across the rungs thread by thread as we went.
In another session during this same period she reported feeling in a “soothing, sleepy place.” This seemed incongruous, because she had been talking about experiences of her father’s cruelty towards her during a time in which her mother was hospitalized. As we explored her sleepiness she realized that this was a way of keeping me away, that my power to heal/know would be what would make her crumble. She could not allow this, so she kept me away by moving into the “soothing, sleepy place.”
“When I move away into a more diffuse, less direct contact then you can’t hurt me,” she said.
We explored in depth how as a child this was one of the only ways she knew to find comfort and how well it had served her in such terrifying times. We also talked about how sad it was that the act of doing what she knew to keep herself safe—keeping me away so I couldn’t hurt her—also kept me away so I could not help her. Here, she reoriented her head and eyes towards me and sat up. This orienting response which occurs through the head, neck and eyes is a common physiological feature of one faced with threat/trauma and is often associated with the renegotiation of trauma (Levine and Fredrick, 1997). She announced that now she was “here” even though it was effortful. She felt more awake. As did I. Further exploration revealed that a way she protected herself when she was experiencing memories and body feelings associated with sexual abuse was to diffuse contact and speak to me from the side, literally turning her head and seeing me more with one eye than the other.
In subsequent work it occurred to me as I observed Dolores in movement that her ability to find a place of bodily comfort was not as accessible to her as it had been at times in the past. Although she had learned progressive relaxation, breathing, and grounding practices and had used these successfully alone, right now the inner state of rest was hard for her to sustain. In a session in which she chose to move, I structured an Authentic Movement session in which she could follow in her body the spectrum between being comfortable and uncomfortable. During a movement period of about ten minutes she walked and moved her arms, spiraling around the bony axis, rolling her shoulders and breathing audibly, especially on the exhalation. She then lay on the floor.
As I witnessed her I felt attentive and restful inside. I contain the experiences I had witnessing, sensing these as a kind of embodied attunement, and I gently encourage her to fully articulate her experience. Dolores reported initially experiencing that she was moving with her anxiety and how she discovered that if she participated with it, it dissipated. More movement and a feeling of strength in her arms and shoulders and an image of a double rainbow came to her. She said she felt the rainbow extend from one hand up her arm and through her torso through the other arm and to her hand, and that it bridged the two parts of herself after a storm. She later was able to recall this image and its accompanying felt sense to ease the tension of the opposites, of comfort and discomfort, when they arose within her.
In the next session she reported:
“I feel more flexible around my wounds. Before I didn’t move well. I was stiff, robot-like. I was afraid if I shuffled I might loosen something and feel pain and hemorrhage. It was not safe talking. I used to think that if emotional stuff came up I would feel worse—but this is an important discovery: I feel relieved. If I wasn’t recognized I wasn’t sure I was there. I only knew myself through other’s reflection.”
In a session not long after this she had worked through another particularly terrifying memory of physical abuse in which she was able to stay present and find relief. Again came her telling of her story of being in her bedroom, lying in bed and peeling the paint on the wall. She recalled how her sister had pulled her own hair out, strand by strand, until a bald spot resulted. There was a hole in the plaster, she said, beneath the paint where she had scratched. I asked her what the sensations are in her body as she recalled this. She replied that the wall felt cool to her head, and she would move in closer and closer so her whole body could feel that relieving coolness. We talked for a while more about how the wall was always there to offer a kind of comfort as her hands dug her a path out of her terror, and I add how sad it seems that her mother could not comfort her. I feel again a deep visceral stirring, then a heaviness—like my heart is dropping into my guts—and sadness. I am moved to share the sadness that I feel knowing how much she suffered. There is an intense feeling of connection between us. She is able to tell me some of what I mean to her in a very vulnerable way. Here the intersubjective field expanded in a small but significant way, I express my feelings and there is a moment of tender interpersonal intimacy, a positive new relational experience for her (Shane, Shane and Gales 1997).
****
Dolores’ father was now nearing death and she wondered how she would respond when the moment came. A session of active imagination began. Sitting in her chair, she focused her attention to sensation and breath. An image arose of a deer. At first she sees it frozen in terror, then it leaps and runs free in the forest. She felt the movement of the deer as if it occurred in her body. She felt frozen with panic in her gut, then her legs began streaming and felt liberated as if from a long captivity.
In a subsequent session we meet outside in a wild and protected place on Mt. Tamalpais to do Authentic Movement. We are in a stand of ancient redwoods. I sit and witness, holding a protected place for her. After twenty or so minutes of moving, she sits with me and reports:
“I drew a circle around myself with first two then four openings to the four directions. I was aware of outer sounds and then an inner awareness. I built a spirit house. There was one flower growing inside and one I put in. The two flowers were my two guides. One I chose and one chose me. One flower is delicate and strong. One flower guide was a bird of paradise. [This was a colorful dry native grass plant, roots and all, that looked, as she spoke, very much like its tropical kin.] I learned from it that paradise is inside me, like the roots and flowering of this plant. I go deep into the earth to know truth and then I fly and flower.”
She expressed feeling her strength and vitality from being outside in nature. She felt a sense of perspective that was at once deep within herself but not so closed in on herself and her fear, more connected to the world and all its beauty. She reviewed her experience of the wilderness journey and how important this had been for her.
Not too long after this her father died. At the service she was given a tropical bird of paradise. This synchronistic event grounded her in her own knowing and awe, and to her surprise she found that a part of her did feel liberated.
Within a few weeks of her father’s death, Dolores was brought to the emergency room for treatment of heart fibrillation which lasted for five hours. She had had some arrhythmic heartbeats before, but none had lasted as long as this. In our session some days after, she turned her awareness towards her felt sense of her heart beating. It was a bit fast at first and she felt some fear. I guided her to stay with the flow of sensation. She reported slowly and attentively that, yes, she felt her heart beating. She could feel the strong beats pounding in her chest. It was a little scary. After a time the beat slowed and she felt somewhat more secure. The beating became comforting. She said she was shifting attachments—her attachments to her parents, her father, attachment to him had been what she had known and now this was changing. Her continued attention to her beating heart began to give her a sense of herself, a sense that yes, she was secure in her autonomy. She had also been surprised that she felt safe at the hospital. She wasn’t frightened of being with the doctor. This feeling of safety was so different from what she had normally experienced.
There was mourning to do, but she was mourning primarily what she never had with her father. In subsequent sessions, the mourning came in and out of foreground. Her father’s death did mark a difference, and the relief she felt in his absence also manifested inwardly: the feeling of threat was lifting.
In this phase of therapy many sessions were devoted to following her felt sense in detail in a similar way as I have previously described. Many times she would find very deep places of relaxation and soothing, and this exploration would fill much of the hour. At times I wondered to myself if this was OK, or if it was another way we were diverting from what needed to be addressed. Yet another part of me trusted the significance this could play in her healing, especially considering how little she had known soothing in the presence of another and thus how hard it was for her to find this on her own. Following these sessions, I felt some affirmation of the appropriateness of this direction when in her daily life she became more adept at bringing herself to a state of presence and attention when she realized she was moving into a hazy dissociated state. She reported more and more enjoyment in her daily life by being wakeful and present. When traumatic memories would surface, she found she had an observing ego in the process and felt she could contain and follow her feelings in a way she had never dared.
In one session she reported that she had been at home and was feeling sadness and then terrible anxiety. She said she felt no self-esteem, that she didn’t deserve anything in this world. She tried to find the inner place of soothing she had experienced in therapy.
“Why doesn’t this continue to work?” she asked. “I would try to bring it back and it would come but just a little. Then I was prompted inside to exhale. I didn’t think of it, or effortfully direct it, but the exhalation came. By breathing I’m not disintegrating. I deserve this space and I could say to the anxiety ‘you can’t take this from me’.”
As we discussed her experience she realized that a situation with a person at work the day before had triggered her feeling states. Her work requires that she travel frequently. In a somewhat unusual circumstance she had been intensely involved with a colleague in a distant city. She was plagued by inner thoughts concerning the woman’s desire to be with her. Despite the woman’s expressed enjoyment of their time working and socializing together, Dolores wondered: ‘Maybe she feels forced to be with me.’ These thoughts triggered within her feelings of unworthiness. Memories arose of her father’s constant refrain: “Who would want to spend five seconds with you?” Arising from the depths of her being, her breath had signified her right to exist, and she claimed it.
Dolores’ therapy continued to unfold in this way, like weaving a textured spiral, working the threads, circling back, arriving in a familiar place yet each time from a slightly different vantage point. Her bodily-felt experience substantiated her subjective experience where words were either not part of the gestalt or when at times the words were too frightening to be held consciously. Her body contained the pain and offered wisdom in finding a way through. Though her dreams have not been the focus of this paper, an account of Dolores’ story in therapy would not be complete without mentioning the primary significance that her dream world also played in bringing forward her subjective experience and offering images of hope and healing throughout.
Of her work in therapy with her body experience, Dolores says:
“When I am too upset or can’t explain or feel confused it’s like I’m hitting against the wall —in a sense of remembering trauma—it’s easier to tell my body experience than things I don’t remember or I don’t have a story of – I get caught confused. I can get confused but with you guiding me that way it flows. It goes like from a feeling of constricted mass and comes out like a waterfall. I don’t know what happens but I feel safer. Your voice means safety. Your therapy voice, which is different. It’s like a lullaby. Like anything I say will be taken into a receiving blanket. No loud sounds or voices – that would scare me.
“I turn inside nothing to be found just to be felt. Sometimes I like to see where my hurt goes…If nothing else my body awakens. I can remember a time I came to see you and all I did was wiggle my toe. The second I really feel something deeply it changes. Like the alchemist changing base metal into gold, all it takes is a breath or a wiggle of a toe or to be with someone I’ve trusted. For me it took a long time. It’s a work of a lifetime.”
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