The body is a contentious issue in the field of psychotherapy. That psychological problems often manifest themselves in physical symptoms and that therapist and client often find themselves engaged in non-verbal communication, is an undeniable fact. But opinions are divided as to how much physical expression is possible – and permissible – in psychotherapy.
On the one hand we have the officially acknowledged forms of psychotherapy: psychoanalysis, behavioral therapy, client-centered and relationship/family therapy. These forms are all based on the use of the spoken word and are less involved with physical aspects. On the other hand there are "alternative" forms of therapy, which concentrate specifically on the body: Gestalt therapy, Bioenergetics, Primal Scream, Rebirthing, Neuro Linguistic Programming and many more. These two circuits are worlds apart when it comes to acknowledgment, education and remuneration, the body itself forming the dividing line: a pronounced absence of the physiological in the official psychotherapy and the expressed presence – sometimes even the glorification – of the body in the alternative circuit.
The acknowledged, verbal psychotherapy and the alternative body-oriented psychotherapy tend to conflict. The alternative circuit regards psychoanalysis as an over-intellectualized and drawn-out process and behavioral therapy as too superficial. The official psychotherapy circuit is generally accused of having no time for the "person as a whole" and that the organization is too bureaucratic with its referrals and intake-procedures.
The alternative, body-oriented forms of psychotherapy are often averse to systematic theory-forming and tend – in the eyes of traditional psychotherapists – to conjure up dangerous "spooks", without being able to handle the consequences. Using such mottoes as the "body’s own wisdom" and "expressing your emotions", the emphasis is too often placed exclusively on unloading emotional stress without any clear context, whereby it cannot always be predicted whether the client is able to integrate these experiences.
Professional conservatism tends to require that traditional psychotherapists totally renounce the physical side of therapy; however, it is not possible to think away the body entirely from the therapeutic relationship. Take, for example, the paradoxical situation in classical psychoanalysis, whereby the client is expected to lie on a couch during the hour with the therapist. The fact that this amounts to a powerfully physical intervention is insufficiently recognized. But after all, the supine position is not only associated with fear, shame and powerlessness, but also awakens in many clients memories of certain physical experiences. During the past ten years more attention has been given to non-verbal communication in psychoanalysis and psychotherapy, but this falls to insignificance in comparison to the attention given to verbal interaction.
One reason for holding back is that even when physical contact is carefully done and applied with caution (for example, when consoling a client or when restraint is used during a panic-attack), the feelings between client and therapist may become unmanageable. The subsequent confusion this produces can undermine the understanding and alliance which the therapy was designed to establish.
A second reason why official psychotherapy maintains a cautious approach to physical involvement is that many psychotherapy clients have been physically or sexually abused as children; this fact is supported by statistics. Research quotes figures of 15% for the entire female population, 30% for female psychotherapy clients and 40% for women admitted to psychiatric hospitals. Taking into consideration the arguable accuracy of these figures it remains an incontestable fact that since the time of Freud we have been confronted with reports of a far higher incidence of physical and sexual traumatization than ever before thought possible. This poses the psychotherapist with a tricky dilemma; the violated body of a traumatized client requires close care and attention on the one hand, while at the same time the therapist must maintain a safe, professional distance. Furthermore, there are few thorough methods or techniques available, and these are insufficiently tested.
Official psychotherapy chooses the safe option and avoids physicality completely, thereby limiting the most direct source of emotional experience to the margins of mental health care. The body appears to have acquired an "alternative" status. Have psychotherapists taken their cautious approach too far and developed it into an inflexible attitude whereby not only physical contact itself, but also all consideration of physical experience is excluded? Wouldn’t this give many clients the impression that physicality is taboo, and might therefore seem like a repeat of past experience? Is it not understandable that clients, having run out of ways of trying to express their feelings verbally, turn to one of the alternative methods in order to "let the body do the talking"?
Meanwhile, psychotherapists now are also making an appearances on the alternative circuit. The fact that psychological problems usually have a physical dimension, whether as cause or effect, can no longer be ignored. Discussions at congresses and in scientific journals often raise the question of whether the body should be involved in psychotherapy. Also psychoanalysts, pre-eminently expert in verbal communication, are hesitantly starting to tackle the issue of "het vege lijf"1. But the bridges being forged between the body and the mind are for many still considered rather too risky to negotiate.
It is in this climate that Pesso psychotherapy is attracting increasing attention. This is not because Pesso psychotherapy claims to have a solution for everything, but because it does answer the question how bodily experience and reaction can be incorporated into psychotherapy in a safe and professional manner. An essential factor in this is that the various forms of physical contact occur only at the client’s initiative and only with persons other than the therapist.
Readers of this book will notice that at the basis of Pesso psychotherapy lies an optimistic vision of mankind, which can briefly be summarized as follows.
It is the natural tendency of a human being to seek ways of enjoying life, through pursuit of pleasure, satisfaction and contact with others. Human nature demands that one’s potential be fulfilled and further developed. Pesso psychotherapy works on the basic principle that this process requires that every human being is respected, as a unique individual, at all levels – body, mind and soul. Where this has not been the case, the client gets a second (symbolic) chance by means of this therapy.
Furthermore, it works on the premise that the individual is driven in this process by an inner instinct. Internal conflicts between the instinctive need for fulfillment and internalized denial manifest themselves in physical symptoms. The body/mind is able to store information and create its own symbolization -- its own memory and language, as it were.
In Pesso psychotherapy the approaches of psychoanalysis and family therapy converge, together with a client-centered attitude, in the one philosophy of treatment. This is coupled with a methodology based on the understanding of human physical and psychological development. As the research of Margaret Mahler and Daniel Stern shows, personal identity is formed within a body process consisting of actions and functions. Meaningful memories which influence our daily life are rooted in action, movement and bodily contact. In Pesso psychotherapy clients are given the time and space to explore, within their own range of physical actions and experiences, the correlation between verbal and non-verbal language and between past and present. Posture and voluntary movement, physical symptoms and complaints bring the client in touch with psychological conflicts, unfulfilled needs and traumatic experiences. The body plays a key role in Pesso psychotherapy, providing the line of approach to help the client trace and process unresolved emotional conflict. Instead of only discussing such conflicts, it allows the client to feel and express them physically and to look for a physically experienced, symbolic alternative.
In the development of a form of therapy in which body and mind are brought together, Albert Pesso and his wife, Diane Boyden Pesso, can be called pioneers. In a process lasting 35 years they have been remarkably successful in tempering their charismatic expertise with a healthy dose of critical objectivity – an example to many formally educated scientists. This has helped and enabled them, together with other tutors, to pass on their methods using well-organized training courses both in the United States and Europe, where their work has widely received acknowledgment and appreciation.
This book offers a lucid, engaging introduction to Pesso psychotherapy. Clear use of language and practical examples describe the points of departure and application of techniques in practice. It is written for clients but also offers the therapist a fresh insight into day-to-day activities. Furthermore, it is a valuable source of information for parents and care-givers.
The author, herself an experienced Pesso psychotherapist, takes on the part of the dedicated and creative narrator, supported in this by the Pesso psychotherapy professional group in the Netherlands. She has hereby created a bridge between the client and the therapist and between language and physicality, worlds which have been kept separate far too long.
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1 Title of Psychoanalytic Symposium, May 1996
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