Tag: Body psychotherapy

Trauma releasing exercises

I am just back from the three-day introductory training in David Berceli‘s Trauma Releasing Exercises (TRE). These exercises and Berceli’s work are well worth knowing. Surprisingly enough, there is no Wikipedia article on Berceli and his work. The article on post-traumatic stress disorder (PTSD) does not mention it either, nor somatic approaches to PTSD at all, even though these have been about for a long time and must in any case be more effective than the “recognized” approaches, CBT (cognitive behavioral therapy), EMDR (eye movement desensitization and reprocessing) and medication.

Berceli (as far as I can see) takes his basic model of the somatic effects of trauma from the work of Peter Levine; in any case the models are very similar. To summarize, the basic idea is that the human animal has (for some reason; we shall come onto this) suppressed a natural response to coping with stress, which needs to be reactivated for healing to occur. However, the two differ considerably in terms of methodology. Levine’s approach, known as Somatic Experiencing (SE), which is quite widely practised in Europe (though not a lot in Belgium), requires exploration of the trauma and the felt sense of the body in response to it. As such, it borrows from Gendlin’s ideas on Focusing and more generally is, it seems to me, within the intellectual tradition of Gestalt therapy. By way of contrast, Berceli’s approach, like most somatic psychotherapy, is more purely process-oriented. As such, it does not require or even directly encourage exploration of the traumatizing events, and particularly not by the therapist; rather, the focus is on what the body is doing in the here and now and on the ways in which the body’s natural attempts to self-regulate are hindered or can be supported. The independence of method from the client’s personal history offers some considerable advantages, since it makes possible group work and relies less on the skills of the therapist.

Berceli’s therapeutic method borrows from Bioenergetics (I may update this article when I have read his books, so check back), rather in the tradition of Alexander Lowen. Its aim is therefore to produce involuntary trembling in the body. Unlike Lowen, there is no element of talk therapy within the method, though Berceli does say that his method can be integrated within others, so leaves the door open to syncretic approaches. Significantly, however, the trembling is reinterpreted compared to the Reichian tradition, to which Lowen remained loyal. Rather than being glossed as the release of sexual/life energy held in stasis by the body, it is interpreted as the reactivation of the post-freezing response of animals described by Levine: “When it is out of danger, the animal will literally ‘shake off’ the residual effects of the immobility response and gain full control of its body. It will then return to its normal life as if nothing had happened“.[1]

Why is this response suppressed in humans? For this, Berceli seems to have no deeper or more convincing answer than does Levine: “Most human cultures tend to judge this instinctive surrender in the face of overwhelming threat as a weakness tantamount to cowardice. However, underneath this judgment lies a deep human fear of immobility. We avoid it because it is a state very similar to death. This avoidance is understandable, but we pay dearly for it.“[1] In other words, the response is suppressed by the ego under the weight of social stigma attached to it. Neither Levine, nor Berceli, as far as I can see, has (or even looks for) any evidence of this claimed stigmatization. Many bodily functions may be disrupted by trauma, but this does not mean that those functions themselves are necessarily stigmatized. Thus this appears to me not very convincing, and basically it eschews a psychoanalytic explanation of ego defenses and their role in the developmental process. There are lots of criticisms which can be easily leveled not only at the model, but also at how the practice relates to it. Most basically, the question arises as to why the practice does not endeavor to, nor succeeds, in simply reestablishing this response and allowing it subsequently to play whatever role it needs to play in the individual’s further experience. Rather it is recommended to continue the practice on an ongoing basis. It therefore does not constitute a “cure” for PTSD, but a door into another dimension of experience. Berceli explicitly encourages such an understanding, and views his work as transformative on a global scale. This is laudable and I thoroughly support it because I believe he is on to something; but it is not convincing theoretically.

The great advantage of Berceli’s exercises over classical bioenergetics (and over Reich’s simplified anatomical model of the biological basis of character formation) is that it is more anatomically informed, and results in exercises which are shorter and easier to carry out. This makes it more suitable for the problem it is intended to address, since persons suffering the physical developmental impact of childhood trauma are often limited in their range of motion. These exercises should absolutely be considered for use in all those contexts where people currently employ Lowen’s exercises (though not his whole framework of Bioenergetic Analysis, which he himself acknowledged did not have the clinical success he hoped for) and its derivates, such as Osho’s active meditations. Because Berceli’s exercises directly solicit and progressively release tensions in the hip adductors, iliopsoas and muscles of the pelvic floor, that is, in all of the major muscles primarily involved in the orgastic response, and they are more easily taught and experienced than existing alternatives, they seem to me the basis for a more effective practice which clients will better be able to follow and stick to (they of course do not substitute for other exercises used in group therapy the purpose of which is rather to generate than to release tensions, which will then be released in other ways).

The other great advantage is that the method can be employed in a very wide range of contexts, from schools to palliative care, contexts in which bioenergetics or anything else “explicitly” psychotherapeutic would have no chance of penetrating. It does not need and does not really have a unifying discourse, which minimizes resistance. People are willing to try it out who would never go near (or for that matter be able to afford) a psychotherapist, and stick with it because, after all, it is only their body doing what it wants to do, and it is hard to be against that.

On the other hand it would at least seem not to be a complete system for spiritual liberation in the sense we derive ultimately from Reich. Berceli applies his technique way beyond the boundaries of PTSD, presumably because people have reported positive effects in those contexts, and has some awareness of the endemic and embedded nature of societal trauma, but the need for wide appeal seems to prevent him from going deeply into underlying societal issues in the radical tradition of much psychoanalytic thought. I am not saying this is a bad choice. Perhaps it is an excellent one. But ultimately, personally and at societal level, one does need to go there. Refusing to do so will always limit the benefits that can be attained.

What Berceli’s discourse seems to me to lack is an understanding that the disruption of the trauma response is ultimately due to the fact that social experience, being so far from the natural state of man, continually regenerates trauma. On top of distorting ego development, social experience also acts in the present. Our shared cognitive models of the world and the human need for relationship continually pull us back to a depressed, unhealthy state, and would do so even if all “residues” of specific trauma were somehow dissolved. We touch here on the manner in which Berceli’s approach is most fundamentally incomplete. It is essentially solipsistic, and presupposes, ultimately as a matter of ideology, the ability of the individual body to regenerate in the absence of regeneration of the collective body and the social tissues, which although they are just as ossified as the somatic tissues, are not directly brought into vibration by the practice. This cannot work. An interpersonal dimension of therapy and practice is absolutely indispensable if we are to begin to reprogram the social mechanisms which propagate and perpetuate trauma.

So I guess that makes me a big fan and a big critic at the same time. However I will do and use the exercises and I recommend them to you to.

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[1] See http://www.traumahealing.com/somatic-experiencing/art_chapter1.html

Reich’s economic model of psychosomatics (2 – the biological core)

Following his discovery of the link between sexual repression and character, Reich inquired into the nature of the mechanism underlying this link. His starting point was the observation that there existed, even if they were hard to codify, characteristic postures and facial expressions which allowed the most unlearned observer to decipher the character disposition of his interlocutor. Reich hypothesized that these resulted from, in the main, hypertonicity of certain functional muscle groups. Almost all muscles display in equilibrium or at rest a natural level of contraction called tonus. When this equilibrium is disturbed by a constant perception of threat, muscles become pathologically hypertonic. The attitude habitually assumed, be it of aggression, mistrust, helplessness etc, then becomes anchored in the muscular economy with attendent effects (though Reich does not discuss this) on skeletal development as well. Reich contends that the somatic and psychic expression of neurosis are functionally identical and mutually reinforcing. The somatic expression he calls the “biological core” of the neurosis. It is similarly this pattern of muscular spasticity which disrupts the orgastic response.

Reich goes on to make his central conjecture, laid out in Function of the Orgasm, that the natural orgasm serves a purpose of discharging vital energy and thereby regulating the energy economy of the body; this is thus a direct somatic parallel to Freud’s libido theory. Disturbances of the orgastic function compel the organism to regulate its energy economy otherwise, whether by reduced energy production (lethargy) or by other, imperfect mechanisms such as compulsive behaviors which only kick in when the tension has reached an unbearable level and then only partly resolve it.

The hypothesis of the “functional identity” of the neurosis and its somatic expression allows Reich to complement then-existing psychoanalytic techniques with a body-oriented approach and, he claims, achieve more consistent results, more rapidly, as well as penetrate some types of neurosis which were less amenable to traditional methods. His espoused technique advocates alternating opportunistically between addressing psychic and somatic blockages. This he called “vegetotherapy” in an allusion to its effects on the vegetative, or what we would now call the autonomic (i.e. involuntary) nervous system. How he did this in practice seems to be less well documented, perhaps because his discovery of the biological core of psychic neuroses leads him into more speculative areas of inquiry and the period of his interest in psychosomatic therapy is as a result relatively condensed, leaving methodology to be developed by others.

This new period in Reich’s life is underscored by a realization that sexual repression has not only somatic effects with psychic correlates – neuroses – but also that these primary somatic effects have in the long term direct secondary chronic effects at the somatic level in the form of illnesses such as cancer, dementia and rheumatic arthritis. This takes the hygienic challenge a long way from treated self-reported actual neuroses with anecdotal curiosities in turn-of-the-century Vienna to treating major plagues of contemporary civilization, both psychic and somatic.

Part 3: Reich’s legacy

Reich’s economic model of psychosomatics (1 – from Freud’s libido theory to character analysis)

Although the work of Wilhelm Reich in relation to what he called sex-economy lies at the root of many contemporary approaches to psychotherapy and personal development, it is widely misrepresented, caricaturized and misunderstood and a summary of it for the educated layman is, to my knowledge at least, difficult to come by. I am often asked to explain Reich’s thought which has very much influenced my own, and so I thought fit to attempt such a summary. In this and the next article, I propose to set out how he arrived at, and the basis for, the character-analytic approach to psychotherapy and his later vegetotherapy which aimed at directly working on what he called the “biological core” of neurosis. In a subsequent article, I would like to offer a review of his theories in the light of current knowledge, and particularly in what one would hope could be described as a somewhat more accommodating social environment than prevailed at the time of his work. (UPDATE: since I wrote this article, a very good overview of Reich’s life and work has been written by Jason Louv, see here. My own treatment is a bit more technical.)

Reich’s developments of psychotherapy all draw root in Freud’s early work. Subsequent developments of Freud’s psychoanalysis, which Reich viewed as a capitulation to social conservatism, took their work in different directions. They share, nonetheless, a substantial common bedrock, and Reich remained deeply admirative of Freud’s labors even when he disagreed with him on fundamental matters.

As is well-known, the various phases of Freud’s thought never resulted in a single synthesis and different strands within it remained in tension with each other. Freud thus never arrived at an integrated theory of psychic functioning. Reich took his lead from Freud’s libido theory of neurosis; neurosis was thus the result of a binding of sexual energy as a result of developmental factors in childhood. Freud never elucidated how this binding took place or how psychoanalysis was precisely supposed to work in order to dissolve the binding and thus resolve neurosis, but he developed different models of psychodynamics, in each case essentially of a mental nature. The blocking factors in neurosis were thus mental representations and the prescribed route to their dissolution ultimately also mental, although it proceeded from the unconscious, which for Freud could not be directly observed.

Reich’s own approach is quite at ease with Freud’s model of the three stages of consciousness, being the system unconscious, the system preconscious and the system conscious. According to this model, drives which arise in the unconscious undergo a sort of filtering process in order to arrive at the level of consciousness, during which their associations and objects change more or less radically. Thus, for example, the infantile desire to suck, if insufficiently satisfied in infancy, persists in the unconscious and is satiated, though never ultimately satisfied, through ersatz means which could involve actual sucking (thumb, lollipop), other oral actions (obesity and bulimia), fixation with oral sexuality, or other forms of clinging behavior not immediately oral in their manifestation. In order to achieve satisfaction of these ersatz or secondary drives, individuals would develop typical strategems which are in a direct line of descent from those they employed successfully in childhood – all essentially manipulative, solliciting one or other emotion on the part of the caregiver which would then elicit the desired response. Some would focus on solliciting pity, others fear, still others admiration, or benevolence through humor, or distraction, etc. Whilst Freud did not feel he had a social mission and confined himself to the therapy of those cases who presented themselves for treatment, it is easy enough to see how the learning process in early childhood coupled with certain not immediately definable characteristics of the child would lead to characteristic dispositions in adulthood, a starting-point for Reich’s work.

Reich’s interest in character was at first prompted, however, by considerations of methodology. Freud and many of his close collaborators had never taken a systematic interest in determining and assessing what worked in the therapeutic context. It was supposed that individuals needed to “cooperate” in the therapy. If they failed to do so, there was no alternative approach available. Reich realized, however, that the fact of cooperation or of failure to cooperate was endogenous to the therapeutic setting. It itself needed to be interpreted and worked through. The manifestation of resistance was evidence that one was reaching carefully repressed material. To dismiss a patient for refusal to cooperate was to admit defeat, perhaps at the moment when one was closest to achieving a breakthrough.

Reich started with a layman’s concept of personality, but soon progressed it to a developmental model in which typical frustrations of infantile libido led to a freezing of certain character responses, which were then overlaid on each other. In the therapeutic setting, the therapist would work backwards through these layers, to arrive at, and liberate, the earliest material.

Reich also noted that all patients presented with actual disturbances of “natural” genital sexuality. These disturbances were of various sorts but fundamentally there were only a limited number of variables. Decreased or absent pleasure in the genital act could be due to (i) diminished sensitivity of the genital apparatus itself, (ii) its failure to respond to conventional stimuli or at all or (iii) a failure of genital response to (sufficiently) engage adjacent muscles involved in the natural orgastic response. Persons with diminished sensitivity were often, in the male, erectively potent or, in the female, highly flirtatious, but derived little pleasure from the sexual act. Reich saw this as an instrumentalisation of sexuality in the service of a secondary drive. Persons with erectile dysfunction or vaginismus were disinterested in sexuality or conventional sexuality because it conflicted with defense mechanisms they had developed. Persons, finally, with a flat orgastic response curve (premature ejaculation in the male, muted or no orgasm in the female) encountered during the process of sexual arousal psychological obstacles which made full sexual expression impossible. This typology of genital response, Reich was able to correlate, albeit loosely, with the stages in the development of the libido posited by Freud as well as with contemporary character. Frustration prior to the oral stage led to a withdrawal of sexual interest and to schizoid character. Frustration at the oral stage led to oral fixation and a lack of autonomy, expressed as sexual passivity and a capacity for surrender but a diminished response. Frustration at the anal stage led to rigidity and inability to surrender, whilst frustration at the genital stage expressed itself as individuals with strong seductive powers and sexually active, but reporting a lack of pleasure in the sexual act and as seeking it for secondary, narcissistic purposes. In Reich’s view, the vast majority of people presented with some form of neurosis and it had both character and genital expression.

Reich’s approach felt little need for Freud’s later ego theory, but remained compatible with it. In addition to his methodological work, Reich’s greatest breakthrough was his solution of the problem of masochism, discussed at length in Character Analysis. Freud had posited a primary masochism, fruit of a biological drive he termed the death instinct (Todestrieb). For Reich this had no parallel in the animal kingdom and was unacceptable. He derived masochism as a secondary drive when the pleasure principle was frustrated by overwhelming violence to which the individual as a small child was powerless to respond. The frustrated drive first sought an outlet in sadism, turning this sadism against itself when it was further repressed. Constant juxtaposition of pleasure and punishment led to a state where they became psychically interlinked. Reich pointed out that no-one took pleasure in actual pain, only in the expectation of it. Pent-up energy which could not be channeled into pleasurable activity led to tension and anesthesia and the need for more extreme stimuli to break through to the core of the sexual drive.

Whilst Freud brokered a peace with society and seems to have viewed sublimation of sexual drives as in some degree necessary to civilization, Reich presents an uncompromising faith in the natural order reminiscent of Rousseau and Nietzsche; for him it is axiomatic that to recover the natural functioning of the human organism is the one and only path to happiness. Natural man is capable, for Reich, of the highest moral qualities and it is his sexual repression that brings evil and suffering into the world.

Part 2: The Biological Core

On the energy economy of the masochistic body type

Some thoughts from personal experience on this topic. This entry is mainly based on self-analysis, on the basis of which I draw some general conclusions; I freely admit the methodological flaw in this way of reasoning (and even more so since I am not a “pure” example of this body type*), but those who are interested in a more systematic account will anyway refer to the literature on the subject. So:

By virtue of repeated violence and threats of violence during early childhood, the masochistic body type (“Maso”) develops two sets of marked body patterns.

Firstly, spasticity of the following muscles or muscle groups: (i) buttocks and thighs (gluteus medius and minimus, pectinius, quadriceps, rectus femoris, and the hip adductors); (ii) the deep pelvic and perineal muscles (the pelvic floor, which consists of three muscles, and the perineal pouch, see here for photo) involved in defecation and urination as well as in maintaining posture and (iii) the transversus and rectus abdominis muscles.

The original purpose of tensing these muscles was to protect the genitals from damage. The need to protect the genitals also has a symbolic interpretation and charge, insofar as it represents an attempt also to defend the ego from assault. The spasticity of these muscles is naturally paired with a lack of tonus in the muscles which move the hip and pelvis upwards and outwards.

Associated with this, a pattern of breathing is developed in response to pain and assault whereby oxygenation of the pelvic region is reduced, and thereby also its sensitivity to pain. This appears to involve primarily the transversus abdominis muscle, which is the deepest of the abdominal muscles and inserts into the linea alba (the line which runs from the solar plexus downwards). Spasticity of this muscle effectively shuts off energy flow along the front of the body, separating the pelvic region from the abdomen. It also limits the depth of abdominal breathing.

In addition to this, the Maso develops constrictions in the jaw and throat, running as far down as the solar plexus and also involving the pectoral muscles. These constrictions aim at inhibiting the vocal expression of anger and pain. The effect of constrictions in this segment is also to draw the shoulders forward and to compress the sternum from the manubrium (upper part of the sternum) which is compressed by the clavicles until the xiphoid process (region of the solar plexus).

In combination, these two groups of muscular spasticities arch the spine in the form of a C, a posture which expresses and communicates resignation and defeat.

Such spasticities develop in early childhood and inevitably have a permanent developmental impact at the skeletal level. The anatomy in particular of the pelvis/hip area is affected by the imbalance between muscle pairs which results from permanent tension in the adductor muscles.

The Maso’s energy economy is characterized by a high level of primary energy in the genital region but a limited ability to circulate and use this energy, requiring discharge at low thresholds, or otherwise manifesting as anxiety. Essentially, the Maso is unable to tolerate a high level of energy is his body, because of the fact that this energy overcharges the genitals. Compulsive masturbation is a way to avoid anxiety. Anxiety manifests itself because the discharge of energy has been blocked. As anxiety increases, discharge scripts are cathected. These scripts are typically sexual in character and develop into more or less developed forms of obsessive-compulsive behaviour. Such scripts may be actually enacted, or merely direct the expression of sexual desire. The masochistic character also has a tendency to overuse and possible abuse of alcohol. In my case there is also a tendency to compulsive eating and obesity, which is a common, but I am not sure whether general, characteristic of the body type.

Clearly, the therapeutic challenge is to loosen these two sets of primary rigidities and to deepen the breathing so that the pelvic area is better oxygenated.

*) As regards physical body armoring, however, I think this type predominates, both based on self-observation and on theoretical grounds which I omit.