CONSIDERATIONS ON COMMUNICATIONS - BOTH VERBAL AND NON-VERBAL IN BODY PSYCHOTHERAPY

This article was published in Body, Movement and Dance in Psychotherapy, Vol. 4, No. 2, August 2009, 121–134.

Introduction

Those practising other forms of psychotherapy are sometimes surprised that language (verbal communication) forms a central part of the therapeutic relationship in body psychotherapy (BP). The erroneous assumption is that body psychotherapists only work by manipulating the body, and therefore language is superfluous. Dance therapy seems to be seen in a somewhat similar manner.

“…some clinical practices have been exclusively based on nonverbal behavior. For instance, dance therapy has been developed on both sides of the Atlantic.” (Philippot, Feldman, Coats, 2003, p.8)

This article will explain the role of both verbal and non-verbal communication in body psychotherapy and illustrate this with composite clinical examples.

Language in body psychotherapy

Body psychotherapy has evolved styles of relating to the “bodymind” of the client to “talk to the bodymind.” alongside the more familiar use of language, i.e. verbal communication (Liss, 1996, 1998; Boadella, 1987). Nick Totton reminds us that “…..thought and language are not ‘mental’ qualities which exist over and against the body. On the contrary, in line with the holistic bodymind concept, thought and language are qualities of the body itself….” (original italics) (Totton, 2003, p.133). Some body psychotherapists regard spoken words principally as energy; words carry energy and are more or less “energised”. Those trained in biodynamic (body) psychotherapy have made a significant contribution to this understanding of the energetics of the spoken word. Likewise, Buddhist psychology sees speech as supported by “the energy of breath.” (Watson, 2002). Breath and speech may be seen both metaphorically and literally as “life” or “energy.” Breath is also regarded as “spirit” in various spiritual traditions.

“Intentional” language is used by body psychotherapists alongside other forms of communication as part of a complex web of communications in the therapeutic relationship (Nunneley, 2000). “Intentional” language involves the psychotherapist choosing words with precision to serve particular therapeutic purposes.

Verbal versus non-verbal communication

Western culture tends to emphasise verbal aspects of communication. We know what we can label and talk about; words make our thoughts rational and tangible. In clinical settings, Scherer (2003, p.v) asserts:

“ therapy in clinical settings has continued to focus on the verbal rather than the non-verbal. There are many reasons for the continued prevalence of the verbal in therapy, including the intellectual influence of psychoanalysis and cognitive therapies, the ease of obtaining verbal reports, the need to classify behaviors and feelings into semantic categories, and the amount and effort and time required to observe and interpret nonverbal behavior.”

Clinical work exists in a cultural context and this focus on the verbal is part of a “hierarchy of knowledge” in Western society, in which certain kinds of knowledge are subjugated to others. So the verbal, objective and rational is regarded as superior to the intuitive, subjective, and unarticulated knowledge (Boyce-Tillman, 2005). This has political consequences concerning what is more valued, receives attention, and gets research funding. Communication is often seen as either verbal or non-verbal (and psychotherapies seen as verbal or non-verbal psychotherapies). This conceptualisation arises from the dominance of dualism, and the tendency towards pairing phenomena with their apparent polar opposites. Things are either/or, rather than both/and. Interestingly, Totton has pointed out that some body psychotherapists believe that they work non-verbally, which is “mainly an illusion.” (Totton, 2003, p.134). Any relationship has both verbal and non-verbal aspects occurring simultaneously. Interest in non-verbal communications in the clinical situation is growing and has emerged from the relatively recent research into emotion, where the significance of non-verbal communications in the expression of emotion, and emotional regulation is being recognised (Damasio, 1994, 2000; Matsumoto, 1987; Panksepp, 1998; Solms & Turnbull 2002). Furthermore, research into mindfulness based therapies for depression and stress reduction is also highlighting the significance of awareness, and “experiencing through the body” (non-verbally) for therapeutic change (Segal, Williams & Teasdale, 2002; Kabat-Zinn, 1990, 2005).

Language for Information or for Emotional Communication

Language may be used for information giving, or for social and emotional communications. Although this distinction is somewhat artificial, often one form of language is dominant in a conversation. In his clinical work, Reich observed the interplay between words and emotional states. He 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.” (original italics) (Reich, 1949/1970 p. 361)

These “movements of living matter” have been called the “felt sense”(Gendlin, 1981, 1996). The felt sense is the collection of physical sensations, both kinaesthetic and emotionally “tonal” occurring in the body, which are the precursor of a named emotion. Similarly Damasio (1994) has described “somatic markers” existing alongside rational thinking and providing vital information for decision making, and essential in social communication. Individuals talking from the “movement of body sensations” are “rooted” in their words. The client’s words have a direct connection with what is moving them physiologically, energetically, and emotionally, and are expressive of the person’s fundamental being. Often “rooted words” are less formed, and can emerge as sounds, and fragments of sentences with pauses in them as the client attempts to find the correct resonant words to convey their experience (Southwell, 1999).

Language as Defence

Words can also be used to obfuscate, distract and camouflage. “Word language” often functions as a defence. Sometimes patients are “drowning in verbiage”, the “meaningless activity of muscles” (Reich, 1949/1970, p. 362). “Talking about”, defensive words can be contrasted to “rooted talking”. Andersen[i] has written of “talking about” language as “dead talk”, lacking “living process” (Andersen, 1991; Shotter & Katz, 1999). So called “dead talk” develops, when a child learns to limit their breathing from being raised in an inhospitable environment. “One could literally say that the rather tense circumstances make the person reduce his/her inspiration from the surroundings” (Andersen, 1991, p.18). This has both biological and spiritual implications. In the clinical situation the psychotherapist might choose to let the client continue to communicate in “talking about” mode leaving the defence in place, or with a more robust client the defence might be challenged.

Clinical example

From “talking about” to “rooted talking”

An example of the shift from “talking about” to “rooted”, emotionally expressive talking comes in the first assessment consultation with a potential new client. After a while I realise that the client has not answered any of my history-taking questions directly. She talks genially and gives content, but I recognise that I feel a bit bored, and puzzled. I track more carefully how I feel and also notice a certain frustration. I then notice that, when I ask a direct question the client answers tangentially, and I am none the wiser about anything definite, nor about her emotional state as expressed by her words. I decide to let her talk in a more free-floating way without asking questions, and to attend more carefully to my own physical state (somatic counter-transference) as it is reflecting our relationship. My presence becomes more spacious and less cognitively insistent. Gradually the client drops down into herself (i.e. her breathing has deepened and fills more of her whole body, she looks more relaxed across her chest and arms). She slowly comes to what feel like central life statements with feeling tones attached to the words.

“I was never allowed by my mother to do anything I wanted to do. Anything I did spontaneously was rubbished….” The client begins to cry. “ I can never get started with anything……..I lack confidence…...I’m angry and frustrated.” The crying has peaked in intensity and moved into hot “charged” words with more anger in them.

By shifting my presence, and listening in a different way, there has been a palpable effect on the client, and she has spoken from below her conscious awareness. By the end of the consultation I have a sense of having “met” the client, and there is a sense of completion and possible new beginning.

Not all emotional expression translates into words

Although Reich found that language can reflect the state of “plasmatic movement” (i.e. the movement of body fluids and energy) in someone, indicating the general sense of aliveness or “living” life state of the person, he also observed that communicating only verbally cannot reach this inner aliveness in another.

“The living not only functions before and beyond word language; more than that, it has its own specific forms of expression which cannot be put into words at all.” (original italics) (Reich, 1949/1970, p. 361)

Reich made an analogy between verbal and musical communication. Music has the capacity to move the listener without words being spoken. Moreover, if someone hears a piece of music and wants to convey it to another, then humming or singing it would be more likely to do so. It would be nonsense to attempt to speak musical notation, or to communicate verbally what the music communicates musically. Reich was aware of the power of music and other forms of non-linguistic communication to take people into deep contact with themselves.

“What is described as the “spirituality” of great music, then, is an appropriate description of the simple fact that seriousness of feeling is identical with contact with the living beyond the confine of words.” (Reich 1949/1970, p. 361)

This finding is significant in the therapeutic relationship. It suggests that the deepest contact and spiritual connectedness with another is probably word free. Maura Sills writes of the relational field of awareness developing, deepening and becoming more inclusive of whole experience between client and psychotherapist in a joint exploration. If the relational field embodies qualities of stillness, warmth, empathic resonance “implicate information is subliminally conveyed and known silently with clear comprehension. Within this kind of relational field, a client might truly hold their suffering in balance and open to an experience of their human beingness that is beyond words.” (Sills, 2006, p. 211)

Winnicott echoes this when he writes of a crucial aspect of the mother – infant relationship in which the mother dwells in silence alongside the infant to foster the development of the true self. “…….it is the experience of being alone while someone else is present.” (Winnicott, 1990/1958 p. 30). The infant has an experience of the presence of the mother whilst being free to be alone and with him or herself. The mother is neither impinging nor depriving. The infant is freed from the need to be alertly watching the mother and her moods to feel safe. The child can trust the mother’s love and is able to simply be with his or her arising experiences.

Challenging the client’s defensive speech – “Getting under the words”

Reich learned to interrupt the defensive speech of his patients and thereby take the patient “to a depth that he tried to flee.” This elimination of verbal (non) communication to a focus on physiological, emotional, and energy movement to invite deeper communication is familiar to many forms of body psychotherapy and the basis of “Vegetotherapy”, a form of psychotherapy created by Reich (1942/1961) and subsequently developed (e.g. Southwell, 1988; Boadella, 1987). Reich learned to move away from listening to the content of words and instead to listen more to their form and function. He listened for “not only what the patient said, but everything he presented, particularly the manner of his communication or of his silence.” The how of the words was more important than what was actually said. “Words can lie. The mode of expression never lies.” (Reich,1942/1961, p.145) Reich saw this as the immediate manifestation of the unconscious and learned to differentiate this from character defence.

Clinical example

Interrupting the Client’s defensive words for more contact

A clinical example of the psychotherapist interrupting the client’s words, and redirecting the focus of attention to deepen the contact between the client and her inner self, as well as her contact with the psychotherapist is from a session with an experienced client, Helen, who has been in body psychotherapy for a couple of years and knows how to use the process. Helen knows that she can run away from herself with flurries of words and ideas, and we have a working agreement for me to interrupt her, if she does not “catch herself”. She can find this very containing. Helen is describing a conversation with a health worker about her ailing father. She is getting lost in the story of who said what and her ideas of what his care should be. I begin to feel confused myself in the detail of the story. I breathe and come back to myself through bringing mindfulness to my experience. I start to recollect where I began to get confused, and my interest waned. As I am doing this Helen is feeling uncomfortable “something niggles and is upsetting.” I suggest that she pauses in the narrative and brings awareness to what is happening in her body. She becomes more inward-focused and somewhat reflective. Her face begins to look “upset.” I notice very tiny movements in her face, and let myself breathe fully. “Upsetness” seems to intensify in Helen. Waves of emotion come up Helen’s body emanating from the abdomen, and she sobs deeply. Through the tears she cries “He is so lonely and distressed”. I assume that she is talking about herself, her father and her relationship with me. Later on we talk together about this tapestry of meaning.

Neuroscience and Communication

Body Psychotherapy has empirically developed ways of working with language, but the development of modern technology such as MRI scans (Magnetic Resonance Imaging), C(A)T scans ( Computed (Axial) Tomography) and PET imaging (Positron Emission Tomography) allows us to see what is active in the brain when performing different tasks. It can also link this to what a person’s emotional experience is at the time. This means that Neuroscience knows much more now about what is happening in the brain when communicating than in Reich’s time.

Left and right brain functions and communication

The right hemisphere of the brain is dominant in the processing of non-verbal communication and visuo-spatial information. It is active in the expression of emotion and in the processing of emotional information. It recognises the elements of speech such as intonation, pitch, speed, volume, rhythm (collectively called prosody) and responds to the evocation of stimuli outside conscious awareness. The right brain is also seen as the unconscious. The right brain is activated by and regulated by the tone of voice and facial expression. This is pertinent in caretaker-infant relationships for the immediate well-being of the child and for the future development of the brain. In psychotherapy relationships it is also highly significant.

The left hemisphere of the brain has long been considered the verbal hemisphere which articulates through language and is concerned with structuring and processing information. It is also more about a conscious understanding of what the other thinks of me (Schore, 1994). In the 1970s drawing with the non-dominant hand was encouraged in the humanistic psychology movement as a way of freeing up creative expression and inviting the spontaneous and intuitive to rebalance an over rational culture (Clarkson, 1989). This rebalancing and connecting left and right brain functions remains a central therapeutic issue. By attending to both verbal and non verbal communication BP endeavours to integrate these functions.

The Autonomic Nervous System and affect regulation

The autonomic nervous system (ANS) is also involved in the communication of emotion by amplifying, sustaining and modulating the intensity of emotional experiences. We can consider different emotions as belonging relatively more to the sympathetic nervous system (arousing aspect) or parasympathetic nervous system (calming aspect). Rage and frustration, for example are more arousing emotions, and sadness and joy are more calming ones (e.g. Reich, 1942/1961; Westland, 1987; Liss, 1989; Carroll, 2005). This capacity to regulate feeling states develops in the infant-mother relationship and is essential for the brain to develop optimally. An attuned caregiver is responsive to her baby’s needs. This includes relating to the level of arousal, and consciousness of the child. It also includes helping the infant to negotiate misattunements. Both caregiver and child will be actively involved in this relational dance (see for example Stern, 1985; Brazelton & Cramer, 1991; Schore, 1994; Murray & Andrews, 2000; Trevarthen, 2003; Gerhardt, 2004; Carroll, 2005).

The Therapeutic Relationship

The therapeutic relationship has both verbal and non-verbal communications going on between psychotherapist and client. These are particularly significant in helping clients to regulate their emotions and to complete interrupted developmental states. For the body psychotherapist, an overarching question is what is happening in the client, and in myself right now, and from moment to moment? What am I/the client experiencing, sensing, thinking, feeling, imaging right now? What is the level of arousal and level of consciousness of the client? How is the client attempting to move towards a greater level of well-being? Various theories, e.g. the charge-discharge cycle, (Reich, 1942/1961), the Vasomotoric Cycle (Boyesen, 1975; Southwell, 1988; Westland, 1997; Eiden, 2002), are held in the background awareness of the psychotherapist about the state of arousal or conversely the resting state of the client. These theories also include thinking about the movement of inner impulses. These impulses are physiological, energetic and emotional, and “impinge from within,” attempting to move the person towards more wholeness and the completion of arrested development. The working assumption is that both the client’s and the psychotherapist’s systems are fluid, continually changing, and expanding to include more, and to go towards greater health. And, moreover, that they interact through the communication, both verbal and non verbal.

From this awareness of the process the psychotherapist decides what she wants to relate to in the client, what sort of relationship is required, what to “invite”, and what intention to hold. For newly qualified psychotherapists this process can seem quite technical and cognitive, but with experience techniques become honed skills. With further maturity and experience these skills become embedded, just part of the human-beingness of the psychotherapist (Kurtz, 1990)

Sometimes there will be more right brain to right brain conversation (one unconscious to another) when there will be more going into the unknown, and being receptive to what is “impinging from within”, and at other times the client’s left brain will be more engaged, perhaps by gathering factual information. In practice, the relationship with a client moves in a dance-like way between the relative dominance of either hemisphere in an unfolding process.

Key aspects of the therapeutic relationship

Many body psychotherapists regard presence, resonance, and intention as key aspects of the therapeutic relationship.

Presence

Presence is something akin to empathy or attunement, but it is more than these terms imply. It is about resonating with the client – somatically, energetically, emotionally, and imaginally, and being present to direct somatic experience of the client. Embodied presence invites presence in those around us. This form of relating is more at an implicit, non-verbal level, the right brain of the psychotherapist communicating with the right brain of the client. When this happens the client will feel “received” and understood. However, oftentimes, when the psychotherapist is frightened or triggered by the client the therapist will go to left brain interventions such as interpretation and explanation when what is needed is a “being with” response. Often the psychotherapist will be unaware of these reactions (Schore, 1994).

Nevertheless, these misattuned events are key moments therapeutically and potentially transformative in the relationship, but too many of them can leave a client feeling that the therapist is just not on the same wave-length and the psychotherapy is likely to be terminated prematurely.

Resonance

Resonance involves the psychotherapist somatically sensing the impact of the client.

“The emotional expression of the patient produces in our organism an involuntary imitation. Imitating, we feel and understand the expression in ourselves and with that in the patient. Since every motion has an expression and thus discloses the emotional state of the protoplasm. The language of expression becomes an essential means of communication with the patient’s emotions.” (Reich 1949/1970, p. 364)

Since the discovery of mirror neurons (Gallese, 2005) we know more about the neurophysiology of this process of “embodied simulation”, occurring at an implicit level and its function in social communications. Reich knew the importance of getting the feel of a patient. He writes:

“Only when we have felt the facial expression of the patient are we also in a position to understand it. To “understand” it means here, quite, strictly to know which emotion is “expressed” in it.” (original italics) (Reich, 1949/1970, p 363)

Usually if a therapist is to notice this impact more consciously a slowing down of awareness is necessary. Time is also needed to feel and digest the impact, and only then to respond to the client with considered speech. Andersen explains that if the psychotherapist’s words are too “unusual” or not “unusual” enough they will either have too much impact or not enough. In feeling the impact it becomes clearer where there are “openings” about what to talk more about (Andersen, 1991)

Intention

Intention is “expressed through subtle and delicate variations on touch and vocal tone.” (Bonenfant 2006, p.120). Bonenfant relates this to the therapist’s “somatic modes of attention” as applied to “corporeal and attitudinal intention,” which Csordas[ii] has written about. I would add presence to this, and observe that the communication does not require physical touching. It is a combination of the intention and presence of the psychotherapist that can have such a potent impact on the client. As a therapist, using intentional language involves tuning into oneself on as many levels as possible – somatic, energetic, cognitive, intuitive, imaginative - by experiencing through the body the impact that the client is having. Nunneley (2000) writes of “attending to the whole person” and then “intending”. Attending shifts awareness between attending to oneself and to the client. Awareness and attention can be sometimes more specifically focused and sometimes more diffuse. Rainer Pervöltz has emphasised that having a mental attitude of intending to achieve something is actually limiting, “the biggest obstacle to change is the pressure to change” (Pervöltz, 1982, p. 139). So intention is an embodied, lightly held trust in the process. Pervöltz continues: “My role as a therapist is to help you rediscover that you can swim – even in deep and seemingly dangerous water. If only you trust that you can, you can.” The form of words used by the psychotherapist will reflect the way that s/he wants to impact on client.

Amplifying and Deepening Emotion or Lowering the Emotional Arousal

There are two basic choices when considering emotional modulation in the therapeutic relationship. Emotional arousal can be amplified or reduced, depending on the therapeutic need. The therapeutic encounter can be conducted more at the “emotional level” or conversely “the matter of fact level” of consciousness. These levels are also called the “tragic and trivial levels” (Boyesen, 2006). Matter of fact relating is close to everyday consciousness and can take the client away from overwhelming feelings. Emotional deepening can take a client towards the discovery of an inner world with strong feeling tones attached to it. At its more profound level it takes the client into stillness, being, and interconnectedness with the universal. At this level of consciousness the boundary between individuals dissolves – there is interconnection.

Lowering the Emotional Arousal

Clients who have suffered early deprivation, invasion or trauma often lack the ability to regulate their emotions. It may be inappropriate to enter into either a transferential or a real relationship (Rothschild, 2000). What is helpful is to talk relatively more to the left brain with the idea of restricting the intensity of feeling. For this the therapist’s presence is closer to the every day level of consciousness – attending to what is known and explicit. It can involve naming what is happening, describing events without inviting the emotional tones, and giving “headlines” of key events rather than going into them. The client is encouraged to reflect on the process. The therapist also holds the relationship more “short rein” with the sense of space between client and therapist reduced so that there is less room for the client to become overwhelmed with feelings. The process will be relatively more outer-directed with the therapist taking more overall charge about what is discussed.

Inviting Emotional Deepening

The late Gerda Boyesen, who developed Biodynamic Psychotherapy found ways of relating to clients and their spontaneous movements, which are often more at an implicit, barely discernible level in the energy field. In this work the psychotherapist brings presence, contact, awareness of the client’s level of consciousness together and uses language that the right brain can understand. Boyesen differentiated “It” and “I” language. So called “I” language has a somebody, who is experiencing a feeling and owning it. For example “I am angry with you.” In contrast “It” language used by the therapist has no ego in it and is more diffuse. “It” language can take the client into emotional energy and the universal, where the boundary between myself and others is indistinct. This is not the same as merging with the client. To invite “It” energy the therapist uses descriptive, non-personalised words. For example “there is anger around…..” The anger is neither yours or mine, it’s in the atmosphere, and the intersubjective relationship.

If the body psychotherapist tunes into the client and senses that there is something impinging from within, she may switch to “It” language. The psychotherapist talks more to the client’s intrapsychic processes. As this becomes the focus of awareness, the interpersonal aspects of relationship fade more into the background. Body psychotherapists often describe this as “talking to the energy”. The body psychotherapist’s energised words talk to the energy of the client.

The psychotherapist might say something like…..”let it move……….., feel where it wants to move…….”

At this point the body psychotherapist’s language and presence are critical. Her presence needs to be anchored, but spacious and long rein, suggestive of endless time. The client may make sounds, or utter words, which are unlikely to be coherent sentences. Spontaneous changes in breathing, and movements will also occur. The therapist quietly notices these and is available to receive the spontaneous “beingness” of the client, rather than anything mechanical or produced.

Clinical example

The movement from “It” into “I”

Penny is lying down on the mattress (a usual piece of furniture in a body psychotherapy consulting room equivalent to the analytic couch). She is in her fourth year of psychotherapy and now has a coherent daily life. The act of lying down invites slowing down, softening and surrender. It is a familiar way for us to be together. I sit by her side on the floor. She has closed her eyes. Almost without needing to say anything, I suggest “…… let yourself go inside, ……feel what is happening …….. “ My tone is soft, and suggesive of there being time.

After a while Penny notices that her breathing feels restricted and tight.

Gently, I suggest that she might let her breathing move into the restriction.

As she does this her breathing changes, becoming somewhat chaotic, then begins to flow apparently more easily. There are minute movements in her hands, and as the movements become bigger, I suggest “………feel what the hands want to do……….”

Tears begin to trickle, and develop into loud sobs. Penny’s body shudders and her arms reach out. “ …….I want my Mummy, I want my Mummy…..”

I feel pain and longing in my chest, as if I will die with the unbearableness of it.

Penny continues to call insistently for her mother; the tones of her words are heart-rending, sometimes more angry (“Mummy’s not coming”) and then Penny says that she is beginning to feel good. “I didn’t know that I could shout that loud….,…. I feel warm all over………. my arms and hands are tingling…..….. I feel pleasantly tired, and my chest feels warm and pulsating.”

In this session, the focus is on letting the client’s impulses emerge rhythmically in their own time. The therapeutic task is to tune into the impulses, to support their emergence, and to “witness”, like a midwife what is completing itself. In later sessions there will be discussion, and meaning brought to the experiences of the session. “Meaning” is used here in the sense that Gendlin has described it as perceptual awareness rather than a conceptual understanding (Gendlin, 1996). Meaning is not imposed on the client. The client needs to have time and solitude to absorb the experience and create their own meaning. Out of this, there might, later on, be new conceptualisations arising.

CONCLUSION

The way language is used in body psychotherapy reflects the complexity of the therapeutic relationship and the particular journey of each client. Verbal interventions are always coupled with considerations about presence, intention, and attention to levels of consciousness in client and psychotherapist. The psychotherapist is required to continually shift attention between relatively more right-brained and more left-brained interventions and to spontaneously use language for different kinds of dialogue and therapeutic outcomes. Certain language usage seems to benefit particular client groups and the clinical use of particular forms of language in body psychotherapy would merit further study.

ACKNOWLEDGEMENTS

I would like to thank Clover Southwell for many hours of discussion on this and other topics.

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