ETHICAL CONSIDERATION IN SOMATIC PSYCHOTHERAPIES

by
Ian Macnaughton, Ph.D., R.C.C.
Marianne Bentzen, M.A.
Erik Jarlnaes, M.A.

INTRODUCTION

This article addresses the need to develop ethical standards in the field of body psychotherapy. It is directed to those counsellors and psychotherapists who utilize somatic approaches in their practice as well as those in the larger psychotherapeutic community. The authors’ intent is to expand the information available in the field, hopefully leading to increased awareness of ethical concerns and the development of appropriate ethical standards of practice.

Somatic approaches in counselling and psychotherapy are becoming more prevalent. In North America and Europe there are now some 52 teaching institutes with training programs extending as long as five years.

The inclusion of the body in understanding the psychological development of the person is relatively new in the western world. Some research is being done in the different aspects of this approach, but as with any emerging field, more is necessary. This paper points out some useful directions for the development of ethical practice consideration

Somatic approaches need additional and more extensive ethical standards than those for conventional counselling and psychotherapy because of a) the nature of touch and personal boundaries, and b) the ability of somatically oriented approaches to bypass a client’s “usual” defenses and coping abilities and by doing so, often activate more powerful and dramatic reactions.

This paper will analyze areas of specific concern, explore alternatives to address these concerns and recommend specific ethical guidelines for those involved in somatic approaches. The development of an actual code of ethics is beyond the scope of this paper. These guidelines are intended to enhance and expand ethical considerations found in professional counselling and psychological organizations.

  1. Ian Macnaughton, Ph.D. is a registered clinical counsellor in private practice in Vancouver, British Columbia. He is a faculty member of the Pacific Coast Family Therapy Training Association. His interest is in the integration of body psychotherapy, traumatic stress resolution, family systems therapy and psycho-spiritual work.
  2. Marianne Bentzen, M.A. is a founding member and trainer for the Bodynamic Institute, Denmark. She has contributed significantly to the formulation of Bodynamic theory, having written on character structure, on a comparison of the Bodymap to the Rorschach test, and on somatic transference. She is currently the Chairperson of the Ethics Committee of the European Association of Body Psychotherapists.
  3. Erik Jarlnaes, M.A. Co-Director of the Bodynamic Institute of Denmark with Lisbeth Marcher, assisted in the theoretical development of Bodynamic Analysis. He is also a Certified Bioenergetic Analyst. He brings his long interest in sports psychology and past experiences to his work.

NATURE AND SCOPE OF THE ISSUE 

A major focus of somatic ethical considerations is the issue of boundaries. Body psychotherapy brings to consciousness aspects of unconscious subtle processes between the client and therapist that are not discernable or are difficult to detect in verbal therapies. 

It is possible to engage in body psychotherapy without involving actual touch. In this instance, the ethical considerations are simpler to formulate and contend with. Where a therapist asks a client to direct their awareness to their breathing, body sensations, or experiences it is not necessary to engage in touch. Nor is touch necessary if a client is asked to merely exaggerate a tension pattern or relax some particular area of their body. 

In the case of body psychotherapy where touching is used the situation is more complex and a greater degree of care is necessary to ensure that ethical issues are fully addressed. This paper is directed to the ethical considerations of body psychotherapy in the broadest sense. The European Association of Body Psychotherapists (EABP) have developed standards of practice, a code of ethics, a definition of body psychotherapy, and competency criteria for therapists. Their definition and criteria are included here to provide a sense of what body psychotherapy is and what areas of competency EABP deem appropriate. 

“Directly and indirectly the psychotherapist works with the person as an essential embodiment of mental, emotional, social and spiritual life. She/he encourages both internal self-regulative processes and the accurate perception of external reality. 

Through his/her work the body psychotherapist makes it possible for alienated aspects of the person to become conscious, acknowledged and integrated parts of the self. 

In order to facilitate this transition from alienation to wholeness the body psychotherapist should have the following qualities: 

  1. Intuitive awareness and a reflective understanding of healthy human development. 
  2. Knowledge of different patterns of unresolved conflicts from childhood and their chronic splits in mind and body. 
  3. The ability to maintain a consistent frame of reference and a differentiated sensitivity to the interrelatedness of: 
    • Signs in the organism indicating vegetative flow, muscular hypertension and hypotension, energetic blockage, energetic integration, pulsation and stages of increasing natural self-regulative functioning. 
    • The phenomena of psychodynamic processes of transference, countertransference, projection, defensive regression, creative regression and various kinds of resistance”. (p.7) 

Introducing the body more directly into the therapeutic process, especially with touching, can generate transference with need fulfilment, sexual and boundary issues. 

The types of touch, as well as the issues of how, where, and when to touch will be the subject of a later article. All of these areas will result in different outcomes for the client. For the purposes of this article a short introduction to the issue of touch will assist the reader to understand the complexity of touch. 

Boundaried touch means that the therapist’s hand is well boundaried, that their touch is firm and definite. In merging touch this sense of boundary is lacking. This type of touch can be simulated by putting two hands together, palm to palm, for an extended period of time. The difference between the two surfaces as separate entities disappears as time goes on. The sense of the two hands has dissolved; they are now one. If the therapist touches with the intention to join in this way, the touch is termed a merging touch. 

Erotic touch involves a sexualized wish that is expressed through the fine motor movement of the therapist’s hand. The neutral touch carries with it a lack of these latter messages; rather, the information does not evoke a meaning other than “being touched”. 

The issue of transference can be somewhat different in body psychotherapy. The following describes some concerns: 

1.Need fulfilment – in giving need fulfilment Bernhardt & Bentzen (1991) have found it is necessary to give the clients some resources in the form of touch but also in the form of enabling primary ego formation, which is largely based on the body ego. (pp.2-4) The use of touch can be very powerful in the therapeutic process. The type of touch, it’s location and the timing involved may elicit very different responses; i.e. a person that has yearned for physical comforting, may be quite stirred by a soft and nurturing touch. This could generate a powerful positive transference response. If the person has a deprived history with little connection with family and social network, the transference generated may make it difficult for the client to maintain their sense of balance. In some cases the therapist may also not be ready to deal with the degree of attachment that is created, and avoid it by touching mechanically hence countertransference reactions may occur. 

2. Sexual Connotations – The issue of where to touch and the type of touch are of course very important with any person where there has been or there is any suspicion of a history of inappropriate sexual behavior. It is quite obvious that touching any areas of the body which are directly involved in sexuality, is an inappropriate event. In addition, great care should be exercised in any touching of the inner thigh muscles. Not so obvious but equally important is the type of touch involved, i.e. whether it is a boundaried or a merging touch, a touch with erotic intent or a neutral touch. 

3. Boundaries – When touch is involved in the therapeutic process, the client’s, sense of personal space is being entered. This is a different experience for each person depending on the setting, the agreement around touch, the type, depth, and duration of the touch and the sensitivity of the therapist. This speaks to the obvious need for the client’s consent for touching.

The issue of boundaries is extremely important. The interaction between client and therapist can reach a deep intimacy, i.e. the therapist being able to perceive and mirror inner body sensations may allow the client to surrender into a dependency which may reflect early dysfunction, and give a strong transference onto the therapist’s perceived magical abilities.

The therapist requires a high degree of skill in sensing his/her and the client’s boundaries. When touching it is necessary to know when a touch is boundaried or merging, erotic or neutral. It is also important for the therapist to be aware of what is happening in their own and the client’s energy fields. The following discussion serves to describe some of the differences in their boundary issues. 

THE PHYSICAL BOUNDARY 

There are various types of boundaries that come into play in body psychotherapy. The first boundary we tend to think of is in the concrete sense, that of physical boundaries. An example of this would be thinking of the skin as a physical boundary, the place where the physical person contacts their environment, and where the body psychotherapist may touch the client. 

THE ENERGETIC BOUNDARY 

This second boundary to be addressed is the energetic boundary, that is a boundary that extends beyond the person’s physical body. This sometimes is thought of as a person’s “energy field” that exists around the person’s physical presence. There are different theories of what this field consists of in scientific terms. Some therapists speak of the electromagnetic or electrostatic field around the body; others utilize the models of the oriental philosophies and religions referring to the energy envelope that is postulated to exist around every person. This is often referred to as the person’s aura, consisting of some seven different aspects of “subtle” bodies round the physical body. Suffice for this discussion is the authors’ experience that often people have reported very accurate awareness of the distance the therapist’s hand is from their body even though their eyes are closed and no noise or breeze is generated in the movement of the hand. This simply means that even though you have not touched the client they can have a subjective awareness of how close the therapist is with their eyes closed. Thus a client can feel invaded or comforted by your energetic “touch” even though you have not physically touched them. 

In the case of a client with poor boundaries, a merging type of touch may precipitate an experience of the client “losing” themselves, while a too firm touch may be experienced as invasive and violation. 

THE INTERPERSONAL BOUNDARY 

The third boundary to be considered is the interpersonal boundary. The concept of individual variation in what constitutes closeness and distance has been researched by Hall (1966). Hall explored the different norms various cultures have of what generates safety, respect and anxiety. We would add that the attention to body awareness, experience and expression, in the therapy process adds a dimension that is rather novel in our culture. This can often result in clients becoming conscious of a sensitivity to their interpersonal boundaries that is new and sometimes disturbing. The necessity to conduct the process in such a way that the client has a therapeutic environment of safety is extremely important. 

SAFETY 

The nature of body psychotherapy is quite intimate, and intimate in a rather unfamiliar way, certainly in a therapeutic setting. Clients may be used to massage, chiropractic or physiotherapy. Attention to the body in psychological healing may not be familiar to them. To develop an appropriate therapeutic rapport it usually is necessary to educate the client in more of the actual process, the theory and principles of practice, than in some other therapy approaches. 

It is necessary to pay attention to the matters discussed previously, and not to engage in any violation of the client’s norms in terms of their body awareness, for this, experience is needed. The impact on transference from this approach should be observed carefully. Then the type of transference elicited must be assessed by the therapist for its impact on the client. 

Nothing will replace the commitment of the therapist to the development of his/her skill in the practice of body psychotherapy. Treating that matter with due respect is paramount. In the field of what has come to be known as body work, there are many well meaning practitioners, with a variety of intuitive approaches. Some of these practitioners do excellent work. When we speak of developing broad guidelines for the protection of the public we need to move beyond these exceptions and address the need for solid grounding in theory and practice. In verbal therapies, the physical boundary and interpersonal boundaries are reasonably focused on, but there is little or no consideration of energetic boundaries. The authors have found that body psychotherapists and verbal psychotherapies alike often engage in energetically merging contact without being aware of it. 

The therapist must have the ethical responsibility and experience to address these considerations. Without a thorough and well developed, supervised background in this field, the therapist can unwittingly engage in unethical behavior even though she/he is well intended. 

PRIVATE CONSIDERATIONS 

The intent of this section is to provide a more complete picture of practice issues that have theoretical, practice and ethical implications. These practice considerations will be the subject of a forthcoming paper by the authors. 

To practice effectively the therapist must develop the ability to intervene in an appropriate manner. This section illustrates two patterns of intervention that can cause distress, too much/too soon and not enough/too late within the context of timing. The examples where are intended to serve as a partial reminder to practicing body psychotherapists of some of the theory and practice dilemmas in this type of therapy. It is also directed to those professionals who do not now use a somatic approach and who are interested in more concrete examples of what practice concerns could arise in body psychotherapy. 

Too Much Too Soon 

It is all too easy for the therapist to overwhelm the client with a body oriented approach. Clients are not used to what will happen if they breathe differently, allow certain muscles to be palpated or stand in certain stress positions. They are much more familiar with the effect of thinking, visualizing, or speaking. When we engage in an approach that is relatively unfamiliar to clients they do not have the usual sense of appropriate and healthy defense. It is possible for them to slip into unfamiliar states of consciousness, access post traumatic shock experiences, or collapse into regression towards early wounds without adequate internal support to resolve these issues. If the client does not have the same access to resources while exploring the therapeutic process, then it behooves the therapist to be even more aware of the possible negative implications of any intervention in the client’s sense of self. 

The use of intense breathing patterns can sometimes lead to wonderful feelings of well being, access to a greater level of intuition, and a sense of spiritual connection. This same intervention with another client or with the same client at a different period in therapy can result in a collapse of resources. Developing a pathway in the psyche that habituates around the transpersonal realms as an escape from dealing with the daily concerns of grounded reality. 

Not Enough/Too Late 

The other polarity is not making appropriate interventions or providing stimulus too late. An example would be where a client is directing their attention to body awareness and reporting it in the session. They report feeling that they are sinking and begin to speak of feeling very needy, and appear frightened. If left to their “natural process” they may well be regressing into a very early developmental phase and may not have adequate resources to renegotiate whatever unfinished business resides there. They may also be accessing a period of post traumatic shock in a manner that will retraumatize them. In these instances the therapist needs to know how to be a sufficient resource for the client so that the process can slow down and not simply spiral into some re-enactment of the original pain. This may require the therapist to touch or hold the client in a particular way. Certain muscle groups can be held or stimulated to hold the client’s experience at a more resourceful level so that they can maintain the resources to renegotiate the original patterning. 

This brings us to a discussion of timing, a very difficult matter to teach. It is much easier for people to learn the skills necessary to conduct an assessment or an intervention. Developing a sense of timing for when to do what is considered an art by many teachers and trainers of therapists. If the therapist’s timing is off they can the wrong thing at the right time or vice versa. Knowing when to intervene in such a way that the client is not overwhelmed and yet is supported to generate the necessary resources to deal with shifting their experience in a positive way rests on a well developed knowledge base, good training and supervision which results in a solid treatment map of the therapeutic journey.

It is the authors’ belief and experience the field of body psychotherapy is presently far too lax in what constitutes professional practice. Notwithstanding many excellent teachers and professional training programs the whole field of practice of body psychotherapy is largely wide open. The EABP has made significant moves to address this issue. In any emerging field that openness is necessary for the discipline to explore a wide enough range to begin to coalesce into a more or less unified body of knowledge, of theory and practice. The opinion of the authors is that the field of body psychotherapy is moving into a more mature phase and with this a need for a more serious look at the ground on which it stands and the ethical considerations in it’s practice. 

RECOMMENDATIONS 

This leads us to the dilemma facing both the experienced and the novice body psychotherapist. As in any specialized form of therapy it is necessary to have certain training and skills. 

Most counsellors will admit that in their more mature years of practice they are slightly embarrassed about what they didn’t know in their early years, despite what they thought at the time was adequate academic knowledge and training. The field of body psychotherapy is so new that there is not a well developed body of knowledge and training criteria to ensure that the aspiring psychotherapist can rely on solid ground. This speaks to a need to be even more rigorous and diligent in learning the component element of the field, training in the skills necessary in assessment and treatment, and adequate supervision. The following would seem to be a beginning framework for ethical considerations in body psychotherapy for the responsible therapist. 

  1. The therapist should engage in a study of the theory and practice of body psychotherapy. This should include at least introductory anatomy, physiology and advanced counselling and psychotherapy capabilities. 
  2. Given the nature of body psychotherapy, the therapists engage in obtaining supervision of their work from an experienced body psychotherapist. 
  3. That the therapist establishes a keen appreciation and knowledge of their own body as a tool of mirroring and intervention, and the depth of contact evoked by this consciousness. 
  4. That the therapist through training and extensive practice supervision establishes a great degree of skill in sensing their own and the client’s boundaries. This sensitivity to boundaries should be developed both in terms of physical touch, energetic presence and boundaries, and interpersonal boundaries. 
  5. The therapist should involve him/herself in a very thorough personal therapy experience in the approach they are studying. 
  6. As a part of the therapist’s training they explore their own bias towards or away from touch and the impact that may have on their work and various clients. 
  7. Specific attention should be placed on the therapist’s awareness of his/her own non verbal messages. The therapist should be aware of these “meta” messages. 
  8. The therapist should give an adequate explanation and education of the process being used and the possibility of a strong emotional response to the proceedings. In no case should touch be sexualized or clients “pushed into an overwhelmed state of being” to resolve their unfinished developmental or shock issues. 

REFERENCES 

  • Bernhardt, Peter & Bentzen, Marianne, (1993) Waking The Body Ego, Unpublished manuscript, Albany, California: Bodynamic Institute, U.S.A. 
  • European Body Psychotherapy Association Information Brochure, Lindau, Germany, (1991). 
  • Hall, Edward, (1966). The Hidden Dimension. 

 

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