Biodynamic Massage The Interface with
Psychotherapy
(This article was originally published in
The Journal of the Association of Holistic Biodynamic Massage Therapists Vol.7
Issue No.1 Winter 2003/2004 ISBN 146-3743)
Gill Westland
A version of this talk was given to the 1st International Touch Conference
and 6th Clinical Reflexology Conference at Christie Hospital, Manchester,
November 2003.
Introduction
I would like to start by saying something about how I came to be working in this
field. Originally I worked as an occupational therapist (OT) and my first job
was at the Maudsley Hospital in London, which is a psychiatric post-graduate
teaching hospital. As a newly qualified OT, it fell to me to run relaxation
groups for in-patients on the acute admissions wards. Conscientiously I taught
recognised relaxation methods, but was concerned that some patients didn't seem
to feel any better; indeed some reported feeling much worse, although they felt
that I meant well. I asked my supervisor for advice and she told me to practice
technique at home. I did this, but slicker technique didn't seem to be the
answer. I continued to run the groups and as I grew more confident I began to
listen more to patients and their own experiences and to ask them what they
thought was useful. Out of this together we began to work out a programme which
seemed to help. But I had little idea of why it did help, and why what was
useful to one, was not to another.
Then I met an OT at a conference who was training in Biodynamic Psychotherapy,
which is a form of Body Psychotherapy and she seemed to have some answers to my
unresolved questions about relaxation methods. In due course I began training to
be a psychotherapist and have been working as a body psychotherapist for the
past twenty years.
Biodynamic Massage
Today I want to focus on Biodynamic Massage and how it relates to body
psychotherapy.
Biodynamic Massage was developed by Gerda Boyesen in Norway, and then in London
from 1968 onwards. Boyesen drew inspiration from various sources. One of these
was her training with the head physiotherapist, Adel Bulow-Hansen. Bulow-Hansen's
work is now called Psychomotoric Technique and is researched at Oslo University.
Boyesen also studied psychology and was analysed by Dr Ola Raknes. Raknes was a
leading psychiatrist and analyst who was part of Wilhelm Reich's circle in the
1930's. Reich resided in Scand-
inavia before moving to the USA, where he died in 1957. He is generally regarded
as the main force behind the development of current day body psychotherapies.
Gerda Boyesen worked in Norwegian psychiatric hospitals and privately. Much of
her work has evolved empirically out of her exceptional observational abilities.
Her theories are consistent with those of Reich, but her clinical work is very
different. In England she established a training institute which taught
biodynamic psychotherapy and ran clinics for the general public. Biodynamic
psychotherapy is practised throughout Europe, Australia, New Zealand, South
America and in some parts of the USA. Nevertheless, there is comparatively
little in print about it and so it is perhaps less known than some other
therapies.
Biodynamic massage has evolved out of physiotherapy methods used in Norwegian
psychiatric hospitals, which sit relatively easily with the medical model and
mainstream science. However, in its development it has moved into the realms of
complementary therapy.
Biodynamic massage as a complementary therapy is a form of psycho-physiological
massage concerned with the integration of all levels of human experience. It
addresses physical, emotional, mental and spiritual dimensions of existence. It
emphasises and directly addresses the energetic and emotional meaning of
physical posture and bodily symptoms.
A key concept which is different from conventional medicine is the view that
there is a fundamental
connection between all beings. Reich saw this connection as a universal life
force. This life force is the glue which connects all of us in this room, with
the rest of humanity, and with the whole environment. So when we hurt another,
we are also hurting ourselves. This understanding opened the way for some forms
of body psychotherapy to embrace aspects of Eastern philosophies and psychology
in the 1960's and 1970's.
The term 'biodynamic' was used because 'bio' means life and 'dynamic' means
movements or forces. Biodynamic massage is interested principally in the
movements of life or the life force in the individual and the establishment of
natural rhythms and movements in the body.
Biodynamic Massage
and Biodynamic Psychotherapy
Biodynamic massage is both a body therapy and a method used in body
psychotherapy. It spans the territory of body therapy and body psychotherapy,
and interfaces with both complementary therapies and psychotherapy. So, whilst
existing in its own right as a body therapy, biodynamic massage has the weight
of body psychotherapy behind it. This has influenced the way that biodynamic
massage is practised.
The common ground -the philosophy
Any therapy has philosophical underpinnings and views on what humans beings are,
how they get sick and how healing occurs. These considerations will shape what
happens and influence the outcome of therapy. Weber has written on the
philosophy of touch and provided us with a three part model. She identifies the
domains of: the physical-sensory; the psychological-humanistic; and the field.
Each
domain is valid and useful at different times. The field domain can embrace the
other two. Each domain has views on what human beings are and this underscores
what is included and excluded and the discussion in each domain. Biodynamic
massage is closest to the field model.
Central to the field model is the idea of universal, interpenetrating fields of
vibrating energy, which connect all organisms at subtle levels of matter. Humans
are localised expressions of these fields, where the energy is relatively slower
and thicker. Humans function both as themselves and as an aspect of the field.
The intention and presence of the therapist in this model are significant. The
particular therapist working with this particular client makes a difference.
When the therapist touches a client, the client is reached at a level deeper
than the visible and behavioural. The actual physical touch confirms and marks
the intention of the therapist, but the client may feel as if they have been
touched before the actual physical touch. This is the potency of touch with
intent.
In daily life we can see something like this when watching parents who are
attuned to their babies or when couples like and know each other well. There is
a synchrony of rhythm, touch, vocalisation, intensity and autonomic nervous
system activity, which is like a dance in the interactions between them.
Different ways of
holding the session/presence
So what I want to emphasise is that how the therapist thinks about the process
has an impact on what happens. Moreover, the psychotherapy training and the
level of personal journeying and exploration that the psychotherapist has
undertaken has a bearing on how the therapeutic relationship unfolds.
Presence
The body psychotherapy journey is about becoming increasingly whole and a fuller
human being. This arises from 'seeing' more clearly how things are. This means
that after a time there will be less energetic restriction and more available
inner space to meet and be with another. This relatively more embodied presence
of the body psychotherapist invites more of the client to be available to
themselves and to the relationship with the therapist. There is the expectation
of the body psychotherapist that they will have the capacity to invite more of
the client into being alive than the biodynamic massage therapist coming simply
out of the therapeutic journey they have each made.
Biodynamic massage and body psychotherapy work at different levels
Biodynamic massage and body psychotherapy operate at different levels of a
spectrum of consciousness. Wilber has looked at levels of consciousness and
identified five bands in a spectrum of consciousness. Each band creates a
boundary of what belongs inside it and what is outside it. This in turn creates
the territory for potential conflicts. As individuals, we become identified with
some bands of consciousness more than others and in doing so separate ourselves
from different levels of reality.
For example, we create a separation between mind and body; thinking and feeling.
We disregard bodies and identify with the rational and intellectual. We can say
that 'we have a body'. Or we can say that 'we do bodywork1. In this thinking
there is a subtlety, which perpetuates a separation of mind and body, but it
also reveals thinking about ourselves as separate from others. It shows that
there is the belief that there is an T to 'have a body', or an T to do
'bodywork'. The person making
these sorts of statements shows an identification with what is called the
ego-mind. The ego-mind is being seen as T. From the perspective of eastern
psychology there is ultimately no T. It feels very different to talk of "being
with a client'; 'relating through touch with the client'; 'contacting and
receiving the client through touch' compared with the earlier statements which
are more about 'doing to' the client.
Wilber postulates that different sorts of therapies operate in different bands
of consciousness. He is aware that he is oversimplifying, but offers a useful
map. From this viewpoint all therapies have their relevance, but function within
different bands of the spectrum of consciousness.
Each of the 'lower levels' encapsulates and can work at the levels above, but
practitioners do not have the capacity to work below the level of consciousness
that they are trained in. However, since this is a model about human beings the
possibility of working at all of the levels is potentially available to us, but
would require further training. I also think that different people have an
affinity for particular levels and therapies.
The levels run from the ego level, where conceptualisation dominates to the
level of unity consciousness, which is central to all religions.
I would like to suggest that biodynamic massage is relatively closer to the ego
level, what Wilber calls the Centaur level. A psycho-
spiritually based body psychotherapy such as the one we practise in Cambridge
is more towards the level of unity consciousness.
Biodynamic Massage in
Theory and Practice
Theory
Boyesen has uniquely described tissue armouring within the body psychotherapy
field. She recognised that ill health seemed to be consistent with lack of
fluid movement and stagnation in the body, and health with fluid movement. She
observed that 'dry' tissues (i.e. skin, connective tissue, muscle) seemed to
lack fluid. She also noticed that sometimes parts of the body have swollen,
warmer, red tissues. This is in the absence of any infection. It is as if there
is an excess of fluid and the fluid creates internal pressure. Individuals with
this symptomology often describe themselves as feeling under pressure and
jittery. This situation is known as distension pressure.
Sometimes tissues can be swollen, but the skin colour ranges from brown to grey
or white and it is cold to the touch. This is called transudation pressure and
is tissue armouring. It is a more chronic patterning. People with depressive
illness, for example have a preponderance of transudation pressure.
Reich saw that fluid draws energy; and energy draws fluid. If there is stagnant
fluid there is impeded flow of energy and conversely, if energy flows, so does
fluid. Boyesen recognised that the 'solution' was to invite the emptying off of
excess fluids and to draw fluid into drier areas of the body. The fluids are
central to self regulation and are fundamentally involved with the inherent
wisdom to heal and connect with essential health.
Apart from tissue armouring, Gerda Boyesen 's other unique contribution is the
theory of psychoperistalsis
She noticed that when clients had tummy rumblings during sessions that there
seemed to be therapeutic benefits. She began to work with an extended
stethoscope to listen more intently to the sounds and gradually developed her
theory that the guts not only digest food, but also regulate affect. Again she
speculated that excessive fluid in the intestinal walls, the distention
pressure, stimulated the peristaltic activity. So biodynamic massage therapists
often work with an electronic stethoscope. This gives the therapist feedback and
guides the therapeutic process.
Autonomic nervous system
observations
In a biodynamic massage session autonomic nervous system reactions such as
breathing, skin reddening, shuddering, shivering, sweating and so on are
observed and used to assist the pacing of a session. This ensures that the
client is less likely to be overwhelmed by any reactions to the process.
Practice
I will now go on to make some specific points about biodynamic massage. Much of
what I say will be true for biodynamic massage irrespective of whether it is
being practised as body psychotherapy or as a complementary therapy.
The therapeutic structure
Biodynamic massage is set in a therapeutic structure of weekly sessions on the
same day and at the same time each week. Sessions are accumulative and refer
back to previous ones, so that there is a continuity. When a client wishes to
stop sessions there is a negotiated process and a period of completion. This
enables the organic unfolding of 'process' to wind down gradually and honours
the relationship between the two individuals. All of this is supported in a
broader framework of ongoing supervision, usually with a body psychotherapist.
Touch
Since we are at a touch conference I would like to talk about the touch in
biodynamic massage. Biodynamic massage has more than sixteen massage forms
within it. Each form has specific touch related to the form. These forms range
from non physical-touch, auric work; to light skin-touch energy work; to work
with connective tissues and fluids; and deep muscular work. The methods of
biodynamic massage are like the words and sentences of a language, but the way
these are put together, combined with the relational presence of the therapist,
form the conversation. The 'conversation' can be fast or slow or still; there
can be gentle pressure or firmer pressure; the finger tips might be used or the
whole hand; sometimes the fore-arms, the elbows and the front of the body can
also be used. It can be done with the client clothed or unclothed. So there can
be more or less direct skin contact.
Each session is different, and methods and style of working come out of each
unique meeting of client and therapist, and the relationship between them.
The therapist hopes to be in contactful touch with the client. When this happens
both client and therapist connect with the universal life force. There is a
meeting at an essential level. Ideally there is a congruence between the
therapist's touch, the language communications used and the presence of the
therapist.
Styles of relationship through
touch
a) There is touching
Sometimes a session can be wordless and the client may have little sense of the
differentiated touch that the therapist is using. The client may be only vaguely
aware that someone is touching them. We can describe this as 'there is
touching'. In this sort of touch relationship, the techniques being used become
a distant background. The focus is on the intrapersonal and universal.
b) I am touching you
At other times there may be contactful touch occurring, and in the foreground
there is an awareness by both therapist and client that 'I am touching you'. It
is then possible to ask questions about the touch, and the relationship between
the therapist and client. Such a question might be "How is it for me to be using
this amount of pressure on your back?" or "How is it for you that I am touching
your foot?"
A session can slip in and out of these modes and also include other levels of
interaction.
c) Connecting words with
body experience
For example, a client may be talking about concerns, whilst being massaged. The
therapist may then verbally invite a coherence between what is being talked
about and how that is being experienced in the client's body in the immediacy of
the current moment. The question might be "As you talk about your holiday, how
does it feel in your body?"
Differences between Biodynamic Massage and Biodynamic Psychotherapy
I would now like to turn more directly to the question of when biodynamic
massage becomes body psychotherapy.
In theory
The range of interventions
In biodynamic massage, there will be less variety of interventions. Generally
there will be talking, massage and sometimes exercises to ground the client. In
body psychotherapy, biodynamic massage is just one of a range of possible ways
of working.
Levels of interaction Biodynamic massage thinks in terms of energetic/emotional
levels of interaction. These levels have different energetic vibrations and
intentionally create relational atmospheres to invite different sorts of
exploration. The levels range from the 'matter of fact' to the 'deep emotional'.
The body psychotherapist is expected to be able to move up and down these
levels according to the demand of the therapy and particularly in the service of
affect regulation. In doing this the client is drawn to new ways of knowing
themselves and away from the habitual. The capacity to pace sessions and enable
an organic unfolding of the client's process is more developed in the body
psychotherapist. This is particularly relevant in work with those who have
current or
developmental trauma in their lives, where there may need to be a lot of work on
slowing down autonomic nervous system responses if the client is not to be
emotionally overwhelmed. In contrast, the biodynamic massage therapist is
expected to hold the client's process more at the 'matter of fact' level and is
not trained in the range of levels of the body psychotherapist.
In practice
The training
There are considerable training differences. The training to work as a
biodynamic massage therapist spans one to two years and involves a minimum of
150 hours face to face study. On qualifying, the work is supervised by a body
psychotherapist. There is no requirement for personal therapy.
The training to be a body psychotherapist includes the biodynamic massage
training, takes about six years and involves a minimum of 900 hours of study.
Additionally, the student has individual psychotherapy for the duration of
training and comes to have considerable self awareness.
The duration of therapy
The duration of therapy is different. Biodynamic massage therapy is a minimum of
six weekly sessions, but can extend for up to about two years depending on the
background of the client and any additional training that the therapist has
done. Body psychotherapy is usually over a longer period of time -perhaps two to
five years and sometimes longer.
The contract
The contract between client and therapist obviously has a central bearing on
whether biodynamic massage or body psychotherapy is occurring. If a client seeks
biodynamic massage from a biodynamic massage therapist, then
sessions will be at the massage level. Equally when a client has biodynamic
massage from a body psychotherapist, body psychotherapy will be occurring.
Where matters can become blurred are circumstances where the biodynamic massage
contract is extended over time. Or where a client seeks 'biodynamic massage'
from a body psychotherapist, which can entail a narrowing of her repertoire to
only biodynamic massage. This blurring is a function of the duration of
sessions, but more significantly the body psychotherapist will be thinking as a
psychotherapist, and the biodynamic massage therapist as a massage therapist.
This will affect what happens in sessions. Interestingly, outwardly the
biodynamic massage therapist and the body psychotherapist massaging a client can
look the same.
Case Studies
I would like to conclude by giving you two examples of clients. One client is a
biodynamic massage one, and the other is a body psychotherapy one. Both clients
had cancer and received biodynamic massage. I will read both summaries and see
if you can tell the difference.
Case 1
Cancer and biodynamic massage Kay sought help because she was stressed at work,
and had a lifetime of feeling below par, but had had no need for formal help
before. She often felt tired and worried, but could not put her finger on why.
The reorganisation of her job, teenage children going off to university and a
reappraisal of herself in midlife all seemed to be relevant to why she was
seeking help. She welcomed the idea of biodynamic massage and had received
aromatherapy in the past at a health club. During the early sessions, the
therapist hoped to make it feel safe and welcoming to encourage the opening up
the psychoperistaltic process. Kay's system seemed somewhat 'frozen'. She was a
person of few words, polite and willing to be helpful with information, but
private about herself.
Early sessions involved moderate muscular touch, emptying and energy
distribution. As she settled into the routine of sessions, she reported feeling
less anxious about her job, but irritated with the changes in the organisation.
She was sleeping better and had less indigestion.
She gradually became more spontaneously forthcoming about herself, but remained
somewhat emotionally distant. Her body became more substantial as her range of
breathing increased and there was a sense that she was more energetically
embodied in her back and legs.
A sign of this manifesting as a change in daily life was the surprise
announcement that she was renegotiating her work. She had decided to try to go
part-time and to only do the work she most enjoyed. She achieved this and began
working three days a week. After a further period of time she went on to do a
foundation art course at the local university. She spoke enthusiastically and
with obvious pleasure as she explained how she had had to give up art at school
because it was not academic enough, although it had been her favourite subject.
She seemed to be taking charge of her life as she quite literally gained the
backbone to do so.
All seemed to be going well, but then she developed abdominal pains. She did not
mention these in her sessions, but later said that she had ignored them and did
not think that they were anything to be concerned about.
After she had been having regular sessions for about a year, one day she arrived
looking strained and pale. She had just had the results of hospital
investigations. She had an ovarian tumour. It was treatable, but the prognosis
was not good. The session gathered up the facts and her options. She was shocked
- not quite believing the veracity of what she had been
told. She was also self recriminating - "How could I have ignored things for so
long?". But she couldn't clearly recall when symptoms first came. The massage
part of the session revealed a shut down system with no peristalsis. This is
characteristic in emotional shock.
Over the next eighteen months Kay continued to come for sessions, but could not
always attend with weekly regularity because of hospital appointments or
weakness. The thrust of the sessions moved towards the relief of various
symptoms and discussion of the immediacy of her current situation. She was
tense, sometimes in pain and at times had breathing difficulties. The therapist
massaged and left it to Kay to talk if she wanted to. The therapist also let the
topic of conversation emerge organically - not forcing anything to be addressed,
but not shying away from the expression of immense suffering. This enabled a
self regulation of what Kay could bear to be with at any time.
So sessions involved talking of outings, visits to the theatre, medical
interventions and very 'matter of fact' exchange. Amidst this there would
sometimes be tears, and anger, but most frequently there was deep fear, terror
and anxiety.
Chemotherapy and surgery left her exhausted, but she was very clear and sharp in
her grasp of the process. She used the internet and was well informed about what
was going on medically.
Over the next months she talked of living as usual or as much as possible in her
daily life, but her future was less certain. She was faced with not knowing how
to plan. She had come to enjoy her job immensely, but had not worked since her
diagnosis. Should she plan to go back, or take early retirement? She did not
know how her health would be and what criteria to use to decide.
She had a period of what turned into a remission of three months, decided to
take early retirement and planned how best to use her remaining possible five
years. Then she had more tests and discovered that there were more tumours. She
was told that she had months to live.
She continued to do what she liked to do for leisure, but needed to get
gardening, cleaning and shopping help. She reported that her husband helped
where he could, but was very distressed and worn out with months of uncertainty
and worry. She was living with the starkness of simultaneously living and dying.
In the sessions she talked frankly and was focussed on the immediacy of her
feelings and concerns. She did not want to die, was afraid of the process of
death, and sometimes thought it would be better if death came sooner. She felt
unwell, but was mostly pain free. She seemed depressed and grieving what she
once was. Her life was becoming more and more narrow.
Her future had gone in any recognisable way. She talked of the past and
contacted the man she didn't marry. She hadn't seen him in years and after his
visit she seemed calmer. She realised that she had made the right decision all
those years ago.
Practically, she put her affairs in order. She described her thoughts on what
happens after death and planned the basic structure of her funeral. Amidst all
of this, she discovered meditation and found some peace in it. Over the months
she seemed to be pared down to something more essential; she was less guarded
and more obviously kind and loving. Her body became more unrecognisable, but her
essence was more visible.
She was brought by her husband for massage sessions when she felt up to it.
Massage was done with her clothed to conserve her energy. She found a whole
massage too much, but enjoyed work on her feet, back and chest. She needed to
either sit up padded with pillows or to lie on her side, but no position stayed
comfortable for long and, whilst not complaining, it seemed too tiring to keep
reorganising her. Massage might last for up to 30 minutes, but was often about
20 minutes. She often reported feeling calmer and more relaxed. She enjoyed firm
emptying touch on her feet; gentle, more muscular touch on her back; and energy
distribution on her chest. She seemed to appreciate the chance to talk with
someone who had got to know her over time and who was not part of her daily
life.
One day, her husband phoned to say that she was too ill to come for her session
and three weeks later he phoned again to say that she had died peacefully at
home. He also expressed his appreciation for the support biodynamic massage had
given his wife.
Case 2
Cancer and biodynamic massage 2 Ellie requested biodynamic massage therapy on
the recommendation of the local Cardiac Rehabilitation Service following her
husband's heart attack. She hoped to come to terms with this catastrophic event
and to find ways of dealing with stress. She described herself as a 'coper' who
bottled up her tension. Over the months of biodynamic massage, she became more
aware of the process of relaxing. She also reported beneficial effects on her
blood pressure, arthritic aches and pains and discomfort from her sinuses.
It looked like her therapy was coming to an end, but about a year after the
first consultation she found a breast lump that on biopsy proved to be malignant
and invasive. During the two sessions prior to the biopsy, most of the session
was taken up with talking about her feelings, fears and plans for the future.
Biodynamic massage followed these discussions and consisted of light basic
touch, energy distribution over her limbs; holding over her chest, abdomen, and
lower back and gentle emptying of neck and head.
Two weeks after the biopsy Ellie had a total mastectomy, removal of lymph nodes
and breast reconstruction. Her biodynamic massage therapist maintained contact
by phone. After ten weeks and just prior to her second course of chemotherapy,
Ellie recommenced biodynamic massage therapy. She
was positive, dressed colourfully and appeared cheerful, saying that she was at
least now managing to get time for herself. The changes to Ellie's body were
colossal. It seemed to her therapist that her whole torso had been rearranged,
with a left breast fashioned from abdominal muscle; an abdominal scar that
stretched from one side to the other with a corner which persistently wept for
weeks. The left leg was unable to straighten as it pulled on the scar, but this
resolved and the scarring on the new breast healed well. The right side of
Ellie's upper to mid-back ached with the effort of holding herself upright and
felt spongey to touch. Ellie's hair began to fall out and she decided that
having no hair suited her and so she stopped wearing hats and head-scarves.
Ellie had biodynamic massage each week prior to chemotherapy as a preparation
for it. Biodynamic massage consisted of very gentle packing, holding, and auric
work over the scar sites. Ellie found the auric work particularly helpful as it
relieved the heavy ache in her new breast. Work over the back was given with
Ellie lying on her left side with her abdomen and breast supported with pillows.
When lying on her back a pillow was placed under her right leg to prevent pull
on the abdominal scar. There was some oedema of the left arm and hand from the
removal of the lymph nodes and Ellie experienced surface neurasthenia of the
upper arm. During chemotherapy, Ellie was given steroids which caused peripheral
oedma and made her feel congested all over. The depth of biodynamic massage was
slightly increased over the periphery (i.e. hands, feet and head) and Ellie
found this gave a pleasurable sense of lightness at the end of the session.
Ellie's diaphragm and rib cage were stiff and holding these areas whilst drawing
attention to her breathing gave her a sense that they were coming 'back to
life'. This was confirmed by the pyschoperistalsis.
Ellie looked forward to her sessions and said that she relaxed more than she
could by herself at home. As Ellie became stronger, biodynamic massage became
slightly more robust and deeper, but holding and packing continued in times of
energy depletion. Over the next two years, Ellie's sessions gradually became
more spaced out - coming weekly, then fortnightly, three weekly and monthly,
until she finished sessions.
Acknowledgements
I would like to thank Andrea Lant for her help with the case studies.
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