Container Model

Building the developmental container for the session.

Relationship + Support + Resources ->-> Competency

(2)

Identify Developmental Stage and Position

  • Use the contract, issues and themes involved, and the way the client presents.
  • From the Manual, use Life Patterns, Key Sentences, and Resources.

(1)
Form a contract/agreement/plan

  • Agree on an issue and get examples of how it is affecting present life.
  • Make the contract clear, precise, inclusive, and doable.
  • What might it be like if we are successful?
  • Keep the plan in focus throughout the session.

(3)
Use the appropriate muscles

  • Watch the body: What is active or alive, what is rigid or collapsed?
  • Which needed abilities are not available?
  • Use the related muscles to help build or release missing resources from this stage.
  • Explore the themes evoked by the muscles.

(4)
Build the relationship

  • Relate around the themes of this stage.
  • Use verbal and physical support to encourage emotional expression and deeper awareness.
  • Adapt and use the affirmative relational messages.
  • Affirm abilities, accomplishments, courage.
  • Listen with your heart. Meta-process at the end.

Building the Developmental container for the session:

  1. Negotiate a contract/plan for what you will work on in this session. Get a recent example. Make the contract clear and doable. Keep returning to the issue decided upon.
  2. Identify the likely character structure and position involved (E or L). Use the contract, the Life Patterns, the Key Sentences, the issues involved, and the way the client presents. What further information can you get that will validate your choice?
  3. What relevant abilities might be missing? Use the related muscles to build or release resources that help explore and deepen the client’s experience of this developmental stage and issue. Resources include centering, grounding, support, balance, and connectedness.
  4. Connect with the client around their experience of the themes for this developmental stage and position. Affirm their resources, courage, risk-taking, etc., and use affirmative relational messages to build your relationship. Support and affirm emotional expression. Go back and forth between 3 & 4 throughout the session.

Following process inside the structure of the container:

  1. Give active feedback about what you perceive, what you sense in yourself, and what you imagine. In general, use interventions that focus the client back to their body sensations.
  2. Find where the aliveness, change, or movement is visible or manifesting, and where it is missing in the body. Have the client focus on the physical sensation there. Don’t over-rely on energy sensing.
  3. Look for changes in facial expression, posture, and breathing. Listen for changes in emphasis and vocal quality. See these changes as possible opportunities to be taken advantage of. Ask: “What just happened?
  4. Do you need to give verbal or physical support? Do you need to challenge some of their attitudes or behavior?
  5. Use the Bodyknot to clarify communications, to help distinguish between perceptions, feelings, and interpretations.
  6. Experiment with asking only a few questions. Use questions that help the client focus back on their body and body sensation.
  7. In these training sessions, take the risk of leaving the “client” with the problem not yet resolved. Do not offer solutions; do not over-focus on helping.

SUPPORTING EMOTIONAL EXPRESSION:

Look for and support nascent expressions of emotion in the body:

  • changing facial expression: quivers or stillness,
  • eye expression
  • changes in breathing
  • tension in jaw or throat
  • change in tone, pattern and rhythm of sound (prosody)
  • Bring awareness to the emerging expression and give space for emotion
  • Be present with simple words and sounds of attuned support
  • Encourage taking time for full expression, often waves of it

Benefits include:

  • creates opportunity to express emotions long held back or given up
  • allows a new body experience
  • creates a new experience of attuned relationship
  • can free energy and vitality, promote greater competency

Affirming your relationship with your client

In Bodynamics, one of the ways we build a container inside of which we follow a client’s process is through affirming our relationship with them. One of the most common and effective ways we do this is through relating around the themes of the character structure and position they are expressing. Another is by using Affirmative Relational Messages (ARMs).

And there are a number of other cues – verbal, visual, and intuitive – that signal opportunities for building a relationship by sharing affirmative thoughts and feelings.

These include:

  • Affirming the client’s resources and abilities.
  • Hearing about their courage and risk-taking in the face of adversity and hardship.
  • Glimpsing a deep part of them, their truth, their authentic self.
  • Sensing their struggle.
  • Sensing their need for support in their life.
  • Feeling proud for them, moved by their feelings and what they faced.
  • When they don’t clearly see their strengths, or how far they have come.
  • What do I like/appreciate/respect/love about this person.
  • What moves me about this person.
  • When they come to a new, transformative awareness.
  • When they have faced an ongoing challenge in a new and productive way.
BUILDING A DEVELOPMENTAL CONTAINER: RESOLVING THE DICHOTOMY BETWEEN WORKING WITH PROCESS OR STRUCTURE IN PSYCHOTHERAPY
by
Joel Isaacs, Ph.D., and Anne Isaacs, LCSW

Abstract: An unresolved question in psychotherapy today is whether to primarily follow process and avoid influencing the client with your own thoughts and feelings, versus how you might bring in some psychological developmental knowledge and your professional knowledge of the issue being explored, to form a structure or container in which you can then follow the client’s process. This paper first outlines the advantages of both. It then describes the process of using a psychotherapy model to build a container in which to follow process. In the latter approach, we attempt to resolve problems/issues as much as possible in the framework of the age level at which they originated. Building resources and practicing new behavior reduces a client’s vulnerability to reflexively using protective behavior learned at an early age. And it is then also easier to learn and integrate new behavior into their present life. It is our contention that this approach can be adapted to enhance the effectiveness of many psychotherapeutic models.
********************

In his groundbreaking book, The Structure of Scientific Revolutions, Thomas Kuhn outlined how paradigms in each area of science are gradually replaced by newer ones. He showed that, as a given area of knowledge progresses and develops, more and more specific information comes to be encompassed. Some of this information can be incorporated into older theories or modes of understanding, and some cannot. A sufficient quantitative increase of knowledge can often lead to a qualitative change in understanding. In trying to apply these ideas to the field of psychotherapy, it seems to us that a process approach, with its broad concepts and assumptions is what is appropriate when a discipline is new or young. Only later, at a point where a sufficiently large amount of information has been correlated, would a structural approach be relevant and appropriate.

The advantages and disadvantages of primarily working with process or primarily working with a structural approach are still unresolved within the psychotherapy community. People often ask how and why we (the authors) went from developing and teaching process-oriented psychotherapy to a system that emphasizes working with developmental stages (Bodynamics’ Seven Developmental Stages). This article will outline our journey, our thoughts along the way, and our present perspective, perhaps offering some insight to others who are in mid-stream or contemplating a parallel journey in their own psychotherapy modality. Along the way we will relate how we have also integrated working with attachment mindsets and with building the interpersonal relationship.

Before proceeding much further let us define process and structure, as we understand them to apply to psychotherapy. In this context working with process often means working with what comes up spontaneously, or involuntarily. There is an emphasis on being in this moment, on allowing and surrendering, on following the client in whatever emerges. Many of the interventions that a therapist will make are guided by global ideas or principles and the practices that have emerged from these, as will be discussed below. This methodology is generally associated with some psychodynamic work, with a re-tuning of the autonomic nervous system, and sometimes with the release of emotions. (2)

Working with structure, as it is used here, describes a therapist making interventions that are specified more precisely by his or her theoretically or empirically based model. The therapist may make decisions on how to explore the issue presented based on criteria that his model says are most connected to a particular issue or to the age level from which it likely originates. It often means attempting to encompass (?) a situation, to stay inside of a framework, to stay with a particular issue and/or age level that is being explored, while working toward completion and integration.

Of course, we recognize that these two approaches are never totally separable. Every process approach has some structure, and every structural approach involves some process work. What we will be discussing are systems that, in the actual practice of their psychotherapy, strongly emphasize one or the other. (?? Will we actually be discussing this?? A few examples of each? Or later?) A rough comparison of the two approaches is outlined in the table below.

PROCESS MODEL
  • Working with what comes up spontaneously or involuntarily.
  • Structure derived from general  principles and assumptions.
  • Open ended.
  • In the present moment.
  • Use intuition. Theory is broad.
  • Allow issues to change with process.
  • Therapist as observer/witness, interpreter.
  • Interventions to keep process clear andd and moving.
  • Client has wisdom within.
  • Unconscious ego gains new resources.
  • Client may feel more alive.
STRUCTURE MODEL
  • Choosing from issues presented and staying with that.
  • Process followed inside of specific container.
  • More specific, often goal directed.
  • Focus on life problems as context.
  • Use theory. Intuition inside of structural model.
  • Stay with one issue.
  • Therapist as “trail guide”.
  • Interventions to move towards elaboration and completion.
  • Agrees, and stresses importance of missing resources or rigid behavior.
  • Conscious ego gains new resources.
  • Client may feel more resourced.

With this broad outline of the terrain we will now go into a more detailed examination of the two differing approaches [as they apply to body psychotherapy], starting with the process model.

WORKING WITH PROCESS IN BODY PSYCHOTHERAPY

Historically, the importance of giving attention to the body was initially affirmed in reaction to psychotherapy being thought of as only relating to the mind. We understand now that the mind constructs many possibilities, can talk itself in and out of many feelings, and that sometimes only one or two of these corresponds to the muscular or visceral reality of the body. So the body, when attended to, could serve as a reality check for the mind. And, it has a lot to say of itself!

Much of the early work with the body was pioneered by Wilhelm Reich. Interestingly, it was while Reich was involved in psychoanalytic work in the circle around Freud in Vienna that he evolved his characterological approach. His work with the body had a strong process orientation, and it is this orientation that is familiar to many modern practitioners. The early process work followed from the main emphases being on body armor and the breaking through of held-back feelings. This led to ideas of increasing the internal energy charge by voluntarily augmented breathing, and to releasing the holding back of energy and emotion by working vigorously on the muscles. In general, roughly the same procedure (process) was usually used for all clients, and used repeatedly.

Working with process has a great appeal. It is engrossing and often leads to dramatic and powerful releases of emotion. It can lead to important, often unexpected experiences or awareness (e.g., a deeper sense of self, a mystical experience of oneness). Process work is often simple and straight-forward, it is “natural”, it is widely applicable, it lends itself to intuition, and it utilizes “the wisdom of the body”. By following a few general principles and using their intuition, practitioners can often see dramatic things happen spontaneously. They can immerse themselves in the “process” of facilitating process, in some unspoken way feeling at one with the client. One does not have to be very directive, and by giving clients a lot of time and space for their own process to emerge and evolve one feels attuned and respectful. One can at times relate what emerges from the process to the issue with which the client started.

CONCEPTS AND ASSUMPTIONS UNDERLYING WORKING WITH PROCESS

Working with process, as we generally understand it, is based on a set of broad concepts. These can include following the flow of energy; removing the blocks; releasing emotions; restoring the pulsation; rebalancing the autonomic nervous system, etc. The work is also based on a set of assumptions. Let us examine these first. One assumption is that when a therapist follows process, the path taken by the client represents healing. In our own experience, this is very true in some instances. However, in other instances a person’s emotional process is simply a series of experiences that are associated to each other in some way. Just as our mind can form a chain of associations, so can the body seek to return to familiar, comfortable places. It can have its own method for avoiding fearful or painful memories and emotions. In these instances, the spontaneous process generated by the client, while probably protective of his integrity in the past, is not necessarily healing in the present.

In working with process there is often an unstated assumption that the resolution of a process is identical to (or at least closely correlated with) the resolution of the problem you started with. Here, the chain that leads from the beginning to the end of a session is assumed to be a chain of causes. It is common, however, that the issue may actually change during process work. You may start, for example, with the issue of being angry with a friend. It may evolve to being angry with a parent, then being sad and feeling abandoned by the parent. Does this sequence resolve your relationship to the friend in the present? Does it clarify why you get angry in general? Does it heal the early wounds and change your relationship to your own past experience? Not necessarily. It is not necessarily true that in the seemingly successful resolution of a body process the original problem (or an earlier problem) is being resolved.

In a similar way, when we follow process as in the scenario given above, the age level from which a client is dealing with an issue may change. In fact, by following process you often regress to younger and younger ages. There is an implicit assumption here that this is a healing or growthful experience. Seeing this kind of regression regularly has led some therapists to believe that birth issues are at the root of most adult problems. While we may sometimes want to facilitate a regression, we can see that developmental issues that first arise at, say, seven years of age (e.g. behavior in groups of peers) will not finally be resolved by going to ages younger than seven years (although the client may lack resources from an earlier age). By following process we do not necessarily resolve a problem encountered at a particular age level. In practice, the more broad or general a technique (e.g. deep voluntary breathing, stress exercises, free association, ..), the more likely that several different age levels will be stimulated. All we can finally say is that the resolution of a process may be related to some resolution of a similar or related problem, at the age it was encountered, or at another age.
NOTE: 5/2013 May want to talk about nervous system regulation.**

Another common assumption is that the resolution of a process related to an issue is the same as (or the most important part of) the resolution of that issue in the client’s present life. It is thought that over time, as a particular process moves to resolution, the person can and will act differently in their life, in this area and possibly in related problematic areas. This is again not necessarily true. Even when the person has more understanding and is less locked into old patterns, the new and appropriate behavior does not necessarily appear to him. Often there must be a conscious re-decision about their responses to certain types of situations, and then the new behavior must be learned in therapy. Then it can be practiced in therapy; then it must be tried in a life situation and refined until it works. Then we can finally say that the person has integrated the new behavior.

The spontaneous nature of body process has led to an idea that the process is expressing the “wisdom of the body”. We sometimes find this elevated to the idea that the body holds some “truth”, some wisdom that will flow if we can just “listen” appropriately. This is sometimes true and often not. If it were mostly true, we believe more people would heal deep psychological problems spontaneously. But we know that there are many people who have exquisite body awareness and also have many chronic psychological problems. Hatha yoga, to give one example, can be quite good for the body and can lead to a lot of body awareness, but does not necessarily produce psychological insight in the practitioner. We can say that some people don’t know how to “listen” to their body, but then we come close to circular reasoning. In our early years, this type of reasoning was sometimes invoked when our process approach did not produce the expected changes. It was common to hear that the client “wasn’t ready” or “didn’t want to change”.

We do, of course, believe that a great deal of or history can be accessed or informed by bringing the body into psychotherapy. However, the issue for psychotherapists is that the body will usually repeat its history, without change. This is an important part of the wisdom of the body: to repeat the strategy that once worked so well. As psychotherapists, it is part of our work to sense when the once protective decisions stored in the body are now the present sources of a client’s problems and limitations.

Working with Structure

For the last twenty years we have been first students, then practitioners, and then trainers in a structural body psychotherapy approach called Bodynamics.

Bodynamics is a somatic developmental psychotherapy developed by a group of 12 Danish therapists working together for over 20 years. Together they synthesized a comprehensive knowledge of developmental psychology, a detailed study of psychomotor movements at specific age levels, and extensive empirical research on the psychological content of each muscle (insert footnote and reference). These have been integrated into a synergistic perspective useable by psychotherapists. Much of the information is organized in a model of Seven Developmental Stages, or seven character structures. In addition, Bodynamics has elaborated 11 practical “ego functions”, such as grounding, centering, energy management, cognitive skills, etc. Both the character structure and the ego functions are delineated by specific collections of muscles.

Together with its diagnostic tool, the Bodymap (ref), this system also provides a new level of diagnosis that informs and guides the psychotherapy. It enables a therapist to go more directly to the likely problem area, or conversely, relate a current issue in a person’s life to specific developmental disruptions. Being able to recognize the skills or abilities that are missing, or the rigidities of behavior that are present, allows a practitioner the option of building or freeing these resources, rather than simply working with a client’s experience of the issue while these resources are missing. It our my sense that the Bodynamic system represents the kind of qualitative change described by Thomas Kuhn.

(((What do we mean when we say working with structure. Basically, we want to talk about the Bodynamic Analytic way of working with structure, character structure. While other systems work with character structure, we have more specific ways of holding a person to one issue in one structure: recognizing the character level from which the problem likely originates; recognizing whether the person is in the early, late, or resourced position of the character level; recognizing when a person moves or jumps between positions in one character, or moves to another structure; working with the specific muscle or muscles that govern the issue in this character level; and using psychomotor movements from a particular age level to resolve character issues without needing the client to regress. It is our experience that holding a person to one issue in one developmental stage leads to a fuller resolution of the issue, and to the fuller integration of gained insights and resources into their present day life.))

BUILDING A CONTAINER : THE RESOLUTION OF PROCESS VERSUS STRUCTURE

The specificity of the Bodynamic model has enabled us to work with structure in a consistent and useful manner**. Recently, by reviewing the demonstration sessions we have done in our trainings, we have been able to formulate this process in a more precise way. (See Figure 1, Building the Container). We can now more directly build a container in which we can follow a client’s process, while holding them to the issue chosen and at the appropriate age level from which that issue most likely arises.

The container we use has four sides or aspects. We start with an adult-to-adult discussion about what life issues the client desires to work on. While listening to a person’s history we may also questioning them about how the feel there history affects their present day life. Often, we can help them to make important changes in the preset without have to do (regressive work?). From this we come to an agreement about what the aims of therapy might be. Here we are involving the prefrontal cortex of the brain. The contract we make to work on these issues also guides what we may choose to work on in a given session. The therapist may then suggest a form in which she believes the work may hopefully elucidate the terrain to be explored. In spoken words this might, for example, sound something like: “From what you’ve told me about yourself and your background, (from the analysis of your bodymap?), and from the way you talk about the issues in your present life, I think you may be lacking a few specific resources or abilities. Let’s try working with your grounding, particularly from your Will Structure, and on energy boundaries, particularly from your Need Structure. After we work on these abilities we’ll then return to the issue you have chosen to work on. It will be important to see what may have changed for you.” That is an example of how we might apply our structure. It helps us to choose the parts of a process most likely related to the issue we have together chosen to work on. The contract is the first side of the container.

While working from a structural model the therapist may be likened to being in the role of a trail guide or pathfinder. Even though the terrain is new each time and different for each client, there are signs, clues, markings if you will, that tell us when we are likely heading in a fruitful direction. Of course, the sensitive therapist uses the client’s spontaneous responses as an indicator of whether or not they are on or close to the trail. She has a good, trained eye for watching bodily responses, for not taking tangential or potentially unrewarding paths, or even interesting or important ones that must be left for another day (e.g., related to some other age or issue, or to a trauma). Staying with the chosen issue and working with developmental themes related to that age and issue is the second side of the container.

The third side involves the building of an interpersonal relationship around the developmental themes. It also includes what we have come to call Affirmative Relational Messages. As examples of the latter, if and when appropriate, we may acknowledge and affirm our relationship with the client with encouraging statements of the kind: “I like that you are willing to express your needs”, or “I can wait till you know what you want to do”. Affirmations like these are spontaneously chosen so that we can express our positive feelings towards the client in words related to the issue being worked with, and to the developmental stage from which it likely arises. Here we are working with the ************** of the brain. (At the end of the session we will also do some meta-processing to engage the ******** part of the brain.)

The fourth and final side of the container involves using the specific muscles that are related to the developmental stage and issue that is being worked on (reference Body Encyclopedia). Use of the muscles has a two-fold purpose. One is that it tends to keep the developmental stage and issue in focus. And second, use of the muscles can build or release appropriate skills or resources, as well as evoke historical material related to the issue. So for example, if we were working with a client and felt it would be helpful to have then sense themselves more fully at a particular time, we would have them use a muscle related to Centering. And, for example, if the issue we were working with was one of asserting their own authority, related to the Will structure (ages 2 – 4 years), we would specifically choose the rectus femoris muscle.

Case studies here?

**********(?Here?) As one example of a missing resource we can examine a client’s ability to set a limit, to push away, and to say “no”. This is the psychomotor function of the triceps muscle, different portions of which come into conscious control during several developmental stages. If, in the period when this psychomotor function was coming under conscious control, the child experienced an early or strongly negative response to this action, then the person’s inner experience as an adult will often be “I can’t really set limits, or say no.” They will often not even sense their impulse to do so. When they do push away they will consciously or unconsciously experience resignation, weakness, or some inability. By contrast, if the parental response to the child’s setting limits was also negative, but was later in the developmental period or less strong, the belief might be “I’d better not push away”, or “I have to push away”. In this case the person will experience an urgency to repeat old behavior that again does not necessarily correspond to the present situation. In both these examples the “body wisdom” or “gut feeling” is often a reaction, in the present, to similar situations that had negative consequences in the past.

It is our experience that, when a client chooses to work with an issue, the muscles related to that issue are generally available to change their (imprinted elasticity). Often in these situations simply teaching new resources and practicing them in session can significantly help to resolve the issue being worked on. Using the example above, difficulty in setting limits and saying NO, is often underlying peoples’ inability to maintain an intimate relationship. Their experience is that after a certain period they begin to feel consistently overwhelmed. Working with them using the triceps muscle against some resistance, together with appropriate verbal expressions, can dramatically change their sense of their ability to set limits. When this is coupled with some practice in session of how and what they want to say to the other person, the changes are quickly internalized and acted upon.
Notes:

(LB: this paragraph is not as smooth as the work prior.)Therapy as teaching: The role of resources. A way to help clients re-experience, re-evaluate, reframe the issues presented. From a previous experience with a client, or from a bodymap, or from how they present an issue, you may suspect that there are things the client does not sense or know, resources that are limited or missing. Teach these, either separately or as part of exploring the issue. Explore how the client’s subjective experience of the problem changes as they embody new resources related to that problem.

Possibly to be included:

  • Distinguish between shock issues and developmental issues.
  • More on the interplay, the inseparability of structure and process. To find the right balance.
  • Resources: Developing resources alleviates fears. Problems lessen, dissolve, rather than necessarily needing to be confronted.
  • Mutual connection
  • More about how Diana Fosha has influenced our work
  • More about work on Attachment being included