THE ART AND SCIENCE OF SOMATIC PRAXIS INCORPORATING US ASSOCIATION FOR BODY PSYCHOTHERAPY JOURNAL volume fourteen ● number one ● spring 2015 2 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Brazil; Serbia; René Kostka, Switzerland; RaeJohnson, Hochmair, Austria; Inge Joachim, Germany; Rubens Kignel, Krefft, Germany; Lawrence E.Hedges, USA;Regina Haiman, USA; Michel Heller, Switzerland; Sibylle Huerta Elliot Greene, USA;Margit Grossmann, Germany; Claire Gottwald, Germany; Herbert Grassmann, PhD, Germany; Giuffra,Glickman,USA; Mary USA;Christian USA;Gary Marcel Duclos, USA;Nancy Eichhorn, USA;Ruella Frank, France; Michael Changaris,USA; Will Davis, France/USA; PhD, USA;Fabio Carbonari, Italy; Fanny Chalfin,USA/ Buehler, USA;Sheila Butler, UK;ChristineCaldwell, Jeff Barlow, Australia; Sasa Bogdanovic, Serbia; Stephen Christina Bader-Johansson, Switzerland; Luisa Barbato, Italy; Peer Review Board: Weiss, PhD, Germany; Courtenay Young, UK. Thielen, PhD, Germany; Joop Valstar, Netherlands; Halko Frank Röhricht,UK;Maurizio Stupiggia, Italy; Manfred Denmark; Gustl Marlock, Dipl. Päd., Germany; Professor PhD, USA;ClorindaLubrano, Greece; LisbethMarcher, Rubens Kignel,Brazil; AliceLadas,EdD, USA;Peter Levine, Professor Ulfried Geuter, Germany; Stanley Keleman, USA; George Downing, PhD, France; LidyEvertsen, Netherlands; Italy; Margaret A.Crane PhD, USA; Will Davis, France; Malcolm Brown, PhD, Switzerland; Fabio Carbonari, Bauer, MD,Germany; Marianne Bentzen, Denmark; Netherlands; Jeff Barlow, BA,MEd, Australia; Prof. Joachim International Board: Advisory Shahar, PhD, Jennifer Tantia, PhD Michel Heller, PhD, Elizabeth Marshall, AsafRolef Ben- Debbie Cotton,Nancy Eichhorn, PhD, LidyEvertsen, Editorial committee: Cover illustration:AlineLaPierre, PhD Cover Design: Diana Houghton Whiting Design/Layout: Ronald Jeans Production Team [email protected] Italian Editorial Committee:Fabio Carbonari, Christina Bader-Johansson, Thomas Harms [email protected] German Editorial Committee: Editorial Intern: Michael Fiorini Submissions Co-ordinator: Rachel Vitale Editor:Associate [email protected] Managing Editor: [email protected] Editor inChief: andpracticethrough ongoingdiscussion. theory exchangeinterdisciplinary withrelated fieldsofclinical field ofbodypsychotherapy as well astoencouragean the exchange ofideas,scholarshipandresearch withinthe The Journal’s promote andstimulate missionistosupport, ibpj.org/subscribe.php. of whichcanbeordered through thewebsite http://www. a continuationoftheUSABPJournal, thefirstten volumes European Association forBodyPsychotherapy (EABP).It is States AssociationforBodyPsychotherapy (USABP)andthe spring andfall.It isacollaborative publicationoftheUnited a peer-reviewed, onlinejournal,publishedtwiceayear in The International BodyPsychotherapy Journal (IBPJ)is (formerly US Association forBodyPsychotherapy(formerly USAssociation Journal) International Body Psychotherapy Journal The ArtandScience ofSomaticPraxis volume fourteen ·numberonespring2015 volume fourteen Jacqueline A.Carleton,PhD Debbie Cotton Jill van derAa Regina Axt,MD, Elizabeth Marshall, Advertising: Changes ofaddress: Payment through banktransfer, AmericanExpress orPayPal. Two-year subscription:Members Yearly subscription:Members Printed singleissueMembers Print subscriptions The IBPJ Editor: [email protected] Correspondence Addresses CPD: CarmenJoanne Ablack Congress Chair:Sofia Petridou FORUM Representative: Stefan Bischof COUNCIL Representative: KathrinStauffer Michael Heller, PhD Ethics CommitteeRepresentatives: Ilse Schmidt Zimmermann, Treasurer:Riepenhausen Thomas General Secretary/Vice-President: Jill van derAa President: LidyEvertsen EABP Board ofDirectors Journal Editor: Jacqueline A.Carleton,PhD Research: Denise Saint ArnaultPhD, RN Membership: Andrea Caplan,BA,LMT Treasurer: AlexDiaz, PhD Secretary: ChristineGindi, MDiv, MA Vice President: Dan Mingle, MBA President: Beth Haessig, Psy.D USABP Board ofDirectors Soboleva; Serbian, Maja Lekic;Spanish, David Trotzig. Portuguese (Brazil) Ronaldo Destri deMoura; Russian, Evgeniya Stavroulaki; Hebrew, RachelShalit; Italian, Fabio Carbonari; Abstract Translators: Young,Courtenay UK. Stupiggia, Italy; Jennifer Tantia, USA;Nick Totton, UK; Laura Steckler, PhD, UK;Sharon Stopforth, Canada;Maurizio Homayoun Shahri, PhD, USA;KathrinStauffer, PhD, UK; Asaf Rolef Ben-Shahar, PhD, Israel/UK; Talia Shafir, USA; Professor Frank Röhricht,UK;Bernhard Schlage,Germany; USA; Mark Rackelman,Germany; Marjorie Rand,PhD, USA; Marks, USA;Elizabeth Marshall, Germany; Susan McConnell, USA; Mark Ludwig, USA;Narelle McKenzie, Australia; Linda PhD, USA;Edmund Knighton,PhD, USA;Daniel Lewis, IBPJ http://www.ibpj.org EABP [email protected] www.eabp.org USABP [email protected] www.usabp.org Publishers: retrieval system,withoutwrittenpermissionofthepublishers. photocopying, recording, orby anyinformationstorageand form orby anymeans,electronic ormechanical, including ofthisjournalmaybereproduced part ortransmittedinany Copyright (c)2012USABP/EABP. No Allrightsreserved. ISSN 2169-4745Printing, ISSN2168-1279Online or theirrespective Boards ofDirectors. necessarily represent theofficial beliefsoftheUSABP, theEABP NB The accuracyorpremises printeddoesnot ofarticles found intheoriginallanguage. mayalso be accepted forpublicationinEnglish, thefullarticle originallywritteninanotherlanguagehasbeen If anarticle archive.php Portuguese, Russian, Serbian andSpanish. http://www.ibpj.org/ website inAlbanian,French, German, Greek, Hebrew, Italian, language. Abstracts are ofarticles tobefoundontheIBPJ Translation isavailable free online. The onlineJournal ispublishedintheEnglish [email protected] : http://www.ibpj.org/subscribe.php [email protected] Albanian,Enver Cesko&students;Eleni € € 17.50, Non-members 30, Non-members € 55.00, Non-members € 35 € 20 € 60. 60. 04 TABLE OFCONTENTS 103 CONFERENCE REVIEW 96 STUDENT RESEARCH SECTION 80 65 48 35 20 10 ARTICLES 08 06 Marcel DuClos SO MEASURE IT Carleton,Jacqueline A. PhD INTRODUCTION Nancy Eichhorn, PhD The BodyinRelationship: Self—Other—Society at the 14thEuropean and10thInternational Congress ofBody Psychotherapy: EABP Science andResearch Symposium Abstracts ofthethree winningpapers oftheEABP Student Research Award United States Masters’ and Doctoral dissertation abstracts Rae Johnson,PhD, RSW, RSMT Grasping andTransforming theEmbodiedExperienceofOppression Nitasha Buldeo, MS, MSc Interoception: AMeasure ofEmbodiment or Attention? Laura Cariola,PhD A. in Person-centred Psychotherapy Semantic Expressions oftheBodyBoundary Personality Christina Bader-Johansson, M.Sc.&AmandaLundvik Gyllensten, Med.Dr, RCPT the Ground?” Individuals WithandWithoutChronic Pain: Whois“Standing withBothFeet on Correlations Between Tests Breathingfor Grounding, andSelf-efficacy in Denise Saint Arnault,PhD&Sharon O’Halloran Biodynamic Psychotherapy for Trauma Recovery: APilotStudy Robyn FlaumCruz,PhD&SabineC.Koch, PhD Reading andEvaluating Quantitative Research inBody Psychotherapy Aline LaPierre, PhD AURORA Cover Image Jennifer F. Tantia, PhD, BC-DMT EDITORIAL INCORPORATING USASSOCIATION FOR BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OFSOMATIC PRAXIS Guest Editor: Jennifer F. Tantia, PhD, BC-DMT volume fourteen RESEARCH ISSUE

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3 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Editorial Introduction Cotton, NDd. They will continue to be assisted by members of the editorial committee, who volume 14 · number 1 · spring 2015 have been unfailingly supportive of me during my tenure. I am very excited anticipating both change and continuity with what we have gained so far. I am sure the new team will have fresh ideas and strategies, (which is why we have chosen Jacqueline A. Carleton, PhD them!) and I look forward to taking a back seat and watching them navigate.

It has been 10 years since we have had an issue devoted to research. Because my own New York City interests have evolved as more clinical and theoretical, it felt delicious to place the 2015 February, 2015 Research Issue wholly in the expert hands of Jennifer Tantia, PhD, former Research Chair of the USABP. She has handled editing tasks from the initial call for papers for this special issue * Jennifer Frank Tantia, PhD, BC-DMT is a somatic psychologist and dance/movement devoted to research through the peer review process to final copyedits. And, as you will see as therapist in the US. She is a research advisor to dance/movement therapy students at Pratt you peruse this issue, she has done a terrific job. * Institute and sits on several doctoral dissertation committees in somatic research throughout In a field such as ours, which was marginalized or which marginalized itself for many the country. Dr. Tantia teaches developmental and somatic psychology and has introduced dance/movement therapy to Adelphi University. Former board member of the USABP, and

THE ART AND SCIENCE OF SOMATIC PRAXIS years, research, in the support of evidence-based practice, is a key to mainstream acceptance. THE ART AND SCIENCE OF SOMATIC PRAXIS

Psychologists of many stripes are currently very interested in our techniques, theories, and former Program Director of the NY state chapter of the ADTA, Dr. Tantia currently serves on ways of viewing both psychotherapy and the human condition. But, without research to back the research sub-committee of the ADTA. She has presented her own research internationally up what we know clinically, it is hard for them to learn from us. and has several publications in both dance/movement therapy and somatic psychology. Dr. On the EABP website, www.eabp.org, all you have to do is select the button marked Tantia works full-time in private practice in Manhattan. Research to unleash a wealth of resources and materials that have been collected over the years, notably by Courtenay Young and more recently by the Scientific Committee. This issue of the IBPJ is a contribution to that substantial body of literature. SO MEASURE IT And, of course, in keeping with our tradition of including art in every issue, we have Marcel Duclos commissioned a poem by Marcel Duclos on the subject of research. Marcel writes: I send you this enigmatic poem as a reflection on the paucity and richness of the of all the means available oft quoted and lauded statistical measures that both succeed and fail at defining the to us who want to know imponderables of a body-inclusive psychotherapy, sometimes as a science and often as some find it quite reasonable an art. To borrow Madhav Goyal’s words, quoted by Mary Sykes Wylie in her article “The when our discoveries low Mindfulness Explosion: The Perils of Mainstream Acceptance” in the 2015 January/ on the scale of measured markets February issue of the Psychotherapy Networker, body-inclusive psychotherapy is “inherently weigh high but seen as trinkets difficult to study and compare (research), (it’s) like trying to pin down clouds in a gale.” This valued as vain commodity fast snatched with impunity INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL does not mean that those among us who have limited skills and resources to carry out formal JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL research ought not to forge ahead even if the study limps a bit, or if the mundane commercial sold to the masses wide and far world might distort the findings for its own purposes. bolstered by line and colored bar no thought of “becoming better Next fall, I will edit my last issue of this Journal after almost 15 years at its helm. The at being worse” no sooner journal has grown and transformed from a members’ benefit for the US Association for than that instant we first omit Body Psychotherapy into the online open access International Body Psychotherapy Journal: the reason we still commit The Art and Science of Somatic Praxis, sponsored jointly by the US Association for Body to daring deep discovery Psychotherapy and the European Association for Body Psychotherapy. It is beginning to be moments of intimacy listed in important data bases and with the help of Noya Abramovich, is beginning to have a beyond the numbers on a chart social media presence as well. stats still honored as an art Jill van der Aa and I have been working on this transition for a couple of years so it has been and will continue to be a gradual process. After considerable thought and consultation, a new team has been chosen. The three- © maduclos, 03-2015 person editorial collaborative will be headed by Asaf Rolef Ben Shahar, PhD, as Editor in Marcel Duclos studied philosophy, theology and psychology in preparation for his vocation Chief. He will be collaborating with two co-editors, Nancy Eichhorn, PhD, and Debbie as a psychotherapist. He is mesmerized by the seriousness of play evidence in body and mind.

4 5 Editorial Laura Cariola (UK) examines in her study, Semantic Expressions of the Body Boundary Personality in Person-Centered Psychotherapy, a psychological insight into the ways in Jennifer Frank Tantia, PhD, BC-DMT which body boundary is a structure formed from early interpersonal development. She discusses how body boundary can be detected and how it results from familial values. She It is a great honor that Jacqueline Carleton has invited me to be the first guest editor for then investigates how body boundary influences linguistic expression in psychotherapy, the International Body Psychotherapy Journal. I am indebted to her for the opportunity to and affects the relationship with oneself as well as interpersonally. Cariola also makes a bring you an entire issue dedicated to research in body psychotherapy- something that is connection between the ways in which language regarding one’s body boundary might very important to me. I also thank Alice Ladas who was the first voice in Body Psychotherapy correlate with Reich’s body armor system. to foster the importance and necessity of research in our field, and by keeping her verve and In the next study, Interoception: A Measure of Embodiment or Attention? Natasha audacity in my mind, I humbly carry the torch this Spring. Buldeo (UK) clarifies the scientific process behind the sentient self, and describes how Research is what turns a common interest group into a professional field. It shows embodied cognition and the felt sense is based in homeostasis. Buldeo describes the effects that a theory or practice is strong enough and interesting enough to explore its depths by of interoceptive awareness when clients are distracted, and offers a beginning explanation questioning it and testing it. The results of such questioning produce greater insights and for how memory is held in the muscles and tissues of the body. Her findings contribute knowledge that further the field’s development. Research helps a common practice grow to the current knowledge of body psychotherapy practice by offering scientific value to THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS from creeping and crawling stages to toddling, walking and eventually up and running! the act of bringing a client’s attention to their own somatic experience during sessions. Although we body psychotherapists have had the pleasure of seeing with our own eyes She suggests that the more accurately clients can perceive bodily activity, the stronger the how our practice works, without research literature to back up our actions, it is only a belief relationship between bodily changes and cognitive-affective process during sessions. system. To the contrary of what has been called a “necessary evil” in body psychotherapy, In the final article of this issue,Grasping and Transforming the Embodied Experience of research augments our convictions and helps us find a common language to describe our Oppression, Rae Johnson (US) offers a model for transformative learning that translates to work to colleagues from other fields. It also deepens and expands the breadth and depth of clinical practice. Derived from educational theory, Johnson’s model highlights the strengths our epistemological knowledge while providing a basis for ethical practice with our patients. of embodied awareness as a sophisticated source for understanding how oppression The current issue of the IBPJ is the first in this journal to celebrate research since the is unconsciously transmitted to our clients. She offers an ethical contribution to body fall issue in 2005, under the former incarnation of the IBPJ: The USA Body Psychotherapy psychotherapy practice by arguing for educators and clinicians to increase attention to our Journal. Our Spring issue is a manifestation of a professional goal for me: to include own embodied awareness in regards to oppressive communication, so that we as clinicians researchers from outside of the field of body psychotherapy and join them with our theory may make better choices regarding how best to communicate our integrity and authenticity and practice. In the lineage of the late Jerome Liss and professor Steven Porges, who on a body level. have both recognized and contributed to the efficacy of body psychotherapy, two new Nancy Eichhorn (US) has written a comprehensive review of the past EABP Science researchers from the UK have contributed their insights to the foundational aspects of our and Research Symposium at the 14th European Congress of Body Psychotherapy, which work such as Body Boundary from a Linguistics perspective and Interoception from the took place in Lisbon, Portugal on September 13, 2014. She includes studies, debates and field of Health Sciences. future prospects for research in body psychotherapy that made for a lively gathering that is The first article,Reading and Evaluating Quantitative Research in Body Psychotherapy by evidently growing in numbers and interest. Robyn Cruz (US) and Sabine Koch (Germany) provides a key for healing the rift between The last part of our issue includes a look at our future researchers in a special student INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL clinicians and researchers by unpacking some of the enigmatic language and formulas research section that includes theses and dissertation abstracts from the US, and the winners JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL that appear in research literature. Their concise overview offers a way to read quantitative of the EABP Student Research award. As our field continues to grow, it is important that research that encourages interest and intelligence in reading, while providing definitions we give our students the support and encouragement that they need to become not only for some of the language that might stall some clinicians from enjoying the fruits of the future clinicians, but also our future educators and researchers. Hearty congratulation research harvest! to all of them! I hope that our current memberships of the USABP and the EABP will The second article by Denise Saint Arnault (US) and Sharon O’Halloran (Ireland): continue to enjoy and support research efforts in the service of helping to expand the value Biodynamic Psychotherapy for Trauma Recovery: A Pilot Study is a long awaited longitudinal and importance of our work world-wide. study that explores Biodynamic Psychotherapy as it is applied to women who have suffered domestic violence in Ireland. The article’s compassionate application to a world-wide pervasive problem is an invaluable asset to the field of body psychotherapy. In the third article, Correlations between Tests for Grounding, Breathing and Self-efficacy in Individuals With and Without Chronic Pain, Bader-Johansson (Switzerland) and Amanda Lundvik Gyllensten (Sweden) seamlessly integrate science and practice of body psychotherapy by measuring the effects of grounding and centering on psychological well-being. Their description of posture, gait and emotional health bring new light to the effectiveness of some of the core foundations of body psychotherapy practice.

6 7 Aurora

Aline LaPierre, PhD

ALINE LAPIERRE is a psychotherapist, author, and artist living in Los Angeles. As an artist, she was trained in France at L’Ecole des Arts Décoratifs where her mentor was an alchemist who taught the metaphysical properties of flow, shape and color. Influenced by the imaginal work of Carl Jung, she attended Pacifica Graduate Institute and curious about the nature of the psyche, trained at The New Center for Psychoanalysis. She is the coauthor of Healing Developmental Trauma. Aline uses art as an active meditation, one that calls on her to be fully engaged in the present moment. She writes about the Aurora series:

THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS “At times, I like to step into what the Japanese call no mind state. Faced with a blank paper, the calligrapher’s brush stroke reflects the artist’s internal state at the moment it touches the paper’s surface—a practice to uncover the hidden essence within.

My doorway into the no mind state is my iPad touchscreen. On the touchscreen, my gesture is recorded as immediately as the calligrapher’s brush stroke on paper. But on the touchscreen, a stunning new dimension appears. In the fluid electronic medium, gestures become threads of light that spread and grow like dendrites in a nervous system, allowing the brain to observe its essential self in motion. I think of this process as a present-day version of Japanese calligraphy.”

Together with Victor Osaka, Aline maintains a fine art and stock photography website at www.TrueLightDigital.com. You are invited to follow their contemplative photography blog at www.TrueLightDigital.WordPress.com. INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL

8 9 10 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Cruz, 2014), but they are important for the survival ofhealthprofessions (Meekums, 2014),buttheyareCruz, forthesurvival important 2014). researchanswering important questions,andtheyhave limitations(Koch, Kunz, Lykou, & controlled trials. These studiesare justonemethodologicalpossibility ofgoingabout literature mostoftenenvisioned isquantitative research studies ofefficacyusingrandomized feel theneedtobeincluded andcontribute. The contribution tothescientific research by health institutions and research communities, body psychotherapists, like other therapists, © Author andUSABP/EABP. Reprints [email protected] Volume 14,Number 1spring2015pp10-19. International BodyPsychotherapy Journal ROBYN FLAUM CRUZ,PhD&SABINEC.KOCH, PhD SRH University DanceMovement Heidelberg, Therapy Program research methodsforclinicians,quantitative research, research design. internal andexternalvalidity are judged;and(c)thebasicsofstatisticalinference. understanding quantitative research are reviewed: (a)thelogicofresearch design;(b)how provide toclients. betterservice To thatend,inthispaperthree related areas centralto one mayadequatelycritiqueandgetmore outofone’s professional reading andultimately, Reviewing thatcontentandits associatedskillscanhelptomakeitmore available, sothat concepts andinformationthatmaynotbeemployed clinicalpracticesettings. ineveryday research andreports isoftenexperiencedasdifficult. articles It requires theuse of own clients.Feeling withandusingsuitablecriteriaforreading comfortable quantitative or evidence-basedresearch studies,thetype of research thatcanbegeneralized totheir and informpractice,manywouldalsoadmitthattheydonotregularly read quantitative opinion. While mostbodypsychotherapists wouldendorsetheideathatresearch canaffect practitioners andguarding againstfallingintopracticesthatare basedonlyonpersonal hastodowithcontinuinggrowthfor healthpractitioners.One ofthemostimportant of Many arguments have been made in the literature for why research is considered important In timesofincreasing pressure tolive uptoevidence-based medicinestandards established Keywords: Lesley University Ph.D. inExpressive Therapies Program Reading andEvaluating Quantitative Research in body-orientedtherapy, bodypsychotherapy, dancemovement therapy, Received: 8October, 2014,accepted15December, 2014 Robyn FlaumCruz, PhD Body Psychotherapy Sabine C.Koch, PhD The Art andScienceofSomaticPraxis ISSN 2169-4745Printing, ISSN2168-1279Online Introduction Abstract &

Europe regarded itispartly asoneformofbodypsychotherapy, relying onthehealingfactors of related professions andresearch canbeusefulinaddingtotheresearch basisofthefield. (Meekums, 2014). But conceptualizing bodypsychotherapy ofalargercommunity aspart even seasonedresearchers canfaceprejudices inlocatingfundingforbody-orientedstudies academic, institutional“home” thatcanbeusedasabaseforapplyinggrantfunds–and skills andresources neededtocontributetheresearch base–whichusuallyrequires an of homogenouspatientgroups thatbodypsychotherapy approaches work. specializations theywillneedtobeabledemonstrateinclinicalstudieswithlargenumbers If bodypsychotherapists donotwanttodisappearfrom healthcare systems,justlikeother practice gap in other health disciplines such as nursing (Cruz &Berrol,practice gapin otherhealthdisciplinessuch as nursing(Cruz 2012,p. 13). There clinical practice and has been referred to as the research-to-practice gap, or the evidence-to- (Karkou & Warnecke, 2014, p. 119). The issue is really one of maintaining high quality in upon practitionersand,asa result, manycannotseeitsvalue fordaily clinical practice” easy one.Research hasbeenseenasanadd-on,externalrequirement, apracticeimposed Warnecke, marriagebetween research 2014).“The andclinicalpracticehas notbeenan andresearchall sorts &Berrol, (Cruz 2012)thatcontinues tobenotedtoday(Karkou & two. But regarding there isalonghistory thedifficult relationship between cliniciansof &Berrol,skills (Cruz 2012;Meekums, 2014)creating anaturalrelationship between the clinicians. It hasbeenarguedthatclinicalskillscaninformandeven overlap withresearch is thecornerstoneofprofessional development andthecontinuingeducationrequired of 2001), consumingresearch toincrease knowledge andunderstandingaboutclinicalpractice research to inform policy-makers and address inclusion in healthcare reforms & Hervey, (Cruz to inform their clinical practice. In fact, while body-orientedtherapists tend to focus on for bodypsychotherapy, pavingthewayformuch-needed research. Thus, by accessingahostof resources, itmaybepossibletoaddress basicresearch premises used todevelop cogenttheoretical argumentscanbefoundinKoch and Fischman (2011). good exampleintheDMTliterature ofhow research findingsfrom otherdisciplinescanbe cognitive processes, andmovement behaviorandemotionalprocesses (Lausberg,2013).A research, ample findingsdocument the relationship between movement behavior and developing theoretical argumentsforbody psychotherapy thatcanthenbetestedwith Meekums, 2014; Meekums, Karkou, &Nelson, 2012;Ren &Xia,2013). To assistwith schizophrenia, depression, andmostrecently dementia(Bradt, etal.,2011;Karkou & among otheroutcomes.In addition,there are Cochranereviews onDMTincancercare, et al.,2014)documentedeffectsonqualityoflife,depression, bodyimage,andanxiety recent meta-analysisofeffectsdancetherapyandonpsychological measures (Koch behavior research thathasbeendeveloping over theyears (Lausberg,2013).For example,a to accumulateindance/movement therapy(Karkou & Warnecke, 2014),andmovement based clinicalliterature ontheeffectiveness ofbody-mindinterventions. Meekums, 2014), and canberightfullycalledoneoftheforemost contributors toevidence- many evidence-based studies on its effects (e.g., Bradt, Goodill, & Dileo, 2011; Karkou & on thehealingeffectsofaestheticsandcreative expression. DMThasbeguntocontribute of thebody-mindconnection,andonotherhanditisacreative therapy, arts relying Dance/movement isinmanywaysrelated tobodypsychotherapies; therapy(DMT) in Despite thisneed,practitionersmaynotbemotivated orhave accesstothespecialized Body psychotherapy practitionerscanalsodrawonsuchresearch resources andusethem Body psychotherapy asaprofession candrawfrom theresearch resources thatare starting READING ANDEVALUATING 11 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 12 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS and scientificevidence hastobeamassed over time. forthatpremise!best thatcanbe doneistoaccumulatesupport No singlestudyestablishesfact also meansthatwhileonemight greatly desire to‘prove’ thatbodypsychotherapy iseffective, the evaluating thestatistical results ofthestudy, atopic thatwillbeaddressed inthispaper. This fact where questions. The answers are probable becauseprobabilistic mathematicalmodelsare usedfor dealsexclusivelythis article withquantitative methods. research. But becausequantitative methodsare oftenconsidered more difficultto understand, from quantitative research. Thus, bothqualitative andquantitative methodsare neededfor research andconsistofcollectionsideasthatpredict andexplainhave empiricalsupport the inabilitytogeneralize theresults toapopulation.Useful theoriesare thecornerstoneof sampling apopulation,inqualitative research keyinformantsare specificallychosencreating ratherthantopeopleorothermembersofapopulation. Ratherthan generalizes onlytotheory data collectionandanalysisare usedinaformative way, and isusefulforbuildingtheory using qualitative methodsinwhichthere isaguidingquestionratherthanhypothesis,and to generalize research Research results tootherpeoplethathelpscliniciansdeliver goodservice. with othermembersofthatpopulationtreated similarly. It isexactlythisqualityofbeingable conducted validly, thenwe cansafelyandreasonably assumethattheresults mightbeachieved and across populations.If thesamplerepresents thepopulationwell andtheresearch hasbeen anditcanbegeneralized to toseeifthere orrefute isevidencetosupport thetheory theory adults suffering from incapacitating anxiety. This type of research is useful because it can test that istestedusingdatacollectedfrom asamplethatrepresents alargerpopulation,forexample, 2013).Quantitativequalitative research methods(Yin, usesadefinedquestionorhypothesis these, the first three are generallyanswered with quantitative methodsand thelast twowith It Starts withtheQuestion how tojudgeinternalandexternalvalidity, andthebasicsofstatisticalinference. for treatment, requires someunderstandingofthe hierarchy ofresearch designs,criteria suchas explain how toread andevaluate quantitative research. Evaluating suchresearch anditsimpact istoreview ofmaintainingprofessional and skills,thepurposeofthisarticle part an important was proposed forpsychology inthe1940s(Baker &Benjamin, 2000). for thedevelopment ofthescientist-practitionermodel,sometimescallBoulderthat researchers abouthow toimprove care thatare ofresearch. worthy This situationwasthebasis best positionedfrom theirdailywork witharangeofclientstoposequestionsandproblems to is broadly informedandengagedinreading research. way, In acomplementary cliniciansare hypothesize based on both knowledge and comparative data. Clients benefit when the therapist to research &Berrol, (Cruz 2012). have beenmanyperspectives presented over theyears aboutwhycliniciansseemindifferent limitedworldview,”parameters ofhisorhersomewhat &Berrol, (Cruz 2012,p. 14). There who works onlyfrom theknowledge baseofpersonalexperiencebecomeslockedwithinthe it wouldbeforeachtherapisttowork onlyfrom hisorherown experiences. The therapist therapist conceivably buildsabaseofknowledge through practice,imaginehow inefficient are practicalargumentsaboutwhyreading each research assiststherapistssuchas,“While ROBYN FLAUM CRUZ,PhD&SABINEC.KOCH, PhD Understanding andthatresearch is thattherapistsdowant toofferclientstheirbestservices We arguethatclinicalpracticeisacomplexendeavor thatrequires thetherapist to The goalofquantitative research istypicallytogenerateprobable answers towho, what, or Research questionstypicallyaddress who,what,where, whyandhow concerns,andof whatever change was observed in participants. In inparticipants. thestrictestsense,causationrequireswhatever changewasobserved that goal ofgoodresearch designistoassisttheresearcher caused inarguingthatthe intervention external validity are and how they are judged, and understanding statistical inference. The fundamentals ofresearch designthatisbasedonlogic,understandingwhatinternaland Research Design, Internal andExternal Validity these asthekeyquestionsquantitative researchers interested inclinicalcare ask. the alternatives (relative efficacy),andhow doesitwork (mediation)? Hollon (2006)presented ask questionsabouttreatment –doesitwork betterthantheabsenceoftreatment? Is itbetterthan sciences research. explanations for theresults –something that iseasierdescribedthandone inreality insocial group. The to researchercontrol the design so that there must try are no other possible the treatment, inthetreatment notother factors, wasresponsible forthechangeobserved of thesethreats intheresearch designaidstheresearcher inhisorheroverall aimtoarguethat intended tobejustenough demonstrate thepointthatlogicallyaccountingforabsence and notethatthelistinghere ofthreats tointernalvalidity isnotexhaustive. Instead, itis See andFeder Cruz (2013)foraninteresting historicaldiscussionofstatisticalregression, regression (peopleselectedforextreme scores willdoworseorbetteratthenexttesting). (people whoseektreatment attheirworstwillgetbetterasafunctionoftime);andstatistical (measurements maynothave beentakenconsistentlyorvalidly); spontaneousremission different reasons includingthat theyreacted negatively to thetreatment); instrumentation might changehow peopleresponded); (peoplemaynotcompletethestudyfor mortality impacted one group and not the other); testing (practice and other effects of thetesting (otherevents couldhave occurredvalidity consistofhistory outsideof the research that the treatment, ordidtheysimplymature outoftheir difficulties? Other threats tointernal potential “threats” suchasmaturation –forexample,didagroup ofchildren changedueto Internal validity was nicely and concisely described by Hollon (2006) and consists of defined when whatisdesired istoattributethetherapeuticchangetreatment (Berrol, 2012). elements of the study design that could be used to argue for rival explanations of the results, in thetreatment group tothetreatment thatwasdelivered. It iscreated by controlling the researcher toarguecausation. inthetreatment group,change observed indesigningresearch isofkeyimportance thathelps research design that enhance internal validity, or controlling alternative explanations for the at thebeginningofresearch, althoughitisnotaguarantee.Addressing features ofthe the treatment helpstheresearcher group further toarguethatthegroups were notdifferent that did not, can be directly compared. to the control Randomly assigning participants or function ofthetreatment becausethetwogroups, onethatdidreceive the treatment andone A control group assists the researcher in arguing that the treatment group changed as a research designfeatures suchas,addingacontrol group whichdoesnotreceive thetreatment. (Cook&Campbell,1979). observed be sufficienttocausethe forthe result, andthetreatmentresult tobe mustbenecessary three conditionsbesatisfied;thatthetreatment mustprecede the result, thetreatment must Evaluating the‘goodness’ ofquantitative research studiesrequires understanding Thinking aboutresearch questionsthatare commoninclinicalwork, onemight,forexample, Internal validity istheamountofconfidencewithwhichonecanattributechangeobserved However, inthepractical sensecausationiscommonlyassistedby argumentsusingbasic READING ANDEVALUATING 13 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 14 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS select individuals with PTSD from the population and randomly assign them to either BP (PTSD) more incognitive heorshemight behavioraltherapy (CBT), thanparticipation (BP) reduced trauma symptoms of people diagnosedwith post-traumatic stress disorder An Example isaconsiderationinchoosingtheappropriate statistical test. number ofparticipants of data(scores vs.yes-no data,ornone,some,alotdata–forexample),andeven thesamplesize or test, ANOVA, Chi-squared, etcetera,dependsontheresearch design–thenumberofgroups, type squared, Mann-Whitney U,and Wilcoxon. The statisticaltestaresearcher uses,soforexamplethet – forexamplegroups defined by sexanddiagnosis,measurements repeated over time),Chi- used for2ormore groups withtheflexibilitytoaccommodatemore thanonegrouping distinction for 1or2groups), analysisofvariance orANOVA (asetofcalculationsspecificallydesignedtobe psychotherapy literature are thettest(whichisaset of calculationsspecificallydesignedtobeused what would be expected due to chance. Some common statistical tests that are seen in the body Statistical testsindicateifdifferences between oramonggroups are duetochanceorgreater than in makingthisandothertypesofdeterminationsaboutthedata. average andcauseittofailbeausefulindicatorforthedata?Descriptive statisticsandgraphsassist the data? Did score everyone close to the group average, or were there extreme scores that affect the one ‘see’ and understand & the Feder,data (Cruz 2013). For example, how clustered or spread are mode, standard Using deviationandproportions. thesestatisticsandgraphssuchashistogramshelps the research. Commontypesofdescriptive statisticsare themean,orarithmetic average, themedian, ofinterestother characteristicsorconstructs – even how onteststhatwere theyperformed centralto areexamine thesample,forexample,whoparticipants intermsofgender, age,ethnicityand been found is different than what would be expected just due to chance. useful.Once datahave beencollected,statisticscansummarizevery andbeusedtotestifwhathas sampling thepopulation,andtheycannotestablishcausation.However, whatstatisticscandois or fixapoor research design. in Statistics alsocannotaddress orerrors poorlydefinedconstructs of statisticsneedstobestatedclearly, andthatisstatisticscannotfixthreats tointernal validity Statistics considered representative ofthepopulationandwhethergeneralizationissupported. thatthesampleiswell-described sothatitcanbejudgedwhetherthesample it isimportant body psychotherapy inhisorherstudy. But additionally, forastudytohave goodexternalvalidity, treatment andthe researcher –itbecomesaconstruct needstodefineexactlywhatconstitutes (asopposedto,forexample,heightorsex).Forobservable example,ifbodypsychotherapy isthe asareesteem isaconstruct genderandintelligence, becausetheyare abstractionsandnotdirectly In research, are constructs abstractions that represent people,ideas,orevents, etcetera.Self- researcher used inthe constructs thoroughlyresearch. needs to havedefined the important very whenjudgingtheusefulnessofresearch.validity isimportant For goodexternalvalidity, the generalizingresultsa study that support topopulationsandeven across populations. External of persons,settings,andtimes” (Cook&Campbell,1979,p. 37).It consistsoftheelements generalized “to andacross alternatemeasures ofthecauseandeffectacross different types ROBYN FLAUM CRUZ,PhD&SABINEC.KOCH, PhD A finalelementthatis required forevaluating quantitative research isstatistics. Thelimitation External validity istheamountofconfidencewithwhich results ofastudycanbe A briefexamplemaybeuseful. If aresearcher wishedtostudywhether bodypsychotherapy Inferential statistics are simplystatisticaltestsusedtocompare scores of1ormore groups. Descriptive statistics help help as offering support for theresearchas offeringsupport hypothesis thatindividualswithPTSD treated with would beexpectedduetochance. Astatisticallysignificant result suchasthisisinterpreted in symptomsbetween thetwogroups (13.85versus 3.64) isstatisticallygreater thanwhat who received BP improved more than the people who received CBT. The improvement so thisresult isinterpreted asstatisticallysignificant.Again, thismeansthatthepeople example in Table 1,theprobability ofthetest result (p=.001)issmallerorlessthan.05 indicates thatthedifference foundbetween groups isnota chancedifference. In this test result isinterpreted asastatisticallysignificant result. Astatisticallysignificant result or .01.Asmallprobability value (forexample<.05or<.01)associatedwithastatistical research, theprobability values ofresults are typicallyevaluated by comparingthemto.05 the testisactuallyprobability value orpvalue (in Table 1, So how isthettestresult reported in Table 1interpreted? The keyfeature oftheresult of level approximate data(scoreinterval equalintervals). pointsonthesymptominventory meetthequalificationofbeing andthedataonsymptom inventory of participants, stated earlier, thettestisasetofcalculationsspecificallydesignedtobeusedfortwogroups CBT BP ——————————————————————————————————————— Group Descriptive andInferential Statistics forSymptom Inventory Scores –BPandCBT Participants Table 1: answer thatquestionistouseinferential statisticsandsubmitthedatatoastatisticaltest. disparity between thegroupsorcoulditjustbeduetochance? meaningful The onlywayto disparity between the means of these two groups is 10.21 (13.85 minus 3.64). But is that those whoreceived CBT whoshowed onlyadifference orchangeof3.64points.In fact,the in symptomsshowing anaverage than difference of13.85pointsonthesymptominventory ontheaverage, intheBPtreatment experiencedagreaterparticipants intervention, reduction post-test, andthedifference between thepretest andpost-test scores. It isclearlyseenthatthe have beenreported. Note thatmeansandstandard deviationsare reported forthepretest, the and standard deviations ( table shows pergroup ( thatthenumberofparticipants or fewersymptomsatpost-testthanwere reported atpretest. creates a larger difference score (See Table 1) and, in this case, would indicate improvement by subtractingthescore atpost-testfrom thescore atpretest. Asmallerscore atpost-test inventory, andthedifference between theirscores before andaftercouldbesimplycalculated offered. mightbemeasured Before participants onasymptom andaftertheinterventions, create astronger research designthancontrol conditionswhere noalternative treatment is favoredcondition, asitisalsoanintervention fortreating PTSD, andactive control conditions or CBT treatment. This isaninteresting choicebecauseCBT represents anactive control In thisexample,theindependentgroups ttestis anappropriate statisticaltestbecauseas Table 1below shows thedescriptive statisticsforthispretend research. Inspection ofthe 14 13 N 30.57, 9.8 31.08, 10.1 Pretest (M,SD) SD ), t test result ( 26.93, 9.9 17.23, 6.7 Post-test (M,SD) t(df) ) and the probability of the t test result ( 3.64,3.0 13.85, 7.2 Difference (M,SD) N ), meansorarithmeticaverages (

p READING ANDEVALUATING =.001).In socialsciences 4.82 (25) t(df) p .001 M p ), ), ) 15 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 16 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS researcher thelarger istogetstatistical significance,andtheconverse isalsotrue; statistical significance. What this means is thatthe larger the sample, more likely a tests. The reason isthatstatisticaltestscombinesample size andeffectsize tocreate hypothesis, butanothercan refute be confusing.In fact,research results canbeequivocal. the One study cansupport BeyondStatistical Tests and effectiveness foratarget population. research helpfulinamassingevidenceoftreatment efficacy studies,whichcanbevery will be described briefly below, is that it allows samples to be accumulated over many like intheexampleusedabove. helpfulaspects ofmeta-analysis,which One ofthevery population, butinlotsofresearch relevant forBP, samplesizes are small, somewhat of subjectsrepresenting thepopulationisrelatively largewithrespect tothesize ofthe targeted by theresearch. Usually, there ismore ingeneralizingwhen thenumber comfort statistical analysis, are intended inquantitative research to stand in for the population analysis, thereader mustalsoconsiderthesamplesizes, whichwhilesufficientforthe and how theywere controlled by theresearcher needtobeaddressed. And,inthe final the studyandwhethergeneralizingisreasonable. Potential threats tointernal validity described, thebetterablereader istomakedecisionsabouttheexternalvalidity of carefully describedandexplained. are andtheparticipants The bettertheconstructs nature of the BP and the CBT treatments and who delivered the treatments should be to beonethatwasappropriate forandsensitive toPTSD symptoms.Also,theexact addition, themeasurement toolfornotingsymptomsandsymptomchange,wouldneed researcher wouldneedtomakesure thattheseverity wasthesameinbothgroups. In severe PTSD symptoms are more difficulttotreat thanlesssevere symptoms,sothe PTSD, wasmeasured andifitsseverity mighthave animpactontheresearch. More also needtopayattentionotherfactors.For example,how well thecentralconstruct, randomly assignedtothetreatment groups asitaddresses apotentialbias,butonewould evidence related tothestudy. were In thatparticipants theexample,it isimportant statistical results suchastheonedemonstratedinexampleare justonepieceof is expectedtobeduetheintervention. quantity ofinterest whichisthechangefrom pretest that topost-testfortheparticipants common use” (Campbell&Stanley, 1963p. 23),becauseitfailstodirectly compare the against eachotheratpretest andagainatpost-testhasaname,the“wrong statisticin person inbothgroups changedinsymptoms.In fact,theapproach oftestingthegroups were different from each other at post-test. But it would not indicate how much each indicate whetherthegroups were different from eachotheratpretest andwhetherthey It wouldbeincorrect toseparatelytestthescores atpretest andatpost-test. That would thatarefor eachparticipant usedinthestatisticaltest(ttest)between thetwogroups. test, itisthescores created by subtractingthepost-testscores from thepretest scores around theaverages – are atpretest displayed andatpost- forthesymptominventory with CBT. BP show more improvement (agreater reduction intraumasymptoms)thanthosetreated ROBYN FLAUM CRUZ,PhD&SABINEC.KOCH, PhD When one reads quantitative research to keep in mind that reports, it is important Note thatwhilethemeansandstandard deviations–theaverages andthespread All research offersevidence, but in quantitative research the evidence can sometimes the samehypothesis duetoresults ofstatistical can be more practical than Cochrane reviews where stricter criteria can greatly limit the areas & Sabers, (Cruz 1998). Especially in areas that need more research, meta-analysis solution totheissueofequivocal results and usefullysummarizes theresearch inspecific establish theusefulnessofanytechniqueforpurpose,meta-analysisoffersagood specific healthandpsychological outcomes.Because asinglestudyisinsufficientto to systematicallysummarize theresearch ondance/movement therapyanddancefor across manyresearch studies. Koch, Kunz, Lykou, (2014)usedmeta-analysis and Cruz, and thenaveraging effectsizes across studiestogetasenseoftheexperimentaleffect is meta-analysis,whichinvolves replacing statisticaltestingwithcalculatingeffectsize are needed for the researcher to get statistical significance. An antidote to this problem size ofthedifference between groups ortheexperimentaleffect,fewerparticipants the professionalization ofbody-oriented therapies. reviewing, discussing,andsummarizingresearch canhave cumulative effectsthat support activity ofindividual, a small practice, or contribute to a national database, this worthwhile health sciences.Regardless ofwhetherwrittensummaries helpestablishguidelinesforan in turnhelpswithemployment, reimbursement, andrecognition ofthefield withinthe for traumatized children, forbreast cancerrehabilitation, andfor Parkinson’s disease. This and sofarhasledtotheinclusion ofdance/movement therapyasarecommended therapy groups canbesubmittedtothemedical result ofsummariesresearch. In Germany, summariesofresearch patient forparticular therapiesforschizophreniaarts andpsychosis inadults,children, andyoung peopleasa National Institute forHealth andCare Excellence (NICE)guidelines,forexample,include process ofprofessionally establishingguidelinesinthehealthcare system. In theUK patient groups thatmightbequiteusefulforthesummaries onevidenceforparticular brings benefitstoboththerapistsandclientsofBPtherapists. It mighteven leadtowritten research withthislistandagroup oflike-mindedcolleaguesbecomesausefulexercise that reviewing research (seeAppendix articles B). We hopethatpracticingreading quantitative for getting started. We have also included alist of questions that can be used as one is that cangreatly enhanceone’s understanding.Appendix onlineresources Alistsjustafew research andeven aquicksearch foranunfamiliartermwhilereading produces information There are resources manywonderful ontheInternet forlearningmore aboutquantitative pool their ‘knowledge’ resources and have &Berrol, funat the same time (Cruz 2012). results getseasierwithexperience.Reading research withcolleaguesallows individualsto one’s comprehension andunderstanding.Reading andworking tounderstandresearch skills, keepingone’s quantitative research skillsfresh takesattention.Practice improves theoretical argumentsare usedtoestablishthevalue ofquantitative research. Just likeother Summary for aninformedresult. available informationsomuchthattheonlyresult is thatthere isnotenoughinformation area, applyingthestringentcriterianeededforthistypeofreview usuallyreduces the org/cochrane-reviews). However, whenthere are limitednumbersofstudiesinaspecific touted ascreating thehigheststandard forevidence-basedcare (http://www.cochrane. Cochrane reviews are highlysystematized reviews of research on specifictopics that are number ofstudiesallowed inthereview sothataverage effectsizes cannotbecalculated. This briefreview ofquantitative andoverview methodsexplainshow multiple, Behandlungsleitlinien (diagnosisrelated groups), READING ANDEVALUATING 17 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 18 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS creative therapies,etc., one ofthemrecently arts awarded withtheResearch Award 2014of movement therapy, embodiment,bodymemory, bodyfeedback,movement observation, Benjamins)(John andofmore than100research onthetopicsofdance articles/chapters Hochschule Heidelberg, Germany; iseditorof“BodyMemory, Metaphor &Movement” Sabine C.Koch, PhD, Psychologist, BC-DMT, Prof. forDance Movement Therapy atSRH Email: [email protected] 1718AndersonPlCruz, SE, Albuquerque, NM87108,412-401-1274, in theArts Therapies, (2nd ed.,2012,CharlesC. Thomas); andCo-author of and Co-Editor of Dance Therapy, Therapies Ph.D. Program; Past President, ADTA; Former Co-Editor, Robyn Flaum PhD, Cruz, BC-DMT, LPCisFull Professor, LesleyUniversity Expressive BIOGRAPHIES Questions toGuide Research Reading Appendix B Helpful Websites Appendix A ROBYN FLAUM CRUZ,PhD&SABINEC.KOCH, PhD 4. 3. 2. 1. Oskar Blakstad (Feb 13,2008).Statistics Tutorial. Retrieved Dec 29,2014from Niles, R.(2008). Statsoft, Inc. (2008). 12. 11. 10. 9. 8. 7. population.) 6. 5. xlrbecm https://explorable.com/statistics-tutorial Explorable.com: http://www.robertniles.com/stats/ http://www.statsoft.com/textbook/stathome.html external validity.) should discuss.) How well(There were shouldbespecificity toenhance defined? themajorconstructs Are there obvious threats tointernalvalidity? (Hopefully no,butifsotheauthor What wastheresearch shouldbespecified.) design?(This What wastheresearch question?(It should beclear.) within eachgroup isincorrect.) Were groups directly compared inasinglestatisticaltest?(Apre-post difference research hypothesis–butauthorsshouldalsoreport effectsize.) What were thestatisticalresults? (Astatisticallysignificantdifference the cansupport This makestheresearch suitableforfuture analysis.) Are descriptive statisticsreported? allimportant (M,SD,andNneedtobegiven. How well didthemeasures (Measurement fittheconstructs? needstofitthepurpose.) generalizable; strengthens externalvalidity.) Was there yes, itmakestheresearch diversity inthesample?(When more usefuland Was yes, itmakesthedesignstronger.) randomassignmenttogroup used?(When How shouldbeobvious were membersofthe recruited? (They participants How(This shouldbecleartoenhanceexternal validity.) wasthepopulationdefined? andEditor-in-Chief Emerita of Dance/Movement Therapists inAction: (2nded.,2013,CharlesC. Thomas). Correspondence to: Robyn Flaum Statistics writershouldknow. every Electronic textbook . Retrieved from The Arts inPsychotherapy Retrieved from

A Working Guide toResearch Options Feders’ Art andScienceofEvaluation American Journal of . She iscontributor

Bradt, J.,Goodill, S. W., &Dileo, C.(2011). Baker, D.B.,&Benjamin, L. T. (2000). The affirmationofthescientist-practitioner: REFERENCES Email: Koch, [email protected] http://journal.frontiersin.org/Journal/10.3389/fpsyg.2014.00537/abstract the AmericanDance Therapy Association: Cruz, R.F.,Cruz, &Berrol, C.F. (Eds.) (2012). R.F.,Cruz, &Feder, B.(2013). Campbell, D. T., &Stanley, J.C.(1963). Yin, R.K.(2013). Ren, J.,&Xia,J.(2013). Koch, S.,Kunz, T., Lykou, R.F. S.,&Cruz, (2014).Effects ofDance Movement Therapy Koch, S.,&Fischman, D.(2011).Embodied Enactive Dance/Movement Therapy. Karkou V., & Warnecke, T. (2014).Editorial: Special issueonresearch, Fall /2014. Karkou, V., &Meekums, B.(2014). Hollon, S.D.(2006).Randomized clinicaltrials.In Norcross, J.,Beutler, L.,&Levant, R. R.F.,Cruz, &Hervey, L. W. (2001). The AmericanDance Therapy Associationresearch Meekums, B.,Karkou, V., &Nelson, E.A.(2012). Meekums, B.(2014).Becoming visibleasaprofession inaclimateofcompetitiveness: The Lausberg, H.(Ed.) (2013). Movement, andDance inPsychotherapy, 9(3), Reviews, Art. No.Reviews, Art. CD007103.doi:10.1002/14651858.CD007103.pub2 psychological andphysicaloutcomesincancerpatients 066X.55.2.241. PMID10717972 A lookbackatBoulder. guide toresearch options (2nd ed.).Springfield, IL:CharlesC. Thomas. research. Reviews. doi:10.1002/14651858. Art. No.:Reviews. doi:10.1002/14651858.Art. CD006868. CD009895 Cochrane Database ofSystematic No. Reviews, Art. CD009895.doi:10.1002/14651858. and Dance onHealth-Related Psychological Outcomes: AMeta-Analysis. Journal ofDance Therapy, 33 Database ofSystematic No.: Reviews. doi:10.1002/14651858.Art. CD011022. Association. pp. 96–105. (Eds.) survey. role ofresearch. Lang Academic Research. nonverbal codingsystem. behaviorwithanintroduction totheNEUROGES Psychotherapy, 41 Evidence-based practices inmentalhealth. American Journal ofDance Therapy Boston,MA:Houghton Mifflin. Case studyresearch (5thed.). Body, Movement, andDance inPsychotherapy, 9(3), (1),46-64. Dance therapy forschizophrenia. (2nd ed.).Springfield, IL:CharlesC. Thomas. Understanding bodymovement: Aguidetoempiricalresearch on American Psychologist , 57-72. Feders‘ therapies andscienceofevaluation inthearts The art Dance movement therapy fordementia. Experimental andquasi-experimentaldesignsfor Dance/movement therapists inaction:Aworking , 22,89-118. Dance/movement therapy forimproving London:Sage. 119-122. , 55(2),241–247.doi:10.1037/0003- Washington, DC:AmericanPsychological Dance movement therapy fordepression . CochraneDatabase ofSystematic CochraneDatabase ofSystematic READING ANDEVALUATING 123-137. Cochrane Frankfurt: Peter The Arts in American Body, .

19 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 20 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS body-oriented intervention designedtohelpwomen intherecoverybody-oriented intervention phaseof DV. andempowermentat support (Hill and Ballou, 2005). This research examinesashort-term, women needhelp feeling wholeandwell. Much recent research treatment supports that aims van derKolk, McFarlane, and Weisaeth, 1996).In addition,from afeministperspective, of security, & personalstrength, 2004;Courtois andself-confidence(Courtois, Ford, 2009; emphasizes thatthe goalofcomplextraumatherapyistoprovide fortheimmediateneeds unexplained symptoms(Crowne etal.,2010;Pico-Alfonso etal.,2006).Most current research abuse anddependencedisorders, eatingdisorders, somatoformdisorders, andmedically an arrayofmentalandphysicalconditions,includingmood andanxietydisorders, substance Tjaden and Thoennes, 1998).Alargepercentage oftraumatized individualsmeetcriteriafor have severe deleteriouseffectsonwomen’s mentalhealth(De Jong, 2002;Kilpatrick,2003; severe mentalhealthconsequencesforitsvictims. The experiences ofdomesticviolence(DV) University Of Michigan SchoolOf Nursing. Acknowledgements: © Author andUSABP/EABP. Reprints andpermissions [email protected] Volume 14,Number 1spring2015pp20-34. International BodyPsychotherapy Journal DENISE SAINTARNAULT, PhD&SHARONO’HALLORAN, BD,MGBII Biodynamic Psychotherapy for Trauma Recovery: APilotStudy mental health,integrative traumatherapy approaches totraumarecovery isneeded. distress, over quality of life, and use of social support one year. More research on integrative that womenwere willingtoengageintreatment, andhadsustainedimprovements in in Westernwomen receiving services domesticviolencesupport Ireland. Findings revealed of Biodynamic Interventionsdelivered onmind-bodyhealingforeight sixmonthsapart measurespre toevaluate andpost-intervention thefeasibility, acceptability and impact reliance on conscious recall.primary This longitudinal pilot study used standardized aim toaddress thephysiologicaleffectsoftraumadirectly withinthebodyitself, without Body-oriented approaches focusonautomaticprocessing, fortreating and trauma survivors Violence socialproblem, oftenresulting againstwomenisaseriousandpervasive in Keywords: Biodynamic psychotherapy, traumarecovery, domesticviolence,women’s University ofMichigan SchoolofNursing This research wasfundedby Safe Ireland by the andsupported Received 15October, Accepted 21December 2014 Sharon O’Halloran, BD, MGBII Denise Saint Arnault,PhD The Art andScienceofSomaticPraxis ISSN 2169-4745Printing, ISSN2168-1279Online SAFE Ireland Abstract & cycle of mind-body triggering can thwart therapy and serve toactuallykeepthepasttraumacycle therapyandserve ofmind-bodytriggeringcanthwart associated withtheevent (Ogden, Pain, andFisher, 2006). This debilitatingandrepetitive are alsoactivated, leadingtoare-experiencingtraumatic memory ofthebodilysymptoms other research warnsthatwhentraumanarratives are retold, bodilyprocesses related tothe processes can promote improvement in some patients (Kubany, Hill andOwens, 2003), andFord,(Courtois 2009). While there issomeevidencethatworking withconscious to resolve theproblematic emotions,behaviors,andphysicalsymptomsofthepatient processes inconjunctionwithremembering ortherapeuticre-experiencing oftheevent these therapies purport tofoster thebody’sthese therapies purport natural healingprocesses, which inturnaffect on consciousrecall ofpainfulmemories. By mitigating thephysiologicalarousal processes, physiological effectsoftrauma directly reliance withinthebodyitself, withouttheprimary treatments) focusonthe physiological, automatic processing, and aimtoaddress the toOgden,forward etal2006)(Kezelman and Stavropoulos, 2012). physical sensationsandpreprogrammed physicalactionpatterns” (van derKolk, 2006,p. xxii and thebodysuggestingwe need to“pay…attention totheexperienceandinterpretation of explore how treatment forcomplextraumacanbe directed towards integrationofthemind (Nijenhuis, van andSteele, derHart, 2010;Ogden et al.,2006).Research isbeginningto Price, 2007;Zelikovsky andLynn, 2002);andmaycausephysicalpainhyper-vigilance affect regulation 2008); mayrelate (Wilson, todissociation(DePrince andFreyd, 2007; 1997). This reflexive neurological responsiveness, which liesoutsideofconsciousness,affects therefore continuing to respond to these stimuli in maladaptive ways (Ford, 2009; Putnam, reflexively triggered by stimuli thattheirneurobiological systemperceives asdangerous, however, maynotresolve leavingclients physiologicalhyper-arousal intheshort-term, 2009; Ogden, Minton, andPain, 2006;van derKolk etal.,1996). Top-down approaches, learn how &Ford, tomanagedisturbingemotionsandreactions 2004;Courtois (Courtois, learn how to identify stimuli that trigger them, understand their responses, and possibly may fostermaladaptive waysoffeelingandbehaving(Kubany, Hill and Owens, 2003).Clients understand how thetraumaticexperienceshave affectedtheirbeliefs,andhow thesebeliefs (Sarter, Givens andBruno, 2001;Ogden, Pain andFisher, 2006). CBT aimstohelpclients cognitive strategiestomanageorinhibitproblematic feelings,thoughts,andbehaviors on whatresearchers are now referring toas“top-down processing,” inwhichclientsuse dissociation (Kezelman andStavropoulos, 2012). includes theinterrelated emotional,physical,behavioral,andsocialdifficulties,as well as approaches mayaddress ofthemultifacetedsyndrome ofcomplextrauma,which onlypart complex traumaare abletoutilize thetreatment approaches developed forPTSD. These Weisaeth, 1996). The research question that remains is whether people who have experienced & Ford, 2004; Courtois trauma populations (Courtois, 2009; van der Kolk, McFarlane, and multiple traumas;however, mostPTSD treatment hasbeen developed andtestedwithsingle and Roth, 1996). ‘‘alive’’ inthebody(Ogden, Pain, andFisher, 2006;Schore, 2002;van derKolk, Pelcovitz, Mainstream psychological therapiesfortraumarely onthepatient’s consciousthought Body-oriented approaches (referred totreating traumasurvivors toas“bottom-up” Most traditionalpsychotherapies, includingcognitive-behavioral depend therapy(CBT), People whoseektreatment fortrauma-related problems oftenhave hadhistoriesof Background andSignificance BIODYNAMIC PSYCHOTHERAPY 21 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS DENISE SAINT ARNAULT, PhD & SHARON O’HALLORAN, BD, MGBII BIODYNAMIC PSYCHOTHERAPY

cognition, emotion and behavior (Solomon and Heide, 2005). Body psychotherapeutic Ireland. Biodynamic psychotherapy is a treatment approach that can help people recovering approaches focus on the physiological arousal processes described above and use interventions from trauma with the bodily and psychological processes of affective and sensory stimulation, aimed at interrupting reflexive responses to trigger stimuli. Bottom-up approaches may also promoting well-balanced and well-regulated physiological and emotional functioning (Boyesen, foster the body’s natural healing processes, which in turn affect cognition, emotion, and 1980; Saint Arnault, Molloy, and O’Halloran, 2012; Saint Arnault, Molloy, O’Halloran, and behavior (Allmer, Ventegodt, Kandel, and Merrick, 2009; Boyesen, 1980; Koemeda-Lutz Bell, 2013; Southwell, 1988). Biodynamic psychology theorizes that painful emotions related et al., 2004; Koemeda-Lutz, Kaschke, Revenstorf, Scherrmann, Weiss, and Soeder, 2006; to traumatic experiences become encapsulated in muscles. Emotional and physical trauma Ogden et al., 2006; Price, 2005; Solomon, Solomon, and Heide, 2009). and shock are stored in rigid and chronically contracted muscles, referred to as armouring. Recent research is beginning to measure the efficacy of a wide variety of body Armouring keeps the psychic and physical energy static, and the body is held in a chronic, psychotherapy approaches. This review will focus only on peer-reviewed evidence about permanent startle reflex. This muscular contraction prevents tensions and emotions from being the usefulness of selected body psychotherapy techniques. However, we acknowledge that released. Armouring is understood to occur in layers, from superficial to deep. In addition to this is a rapidly expanding field and welcome much more research in this area. Probably storing tension and emotional pain, armouring traps bodily fluids and restricts blood circulation the most widely known of these methods is Eye Movement Desensitization and Reprocessing that would remove biochemical deposits at the time of the trauma or shock. This is referred to THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

(EMDR). EMDR is a combination of body-focused (bottom-up processing) and cognitive- as tissue armour, or a concentration of metabolic residues in the body, such as adrenaline and behavioral (top-down processing) treatment primarily for PTSD (Kutz, Resnik, and Dekel, lactic acid. The storage of tension and fluid by the body may repeatedly engage the sympathetic 2008; Servan-Schreiber, 2000; Shapiro, 2009). EMDR focuses on reprocessing the stored nervous system, keeping the person in a chronic state of hypervigilence or shock. This chronic memories of the traumatic experience, enabling the client to use cognitive and affective state of sympathetic nervous system excitement can exhaust adrenal glands and other feedback mechanisms to reach an adaptive resolution. Another promising line of research involves mechanisms that would normally engage to restore a state of neurological quiet and equilibrium Somatic Experiencing, which is a treatment technique developed to respond to the biological, (Boyesen, 1980; Saint Arnault, Molloy, O’Halloran, and Bell, 2013; Saint Arnault, Molloy, and reflexive, and defensive bodily responses to trauma, and to residual trauma-related fearfulness. O’Halloran, 2012; Southwell, 1988). The treatment aims to help the client complete the response that was interrupted at the time Boyesen hypothesized that emotions are spontaneous bodily processes that may be inhibited of the trauma, and teach self-regulation skills (Leitch, Vanslyke, and Allen, 2009; Levine, by muscular contraction (Boyesen, 1980). Conscious and unconscious processes trigger 1996). In a retrospective study of bioenergetic therapies, Ventling (2002) examined the these biological and emotional imbalances, and these, in turn, prevent the flow of physical recovery of 149 former patients who had terminated their therapies after a minimum of 20 and emotional feelings in order to limit emotional pain. This biodynamic repression prevents sessions 6 months to six years earlier. She found significant positive changes in interpersonal spontaneity and disturbs normal physical, mental and spiritual homeostasis. The Biodynamic and psychosomatic problems and the effect of body work on physical consciousness, psychotherapist uses specialized touch techniques to locate areas of tension in the muscles, and cognitive insights and changes in quality of life, with 107 (75%) patients indicating a stable the aim is to release tissue armouring and trapped energy to promote energy discharge and or even improved condition (Ventling, 2002). In a multinational study, Koemeda-Lutz et resolution (Saint Arnault et al., 2013; Saint Arnault, Molloy, and O’Halloran, 2012; Saint al. (2003) compared routine applications of body psychotherapy in outpatient settings to Arnault et al., 2012). Biodynamic therapists use stethoscopes to listen to peristaltic sounds other outpatient psychotherapeutic patients after 6 months of therapy, and found that the (rumblings in the gut) that allow them to track the body’s parasympathetic activity (which body psychotherapy patients (N=78) had significantly improved with small to moderate signifies relaxation) (Boyesen, 1980; Saint Arnault, Molloy, O’Halloran, and Bell, 2013; Saint

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL intraclass effect sizes. After two years of treatment, large effect sizes were attained in all Arnault, Molloy, and O’Halloran, 2012; Southwell, 1988). JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL scales (N=21) (Koemeda-Lutz et al., 2003). Price (2007) found that dissociation can be Biodynamic Psychology also uses group methods to facilitate healing. One important significantly reduced with the addition of body-oriented therapy as an adjunct to traditional technique is a Biodynamic version of psychodrama, including techniques such as role-playing, psychotherapy for women who were recovering from sexual abuse. In a sample of 24 women role reversal, mirroring and doubling (Saint Arnault, Molloy, O’Halloran, and Bell, 2013). who received eight, one-hour body psychotherapy sessions, dissociation was reduced (Price, Biodynamic psychology theorizes that by completing the reaction or response that was already 2005; Price, 2007 ). This present pilot study, we hope to contribute to this growing body activated but not expressed in the original situation (referred to as therapeutic ab-reaction), the of research by examining the acceptability, feasibility, and initial estimates of the effect of autonomy, dignity, strength and spontaneity of the ‘primary personality’ is restored (Klopstech, Biodynamic Psychotherapy to promote trauma recovery for a sample of women receiving DV 2005; Saint Arnault, Molloy, and O’Halloran, 2012; Saint Arnault et al., 2013). services in the West of Ireland. Methods Theoretical Rationale for Biodynamic Intervention for Trauma Design Biodynamic Psychology and Psychotherapy is a very specific form of body psychotherapy that This paper reports a longitudinal pilot study that used Biodynamic methods to foster was developed by a Norwegian physiotherapist and psychologist Gerda Boyesen in the 1940s healing for eight women who were receiving DV support services in Western Ireland. (Southwell, 1988). Several major institutes train students in Biodynamic psychotherapy The aim of this research was to examine the feasibility and acceptability of three 2 ½ day in Europe, including centers in the Netherlands, Germany, Italy, France, England, and Biodynamic Interventions, complemented by a three-hour individual bodywork session.

22 23 DENISE SAINT ARNAULT, PhD & SHARON O’HALLORAN, BD, MGBII BIODYNAMIC PSYCHOTHERAPY

The data reported here are part of a larger study that uses mixed biological, qualitative, All CESD, anxiety and physical and emotional symptoms were measured using the same Likert quantitative, clinical ethnographic and experience sampling methods to examine the healing scale with “0” indicating little or no times per week to “3” indicating most or all of the time. Depression experience for eight women receiving DV services in Western Ireland. was measured with the Center for Epidemiologic Studies-Depression scale (CES-D), developed at a An Institutional Review board approved all procedures. The lead author, a master’s prepared division of the National Institutes of Mental Health, in 1971 (Radloff, 1977). The CES-D is a self- Psychiatric Mental health nurse, attended all group sessions, and at least two members of the report scale that is an amalgamation of previously devised depressive inventories. Cronbach’s alpha research team attended all of the individual sessions. The Gerda Boyesen International Institute reliability for the CESD with this sample ranged from .95-.96. Anxiety was assessed using the Zung (GBII) provided all of the treatment. Mary Molloy, the principle of GBII, has been providing Anxiety Self Report (Zung, 1971), which is a 20-item instrument. Cronbach’s alpha reliability for biodynamic education and treatment internationally for over 30 years, delivered all of the this sample was .84 (Zung, 1971). Physical and emotional symptoms were measured with the 45-item interventions. She was assisted by two senior therapists who hold director positions in GBII, Composite Symptom Checklist (CSC), which included 22 physical items and 23 emotional items and the director of the SAFE Ireland (herself a qualified Biodynamic therapist). (Saint Arnault & Fetters, 2011). Quality of Life was examined with the Medical Outcomes Study Short Form-36 Health Survey (SF-36). The SF-36 was developed in the USA and has been used Sampling, Recruitment, and Retention in a number of countries (Ware et al., 1998; Ware, Kosinski, & Keller, 1994; Ware & Sherbourne, THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

We recruited a convenience sample of women receiving DV services who were in the 1992). We selected the sub-scales representing Bodily Pain, Vitality, Social Functioning and Role recovery phase of their survivorship, were at risk of somatic and psychological symptoms Functioning. Social Support Satisfaction was measured with the Social Support Questionnaire for and disorders related to their trauma, and expressed a desire for healing from the effects of Transactions (SSQT)(Suurmeijer et al., 1995) that measures satisfaction with social support in that trauma. We sampled women in Ireland because they were proximate to an established five domains: Emotional Support, Problem Oriented Emotional Support, Social Companionship, Biodynamic therapy clinic and training center (GBII). Inclusion criteria were women over Instrumental Support and Problem Oriented Instrumental Support. Cronbach’s alpha reliability 21 who were receiving services and had a case manager, spoke and read English, and who ranged from .92-.95 (Suurmeijer et al., 1995). Social conflict was measured with Social Conflict agreed to the treatment. We used the Kessler 6 (K6) to screen for distress. The K6 is a Scale (SCS), a subscale of the Quality of Relationship Inventory (Pierce, Sarason and Sarason, 1991). six-item distress inventory designed to screen for the likelihood of significant psychological symptomology (Kessler, et al, 2002). Because we knew that the distress for women who have Intervention experienced DV is generally high, we set our exclusion criteria quite high, allowing women Participants in the BP intervention were treated over a 12-month period between May 2011 with K6 scores under 20 to enter (Kessler, Andrews, et al, 2002). However, women who were and May 2012. Our intervention consisted of both a group intervention and an individual actively psychotic were excluded. bodywork session six months apart. In the group portion of the intervention, we focused on a Women receiving DV services were notified of the opportunity to participate in the study biodynamic version of psychodrama, for which examples are published elsewhere (Saint Arnault, by their case manager, or through seeing the poster at the DV shelter. Those expressing Molloy, O’Halloran, and Bell, 2013). Within this group, other members of the group might interest to their case manager, and who were deemed by their case manager as appropriate for become part of the psychodrama; however, most of the time the most of the therapeutic work was this trial were given the contact information of the Project Coordinator at SAFE Ireland to done with the therapist in a one-on-one and the participant, witnessed by the group. The other arrange an intake screening. If the woman met criteria, potential participants were informed component of our intervention was a bodywork session aimed at releasing tissue armoring and of the BP protocol, the research instruments, and the incentive payment. Women who agreed trapped energy, and the specific technique depended on the location of the trapped energy, but

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL received the informed consent, the survey packet, directions to the pre-treatment qualitative included well-known Biodynamic massage techniques. During both the group and the individual JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL interview, as well as directions and details about the workshop itself. Participants received sessions, the therapist worked with the body and the psychological content that comes to the written information and reminder phone calls before the scheduled interviews. In case of surface to promote energy discharge and resolution (Saint Arnault et al., 2013; Saint Arnault, adverse events, women were instructed to call their case manager or the SAFE Ireland office. Molloy, and O’Halloran, 2012; Saint Arnault et al., 2012). The SAFE Ireland director coordinated any followup needed. Case managers monitored The philosophy that guided the interventions provided in this study have been reported women regularly and coordinated closely with the SAFE Ireland staff to create what we elsewhere (Saint Arnault, Molloy, & O’Halloran, 2012). In summary, the therapeutic team termed “wrap-around” services. employed a biodynamic environment, which was understood as a space that affirmed the integrity of each person, and supported honest self-expression without judgment. This was a conscious Instruments and Measures creation of a safe and structured environment that aimed to allow self-discovery, release of trapped Demographic data included age, education, and employment. The survey measures were energy, and promote the re-integration of the mind and body. In addition, the treatment team assessed at baseline, six weeks pre and post each intervention. Psychological distress data included used a system of holding, which involved supporting the participant to take time, with focused depression, anxiety, and psychosocial symptoms. Physical distress measures included physical support and encouragement, to express feelings or thoughts arising from the intervention. symptoms. Overall quality of life was measured with the Vitality, Social, Role-Emotional and Holding attention allowed the participant to complete their thoughts, feelings, and the interrupted Role functioning subscales of the SF-36 to gain a full understanding of women’s wellbeing. impulses without judgment or interruption. In the bodywork sessions, holding the muscle or Social support and Social conflict was measured with Social Conflict Scale (SCS), a subscale of part of the body that had been weakened aimed to allow the complete circulation of energy. An the Quality of Relationship Inventory (Pierce, Sarason and Sarason, 1991). important focus of our Biodynamic psychotherapy intervention was listening to the body, whereby

24 25 DENISE SAINT ARNAULT, PhD & SHARON O’HALLORAN, BD, MGBII BIODYNAMIC PSYCHOTHERAPY

the therapist assists the participant to gain awareness of habitual movements and discover their Table 1: Health indicators changes over time (*p <05) source through observation and mirroring, or encourages the participant to consciously alter or d d d exaggerate these movements or bodily sensations to facilitate self-discovery and the discharge of Health T1 T2 T3 T4 T5 T6 Measure trapped energy. Consistent with the Biodynamic psychotherapy goal of completing emotional M (SD) M (SD)sig. M (SD)sig. M (SD)sig. M (SD)sig. M (SD)sig. Emotional 47.3 (15.6) 24.9 (17.2)* -1.4 23.9 (18.8)* 20.4 (21.1)* -0.12 20.5 (21.0)* 18.0 (19.2)* -0.12 cycles and facilitating vegetative discharge of trapped energy, the therapist assisted the participant Physical 34.4 (11.0) 16.9 (9.8)* -1.7 17.8 (9.9)* 16.8 (10.1)* -0.1 17.3 (9.7)* 13.8 (9.9)* -0.36 in the discovery of the psychological and bodily places where energy had been stored, and held Depression 36.3 (13.8) 18.0 (14.5)* -1.3 20.5 (13.3)* 17.6 (15.2)* -0.2 18.3 (14.5)* 14.5 (14.6)* -0.3 attention there while the participant completed the action, spoke the unspoken, or gave expression Anxiety 31.3 (10.8) 15.9 (8.6)* -1.6 18.4 (10.6)* 21.4 (7.8)* 0.3 19.6 (9.9)* 17.9 (11.7)* -0.2 Support 47.8 (11.3) 53.4 (14.4) 0.4 57.0 (13.0)* 59.6 (14.9)* 0.2 59.9 (15.2)* 61.3 (16.2)* 0.1 to the energy that needed to be discharged. Conflict 17.8 (3.4) 13.1 (6.0) -1.0 13.4 (3.2)* 14.6 (2.9) 0.4 14.8 (2.8) 13.1 (2.9)* -0.6 Vitality 25.0 (18.9) 46.9 (16.7)* 1.2 42.5 (19.6)* 35.0 (26.3) -0.3 35.0 (26.3) 43.8 (17.7)* 0.4 Bodily Pain 42.8 (29.7) 55.9 (31.0) 0.4 59.1 (22.6)* 55.9 (22.5) -0.1 57.5 (24.6) 59.1 (58.7) 0.04 Analysis Social 48.4 (30.9) 62.5 (30.6) 0.5 59.4 (18.6) 53.1 (19.8) -0.3 56.3 (24.1) 56.3 (20.0) -- Role 25.0 (38.8) 45.9 (39.6) 0.6 46.1 (32.2) 45.8 (35.4) -- 50.0 (39.8) 45.8 (46.9) -0.1 We evaluated the impact of this treatment on the psychosocial health and wellbeing

THE ART AND SCIENCE OF SOMATIC PRAXIS Distress THE ART AND SCIENCE OF SOMATIC PRAXIS

using baseline assessments and 6-week post-intervention standardized psychological, and quality of life measures for all workshops. According to recent research, paired t-test can The distress indicators in this study were emotional symptoms, physical symptoms, be used with small sample sizes (De Winter, 2013). Therefore, we used t-test to compare depression scores and anxiety scores (see Chart 1). The women in the cohort study had statistically pre and post-intervention scores for all time points (see Table 1). We also used means and significant and sustained improvements in all of their distress indicators. There was a large effect standard deviations to calculate Cohen’s d effect sizes. Cohen (1988) reports the following on emotional symptoms after the first workshop (baseline M=47.3, SD=15.6) compared with interpretation guideline for interpretation of effect sizes: 0.1 to 0.3 is a small effect; 0.3 to 0.5 six-week findings, M=24.9, SD=17.2 t( =3.7, df=7, p=.01; d=-1.4). These means remained low, is an intermediate effect and 0.5 and higher is a strong effect. with statistically significant mean differences across all time points (mean range was from 18- 23.9, p.> .01) compared with the baseline. Physical symptoms declined after the first workshop Findings (baseline M=34.4, SD=11.0) compared with six-week findings, M=16.9, SD=9.8 t( =8.8, df=7, p=.00; d=-1.7). These means remained lowered, with statistically significant mean differences Sample Characteristics across all time points (mean range was from 13.8-17.8, p.> .01) compared with the baseline. Eight women volunteered for this study, attended all workshops and the individual Depression symptoms reduced after the first workshop (baseline M=36.3, SD=13.8) compared sessions, and completed all instruments. The average age of the women was 44 years. The with 6 week M=18.0, SD=14.5)(t=5.8, df=7, p=.00; d=-1.3). These means remained low with range of time the women were with their abuser was 5-20 years. Four of the women had statistically significant mean differences across all time points (mean range was from 14.5-20.5, experienced and/or witnessed abuse as children, and several had experienced sexual abuse p.> .01) compared with the baseline. Finally, Anxiety symptoms declined after the first workshop or rape either as children or in the abusive relationship. All of the women had been out of (baseline M=31.3, SD=10.8) compared with six-week findings, M=15.9, SD=8.6, t( =5.4, df=7, the violence for over four years, and two of the women were in new relationships. All of the p=.01; d=-1.6). These means remained low with statistically significant mean differences across all women were in DV support services at the time of the study, and all but one had been in time points (mean range was from 17.9-21.4, p.> .03) compared with the baseline.

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL these services for years. Most of the women had vocational training and one had a graduate JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL degree. All of the women were residing in rural areas of Ireland. Chart 1: Distress Changes One of the findings from this study is a detailed picture of how trauma devastates the quality of life for women, even after years away from the abuse. The mean Kessler score Distress of the women was 13.4 (SD=4.9), with a range from seven to 20 at baseline. The CESD 50.0 scores ranged from 18-56 and the mean was 36.2 (SD=13.8) (cut-off, for indicating clinically 45.0 significant depression, is 16)(Radloff, 1977). While the mean is still in the moderate range, 40.0 Zung Anxiety Scale scores ranged from 18-46 with a mean of 31.3 (SD=10.7)(cut-off for 35.0 Physical moderate to severe anxiety is 45-59)(Zung, 1971). Physical and emotional symptoms were Emotional also high. On the CSC, women’s sum of symptom scores ranged from 19-54 with a mean 30.0 Depression of 34.4 (SD=10.9). On the emotional symptom checklist (23 physical symptoms including 25.0 Anxiety depression, sadness, anxiety, fear, anger, loneliness, and out of body feelings), women’s 20.0

sum of symptom scores ranged from 27-68 with a mean of 47.2 (SD=15.5). There are no 15.0 cutoffs for these scales, however Escobar reports that even three somatic symptoms predicts 10.0 psychopathology (Escobar, Cook, Chen, Bara, Alegria, et al, 2010). Four of the eight women T1 T2 T3 T4 T5 T6 were on antidepressant medication, sleep aids, or both. The Kessler, CESD, Zung Anxiety scale, or symptom scores did not correlate with age, employment status, or education. 26 27 DENISE SAINT ARNAULT, PhD & SHARON O’HALLORAN, BD, MGBII BIODYNAMIC PSYCHOTHERAPY

Quality of Life Discussion The Quality of Life indicators used in this study were vitality, bodily pain, social functioning Having endured psychological, physical and sexual violence significantly increases the and role functioning (see Chart 2). The women in the cohort study had some statistically incidence of mental health problems, including depression, posttraumatic stress disorder, significant changes in vitality. There were no statistically significant changes in social functioning anxiety, suicidal behavior, sleep and eating disorders, social dysfunction, and an increased or at any time point. Vitality means were statistically increased from baseline (baseline M=25.0, likelihood of substance abuse (Pico-Alfonso et al., 2006). This was true for the women SD=18.9) compared with six-month time point mean of 42.5, SD=19.6 (t=-2.6, df=7, p=.04; in our sample, for whom the level of distress was extremely high. What was surprising, d=1.2); and at the one-year time point (M=43.8, SD=17.7)(t=-2.5, df=7, p=.04; d=0.4). however, was that in the early conceptualization of this study, we met with DV service providers from our recruitment site, and decided to offer this research study only to Chart 2: Quality of Life Changes recipients who they considered to be stable and ready for healing. The women who joined our study were stable: raising children, working or going to school, and generally getting Quality of Life on with their lives. These data underscore the amazing resilience of women who move on 65.00 with their lives and families despite carrying a significant symptom burden. It also suggests THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

60.00 that the symptom burden carries on for many years after leaving a relationship. The field of women’s mental health could benefit from more studies about the readiness of women to 55.00 avail themselves of services, and the types of services needed at critical junctures extending 50.00 Vitality well beyond the first year after leaving an abusive relationship. 45.00 Role Funct. This study suggests that Biodynamic therapy can be rapid, which is consistent with Bodily Pain 40.00 the limited theoretical literature (Boyesen, 1980; Southwell, 1988). From a neurological Social Funct. 35.00 standpoint, the person can move from a chronically hypervigilant state (experienced by the person as anxiety, depression, and physical pain) to normal and self-regulating states of 30.00 arousal dictated by present circumstances. Indeed, we saw instabilities in some symptoms 25.00 T1 T2 T3 T4 T5 T6 over the course of the year that may be related to these neuro-fluctuations, even though the women were on their way to healing and stable change. Theoretically, the principle of neuroplasticity can be seen as a building block effect, such that trauma exposure can result Social Support and Social Conflict in incremental enlargement of a fear network in the brain (Kolassa and Elbert, 2007). The social indicators in this study were use of social support and social conflict (see Chart However, we believe that this same neuroplasticity can allow people to begin to rehearse 3). The women in the cohort study had statistically significant and sustained improvements in and relearn life patterns that can restore wellbeing. Feeling a renewed sense of coherence their use of social support at 6 months and for the rest of the time points. Social conflict scores and feeling able to use available social supports (or beginning to form relationships that were statistically reduced at the six-month point and after the year out intervention. There was are fulfilling) can enable the person to re-build a life of health. The benefits of the value of an improvement in use of social support (baseline M=47.8, SD=11.3) at the 6 months (M=57.0, positive emotions is theoretically explicated by Frederickson (Fredrickson, 2001; Fredrickson INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL SD=13.0, (t=-4.1, df=7, p=.01; d=0.4). These mean improvements remained with statistically and Cohn, 2008). Her Broaden and Build theory suggests that positive emotions broaden JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL significant mean differences across all remaining time points (mean range was from 59.6-61.3 p.> people’s moment to moment thoughts and actions, allowing them to recognize and respond .01) compared with the baseline. Social Conflict scores declined (baseline M=17.8, SD=3.4) at the to situations that promote life, happiness, satisfaction and peace. Making these moment- six-month point (M=13.4, SD=3.2)(t=4.6, df=7, p=.00; d=-1.0). These means were statistically to-moment cognitive, affective, and behavioral choices allows people to bring in resources lowered again after the year out intervention (M=13.1, SD=2.9, (t=3.2, df=7, p=.01; d=-0.6). that further promote their health and wellbeing, including everything from activities, to creative pursuits, to social relationships. When people are trapped in reflexive and habitual Chart 3: Social Changes responses formed during times of trauma, and reactivated and reenacted repeatedly after the threat has passed, their ability to identify and use potentially positive situations is 62.00 diminished. When these reflexive pathways are interrupted, a person’s natural inclination

52.00 to identify and use situations to their advantage is enabled. From a Biodynamic point of view, the discharge of energy that prompts habitual 42.00 Social Support patterns may have enabled the women to recognize and use the positive circumstances and 32.00 Social Conflict relationships they had put into place in their lives, and to learn new patterns of thinking,

22.00 acting and relating such that they were able to maintain health and build from there. We believe that 12 months is a short time for such broaden and build changes to achieve 12.00 T1 T2 T3 T4 T5 T6 their full effect. However, these data do suggest that the reduction in symptoms and

28 29 DENISE SAINT ARNAULT, PhD & SHARON O’HALLORAN, BD, MGBII BIODYNAMIC PSYCHOTHERAPY

the restoration of wellbeing was sustained over that time, providing the women with the DV women and demonstrated that these women were able to gain significant reductions opportunity to begin to find and/or practice new healthful patterns of thinking, feeling, in their symptom burden. In addition, the measures of quality of life showed that these and relating. Further research is necessary to learn what resources and support women may reductions in symptoms may have translated into an improvement in their quality of life, need to make the best use of this critical time in their recovery. especially in the areas of bodily pain and vitality. The clinical foci were working with the We saw stages of recovery in the women that are somewhat different from those reported feelings of being stuck or frozen, and opening up to life and relationships. The aim seemed in the literature (Herman, 1997; B. A. van der Kolk et al., 1996; B. A. van der Kolk, D. to be to help the women get re-activated, and re-engaged in their lives, to complete actions Pelcovitz, & S. Roth, 1996). Herman recognized the establishment of safety, remembrance they needed to complete, and to release the trapped energy so that it was available for other and mourning, and finally reconnection with ordinary life. The women in this study had important uses. been out of their relationships for over four years and had established relative physical safety. However, we found that feelings of safety, security and emotional safety remained BIOGRAPHIES an on-going struggle. In light of the number of symptoms and our earlier discussion of Denise Saint Arnault, PhD, RN is an Associate Professor of Nursing at the University the nature of chronic activation of the sympathetic or immobilization systems, women of Michigan. In clinical practice as a psychiatric nurse, she provided psychotherapy for THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

were often not feeling safe. Our findings also indicate that reconnection with ordinary women who were recovering from trauma. Her recent research has focused on the use of life involves numerous processes, and that this was often difficult for participants in our integrative interventions to aid in trauma recovery, including Biodynamic Psychotherapy study. For example, since women were grappling with numerous physical and emotional and narrative approaches to promote help seeking for distress. Other research includes symptoms, meeting the challenges of day-to-day life was a struggle. In general, women federally funded studies that examine personal, cultural and social influences on illness learned that the Biodynamic view of trauma could help them understand that even after so experiences and help-seeking for mental health distress and trauma. many years away from the abuse, trapped energy and incomplete cycles could explain why Email: [email protected] they had difficulty achieving the zest, vigour, vitality and social engagement that they had been searching for. Sharon O’Halloran, BD, Dip. Mediation, MGBII, has been the Director of SAFE We defined healing broadly and theorized that earlier interventions would “unfreeze” Ireland, the national representative body for domestic violence services in Ireland for the women’s neurophysiological system. However, we gave two more interventions aimed the past 13 years. She has worked in the community for over 20 years with expertise at not only reducing symptoms but also improving functioning. While there are dramatic in organisational change, leadership, social change and violence against women. As changes in symptoms that were sustained over time, the changes in other aspects of part of her work with SAFE Ireland she explores new ways of healing from trauma and health such as quality of life or meaning were slower to change. For example, while social ending intergenerational cycles of domestic violence. As a fully qualified biodynamic functioning (as measured by the SF-36) didn’t improve, social conflict reduced and use psychotherapist, she is also interested in the intersection between organisational of social support increased. When we understand healing as moving beyond symptom development, social change and healing. reduction to moving back into the social world after social isolation, this finding is an Email: [email protected] important one. In addition, since symptom burden, functioning and social engagement are interrelated, we can expect that over the course of a year, people healing from trauma might REFERENCES

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL experience uneven changes or times when their problems return temporarily. Therefore, Allmer, C., Ventegodt, S., Kandel, I., & Merrick, J. (2009). Positive effects, side JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL we recommend future research that maintains a broad-based conception of what healing is effects and adverse events of clinical holistic medicine. A review of Gerda Boyesen’s expected when, and why these may be so. nonpharmaceutical mind-body medicine (biodynamic body-psychotherapy) at two The limitations of this pilot study include the very small sample. In addition, we did centres in United Kingdom and Germany. Int J Adolesc Med Health, 21(3), 281-297. not use a control or treatment as usual group. Our aim was to determine the feasibility of Boyesen, G. (1980). Collected papers of biodynamic psychology (Vol. 1 & 2). London: this approach to healing for women from this population, and we discovered that women Biodynamic Publications. would not only engage in the healing, but also engage in research related to the value of Cohen, J. E. (1988). Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ, this approach for their mental and physical health. The data reported here are promising Lawrence Erlbaum Associates, Inc. and support larger and more complex trials and comparison research studies with other Courtois, C. A. (2004). Complex trauma, complex reactions: Assessment and treatment. types of more standard intervention methods such as cognitive behavioral therapy. While Psychotherapy: Theory, Research, Practice, Training, 41(4), 412-425. we did not collect all of the data from our sample about past history with the mental Courtois, C. A., & Ford, J. D. (2009). Treating complex traumatic stress disorders: An health system, women reported diagnoses and medication usage, suggesting at least some evidence-based guide. New York: Guilford Press. encounters with the medical system. Crowne, S. S., Juon, H. S., Ensminger, M., Burrell, L., McFarlane, E., & Duggan, Additional research is needed to learn what services women access and the benefits and A. (2010). Concurrent and Long-Term Impact of Intimate Partner Violence on limitations of those services to assist with the healing women need to fully thrive after Employment Stability. Journal of Interpersonal Violence, 26(6), 1282-1304. leaving an abusive relationship. This was an important longitudinal study of a cohort of De Jong, J. (2002). Trauma, war, and violence: Public mental health in sociocultural

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32 33 DENISE SAINT ARNAULT, PhD & SHARON O’HALLORAN, BD, MGBII CORRELATIONS BETWEEN TESTS

Ventling, C. D. (2002). Efficacy of Bioenergetic Therapies and Stability of the Correlations Between Tests for Grounding, Breathing and Therapeutic Result: A Retrospective Investigation. USABP Journal, 1(2), 5-28. Self-efficacy in Individuals With and Without Chronic Pain: Ware, J. E., Kosinski, M., Gandek, B. G., Aaronson, N., Alonso, J., Apolone, G., . . . Sullivan, M. (1998). The Factor Structure of the SF-36® Health Survey in 10 Who is “Standing with Both Feet on the Ground?” Countries: Results from the International Quality of Life Assessment (IQOLA) Christina Bader-Johansson, MSc Project. J Clin Epidemiol 51(11), 1159-1165. Ware, J. E., Kosinski, M., & Keller, S. K. (1994). SF-36® Physical and Mental Health & Summary Scales: A User’s Manual. . Boston: The Health Institute. Eidg. anerkannte Psychotherapeutin, ASP, Switzerland Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-Item Short-Form Health Survey (SF-36®): I. conceptual framework and item selection. Medical Care, 30(6), 473-483. Amanda Lundvik Gyllensten, Med.Dr, RCPT Wilson, J. P. (2008). Culture, trauma, and the treatment of post-traumatic syndromes: A Associate Professor global perspective. Ethnocultural perspectives on disaster and trauma, 351-375. Lund University, Department of Health Sciences, Sweden THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

Zelikovsky, N., & Lynn, S. (2002). Childhood psychological and physical abuse: Psychopathology, dissociation, and Axis I Diagnosis. Journal of Trauma and Received 29 June, accepted 2 December 2014 Dissociation, 3(3), 27-58. Zung, W. K. (1971). A rating instrument for anxiety disorders. Psychosomatics, 12(6), 371-379. Abstract Postural balance (grounding) and breathing are basic psychomotor functions that can be disturbed in patients with chronic pain. Self-efficacy plays an important role in treatment programs that address improved coping with pain. The aim of this study was to evaluate whether balance and breathing tests could discriminate between a group of patients with chronic pain and a healthy group and to test their correlations with psychometric tests. A conceptualization of grounding that incorporates physical and psychological factors is proposed. Methods: In this cross-sectional study 62 patients with chronic pain and 40 healthy individuals were examined using physical tests to measure postural balance and breathing and psychometric tests to measure self-efficacy and pain. Relationships among the measures were analyzed. Results: Significant differences (p<0.001) were found between the patient group and the control group in all balance and breathing tests and in the self- efficacy tests. Participants who performed correctly in two or more of the balance tests were ten times more likely to report high self-efficacy than those who did not. Conclusion: The INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL balance, breathing, and self-efficacy tests discriminated significantly between the groups. JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL Concurrent validity between some balance tests and self-efficacy could be shown. Further studies to confirm that predictive validity should be done.

Keywords: chronic pain, grounding, breathing, rotation, postural balance, self-efficacy

International Body Psychotherapy Journal The Art and Science of Somatic Praxis Volume 14, Number 1 spring 2015 pp 35-47. ISSN 2169-4745 Printing, ISSN 2168-1279 Online © Author and USABP/EABP. Reprints and permissions [email protected]

Acknowledgements: A grant from CH-EABP provided statistical support for this study.

A majority of patients with low back pain and pain in general are categorized as having non- specific back pain (NSBP, no clear physical cause) or medically unexplained symptoms (MUS) (Kirmayer, Groleau, Looper, & Dau, 2004). Many develop chronic pain lasting longer than three months (Chou & Shekele, 2010). There is evidence that depressed mood, distress, fear-avoidance behavior, and tendencies to somaticize and catastrophize are important background factors and 34 35 36 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS measures of posturalswayandcenterofpressure, whileanindividualstands onaforce platform,are of copingwithNSBP(Denison, Asenlöf, Sandborg, &Lindberg,2007).Finally, inmedicalresearch, variance inthetreatment outcomeofpainpatients.It role intheimprovement plays animportant effectively control specific events in life (Bandura, 1997). Self-efficacy can account for significant assessed related topostural balance andmovement. Self-efficacy isthebeliefinone’s own abilityto with asymbolicmeaning,butcan itbeexplored scientifically? Ponty, 1962). The expression “to standwithbothfeetontheground” speaksamind-bodylanguage ability toground oneselfinlife (Gyllensten, Skär, Miller, & Gard, 2010;Lowen, 1976;Merleau- experience ofbeinggrounded hasadeeperpsychological meaningrelating toexistenceandthe also from aninnertransferred feelingofpsychological safety–beinggrounded andcentered. This neuromuscular postural function legs, fromand feet. the trunk, To feel safe while standing derives (B.H.Bunkan,the trunk ongoingpersonalcommunication,2003-2014). persist, breathing musclescanstiffen,contributingtoadecreased rotation oftheposturalmusclesin over-stabilizing orstiffeningtheposture (Kolar etal.,2012). When thefearpatternsdescribedabove steeper slopepositionofthediaphragmmuscle(duetoincreased tension),whichhastheeffectof proprioceptors inthejointcapsulesandmuscles.One causeofpersistentlow back painmaybethe systemdecreases of the precisionactivity inthesympatheticnervous intheservomechanism muscle –ashutdown describedby Porges (2011).Johansson etal.,(1999)statethatincreased reaction, withhightonusabove low tonusbelow thediaphragmmuscleandvery thediaphragm 1993). Cuthbert, response isreleased dependsonthegeneralemotionalstatusofamygdala(Bradley, Lang,& Sjölander,again (Johansson, Djupsjöbacka,Bergenheim, &Pedersen, 1999).How easilythestartle sensitivity ofthemusclespindles,whichtriggerspain,againfear, beginningthecycle system,whichincreases thestatic triggered, triggersthesympathetic nervous whichfurther extremities increases inpreparation forrunning. person breathes inandholdsthebreath, theintercostal muscles contract,andtonusinthelower arms and elbows flex, the shoulders are protracted andraised,the abdominal musclescontract,the center of the body to protect the the solar plexus and diaphragm, the neck and back bend forward, following somaticresponse patterns: The muscle tonusincreases intheflexor musclesaround the reactionand/or bodilypain,thisunconsciousstartle isreleased (Brown etal.,1991),leadingtothe 1996). When thethreat issudden,suchasanunexpectedsoundorvisualimpression, afree fall, becomesconscious(Davis, Falls,response isnotnecessary) Campeau,&Munsoo, 1997;LeDoux, material, whichthenconnectstotheprefrontal where cortex fear(ortherealization thatafear to theamygdalainlimbicsystem,settingarousal level andprocessing emotionalunconscious released from thelower ofthebraininreticular parts formation(RF). The RFconnectsdirectly development ofchronic pain. treatments. This studyhypothesizes thatmotorpatternscouldbeeffective predictors forthe the relationship between NSBP, depression andcoordination dysfunctioncouldleadtonovel mechanical pressure ontissuesandjoints(Luomajoki, 2011;O’Sullivan, 2005).Understanding & Linton,2000).Some NSBPpatientshave coordination dysfunctions,whichcanleadto predictors ofthedevelopment ofchronic pain(Pincus, Burton, Vogel, &Field, 2002; Vlaeyen MSc&AMANDA LUNDVIKCHRISTINA BADER-JOHANSSON, GYLLENSTEN, Med.Dr, RCPT The experienceoffearreflexively activates musclesinanarousal andstartle reaction pattern Another area ofstudy, self-efficacy, has beenexaminedinthepainliterature, buthasnotbeen Being abletostandphysicallyontheground withbothstabilityandflexibility requires adequate A personwhoexperiencesadultordevelopmental traumaislikelytohave sustainedashock If thisarousal patternpersistsover timeitcreates aviciouscycle inwhichadditionalfearis (24 womenand16men)(See Table 1.). pain lastinglongerthanthree weeks duringthelastyear. The resulting group consisted of40persons assessment. To beconsidered fortheCG,individuals neededtobehealthy, withnomusculoskeletal waspostedinletterboxes, participation andrespondentsvoluntary cametoaprivate clinicfor men between theages of30and60(see Table 1). the lastsixweeks, andpaindue tomalignancy. The resulting were participants 35women and27 radiating painwithaneurological correspondence toonesegment,herniateddiscdiagnosedwithin withpersistent pain.Excludedsyndrome, musculardysbalanceandwhiplashinjury diagnoseswere: chronic panvertebral musculoskeletal pain,post-operative persistentpain,lumbago,cervicalgia, diagnoses were: fibromyalgia, chronic fatigue syndrome, non-specific low backpain,non-specific according totheinclusionandexclusion criteriadescribedbelow. based painclinic. The inpatientswere chosenby theheadofPhysiotherapy Department more thanthree monthswere consecutively chosenover aperiodoffive monthswithinahospital- and assessmentforms.For thepatientgroup (PG),62inpatientswith musculoskeletalpainlasting Participants 6. 5. 4. 3. 2. 1. individuals and a group of patients with chronic pain, and individuals andagroup ofpatientswithchronic pain,and with chronic neckandbackpain. No studyhasbeenfoundthatcorrelates balanceandbreathing teststopsychometric testsinpatients common methodsfortestingposturalcontrol (Muto etal.,2014;Ruhe, Fejer, & Walker, 2011). Is there anassociationbetween the sumofthebalancetests,breathing tests and Is there anassociationbetween thesumofbalancetests,breathing testsandthe Is there anassociationbetween thethree breathing testsandthepsychometric testsforself-efficacy Is there anassociationbetween thethree balancetestsandthepsychometric testsforself-efficacy Is there adifference inlevel ofself-efficacybetween thehealthygroup andthepatientgroup? Do thesixbalanceandbreathing testsdiscriminatebetween ahealthy group andagroup of The Research Ethical CommitteeoftheMedical Faculty ofLund University, Sweden approved The control group (CG)wasrecruited inthefirst author’s homevillage.Aflyer requesting The diagnosesusedwere Allowed thosemadeby amedicaldoctor andfoundinpatientcharts. wereAll participants required tospeakGerman andtobecapableofunderstandingtheconsent experienced pain? level ofself-efficacy? and experiencedpain? and experiencedpain? patients withchronic musculoskeletalpain? 2) To validate sixbreathing andbalancetestsinrelation toseveral psychometric tests. 1) To assesspossibledifferences inbalanceandbreathing functionbetween agroup ofhealthy The generalaimsofthisstudywere: Research questions Methods Aims CORRELATIONS BETWEENTESTS 37 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 38 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS without putting the lifted foot back on the ground for at least 30 seconds but demonstrates many without putting theliftedfootbackonground foratleast30secondsbut demonstratesmany Scoring isasfollows: 0=thepersoncanstandcorrectly >30seconds;1=thepersoncanstand to standonfirstand results forthebestleg were chosen forthe report. Three tries were allowed. a centerlinewhilestandingonone legwitharmshangingatthesides.Participants chose whichleg 1991). (Johansson, have beenvalidated formeasuringposturalswayin an unpublishedpilotstudyforNSBPpatients best result ofthebreathing andbalance testswascounted. The balancetestsusedinthepresent study psychometric tests.Afterthepsychometric tests,thebreathing andbalancetestswere repeated. The treatment periodofthree tosixweeks (cross-sectional design). exercises. The testswere carriedoutonceby thefirstauthorofthispaperat anytimeduringthe TAU includedergonomictraining,strength andendurancetraining,poolexercises andrelaxation Materials andProcedures ______Education Foreigners livingin------citizen Single Married/cohabiting Men Women Mean Age ______Table 1:Demographic and Pain Characteristics ofParticipants only bepresented confidentiallywitheachpersonbeinggiven anumber. wasvoluntary,participation couldwithdrawatanytimeandthatthedatawould thatparticipants participate. The correspondence containedinformationaboutthepurposeofinvestigation, that the study, LU 368-03.Participants were informedinwritingaboutthestudybefore theyagreed to MSc&AMANDA LUNDVIKCHRISTINA BADER-JOHANSSON, GYLLENSTEN, Med.Dr, RCPT Standing on one leg (Johansson, 1991) Standing ononeleg(Johansson, Testing began with the breathing and the balance and coordination tests, followed by the Clinical tests. Patients were scheduledforthisproject aswell asfortreatment asusual (TAU) withintheclinic. University College Trade school schoolorLess Compulsory > 2years 1–2 years 3-12 months Duration ofpain ______3(5%) 10 (16%) 32 (52%) 17 (27%) 19 (31%) 43 (69%) 25 (40%) 37 (60%) 36 (59%) 11 (17%) 15 (24%) 27 (44%) 35 (56%) 44.2 (n=62) % Patient Group . This testexaminestheparticipant’s abilityto maintain 13 (32%) 15 (38%) 12 (30%) 0 0 40 (100%) 4(10%) 36 (90%) 16 (40%) 24 (60%) 45.3 (n=40)% Control Group described above. thoracic spine.Participants chosetheturningrhythmby themselves. Scores rangedfrom 0-2as neck,andupper examines stabilitycombinedwithflexibilityin rotation oftheupperbodyparts, only forthepatientgroup. investigation, “arthritis or fibromyalgia” was replaced by “disease/symptom.” The ASES-Dwas used the maximumscore was 8andthe total meanscore ofcertainty was4.7 (SD, 1.6).In the present eight scores. In aGerman investigation of148fibromyalgia 2003) patients(Müller & Hartmann, more strongly perceived self-efficacy. Eachscore wascalculatedseparately, as well asthemeanof 2003). Hartmann, Values Higher certain). scores to10(very uncertain) indicate rangefrom 1(very language version oftheAmerican ASES(Lorig,Chastain,Ung, Shoor, &Holman, 1989;Müller& can reduce thesymptomatleastabit?”)were formGerman- assessedwiththe8-itemvalidated short concerning coping with pain and other disease-related symptoms (e.g., “How sure are you that you measured incm. pain intensityexperiencedduringthelastthree days. The distancefrom theleftto therightendwas on therightwasmarked 10(unbearable, maximalpain). The patientmarked thelinetoindicate scale (Huskisson, 1983). The endpointontheleftwasmarked 0(nopainatall)andtheendpoint groups withNSBPby theauthorsmentionedforeachtest. Psychometric tests (“like ahard tire”). of meat”); -1=hypotonic(“likewhippedcream”); hypertonic and2=very 1=slightlyhypertonic; at thebasalcostallevel. Scoringisasfollows: 0=normalelasticity(popularlysaid“likearawfillet 2003). The examiner putsbothhands on thechestto assess elasticity while compressing the chest with atapemeasure heldatthelevel ofthexiphoid process. left leg,five withtherightandfive withtheleft.be Toachieve afullscore, must theparticipant andbackwardlong alternatingforward stepswithreciprocal armmovement: five stepswiththe ability torotate thespineandcoordinate between theleftandrightsidesofbody. It consistsof with flexibilityinthelegsandpelvis,lumbarlower thoracicspine,andtotesttheparticipant’s seconds. equilibrium reactions 2=thepersoncannotstandononelegfor30 inthearms,legandtrunk; basal costal.Acontrolled diaphragmbreath was categorized asbasalcostal. thebreathing. examiner observed The deepbreath locationwascategorized aseitherhighcostal or evenrotation withprompting. inthetrunk, andbackwards);leg forwards thereciprocal 2=personcannotperform movements correctly with (e.g., candoreciprocal movements afterbeingreminded thatheorsheismoving thesamearmand is asfollows: correctly; correctly 0=testisperformed 1=personcanperform afterbeing prompted able tochangelegstwiceandcountthe15stepshim–orherself. mustrotate. Scoring The trunk “Standing ski step” 1991). (Johansson, General Self-efficacy. Self-EfficacyArthritis Scale(ASES)-D– German version Visual AnalogueScale(VAS Pain). All psychometric testspresented below have beentestedforreliability andvalidity forpatient Chest elasticity. Standing on one leg while rotating the head left and right (Johansson, 1991) Standing on one leg while rotating the head left and right (Johansson, Deep breath test Deep breath location. The qualityofchest elasticity was assessed with a modified Bunkan test(Bunkan, . The increase ofchestcircumference incm,whiledeepbreathing wasmeasured (Jerusalem& This assessment toolintendstoreflect a personaltrait During allthree breathing sat on achair while the tests, the participant Pain intensity wasassessedwitha10-cmvisualanalogue This testwaschosentoexaminestabilitycombined CORRELATIONS BETWEENTESTS . Self-efficacy expectancies . Self-efficacy expectancies . This test test . This 39 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 40 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS counted aslow painand>6wascounted ashighpain. scores below andabove the meanvalue were definedaslow andhigh respectively. VAS pain self-efficacy tests were dividedbelow andabove themean values obtainedinthisstudy. Self-efficacy were dichotomized anddividedintotwogroups: Good balance(0-2)andpoor(3-6). The counted together(range=0-6), providing amaximumsumof0orminimum6. The variables probability testswere two-tailed.For thelogistic regression analysis, thethree balance tests were to determinetheimpactof psychometric testsand VAS painonthe balance functions. The between variables measured on a nominal scale. Stepwise logistic regression analysis was performed Spearman’s rankcorrelation coefficient. Fisher’s exacttestwasusedtomeasure associations chest expansion,elasticity, andself-efficacy tests. See Table 2. itatall). perform The Mann-Whitney Utestwasusedtoanalyze ordered categoricaldatasuchasthe result “No” isdefinedasascore thebalancetestsatisfactorilyorcannot of1or2(cannotperform The result “Yes” isdefinedasascore thebalancetestcompletelysatisfactorily). of0(canperform The Statistics used thisinstrument. FKK/C are unrealistic intheirestimationofown personalities(Krampen,1991).Bothgroups to learnedhelplessness.People low highscores scores ofFKK/SK,andvery withvery ofFKK/Pand FKK/P andFKK/Cpointstodepression withastrong beliefinexternalcontrol, asituationsimilar computed. Alow FKK/SKscore pointstolow self-efficacy. Alow FKK/SKscore togetherwithhigh mean value 26.8(SD6.2). mean value 26.1(SD5.9);and4.FKK/C“Fatalistische Externalität”/fatalistic externalityorchance, value 32.4(SD5.4);3.FKK/P“Soziale Externalität”/socially causedexternalityorpowerful other, on mewhetherotherpeopleadjusttomywishes.”;2.FKK/I“Internalität”/ internalcontrol, mean concept ofpersonalcompetence,meanvalue 31.9(SD6.1),withquestionslike,“It mainlydepends true). false)to6(very (very are:The fourparts 1.FKK/SK“Selbstkonzept eigener Fähigkeiten”/self- item questionnaire eachwith eightitems.Eachitemhassixscores containsfourparts, ratedfrom 1 ornot(externalcontrol belief, ordestiny). The32- influence asituation(internalcontrol belief) A control belief is defined asthe extent to which an individual believes heorshe can personally behaviors are basedon,andcontinuouslymodified by, information. multiplesources ofsensory pattern ofpersonalityvariables makesitpossibletopredict courseofaction.Beliefs and acertain ofpersonalityandthecontrol belieftheory,action theory whichsays thatknowing thesystematic reliability: .64 to.82). It is also correlated withthe Beck Depression Inventory. It is based on the adults andfoundtobereliable andvalid (Cronbach’s Alpha:.70to.90;Spearman-Brown Split-half Kontrollüberzeugungen; FKK) Both groups answered thisquestionnaire. the wallhadfallen,generalself-efficacyscalepredicted psychosomatic symptoms two years later. Greenglass (1999)showed thatforasampleofEastGerman adultsmoving to West Germany after people usingthisassessmenttoolyieldedameanvalue of2.9(SD0.4).Schwarzer, Mueller, and estimated generalself-efficacy. Themaximumscore is4.Collectionof Internet datafrom 10,000 hard enough.”)Itif Itry contains10itemsscored onfourscales:thehigherscore, thehigher life(e.g.,“Icanalwaysmanagetosolve difficult with difficultiesandbarriersineveryday problems Schwarzer, 1992).It queriesanindividual’s expectancyofgeneralcompetenceandcapacitytodeal MSc&AMANDA LUNDVIKCHRISTINA BADER-JOHANSSON, GYLLENSTEN, Med.Dr, RCPT Questionnaire on Competence and Control Belief (Fragebogen zu Kompetenz und Associations between thepsychometric testsand the balancefunctionswere calculatedwith To compare patientsandcontrols theFisher’s exacttestwasusedtoanalyze categoricalvariables. In thepresent study, eachscore wascountedseparately, andameanscore foreachsubscalewas . (Krampen,1991)wastestedon2028German This instrument ≤ 6 was 6 was ______Test Type Efficacy Tests) Basal CostalBreathing) and Mann-Whitney U Test (ChestExpansion, ChestElasticity andSelf- and Control Group (CG) Using Fischer’s Exact Test (Balance Tests and Tests forHigh Costaland Table 2: Comparisons of Balance, Breathing, and Self-efficacy Test Results for Patient Group (PG) (see the CGparticipants Table 2). chest lessduringdeepbreathing, hadalesselasticchest andreported lower self-efficacythan Individuals inthePGhadpoorer balance,usedhighcostalbreathing more often,expandedthe Results ______FKK/SK General self-efficacy ASES-D Self-efficacy ______Chestelasticitymedian Chestexpansionmedian ______Basal costal High costal Breathing ______Total balancescore =3-6 Total balancescore =0-2 Ski step One legstandwithheadturn One legstand Balance ______Highly significantdifferences (p<0.001) were foundbetween thePGandCGinall variables. b and higherchest elasticity. a translated from theGerman). on CompetenceandControl Beliefs/Self-concept ofPersonal Competence(title Note. ASES-D=AmericanSelf-Efficacy Scale-Deutsch. FKK/SK=Questionnaire For balance andbreath elasticityscores only, lower scores indicatebetterbalance Measured incm. a (range) b (range) a a

No Yes No Yes No Yes 2.0 (-1.5-5.0) 1.0 (-2-2) PG (n=62) 29.8 2.7 4.8 M 26 (41.9%) 36 (58.1%) 56 (90.3%) 6(9.7%) 54 (87.1%) 8(12.9%) 33 (53.2%) 29 (46.8%) 43 (69.4%) 19 (30.6%) 8.0 0.7 1.7 SD CORRELATIONS BETWEENTESTS 3.3 0.0 CG (n=40) 36 3.2 M 36 4 5(12.5%) 35 (87.5%) 12 (30%) 28 (70%) 1(2.5%) 39 (97.5%) 0 40 (100%) (0.0-7.5) (-1-1) (90%) (10%) 4.6 0.4 SD <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 p 41 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 42 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS the estimated odds ratio because very few patientssucceededinthebalancetests. few the estimatedoddsratiobecause very contained thevalue one. within pointtoanuncertainty The wideconfidenceintervals was whilestanding. VAS paindidnotpredict goodbalancesincetheconfidenceinterval or shecouldhandleandhave animpactonpain,the better theperson’s coordination in thePGscored >4.8ontheASES-D. The more apersoninthePG believed thathe value of4.8.(R areThe resulting presented oddsratioandconfidenceintervals in Table 4. three self-efficacytestswere dichotomized asbelow andabove meanvalues forthisstudy. poor (3-6) balance, and VAS pain was dichotomized as below versus above 6 cm. The removed from themodel. The sumbalancescore wasdichotomized asgood(0-2)versus out. Since thebreathing testsdidnotcorrelate withthepsychometric tests,theywere pain) as predictors of the sum balance score, a stepwise logistic regression was carried ______Sum balance(0-6) Ski step Standing onone legwithheadturn Standing onone leg ______Balance Test ______OrderSpearman Rank Correlations Table 3: Correlations of Balance to Self-efficacy tests and Pain in the Patient Group, using a weak correlation tothetestofstandingononeleg. correlated withthepsychometric tests.Both VAS painandthebalancetestsshowed only the correlations toself-efficacytestsincreased intwotests.None ofthebreathing tests correlated only to general self-efficacy. When the sum of the balance tests was calculated, turning andgeneralself-efficacy, ASES-DandFKK/SK(see Table 3). The standingskitest MSc&AMANDA LUNDVIKCHRISTINA BADER-JOHANSSON, GYLLENSTEN, Med.Dr, RCPT Moderate correlation wasseenbetween standingononeleg with andwithouthead The variable thatbestexplainedgoodbalance was anASES-Dscore above themean To determinetheimpactofpsychometric tests(three self-efficacytestsand VAS Self-efficacy testswere notsignificant. Table doesnotincludebreathing tests.Correlations between breathing measures and ns= notsignificant,p>.05,significant*p<.05,**p<.01,***p<.001 of Personal Competence(titletranslatedfrom theGerman). Deutsch. FKK/SK=Questionnaire onCompetenceandControl Beliefs/Self-concept Note. General SE=generalSelf-efficacy. ASES-D=AmericanSelf-Efficacy Scale– 2 =0.28).Odds were 10timeshigherofhavinggoodbalanceifaperson -.57*** -.47*** -.42*** -.46*** SE General -.47*** ns -.49*** -.37** ASES-D -.46*** ns -.38** -.44** FKK/SK ns ns .29* Pain General Self-efficacy >2.7 ASES-D >4.8 ______Measure ______Balance inthePatient Group (n=62) Table 4:Summary ofUnivariate LogisticRegression Analysis Predicting Having Good diaphragm breathing. potential differencescould tease apart between patients with basal costal and controlled expand the chest as much even the poorest in the CG. Additional performers research possibly indicateafreeze reaction withhightonus. Very were PGparticipants few ableto group mayhave includedpersonswithcontrolled diaphragmbreathing, whichcould approximate–highbreathing costalandbasalcostal. locationwasvery The basalcostal welldifferentiated from oneanother. thePGand CGvery The differentiation ofthe usingmeasuresfurther ofemotionalstylesandbreathing. suggested by Reich (1949)andLowen (1976). These possibilitiescouldberesearched to withholdemotions,aphenomenoncommonlyseen by bodypsychotherapists and a signofguarded behavior, ingeneral. It mayalsobeasignofincreased tensioninorder Bunkan, Opfjordsmoen, Moen, Ljunggren, &Friis (1999,2003). This stiffnesscouldbe freeze orshockreaction withhighcostalbreathing, describedby Porges (2011). costal breathing. Sudden ordevelopmental traumacanfixateapersoninchronic startle, deeply andthusincrease thechestcircumference, withmore showing PGparticipants high The groups differed significantlyinthelocationofbreath andintheabilitytobreathe Discussion 20 alsohadpoorbalance(scores of3-6). reported low 19ofthe self-efficacyontheASES-Dandgeneralinstruments. competence), a sign of learned helplessness and depression, 18 of these patients also (chance control) togetherwithalow score onFKK/SK(self-conceptofpersonal ______VAS pain<6 FKK/SK >30 The breathing testsdidnotcorrelate significantly withthepsychometric tests,yet showedPG participants lesselasticityinthechest,consistent withthefindingsof Highly significantdifferences were foundbetween thePGandCGinall variables assessed. Of the20patientswhoscored highon the FKK/P(powerful others)andFKK/C Competence (titletranslatedfrom theGerman). VAS = Visual AnalogueScale. SK =Questionnaire onCompetenceand Control Beliefs/Self-concept ofPersonal foroddsratio(OR).ASES-D=AmericanSelf-Efficacyinterval Scale–Deutsch, FKK/ Note. Balance measure usedwasthedichotomized sumbalancescore. CI=confidence 6.1 10.0 OR 0.4 4.6 [2.0 -18.2] [2.5 -39.7] 95%CI [0.1 -1.3] [1.6 -13.5] CORRELATIONS BETWEENTESTS 43 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 44 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS in theclinicalassessment ofpatientswithpain. For the generalpractitioner, psychotherapist cutoff >9wasestimatedasanegative predictor oftreatment outcome. affect thegrounding capacity. In thepainclinicof Valens, Switzerland, VAS painwitha predictor forgoodorpoor balance.It highpainintensitylevels ispossiblethatonlyvery and thiscorrelation wasweak. Therefore, thethreshold of>6cmwasnotagooddichotomized these findingsstatistically. also hadpoorbalance(scores of3-6).Further studiesusingalargersamplesize couldverify depression interest aspain.Of particular inthepresent studyisthat19ofthese20patients self-efficacy, andpessimism.Clients oftenexpress theirinnerexperiencedhelplessness and (2003), whichshowed strong correlations amongdepression itemsintheASES-D,general helplessness anddepression. This isinaccordance withMüllerandHartmann’s findings Twenty patientshadalow score onFKK/SKandahighscore onFKK/PC,signifying learned The value isthussufficiently dichotomized inthecalculationforpredictors ofgoodbalance. value of 4.7 obtained in a study of patients with fibromyalgia 2003). (Müller& Hartmann, (Denison etal.,2007). Another studypointstothecorrelation between low fear-avoidance andhighself-efficacy self-efficacy (ASES-D)correlated withabettertreatment 2003).result (Müller& Hartmann, add additionalexplanations.AGerman studyofpatientswithchronic painshowed thathigh the correlation between balance and self-efficacy. The other two self-efficacy scales did not 3-6 andgoodbalance=0-2)wasdone.Of theself-efficacytests,ASES-Dbestexplained in which balance scores were dichotomized intoclinicallyrelevant cutoffs (poor balance = have goodbalance. balance. Participants withhighscores (>4.8)ontheASES-Dwere 10timesmore likelyto -.57), indicatingthatfactorsotherthanself-efficacycouldinfluenceandexplainpoororgood The sumbalancecorrelation coefficientofthepsychometric testswasmoderate( on onelegforlongerthan30seconds,he/sheismore likelytohave alow self-efficacyscore. developed inthelegs(Lowen, 1976). This studyindicatesthatifapersonisunabletostand has notbeenallowed expression (stamping,kicking),sothatahealthychargehasnotbeen 1967). From a psychomotor developmental perspective it is possible that theirown will not assessedinthisstudy. hard centralmusclesandslackperipheralmuscles. The consistencyofthelegmuscleswas healthy subjectsandpatientswithpain,psychosis ornonpsychotic mentaldisorders were muscle consistency, Bunkan etal.,(2003)foundthatthestrongest discriminatorsbetween leg were unabletostandeven five secondsbefore losingtheirbalance. Based onpalpating 2001). In thepresent study, poorlystandingonone someofthepatientswhoperformed coordination patternsthatindicatedguarded behavior(Selles, Wagenaar, Smit, & Wuisman, which alower degree rotation duringwalkingwasfoundtobeduehyperstable oftrunk time. These results are consistentwiththoseofanotherstudychronic painpatients,in whichareand trunk, likelytobeinfluencedifapersonexperiencesincreased tonus over the standingskistepwere themostdiscriminatingtests. They includerotation oftheneck MSc&AMANDA LUNDVIKCHRISTINA BADER-JOHANSSON, GYLLENSTEN, Med.Dr, RCPT PG participants mightalsohave beenexhibitinglearnedhelplessness(SeligmanPG participants &Maier, The balancetestsofstandingononelegandturningtheheadfrom sidetoand The present ofintegratingbothbalanceandself-efficacy tests studysuggests theimportance Of thethree balancetestsonlyonecorrelated witha reported experienceofpain(VAS>6) In thisstudy, themeanvalue oftheASES-DwithinPG(4.8)wasclosetomean Since theresults ofthebalancetestswere notlinear, aunivariate logisticregression analysis r = -.46to in terms of sex and age, the group contained mostly Swiss with higher participants Limitations state couldbevaluable forgeneralpractitionersandtherapists. about psychological traits. A somatic test that says something about patients’ psychological capacity. NSBPpatientsare usuallymedicallyorientedanddonotwanttohearanything in adjustingtoreality by increasing self-efficacyinsteadof theirtrue overestimating their theirown intrusting competence,orindividuals withpainwhomayneedextrasupport manageable balancetestswithouttheneedfortechnicalequipment.Such testscouldidentify or physiotherapistworking withNSBPpatients,itmightbehelpfultohave access toeasily Email: [email protected] 2001 on“Basic BodyAwareness Therapy. Assessment,treatment andinteraction.” ofHealthDepartment sciences.She madehermedicaldoctoratethesisatthe Lund University Amanda Lundvik Gyllensten, Med.Dr, RCPT isanassociateprofessor attheLund University Email: [email protected] Telephone: +41447864393. Correspondence: CBader-Johansson, Erlenstrasse 92,CH-8832 Wollerau, Switzerland. ASP whoworks inprivate practicenearZürich,Switzerland. Christina Bader-Johansson, MSc,isabodypsychotherapist EABPandpsychotherapist BIOGRAPHIES echoes theexpression. a stableandrealistic personwhocancoordinate thebodyinaflexibleway. This study the breathing testsdidnotcorrelate withthetestsofself-efficacy. their sumscore systematicallycorrelated withallthree self-efficacyscales.In contrast, tests highlydiscriminatedbetween thePGandCG. Two ofthebalancetestsandespecially Conclusions low self-efficacy. for more definite statistical results concerning correlations between poor balance and correctly. Increasing thenumberofindividualsinPGafuture studywouldallow the balance due teststo the small number of people in the PG who could perform of participants’ group membership. withouttheratershavingknowledgevideotape thetestsandstudyfilmsafterwards, (thefirstauthor)couldleadtobias.Anothermethodwouldhave beentoobserver experienced,usingonlyonea standardized wasvery scoringwasused andtheobserver influenced self-efficacy, whichwasfoundtobehigherinthecontrol group. Even though education andwhowere cohabitingormarriedintheCG. These variables mighthave This studyhasanumberoflimitations.AlthoughtheCGandPGwere well matched The folkloricexpression “to standwithbothfeetontheground” generallyrefers to The present studyshows thattheposturalbalance,breathing tests,andself-efficacy intheestimatedoddsratio,The widevariance coefficientpointstoanuncertainty CORRELATIONS BETWEENTESTS 45 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 46 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Lorig, K.,Chastain,R.,Ung, E.,Shoor, S., &Holman, H.R.(1989).Development and LeDoux, J.(1996).Emotional networks view. andmotor control: Afearful Kirmayer, L.J.,Groleau, D.,Looper, K.J.,&Dao. M.D.(2004).Explaining medically Krampen, G.(1991). Kolar, P., Sulc, J.,Kncl,M.,Sanda, O.,Andel,R.,Kumaqai, J.,Cakrt, K.,&Kobesova, A. Johansson, H.,Sjölander, P., Djupsjöbacka,,M.,Bergenheim, M.,&Pedersen, J.(1999). Johansson, C.(1991).Is theposturalcontrol deterioratedinagroup ofchronic neck-and Jerusalem, M.,&Schwarzer, R.(1992).Self-efficacy asa resource factorinstress appraisal Huskisson, E.C.(1983). Visual AnalogueScale.In: Melzack, R.(Ed.), Gyllensten, A.L,Skär, L.,Miller, M.,&Gard, G.(2010).Embodied identity–Adeeper Denison, E.,Asenlöf, P., Sandborg, M.,&Lindberg,P. (2007).Musculoskeletal painin Davis, M.,Falls, W.A., Campeau,S.,&Munsoo, K.(1997).Fear-potentiated Aneural startle: Chou, R.,&Shekele P. (2010). Will thispatientdevelop persistentdisablinglow backpain? Bunkan, B.H.(2003). Bunkan, B.H.Opjordsmoen, S.,Moen, O.,Ljunggren, A.E.,&Friis, S.(2003).Palpation of Bunkan, B.H.,Opjordsmoen S,Moen O,Ljunggren, A.E.,&Friis, S.(1999). What are the Brown, P., Rothwell, J.C., Thomson, P.D., Britton, B.L.,Day, B.L.,&Marsden C.D.(1991). Bradley, M.M.,LangP.J., &Cuthbert B.N.(1993).Emotion, novelty reflex: andthestartle Bandura, A.(1997). 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Bioenergetics. The revolutionary therapy thatuseslanguageofthebodytoheal (3), 175-181. The Polyvagal theory. Neurophysiological foundationsofemotions, (4), 242-255. Movement asasubgroup control ofNon-specific impairment Low Back The Phenomenology ofperception. The Phenomenology New York: Coward, McCann andGeoghehan, Inc. (1),1–9. European Journal ofPain, 7 European Spine Journal, 20 Pain, 85 New York: W.W Norton &Company. (23). Advance onlinepublication.Retrieved , 317-332. Anxiety, Stress andCoping,12 London:Routledge &Kegan. CORRELATIONS BETWEENTESTS (2), 163-171. (3), 358-368. (Doctoral Dissertation). Journal of European Clinical , Spine, 47 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 48 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS within thepsychotherapeutic context. Out ofthiscontext, thisstudymightbehelpful to as well awareness asindicating how isembodiedinthe languagepatientsuse bodyboundary the effectiveness awareness ofpsychotherapy tobringaboutchangesinthebodyboundary Such finiteness would represent changes in body boundary someempirical support related to finiteness withinanempathicpsychotherapeutic process.changes intheirbodyboundary formation and Rogerian person-centredbody boundary theory, patientsshouldexperience development ofpsychological disturbances. Given thetheoretical relationship between the internalisationofvalues selfcontributetothe thatare withthetrue incongruent occurrence,to beafortunate Rogerian (1951,1961)statesthat person-centred theory 1958). Althoughexposure toastableandsecure family environment istypicallyperceived influenceintheformation ofbodilyboundaries(Fisherthe mostimportant &Cleveland, familial, stableandsecure values andbehaviouralexpectationsare assumedtorepresent awareness. Particularly,differ in their body boundary the exposure and internalisation of values wouldstimulatechangesinpatients’ finiteness. Individuals typically bodyboundary © Author andUSABP/EABP. Reprints [email protected] Volume 14,Number 1spring2015pp48-64. International BodyPsychotherapy Journal LAURA A.CARIOLA,MA boundary and its regulatory functionofinter-andintra-psychic anditsregulatory processes. boundary might benefitbodypsychotherapy practitionerstoobtainadeeperinsightintothebody sessions intheverbal behaviouroflow andhighbarrierpatients. The findingsof thisstudy program (LIWC) (Pennebaker, Booth,&Francis, 2007),aswell asprogressive psychotherapy general semanticcontent,asmeasured usingtheLinguisticInquiry Word Counttextanalysis barrier imagery, asmeasured usingtheBody Type (BTD) Dictionary 2006),andthe (Wilson, person-centred psychotherapy. It doesthisby measuringthestrengths ofassociations between finitenessoftwelve examines theuseofwords patientsattending andchangesinbodyboundary and Roger’s influenceonthedevelopment ofbodypsychotherapy, thiscorrelational study disturbances (Rogers, 1951,1961).Given formation thisrelationship between bodyboundary finiteness(Fisherbody boundary &Cleveland, 1958)andthedevelopment ofpsychological and behaviouralexpectationsrepresent influenceintheformationof themostimportant This studyisbasedontheassumptionthatexposure andinternalisationofsocialvalues, centred psychotherapy This article aimstoexploreThis article whethertheclarificationofinternalisedfamilialand social Keywords: Semantic Expressions oftheBodyBoundary Personality Bodyboundaries,psychotherapy, semantics,primordial cognition,person- in Person-centred Psychotherapy Received 15October, accepted20December, 2014 Laura Cariola,MA A. Lancaster University The Art andScienceofSomaticPraxis ISSN 2169-4745Printing, ISSN2168-1279Online Abstract or differentiation. (Fisher, 1970,p. 155). self objectsandtheoppositepoleispersonwhoregards hisbodyaslackingdemarcation hisbodyasclearlyandsharplybounded,withahighdegreeviews ofdifferentiation from non- definiteness personsascribetotheirbodyboundaries. At oneextreme istheindividualwho their bodyboundariestotheextentthatthere isconsiderable variation inthefirmnessor Fisher andCleveland’s Concept Boundary Body personality.psychic functionsassociatedwiththebodyboundary practitioners ofbodypsychotherapy theirunderstandingoftheintra-andinter- tofurther climbing thoughawindow”, “an amputatedarm”, “an openmouth”, and“a bleedingleg”. smoking apipe”, and“a pregnant woman”, andexamplesofPenetration responses included“a man were indicatedalowfrequency barrierpersonality. ofbarrierimagery Examples ofbarrierresponses correspondedfrequency toahighbarrierpersonality, ofbarrierimagery whereas alow fragility andpermeabilityofdefiniteboundaries. Based onthisscoringsystem,ahigh whereasrelated totheboundaries ofadefinitestructure andsurface, penetrationimagery emphasisedtheprotective andenclosingfeaturesbody boundaries.barrierimagery ofthe the frequency ofwords thatrelated tothedefinitenessandpermeabilityofanindividual’s (Rorschach, 1921),Fisher andCleveland developed amanualscoringsystem thatmeasured less definitebodyboundaries. to theprotective andenclosingfeatures intheirenvironment, asopposedtoindividuals with more definitebodyboundarieswould show agreater tendencytodirect theirvisual attention experience oftheirown bodyboundariesontotheirenvironment. Therefore, individualswith might represent more functionalformsof regulating emotions. whereas body boundariesinthemiddlerange onthehigh-low barrierpersonalitycontinuum and low bodyboundariesmight be perceived to result in defensive forms of affect regulation, also not explicitly stated by Fisher and Cleveland (1958), the extreme development of high enclosing container“whose wallswouldprevent theoutbreak oftheseimpulses” (p. 55).If are perceived asunacceptable,overwhelming orthreatening. The bodyfunctions,then,asan level, reflect a defensive function by containingandcontrolling thesenegative emotionsthat enclosing peripheriesandtherigidappearanceofbodilystiffness might,onapsychosomatic in expressingreservations negative emotions, such as anger and frustration. The focus on Fisher andCleveland’s showed ofhighbarrierpatients withrheumatoidarthritis observation a favourable personality trait compared to the low barrier personality, it has to be noted that instability, as insecurityandtension.Although highbarrierpersonalitiesmightbeconstrued with lessdefinitebodyboundarieswouldgrow upinfamilyatmospheres characterised by values aswell astheabilitytomaintain stableandintimaterelationships, whereas individuals with definitebodyboundarieswouldhave mothersthatprovided asecure modelandstrong Based onthisresult, Fisher andCleveland (1958,pp. 259-260)interpreted thatindividuals scored lower on maladjustment and rigidity scales than mothers of low barrier personalities. from interactions in family environments. For example,mothersof high barrier personalities finitenessiscorrelated tothesocial values andbehaviouralexpectationslearnedbody boundary Fisher andCleveland reasoned thatindividualswouldproject theirphenomenological Fisher intheappraisalof thatindividualsvary andCleveland (1956,1958)observed In aseriesofempiricalstudiesusingprojective tests,includingtheRorschach inkblottest Most importantly, Fisher andCleveland (1958)suggestedthatanindividual’s degree of “a stripedzebra”, “a womanwearing ahigh-neckeddress”, “a tower withstonewalls”, “a man SEMANTIC EXPRESSIONS 49 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 50 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS inward focus is thought to facilitate an authentic experience of emotions and feelings as part of beingaware ofandexperiencing internalprocesses inthe present ratherthaninthepast;this such psychotherapeutic approaches facilitates“a movement inwards” (Davis, 2012)as ameans expressive behaviour (Röhricht,Gallagher, Reuter, &Hutto, 2014). The mind-body focusof enacted withinthepsychotherapeutic relationships through direct physicalcontactand aspects oftheself-experience and grounded intersubjective meaning thatare explored and psychotherapy perceives thebody, mind,internal andperceptual processes tobeintertwined psychotherapy, gestaltpsychotherapy, dance/movement therapyandbioenergetics.Body a foundationforpsychotherapies thatusebodyawareness ormovement, includingbody approval. self-concept, inadditiontorecognising thatisindependentof external theirpersonalworth growth enablespatientstofindtheirphenomenological selfanddevelop astableandhealthy to graduallyassumemore theirintuitions,values, needsanddesires. inclinationtotrust This 2) unconditionalpositive regard, 3)empathicunderstanding—patientswillbesupported depend substantially on three core conditions — 1) the therapist’s or genuineness, congruence desired psychotherapeutic changes to occur. Through the psychotherapeutic processes that climate asapre-requisite foradeepunderstandingby thetherapistsoftheirclientsandfor the therapist. Most importantly, Rogers (1961) stressed the notion of the psychotherapeutic feelings andthoughts,thustheirphenomenologicalexperiencesare fullyacknowledged by therapists’ useofreflection asameans tosummarisewhattheclientexpresses abouttheir Rogerian Person-centred Psychotherapy moral conventions, anditisthecognitive functioningofolderchildren andadults. process isabstract,related totheprinciplesof grammarandlogic,timespace,social states.In dream, contrast,secondary hallucinatory meditative, mystical and drug-induced associated withthecognitive functioningofAltered States ofConsciousness, including moral conventions. It isalso theprincipalawareness ofyoung children, andithasalsobeen is concrete, irrational,unrelated to spatio-temporal constraints,andfree from social and processes. Primary andsecondary processfunctioning thatdifferentiate between theprimary conceptual thoughtrepresent similarconceptstotheFreudian (1900)modesofcognitive as self-reference, aswell asaffective andcognitive processes. Primordial mentalactivityand personalities showed increased useofsemanticcontentrelated toconceptualthought, such as group references, processes, andspatialreferences. somatosensory In contrast, low barrier of high barrier personalities used more words associated to primordial mental activity, such the bodyandunconscious,Cariola(2015)identifiedthatautobiographicalmemories (Bollas, 1987).Based ontheFreudian (1923)thatperceives arelationship theory between internal experiencesisassumedtoindicatedissociationfrom one’s emotionsandthoughts internal moodstatestotheirsocialenvironment, whereas theinhibitiontoexpress one’s individuals withcoherent selfandbodilyschemas are assumedtocommunicatetheir a coherent selfandbodilyschema(Ogden, 1989;Bick, 1968, Winnicott, 1971). Thus, socialization experiencestorepresent oneofthestrongest influencesontheformationof LAURA A.CARIOLA,MA These findingsare alsoconsistentwithpsychodynamic theoriesthatperceive early Rogers’ (1951,1961)person-centred approach topsychotherapy as canbeconstrued Reich’s Armour Bodily Person-centred psychotherapy employs anon-directive approach emphasisingthe Rogers’ core conditions psychotherapy transcripts.Correlations of semanticcontentconsistent withtheresearch discrepancy, tentativeness, certainty, inhibitionandexclusion words) in the combined spoken positive emotionsand negative emotions)andcognitive mechanisms(i.e.,insight,causation, verbs, presentverbs, tense,pasttenseandfuture auxiliary tense),affective processes (i.e., thought, suchasself-reference (i.e.,first-personsingularpronouns), verb forms(i.e.,common wouldbenegatively correlated withsemanticcontentrelatedbarrier imagery toconceptual to personalconcerns(i.e.,work, achievement, leisure, home, money, religion anddeath). motion), bodily processes (i.e., body, health, sexual and ingestion) and references related process (i.e.,seeing,hearingandfeeling), spatial references (i.e.,relativity, spaceand as group references (i.e.,first-personpluralpronouns andinclusionwords), perceptual would correlate positively withsemanticcontentassociatedprimordial thought,such dream memories (Cariola, 2015), the first hypothesis(H1) predicted that barrier imagery content associatedwithprimordial and mentalactivityinthewrittennarrationofeveryday popularised by Wilhelm Reich (1897-1957)(e.g.,Carleton,2002).ConsistentwithFisher and for thewholeself;therapywith‘no-body’ isimpossible” (p. 127). humans are essentiallyinteractingbodies “and we are confronted withthebodyasametaphor by focussingpredominantly onpatients’ verbal content,aspointedoutby Leijssen(2006), here-and-now. Althoughverbal psychotherapists mightassume astronger theoretical level person-centered by focusingontheexperientialandembodiedinnerselfsituatedwithin (Fernald, 2003).In thissense,Rogerian therapyinfluencedbodypsychotherapy inbecoming organism totheextentthatbodywouldmanifestpatients’ momentsofself-actualization that psychological changes would result in experiential shifts and physical loosening of the of aself-actualisationprocess (Behr &Becker 2012).In particular, Rogers (1961)emphasized Hypotheses structure, anddissolve therigidbodyarmour. theexpressionpatient isabletotrust ofrepressed instinctualmaterial,reduce thedefensive in the development of psychological disorders. Through Reich’s psychotherapeutic process, the repressed contributing factors instinctual demands is thought to be one of the most important moral demandsoftheouterworld. The resulting lackofawareness, or‘contactlessness’, ofthese anxieties thatare generatedby theconflictbetween the repressed instinctualprocesses andthe the individual and the outer world. The body armour provides a chronic barrier that wards off shell istherepresentation ofthesediscrepancies, notonlywithintheindividualbutbetween 2005). Given thediscrepancy amongtheselayers, Reich (1945)arguedthatthehard body third layer relates self(seealsoConger, tothebiologicalexperiencesandprocesses ofthetrue unconscious andrepressed drives, whichare embodiedincontractedmusculature; andthe conventions, suchasconscientiousnessandpoliteness;thesecondlayer relates toanindividual’s comprised ofthree layers: thefirstlayer relates totheexpression ofprevalent social values and in relation tosocietalmoralexpectations andvalues. According to Reich (1970),the bodyis such as emotions and actions. These instinctive processes are perceived to be unacceptable musculature andhardened ofbodyarmourholdsrepressed surface instinctive processes, of unacceptableemotions,Reich’s (1945)“ behavioural internalisations,aswell asrepresenting acontainerthatinhibitstheexternalization Cleveland’s wouldembodythesumofallsocialand (1958) assumptionthatthebodyboundary Given thatprevious research demonstratedthathighbarrierpersonalitiesusesemantic Consideration ofthemind-bodyrelationship inpsychotherapy wasfirstintroduced and Character Analysis” arguedthatthecontracted SEMANTIC EXPRESSIONS 51 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 52 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Demographics ofpatients’ agerange, sexualorientationandmaritalstatus Table 1: and maritalstatus,canbeseenin Table 1. sessions. The demographicinformationofthepatients, includingagerange,sexualorientation women) whoattended20consecutive once-weekly Rogerian person-centred psychotherapy psychotherapeutic sessions. transcripts selected for the purpose of this study were based on patients that attended twenty modalities were oftenprovided consecutive withonlyafew sessions.Out ofthiscontext,the session representing thefinalsession. In contrast,thetranscriptsofotherpsychotherapeutic of transcriptsindividualtherapiesbasedontwenty consecutive sessions,withthetwentieth centred approach topsychotherapy, however, isthemostcomprehensive becauseitoffersarange of distinguishedpractitionersandacademics. The transcriptdatabaseoftheRogerian person- American Psychological Association’s Ethics Guidelines, andwere selectedby aneditorialboard (2012), thepsychotherapy transcriptswere provided by practicingtherapistswhoadhered tothe study. According totheaccompanying‘CounsellingandPsychotherapy Transcripts’ handbook ‘Counselling andPsychotherapy Transcripts’ database(2012)whichprovided thedataforthis Method and high-low barrierpersonalitycontinuums. lies in the middle range rather than the extreme ends on the body boundary True- False Self based ontheassumptionthatexpression selfaswell astheformationof ofthetrue inhighbarrierpatients.Incorrelate thissense,studyis negatively withbarrierimagery inlowsessions wouldbecorrelated positivelybarrierpatientsbut withbarrierimagery experiences andvalues, thesecondhypothesis(H2)predicted thatprogressive psychotherapy andbecomeconsciouslyaware patientstotrust oftheirorganismictherapy aimstosupport formation (Fisher &Cleveland,1958; Rogers, 1967).Consideringthatperson-centred behavioural values, or the lack thereof, influence the development of the body boundary might alsobeindicative ofapatient’s increased orreduced bodilyarmour(Reich, 1946). psychotherapy, the statistical relationships between these semantic items and barrier imagery behaviour andtoexperimentallyderived autobiographicalmemories.In relation tobody andprimordial mentalactivitycanbe generalised to naturally occurringlanguageimagery hypotheses wouldthendemonstrateexternalvalidity inwhichanassociationbetween barrier LAURA A.CARIOLA,MA = 5) Female (N = 7) Male (N Gender Additionally, proposes psychological thattheinternalisationofsocialand theory The psychotherapy transcriptsusedinthisstudywere basedon12patients(7menand5 Patients’ verbal behaviour inpsychotherapy transcriptswere sourced from theonline Data 1 11-20 Age Range 4 5 21-30 1 1 31-40 5 6 Heterosexual Sexual Orientation - 1 Bi-sexual 3 6 Single 1 - Engaged Status 1 1 Married beginnings with barrierscores lessthan themedianvalue (<1.69)were categorisedas atthebeginningoftheir therapy.frequencies ofbarrierimagery Therefore, psychotherapy used todividethepsychotherapy transcriptsinto twopatientgroups thatusedhighandlow frequency ofthefirstpsychotherapymedian value of1.69 forthebarrierimagery sessionwas (SD =.66).By drawing onthemethodologyappliedby Fisher andCleveland (1958),the first sessionsofthepsychotherapy transcriptshadamean1.72ofandmedian 1.69 based onFisher andCleveland’s awareness (1956,1958)scoringsystemofbodyboundary andpenetrationimagery,calculates thefrequency ofsemanticitemscategorisedasbarrierimagery Measures andAnalysis (SD =2,773.22). length of1,341.397words withameanof6,210.17words perpsychotherapy sessiontranscript psychotherapy sessiontranscript(SD=678.36). The patients’ verbal behaviourhadatotaltext verbal behaviourhadatotaltextlengthof358,137words, withameanof1,577.70words per with ameanof3,836.42words perpsychotherapy transcript(SD=3,057.79). The therapists’ Statistical analysis psychotherapeutic theoriesandconstructs. within thepsychotherapeutic settingsandtoassesshow the semanticcontentalignedtoexisting patient’s verbal behaviourwere selectedrandomlytodemonstratetheuseofsemanticcontent the following formula: The frequency rateusedinthisstudyforbothlinguisticandgrammaticalvariables wasbasedon 2008). categories (Wilson, which indicateshow manytotallexicalitemsmatchthedictionary lexical contentintexts(Hogenraad etal.,2003). The PROTAN computesthefrequency rate, the PROTAN contentanalysissoftware program, whichmeasures occurrences ofcategory-based ‘emotions’, ismadeofsemanticitemsthatrely ontheresearchers’ subjective judgment. to objective grammaticalconventions; however, thesemanticcontentofothercategories,suchas the). Grammatically basedcategoriesare basedontheclassificationofsemantic itemsthat relate words’ includestothe‘articles’ category sub-category, whichismadeup of three words (i.e.,a,an, sub-categories. For example, as noted by Tausczik and Pennebaker (2010, pp. 27-28), the ‘function ‘Function Words, ‘Psychological Processes’’ and‘Personal Concerns’. Eachofthesecategorieshas main categoriesandsub-categories. The semanticcategoriesare based on thefollowing categories: The LIWC ishierarchically organisedsothatoneword dictionary canbeascribedtodifferent based onapproximately 4,500words andword stemsthatare assignedto80semanticcategories. Francis, 2007)calculatesthefrequencies ofpredefined typesofsemanticcontent. TheLIWC is word stemsthatare 2008). assignedto12semanticcategories(Wilson, penetration imagery, and70exception words thatprevent theerroneous matchingof ambiguous (Cariola, 2014a, b). In total, the BTD contains 551 words for barrier imagery, 231 words for Initial descriptive statisticsregarding revealed thefrequencies thatthe ofbarrierimagery The Body Type that (BTD) Dictionary 2006)isacomputer-assisteddictionary (Wilson, The 12person-centred psychotherapy transcriptshadatotaltextlengthof1,699.534words To contextualize abetterunderstandingofthequantitatively derived results, samplesof For thecomputerisedcontentanalysis, theBTD andLIWC were appliedtothetextsusing The Linguistic Word textanalysisprogram CountInquiry (LIWC) (Pennebaker, Booth,& SEMANTIC EXPRESSIONS 53 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 54 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS transcripts. Notes: *p<.05level, **p<.01level: andsemanticcontentofthepatients’imagery verbal behaviour inthecombinedpsychotherapy Table 2:Positive Spearman rank correlation coefficientsofpositive correlations between barrier positively withsemanticcontentassociatedprimordial mentalactivity(Tables 2and3). Results barrier patients. inthepsychotherapythe progression transcripts oflow ofsessionsandbarrierimagery andhigh overall verbal behaviour. The testwasalsousedtoexplore thestrengths ofassociationsbetween andthesemanticcontentofLIWCof associationbetween barrierimagery inthepatients’ patients were 4menaged21to30years and2womenaged21to40years. barrier patientswere 3menaged11to30years and3womenaged21to40years. The low barrier were classifiedashighbarrierpatientsand 6 were classifiedas low barrierpatients. Thehigh sessions ofthepsychotherapy transcripts.Asaresult ofthismediandivision, 6ofthe12patients barrier patients(N=6)hadameanof2.30(SD.29)forthefrequencies inthefirst showed thatthelow barrierpatients(N=6)hadameanof1.13(SD.24)andthatthehigh categorised as‘highbarrierpatients’. ‘low barrierpatients’, whereas barrierscores greater thanthemedianvalue (>1.69)were LAURA A.CARIOLA,MA A Spearman rankcorrelation coefficient(Spearman, 1904)wasusedtoexplore thestrengths After thepsychotherapy transcriptswere thedescriptive statistics dividedintotwoequalparts, Consistent with the first hypothesis (H1), the results demonstrated that barrier imagery correlated correlated Consistent withthefirsthypothesis(H1), results demonstratedthatbarrierimagery Family Prepositions Articles 3 1 Linguistic variable Time Space Motion Relativity Death Money Home Leisure Work Ingestion Health Body Biological processes Swear words Inclusion Inhibition Anger rd st pluralpronouns singularpronouns barrier imagery .251** .235** .396** .194** .275** .223** .395** .367** .446** .224** .444** .519** .383** .270** .337** .202** .348** .324** .182** .191** .221** .138* p <.01level: of thepatients’ verbal behaviourinthecombinedpsychotherapy transcripts. Notes: *p<.05level, ** Table 3:Negative Spearman rank correlation and semanticcontent coefficientsbetween barrierimagery patients’ explorationoftheir personal relationships. A highprevalence ofthird-person singular her, andhim), indicatinganincreased non-immediate,orextended, other-focusrelated tothe andthird-personpositive association between singularpronouns barrierimagery (e.g.,she, interpersonal material processes (Halliday, 1985). Consistent with this view, there was a weak usage of group-references andnon-immediate othersassociated with barrier imagery, relate to mental processes that relate toaffective andcognitive statesandchanges,whereas anincreased immediate and external to the self (Rogers, 1961). An increased self-focus emphasises internal by focusingonobjects and,inrelation tothepsychotherapeutic context,problems thatare non- to asphaticconversations (Malinowski, 1972),andcontainarestricted level ofself-disclosure patients are unaware of their feelings. Here, conversations maintain a superficial tone, referred a blockedinterpersonalcommunication,orso-calleddefence mechanismofdenial,inwhich on person-centred psychotherapy (Rogers, 1967),areduced self-focus wouldbe indicative of first-person singular pronouns (e.g., I, me, and mine) implies a reduced self-focus. By drawing self ratherthanothers.Particularly, theweak negative and correlation between barrierimagery I, them,andher)therefore indicatedanemphasis onconversational topicsthatrelate tothe we mind?” or“Well we were bothmore orlesselatedbecause following phrases [Patient 3]: in relation toothers,suchasthepatients’ inthe whichcanbeobserved therapistandpartners, inclusive thinking.In thissense,self-expectationsandinternalexperiencesare over-generalised The use of collective group references resonates withalackof self-other differentiation andover- words (e.g.,and,with,andinclude)showed aweak positive associationwithbarrierimagery. are quitehopeful”. In contrast, barrier imagery wasweaklyIn negatively correlated contrast,barrierimagery withpersonalpronouns (e.g., Group references, suchasfirst-personpluralpronouns (e.g., we, us,andour),inclusion Feeling Perceptual processes Exclusion Tentativeness Discrepancy Causation Insight Cognitive processes Anxiety Positive emotions Affective processes Negations Present tense Auxiliary verbs Verbs Impersonal pronouns 1 Pronouns Linguistic variable st singularpronouns “Are “Are we supposed to sit here and just tell anything that comes to my barrier imagery we -.316** -.268** -.241** -.257** -.408** -.422** -.179** -.376** -.363** -.353** -.180** -.328** -.326** -.356** -.226** -.278** -.158* -.160* bothwanttogetthisproblem resolved, so SEMANTIC EXPRESSIONS 55 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 56 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS personal inter-personal qualities.Conversely, aweak positive correlation between barrier imagery relate tobeingsociallypositively evaluated by othersbasedonsuperficial values ratherthanon not even arelative or really thatclose”. giftfor somebodywhois I meanitwasstillasubstantial amount forjustlikeasmallhousewarming K.M. Hightower’s...like I and inrelation references, tomonetary “So, Iremember Iwent outandI a fewtimestomy-well, theoldhigh ofbaskinginthe sort relates toamaterialisticandachievement orientatedfocus,e.g.,[Patient 124] concerns, includingwork (e.g., job, majors,andXerox) andmoney (e.g.,audit,cash,andowe) and shescreamed athimabout,oh,maybeshesent mad, andshewassittingthere yelling attwoofherown kidsandoneofthepeopleacross thestreet’s kids, who theywere andsohetoldher, andshecameover andtoldmy to answer the thisoldlady’swhat happenedwas,somekidshadrung and indicatesan emphasis of container-schematic precepts —e.g.,[Patient 110]: kitchen, andhouse),whichmirrors afocusontheimmediateandintimatesocialenvironment you thatlastweek”. that my down and thought about, tried to think about that, too. And, I was thinking...because I felt this before, focus onfamilyrelated themes,asdemonstratedinthefollowing patient’s statement[Patient 11]: andfamily-related referencesimagery (e.g.,daughter, husband,andaunt)highlightstheinflated (Fisherboundary & Cleveland, 1958). Therefore, a weak positive associationbetween barrier the phenomenologicalself. This process precedes theembodimentofthesevalues withinthebody process offamilialandsocialintrojects thatare withthevalues andexperiencesof incongruent Person-centred psychotherapy assumesthat psychological disturbances are acquired through the unwinding. Not exactlyorcontinuingmytherapy”. guess beingbasicallyinsensitive. Which justmakesmefeellikeIamnotgettingaheadofthings to tell or justaboutpeoplethan And likejust the resident psychiatrist I went to last year I knew damn well Iknewmore about physiology these guysthatIamworking withare you know mysuperiors.Do notknow me.Or knowlittle. every Which Iamdoingnow. And And Iamworking instateandhospitalssoforth. realizing that PATIENT: going tohappenhere”. COUNSELOR: “ following example[Patient 6]: (Hancock etal.,2008)withinthepsychotherapeuticin context,whichcanbeobserved This strategyindicatesreduced personalresponsibility anddissociationfrom statementownership in theconversational situation(McCarthy, 1991)aswell astojustifytheirfeelingsandconcerns. pronouns mightalsorepresent astagingstrategytoregulate ofbeingthefocus theirdiscomfort LAURA A.CARIOLA,MA A weak tomoderatepositive andreferences correlation between barrierimagery topersonal correlatedBarrier moderatelypositively withhomereferences imagery (e.g.,apartment, “Because Iwasalready invitedby Jodie’s him mother theweek before completely reversed. CompletelyignoringwhatIhadmeant.And just I “Well yeah well of my experiences comes with working asa part counselor withmyself. door, mighthave rejected me,likemy And -well aboutwhat’s thatleadsyou tobevery you saidskeptical-Iguessalsoleery and her husband had seen the kids running away from the andherhusbandhadseenthekidsrunning accomplishments spent he did. like a whole part-time likeawholepart-time He didnot- -well, basedonwhenIgobackhome.Like, Ihave spokenquite school This materialisticandgoal-orientatedfocuscouldpossibly keepsinvitingmeback.Iwasthe first mother he wouldgive mebackthenextweek whatIhadtried mother over todinner. See, itwasalmostlike-andIsat pay check doorbell, home” didnotreally care. You know Ithinktold . so she had come up from the basement soshehadcomeupfrom thebasement , whichislike15 neighbour. bought And, the door, “I -althoughIenjoy bucks. her something from her somethingfrom graduate neighbour and so he knew andsoheknew It’s, well...but “And, I guess in got all gotall class ”, ”, [Patient 6]: coffin, andkill),suchasself-directed aggressive behaviourintheform of suicidalideation,e.g., now-and-here concernassociatedwithprimordial mentalactivity(Robbins, 2011). and present tenseverbs (e.g.,is,does,andhear)indicatesareduced reality-based behaviourand verbs (e.g.,am,will,andhave) andverbs (e.g.,walk,went, andsee),includingauxiliary imagery patients’ thoughts and feelings. In contrast, the weak negative correlations between barrier block, constrain,andstop),whichmightberelated totheinhibitedexpression ofhighbarrier was alsoasignificantpositive andinhibitionwords correlation between (e.g., barrier imagery (Pennebaker, 1989;Pennebaker &Beall, 1986; Traue &Pennebaker, 1993).Accordingly, there punishment-reward behaviourtoavoid sociallyrejecting anddisapproving socialjudgment psychotherapeutic feature ofthepreviously repressed angerand thelooseningofconditioned the positive andaggression correlation words between barrierimagery mightrepresent a stiffening ofthebodymusculature inhighbarrierpersonalities(Fisher andCleveland, 1958), super-ego (Freud, 1923). to avoid interpersonal rejection, as well as the harsh criticism of the internalised sadistic parental which thepatientwouldresist thelearnedmasochisticsubmissiontoparental demandsasameans manifestation ofthepatientembodyinganagentchange(Coghlan,1993;Nevis, 1987)in introjects (Fenichel, 1945;Freud, 1905).Aresistance maybethenperceived asanadaptive distressing experiencesthatresult inagradualresistance tomaladaptive parental andsocial within thetherapeuticcontextwouldfacilitateanessentialcathexistoexplore interpersonally unacceptable expression ofrageandanger(Fisher &Cleveland, 1958),theexpression ofanger barrier individualsintrojected theirparental social andbehaviouralvalues, suchasthesocially as well asareaction ofperceived threats function.Consideringthathigh andaself-preservation movements associatedwithprimordial mentalactivitytobringaboutanegationandseparation you oughttobeabletellthemyou are orexpress angry itorsaysomethingdosomething”. because Ijustfeellikeifyou are relation to others, e.g.,[Patient 27]: “Well, I think tobe worried aboutthatis, it makessense to me is justreally. Like Ibefore thathadgone through afantasticallylongtime”, orthefeelingofangerin it waslikeaboutthethird nightwithin thelastweek thatIwokeupandwantedto words (e.g.,hate,kill,and annoyed) andswear words (e.g.,damn,piss,andfuck),whichindicate showedaffective processes, barrierimagery asignificant weak positive correlation withanger to thetherapist.Althoughaheightenedprimordial mentalactivity typicallyrelates toreduced awareness of both positive andanxiety-related emotionalexperiences and the communication that areand anxiety words and relatednervous) (e.g., worried, fearful, to the reduced conscious processes (e.g., happy, cried, and abandon), including positive emotion (e.g., love, nice, and sweet) much, you know. Iliketo his psychology unstructured behaviourassociatedwithprimordial mentalactivity—e.g.,[Patient 2]“ and leisure words (e.g.,cook,chat,andmovie) isconsistentwith thecreative expression and references related toself-harming,e.g.,[Patient 6]:“ psychotherapeutic context. These angeremotionscanbedirected towards theselfinformof finitenesswithinthe an emphasisofanger-related experiencesassociatedwithabodyboundary Barrier imagery alsoshowedBarrier imagery aweak positive associationwithdeath-related references (e.g.,bury, Given thattheinhibitedexpression ofanger-related emotions hasbeenassociatedwiththe According toRayner(1995),aggression involves theactualorsimulatedactivation ofmuscular As expected, barrier imagery wasweakly tomoderatelynegatively associatedwithaffective As expected,barrierimagery “Well, whenItriedto book . However, he does not because I do not do it that much. I am not interested in that read , butIliketo angry angry kill myself abouttwo years agoorwhenever ithappened,andIsaw and you are read novels angry angry historical And, you know, itwaslikereally while somebody is saying something to you, while somebodyissayingsomethingtoyou, novels , andhedoesnot”. SEMANTIC EXPRESSIONS cut myself, which myself,which stupid So, I , but , but read

57 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 58 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS identified as a marker of memory inaccuracies (Hernandez-Fernaudidentified as a marker of memory & Alonso-Quecuty, 1997; (Robbins, 2011).Based oncognitive psychology, processes hasalsobeen adeflationofsensory (Cariola, 2015). This low activation ofperceptual processes typicallyrelates toconceptualthought inspokentherapeuticdiscourses compared towritten autobiographical memories boundary stimuli receptivityand lowered to environmental sensory sensitivity of the external skin body heard, andfeeling),includingfeeling wordsobserving, (e.g.,feelsandtouch),indicatingareduced about objects—e.g.,[Patient1993) andaheightenedfocusonsurface-defining 11]: concreteness inprimordial mentalactivity(Bucci, 1978; Mergenthaler 1997;Loewald, &Bucci, (e.g., a,an,andthe),whichcorrespond tothetendencyofobjectification,which reflects the just thethoughtthat...”. should notIhave just 2011) —e.g.,[Patient 124]: impressions associatedwithprimordialcharacteristic andsomatosensory functioning(Robbins, and season),aswell asprepositions (e.g.,to,with,andabove), reflect further thepsychosomatic motion (e.g.,arrive, car, andgo),space(e.g.,down, in,andthin)time(e.g.,end,until, positive correlations withrelativity (e.g., area, bend, andexit), including references related to I usedto because Ilaidthere and worriedall night aboutsomething I really did notneedtobeworriedabout. 3]: and spit),health(e.g.,clinic,flu,pill)ingestiondish,eat,pizza),e.g.,[Patient processes (e.g.,eat,blood,andpain),includingreferences related tothebody(e.g.,cheek,hands, (Freud, 1936). which patientswouldavoid unconsciousconflictsthrough theprocess of reasoning andlogic cognitive processes mayindicatealowered neurotic defencemechanismofintellectualisationin and insights. To someextent,thereduced usageofsemanticcontentthatisclassifiedtomeasure a reduced presence ofcomplexcognitive processes toproduce accurateaccountsofexperiences therapeutic context.Similarly, low frequencies ofdiscrepancy words andexclusion words indicate self-reflection andthesense-making processes ofthecontentthatisbeingexplored withinthe the reduced use of insight words, tentativeness and causation words indicate a lower presence of and never) were weakly to moderately negatively correlated with barrier imagery. Specifically, and guess) and exclusion words (e.g., but, without, and exclude), and negations (e.g., no, not, discrepancy words (e.g.,should,would,andcould),tentativeness words (e.g.,maybe,perhaps, insight words (e.g., think, know, andconsider),causation words (e.g., because,effect,andhence), would bemotivated by parental rejection ofthepatients’ authenticself. fantasies torepresent patients’ unconsciousrevenge anddesire theirparents. tohurt Such revenge with Fisher and Cleveland’s Bowlby (1958) observation, (1980) conceptualised death-related because Iwouldnothave anyexpectationstolive uptotheirexpectations”. of it, and yet, I knew now personally— if everyone anxieties, such as through theuse of death-thematic fantasies, e.g., [Patient 32] death-relatedand destructive references mightalsobeindicative ofthepresence ofannihilation and anger, as noted in the psychoanalytic literature (see Hurvich, 2003), the use of anger words a psychiatrist where I was when I got out of the hospital”. LAURA A.CARIOLA,MA “She wouldbe Similar toaffective processes, cognitive processes (e.g.,cause, know, andought),including Conversely, wasweakly negatively correlated barrierimagery withperceptual processes (e.g., Furthermore, wasweakly tomoderatelypositively correlated barrierimagery withbiological the chew fellow. It isjust (Ingestion) my sleeping come the barrier imagery was also moderately positively associated with articles wasalsomoderatelypositively associatedwith articles barrier imagery (Motion) (Body) and pointofthething”. fingernails “How willIinteract in (Space) here andbehonest?Ihopeambeinghonest.However, wake (Body)clearbackto the quick…”. (Body) up the next morning, Iamdead (Body) upthenextmorning, died, now Given the relationship between destruction I thinkmylifewould be completelydifferent (Time)? Why shouldIhave done that? Why Particularly, andconsistent The moderate tostrong “I cannot conceive “I cannot conceive “Not thatIcare tired (Health) limited capacitytoengageinself-reflective and mentalisationprocesses (Fonagy & Target, 1996). understand theirown orothers’ implicitorexplicitmentalstates. This decreased abilityindicatesa ability toacknowledge theirinternalandexternalreality, aswell astheirlowered abilityto perceptual process inheightenedbarrierawareness wouldthenindicatepatients’ dysfunctional exclude insightsthatare inconsistentwiththeirinternalisedvalue systems.Lower frequencies of process isalsoconsistentwiththeRogerian (1961)assumptionthatindividualswoulddefensively (Brainerd &Kingma,1984;Reyna &Brainerd, 1998;Spence, 1982).Areduction ofperceptual representations oftheirinter-andintra-psychic oftheirpersonaltruths experiencesthatformpart perceptual processes mightrelate todiscursive themesthatare basedonpatients’ fuzzymemory Johnson etal.,1980;Schooler, etal.,1986). Within thetherapeuticcontext,areduction of based language behaviour. Conversely, correlated positively with barrier anger imagery words, to, bothelicitedwrittenautobiographical memories,andnaturallyoccurringpsychotherapy- finitenessandsemantictendenciescanbegeneralised the relationship between bodyboundary indicate anexternalvalidity ofthesemanticbehaviourassociatedwithbarrierimagery. Therefore, memories(Cariola, 2015),theresults the semantictendencyofwritten narratives ofeveryday inrelationthe correlations tothepatients’ ofbarrierimagery verbal behaviour were consistentwith with primordial thought,suchasself-references, verbs, cognitive and affective processes. Because correlated negatively withsemanticcontentassociated and personalconcerns.barrierimagery associated withprimordial mentalactivity, suchasgroup-references, biologicalprocesses, relativity positively correlated first hypothesis (H1), barrierconsistently imagery with semantic content Discussion andLimitations allow wouldfurther patientstofulfilthepotentials of theirwholeself.functional bodyboundary values, inadditiontoagreater othersandtoengagewiththeirexperiences. capacitytotrust This that mightenablepatientstoacknowledge theirfeelingsandrely ontheirown judgmentsand phenomenological self. embodiesafunctionalself-other differentiation Areduced bodyboundary to formulatevalues andbehaviouralresponses thatare withtheneedsoftheir congruent would encouragefunctionalformsofself-andother-relating, aswell asfacilitatingthepatient andempathicenvironment oftheperson-centred1958), thenurturing therapeuticenvironment are tosomeextentinconsistentwiththepatients’ phenomenologicalself(Fisher &Cleveland, punishment-reward response (Fisher &Cleveland, 1958). would result inthereduction ofmuscularsensitivityassociatedwithasociallyconditioned of theencapsulatingbodyboundary. Particularly, theabsenceofpunishinginterpersonaljudgment andtraumaticexperiences. and thoughts,includingfrustrations This factorresults inthelowering empathic andnon-judgmentaltherapistallows patientstoexplore andreflect ontheiremotions their parental andsocialintrojects thatwere withthephenomenological self. incongruent The finitenesstoclarify environment thatenablespatientswithpreviously heightenedbodyboundary Therefore, confirmed. thesecondhypothesis(H2)wasonlypartly sessions were inlow notsignificantlycorrelated barrierpatients,p> .05. withbarrierimagery sessions were weakly negatively correlated withbarrierimagery, r=-.216,p<.05,butprogressive Strengths ofassociationbetween psychotherapy sessionsandsemanticcontent The results ofthisstudyconfirmedsomethe research hypotheses.Consistentwiththe Given that bodyboundariesdevelop asaresponse totheinternalisationofsocialvalues that therapeutic inhighbarrierpatientssuggeststhatasupportive The reduction ofbarrierimagery A Spearman rankcorrelation coefficientshowed thatinhighbarrierpatients,progressive SEMANTIC EXPRESSIONS 59 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 60 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS should explore the behaviour of body boundary imagery and other semantic content in a wider andother semanticcontentinawider imagery should explore thebehaviourofbodyboundary contain acomprehensive setofperson-centred psychotherapy transcripts. Thus, future studies Psychotherapy Transcripts, Client Narratives, and Reference Works in thesestudieswere forexample, theonline‘ tosomeextentopportunistic; analysis research andare thusnotuniquetothestudy. 1980).low& Lewis, effectsizes, however, represent an inherent andgeneralproblem incontent differences between theexperimentalandnullhypotheses(e.g.,Gigerenzer, 2004;Michalczyk of effectsize identified inthisstudyhighlighttheimportance values asstatisticalmeasure toassess medium, irrespective ofthehighlevels ofstatisticalsignificance. In thissense,thesmalleffectsizes used to explore the semantic differences between barrier personalities were often only small to on thereliability oftheresults andthevalidity oftheirinterpretation. Thus, theeffectsizes size andsampleselection. The notionofeffectsize represents astatisticalweakness thatimpinges statistical approaches, thisstudypresented somemethodologicallimitations,suchastheeffect & Leudar, 2010;Rogers, 1957). and gestures, acooperative andhelpfulattitudeby understanding thepatients’ feelings(Fitzgerald his modeofcommunication,suchasthecontentandtonevoice aswell asfacialexpressions empathic listener, thetherapistconcentratesattentiontowards thepatientandconveys inheror unconditional positive regard (Rogers, andcongruence 1951,1961).In therole ofanactive and personality changeisbasedonthefunctionaltherapeuticalliancethatcharacterisedby empathy, behaviour. Onepremises of the most important of the person-centred approach for a successful with thehard bodyshellbeingdissolved through thepsychotherapeutic process. armours, andchangesinlinguisticfeatures mayindicatedefensive mechanismsthatare associated linguistic features mayenabletherapists todifferentiate between patientswithhard andsoftbody differ intheirsemanticexpression from patients withasofterbodyshell.In thissense,theuseof body armour, theresults ofthisstudyindicatedthatindividualswithaharder bodyshelltendto finiteness. embodied intheincreasedIn bodyboundary relation to Reich’s (1945)conceptof psychotherapy wouldclarifypatients’ socialvalue systemsandbehaviouralexpectationsthatare Summary finiteness. boundary or theirpersonalitypredispositions. This psychotherapeutic process resulted inchangesofbody ridding themselves ofinauthenticvalues thatare withthephenomenologicalself notcongruent enablepatientstoexploreperson-centred theiremotionsandinsightsinadditionto interventions suggests thattheempathicandunconditionalacceptanceoftherapeuticrelationship in did not increase in lowthat barrier imagery barrier patients (H2). This change in barrier imagery a process inwhichthepatientcanexpress withinasafeenvironment. theirangerandfrustrations thickening ofthebodyboundary. The person-centred therapeuticapproach wouldthenrepresent provide someevidenceofthepatients’ ofinternalisedparental frustrations values thatconstitutea & Cleveland, 1958),suchaninflationofangerwords in relation tobodyboundariesmight isassumedtorepresentboundary acontainerofunexpressed angerandnegative emotions(Fisher which are typicallyassociatedwithconceptualthought (Cariola,2015).Given thatthebody LAURA A.CARIOLA,MA The results provided someconfirmationofthe research premise thatperson-centred wasreducedThe results inhighbarrierpatientsand alsodemonstratedthatbarrierimagery Another weakness of thestudyisrelated tothedatasampleselection. The textsamplesused Despite thetheoretically grounded decisionsthatdeterminedthemethodologicaland Future research shouldalsoexplore therelationship between patients’ andtherapists’ verbal ’ database (2012) happens to ’ database (2012) happens to Counseling and Counseling and psychotherapeutic encountertoexplore theirauthentic emotions andinternalprocesses, whereas Bick, E.(1968).Experience oftheskininearlyobjectrelations. Behr, M.,&Becker, M.(2012). Scalesforexperiencingemotions:Awareness, appraisaland REFERENCES Email: [email protected] the United Kingdom. Centre for Cyber Security and Information Systems at Cranfield University, Defence Academy of responses, autobiographicalmemoriesandtherapeuticdialogues.Lauraisafacultymemberinthe and bodyboundariesby focussingonthequantitative andqualitative contentofprojective test psychodynamic conceptsoflanguagebehaviour, withspecific reference toprimordial thought Laura A.CariolaisaPhD studentinLinguisticsatLancasterUniversity. Her research explores BIOGRAPHY a diagnostictoolandmeasure oftherapeuticoutcomes. enable bodypsychotherapists toapplyFisher andCleveland’s conceptas (1958)bodyboundary body psychotherapy. Apositive identificationbetween thesepersonalityconcepts wouldthenalso body boundaries as measured usingtheBTD and the presence of bodily armour as assed through concept withReich’s (1945)bodyarmour, future studiesshouldassesstherelationship between relations. Althoughthisstudytheoretically alignsFisher andCleveland’s (1958)bodyboundary in socialinteractionsthatare notathreat totheselfbutare perceived asreasonable caringsocial more socialreferences reflecting theirincrease andagreater toengage senseofself-worth trust self.phenomenological experience of the true In contrast, low barrier patients would use gradually communicate theiremotionsandthoughtstotheenvironment thatare withthe congruent other-relating. For example,highbarrierpatientswouldusemore words thatenablethemto are offered inthepsychotherapeutic settingandthustoestablishbetterformsofself-and patients withlow bodyboundariesmightbeabletointernalize structures thesupportive that Conclusion modality. attributed tothepatients’ attendancetobodypsychotherapy sessions,butrathertotheRogerian results ofthesestudiescannotindicatetheextenttowhich changesinverbal behavioursmightbe generalisable. Given that thisstudy is basedonperson-centred psychotherapy transcripts, the awareness andsemanticcontent mightbemore to whichchangesinbodyboundary broadly gestalt psychotherapy, tomentionafew. By investigating awiderrangeofmodalities,theextent range ofpsychotherapy modalities,suchasbodypsychotherapy, psychodynamic therapies,and Cariola, L.A.(2014a).Assessing theinter-methodreliability and correlational validity of Bucci, W.(1997). Brainerd, C.J.,&Kingma,J.(1984). Do children have toremember toreason? Afuzzy- Bowlby, J.(1980). 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63 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 64 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Winnicott, D. W. (1971). Wilson, A.(2006). for The development andapplicationofacontentanalysisdictionary W. Pennebaker (Eds.), Traue, H.C.,&Pennebaker, J. W. (1993).Inhibition andarousal. In H.C. Traue &J. Thorne, B.(2003).Person-centred therapy. In W. Dryden(Ed.), Tausczik, Y. R.,&Pennebaker, J. W. (2010). The psychological meaningof words: LIWC Spence, D.(1982). Narrative New andhistoricaltruth. truth York, NY: Norton. Spearman, C.(1904) The proof andmeasurement ofassociationbetween twothings. Schooler, J. W., Gerhard, D.,&Loftus,E.F. (1986).Qualities oftheunreal. Rorschach, H.(1921). LAURA A.CARIOLA,MA Huber. therapy 24-54. and computerized textanalysismethods. American Journal ofPsychology, 15, Memory, Learning, Experimental Psychology: andCognition,12, edu.au/index.php/sensoria/article/view/389e ofmind,brain,¬A journal andculture, 10. body boundary research. body boundary (pp. 131-157).London,UK:Sage Publications. Emotion inhibitionandhealth Psychodiagnostik. Playing andreality. Literary andLinguistic Computing,21 72-101. Leipzig,Germany: Ernst Bircher Verlag. Journal ofLanguageandSocialPsychology, 29, New York, NY: Routledge Retrieved from http://sensoria.swinburne. (pp. 10-31).Seattle, WC:Hogrefe & Handbook ofindividual 171-181. , 105-110. Journal of

allowing theorganismtoregulate theinternal statehomeostaticallyand whichmayalsogive of processes by whichphysiological signalsinthebodyare transmitted backtothebrain, Pollatos, 2012).In amore detailed definition,interoception isdescribedas the collection musculoskeletal apparatus)and visceroception (signalsfrom theinnerorgans)(Herbert & ‘‘interoception’’ includes twoformsofperception: proprioception (signalsfrom skinand the viscera iscommonlyreferred toasinteroception (Dunn etal.,2010).Asageneralconcept processes (Herbert &Pollatos, 2012). andwell-being, and underliemood,emotionalstate,andfundamentalcognitivefor survival intuitive notionthat bodily sensations are intrinsically tiedtolife, represent relevant signals this provides asenseofourphysicalandphysiologicalcondition. These feelingsgenerate the © Author andUSABP/EABP. Reprints [email protected] Volume 14,Number 1spring2015pp65-79. International BodyPsychotherapy Journal embodiment. fMRI studies suggest that brain areas known to mediate selective Interoception provides alinkfortheaffective andcognitive mechanismsof somatic awareness and clinicalpractice. somatic awareness andmaybeusefulasameasure inbodypsychotherapy research marker hypothesis. Most this implies that IA may be a good measure importantly of somatictheoriessuchasthe attention iscompromised whichsupports showing greater sensitivity. These findingssuggestthatIAispossibleeven when IA was shown between the tasks with the modified mental tracking task (MMTT) (9female,11male)wasmeasured.participants Asignificantdifference inmean andamodifiedversion ofthesametask,IA20healthytracking task(MMT) attention iscompromised. Using twoversions ofanIAtask,thestandard mental attempts tounderstandthisrelationship by consideringwhetherIAispossiblewhen between attention,embodimentandinteroception ispoorlyunderstood. This study attention, are alsorelevant forinteroceptive awareness (IA). Yet therelationship The perception of feelingsinbodilysystems,includingjoints,muscles, skinand We canallperceive feelings from ourbodyrelated toitsinternaland externalstateand Keywords: Interoception: AMeasure ofEmbodiment or Attention? University ofNorthampton, Department ofPsychology Interoception, attention,embodiedcognition,measures ofembodiment, - Leonardo da Vinci 1452–1519(Nardini, 1999) Received 1September, 2014;Accepted 3January, 2015 Everything we know beginsfrom feelings” Nitasha Buldeo, MS,MSc The Art andScienceofSomaticPraxis ISSN 2169-4745Printing, ISSN2168-1279Online Abstract INTEROCEPTION: AMEASUREOFEMBODIMENT 65 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 66 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS insufficiently differentiated toenableemotion-specific responsepatterns (Cannon, 1931). Early challengestotheJames-Lange position, rested onbeliefsthatautonomicoutflow was physiological responses are causalinemotionalexperience(i.e.,‘feelings’), (Friedman, 2010). collectively labelled the‘James–Lange ofemotion’, theory thepremise whichsupports that physiologist CarlLangeinthe sameera(Lange,1885/1912). The twomodelsare often similar to,althoughmore limitedthanJames’, wasindependentlyproposed by Danish that are elicitedby thoseobjectsandevents (Reimann &Bechara, 2010).Amodelofemotion to feedback objects of and the eventsvisceral responses in the world – arise from the sensory Interoception asabasisofembodiedprocesses such aschemical,barometric orelectricalhave aneffectonthebody. the usualexteroceptive perception viathesenseorgans,asavariety ofenvironmental stimuli or motivated action.Furthermore interoception impliesanabilitytodistinguish more than 2012). This highlights the role of homeostasis in what we think of as conscious, deliberate regulate theinternalstate(Craig, 2008;Herbert &Pollatos, 2012; Verdejo-Garcia etal., activities thatiscloselyassociatedwithconsciousormotivated actiontohomeostatically which is:anoverall representation oftheinternalstatewithincontexton-going body (Craig, 2003,2009). opensupawiderconceptualizationof‘‘interoception’’,This view evolutionarily ancient,hierarchical homeostatic system thatmaintains the integrity ofthe found inthedorsalhornofspinalcord, thatevolved from theafferent limbofthe represented pathway, inthelamina-1-spino-thalamocortical system aphylogeneticallynew conditions ofalltissuesthebody. According tothisview, allsensationsfrom thebodyare image ofhomeostaticafferent activitythatreflects allcomponentsofthephysiological that couldinfluencehighermentalfunctions(cognition)andbehaviour(Cameron, 2001). pathways mayalsotransfersources ofinformationaboutthestateandfunctionbody of purely physiologicalreflexes likebreathing andbloodpressure. However theseafferent informationfrom thebodytobrainfacilitateshomeostaticregulation sensory carry holistically control ormaintainthishomeostaticmilieuinterieur. The afferent pathwaysthat systemenablesthebodytoinformation travelling from thebodytocentralnervous track themoment-to-momentfluctuationsofthesephysiologicalparameters.Afferent homeostasis implytheexistenceinbodyofmechanismsby whichtheorganism can called this maintenanceprocess – homeostasis(Cannon, 1953). Both milieu interieur and to maintaintheseoptimalparameters(Gross, 1998).Several decadeslater, Walter Cannon correct (Cameron, 2001).Implied inBernard’s wastheideathatbodywouldseek theory that there are across organismic circumstances optimal physiological conditions that vary is that most,ifnotall,ofthesephysiologicalparametersare notnormallystatic,thetheory parameters thatdefinedthenormalinternalstateoforganism.Althoughitisnow known Bernard’sbe agoodplacetostart. ideawasthatthere wasanidentifiablesetofphysiological of the concept of the milieu interieur by Claude Bernard approximately 150 years ago may Garcia, Clark, &Dunn, 2012). rise toawareness ofbodilyfeelings(e.g.pain,touch,temperature) (Cameron, 2001; Verdejo- NITASHA BULDEO, MS,MSc The originoftheterminteroception cannotbeprecisely specified. However thedescription William James (1884)proposed thatsubjective feelings–themeaningthatisattributed In keepingwith the above idea, evidence suggeststhat primates have a distinct cortical responses forthe notonlycontributestofeelings,butthatthismappingisalsoimportant Tranel, mappingofvisceral &Damasio, 1991);Damasio (1994)arguesthatthesensory Singer, 1962). While inthesomaticmarker hypothesis(SMH)(Damasio, 1996;Damasio, emotional experienceisaproduct ofthecognitive appraisalofbodilyarousal (Schachter& and decision-making.For example,theJames-Lange wasmodifiedtoarguethat theory cognitions are infactembodied.Much ofthisdebatehasfocusedonemotionalexperience Gianaros, &Critchley, 2010). argument andcontributedtoarevival ofsomatictheories(Damasio, 1994;Harrison, Gray, (Porges, systemspossessexquisite organ-specific 2007)nervous regulation hascountered this Demonstration 2008;Morrison, thatbothsympathetic(Janig, 2001)andparasympathetic immediate present moment(Herbert &Pollatos, 2012). This may alsodefinetheembodied ultimate representation of all one’s in the feelings, thereby constituting the “sentient self”, & Pollatos, 2012). modalitiesfrom different ofthebrain(Herbertenvironmental parts stimuli ofmanysensory integrates thehomeostaticre-representations withactivityassociatedemotionallysalient aresensations intheposteriorinsular cortex thenre-represented inthemid-insulathat toward theanteriorinsula. ofthedistinct,individually mappedThe neuralconstructs integrated with contextual motivational and pleasure producing information as they progress coming from visceralchanges,firstproject totheposteriorinsula,andbecomeprogressively processes. Rawinteroceptivewith behavioral,cognitive signalssuchasthose andsensory insula iscentraltothesequentialintegrationofbody’s homeostaticcondition primary of theinsulaare involved indifferent andsuccessive stepsofneuralprocessing. Hence the inputfrom different modalitiesofthebody.sensory It issuggestedthatdifferent portions and behavior(Beauregard, 2001;Bechara, 2004). generated andexternallyinducedemotions(Anders,2004), and theself-regulation offeelings Dolan, 2000)foremotionprocessing andreactivity (Phan, 2002),forthefeelingofself- state(Critchley,internal emotionalandviscerosensory Corfield, Chandler, Mathais, and show forsomatictheories. cortex) support These structures are relevant formonitoringthe (ACC),cortex andprefrontal (ventromedial cortices prefrontal dorsolateralprefrontal cortex, cingulate theinsularcortex, andsomatomotorcortices, brain comprisingthesomatosensory al., 2010;Moors, 2009). best viewed asaconsequence, ratherthanthecauseofcognitive-affective activity(Dunn et bodily responses occurrelatively lateintheinformation-processing chain,andare therefore Bechara, 2010). These modelsstillremain controversial though,withcriticsarguingthat function thattiescontrol ofthevisceralstatetodecision-makingandaffect(Reimann & The SMHarguesthatthisistheessentialfunctionofventromedial prefrontal cortex—a of externalstimuliintochangesinthevisceralstatethatreflect theirbiological relevance. properties and theSMHholdthatbrainmustcontainasystemtranslatessensory may notbepredicted decisively through ‘‘cold” rationalityalone.BoththeJames-Lange view aids indecision-makingwhichthere isaneedtoweigh positive andnegative outcomesthat function to‘‘mark” potentialchoicesasbeingadvantageous ordisadvantageous. This process execution ofhighlycomplex,goal-orientedbehaviours.In thisview, visceralresponses There has, however, been considerable debate about the extent to which feelings and This results ina“global emotionalmoment” intheanterior insulathatrepresents the Within theinteroceptive network theinsularepresents aconvergence siteofviscera- However, recent neuroanatomic evidenceofan‘‘interoceptive neuralnetwork’’ inthe INTEROCEPTION: AMEASUREOFEMBODIMENT 67 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 68 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS MTT. To overcome theconfounding effectsofcognitive processes, randomisedtimeintervals combination ofattentionaland cognitive processes mayconfoundIAasdeterminedby the beatperception. individual attentionalabilitiesalsohave aneffectonheart heartbeats, This (Brener, Knapp, are and Ring, 1995). Also, because participants asked to attend to their basedontheirunderlyingbeliefsabouthow worksnumber ofheartbeats fastthe heart Participants maycomplete thetaskby countingtime andusingthistoestimateaplausible effect size andgreater sensitivity. However thismaybedue totheuseofcognitive strategies. (Schandry, 1981)isthemostfrequently usedHBPtest. hasahigher This isbecausethe MTT (Eichler, 1994;Knapp-Kline,2005). method,firstdescribed by Schandry The MTT at chancelevels, withrelatively low rates(40-50%classifiedasperceivers) ofdetection differences (Dunn using this method perform of participants et al., 2010).A large proportion who have used them. The sensitiveTDP method is not measurea particularly of individual (Schandry, 1981). ratealsobeingmonitored withtheirheart electronically (objectivetime interval, measure) are required (subjective measure) toattendto,andcounttheirheartbeats forarandom from tone. anexogenously participantstheir heartbeat presentedWhile intheMTT auditory monitoring device.In anddiscriminate have toattendtheirheartbeats TDP participants signal from theobjective, ‘‘true’’ cardiac rate signalobtainedfrom a physiologicalheart perception scoresheartbeat thatcharacterize thedeviationofsubjectively feltcardiac withoutfeelingfortheirpulse. heartbeats These testsallow thecalculationofindividual In are tofocusonorselectively attendtotheirown boththesetasksparticipants instructed 1981) and the “mental tracking task” a tracking or counting task (Schandry, (MTT), 1981). procedures” Brener, adiscriminationtask(J. (TDP), Liu,X.,Ring,C.,1993; Whitehead, Wildmann, 1982). There are twomainHBPmethods(Dunn etal.,2010)“tone detection HPB relies onindividualsensitivity forcardiac signals(‘‘cardiac awareness’’) 1994; (Jones, Heart BeatPerception (HBP) and Gendlin (Aposhyan, 2004;Gendlin, 2003). the therapisttodetermineclient’s level ofbodyawareness asdescribedby bothAposhyan IA maytherefore componentofbodypsychotherapy practiceasitmayenable beaprimary sensation andeithercount(mentallytrack),ordiscriminatethefrom otherstimuli. individual IArequire physiological tofocus,orselectively attendto,aparticular participants interoception (H.D.Critchley, Wiens, Rotshtein, Ohman, &Dolan, 2004). Tests tomeasure Interoceptive Awareness (IA) “felt sense” (Gendlin, 2003)inbodypsychotherapy practice. 2012). This process mayprovide thephysiologicalcorrelate ofwhathasbeendefinedas a mind’’ aswell astheaffective andcognitive mechanismsofembodiment(Herbert &Pollatos, considered astheawareness ofhomeostasis)provides alinkforthe‘‘body’s role increating the is builtonhomeostasis. Therefore theneuroanatomic basisofinteroception (whichmaybe 2009). theproposition thatbothsubjectiveThis supports awareness andembodiedcognition subjective momentintime(Craig, feelingsfrom thebodyandfeelingsofemotionatacertain experience. providesThe anteriorinsulacortex auniqueneuralsubstratethatinstantiatesall NITASHA BULDEO, MS,MSc The term‘‘interoceptive awareness’’ (IA)isusedtodefinetheconsciousawareness of Both ofthesemethodsare susceptibletonumerous confoundsasreported by many Heart beatperception (HBP)isthemostfrequently usedIAmeasure (Dunn et al.,2010). to commencing with the MTT participants were participants givento commencing withtheMTT the following (Figure instructions 1). During alltrialsECGwasrecorded usingthe Biopac version 2.7.2asdescribedabove. Prior the second and third block). wereThe time intervals pseudo-randomized in all four blocks. each makingup12trialsandfour practicetrials(twobefore thefirstblockandoneeach before counting periodsfollowed standard resting periods(20s). There were three blocksoffourtrials 1992; Knoll&Hodapp, 1992). individual differences thantonedetectionalternatives (Dunn etal.,2010;Ehlers &Breuer, 1981) isawell-validated detectiontaskandwasfoundtobemore heartbeat sensitive to were reversedthe twoindependentvariables (MMTandMMTT) inhalfoftheparticipants. (experimental condition2).In order tocounterbalancetheeffectsoffatigue,order of (1981)vs.amodified version ofthesametesti.e.MMTT 1) asdescribedby Schandry perception (HBP) task, the standard Mental Tracking Task (experimental condition (MTT) study usedarepeated measures (within-group) experimentaldesign. differencesthese individual or between-participants asapotentialextraneousvariable, this highlights significantinter-individualdifferences inIA (Herbert & Pollatos, 2012). To remove & Schandry, 2007;Schandry, 1981)andthegastrointestinal system(Stephan etal.,2003) excluded Full from participation. detailsoftheprocedure are available inAppendix 1. diagnosis of diabetes mellitus,tachycardia, orperipheralvascular diseasewere hypertension with learning,communicationoruncorrected visualdifficultiesas well asindividualswith a from analysis.Outliers were excluded tomaintainhomogeneityofthedata.Individuals female, 11 male) completed this study, however were 8 (4 female, 4 male) participants excluded poorly understood. To betterunderstandthisrelationship, thisstudyaimedtoanswer the unhampered by attention, as the causal relationship between attention and interoception is (measured usingMTT). with high IA in SA and divided attention (DA) tasks for participants better performance et al., (2004) and Matthias, Schandry, Duschek, & Pollatos, (2009), also found significantly object while ignoring other irrelevant(the act of focusing on a particular stimuli). Critchley found tounderliebothIA(awareness ofinternalbody states)andselective attention(SA) overcome. Furthermore, neuroimaging studiessuggestastrong correlation areas incortical tasks.Howeverset ofMTT theconfoundingeffectofattentionalabilityismore difficultto and repeated measures are usedwithpracticetrialsinterspersedbetween actualtrialsineach Method another task. if bodyawareness ofunconsciousstimuli ispossibleeven whenapersonisfullyengagedin for somatic psychotherapy both clinically and theoretically, to determine as it is important question, “isIApossiblewhenselective attentioniscompromised?” This hasimplications In this study the MTT was tested using three time intervals of25,35,40seconds.All In wastestedusingthree timeintervals thisstudytheMTT (Schandry, which wasfirstdescribed by Schandry The mentaltrackingtask(MTT), MTT IA (thedependentvariable (DV) wasmeasured usingtwoversions ofaheartbeat Research onboththecardiovascular system(Critchley etal.,2004;Herbert, Pollatos, Interoceptive Awareness (IA) sampleof20right-handedindividualsbetween theagesof18to60(9An opportunity It isdifficulttodetermine ifgoodattentionprocessing facilitatesbetterIA,orifIAis Participants INTEROCEPTION: AMEASUREOFEMBODIMENT 69 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 70 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Figure 2:Mental Tracking Task Flow (MTT) Diagram Figure 1:Instructions andMMTT forMTT NITASHA BULDEO, MS,MSc the three heartbeat perception intervals accordingthe three perception intervals to thefollowing heartbeat transformation: Herbert perception score et.al.(2012). Aheartbeat was calculatedasthemeanscore across whiletheyweredistract theparticipants countingtheirheartbeats. for 30msecandthesecondsurprised facialimagefor800msec. This wasdoneinorder to Facial Images) on the monitor. The first affective image (happy, sad or neutral) was presented Figure 3:Modified Mental Tracking Task (MMTT) Flow Diagram depicted inFigure 3. andprocedure.3), timeintervals, The onlydifference wastheadditionofaffective imagesas the quality of their performance atanytimeduringtheprocedure.the qualityoftheirperformance analysis. Participants were notinformedaboutthelengthofcountingphase norabout foranyreason,to countheartbeats 00couldbeentered. This denotedafalsetrialduring keys viathekeypad.If the“go” or“stop” wasunable cuewasmissedortheparticipant countedusingnumerical hadtoenterthenumberofheartbeats the stopsignals,participants Followingattempt anyothermanipulationsthatcouldfacilitatethedetectionofheartbeats. cue, bothpresented onthemonitor. Participants were notpermittedtotaketheirpulseor to counttheirown onseeinga“go” heartbeats cueandtostopcountingonseeinga“stop” MMTT was similar in all respects to the MTT above, wassimilarinallrespects totheMTT (FigureMMTT includingtheinstructions Interoceptive awareness (IA)wascalculated usingaformulapreviously employed by The “go” cue was followed by the presentation of two affective facial images (Karolinska Modified (MMTT) MTT As depictedinFigure 2above, were participants askedtopress enterwhenready andthen INTEROCEPTION: AMEASUREOFEMBODIMENT 71 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 72 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Table 1:Scatterplot:Relationship between andIAMMTT IAMTT calculated (d=0.516)usingtheformulasuggestedby Cummings (Cumming, 2012). forthiscorrelation (r)is0.564to0.965. 95% confidenceinterval Effect size (Cohen’s d)was A strong (r=0.870)wasfound. positive correlation andIAMMTT between IAMTT The MMTT. Table 1is a scatterplotdepictingtherelationship andIAMMTT. between IAMTT either greater than or equal to (>/=) IA measured on MTT. No scored participant lower on difference =0.003. significant ( a SDof0.019andSEM0.006(Table 2). The paired two-tailed t–testwasstatistically standard error ofmean(SEM)0.006. (n=11)was0.07,with The meanIAonMMTT Mean (n=11)was0.06withastandard IAmeasured onMTT deviation(SD)of0.0201and the meanIAscores andMMTT. measured onMTT wassetat95%. Confidenceinterval Results score (Herbert etal.,2012). perception perception. IAwasestimatedasthemeanheartbeat absolute accuracyofheartbeat analysis. The maximumnumberoftrialswas12. Participants hadtohave completedmore than10trialssuccessfully tobeincludedinthe NITASHA BULDEO, MS,MSc Alpha wassetat0.05andapaired t-testwasusedtoexaminethedifference between perception scoreThe heartbeat varies between 0and1. The maximumscore of 1 indicates A trialwasconsidered entered successfuliftheparticipant anumberotherthan00. It was wasalsointeresting IAmeasured tonotethatforallparticipants usingMMTT α =0.05)(t(11)3.3166,p<0.01(p0.0078)),df10andstandard error of • • n is the number of successfully completed heartbeat perception trials. n isthenumberofsuccessfullycompletedheartbeat 1/n(1−(|recorded heartbeats|)/recorded heartbeats−counted heartbeats) 2006; Koivisto, Kainulainen,&Revonsuo, tothis,thedatainthisstudy 2009).Contrary are identicaltothecontentsofattention(Dehaene, Changeux,Naccache, Sackur, &Sergent, attention toanobjectinorder tovisuallyexperienceitandthatthecontentsofconsciousness doesnotnoticeit)implythatwe mustpaya visualstimulusisintroduced andtheobserver to thefirst)andchangeblindness(aperceptual phenomenonthatoccurswhenachangein that thesecondoftwotargetscannotbedetectedoridentifiedwhenitappearscloseintime phenomenonattention iscompromised. Phenomena suchasattentionblink(anobserved beinghigher.on MMTT This suggeststhatinteroceptive awareness ispossibleeven when withthemeanIA andthemodifiedmentaltrackingtask(MMTT) tracking task(MMT) Discussion using non-affective distractorimages (neutralsymbolsornumbers). may explaintheeffectsize oftheMMTT. It wouldtherefore beinteresting totestMMTT Affective imagesare known toevoke emotionalresponses andautonomicchanges,which autonomic changes(Herbert etal.,2012;Pollatos, Herbert, Matthias, &Schandry, 2007). emotional response andcardiovascular autonomicreactivity indifferent situations evoking MMTT. This isbecauseIAaccessedby cardiac awareness isrelated togreater sensitivityto recommended. a smallsample,itisdifficulttodetermine. In future studiestheinclusionofaDAtaskis is notinvolved inthisstudyhadgoodDAability. or that alltheparticipants Asthiswas scoringlower withnoparticipant onMMTT.on MTT This wouldsuggestthateitherDA all theparticipant’s were IAscores onMMTT eitherhigherthanorequaltoIAmeasured may have beenabletodothiswhilethedistracting imageswere beingpresented. In thisstudy tosplit theirattentionalresources,not established.DAenablesaparticipant andparticipants psychotherapy setting(Rothschild, 2000). thatunconsciousinformationmaybeheldinthebodyandprocessed withinabody theory one is not consciously attending to. the conjectureThis supports from body psychotherapy al., 2010)andassuggestedby thisstudymayoccurby processing visceral informationthat 2000; Dunn etal.,2010).Intuition maybelinkedtointeroceptive awareness (Dunn et judgments are tiedtoneuro-physiological systemsassociatedwithemotion(Damasio, 1994, are ‘‘affectively-charged’’ isunderscored by research suggestingthatintuitive processes and arise through rapid,non-conscious,andholisticassociations.’’ The premise thatintuitions or intuitive decision-making.Intuitions are describedas‘‘affectively-charged judgmentsthat present simultaneouslyinapatientundergoingsomaticpsychotherapy. somatic processes. Awareness ofsensorialandcontrastingemotionalexperiencemaybe of attentionmaybeidenticaltothecontentsconsciousness,thisnotsoforother us reason toquestionthissupposition. While inthecaseofvisualprocessing, thecontents in visualawareness studiestomake assumptionsaboutconsciousnessandthisstudygives somatic psychotherapy fortworeasons. Firstly, cognitive scientiststendtousedataobtained distinct brainprocesses (Koch & Tsuchiya, 2007). Kochand thisstudysupports and Tsuchiya’s thatattentionandconsciousnessare two theory rateeven ifattentioniscompromisedsuggests thatitmaybepossibletoconsciousofheart This studydemonstratesadifference inmeanIAmeasured viathestandard mental The affective nature oftheimagescouldberesponsible formeanIAbeinghigheron However aweakness ofthisstudywasthatparticipants’ dividedattention(DA)abilitywas Secondly somatic theories such as SMH and others describing intuition this study supports The implicationsoftheseresults are valuable forthefieldsofembodiedcognitionand INTEROCEPTION: AMEASUREOFEMBODIMENT 73 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 74 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS Craig, A.D.(2003).Interoception: thesenseofphysiological conditionofthe Craig, AD.(2008). Interoception andemotion:Aneuroanatomical perspective. In M. Constantine, L.L.,&Lockwood, L.A.D.(1999). Cannon, W.B.(1953). Cannon, W.B. 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She alsotrainedinHypnotherapy, NLP, Nutrition needling.Her anddry passionfor Transpersonal Psychology andConsciousnessStudies attheUniversity ofNorthampton, a Masters inHealth SciencesattheUniversity ofJohannesburg, RSAandanMSc.In Fascinated by themind-body connectionsincechildhood,Nitasha Buldeo completed BIOGRAPHY an individualis. body psychotherapy practice,asIAmaybeanobjective measure ofhow somaticallyaware measure forsomaticawareness inresearch andtoevaluate somaticinterventions andclinical cognitive-affective processing (Dunn etal.,2010).Hence IAmaybeausefulobjective can perceive bodilyactivity, thestronger therelationship between suchbodilychangesand forembodimentstudiesasitwouldseemthatthemoreimportant accuratelyindividuals is becomingapopulararea ofstudyamore sensitive measure wouldbeuseful. 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away from agenericPnP monitor(Resolution 1366x768,Landscape, 60Hzscreen refresh the chairpositionwasadjusted sothattheparticipant’s facewasapproximately 140cm approximately 3minutestocomplete.Once thebaseline-recording periodwascomplete, and thiscouldresult inhigher IAscores (Khalsaetal.,2008). The questionnaire took Practitionerssport. ofeither ofthesemaybetrainedtomore aware rates oftheir heart brief questionnaire inmeditation techniquesor todetermine theirlevel ofparticipation rate) to beassessed.During wereECG (heart thisperiodparticipants askedtoanswer a Function, Low Pass Filter -0.5Hz. Settings ontheECG100were asfollows: Gain -500,Output Selection –R Wave Detector Hz –settingsonBiopac. setanddoesnotrequireThe ECG100isfactory calibration. Response), analysedforthisstudy. whichwasnotfurther Signals were sampledat500 (Electrocardiogram) objectively aswell todetermineheartbeats asGSR(Galvanic Skin The corresponding software (AcqKnowledge, version 4.2Biopac (2.4.3)recorded ECG were attachedtoaBiopac MP150,version 2.7.2.systemusingtheECG100module. leadtotheleftankleandblack(ground)wrist, red leadtotherightankle. (VIN+) These in Figure 2.ECGleadswere attachedtotheseasfollows:leadtheright white(VIN-) above themedialmalleolusaswell asontheinnerrightwristatcrease asshown with 10%Chloridewet gel)were attachedtotheinnersideofbothleftandrightankles, and inFigure 1.A10009-100disposableECGMedical Sensors (13/8inchvinyldisc of lightbeingthemonitorandbacklitkeyboard. The apparatussetupisdescribedbelow APPENDIX 1 Wildmann, H.E.,Jones, discriminationscores G.E.(1982).Consistencyofheartbeat Whitehead, W.E., Drescher, V.M. (1981).Perception ofgastriccontractionsandself- Verdejo-Garcia, A.,Clark, L.,&Dunn, B.D.(2012). The role ofinteroception in Stephan, E.,Pardo, J.V., Faris, P.L., B.K.,Kim,S.W., Hartmann, Ivanov, E.H.,. Schandry, R.(1981).Heat beatperception andemotionalexperience. Schachter, S.,&Singer, J.E.(1962).Cognitive, social,andphysiologicaldeterminantsof Rothschild, B.(2000). Reimann, Martin, &Bechara, Antoine.(2010). The somaticmarker as framework The experiment started witha10-minuterecordingThe experimentstarted period,whichenabledthebaseline The studywasconductedinadarkened acousticisolationroom withtheonlysources Psychophysiology, on the Whitehead procedure inknowledge-of-results-trained anduntrainedsubjects. ofgastricmotility.conrtol 1869. doi:10.1016/j.neubiorev.2012.05.007 addiction: acriticalreview. 483-488. emotional state. Treatment. 10.1016/j.joep.2010.03.002 future neuroeconomics research. ofdecision-making:Review,a neurological theory conceptualcomparisons,and Gastrointestinal Surgery, Goodale, R.L.(2003).Functional neuroimaging ofgastricdistension. New York: W.W. Norton &Company. 19(592). Psychological Review, The BodyRemembers - of The psychophysiology Trauma and Trauma 7, 740-749. Psychophysiology, Neuroscience &Biobehavioral Reviews Journal ofEconomic Psychology, 69,379-399. INTEROCEPTION: AMEASUREOFEMBODIMENT 17,552-557. 31(5),767-776.doi: Rev, 36(8),1857- Psychophysiology Journal of , 18, 77 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 78 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS version 20forMAC wasusedtoanalysethedata. device wasthenswitchedoff. AlldatawassubjecttotheData Protection Act (1998).SPSS weretwo wascompletedparticipants theexperimenter. askedtoalert The Biopac recording twoofthestudy,part thecuedandun-cuedsubliminalaffective primingtask.Once part asked thesecondrelevant question.Arest periodwasallocatedandthisfollowed by second HBPtask.Afterthefourreplications were ofthesecondHBPtask,participants Arest period wasthenallocatedandthisfollowedtracking task(MMTT). by the oriftheywerestrategies usedintheMTT aware ofthedistractionsinmodifiedmental the fourreplications were ofthefirstHBPtask,participants questioned aboutcognitive that theyhadtocalloutifanythingwasrequired. The firstHBPtaskthenfollowed. After wereoff andthedoorshut,butparticipants aware thattheexperimenter wasoutsideand wouldbepresentedexplained thatallinstructions onthemonitor. Lightswere switched ECG. Participants were shown thenumericalkeys,enterkeyandmouseitwas movedthat participants theirhandonlytoenterdata,thereby reducing noiseonthe were fordataentry. usedby the participant Placing thewristonwhiterectangle ensured Backlight Technology by Illuminations Inc.) andawired mouse(Mikomi, AM-M259)that 21 cmwide). This waspositionedjustbelow thewired numericalkeypad(Mad Catz V.5, software, andassistedwiththeanalysisofdata. exact presentation timeofvarious stimulitobe recorded by Biopac andtheAcknowledge (Version 4.5). ofthestudy,stimuli forallparts were presented onthismonitorusingSuperlab software attention (Constantine&Lockwood,1999;Noiwan &Norcio, and 2006).Allinstructions presented were alsoblackandwhite.No colourwasusedasthiscoulddistractordivert using whiteseriftypeface(Georgia) (fontsize 16to20)onablackbackground. Allimages rate, 32bit True andstimuliwere Colour).Allinstructions presented onthemonitor NITASHA BULDEO, MS,MSc Participants were askedtoplacetheirrightwristonawhiterectangle (14.8cmhighx Superlab software interactedwithBiopac viaaStimTracker™ device. This enabledthe Figure 1:Apparatus Set-up Figure 2:Placement ofECG Electrodes andLeads INTEROCEPTION: AMEASUREOFEMBODIMENT 79 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 80 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS and therefinements ofpracticecarefully crafted by so many dedicatedpractitioners. improvisation. In developing thisapproach, Iamindebted totheexcellence oftheseideas to postmodernism,andpractices asdiverse asconsciousness raisingcircles anddance philosopher Maurice Merleau Ponty. They straddleintellectualtraditionsfrom pragmatism the work of Brazilian educational activist Paulo Freire to the French phenomenological Alexander, around theturnoflastcentury. They spancontinentsandcultures, from educator John Dewey and the somatic practicedeveloped by his friend and colleague, F.M. practices theseideashave generated. They reach backatleastasfartheearlyAmerican 2009; Johnson &Caldwell, 2010). colleagues andIhave conducted intotheembodiedexperienceofoppression (Johnson, a somatic psychotherapist andmovement educator, andbeeninformed by the research and responded toissuesofsocialjustice. The approach hasevolved from mywork as embodiment studieswhileaddressing criticalgapsinhow thesefieldshave understood model ofpractice,thisapproach integrateskey findingsfrom education,psychology, and professionals. Comprising a conceptual framework and aand other human service work grounded inresearch anddesignedforuseby socialworkers, counselors,educators, © Author andUSABP/EABP. Reprints andpermissions [email protected] Volume 14,Number 1spring2015pp80-95. International BodyPsychotherapy Journal RAE JOHNSON,PhD,RSW, RSMT for addressing problematic experiencesinrelation tothebodyandsocialjustice. research ontheembodiedexperienceofoppression, anintegrative model thispaperarticulates insufficiently attentive tothe role ofsocialpower ininterpersonal relations. Drawing oncurrent embodied experience(e.g.somaticeducationandcounseling/psychotherapy) are role innavigatingoppressive socialinteractions.Conversely, existingmodelsofworking with education, multiculturalcounselingandsocialwork) are insufficientlyinclusive ofthebody’s theseexperiencesofoppression, to view existingsocialjusticemodels(e.g.,anti-oppressive education, counseling,andcriticalembodimentstudiesofferpowerful lensesthrough which and mediatingthetraumaticimpactofoppression. Althoughconceptualframeworksfrom Research role ofthebodyinnavigatingexperiencessocialdifference hasestablishedthecrucial education, multiculturalcounseling,experientiallearning The ideasthatformthebasisofapproach have existedformanyyears, ashave the This paperintroduces approach aninterdisciplinary todiversity andanti-oppression Keywords: Grasping andTransforming theEmbodiedExperienceof embodiment,oppression, socialjustice,diversity, anti-oppressive Received 7September, 2014;Accepted 14December, 2014 Rae Johnson,PhD, RSW, RSMT Pacifica Graduate Institute The Art andScienceofSomaticPraxis ISSN 2169-4745Printing, ISSN2168-1279Online Oppression Abstract experience ofoppression pointtheassumptionthatoppression takesasitsstarting isa and thatwe becomemore skilledatnavigatingthemhonestly, respectfully, andwithgrace. of privilege,discrimination,andmarginalizationare ofourawareness brought tothesurface whose intentionsare tohelpratherthanharm,itisessential thattheembodieddimensions interactions. inflict ononeanotherinoursimplesteveryday professionals For humanservices and deeplyentrenched socialissue–thesystematicand mostlyunconsciousoppression we approaches from responding aseffectively astheymighttowhatisarguablyourmostpressing models, it becomes possible to identify some of the missing pieces that have prevented these their integrationisnovel. By bringingtogetheranumberofdifferent theoretical andpractical 1 learningasaprocess education,whichviews inwhichlearnersactively the fieldofconstructionist fostered theircapacitytocontributesocietyinafree andproductive way. Dewey’s ideasinform in experience,relevant totheissuesof learners’ lives inthecontextof their own communities, and Learning andUnlearning Oppression transforming embodied perspectives withanexperientiallearningmodelallows theinherent “grasping and theory, nonverbal communication,andtraumatology. This integrationofcriticalanalysisand perspective. The modelalsointegrateskey contributionsfrom somatics,criticalembodiment counter-hegemonic theorists andmulticulturalcounselingfleshesoutanecessary inthispaper,as afoundationforthemodelarticulated whilethework ofcriticaleducational locusforimplicitsocialcontrol. embodiedinteractionsasaprimary maintains oureveryday widespread source ofsocialknowledge dismissalofthebodyasanimportant andeffectively of therelative lackofattentionitisgiven (Weiss, 1999). This inattention colludeswitha often persistsbeyond thehard-won because changestolawsandsocialstructures, inpart or legislatedinequities;rather, itfocusesonamechanismforreproducing oppression that micro-sociological perspective doesnotnegatethesignificanceofinstitutionalized oppression strategies inorder totransformourindividualandcollective experienceofoppression. This than innate(Freire, 2000).By extension,itshouldbepossibleto“unlearn” theserelational 2001, p. 20)andthatthebehaviorswe usetoenactoppression are mostlylearnedrather to dominate and benefit from the exploitation and subordination(Johnson, of another” a“systemsocial construction; ofsocialinequalitythrough whichonegroup ispositioned suggestions forimplementation. describes the model of practice based on the conceptual framework, and offers examples and on thestrategicintegrationofliterature referenced above. ofthepaperThe secondpart key toitsdeconstruction. kindofexperience(oppression)to beappliedaparticular whoseembodieddimensionsare

In Kolb’s cycle, “grasping” refers to ways ofunderstandingexperience by feelingandthinking, and in some meaningful, intentional way(Kolb,in somemeaningful, 1984). “transforming” toreflecting optionsinorder onandexperimenting withnew toshiftorchangethatexperience The approach describedinthispaperforgraspingandtransformingtheembodied asthefoundationofthisapproach areWhile theideasandpracticesthatserve notnew, Educational theorist John Dewey (1897,1916)believed thatthebestlearningwasgrounded John Dewey’s educationalphilosophyandDavid Kolb’s cycle ofexperientiallearningserve This article is structured in two parts: the first articulates aconceptual frameworkbased thefirstarticulates isstructured intwoparts: This article 1 ” functionsofKolb’s widelyusedandrecognized cycle ofexperientiallearning Conceptual Framework GRASPING ANDTRANSFORMING 81 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 82 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS (and may be unlearned); 1) we learn from experience as well and as thereforethrough instruction, human experience. addressing oppression, emphasizingthefluid,context-specific, andhighlysubjectiveof nature prior tendencytoward over-simplification and generalizationwhenproposing strategiesfor aswell asby Buddhistinformed by queertheory philosophy. Likehooks,Kumashiro resists a Kumashiro develops criticalpedagogyby (2000)further infusingapostmodern perspective teaching andlearningtoissuesofrace,gender, andethnicity. Anti-oppressive educatorKevin intersecting dimensionsofsexismandracism,hooksexpands theconcernsofanti-oppressive to multiculturalcontexts.Asoneofthefirstfeministtheorists towriteconvincinglyaboutthe hooks (2014)drawssignificantlyon Freire indeveloping ananti-oppressive pedagogy relevant manipulated, coerced, orignored duetoourmembershipinasocialgroup. can all learnthe ability toidentify and evaluate theaspectsofourexperience in whichwe feel surrounds oppression, we are allcapableofacriticalconsciousnesssocialreality. That is,we insisted thatnomatterhow submergedwe are intheculture ofsilenceandinvisibilitythat that we mustunderstandthesystemsandmechanisms thatperpetuatethestatusquo. He also responsibility, through reflection andaction. In order tocreate culture differently, Freire argued social realities inturncreate usasinherently social beings.Social transformation istherefore our realities them as pre-existing (rather than viewing and immutable structures) and that those oppressive educationperspective. LikeDewey, Freire believed thatwe create socialandcultural never politicallyneutral. circumstances ofentrenched socialoppression (Freire, 2000;hooks,2014),andthateducationis (Kumashiro, 2000). Anti-oppressive educators argue that learning is fundamental to overcoming understood asanyeducationalapproach thataimstochallengemultipleformsofoppression queer, postcolonial,andothersocialjusticeapproaches), anti-oppressive educationcanbebroadly us learnfrom experienceaddress issue. thisparticular interpersonal andsocialpower, thattheeducationalstrategies designedtohelp itseemsnecessary thingswe learninhierarchicalthe mostimportant societiescenters ontheuse(andmisuse)of subtle intersectionsofprivilegeanddiscrimination,oppression isalifelesson.Given thatoneof interactions. andinformsoureveryday worldviews, Working through complexandsometimes negotiate power differentials amonggroups andindividuals.It shapes ouridentitiesand imprints ofhow totreat (andexpecttobetreated by) peopledifferent from us,andhow to their lifeexperienceshave influencedandaffectedthem. activity thatisdeeplyinformedby wholearnersare, whattheyalready know andbelieve, and how and ourrelationships toothers.From anexperientialperspective, learningisacomplex,holistic ofourselves information andexperiences,theseinteractionswiththeworldchangeourview world andourselves inaninteractive, ongoingaction/reflection cycle. As we encounternew knowledge ofthelearner. that isnecessarilymediatedby thecontextoflearning,socialenvironment, andtheprior these experiencesare thenappliedtothereal-world contextofthelearner, resulting inknowledge knowledgeconstruct from their own experiences. from The concepts and principles constructed RAE JOHNSON,PhD,RSW, RSMT For many, thelifeexperience of beingoppressed andoppressive creates deep and lasting Scholars inexperientiallearning(Boud,1985;Kolb, thatwe learnaboutthe 1984)assert These educationaltheoristsprovide anumberof usefulinsightsintohow oppression islearned While Freire’s analysis of oppression focuses largely on social class, educational theorist bell Paulo Freire’s Encompassing avariety ofeducationalapproaches (includingfeminist,critical,multicultural, Pedagogy oftheOppressedPedagogy (2000)isfoundationaltounderstandingananti- embodied interactionswe have witheachother. most significantandenduringstrategiesforperpetuatinginequitablesocial relations: theeveryday theseperspectives consistentlyfailtoaddressand maintainedasasocialconstruction, oneofthe However,serve. as valuable as these contributions are to understanding how oppression is enacted oppression must continually adapt tothe changing contextsanddiverse needs of the people they force andcorresponding “bottom-up” resistance), and4)practicesdesignedtoresist andtransform through multiple,intersectingsocialidentitiesandpositions(ratherthanasasingle“top-down” patterns andstructures requires anunderstandingofhow theyfunction,3)oppression isenacted experiences, notjustprovide onculturalcompetency, instruction 2)changingoppressive social the strategieswe employ tochallengeoppression mustprovide toexplore opportunities our 2 of therelationship. right oftheindividualwithhigher statusorpower, andthisprerogative affords themmore control initiate touchwithhersupervisor. This initiation orincrease ofintimacyandinformalityisthe the course of making a conversational point, but the employee does not have the same license to more formaldemeanor. maytouch hisemployee That samesupervisor casuallyonthearmin in arelatively casualandrelaxed posture, whilehisfemaleemployee isexpectedtomaintaina or reciprocate. For example,inconversation withan employee, amanmayleanbackinhischair to have therighttoexercise familiarities whichthesubordinate certain isnotpermittedtoinitiate 1995). In thesecases,theindividualwithmore power isusuallyacknowledged (by bothparties) behaviorsrelatedof anunequalaccesstocertain toinformalityandintimacy(Freeman &Henley, nonverbal exchanges between individuals from dominant/subordinate socialgroups. findings ofthis research istheconclusionthat asymmetricalinteractionsare ahallmark ofthe differences across arangeofsocialcategoriesandculturalgroups. One ofthemostsignificant of interpersonal interaction and helped us to better understand the nonverbal communication inhumaninteraction,EkmanDespite itsimportance andFriesen (1969,p. 181)note: structure) isthelocusformostcommon means ofsocialcontrol (Freeman &Henley, 1995). researchers arguethatthenonverbal componentofsocialinteraction(ratherthaninstitutional of competence, sincerity, authority, and vulnerability (Manusov & Patterson, 2006). In fact, some environments inintricateways,providing insightintoemotionalstatesandinfluencingperceptions comportment Oppression Embodied

According toMarcel Danesi, (1999),humanbeingshave thecapacitytoproduce nearlythree-quarters of Rodman, 1983;Mehrabian 1968,1981). 70% ofamessage’s meaning (Birdwhistell, 1970)andupto90% ofitsemotionalcontent(Fromkin and estimatessuggestthatthenonverbal componentofhuman communicationaccountsfornearlyConservative a milliondistinct physical signs,includingdifferent bodilypostures, hand gestures, andfacialexpressions. This nonverbal asymmetry between individuals with differing social status can take the form between individualswithdifferingsocialstatuscantaketheform This nonverbal asymmetry Nonverbal communicationresearchers have shedlightonthislargelyunconsciouselement Scholars innonverbal communicationhave longrecognized thesignificanceofourbodily within awareness. what isshown failbecausetheinformationaboutwhatisoccurringnotcustomarily behavior seems to be enacted withlittle conscious choiceorregistration; to inhibit efforts their stream ofbodymovements andfacialexpressions. Most interactive nonverbal and noonetellsthem.People learntodisregard internalcuesthatare informative about [Most people]donotknow whattheyare doingwiththeirbodieswhentheyare talking, 2 andarguethatnonverbal behavioraffectsourrelationships andinterpersonal GRASPING ANDTRANSFORMING 83 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 84 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS and themassive globalincidenceofwar, politicallydirected torture, famine, rape,anddomestic somatic theorists suggest that the legacy of oppression is perhaps most strongly felt in our bodies, in response toindustrialization, rationalization,andthecommodificationofbody. Other for areturn tothelived experienceofthebodyisrelated totheevolution ofthehumanspecies, seminal work onsomatics, practitioners have nottakenupsocio-politicalissuesspecifically, exceptions. withafew Hanna’s inform changes in cognitive perceptions that, in turn, affect our relationship to the environment. physical musculature phenomena create adjustments inouremotionalstate.Changessensory our perceptions oftheexternalenvironment affectourperceptions oftheinnerone.Shifts in the wayinwhichwe perceive it(Greene, 1997). This “somatic” understandsthat pointofview that we domore thansimplyperceive reality through ourbodilysenses;reality by isconstructed by Maurice Merleau Ponty (1945)andelaboratedby Thomas Hanna (1987-88)whichargues argued thattheseinteractionsare nothinglessthantheprocess whereby we become whowe are. In fact, a number of embodiment theorists (Butler, 1990, 1993, 2004; Weiss, Hanna, 1970) have earliest socialencountersonwards, andare deeplyentwined withoursenseofpersonalidentity. clothes we putonortoolswe use. These embodiedinteractionsare learnedimplicitlyfrom our highly complex,fluid,andcontextualized, andtheyare like notjustexternalactions we perform, read by) othersonabodylevel. However, torecognize itisimportant thattheseinteractions are interactionswithothers–tohownonverbal componentsofoureveryday we read (andare being task oflearningfrom theexperienceofoppression mustinvolve becomingmore attunedtothe mis-attunement inthetherapeuticsetting. of thetherapistandclient’s resulting somaticresponse contributedtoexperiencesofcultural interpersonal interactionsas“micro-aggressions”, Rivera (2010)foundthatthe nonverbal behavior practice. Informed by Sue’s andthenotionofoppressive (2010)multiculturalcounselingtheory communication research have now and beenmadeintherealm ofmulticulturalcounselingtheory attemptstoextendthe insights ofanti-oppressivethe classroom, andpreliminary nonverbal social conventions tothepointwhere theymay nolongereven berecognized asoppressive. in dominance and submissionquickly slip below the level of awareness, effectively internalizing transmit. Freeman &Henley (1995)arguethattherepetitive andinsidiousnature oftheseexercises affirm that status intheir response to those messages, as well as in the messages they themselves social statusthrough thenonverbal messagestheyreceive from others. They are alsorequired to to Henley (1977),membersofsociallysubordinated groups are constantlyreminded oftheirinferior (adapting toanother’s nonverbal behaviors)(Henley andLaFrance, 1995). more sensitive (accurate in decoding another’s nonverbal expressions), and more accommodating of thatgroup willgenerallybemore gesturallysubmissive, more readable (nonverbally expressive), behavior. In thosesituationsinwhichonesocialgroup isregarded asinferiortoanother, members interaction are foundinthe use of eye contact,control over time,andothercategories of nonverbal with lower statustendtoyieldspacethosewithhigherstatus.Similar findingsofasymmetrical dominant animalsandhigh-statushumanbeingsare afforded greater personalspace,andthose nonverbal interaction.Earlystudiesinnonverbal communication(Sommer, 1969)showed that RAE JOHNSON,PhD,RSW, RSMT Although these asymmetries are often subtle, their impact over time is considerable. According The useofpersonalandinterpersonalspaceprovides anotherexample of asymmetrical Although somatictheoriesrecognize theintegralityof environment withthesoma,somatic This perspective isechoedinthe embodied,existentialformofphenomenologyputforward Given the compellingevidencefrom theliterature ofthe onnonverbal communication,part Not surprisingly, theseasymmetriesfindtheirwayintothecounseling room as well as Bodies inRevolt (1970), clearly articulates his argument that the need hisargumentthattheneed (1970), clearlyarticulates should notbeappliedinageneralized, mechanistic,orsuperficialway. Rather, understandinghow by thenonverbal communicationresearch (i.e.,“take upmore space”, “use direct eye contact”) (andvaried) identitiessuggeststhatthestrategies implied with othersasconstitutive ofourvery numbness, or constriction. Simultaneously, the somatic recognition of embodied engagement of bodilyexperiencesoppression thatmayinitiallyreside withinusonlyasavague unease, findings ofnonverbal communication,itbecomespossibletodifferentiate aspects theparticular and politicalact(Haines, 2014). strategy forreclaiming ourbodiesforourselves, andunderstandingthisprocess asbothapersonal networks inwhichwe live” 1995,p.ix). (Johnson, In thatrespect, somaticscanbeseenasa indicates a “...criminal disregardviolence in this century for the muscle fibers, fluids, and neural that explains and addresses how our bodily selves are implicated in, impacted by, and constituted nonverbal communication, somatictheory, andtraumatology, aconceptualframework emerges An Integrative Framework interactions asasource ofchronic complextrauma. oppression, andthebody, andarguesforareevaluation ofthesignificanceoppressive nonverbal effects ofprolonged duress. My own researchthelinksbetween trauma, articulates (2009)further in astress disorder, andrecommend changestoformaldiagnosticcriteriaacknowledge the absence ofasingleacutetrauma. They suggestthatenduringpsychosocial stressors may result thoughtsand images,avoidancesymptomatology (intrusive behavior, andhyper-arousal) inthe by ScottandStradlingsupported (1994),whoreported examplesofPTSD thatdemonstratefull degree of alienation from the body. This conceptualizationofoppression astraumaticisfurther bodily assaultoccurs.In particular, she notesthatthe trauma of oppression often results in some and argues that there is a physicality to trauma that must be recognized even when no overt classist, homophobic,andableistsociety” (Burstow, 2003,p.1296). people are routinely worndown by theinsidioustraumainlivingdayafterasexist,racist, are violatedinwaysthathave lastingpsychological pointisoppressed effects.She writes,“The trauma andcommunitytoarguethatindividualsfrom oppressed andmarginalized groups societal oppression. For example,Burstow citesscholarsworking inthearea oftrans-generational and abuseresulting inpost-traumaticstress disorder (PTSD) existswithinalargercontextof Pain &Minton, 2006;van derKolk, 1994). effects oftraumahave now beenwell &Segal, documented(Jaffe 2005;Levine,1997;Ogden, human beings are affected by traumatic experiences. Within the field of traumatology, the somatic relevant. Psychological researchers andtheoristshave developed different understandingsofhow setofresearchinteractions asaformofchronic traumaanotherimportant findingsbecomes damaging and insidious effects of nonverbal subordination, when one understands these everyday work Iamproposing inthispaper. While nonverbal communicationresearchers pointtothe Oppression asEmbodied Trauma how besttocommunicateourintegrityandauthenticityonabodylevel. we perpetuateinequitablerelations through ourbodiesallows ustomakeindividualchoicesabout By categoriesandspecific infusingthissomaticperspective withtheclearlyarticulated research By integratingkey ideasandfindingsfrom anti-oppressive andexperientialeducation, Burstow describestraumaresponse notasadisorder, butasareaction toakindofwound, Many theoristsandresearchers inthefieldoftraumatologysuggest thatmuchoftheviolence tofullyfleshouttheembodiedapproach todiversity A finalconceptualintegrationisnecessary GRASPING ANDTRANSFORMING 85 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 86 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 3 diversity more specifically. Agraphic representation ofthemodel isincludedas Table 1. as well asthewaysthesephaseshave beenelaboratedtoaddress issuesofembodiment and Readers familiarwithhiswork willsee theclearoutlinesofhisfourstagecycle inmymodel, no aspectsare overlooked, andmaximizing thelearningpossiblefrom anygiven experience. This naturalprocess canbeenhancedby focusingintentionallyoneach phase,ensuringthat of fourstages: on thework ofDewey, Freire, andPiaget, Kolb’s consists (1984)experientiallearningtheory the work ofDavid Kolb, whosecycleasitsfoundation.Building ofexperientiallearningserves issues of social power, privilege and difference. In developing it, Iamsignificantly indebted to of the body (e.g.bodily sensation, body image, and nonverbal communication) in exploring Cycle ofEmbodied Critical Transformation across arangeofprofessional contexts. professionalsaccessible andrelevant working tocounselors,educatorsandhumanservices represents myown attempttoaddress thesemultiplerequirements inaformatthatis oppression onembodiedexperience. The modeldescribedinthesecondhalfofthispaper somatic literacy and relational, beabletowork withthecomplexity ofintersectingsocialidentities,support in whichthebody’s learningisfigural. It wouldfacilitate(un)learningthatisexperiential oppression work wouldbeoneinwhichoppression isunderstoodaslearnedbehavior, and this conceptualframework, andare by research eachsupported andtheoretical testing. through inequitablesocialrelations. The statementsthatfollow canbeconsidered thepillarsof RAE JOHNSON,PhD,RSW, RSMT

Somatic literacy is a term coined by Paul Linden (1994) todescribe a degree of conscious awareness of bodily sensations andactions. According toKolb, thesestagesrepresent thenaturalprocess oflearningfrom experience. This sectiondescribesamodeloftransformative learningthatprivilegestheknowledge Based acomprehensive ontheseassertions, andinclusive approach todiversity and anti- 4) acting(active experimentation). 3) thinking(abstractconceptualization),and 2) reflecting (reflective observation), 1) experiencing(oftencalledconcrete experience), • • • • • • • • Oppression istraumatic. Trauma is mediated through the body and manifests in embodied experiences of Oppressive socialrelations are characterized by asymmetricalnonverbal interactions The nonverbal componentofsocialinteractionisonethemostpowerful, We learnaboutsocialsystemsthrough interpersonalnonverbal interactions. locusoftheseintersectingsocialidentities. Our bodiesare aprimary Our experiencesshape(andare shapedby) multipleandintersectingsocial We learnoppression implicitlyandrelationally, experiencesof through everyday post-traumatic stress symptoms. across arangeofbehavioralcategories. ubiquitous, andinsidiousmeansofsocialcontrol. identities. social andpoliticallife. 3 andfluencyinbodylanguage, recognize thetraumaticimprintof elaborate themodelusingexamplesfrom myown experience,anddescribetheprocess from model, and includes suggestions for program planning and evaluation. As much as possible, I Each oftheseissuesare addressed inthemodelasseparate,well asoverlapping, components. source ofknowledgeand 5)thebodyisanimportant andpower inunlearningoppression. role innavigatingoppressiveplays animportant interactions,4)oppression affectsbodyimage, responses tooppression withrespect (particularly toconstrictionandarousal), 3)bodylanguage multidimensional, 2)there isarelationship between thesomaticeffectsoftraumaandembodied of thatstudycanbesummarized asfollows: 1)theembodiedexperienceofoppression is conducted intotheembodiedexperienceofoppression 2009). (Johnson, The findings power asthefacilitator, andhow mybodycommunicates mybeliefs,attitudes andvalues to where encouragementand empathyprecede challenge and risk.Irecognize andsupport my appreciate thatlearningand unlearningcanbehard, andwork tocultivate anenvironment to material,andencouragemultiple perspectives onasingle“shared” event. Idomy bestto Given theoften-charged materialbeingexplored, Ialsoprepare for unanticipatedresponses learnsdifferently,everyone and that reactions toexperientialexercises across learners. willvary tokeepinmindthat review the criticalandconstructive ofanexperience.Itry and supporting occur within the field, creating an atmosphere conducive to honest and respectful disclosure, experiences. Asafacilitator, myfocusshouldbeonrecognizing forlearningasthey opportunities help prepare learnerstobecomeactively engaged inunderstandingandworking withtheirown learners ascentraltotheprocess. My knowledge role isnot toimpart or information,butto to thismodel. 2005) and feminist therapy (Burstow, 1992) offer facilitation strategies that are better suited (Martín-Baró, Aron andCorne,1994),communitypsychology (Nelson andPrilleltensky, Approachesparticipants. toworking withothersthathave emergedfrom liberationpsychology toreinforceand wouldonlyserve pre-existing asymmetriesinrole power between facilitator and and privilege.A“top-down” withthismodel, orcounselingstyleisincongruent instructional facilitating someoneelse’s. prerequisite,an important sothatIhave more thanmyown experiencetoreference when assumptions, andprojections. Prior traininginsomaticsanddiversity work hasalsobeen facilitation withsomeawareness ofmyown potentialtriggers,blindspots,expectations, that Ihave personallyexperiencedhomophobicdiscrimination),butthatIshouldenterthe havein order identical experiences as my participants to beinformed and helpful (for example, understanding ofembodimentandoppression. This isnottosuggestthatasafacilitator, Imust addressed. In working with thismodel,Ihave founditessentialtohave asolidpersonal thoughtfully andhonestlyexaminingourown experiencewithrespect totheissuesbeing insistence that practitioners wishing to facilitate a process for someone else must prepare by Embodied Critical Pedagogy andFacilitator Preparation be curiousabouthow theymightapply this modeltotheirown practice. butthatIwriteforanintendedaudienceofprofessionalsperspective whowill islessimportant, my perspective asfacilitator. This shouldnotbetakenasanindicatorthattheparticipant’s This section also articulates pedagogicalandfacilitationissuesrelevantThis sectionalsoarticulates totheuseofthis informedby researchThis modelofembodiedcriticaltransformationisfurther Ihave In thespiritofthesecounter-hegemonicapproaches, totreat Ibelieve itisimportant the As afacilitator, Iapproach thiswork from aperspective thatacknowledges issuesofpower A hallmark ofmostexperientialeducation,socialwork, andcounselingmodelsisthe GRASPING ANDTRANSFORMING 87 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 88 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 4 include interoceptive dataandnonverbal behavior. activities designedtoelicitexperiences ofprivilege,discrimination,ormarginalization,and to Kolb’s cycle, thisphaseofthecycle ofembodiedcriticaltransformationfocusesspecifically on are todiscover criticalofit,orwork withapartner theirown personal spaceboundaries.Unlike the room thatsymbolizes oppression tothem,drawapicture ofhow theirbodyfeelswhenthey is assignedatask,or“experiment”. For tolocateanobjectin example, Imightaskparticipants experience. In otherwords, itbeginswithdoingsomethinginwhichtheindividualorgroup with ourfirstexperientialexercise anduseofthefullcycle transformation, referencing Kolb’s experientiallearningtheory. The sessionthenbeginsinearnest, From there, Iprovide abriefdescriptionofthecourseanddescribecycle ofembodiedcritical and abodygesture thatexpresses how are participants feelingintheirbodiesthemoment. introductions thatusuallyincludeanexpression ofparticipants’ hopesandfearsaboutthecourse, projector screen toread forparticipants andmullover astheyarrive. Aswe begin,Ifacilitate through aseriesofstrategiesandactions.Iwilloftenputrelevant, inspirationalquoteonthe conceptual frameworkandresearch findingsthat are thebasisforapproach. research paperontheembodiedexperience of oppression 2009),whichoutlinesthe (Johnson, advocates forareturn tothebodyinworking withissuesofgenderanddisability, andmyown by providingparticipants advance readings. IoftenassignEli Clare’s andguidelinesforthesafeuseoftouchmovement. participation, strategies), voluntary includes adiscussionofsafetyguidelines(suchasconfidentiality, non-coercion, and bracketing agreeparticipants totaketherisksentailedin openinguptoexperience.My orientationalways another andthelearning/counselingcontext,toengageinaprocess ofinformedconsentbefore isfamiliarwithanexperientialapproach, Itakecarenot everyone toorientstudents/clientsone “intervention” tomakesure theyalignwiththestatedobjectives ofthecourseorsession.Since learner/client characteristics,andtothinkthrough “exercise” theobjectives foranyparticular or tobasemystrategiesonthelearning/counselingcontextand I have founditimportant Program Planning Using theCycle ofEmbodied Critical Transformation experience isvalued by thefacilitator. thattheirembodied needsofthebodysignalstoparticipants thesensory container thatsupports affected by our environment than we realize (Gladwell, 2007). I have found that creating a and fresh airmightseemlikerelatively insignificantdetails, research shows that we are more seats,naturallight, ofmyfacilitation.Althoughconcernssuchascomfortable setting aspart upon normsofsafetyandmutualrespect. participants. To to question my authority within the agreed that end, I encourage participants RAE JOHNSON,PhD,RSW, RSMT

Although thedescription inthispaperfocusesonthe useofthiscycle with agroup inacourse orworkshop setting, Ihave alsouseditwithclients inindividualcounseling,andfound iteasilyadaptabletothatsetting. When generating ideas for exploring embodied experiences of oppression using this model, When generatingideasforexploringembodiedexperiencesofoppression usingthismodel, Perhaps more thanisusuallythecaseforexperientiallearningsituations,Ialsoattendto Like Kolb’s cycle, thecycle withaconcrete of embodied criticallearningusuallystarts Phase One: Embodied Experience ofOppression arrive andtheclassbegins,Icontinueorientationcontainmentprocess As participants Because Iusethiscycle primarilyinthecontextofgraduatecoursework,Ialsoorient 4 . Stolen Bodies (2001), which (2001), which somatic disequilibrium. When reflection inpairsorsmallgroups, Iattendtothe isundertaken questions are intendedto illuminate allfacetsofanexperienceandevoke a tolerableamountof “dominant” culture and“home” culture normswithrespect totheexperiencebeingexplored. My to question social norms and assumptions. Ialso ask about privilege, and encourageparticipants and acounter-hegemonicperspective explored. Asafacilitator, Iactively inquire aboutpower and the emphasisonsocialcritique isemphasized. The dominant ordefaultsociallensisidentified, areparticipants encouragedtoexaminetheirexperiencesfrom multiple perspectives, inthismodel out ofcrisismodeandintoamore responsive andproactive stance. next without a moment to investigate the cause of the flames. Reflection is the first step in shifting discrimination. We allknow what it’s like to operate in crisis mode, putting outonefire after the time toreflect individualsdealingwithoppression ontheirexperiencescanhelpsupport and to powerful andempowering insights.Asthe above quotesuggests,thesimpleactofproviding asking therightquestionsandguidingconversations instrategicwayscanhelpopenparticipants the mostfrom thisphaseoflearning.Facilitating embodiedcriticalreflection ischallenging,but in groups, butmostpeopleseem toneedarelatively quietandtime-spacious environment toget be experiencedasachaoticorundifferentiated mass.Reflection canbedonealone,inpairs,or andexaminingeachfacetofanevent thatmayinitially taskofunpacking,deconstructing, crucial strength, empowerment, andresistance –notjustsitesofdistress andlimitation. exploreexperiential componentsdesignedtohelpparticipants how theirbodiescanbesitesof degree towhichjudgments,assumptions,andprojections are basedonbodyimage.Ialsoinclude of nonverbal communication,andanexercise on“reading” explore bodieshelpsparticipants the Exercises onembodiedboundaries,safetouch,andkinestheticempathyhighlightsomeelements privilege’ choosereal inwhichparticipants objectstosymbolize thesocialprivilegestheyenjoy. speaking. Other exercises includeavariation onMcIntosh’s (1988)‘invisibleknapsackof relational nature more ofembodimentandgetsparticipants warmeduptoeachotherwithout and standing,eventually moving around theroom withothers. This exercise highlightsthe noticebodilysensationsastheyshiftfrom lyingquietlyontheirown,participants tositting participants’ bodiesinsomeway. the essentialcriteriaare thattheexperiencesaddress issuesofsocialpower, andthattheyengage amore embodiedstateofconsciousness.In choosingordesigningexperientialcomponents, of) exercises too longorelaborate,andtoallow totransitioninto(andout timeforparticipants your partner, noticethequalityofyour breathing.” Ihave learnednottomaketheexperiential inclusive orevocative ofembodiedsensationormovement. For example,“as you move toward allow toengagewithitintheirown participants way. Asmuchaspossible,Iuselanguagethatis topic. They work bestwhenItakethetimetosetupexperienceclearlyandcarefully, andthen along acontinuumfrom lesstomore interactive, andfrom lesstomore challengingintermsof sensation inrelation toissuesofpower, privilegeanddifference. Iusuallysequencetheexercises While reflection in most experiential learning models is intended to be “critical”, in that Reflection oftheexperientiallearningprocess. isperhapsthemostimportant In it, we beginthe Some examplesofexperientialexercises Ihave usedincludeimprovised movement inwhich Phase Two: Embodied Critical Reflection These embodied experientialexercises are intended toevoke a tolerableamountofbodily “For individualswhoexperiencemonetary, timeorbandwidthpoverty, reflection is a luxury good.”(Konnikova,reflection isaluxury 2014, p. SR1.) GRASPING ANDTRANSFORMING 89 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 90 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 5 experience, while benefiting from the validation and elaboration of externally generated concepts. (Atkins, 1998).In thisway, stayanchored Ihelptheparticipant inself-generatedideasabouttheir musculoskeletal responses tochronic trauma(Scaer, 2014), oraboutshameandqueerbodyimage theirintegrateddistillationof“ribcagewant tohelpsupport collapse” by offeringideasabout concepts andresearch findingsaboutbodyimageandtrans*oppression. For example,Imight image). that sensation(andpossibly, by extension, their next experienceoffeeling judgedaround body sensation ofcollapseeasilyleadsthemtoexperimentwithhow theymightwantto shiftorchange affirmation onabodylevel –asenseof release, relief, andsettling. Once confirmed,thisdistilled with theirexperienceoffeelingjudgedaround their bodyimage,theydescribeacorresponding anchored intheirbody. When Icheckwiththemtoseeifthesensationofribcagecollapse‘fits’ have undergone,thatsensationnow symbolizes awholeset ofunderstandingsthathasbecome accompanies theexperienceoffeelingjudged,becausereflection anddistillationprocess they their ribcage.Althoughitmightseemlikethiscollapsingfeeling is“just” abodilysensationthat because oftheirnon-normative genderpresentation isdistilledintoasensationofcollapsein sensation insteadofacognitive thoughtorconcept.Perhaps anexperience offeelingjudged of integration. of somethingthatwaspreviously unclear, inaprocess oforganizinginformationatahigherlevel described by Gendlin is a bodilychangeandsense of release understanding that accompanies a new illustration ofhow thebody can generateexplicitknowing from implicitdata.In it,the‘felt shift’ and testingthemfor“fit” isunderscored. Eugene Gendlin’s from experienceisnotalwaysarationalprocess, andtherole ofthebodyingeneratingconcepts words). In thecycle ofembodiedcriticaltransformation,itisrecognized thatmakingmeaning this model,Iexpandthenotionofconceptstoincludeimages,sounds,andgestures (notjust conceptualization phase,andischaracterized by anemphasis onthinkingandhypothesizing.In more cohesive whole.In Kolb’s modelofexperientiallearning,thisisreferred toastheabstract the nextstepincycle todistillthesevarious aspectsandperspectives asksparticipants intoa clarify allitspossiblemeanings. reflection, gatheranembodied participants “felt sense” and moving through anexperiencetoextendanddeepenreflection. During embodiedcritical bodily expression (i.e.movement). This modeldeliberatelyengagesthisnaturalprocess offeeling this modelrecognizes thatreflection isnotsimplyacognitive process, butalsooccursthrough toilluminatetheirexperience.In otherwords, their capacityforbodilysensationandimagery bodies during(andafter)theevent, toidentifythenonverbal behaviorthatoccurred, andtouse perspective. During reflection, theyare encouragedtobecuriousabouthow theyfeltintheir disregarding theinputofothers. over –inotherwords, ontheirown outsideobservations toclaimexpertise experiencewithout interactive/relational to privilege self-reflection element of reflection, participants and support RAE JOHNSON,PhD,RSW, RSMT

The term‘felt sense’ isusedby Gendlin (1984)todescribe thesecondstepinFocusing. After identifying, critically examining, and gathering together all the elements of an experience, After identifying,criticallyexamining,andgatheringtogetheralltheelementsofanexperience, Phase Three: Integrated Distillation In are thismodel,participants alsoaskedtoexplore theirexperiencefrom asomatic Further facilitationaround thisexperiencemightinclude somereferencing topre-existing For mightgeneratean“integrateddistillation” example,aparticipant intheformofabodily 5 of the experience that begins to help oftheexperiencethatbeginstohelp Focusing (1981) provides anexcellent to thetaskofexperimentingchangethatexperienceintheirbodiesandworld. completion and orientation,asafacilitator, Ithinkabouthow tobuildinthespaceand the “embodied criticalexperimentation” withasenseof stageusuallyleaves participants celebration oflearning.Although engagingwithonecompleteturnthrough thecycle to embodied criticalexperimentation allows them tokeeplearninginaproactive way. way, and beingintentionalaboutembodiedcriticalreflection, integrateddistillation,and changes them,orientsthem to theproblem orissueinaslightly(orhugely) different to adjusttheirunderstandingoftheissue,ordevelop refinements ofaction.Eachencounter their experimentworked, they maygobackintothereflection andconceptualization phases cycle, experienceofbeingintheirbodydifferently. basedonthisnew Depending onhow themselves). carry shame) orothers(showing respect fortheirembodieddifference because ofthewaythey situation, andmayleadtootherchangesinthem(forexample, feelingprideinsteadof but thatliftingtheirribcagewill solution totheproblem offeelingjudged(or being judged)around trans*bodyimage, gender presentation. To beclear, it’s andcomplete notthatliftingtheirribcageisa certain with keepingtheirribcageliftedinthefaceofperceived orjudgmentabouttheir scrutiny the worlddifferently helptoshiftit.For experiment example,Imightsuggestaparticipant distillation ofmeaningintheprevious phasetoassessiftheexperimentalwaysofbeingin behaviors,andtoreferembodied experienceastheyplaywithnew backtotheintegrated environment. waysofbeingintheirbodiesarelativelyand topracticenew safeandsupportive provide toapplytheirconceptsreal-world withanopportunity contexts, participants that peerscanhelpeachotheridentifywhatneedstobechanged,andhow. Role-plays can constraints onchoiceofaction. This phaseoftenworks well inasmall group format,so behaviors,andthesocialacknowledge new thechallengeandriskofenactingcertain tobecuriousaboutthebroader implicationsoftheirexperience,Ialsoask participants of embodiedoppression theyhave identified intheprevious phasesofthecycle. AsI the world.Specifically, toexperimentwithsolutionstheproblem itasksparticipants Once theexperienceofoppression explored, move hasbeen meaningfully participants Phase Four: Embodied Critical Experimentation Lastly, working thiscycle shouldalsoattendtoclosure, acknowledgment, andthe The real-life response toaparticipant’s round experimentssends themintoanew ofthe As afacilitator, Ifindithelpfultoremind tostayconnectedtheir participants This phase of the cycle ways of acting in (not just thinking about) focuses on new • • • • • • The hallmarks oftheintegrateddistillationphaseare: The process results inanembodied“felt shift” intheparticipant Concepts maytaketheformofembodiedimage,posture, ormovement (not Self-generated conceptsare privilegedover other-generatedconcepts It generatescriticalconceptsthatare embodiedaswell ascognitive The process works tohelp“name” nonverbal (i.e.,embodied)micro-aggressions Analysis, insightand meaning making in thisphase includes somaticand just words) social data change theirexperience GRASPING ANDTRANSFORMING thenexttimethey’re inthat 91 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 92 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS for graspingand transformingthatexperience. experience ofoppression that focusesonthelived experienceoftheoppressed, andoffersstrategies of embodiedcriticallearningdescribed inthispaperoffersonewaytowork withtheembodied timely additiontothetoolsand strategiesalready inuseamonghelpingprofessionals. The model role insocialinteractions, amore embodiedapproach todiversity andanti-oppression work isa escalating environmental andeconomicconcerns. With theincreasing recognition ofthebody’s Conclusion in diversity work thatfeelsstrengthening andgrounding (ratherthandiscouragingorshaming). emphasize resourcing before repairing, remark participants onhow itfeels toengage important In thesamewaythatsomatictraumamodels(Levine,1997;Ogden, Minton andPain, 2006) itistocultivate thelivingbody asaresourceimportant forpersonal resiliency andsocialadvocacy. microaggressions with body image. Participant or struggle feedback has also underscored how often relieved torealize thattheyare not‘overreacting’ whentheyare sensitive toembodied by a process thatrecognizes how muchofoppression isenactedthrough the body. They are cycle mostvalued by thosewhoengage withit.Consistently, express participants feelingvalidated ofthecycle. content, anddelivery Ihave alsocometounderstandsomeoftheaspectsthis critical learning,usingthesamefourphases: learning (andchange)isreally anddirects asfacilitators. takingplace,andsupports ourefforts in individual counseling. Having clear assessment strategies helps us to understand what kind of of theirfacilitation,makingevaluative mechanismsexplicitandintentionalcanbehelpful,even outside formalagencyandinstitutionalsettingsmaynotconsiderassessmentanessentialpart or hindereddesign and facilitation supported that process. Although practitioners working I believe it’s toknow important ifthishappened,andtounderstandwhatelementsoftheprogram graspandtransformtheexperienceofoppressionhelp participants intheirbodies.Asafacilitator, Program Evaluation Using theCycle ofEmbodied Critical Transformation tosharefor participants whatwaslearned,andtoidentifynextstepsintheirprocess. states before theyleave theclassorsession.Iusuallyendmysessionswithanopportunity toshiftsafelyoutofdeeplyinteroceptivetime forallparticipants oremotionallycharged RAE JOHNSON,PhD,RSW, RSMT Program evaluation canbestructured onthesamecycle patternasthemodelofembodied The cycle ofembodiedcriticaltransformationdescribedonthepreceding pages isdesignedto Social justiceremains oneofourmostpressing andintransigentissues,especiallyinthefaceof Over theyears, theseevaluative strategieshave hadasignificantimpactonthestructure, • • • Using thesethemes,Irevise theprogram ormyfacilitation strategiesaccordingly, I then First, feedbackaboutthe Igatherparticipant and meaning. reflections intobroad themesthat “feel right” inmybodywhenIconsidertheir previous evaluations thatthisiswhere oftenstruggle. participants embodied sensationandintegrateddistillation,asIhave learnedfrom numerous the session.Iaskwhatworked anddidn’t work, andoftenfocusspecificallyon experiment reflect onthisinformation,andaddittomyown impressions. I with them the next time I facilitate. withthemthenexttimeIfacilitate. experience , both during and after , bothduringandafter distill these these Damasio, A.(2008). Clare, E.(2001).Stolen bodies,reclaimed bodies:Disability andqueerness. Butler, J.(2004). Atkins, D.(Ed.). (1998). REFERENCES Email: [email protected] University andtheChicagoSchoolofProfessional Psychology. in somaticpsychology attheSanta Barbara Graduate Institute, Naropa University, Meridian lived experience of the body. Dr. Johnson presents internationally and has held leadership roles a non-profit educationalorganizationdedicatedtoadvancing scholarshiponthe interdisciplinary depth psychology atPacifica Graduate Institute, anddirects the Institute for Embodiment Studies, Rae Johnson, PhD, RSW, RSMT is the associate chair of the somatic studies/ specialization in BIOGRAPHY Grosz, E.(1994). Greene, D.(1997).AssumptionsofSomatics, Part II. Gladwell, M.(2005). Gendlin, E. T. (1981). Freire, P. (2000). 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93 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 94 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS McKinley, N.M.(1998).Gender differences inundergraduates’ bodyesteem: The McIntosh, P. (1988). Martín-Baró, I.,Aron, A.,&Corne,S.(Eds.). (1994). Manusov, V., &Patterson, M.L.(2006). The SAGE Linden, P. (1994).Somatic literacy:Bringing somaticeducationintophysicaleducation. Levine, P. (1997). Kumashiro, K.(2002). Kumashiro, K.(2000). Toward ofanti-oppressive education. atheory Konnikova, M.(2014).No money, notime. Kolb, D.A.,Boyatzis, R.E.,&Mainemelis, C.(2001).Experiential learningtheory: Kolb, D.A.(1984). Kolb, A. Y., &Kolb, D.A.(2012).Experiential learningtheory. In N.M.Seel (Ed.) Johnson, R.,&Caldwell, C.(2010). Johnson, R.(2009).Oppression embodied:Exploring theintersections ofsomaticpsychology, Johnson, D.(1995). Johnson, A.(2001). Jaffe, J.,&Segal, J.(2005). Jacobson, M.,&Ruddy, M.(2004). hooks, b. (2014). Henley, N.&LaFrance, M.(1984).Gender asculture: Difference anddominance in Henley, N.&Harmon, S.(1985). The nonverbal semanticsofpower andgender:A Henley, N.(1977). Hanna, T.(1970). Hall, J.A.(1984). Haines, S.(2006).Somaticsandtrauma: The approach. RAE JOHNSON,PhD,RSW, RSMT teaching experientialreflection. Intercultural Insights nonverbal behavior. In A. Wolfgang (Ed.), Nonverbal Behavior perceptual study. In S.L.Ellyson andJ.F. Dovidio (Eds.), Cliffs, N.J.:Prentice-Hall. Baltimore: Johns Hopkins University Press. for Research on Women. correspondences through work inwomen’s studies. Cambridge, MA:Harvard University Press. Communication. Journal ofPhysical Education, Recreation &Dance, 65 New York, NY: Routledge. Research, 70 styles, 1 Previous research directions. andnew development. Encyclopedia oftheSciencesLearning 6th AnnualUnited States AssociationofBodyPsychotherapy Conference, October 2010. trauma, andoppression. helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.html somaticsandtrauma.org/approach_course.html , 227-247. (1), 25-53. Englewood Cliffs,NJ: Prentice-Hall. Teaching totransgress. Bodies inrevolt: Aprimer insomaticthinking. Waking thetiger:Healing trauma. Nonverbal sexdifferences: Communication accuracy andexpressive style. Power, privilegeanddifference. Body politics:Power, sex, andnonverbal communication. Thousand Oaks, CA:Sage. Experiential learning: ExperienceExperiential asthesource learning: and oflearning Bone, breath, andgesture. White privilegeandmaleprivilege: Apersonalaccountofcomingtosee (pp. 151-164).New York, NY: Springer. (pp. NY: 351-371).Lewiston, C.J.Hogrefe. Troubling education:”Queer” activismandanti-oppressive pedagogy. Post-Traumatic Stress Disorder. International Journal ofBodyPsychotherapy, 8 Oklahoma City, OK: Wood’N’Barnes Publishing. Oppression embodied. Open tooutcome:Apractical guideforfacilitating& New York, NY: Routledge. Perspectives andcognitive onthinking,learning, (pp. 1215-1219).New York, NY: Springer. New York Times, Berkeley, CA,North Atlantic Books. Nonverbal Behavior: Perspectives, Applications, Mountain View, CA:Mayfield Publishing. Wellesley, MA: Wellesley CollegeCenter Berkeley, CA: North Atlantic Books. Handbook ofNonverbal Retrieved from: http://www. Writings foraliberation psychology. (7), 15-21. Conference Proceedings from the Retrieved from http://www. Novato, CA,Freeperson Press. p. SR1. Power, Dominance, and Review ofEducational (1), 19-31. Englewood

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95 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS 96 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS This impliesa connection between theabilitytobeembodied andhealingsexualshame. ofpsychotherapy toaddressreported ahistory theshame resulting from pastsexual behaviors. co-researchers. The twoco-researchers whowere abletodescribetheirembodiedexperience notably, theirabilitytodescribeembodiedexperiencewasabsent inallbuttwoofthe commitment challenges,and the relinquishing ofpersonalagency oftheirsexuality. Most findings reveal patternsofinternalandexternaldissociation, shamethatbecomesanger, using NVivo 10 software andthevan KaamMethod, modified by Moustakas (1994). The sexual encounters. The texturaldataderived from theco-researchers’ words were analyzed common datingbehavior, theco-researchers expressed shameanddistress becauseoftheir 1981) Althoughmostofthesexualencounterswere non-paraphilicandmightbeviewed as usingopen-endedquestionsandaFocusingwomen were interviewed exercise (Gendlin, compulsive sexualbehaviorsasanembodied experience ofheterosexual women.Eight This doctoralresearch studyusedaphenomenologicalqualitative approach toexplore study onhow we choosewhatwe eat. Full documentavailable atwww.elizabethlutz.com. potential fortheuseofintegrative assessmentinhealthcare, phenomenological andfurther directions research forfurther inintegrative medicine,hermeneuticsofattachmenttheory, assessment andtreatment ofcommonclinicalpresentations ofanxietyandstress disorders, groupsubscales from (N=504).Included theMAIAinparticipant are implicationsfor Attachment stylesubscalesfrom theECR-Rwere foundtocorrelate tobodyawareness were correlated withtheattachmentstyle(ECR-R)andbodyawareness (MAIA)subscales. regulation activities,andstress-related diseasesbasedonanxietyreported by participants the KaiserAdverse ChildhoodExperiences (ACE) study(Felitti etal.,1998).Stressors, stress- of Interoceptive Awareness (MAIA;Mehling etal.,2012),anddemographicdescriptorsfrom Close Relationships Revised (ECR-R;Fraley etal.,2000),theMultidimensional Assessment examinedcorrelationsdissertation between anxietysubscalesmeasured by the Experiences in (AIC),withinthebiologicaltemplateformedduringearlyattachment. cingulate cortex This correlates ofthesebehaviors.Somatic informationisencoded synergisticallyintheanterior pain management, obesity, exercise and eating, and other anxiety disorders focuses on neural Multidisciplinaryand clinicalefforts. literature inaffective neuroscience, psychobiology, Attachment styleandbodyawareness are anincreasing focusofinterpersonalbiologyresearch DISSERTATION ANDMASTERS’THESESABSTRACTS from Somatic Psychology andotherGraduate Programs A Phenomenological Exploration ofCompulsive Sexual Behaviors THE CHICAGO SCHOOLOFPROFESSIONAL PSYCHOLOGY Quantitative Correlations between Attachment Styles (ECR-R) Dissertation andMasters’ ThesesAbstracts as anEmbodied Experience ofHeterosexual Women Elizabeth Juliet-Lyle Lutz, 2014 DISSERTATION ABSTRACTS and Body Awarenessand Body (MAIA) Giselle Teller-Holt,2014 Is Your Brain onBoard? of sexualshame. future research intotheinterconnectedness ofone’s abilitytobeembodiedandtheabsence impactsthedevelopment offemalesexuality.attachment history The researcher encourages adult brought into the house by their mother or stepfather. the literatureThis supports that or physicallyabsent;theywere sexuallyabusedby theirstep-father/step-brother/other male did notfeelsafewiththeirfathers/stepfathers;biologicalfatherswere emotionallyand/ All eight co-researchers came from a dysfunctional family-of-origin system, such as: they future direction are offered. were mostatriskofharmwithsuchtechnologies(p<.001).Adiscussionandconsiderations for (p<.001) andratedriskstoclientanonymityconfidentialityastheaspectsoftherapythat more likelytobehelpfulinthetherapeuticprocess thanothermeansofremote communication individual orgroup clients.Dance/Movement therapistsratedthetelephone assignificantly differences were notdiscovered intheuseofremote communicationtechnologiesbetween were more likelytoengagethetherapeuticprocess over thephone(p<.001).Significant communication withclientsthanothertechnologies(p<.001).More experienced therapists demonstratedthatthetelephonewasusedsignificantlymore oftenfor this survey remote of theAmericanDance/Movement Therapy Association(ADTA). Information gathered from within theDance/Movement community,Therapy (DMT) wasdistributedtomembers asurvey Hedges, &Prochaska, 2002).In toidentifycurrent aneffort trends regarding thesetechnologies phenomenon within the counselingfield andis predicted to risein thecoming years (Norcross, The useofRemote Communicationtechnologiesinfacilitatingtherapyhasbeenanemerging on audience. impactanalyzing data, thecreation andthedissectionofperformance oftheperformance, of theresearch process. inthe process ofgatheringandThis studyincludeditsparticipants employs who are community membersasactive participants involved inmost, ifnotall, the useofresearch asamethodforimproving communitystructures from theinsideand gather and analyze data. Although it is not without flaws and limitations, CBPR facilitates (CBPR)was thequalitative methodusedtoCommunity-based-participatory-research third wave feminism,demonstratinganeraof“girl power,” choice,andgenderequality. Resultsthemes, andembodythelived experiencesofthe participants. echothetenetsof the twenty-first century?” The author used dance and movement to generate ideas, explore doesitmeantobeagirlinschool, tocreate centered aperformance onthequestion,“What This studyworked atanurbanmiddle withagroup ofadolescents-assigned-female-at-birth The Dance ofCultural Identity: The Use ofDance/Movement Therapy toExplore Race andGender withaGroupRace ofAdolescents-Assigned-Female-at-Birth Remote Communication Technologies inDance/movement Therapy: Survey Results of Therapist Uses andPerceptions MASTERS THESES ABSTRACTS MASTERS THESES NAROPA UNIVERSITY Etalia Thomas, 2013 Etalia Thomas, Marcel Zobel, 2013 DISSERTATION ANDMASTERS’ THESES ABSTRACTS 97 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS DISSERTATION AND MASTERS’ THESES ABSTRACTS DISSERTATION AND MASTERS’ THESES ABSTRACTS

Implicit Bias and Body Psychotherapy: of early attachment relationships, can result in symptoms of dissociation commonly seen Cultural Competence from a Body-Centered Perspective in dissociative disorders, personality disorders, and post-traumatic stress disorders. This Manuel Gomez, 2013 theoretical article proposes an application of dance/movement therapy as facilitative of right A body-centered perspective is proposed to enhance the three aptitudes of knowledge, brain integration in adult clients who present with trauma-related dissociative symptoms. awareness, and skills, expected of culturally competent psychotherapists. Information and Findings from trauma psychology, neuroscience, and dance/movement therapy literature strategies are provided to support counselors in the process of assessing, identifying, and are used to create an attachment-oriented theoretical foundation for how dance/movement reflecting on their own implicit biases; expanding the counselor’s capacity to become aware therapy might support the integration of dissociated somatic, emotional and psychological of their implicit biases; and developing body- oriented interventions to counteract the experiences. A model for case-conceptualization and treatment planning is proposed according expression of implicit bias when interacting with clients targets of bias. to a phase-oriented trauma treatment framework, with interventions accompanying the three phases of safety and stabilization, integration of traumatic memory, and development of Therapist Qualities, Interventions, and Perceived Outcomes: the relational self. In particular, dance/movement therapy interventions such as body-to- Bringing Developmental Movement into Body Psychotherapy body attunement, kinesthetic mirroring, interactive regulation, self-awareness, symbolism THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

Becky Snell, 2013 and expression, and interactional movement are examined as applications that may support The past decade in the field of psychology has seen an increasing awareness of the connection bottom-up integration and resolution of psychological trauma. Theoretical limitations and between mind and body in psychotherapy. Working directly with the body, utilizing suggestions for future research are also discussed. Developmental Movement in particular, has had success with children, some developmentally challenged, in reading, balance, and coordination (Goddard Blythe, 2005). Previous research has been done with children utilizing Developmental Movement, and has shown a decrease of undesirable behaviors related to Attention Deficit Hyperactivity Disorder (Patterson, 2010). JOHN F. KENNEDY UNIVERSITY However, research on utilizing Developmental Movement with adult clients is lacking. In MASTERS THESES ABSTRACTS response, this research study was conducted to assess how Developmental Movement can be used with adult clients in individual psychotherapy. This research presents a qualitative Reclaiming Your Inner Dance: interview study that seeks to answer this question and take a step in filling this gap in the Body Dance/movement Therapy for Sexual Trauma Survivors Abroad Psychotherapy literature. Five therapists utilizing Developmental Movement in individual Musenge Luchembe Hayslett, 2014 therapy sessions with adult clients were interviewed. Results of this study indicate that there The objective of this Professional Integrative Paper is to utilize the contributions of Dance/ are themes consistent among the interviewees regarding the qualities that a therapist needs movement Therapy (DMT) pioneers in order to illustrate that DMT is an effective therapeutic to have to facilitate a session utilizing Developmental Movement, the types of interventions technique for survivors of sexual trauma that can be applied to immigrants and refugees in the used, and the perceived outcomes of utilizing Developmental Movement with adult clients. United States as well as abroad in their native countries. Part One explores therapy techniques developed to treat clients with varying levels of functioning, struggling with intrapersonal and Reparative Dances: interpersonal relationships due to symptoms from psychosis, PTSD, or stressors produced

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL Applying Daniel Stern’s Forms of Vitality to the Dance Movement Therapy Dyad from living in a highly mechanized society. Part Two includes the clinical applications of these JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL Hillary E. Sinn, 2013 methods with three young women as they begin their three month long residential treatment “Vitality forms,” a concept introduced by Daniel Stern to describe the total felt experience program for trauma survivors in Zambia. Part Three covers the writer’s personal experience of dynamic qualities within the body and between bodies in relationship, is offered as a with DMT for sexual trauma. The discussion also describes areas for additional research and theoretical framework to the therapeutic dyad of dance/movement therapy (DMT). Although implications for future research. DMT has its roots in body-based attunement and has a long history of responding to and tracking dynamics in relationship, the field has not explicitly framed the work in this way. An Improved Public School Life This article proposes that dance/movement therapy is a clinical application of Stern’s concept, Jill A. Sweeney, 2014 and explores the possible benefits of invoking the concept of “vitality” in communicating the The public school system is failing our country, and some of the things that can be enhanced work. A case vignette is offered to illustrate the presence of vitality forms within the context upon are an improved curriculum and a holistic look at the students in classrooms. The of a DMT session. discussion explores alternative methods from the perspectives of transpersonal psychotherapy and humanistic theories. A clinical perspective explains how a psychotherapist in each classroom The Integrative Power of Dance Movement Therapy: Implications for the Treatment of could aid the teachers and help to improve behavioral and emotional issues for students. Dissociation and Developmental Trauma Bridging home and school life together with psychotherapy will positively impact racial issues, Laura Pierce, 2013 poverty, and high incarceration rates due to the existing school system. An improved public Chronic and compounding exposure to traumatic events, especially within the context school system will promote a positive academic experience, healthy relationships, better mental

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health, increased self-esteem, and offer resources to prepare students to enter the world as self- They want to do everything right, to progress, thereby becoming victims of high expectations, sufficient adults. reducing their body consciousness, worsening their symptoms, and hampering the development of a therapeutic relationship. This is where a touch (contact) intervention becomes a valuable A Holistic View on PTSD complement: clients do not have to achieve anything beyond observing and – to the extent of Noelle Morra, 2014 their possibilities – communicating. Expectations are reduced and the therapeutic relationship The Veterans Administration has addressed a large spectrum of challenges that the mental begins to take hold as effect (power) factor. However, especially in the touch intervention, the health profession are up against when treating PTSD. A considerable amount of time, effort line between “not having to talk” and “not being able to talk” seems quite thin. The former and resources are contributed to Veterans in the hope that lives will be improved for those occurs when the body relaxes moderately. The latter happens in conjunction with a sudden who have served our country honorably. It is vital to understand how and to what extent increase or decline in tonus or with vague bodily perceptions, thoughts, and fantasies. stress contributes to mental dysfunction in terms of its chemistry, its stages, and its origins. It This is dissociation. Those affected often do not realize that they are dissociating, even though is also vital to have a strong understanding of the introduction of stress education and stress their lives, relationships (including their relationship with their own bodies), and bonding interventions, as they should be a critical component during the counseling process because of capacity are compromised. In this thesis, the author reviews the manifestations and possible THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

both the emotional and chemical imbalance it generates in the brain and body. In addition, by neurological and psychogenic origins of dissociation. In particular, it looks at dissociation addressing the various aspects of prolonged exposure therapy that need improvement, with the as a consequence of early trauma during the pre-speech development phase and reaches necessary focus on improvement of cardiovascular health and improvement of basic life skills in conclusions for the therapy of dissociative adults. It presents the AKPT concept of extended PTSD patients, the advancement will significantly increase the quality of the recovery of long- countertransference and shows how it can be applied to work with dissociative clients. In term health for veterans. search of forms of communication promoting contact, it proposes a model of communication appropriate for development, and examines the possibilities and limitations of the touch The Use of Ritual for Practitioners of Hospital Psychotherapy intervention. A case study illustrates the application of the concepts and models presented. Camille Campbell, 2014 This paper explores the psychotherapist’s use of personal ritual as a powerful tool to increase clinical effectiveness with patients seen in hospital settings. The author suggests that REIDMAN INTERNATIONAL COLLEGE FOR COMPLEMENTARY MEDICINE understanding the therapy relationship neurobiologically can aid therapists in understanding ISRAEL their own mental integration and in creating effective rituals for self-care. This idea is examined The language of crying in body psychotherapy from a theoretical, personal, and clinical perspective. The author provides a pragmatic definition Liron Lipkies, 2014 of personal ritual and presents a theoretical foundation drawn from interpersonal neurobiology Everybody cries. From the moment we emerge into this world, and throughout our lives as and sensorimotor psychotherapy. The personal section delves into the author’s yoga and adults, we cry in different situations and under various conditions. The reasons why a person meditation practices and explores their connection to the ideas raised in the theoretical section. chooses to cry or not to cry, the type of crying, the purpose of crying, its impact on the other Finally, the clinical implications of these ideas are explored in three case studies. The author’s person and the accompanied sensations, all these kept theoreticians and clinicians interested stated goal is to leave the reader with a working definition of ritual and an idea of how to create and curious for hundreds of years, from Darwin in 1872 to contemporary research conducted

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL one and implement it into his or her clinical work. in the last few years (Kottler & Montgomery, 2001; Vingerhoets, Cornelius, Van Heck & JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL Becht, 2000). However, since crying is structured as an adaptive behaviour which harnesses the other person to help (particularly during infancy when the baby uses crying as a language through which it asks of its primary attachment figure to provide it with its basic needs that EUROPEAN ASSOCIATION FOR BODY PSYCHOTHERAPY the baby cannot provide for itself) (Nelson, 1998), I have chosen to examine crying primarily 2014 STUDENT RESEARCH AWARDS as a language within relationships, while relying on attachment theory (Bowlby, 1951, 1965). This study offers two vignettes to demonstrate two different types of crying. The first INSTITUT FÜR ATEM & KÖRPERPSYCHOTHERAPIE vignette describes chaotic crying which expresses a primal language characteristic of early SWITZERLAND infancy. The second vignette presents an organised crying which is accompanied by verbal „Ich geh dann mal weg.“ Kommunikation bei dissoziativen Phänomenen in der AKPT explanations attempting to clarify the cause, which is indicative of later developmental stages “I’m going away” Communication in Dissociative Phenomena in Breath where crying can also be interpreted as manipulative (Zeifman, 2001). Here, I emphasise the and Body Psychotherapy importance of non-judgmental examination of the subsymbolic communication therein. The Mona Gollwitzer, 2014 therapeutic work in this situation involves an appropriate and non-shaming conversation Many clients have experienced behavioral therapy, psychoanalysis, or other verbal psychotherapy. also taking into account the subsymbolic aspects of the communication (talking with the They do not (or no longer, or only up to a point) believe in the effects of verbal therapy. body in its own language), as well as validating the symbolic-verbal messages. The important However, at the beginning they are very quickly overwhelmed by breathing and body exercises. point raised here concerns the issue that when a client cries, the crying in itself is already

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a subsymbolic communication, and therefore behind the words there will also be another EABP Science and Research Symposium emotional experience which is likely to manifest in resonance or as countertransference. at the 14th European and 10th International Congress ECOLE BIODYNAMIQUE, FRANCE of Body Psychotherapy: LACAN BIODYNAMIQUE un Autre regard sur les psychoses The Body in Relationship: Self—Other—Society Towards a biodynamic psychosis treatment Grégoire Rodembourg, 2014 Nancy Eichhorn, PhD Monitoring psychotic patients either in institutions or in private practices requires the adoption, and the support of, a particular transfer modality. Studying the works of both The second EABP Science and Research Symposium provided a forum to discuss recent Freud and Lacan on this subject has brought to my attention a number of points in common research, networking opportunities, and publishing options for body psychotherapists and between the psychoanalytic treatment of psychosis and Gerda Boyesen’s biodynamic researchers. The framework, formed during the Australian Congress four years ago, initiated approach. After having isolated the specific transfer modalities of the psychotic structure, the first symposium held at the 2012 Cambridge Congress. The Lisbon symposium stimulated THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

we look at the different possible treatments. The focus will mainly be on the dynamics of the necessary conversation and collaboration to advance research in body psychotherapy and accompaniment and on the position of the caseworker. By opting for a presence which its clinical application. The 90-minute symposium comprised three segments: current research is drained of all personal will in regards to the individual, the therapist can facilitate the studies dealing with isolation, loneliness, and chronic depression; the EABP collaborative insurgence of new possibilities of being and self realisation; more creative, more respectful practice research network and writing clinical case studies; and updates in the field. of the patient’s vital force and personal dynamics. Clinical studies show how this attitude A Closer Look at Extreme Loneliness: Theory, Effects, and Possible Treatments allows the psychotic individual to have a different type of social relationship with the other, Extreme loneliness was defined as a distressing feeling in conjunction with the perception significantly reducing the need to resort to a sacrificial act as a healing attempt. Finally that the quality of one’s social relationships is lacking—it is not the same as social isolation. It we will compare the psychoanalytic and biodynamic approaches pointing out similarities was noted that 15% to 30% of people living in the United States of America live with extreme pertaining to the position of the therapist in the relationship, the fitting out of the work loneliness and that related health issues run the gamut from physical concerns such as heart schedule and the interest for the patient’s own dynamics. disease, sleep loss, and increased mortality to mental/emotional concerns such as depression, anxiety, and diminished self-esteem. Treatment approaches need to target enhanced social skills, social support, and social opportunity. According to body psychotherapist Maurizio Stupiggia, Vice President, Italian Association for Body Psychotherapy, people living with extreme loneliness have lost their connection to their body and therapists need to use the body in a special way to bring about recovery. EABP Collaborative Practice Research Network and New Research Perspectives Body psychotherapists/researchers/writers discussed means to gather data, connect with training institutions to create an effective research structure, and support research while

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL maintaining a clinical practice. Michael Heller, PhD, author of Body Psychotherapy: History, JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL Concepts and Methods, said that networking was necessary in order to ascertain who is working with body psychotherapy practices around certain pathologies (i.e., anxiety, depression) and to promote the use of body psychotherapy practices within the general clinical world. Discussions occurring on LinkedIn, i.e., Somatic Perspectives on Psychotherapy were mentioned as ways to network. Lidy Evertsen, EABP president, suggested inviting EABP members to share their written cases with a network of colleagues for response and reminding authors to reference their own theoretical background in case study presentations. The reality that many clinicians are not trained in nor interested in conducting research was explored. Options to resolve this issue included creating a new agenda for research and supporting therapists to connect with researchers. Jennifer Tantia, USABP Research Committee chair, supported the idea of collaboration suggesting that if practitioners are going to contact researchers, they need to learn how to speak the language of research, and read their studies before contacting them to propose a potential liaison. Jill van der Aa, EABP General Secretary and Vice-President, reminded the audience that EABP policy has always been to connect professionals and enable collaboration.

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Efficacy study: An exploratory randomized controlled trial of body psychotherapy the untrained, were honored during this session as presenters and audience members alike for patients with chronic depression exuded a trust and a knowing. The organization worked well with a different moderator According to Frank Röhricht, MD, FRCPsych, “We [body psychotherapists] are making representing each segment and different presenters offering their piece yet all remained ground when we are accepted in medical journals.” His current research study, “An exploratory on stage and contributed throughout. The overarching theme of loneliness (and isolation randomized controlled trial of body psychotherapy for patients with chronic depression”, provided a focal point for presentations creating continuity as well. I appreciated the audience involving patients with chronic major depressive disorder and dysthymia, was published in the participation and the respectful tones as ideas were offered without challenge or criticism; Journal of Affective Disorders, 155(1), 2013. In this study, Röhricht, Papadopoulos, and Priebe it was an open forum with space for everyone’s voice. And when one panel member did conducted a meta-analysis of the literature on major depressive disorder and a randomized, challenge another regarding his stance on body psychotherapy versus dance and movement mixed-method clinical trial utilizing a manualized body psychotherapy model in a group therapy, the moderator handled the tension with a compassionate and honest response: yes, therapy setting. Eight participants received 20 intervention sessions (90 minutes each) for this is important but not right now. The controversy was set aside to be discussed at another 10 weeks. Outcome data showed a significant reduction in the treatment group: improved time. breathing patterns, improved mood, less pain, shifts in physical posture and gait. The next step I have never attended a science and research symposium so I came with no preconceptions. THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

is to obtain grant funding for a larger study. I left with information to join the collaborative, access to a template to write an academic case The case study approach: An open invitation to case study research study, concepts addressing quality research, and new contacts for networking. Considering Shelia Butler, EABP collaborative practice research network organizer, engaged the the ramifications of all the topics offered, more time and perhaps pull-out groups might have audience in an experiential exploration of case studies. She shared pictures of an unkempt man been considered. The first annual symposium (2012) was a daylong event held Post-Congress whose 20-year residence, noted as his ‘island’, was a cardboard box. He came to therapy of in Cambridge. Perhaps the third annual symposium can also be a daylong event within the his own free will. She asked the audience to consider how they would approach a therapeutic parameters of the actual Congress so more participants can attend. relationship. Responses varied from “I would assume it would be difficult to reach him through The third annual science and research symposium will be given at the next EABP Congress interactions,” to “I wouldn’t assume our work would take place in my office. I would join him in Athens, Greece, 13-16th October 2016. some place under a tree, meet on his ground.” Butler used the experience to invite therapists to write case studies based on clients who REFERENCES stand out, whose story is uniquely their own. Therapists, she said, can explain and/or advance Heller, M. C. (2012). Body psychotherapy: History, concepts, methods. New York: W. W. Norton & Company. methodology by understanding and writing about the complexity of the therapeutic encounter. Röhricht, F., Papadopoulos, N., Priebe, S. (2013). An exploratory randomized controlled Butler then discussed different types of case studies and the need to develop a framework for trial of body psychotherapy for patients with chronic depression involved patients with writing about them. Courtenay Young added that a ‘how-to’ article for case study writing is chronic major depressive disorder and dysthymia. Journal of Affective Disorders, 155(1). available on the EABP website. Training and Research opportunities The Wilhelm Reich Foundation was briefly described; the foundation funds research studies designed to inform the world about body psychotherapy work. Those interested can

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL contact Joop Valstar from the EABP. JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL Herbert Grassmann, Chair EABP Science and Research Committee, and Stefan Bischof, EABP Forum Executive Committee, addressed critical thinking skills in training programs, generating a student thesis data base, ways to improve research quality, and academic writing in the body psychotherapy field. Jennifer Tantia overviewed the science and research situation in the US. According to Tantia, five graduate programs exist offering body psychotherapy degrees: three at the master’s level and two at the doctorate. As a research advisor to several student doctoral students, Tantia shared that students investigate body psychotherapy topics, but their dissertations are based in fields adjunct to body psychotherapy, i.e. social work, physical education, sociology, etc. Her current goal is to implement alliances between psychotherapists and researchers resulting in collaborative research for body psychotherapists.

Closure The room pulsated as ideas floated from the stage out to the audience and returned with additions, modifications. Science and research, potentially fearful topics for the uninitiated,

104 105 WRITING ABOUT BODY PSYCHOTHERAPY Squaring the Circle: Bridging the Gap Between Research and Practice An invitation to write for us, with us, with support along the way. Your writing can contribute to and About the EABP Collaborative Practice Research Network (CPRN) enrich the ‘body’ of critical and reflective content, as well as to the clinical expertise, in the ‘field’ of body psychotherapy. The awareness of the importance of fostering different models of research, particularly those linked more closely to the actual practice of body psychotherapy and those Whom can you write for? encouraging a two-way communication between researchers and practitioners, has led to the We suggest that – for a professional article – you consider: creation of the EABP Collaborative Practice Research Network. This is an exciting new initiative to provide a forum for dialogue, debate and the The EABP/USABP peer-reviewed International Body Psychotherapy Journal (for original work only): development of innovative and creative research methods and projects that assist clinical www.ibpj.org practice and help body psychotherapy (and/or somatic psychology) to develop an empirical The peer-reviewed journal of Body, Movement and Dance in Psychotherapy (for original work only): underpinning of its professional practice. www.tandfonline.com/toc/ tbmd20/current#.VBfpFS6wJRU The aim is to broaden knowledge of the field of body psychotherapy through Or: (for German language authors) körper – tanz – bewegung: Zeitschrift für Körperpsychotherapie communities of practice and clinical research. It explores how a CPRN can transform perceptions of psychotherapy research and practice, strengthen connections between THE ART AND SCIENCE OF SOMATIC PRAXIS THE ART AND SCIENCE OF SOMATIC PRAXIS

und Kreativtherapie: www.reinhardt-verlag.de/de/zeitschrift/51830 members, and encourage continuous development and co-creation among participants. This (You will find the necessary “instructions for authors” on their various websites.) important initiative is an opportunity to make a significant difference within our profession Or: for something a bit more conversational: Somatic Psychotherapy Today: and to develop – together – the foundations of both scientific and clinical practice research. https://www.SomaticPsychotherapyToday.com Specifically, we are planning to explore and develop, at local and international levels, Or: Something for a newsletter of your particular professional association, modality association, or a variety of strategies to support practitioners’ research and look at what types of research national association in psychotherapy; potentially provide a broadening of our understanding and practice of psychotherapy, Or: A comment or a thread in one of the Somatic Perspectives LinkedIn group discussions, facilitated and how various types of research advance, improve and extend our knowledge of body by Serge Prengel: www.linkedin.somaticperspectives.com psychotherapy. We will do this by bringing together practitioners and researchers from Or: Possibly, a chapter for an edited book, on a particular theme, possibly like one of the series being around the world, both online and face-to-face, to discuss ways of bridging the gap between published by Body Psychotherapy Publications (BPP): clinical practice and research. www.bodypsychotherapypublications.com. The committee has organized two symposiums in conjunction with the 2012 and 2014 Or: Something to be published somewhere else, at some other time, in a different medium; or for a EABP Congresses. The next symposium will be held during the 15th European Congress of personal internet blog; or . . . maybe just for your personal journal. Body Psychotherapy in Athens Greece, 13-16th October 2016. We would like to invite you to join us and become part of this exciting and innovative What can you write about? initiative. If you are interested please contact Sheila Butler and Herbert Grassmann - cprn@ You can write about attending a recent Congress, or seminar, or about attending a different event; eabp.org - or about your student thesis; - or your experience of writing your student thesis; - or a special or EABP Science and Research Committee - Sheila Butler, Herbert Grassmann particularly interesting case history; - or an aspect of your personal therapy; - or about working with a (chairperson), Frank Röhricht, Maurizio Stupiggia, Joop Valstar, Courtenay Young and particular client group; - or about a development of theory or practice; or - even about your reflections Jennifer Tantia www.eabp.org/research-scientific- committee.php on the field of Body Psychotherapy. Strengthening links between practitioners and researchers at every stage of the process

INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL How to get started writing professionally? JOURNAL PSYCHOTHERAPY BODY INTERNATIONAL There is an article in the journal of Body, Movement & Dance in Psychotherapy www.tandfonline.com/ News: doi/ full/10.1080/17432979.2010.530060#.VBfsNC6wJRU (You can also find a free copy here.) The Society for Psychotherapy Research (SPR), an association devoted to the development And there are some recent guidelines about how to write a professional Body Psychotherapy Case and dissemination of research on psychotherapy has some exciting upcoming SPR events: Study: www.eabp.org/researchcase-study-guidelines.php. There are also many articles on the Internet (in • The International Annual Meeting in Philadelphia, USA in June 2015 from 24th different languages) about how to write. to 27th June. If you want any further assistance with where to publish, or with the process of editing, or re-editing, or • The European Conference on Psychotherapy Research in Klagenfurt, Austria, with the complications of the publication process, the following people may be able to offer you some help. September 24th to 27th, 2015, and the planned 2016 International Meeting in They are all professional body psychotherapists, editors and writers: Jerusalem, Israel in June 2016. Nancy Eichhorn: [email protected] You might also like to browse the Psychotherapy Research Journal pages, especially the Jacqueline Carleton: [email protected] Special Issues and the online resources; there is a lot of information on the integration Gill Westland: [email protected] of theoretical, empirical and clinical knowledge in psychotherapy. See http://www. Jennifer Tantia: [email protected] psychotherapyresearch.org Courtenay Young: [email protected]

Sincerely, EABP Publications Committee http://www.eabp.org/publications.php

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108 109 110 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL THE ART AND SCIENCE OF SOMATIC PRAXIS theory andpractice. theory exchangeinterdisciplinary withrelated fieldsofclinical field ofbodypsychotherapy as well astoencouragean the exchange ofideas, scholarshipandresearch withinthe The Journal’s promote andstimulate missionistosupport, Criteria for Acceptance [email protected] formore information. our members.Please contactJill van derAa conferences, trainingprograms, etc.ofpossibleinterest to The IBPJJournal forbooks, acceptsadvertisements Advertising Information Journal. received willbepublishedinthenextvolume ofthe and requests foradditionalfeatures. Aselectionofthose already publishedinthejournal,butalsosuggestions communications commentingonanddebatingworks The editorsare eagertoreceive letters,particularly Letters to the Editor standards forcitation.(CitationSimplifier.) Copyright We generally follow American Psychological Association attribution shouldbe includedinthereferences atthe end. author’s surname,publication dateandpagenumber. Full References: address, acknowledgment ofresearch etc. support, author’s degrees, institutionalaffiliations,training,e-mail biography (100words). The biographyshouldinclude the (±100-350 words), keywords (3-5),text,references, Order ofinformation: Title, fullauthorship, abstract must befree ofotherformatting. page numbers.Paragraph indent.5cm. The manuscript one-inch (25mm)marginonallfoursides.Please include Manuscript shouldbesingle-spacedin10pt.type,witha of theAmericanPsychological Association. Please consultthelatesteditionofPublication Manual Formatting: Submission: For submissiondetailsseewww.ibpj.org Authors’ Guidelines • • • • • following questions inmind: Our Editor andreviewers willread withthe eacharticle published orsubmittedforpublicationelsewhere. oftheauthorthatithasnotbeen onthepart certification to the analyses andliterature reviews. Submission ofanarticle data, casestudies,aswell ascomparative andsecondary theory, qualitative andquantitative research, experiential First oforiginal considerationwillbegiven toarticles something other than it purports tobe? something otherthanitpurports submitted presents such,istheanalysisforced orisit controlled studiesandstatistics, ifthemanuscript the fieldtocreate perspective? anew our bodyofknowledge? andhowinterventions theywork, outcomesthataddto i.e., background information, descriptionofprescribed hold onto? some uniquenuggetorgemthereader canstore awayor and addtothebodyofknowledge? Given thatthefielddoesnoteasilylenditselfto If thisisareflective piece,doesittie togetherelementsin If itisacasestudy, isthere abalanceamongtheelements, If itisadescriptionofwhatwe already know, isthere How doesmaterialinthismanuscriptinformthefield International BodyPsychotherapy Journal References withinthetextshouldinclude

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RESEARCH ISSUE Guest Editor: Jennifer F. Tantia, PhD, BC-DMT

TABLE OF CONTENTS

04 INTRODUCTION Jacqueline A. Carleton, PhD

SO MEASURE IT Marcel DuClos

06 EDITORIAL Jennifer F. Tantia, PhD, BC-DMT

08 AURORA Cover Image Aline LaPierre, PhD

ARTICLES

10 Reading and Evaluating Quantitative Research in Body Psychotherapy Robyn Flaum Cruz, PhD & Sabine C. Koch, PhD

20 Biodynamic Psychotherapy for Trauma Recovery: A Pilot Study Denise Saint Arnault, PhD & Sharon O’Halloran

35 Correlations Between Tests for Grounding, Breathing and Self-efficacy in Individuals With and Without Chronic Pain: Who is “Standing with Both Feet on the Ground?” Christina Bader-Johansson, M.Sc. & Amanda Lundvik Gyllensten, Med.Dr, RCPT

48 Semantic Expressions of the Body Boundary Personality in Person-centred Psychotherapy Laura A. Cariola, PhD

65 Interoception: A Measure of Embodiment or Attention? Nitasha Buldeo, MS, MSc

80 Grasping and Transforming the Embodied Experience of Oppression Rae Johnson, PhD, RSW, RSMT

STUDENT RESEARCH SECTION

96 United States Masters’ and Doctoral dissertation abstracts Abstracts of the three winning papers of the EABP Student Research Award

CONFERENCE REVIEW

103 EABP Science and Research Symposium at the 14th European and 10th International Congress of Body Psychotherapy: The Body in Relationship: Self—Other—Society Nancy Eichhorn, PhD

Journal (ISSN 2169-4745)