in “The Art of Contact” – Bernard Maul Ed., Berlin 1992 (Edizione inglese e tedesca).
Luciano Rispoli, Clinical psychologist, Founder of Functional Therapy, President S.I.F. (Italian Society or Functional Bodypsychotherapy), Member of National Board of the Italian Society of Clinical Psychology, President of the Italian Scientific Committee for Bodypsychotherapy and of the Comite’ Scientifique Internationale pour la Therapie psychocorporelle (International Scientific Committee for Bodypsychotherapy); his address: Vico S.Maria, App.23, 80132 Naples, Italy.
In this paper I intend to talk firstly about how we can get closer to a working definition of what contact really is in a functional theory of bodypsychotherapy and then I will categorise various kinds of touch which distinguish true contact with the patient’s needs at different phases of the therapeutic process from mere techniques to be applied according to some indefinable “intuition”.
Contact
When we talk about contact in bodypsychotherapy we refer to a concept and basic, central element of those theories which consider people holistically, and which take into consideration the deepest functioning of all the levels which go to make up the totality of the Self. Thanks to recent research and to discoveries made in the fields of psychology, physiology and our own field of bodypsychotherapy over recent years it is possible now to understand a bit more clearly the phenomenon of contact and in particular deep contact. Various authors in the area of psychoanalysis (such as Bowlby, Winnicott and in particular Hartmann) and Gestalt therapy (Perls) or the humanistic therapies (e.g.Rogers) have underlined the importance of empathy in psychotherapy. In the etymology of the terms, cum-tactum (touch together) and empathy (to perceive intimately the patient’s world), we can already glimpse how they are to be considered with respect to more than one level of functioning of the human being. and how closely they are related to bodily touch. What is more, nowadays the studies and discoveries about the significant perinatal period have shown us how the baby is not isolated in a perceptual solipsism but is in dose contact with the outside world, via more than one perceptual channel, all interconnected amongst each other and with the emotional, imaginative and motor world of the child. This should enable us to clear the field of the idea that empathy is some kind of “magic”, “ineffable” condition or mysterious state, to be achieved only by means of a je ne sais quoi called intuition. Indeed intuition is based on very precise communicative signals, which so far we are in the process of pinning down and analysing in ever more throughfashion. Certainly it is a long haul because the levels via which people communicate and “talk” to each other are many and contemporaneous, thus creating a kind of circular field with various parallel channels of feedback. The Functional approach to Bodypsychotherapy sets itself the task of studying such levels of relationship, all the functional processes set in action by the Self system and above all the laws which govern them, and those interconnections and interrelations between the various levels and sublevels which make up the Self. From such a viewpoint contact is seen as the possibility of going under the stereotypes and the aridity of the false Self, and of getting down to the deep nucleus of the Original Self, where all the functional levels are present, related and closely integrated: emotions – movement i.e. gestures, posture, body shape; rationality i.e. awareness, immagination, the symbolic; physiological activation i.e. tone of voice, muscular tone. perceptions, termperature, breathing. skin colour etc.
Contact as means and contact as an end
We have to take into consideration the fact that in psychotherapy it is not possible to speak of only one of the two poles which constitute the complex field of activation of the phenomena under examination. There are two Self systems involved, that of the therapist and that of the patient or group, these come into interaction with each other and at more than one level and function. This constitutes a very particular and specific field configuration, which can now be analysed and broken down into its various components in order to understand better the laws which govern its functioning. Indeed once the functional diagrams have been drawn up with the present constellation of the various functions (and how they gradually became altered and transformed over time), both of the therapist and of the patient, it becomes possible to understand the reciprocal influences of these two systems. A particular sensitivity in the therapist’s imaginative area for example might solicit excessively the patient’s fantasies or might mean less attention is paid to the level of movement or to the various physiological variations. Thus deep contact is possible only if such alterations do not impede the penetration to the deep original nucleus of the other. In this way it can only be i obtained if there exists or is created in the therapeutic process a moment of integration or the Self for both, via those functional levels which have remains in deeper interaction with the others. For a therapist then, contact, if understood in this sense, becomes a fundamental part of his/her work, without which there remains only empty actions, a sterile technicism which does not take into account the affective unvolvement of the other. A part from any difficulties which may emerge from the meeting between and the superimposing of two functional systems, it is the therapist’s Self which remains the key instrument in the relationship. It is fundamental for therapeutic work to know the characteristics of one’s own Self in order to be able to decodify a the excessive, or too weak resonances, the internal movements, both immaginative, a symbolic or self perceptive. This is what we call working with extended countertranceference (i.e. extended to include the various psychocorporal levels); if I know the history of my alterations and my own therapeutic path then as a therapist I can understand why at that point of the session a fantasy suddenly occurs, or a pain in the shoulder, an old familiar sensation in the stomach and so on and understand too their meaning in relation to the patient and to his therapeutic process. OnIy in this way can I reach my patient where he is: through my self I can create the contact and empathy with his particular condition and after distinguish clearly what is his from what is mine.
The use of the therapist’s Self or of the auxiliary Self is currently one of the most important points in the theory of technique. This cannot be left to chance but must he adapted to the person and above all to the different phases of the therapy itself. For example in the initial phases of therapy the therapist’s own emotions cannot be used directly, cannot be poured out to the patient because he can in no way be burdened with the responsabilty for what happens in therapy. At the same time, on the other hand, it will be the therapist’s auxiliary Self which will express by breathing, movements, reconnections, memories where ever these parts in the patient are lacking, disconnected, or atrophied. Such a condition of deep contact will become in its turn an important point for the patient to reach and it is indispensable for him to be able to reach it without help from the therapist. also outside the special conditions of the session or therapy.
Deep contact becomes in its turn a fundamental tool for the patient: to reach others there where they are and to modify external situations without being paralysed by closures, alterations of the Self. other people’s fears.
Touch
In contact the importance of physical touchìng has largely been recognised and by now demonstrated in numerous studies. The evocative power of touch is connected to the existence of a peripheral body memory which is embedded into the functioning of the muscular and physiological structure of the organism. What is less well known is how important it is that this memory should not remain “unaltered” throughout the therapy i.e. that it is not sufficient merely to recall it to the surface in order to achieve significant changes in the Self. What is necessary as a basic principle is the reconnection of this experience, encapsulated in the body, crystallised in the particular modality with which past relationships have been conducted, with all the other levels of the Self, in order to reconstruct slowly an integration which has to some extent been lost and to render stable the modifications which have taken place. Otherwise there is a risk that the same mechanisms of events with the same stereotypical and scleroticised modalities will reccur or even that the disconnections and existing alterations will become entrenched. From this we can see the importance of a meticulous and patient work of reconnection, for example between touch and words, and tone of voice, and breathing with the constant presence of the therapist’s auxiliary Self, taking care to move and modify gradually but constantly the response modalities, patterns, character traits.
Different kinds of touch and different aims
Although it is merely arbitrary to separate any one kind of touch from the context in which it occurs let us now try to analyse the various objectives (as functional bodytherapy has explored them) that we can try to achieve through direct contact with the patient’s body.
1. Touch to rediscover and extend movement.
This is nearly always a type of touch which involves the whole body of the patient (independently of its specific situation). It serves to facilitate movements which would be impossible without guidance from the therapist or which would always take on the old repetitive modality: too brusque or too jerky or with too little energy, too limited etc. The hands of the therapist guide the movements with precision and scrupulousness in order to arrive at, not the usual emotion which will always be set off by an habitual movement, which will always keep the same modality, hut rather that nuance and emotional colouring which the person has rarely managed to achieve; then connecting it and getting him to feel it just with the right kind of movement. Movements which have been softened by being accompanied by the hands of the therapist (linked by the latter to an apt tone of voice, to a pertinent memory) can reawaken finally feelings of tenderness which might have seemed to have been extinguished forever in the expression and in the perception of the patient.
- Touch can accompany gently but precisely such a movement helping it to proceed in the right direction, if this should be already possible for the patient.
- Otherwise in the early phases of the therapy touch can substitute the missing movement finally allowing the person to begin to experiment and rediscover lost sensations.
- Otherwise touch can be used to encourage the growth of a movement particulary those requiring strength and energy, by opposing the movement and setting off the desire to carry it out and overcome the obstacle, to finish it and not to leave it half done and useless.
2. Touch to underline sensation.
This is a kind of touch with varying intensity and strength and the same time with varying slowness and speed so that it can explore and gradually reawaken different types of body perceptions. Naturally in this case also touch is more diagnostic and is limited to exploring the range of sensations and emotional states. In order to become decisively therapeutic it would be necessary to insist on those perceptions which seem to be missing from the patient’s range of possibilities, those which he has great difficulty in taking in. In this way a strong touch can restore a sensitivity to pain which might have been anaethstetised and a gentle touch can loosen up the sensations of fear of contact which might have been associated with it if all this takes place gradually and above all with the intervention and continual support of the other areas of the Self of the patient.
3. Touch to mobilise posture.
In this case the therapist, by means of his own hands, can encourage both the awareness and perception of chronic and stereotypical postures and help to gradually extend the range of possibilities. If a posture is exaggerated by the touch of the therapist the person can more easily become aware of what it really “means” what can be the implicit unconscious message that the patient continually sends out to the world by means of this posture. In a later phase of the therapy on the other hand it will be more important to help with considerable presence so that posture can be abandoned and to go beyond this in order to be able to take up positions of the body which express completely different emotional nuances, so many different and mobile expressions of the Self, to the surrounding world.
4. Touch to modify muscular tone.
The chronic state of basic muscular tone, that which governs the way of moving and not its extension does not allow the patient to modify his perception of his being in the world, a basic hypertonic state in certain particular areas of the body transmits a continuous alarm signal of vigilance, an unpleasant sensation of approaching danger unconnected to what is objectively taking place in the surrounding environment. On the other hand a prolapse in the muscle system of the shoulders and the back often will produce a devastating sensation of defeat, impotence and ‘melancholy”, typical of the depressive syndromes and significantly present as a position of the body in all periods of history with these same characteristics. Touch in this case is a really deep massage; it must be able to reach down to the internal points at which muscles are attached and interfere with the feedback signal which starts from the muscle spindle in order to be able to interupt the chronic state of short circuit which has made this postural function incongruous and split off from the others. Thus it must be a physically intense, slow and deep touch, aimed at moving the muscle mass, at holding it and slowly modifying the tone and the set round the bone structure.
5. Regressive touch.
The worry about whether touch is necessarily “erotic”, so typical of those who have no direct knowledge of the work of bodypsychotherapy, can be justified only if one does not know how to use an appropriate touch for the phase of therapy which is being undergone. lt is necessary to point out however that the techniques and knowledge at our disposal today permit us to enter much earlier into the phase of therapy known as “regressive”. A great amount of therapy is thus carried out from the start on experiences and sensations which are particulary early, certainly pre-genital in nature, in which sexuality is far from being so full of the problems and feelings of guilt as in the adult. But in order to be able to “by pass” the danger and get to such early sensations it is necessary to use a regressive touch from the very early phases of therapy. The therapist has to use notable pressure and has to take hold of the patients body, holding it and thus bringing out in the body memory sensations which are very similar to those felt by a neonate in the strength and grasp of an adult. The effect is immediate hut precise: the patient rapidly abandons thoughts linked to adult sexuality and lets himself go into these antique perceptions. At the same time for the therapist the other takes on an infantile aspect of littleness, fragility, dissipating sensations or erotic thoughts and the therapist is caught up further into taking care of this little one’ who he has before him, with all the infantile emotions. characteristic postures and movements literally in his hands. A light touch which just brushes over the person is alarming in this phase since it does not bring back early sensations in a clear fashion. One patient reported feelings that that kind of touch led him to expect anything: seduction, betrayal, violence and this because in an early phase of therapy it can be perceived as being falsely gentle.
So a gentle touch will be extremely useful but in a later phase when the relationship has already become established, regression has been set up, initial diffidence and the first negative transference overcome and positive transference consolidated. A particular means of taking hold of the muscle goes lo make up this kind of regressive touch, which is aimed at restoring in the patient a fundamental and necessary condition, that of being able to just be. The muscle is held and “contained” with great calm and strength and slowness so that the patient can finally stop holding himself since he can now feel it is no longer necessary. In some ways it is an overwhelming experience: the person feels for the first time after a long period that he does not need to do anything other than just let go, and he lets go with the various parts of the body, bit by bit until he rediscovers this capacity for being. This is an ability that is very familiar to the neonate, no yet under stress and alarm, for example when he lets go of the breast, full and satisfied getting his mouth fall open, closing his eyes and lying back quite happy to be put down gazing into space and with his body totally relaxed.
6. Reconnecting touch.
The therapist, with his/her own hands puts various parts of the patients body in touch with each other, not in the gestalt meaning of the term of putting into contact different aspects of the personality not in the energetic sense of getting energy to circulate. The intention is to make certain zones feel together, zones and areas which can be split in the perceptions going into the sense of reconnecting the Self, uniting the upper and the lower parts of the body, to rediscover an original unity, since lost.
7. Touching and pain.
One of the most frequent problems which come up in therapy is that often the patient is closed off in an indistinct “knot” of physical and psychic unease of gloomy and untouchable pain which he is not even capable of noticing but which produces a visible state of suffering, a gloomy state of mind even more anguished because not understood. In these cases it is necessary to open up the “knot” put hands on the s suffering in order to make it perceptible to be able to circumscribe it first and then h to lei it slacken off. There are areas of the body which are extremely painful which the patient is not even aware of; if one can touch this suffering and massage the area, even if is painful, the “cosmic’ sense of pain which is so unbearable becomes ever more delimited, human and bearable until it is mixed with a clear sense of relief and pleasure. The suffering no longer works at an underground subtle level but takes shape openly so that the touch it self can work modifying and acting deeply and truly on both the psychic and the physical condition.
8. “Parental” touch.
This last aspect of the aims and modality with which one can use a direct touching of the patient’ s body in therapy allows us to offer another concrete example of what we mean by modularity and evolution in therapy, that is of a concept of therapy which divides it into successive distinct phases. One of the criteria via which we can study the succession of phases is that known as the criteria of perception, that is the way in which the patient perceives his/her own therapist throughout the development of their relationship. On this topic one can distinguish 4 phases in the journey from dependency to independence:
- a parental experience
- modified parental experience;
- perception of the therapist as a person;
- final collaboration.
Even if the phases are not completely separate in the chronological sense, the use of touch must necessarily be different in each phase. In the first phase all work is aimed at getting the sensations which were part of the family history to re-emerge, even those which are less superficial and are much more deep set, with the aid of a kind of touch which can recall them, a touch which should resemble by exaggeration that of the patient’s parents: provocative, falsely gentle, oppressive, insecure, painful, violent or whatever they were. In the second phase however one aims to change the history of the patient with an experience of a totally different touch.
As I wrote in a previous article: “The sensations of the patient in the initial phase are like something that has already been experienced. Fear and pain at exposing himself and in this way repeating frustrating experiences constitute the fundamental nucleus of the difficulty in analysis. The therapist represents the parental figure, because of the conditions of transference and initial regression both of which reproduce early experiences. The patient, having been encouraged in his/her perceptions, motor and emotional areas reacts automatically to the therapist, exactly as if the therapist was one of those affectively important figures from his/her childhood. But while on some levels the reactions of the patient go over those early patterns of childhood, on other levels of the Self he/she can take in, record and give value to the new data coming from the present reality, which are so different from those of the past. Early fantasies are contradicted by perceptions which are to be had in the session; automatic emotional reactions are mitigated by physiological modifications which put emotions back in touch with what is really happening on the outside. In this phase of modified parental experience one can speak of a real “corrective emotional experience”. The parent that the therapist now embodies must be very different from the real parents. (Rispoli 1990)” Thus touch again presents itself as one of the pillars of bodypsychotherapy, but only if it is guided in clear and unequivocal way by a precise theory of technique stemming from a general theoretical model. The danger is that of repeating the archaic experience and thereby deepening the splits of the Self. It is precisely because of such evocative power that a wrong touch, unsuitable for that particular phase of therapy can, iremediably put at risk that difficult and complex process. A process which, if one uses in unitary fashion all the levels and psychocorporeal processes, tends to re-establish in the patient a harmonious and well-balance Self; in other words a full capacity for living.