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9 Body-Centred Psychotherapy (BCP)

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9 Body-Centred Psychotherapy (BCP) Rachel Sabin-Farrell & Roger Bretherton 9 Body-Centred Psychotherapy (BCP) Body-Centred Psychotherapy (BCP) takes as its starting point the principle that all psychological experiences, pleasant and unpleasant, are embodied experiences (Keleman, 1981). As philosophers are keen to remind us, we do not just have bodies, we are bodies (Marcel, 1964). The world around us from conception onwards affects and leaves its mark upon the body; a point increasingly emphasised in developmental interpersonal neurobiology (Siegel, 2010) and developmental psychology (Gerhardt, 2006). For this reason, BCP asserts that the body deserves great attention in clinical practice. Recognising the importance of the body is not unique to BCP however. Therapies from the cognitive-behavioural tradition, for example, stress awareness of physiologi- cal phenomena and include bodily awareness in their formulations (e.g., Padesky & Greenberger, 1995). Eye Movement Desensitisation and Reprocessing (EMDR) con- siders physical sensations a central part of the trauma treatment protocol (Shapiro, 2001). The humanistic school of psychotherapy equally pays great attention to the body. Gendlin, a philosopher working alongside Carl Rogers, developed ‘focussing’, a technique by which an embodied felt-sense expresses itself in language (Gendlin, 2003). Likewise, several of the therapeutic experiments designed by Frederick Perls aim to foster awareness of habitual gestures and bodily responses (Kepner, 1987). Similarly, psychodynamic approaches demonstrate interest in bodily experience, and the muscular tensions and somatic symptoms habitually reported by analytic patients (Reich, 1980; Young, 2006). Some psychodynamic practitioners have even been so bold as to state that the body is the unconscious (Lowen, 1975). Contempo- rary BCP draws upon, or incorporates, many approaches, but in recent decades it has undergone considerable theoretical development. Carroll (2003) suggests that there is a ‘cultural and paradigm shift’ towards recognising the embodiment of psychological processes and therefore the importance of the role of the body in therapy. Research on psychological trauma (e.g., van der Kolk, 1996, 2014) and the neuropsychological literature with links to attachment theory (Schore, 2003; Solomon & Siegel, 2003), has further driven BCP to gather a repertoire of therapeutic techniques, many of which are outlined below. BCP is therefore most accurately viewed as a cluster of psychotherapies rather than a single approach (Totton, 2003) and can be usefully grouped into three discern- ible models: the adjustment model, which views the correct aligning of the body as a way to psychological health; the trauma model, which holds therapy to be a process of abreaction or emotional expression in which past trauma is released from being trapped in the body; and the process model, which aims to sensitively facilitate the healing or psychological growth process latent in the body. Each of these models has Empirical Evidence 143 its advantages and drawbacks, but many contemporary systems of Body Psychother- apy are a synthesis of these approaches. The term BCP in this chapter is therefore used to denote an approach which is a synthesis of these three models and is derived from, but not confined to, that elabo- rated by Ron Kurtz (1990), often called Hakomi (a Native American term paraphrased as ‘to be well in all one’s worlds’). We draw to some extent on the historical BCP litera- ture of Character Analysis (Reich, 1980) and Bioenergetics (Lowen, 1975). We incorpo- rate more recent contributions to the BCP literature from Character Styles (Johnson, 1994), Trauma Therapy (Levine, 1997; Rothschild, 2000), Attachment (Schore, 2003), Focussing (Campbell & McMahon, 1997; Friedman, 2007), and Executive Development (Cotter, 1996). We also anticipate further developments in the pioneering work of The Sensorimotor Psychotherapy Institute (www.sensorimotorpsychotherapy.org), only some of which have yet found their way into the public domain in the form of articles and book-length monographs. But in using the term Body-Centred Psychotherapy we are primarily drawing on the approach outlined by Kurtz, with some notable addi- tions from the other models. One of the unique theoretical contributions of the BCP approach is the notion of ‘character strategy’, a set of short-hand characterisations that aid the therapist to quickly understand the habitual ways in which their client relates to the world. Char- acter strategies are not personality types but rather themes that can be identified in people. Any given client can present with several character strategies in operation. They do not represent a person’s identity but rather habitual patterns of relating to the world. Over the last century, various schemes of character strategies have been pro- posed in BCP (Cotter, 1996; Johnson, 1994; Lowen, 1975; Reich, 1980). In the Hakomi approach, Ron Kurtz (1990) developed a roster of eight strategies, each named func- tionally rather than pathologically. He viewed character strategy as a “strength devel- oped to the point of imbalance” which becomes “a weakness” on the basis that “every function overly developed in one direction leaves another direction undeveloped” (p. 40). Ogden added a sensitive/emotional character strategy to the eight put forward by Kurtz (Fisher & Boreham, 2014a). Understanding the character strategies, and how they influence the organisation of present moment experience, is a key part of the theory and practice of Hakomi and Sensorimotor Psychotherapy and will be utilised in the formulation below. 9.1 Empirical Evidence In terms of evidence-base, BCP as a movement has tended to eschew randomised controlled trials (RCTs) and other clinical research methods. Dinas (2012) highlighted the difficulty of constructing useful outcome measures or psychometric instruments when therapeutic changes are difficult to put into words. In addition, it is challenging to devise an RCT with a therapy that tracks the client so closely and alters technique 144 Body-Centred Psychotherapy (BCP) based on the in-session experience of the client and in-vivo experimentation. Similar problems of evaluation are reported in other therapeutic approaches that construct a bespoke treatment strategy for each client (Yalom, 2009). Nevertheless, some single-case and anecdotal evidence for BCP effectiveness has been accrued. Individual clients report the benefits of the approach (Dinas, 2012; Fisher & Ogden, 2009), as do participants in a stabilization group intervention (Langmuir, Kirsh, & Classen, 2012). In addition to this, clinicians in the trauma field endorse the theoretical necessity of focusing on the body (Lanius, Lanius, Fisher, & Ogden, 2006; Levine, 1997; van der Kolk, 1996, 2014) and have published case exam- ples (Rothschild, 2003). However, further studies on BCP are needed to establish the evidence-base for this approach. 9.2 Formulation in Action The formulation presented in this chapter therefore uses the term ‘body centred psy- chotherapy’ (BCP) to refer to Hakomi and Sensorimotor Psychotherapies. Within this approach, key factors to inform an initial formulation include: indications of past trauma (either event-based trauma or attachment-related developmental trauma), character strategy, and how present moment experience is organised, and could provide a frame to access ’core material’ for intervention. Our initial hypotheses were that Molly’s main issues were driven by charac- ter strategy developed in her early and subsequent attachments and relationships. However, there may also be traumatic roots to her difficulties. 9.2.1 Character Strategies When looking for possible character strategies, we pay attention to how they cur- rently appear and play out in relationships, work, decision making and other key areas of a person’s life. In the assessment phase, we would assess particularly how the character strategies are manifested in the body and what the current ‘felt sense’ is within the session when attention is paid to elements of the story or difficulty being described. From the case description, we will highlight certain information which may indicate certain character strategies. However, accurate identification of charac- ter strategies requires a therapist to be in contact with a patient (Glazer & Friedman, 2009), and any conclusions drawn from a written account are therefore reflective of working hypotheses. On first reading it appears that Molly exhibits what BCP would call Sensitive- Withdrawn (S/W) character strategy. She takes refuge in withdrawing from people as it feels threatening to be in contact with others. The other main character strategy evidenced in the case is named Expressive-Clinging (E/C) in the BCP nomenclature. Formulation in Action 145 This is a strategy that attempts to maintain contact with others by dramatising to sustain attention. The indications of clinginess in relationships and words such as ‘dramatic’ used by her parents to describe Molly give a clue to this strategy. While other strategies may also be present or uncovered during therapy, the initial formula- tion stresses the tension exhibited in Molly between her dominant S/W presentation and the signals of an E/C strategy. While the S/W strategy seeks to withdraw from others, the E/C strategy clings to them. They therefore represent conflicting needs in Molly and it is possible that she is pulled between the opposite desires of seeking sep- aration yet needing togetherness. This inner conflict is seen
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