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Therapist’s Body Awareness in the Client –Therapist Interactive Process

Barbara Karlsen

May, 2012

Submitted in partial satisfaction for the Somatic Counseling Psychology Program

requirements of a master’s degree in Body Psychotherapy

Naropa University

Boulder, Colorado, USA

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Title: Therapist’s Body Awareness in the Client –Therapist Interactive Process

Author: Barbara Karlsen

Abstract

Body psychotherapists focus not only on the client’s body in clinical practice, but their own

body as well (Field, 1989; Shaw, 2004; Stone, 2006). This moment-to-moment attention to

the somatic process emerging between therapist and client is an integral part of the affective

dynamics between the body psychotherapist and client, and forms a central part of the

therapeutic alliance. Attending to this inner “felt sense” (Gendlin, 1992) requires the body

psychotherapist to have a keen awareness of their bodily response, and to use their body in a

sensitized matter. Using a qualitative research design, three body psychotherapists were

interviewed to explore the role of their body awareness in the therapeutic relationship.

Results showed the therapist’s body awareness forms a distinct dimension of subtle

interaction within the therapeutic dyad and is used to perceive information about the client

and the therapeutic alliance. Results also show that clients learn from the therapist’s body

awareness, and the field of body psychotherapy gives client’s permission to feel and move

their bodies as part of the therapeutic process.

Keywords: attunement, body awareness, body psychotherapy,

implicit communication, non-verbal communication.

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Introduction

The role of the therapist’s body awareness in the therapeutic relationship is largely

unexplored and undefined. When the body in the therapeutic encounter is written about, it is

predominantly the client’s body that is the focus of attention, and there is little reference to

the therapist’s body while working in the therapeutic dyad (Shaw, 2004).

In a body psychotherapy session, the therapist has to be aware of and track “felt

changes” within their own body, while at the same time track and help to regulate the client’s

experience as a source of insight about their health and wellbeing (Aposhyan, 2004). This

moment-to-moment attention to the somatic process emerging between therapist and client

requires a particular type of attention that reaches beyond tracking body postures and

movements, and requires a subtle attention to internal states. The author considers the body

psychotherapist’s body awareness to be a key component of this subtle attention. This

qualitative research study is an attempt to explore and determine a therapeutically relevant

concept of body awareness and it’s therapeutic relevance for the body psychotherapist in the

therapeutic dyad.

This author defines body psychotherapist as a psychotherapist who is trained in

specific skills such as body, movement and sensorimotor tracking in the process of

psychotherapy. The author will define body awareness using a definition proposed by Bakal

(1999), “the ability to perceive, interpret, and act on the basis of internal bodily

sensations”(p. 78). In the therapeutic encounter, a body psychotherapist uses their sensorial

experience as a source of knowledge, and recognizes that body- to- body communication

between client and therapist is important (Appel-Oper, 2010; Field, 1989; Shaw, 2004; Stone

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2006; Tantia, 2011). The therapist tracks his or her own nonverbal body communication by

feeling into their body, and receives the patient’s nonverbal communications through their

inner “felt sense” of the other (Gendlin, 1992). This paper posits that attunement, resonance

and nonverbal communication are considered important therapeutic skills, and require that

the therapist develop a keen awareness and understanding of their own body (Aron, 1998;

Rumble, 2008;Wilkinson, 2010). The author wonders what is it about therapist’s body

awareness that is unique and how then can it be used to facilitate or even augment the

therapeutic relationship? Using data from three qualitative interviews with body

psychotherapists in the Boulder, Colorado area, key concepts and themes pertaining to the

therapist’s perception and understanding of their body awareness in the therapeutic dyad

were compiled. The questions were structured in a way to help the respondents reflect both

conceptually and experientially. The respondents were able to stray from the interview

questions in the way they needed to describe their personal experience. All interviews were

recorded, transcribed and coded. Relevant words, phrases or statements within the text were

selected and categorized into Codes. Dominant and repetitive categories from the Codes

were then reconfigured into Themes to capture the essence of participant’s key concepts

from their initial descriptions. Themes were then used to formulate theoretical constructs.

Research Literature

Literature on the therapist’s body awareness, and the therapist’s awareness of their bodily

experience as an additional source of information in the therapeutic dyad were reviewed.

While the bulk of research focuses on patient’s verbal and cognitive domains, there is limited

reference to the relevance of attending to the therapist’s or the client’s somatic experience

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during the therapeutic encounter (Boadella, 1997; Dosamantes- Beaudry, 1997; Kepner,

1993; Shaw, 2004). When therapist’s somatic reactions during therapy are mentioned, it is

mostly pertaining to the idea of somatic countertransference. Somatic Countertransfence is

“the effect on the therapist’s body of the patient, and the patient’s material” (Forester, 2007,

p. 129). It may be a somatic reaction to something about the patient that evokes the

therapist’s own material (Casement, 1985). For the purposes of this paper, this author feels

that classical psychotherapeutic terms like countertransference may be inadequate when

addressing the role of the therapist’s body awareness in the therapeutic alliance.

A thematic review of the literature was done to illuminate the therapist’s bodily

experience from a neurobiological and a phenomenological perspective, and the specific

processes that may account for the therapist’s body as an “organ of information” (Samuels,

1993, p. 33) and vehicle of “implicit communication” (Chused, 2007, p.879). Key concepts,

existing theories and major theorists were reviewed.

Right Hemisphere Implicit Processes in Psychotherapy

Recently neuroscience has added much to our understanding of the psychoneurobiological

mechanisms involved in nonverbal implicit communications (Schore, 2005). This knowledge

has expanded our view of what happens in the interactive process between client and

therapist. Right hemisphere implicit structures are associated with the nonverbal, symbolic

and unconscious components of neural processing as opposed to the more explicit conscious

processing of the left hemisphere (Happaney, Zelazo, & Stuss, 2004). Implicit

communication expressed in body movements, posture, gesture, facial expression, voice

inflection, and the rhythm and pitch of the spoken words is an ongoing process in any dyad,

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and can provide information about one another without explicit acknowledgement ever

occurring (Schore, 2011; Dorpat, 2001). This has been referred to as “implicit relational

knowing”- a noninterpretive mechanism of the change process that does not rely on words

(Lyons-Ruth, 1998; Schore, Stern et al., 1998). Infant researchers, focusing on the facial

expressions, gestures, and prosody of mother/infant pairs have recently emphasized implicit

processes, and automatic actions (Beebe, Knoblauch, Rustin, & Sorter, 2005). This ongoing

paradigm shift from the explicit, verbal, conscious, and analytic self to the non- verbal,

unconscious, corporeal implicit self is becoming increasingly well known within the

psychotherapy world and has great implications for the role of the therapist’s bodily presence

as an intervention in the therapeutic relationship (Schore, 2011).

Affect attunement is another right hemisphere implicit process that is considered a

crucial aspect of the therapist’s interaction with the client (Beebe and Lachmann 2002; Stern

et al; 1998; Tronick et al, 1998; Wilkinson, 2010). According to Wilkinson (2010, p. 45),

attunement is “being aware of and responsive to another.” Rumble (2010) posits, “the body

forms a distinct dimension of attunement which can be explored by paying careful attention

to body sensations” (p. 130). This bodily dimension of attunement might also be considered

attunement between bodies, where one body impacts another. In other words, the body is

there for both for the therapist and the client, and is a direct participant in the interaction

(Rumble, 2010).

Affect attunement requires the therapist to track and helps to modulate client arousal,

and forms a rhythmic background to the ongoing verbal exchange between client and

therapist (Beebe & Lachman 2002). A key theorist in this area, Wilkinson (2010) has

assembled many theoretical and scientific sources and makes a solid case for “right- brain,

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implicit intersubjective affective transactions”(p.65). She asserts, “attunement and embodied

empathetic engagement are crucial in transforming the client’s internal working

model”(Wilkinson, 2010, p. 33). A growing number of neuroscience researchers now

emphasize the need for giving attention to nonverbal variables such as tone, tempo, rhythm,

prosody as well as body signals in the therapists’ interaction with the client (Hutterer and

Liss, 2006; Porges, 2009a; Schore, 2005; Stern, 2004). Schore (2008b) stresses how much

more than words is involved in therapy, and endorses the view of Hutterer & Liss (2006)

who emphasize the need for nonverbal variables such as tone tempo, rhythm, prosody and

amplitude of speech as well as body signals to be considered as crucial aspects of the

therapist’s interaction with the patient. According to Behnke (1995), body awareness is a

right hemispheric function that helps us attend to our emotional, ongoing, bodily felt

experience and to differentiate it’s meaning further through words.

Relational Intersubjectivity and Mutual Co-creation

To posit the relational role of the body in psychotherapy, contemporary relational and

intersubjective theorists were reviewed. Relational psychoanalysis privileges the role of

“intersubjectivity” over subjectivity and objectivity (Mills, 2005). Intersubjectivity refers to a

condition of interpersonal interaction. In his critique of relational psychoanalysis, Mills

(2005) emphasizes “dyadic attachments, affective attunement, and mutual recognition over

the role of interpretation” (p.155). Mill’s view demonstrates a relational dynamic that equally

applies to the mother- infant dyad and the therapeutic encounter (Beebe & Lachmann, 2003).

To help provide a theoretical framework for viewing the relational and intersubjective nature

of therapy, infant researchers such as Beebe and Lachmann (2002), Schore (2004), Stern et

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al., (1998) and Tronick et al (1998) were reviewed. Their focus is on two bodies in

relationship whereby each partner impacts on each other. Of particular interest is their

concept of “affect attunement” which posits that affects (intense emotions) play an

intersubjective role in the early pre-verbal relationship between infant and caregiver (Stern,

1985). According to (McCluskey, 2005), the infant’s affective display is a powerful signal

that calls on the caregiver to respond. Interactive regulation flows in both directions on a

moment to moment basis so that each experiences influencing, as well as being influenced by

the other (Beebe &Lachmann, 1998). The dynamics of this call and response lies in the

ability of the caregiver to attune to and modulate affects within tolerable parameters (Mc

Cluskey, 2005).

Infant researchers with an object-relations perspective such as Winincott (1971),

Mahler, Pine and Bergman (1975), focused on the physical and emotional contribution of the

caregiver to the infant’s emotional development, and emphasized the role of the mother in

the acquisition of the infant’s sense of embodiment. The emotional resonance of the

caregiver with the infant’s somatic experience provides the child with a mirror that reinforces

and affirms his or her sense of embodied existence (Mahler, Pine &Bergman, 1975). Infant

researchers Beebe and Lachmann (2002), Schore (2004), Stern et al., (1998) and Tronick

(1998) contend that this view of nonverbal interaction as a coordinated state, is as relevant to

adult communication and the client /therapist interaction, as it is to mother infant

communication. In somatic psychotherapy practice, body-to-body interaction, nonverbal

interaction and affect attunement between therapist and client has always been an important

way of working in the therapeutic relationship (Gratton, 2010).

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Embodiment

Most of the emphasis in somatic psychology to date has focused on subjective experience

through the body rather than on embodied relationship (Dosamantes-Beaudry, 1997; Shaw,

2004). There is a prevailing attitude in body psychotherapy that the therapist’s physical

resonances, or reactions, such as subtle changes in postures, gestures, and movements are

mainly used for further information on the client (Joyce & Sills, 2001), or are viewed as

physical counter-transference (Soth, 2006). To provide a broader conceptual framework for

embodied phenomenon relevant to this discussion, this author will turn to Philosopher

Merleau- Ponty (1963). The importance of his work in constructing a broader notion of

embodiment is summed up by the following quote, “it is through my body that I understand

other people” (1963, p. 186). Embodiment from this approach can be used in conjunction

with intersubjective meaning; by providing what Gendlin (1981) might describe as inner “felt

sense” to the other’s posture, gestures and movements. In a process of moment-to-moment

body communication, therapist and client co-create an embodied field in which both relate

with and refer to one another (Apel-Opper, 2010). Just like the infant comes to know his or

her sense of embodiment through the caregiver’s handling (Winicott, 1971), “the somatic,

nonverbal intersubjective dialogue begun in infancy continues to be carried on automatically

and unconsciously into adulthood, even after the acquisition of verbal language”

(Dosamantes-Beaudry, 1997 p. 520).

Researchers Field (1989) and Shaw (2003) have investigated the therapist’s

phenomenological experience of their bodies to gain a deeper insight into the embodied

experience of the therapeutic encounter. The importance of their research has contributed

greatly to the theory of embodiment and in particular psychotherapist embodiment. A major

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theme to emerge from Shaw’s (2004) research is that “the therapist’s body is used as means

to monitor the psychotherapeutic process, and that knowledge of the therapeutic encounter

can be acquired somatically by psychotherapists”(p. 285). As Stone (2006) reports, “the

therapists body acts as a tuning fork to resonate with the client’s experience”(p. 109).

Methods and Participants

Participants included three licensed body psychotherapists in Boulder, Colorado. All three

psychotherapists who took part in this study were selected based on the fact that they had

been in private practice for at least ten years. This was considered an adequate amount of

time to have experienced working with a variety of clients, and to have developed a keen

sense of bodily awareness in therapy. Two out of the three participants belonged to a

professional organization such as the United States Association of Body Psychotherapy, and

all three participants completed a recognized body psychotherapy training program. The

sample for the study was comprised of two Caucasian women and one Caucasian man. Their

ages ranged from 49-55 years old. Two out of the three therapists identified themselves as

body psychotherapists and one therapist identified as a somatic psychotherapist.

Procedure

Five open-ended questions were asked by the researcher during the interview with the

intention of obtaining information the participant deemed pertinent from his/ her experience

of perceiving and using their body awareness in the therapeutic encounter. Five questions

were formulated prior to the interviews, and expanded upon both conceptually and

experientially in the interview process. Questions were asked in order to elicit concepts and

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personal experiences pertaining to how the therapist might describe, and report their body

awareness operating in the therapeutic encounter. The interviews were digitally recorded and

transcribed. Following the transcription of the interviews common quotes, words and phrases

within the text were selected through a first round of coding using an in vivo coding method.

The second round of coding led to themes arising from the in vivo coding using a descriptive

coding method. Care was taken to incorporate all relevant information as clients described

personal accounts of their body awareness while working with the client.

Results

Codes are listed in Table 1. Themes arising from codes are listed in Table 2.

Table 1: Codes

Interview Questions First Order Themes

1.a. What is your personal

definition of body

awareness?

“ an informed, full bodied experience”

“ a streaming of information through my senses that informs

me”

“ using my body to observe and listen with”

“ allowing myself to be affected”

“ attention to bodily sensations and perceptions”

1.b. How do you use it in

the therapeutic

relationship with a client?

“ my primary method of perception”

“ to notice how I am in relationship with my client “

“ moment to moment tracking of information on many levels”

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“ to notice changes occurring within me and in the client”

2.a. Does your body

awareness inform you or

signal you in the

therapeutic relationship

with a client?

“yes”

2.b. How? “ sensations and impulses moving in me”

“ activation, heat, discharge ”

“ feel responses in my body”

“ a lot of perceptions at once”

“ a bodily felt sense of something”

3.a. How would you

define body awareness?

“ a full bodied participation”

“ a field of potency within, between and beyond”

“ a body intelligence that is tracking and recording”

“ integration of emotion, thought and physical”

3.b. What does it involve? “attention”

“being fully present with”

“a deep listening within and without”

“connection”

“willingness to be affected”

4.a. What is your

perception of the client’s

“helps them to drop into their feelings”

“helps them to feel something they may not be feeling yet”

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response to your body

awareness in the session?

“gives them permission to feel”

“curiosity”

“gives them a body experience”

4.b. Do you feel that the

client learns from your

body awareness?

“Yes”

5.a. Has your body

awareness changed over

the course of your

professional career?

“Yes”

5.b. How? “deepened”

“it has become more sophisticated”

“I am able to access more”

“increased my capacity to be with intense feelings”

“more resourcing in myself”

6.a. Has this changed your

therapeutic relationship

with the client?

“Yes”

6.b. How? “much more accepting and relaxed with client”

“increased feeling within myself”

“much more present with myself and client”

“offers more possibility where client can go”

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“I am more aware”

Table 2: Themes Arising From Codes

Interview Questions Second Order Themes

1.a. What is your personal

definition of body

awareness?

Using my Sensory Experience to Observe, Listen and be

Affected by the Therapeutic Relationship

1.b. How do you use it in

the therapeutic

relationship with a client?

Tracking the Therapeutic Relationship

2.a. Does your body

awareness inform you or

signal you in the

therapeutic relationship

with a client?

Yes

2.b. How? Bodily Felt Sense

3.a. How would you

define body awareness?

(Author Discarded as too similar to other questions)

3.b. What does it involve? Presence that Facilitates Connection

4.a. What is your

perception of the client’s

response to your body

Permission to Feel Body and Emotions

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awareness in the session?

4.b. Do you feel that the

client learns from your

body awareness?

Yes

5.a. Has your body

awareness changed over

the course of your

professional career?

Yes

5.b. How? Deepened Capacity to Access More in the Therapeutic

Relationship

6.a. Has this changed your

therapeutic relationship

with the client?

Yes

6.b. How? Able to Discern and Accept Differences Between Self and

Client

Discussion

In this study the role of the therapist’s body awareness in the therapeutic process was

explored. According to the interviewees, the therapist’s body awareness involves more than

just moment-to-moment physiological tracking. It involves an active engagement. This is

seen through the therapist using his/her own body to perceive, facilitate and to be affected by

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the therapeutic encounter. All three participants mentioned body awareness as their “primary

mode of perception” in the therapeutic relationship.

A second theme to emerge includes body awareness as an educational experience

wherein the client is “given permission” to engage in their bodily states. This suggests that

mirroring and reflecting body states, and using statements such as “what does your body

want to do?” and “how does your body want to move?” gives clients more options/ways to

include their bodies in the therapeutic encounter. This has great implications for body

psychotherapy and in particular it’s use as an intervention in therapy that has to do with

bodily states involved in trauma.

The third theme to emerge from the data is that amount of time in the therapeutic

relationship appears to be a factor influencing the development and refinement of body

awareness. The data shows that over time, body awareness develops into “deeper contact”

that influences therapists perceived awareness, and capacity to tolerate a wide range of

affective and somatic experiences in the therapeutic process. All participants mentioned

being “more accepting of where the client was at” and “having the increased capacity to

refrain from action and to remain curious.” This increased capacity to contain has great

implications for the field of body psychotherapy and in particular the field of trauma therapy.

In reference to a current and relevant therapeutic concept of body awareness, this

researcher proposes the following; therapist body awareness is a subtle and distinct

dimension of ongoing somatic interaction, and the primary process of perceiving information

for the body psychotherapist in the therapeutic process. Based on the three themes that

emerged from the data, the therapist’s body awareness has a significant role in the

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therapeutic encounter and can be considered to be a vital affective, relational and somatic

intervention in the therapeutic process.

Limitations

Limitations of this study include a homogenous sample of participants in regards to

theoretical orientation, apparent personal identity and educational background. All three

participants were affiliated with the same community; with theoretical foundations in body –

based approaches to therapy. It was noted after the data collection that all three participants

were also affiliated with the same academic community, and had a similar educational

background. It was noted that participants interviewed had a lack of diversity and shared a

similar ethic and racial background. Also, only three interviews were conducted for the

study, which likely did not achieve data saturation.

Limitations within data collection and methods involved throwing out question # 3

because it was deemed to be similar to question #1, and did not derive any new data.

Personal biases of the researcher include a preference towards body- based therapies and a

conceptual framework that values body awareness.

Conclusion

Body psychotherapists use their body awareness as a crucial source of information and

agency in their clinical work. When attended to, the therapist’s body awareness can inform

the therapist, facilitate the therapeutic alliance, and help the client make sense of their bodily

experience.

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Body psychotherapy training has always emphasized the somatic component of both

the therapist and client’s experience in the therapeutic relationship. However this is only one

component of somatically –oriented psychotherapies. The clinical importance of the

therapist’s embodiment and ability to reflect on his or her sensory experience with acuity and

clarity is often underscored. As therapists how do we train and cultivate this capacity for

sensory acuity and depth of bodily awareness? It is important to distinguish between

therapists’ bodily awareness in the moment, and therapist’s ongoing relationship to his or her

bodily process and how this is helpful to the therapeutic process. A future study using more

participants could look at how body psychotherapists cultivate a personal sense of

embodiment- a concept of which body awareness is just one aspect, and what that requires.

One could also include and explore how the therapist feels this practice affects the depth of

exchange between the client and therapist. This study could also include the client’s

perspective of the therapeutic exchange and whether this had increased meaning for them as

well. This could provide the basis for further research into the notion of therapist

embodiment, what this involves, and how it can be addressed and cultivated in the training of

therapists.

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