Loneliness and its expressions in the body, a case study of body-mind balancing psychotherapy treatment.
Loneliness takes many forms and expressions in the body. This article gives the relative theoretical background on the reasons why loneliness is a difficult aspect in a person's life. The case study here presented is a summary of a year treatment through body-mind balancing psychotherapy.
In order to stress the difficulties a person encounters while he or she feels lonely, it is important to explain the importance of interpersonal relationships.
?Interpersonal relationships are the foundation and theme of human life, most human behavior takes place in the context of the individual?s relationships with others? (Reis, Collins & Berscheid, 2000; p. 845), therefore, it influences human behavior and life span development, that is, it changes the individual?s mental, physical and spiritual properties and their developmental course.
The essence of an interpersonal relationship lies in the interactions (Cohen, 2004) that take place between the relationship partners, while by interaction is meant influence; each partner?s behavior influences the other partner?s subsequent behavior (Berscheid & Reis, 1998).
Social interaction is necessary for a relationship to exist, but it is not sufficient, there has to be mutual influence on each other?s behavior for an extended period of time and for which the partners? mental representations of the relationship are idiosyncratic to the relationship along several dimensions (Reis, Collins & Berscheid, 2000): identity domain which includes reflexivity and motivation as keys to internal self standards and external self relevant feedback (Riley & Burke, 1995); attachment domain (Bowlby, 1979, 1982) characterized by proximity maintenance within a protective relationship; a hierarchical power domain, characterized by use and recognition of social dominance; a coalitional group domain, which concerns the identification and maintenance of negotiation of matched benefits with functional equals; and a mating domain concerned with the selection and protection of access to sexual partners (Bugental, 2000).
Each domain differs functionally from the others by differing sensitivities to certain social cues and by different operating principles. These domains provide a systemic approach to relationships; this perspective argues that ?from the moment of conception, individuals are nested in social relationships that influence the nature and operation of the many hierarchically organized biological and behavioral systems each individual encompasses; each relationship is itself nested in a social environmental system and in a physical environmental system, which together represent each relationship and together (the systems) are simultaneously evolving and influencing each other over time? (Reis, Collins & Berscheid, 2000; p.850).
Thus, a relationship is a system, in which feedback loop is provided through patterns and transference, such as in single therapy and in group-dynamics, which in this respect can be considered a system, as well. Feedback loops represent system processes and patterns of organization.
Social interactions and relationships are important because they appear to have strong consequences for successful survival, physical and mental health (Cohen, 2004) due to the adaptive value of social relationships (Perry-Smith & Shalley, 2003) that facilitate the formation and maintenance of social bonds, relationships are people?s most frequent source of both happiness, distress and needs about quality of life (Hansson et al., 2003).
Morbidity and mortality are substantially influenced by the formation and disruption of ongoing relationships across specific manifestations, such as social isolation and rejection, frequency of social contact (Cohen, 2004), network size (Katz et al., 2004), social relationship dissatisfaction such as: marital dissatisfaction, divorce and bereavement, which are linked with the onset, course and treatment of adult psychiatric disorders, including depression, anxiety disorders and psychosis (Whisman, Sheldon & Goering, 2000).
Baumeister & Leary (1995) as stated in Reis, Collins & Berscheid (2000) theorize that humans developed a ?need to belong?, a drive to form and maintain at least a minimum number of lasting, positive and significant interpersonal relationships. Fulfillment of this drive requires that the individual engage in frequent and affectively pleasant interactions (Casciaro, Carley & Krackhardt, 1999) with at least a few other people.
The evidence to this theory is that people in virtually every known society belong to small, primary groups that involve face to face interactions; that people universally appear to respond with distress and protest to the end of a relationship; and that interpersonal concerns and relational structures strongly influence cognitive processing (Reis, Collins & Berscheid, 2000).
Sociality remains central to human health and well-being. Social support refers to a social network?s provision of psychological and material resources intended to benefit an individual?s ability to cope with and buffer stress (Helgeson, 2003) through social group membership and networks (Cohen, 2004; Katz et al., 2004), which are important for the mental health of the individual. Such groups provide the necessary support to its members during their life cycle in general and in particular in times of crisis (Bloch & Singh, 1997).
Efforts to understand how adult relationships form from a superficial stage to deeper and more interdependent levels of involvement have brought forth enhancing behaviors: self-disclosure is one behavior for which members of an ongoing relationship generally establish reciprocity; intimacy, another characteristic of relationship development; shared self-understanding and responsiveness to nonverbal cues (Reis, Collins & Berscheid, 2000); commitment and satisfaction (Perry-Smith & Shalley, 2003).
It is important to note, nonetheless, that relationships change and are dynamic, since human capacities, needs and activities change across the life span and influence over individual?s quality of life (Hansson et al., 2003). Some of these changes are voluntary, when individuals have relatively robust capacities for selecting, maintaining and terminating social contacts. Others are the result of life circumstances and lower capacities, which may cause co-morbidity and mental disorders.
In this respect, it is relevant to stress that ill individuals? social networks tend to be negative, that is spread disease and the opportunity for conflict, exploitation, stress transmission and feelings of loss and loneliness (Davidson et al., 2001; Cohen, 2004; Katz et al., 2004).
Social networks are important for individual?s physical, as well as, mental health, therefore it is not surprising that people with psychiatric disabilities have fewer social contacts than others and that the number of people with whom they have regular contact, between six to twelve, is significantly lower compared to the general population (Davidson et al., 2001). In addition, the few relationships that people with psychiatric disabilities do have, they have been described as ?uni-directional? rather than reciprocal, in that they appear to receive more support, than they are able to give. As a result, family members appear to represent the primary source of social support for many individuals, and they tend to report feeling overwhelmed by the needs of their disabled relatives (Mueser et al., 2001; Berglund & Vahlne, 2003).
Patients report difficulties that are due to the nature of their disorders, including deficits in social skills and judgment; thought disorder; lack of attention, concentration and communication difficulties; hypersensitivity to negative affect and interpersonal conflict; loss of self and anxiety (Davidson et al., 2001).
Recently, clinical investigators have begun to attribute to the social isolation of individuals to the nature of the disability itself, citing such factors as social skills deficits, affect dysregulation, asociality and anergia as reasons for why it appears to be difficult for people to establish and maintain reciprocal, caring relationships.
Consequently, the lack of social support experienced by lonely people is seen as having been brought about primarily by the ravages of the disorder itself, leaving the person isolated, apathetic but still desiring companionship or interpersonal relationships (Davidson et al., 2001), but lacking the capacity of attaining and maintaining them over time.
The Importance of Social Support
Social support relates to different aspects of social ties: information, emotional support (Helgeson, 2003), which involves the expression of empathy, caring, reassurance and trust; it provides opportunities for emotional expression and venting (Cohen, 2004); practical support, companionship, close confiding relationships, engagement in communal activities, objective and subjective assessment of such supports and satisfaction with it. The term ?support? implies that all such relationships are by definition beneficial (Green et al., 2002).
Lonely people have deficits in social and leisure involvement and an absence of meaning in their lives compared with people socially involved.
Furthermore, inaccurate perception (Bonito, 2002) is found in most of the conditions, but the nature of the failure varies considerably. In this context body-mind balancing psychotherapy in single therapy and/or group-dynamics provide a setting of imitative situations (Yalom, 1995) of real life within the session, which is directly concerned with the patients? social behavior through the body. Our body is the endeavor in which we sense, feel and act, the body memory stores our past and present experiences thus projecting them into the future. Focusing on the body memory allows change in time, through due process, these patterns, and it allows to overcome loneliness, anxiety, depression and other disorders, by finding in the body sources of strength and energy that were dormant.
An Interpersonal Approach
Interpersonal Relationships can be considered a ?configuration made up of two or more people, [in which] they collaborate towards the achievement of a common goal?, thus creating meaningful communication about contexts of experiences. (Sullivan, 2000).
Aristotle referred to man as a ?social animal? and he considered ?man?s affiliative needs to be a source of strength? (Rutan & Stone, 2001, p. 8). Therefore, the process of socialization is necessary to men for the satisfaction of their needs such as: the need to associate to others for work, for play, for sexual satisfaction, for the transmission of knowledge; and the need to be part of a group. Complete isolation is unbearable and incompatible with sanity (Fromm, 1947).
The progress of body-mind balancing psychotherapy theory led on the relationship of man to others, to nature and to himself through the body. It was assumed that this relationship governs and regulates the energy manifest in the passionate strivings of man. One of the pioneers of this view was H.S. Sullivan (1932) defined the basic formula of all psychotherapy is that of interpersonal relations.
Sullivan perceived mental health as influenced by all of the socioeconomic and cultural factors involved in the relationship of human beings with each other and their world. He attributed to expressions of anxiety and hesitancy or even resistance to growth, that almost all people show some difficulty in living and cooperating with each other, and many have severe dysfunctions.
Sullivan (1953) described human development in the effort to satisfy needs in a social and cultural world, developing relations to others, and learning language within social interactions, there lies the infant?s learning, during activity situations with primary caregivers, in which fundamental perceptions of the self and the self in relation to others are formed. Through the child?s daily interactions through his body a sense of the self is formed (i.e. the good me) together with the boundary areas of insecurity and anxiety (i.e. the bad me); the anxiety thus aroused by the variety of life most people keep at bay.
A person learns to disrupt situations that provoke anxiousness by placating or misleading or distancing others than to communicate with others within the positive satisfaction of needs. The personal anxiety system described by Sullivan (1953) finds its corrective recapitulation of the primary family group (Yalom, 1995), during single therapy and group dynamics.
?Sullivan?s formulations are exceedingly helpful for understanding the therapeutic process, both in single therapy as in group dynamics. [?] Sullivan contends that the personality is almost entirely the product of interaction with other significant human beings. The need to be closely related to others is as basic as any biological need and is, in the light of the prolonged period of helpless infancy, equally necessary to survival? (Yalom, 1995; p.19).
These interactions influence over the development of the self based on the perceived appraisals of significant others. The process of constructing our self-regard on the basis of reflected appraisals is based on the subject development cycle. Sullivan claimed that these interactions may be distorted, which occurs in an interpersonal situation when one person relates to another not on the basis of the realistic attributes of the other, but on the basis of a personification existing chiefly in the person?s own fantasy (Sullivan, 2000).
Furthermore, Yalom (1995) contends that interpersonal distortions tend to be self-perpetuating; Sullivan (2000) view is that these distortions are modifiable through consensual validation; that is, through comparing one?s interpersonal evaluations with those of others. This concept is important in therapy, where it occurs that a person alters his/hers distortions after sampling the other member?s views (Yalom, 1995).
Therefore, Sullivan?s (2000) therapeutic process is the study of processes that involve or go on between people. Treatment should be directed toward the correction of interpersonal body distortions, thus enabling the individual to lead a more abundant life, to participate collaboratively with others, to obtain interpersonal satisfactions in the context of realistic, mutually satisfying interpersonal relationships. (Sullivan, 2000), since ?people need people - for initial and continued survival, for socialization and for the pursuit of satisfaction? (Yalom, 1995; p.21). It is not surprising to find that Yalom (1995) views interpersonal relationships as one of the therapeutic factors for interpersonal learning.
Body-mind balancing psychotherapy focuses on the patient's body through movement, self imagery focusing, self touch and touch, correlating in the adult patients senses, emotions and understanding.
The transitional space in which patients engage in body-mind balancing psychotherapy, is an intermediate area, it offers a setting in which they receive the support they need using their body as a means of stimulation of creativity, self-knowledge and understanding through this process they achieve competence and control, thus lowering anxiety about feelings of vulnerability, anxiety and isolation.
The Support and Benefits of Body-mind balancing Psychotherapy treatments
The therapist comments on the social behavior of the patient, in the hope that patients will profit from belonging to a friendly and supporting environment, and thus will be able to try out new social techniques in the safe environment the treatment provides. (Bion, 1961; Johnson, 1994; Yalom, 1995).
The meeting is viewed as a therapeutic environment (Chazan, 2001) in which the affective component consists of learning to identify and express feelings, finding safe and appropriate outlets for avoided feelings and defenses (Bowins, 2004) and tolerating high levels of emotion without becoming overwhelmed (Wise, 2003) through the body.
Single therapy shares features similar to social skills training and are often structured and task focused to promote social functioning, interpersonal relations, cognitive functioning, and problem solving skills (Ahmed & Boisvert, 2003), therefore social relationships can help to buffer the effects of stress and anxiety on mental health (Helgeson, 2003; Cohen, 2004).
Body-mind balancing psychotherapy role is to establish a frame work that include rehabilitative activities in order to maintain the locus of control achieved by each patient and creating a supportive environment in the hope to achieve consensuality, cooperation and competence (Bazerman, 2001).
The Use of the Body
The patient body experience is a tangible vehicle; it connects to the present and a particular place, even if the subject matter refers to the past. The body expression understanding helps to see that our troubles do not have to be ?so scary?. Body-mind balancing psychotherapy helps us to open up verbally; it is a vehicle of communication. It connects the inside and outside world, it makes the therapeutic process visible as a guide to universal qualities of the senses experience (Johnson, 1994).
Body-mind balancing psychotherapy provides a connection in which primary creativity and objective perception based on reality testing is allowed, through the body expressions of sense, feelings, emotions and memories.
Winnicot (1971) assumes that the task of reality acceptance is never completed, that no human being is free from the strain of relating inner and outer reality, and that the relief from this strain (which otherwise raises anxiety) is provided by an intermediate area of experience, which is in direct continuity with the play area (p. 13).
Winnicot (1971) called this area ?potential space?, the area between the infant and the mother, between therapist and patient and between the group members and the group leaders. In other words, ?it is play that is universal, and that belongs to health: playing facilitates growth and therefore health; playing leads into relationships; playing can be a form of communication in body-mind balancing psychotherapy and lastly, psychoanalysis has been developed as a highly specialized form of playing in the service of communication with oneself and others?, (p. 41) since an important feature of playing is the freedom to be creative in an environment that promotes emotional development, through creativity and expression of feelings about their lives (Hannah, 1992). Winnicot (1971) states that it is creative apperception more than anything else that makes the individual feel that life is worth living, it also provides a reason for working together and to gain confidence in their abilities (Hannah, 1992).
Patients lack any feeling of worth in life, they relate to despair, anxiety, hopelessness and fear, they feel that life is not worth living, they live uncreatively and for Winnicot such ?a way of living in the world is recognized as illness (p. 65). Therefore, creativity belongs to being alive.
Karterud & Urnes (2004) clinical experiences reports that ?patients may learn from exploring and playing with feared situations in safe surroundings and appreciate non-verbal modes of exploring and expressing contents of the mind.
Body-mind balancing psychotherapy is a non-verbal mode of exploration at first, it evokes a deeper connection to ones body, images, memories, feelings and emotions, the verbal part of the session connects the response from patients and the therapist to their production, helps them understand and reflect upon the content of their own mind in comparison and contrast with their body.
Case Study
Case History
Background Information
(Identity details have been modified in order to protect the patient privacy).
Eran (alias name) was born and raised in Jerusalem, Israel. His father, who died when Eran was 36 years old, was a locksmith. His mother was a homemaker. Neither of his parents finished high school. Eran is 52 years old and has been working as a taxi driver for a local company for the past 30 years. He reports that he likes his job and enjoys interacting with people.
Eran has a younger sister who lives in the United States, where she lives with her family. Eran has very seldom any contact with her.
Eran has been unmarried his entire life, he never developed permanent lasting relationships. He reports that the relationships that he had where sporadic and short. The longest relationship lasted 4 months and Eran has very little insight on why it ended.
He lives a celibate life in the past few years, with the exception of occasional sexual encounters, which in recent years have become rare, Eran self-image is low, he reported to feel unattractive since he gained weight. In the past 10 years he kept gaining weight Eran believe that his job as a taxi driver is quite sedentary and since he no longer as the energy to work out he keeps gaining weight and feeling unattractive.
Eran used to be involved in Tai Chi and Chi Kong but he no longer practices it. During the past three years coworkers have noticed a gradual change in Eran. While he always seemed cheerful and fun to be with, he started to withdraw from his social interactions, he spent his time on his own, he stopped going to after work meetings, to his Tai Chi group. He blamed his back for this ailment. He went to several doctors who found nothing physiologically wrong with him. But, Eran was in constant pain, it was difficult for him to bend without feeling his lower back. He started spending his free time at home, laying down, watching TV at all times.
Eran work as a taxi driver has no movement and is quite sedentary; during his free time he is quite passive in his activities and become uninterested in engaging in his previous social life.
His self-image began to deteriorate, his lower back pain was getting worst and he was on the on set of depression. All he could manage was work and the basic necessities to run his home.
At the urging of his orthopedist Eran sought help to relieve his lower back pain which has become unbearable and debilitating.
II. Intervention
The therapeutic process lasted two years in which Eran worked through his depression and disruptive body-image, in time he found the energy to renew his social life.
Eran body had a lot to say, we worked through his lower back pain for months, and slowly he started to realize that he had a hard time relaxing his back-muscles, he understood that he lacked the feeling of being able to lean on somebody, having always taken care of himself, he could not rely on anyone but himself.
At the same time he could not let anyone else lean on him, since he was able to sustain only himself, women needs for companionship were too much for him, hence his intimate relationships were short and quite a part from each other.
In time Eran was able through touch and guided imagery to relax his lower back muscles, the more freedom from pain he felt the easier was for him to move.
After 4 months, the therapist suggested to Eran to engage in a sport of his choice, he felt this was too much for him, through a verification process the suggestion of swimming was proposed to Eran. He loved to swim as a child, and decided to give it a try.
He registered to his area country club and began swimming twice a week regularly, after two months he made it to three times a week. Slowly he started to feel better and to meet other people at the club.
The trainer suggested to him some basic work out with weights and a visit to the club dietitian.
Eran physical state was improving steadily, this opened up issues regarding his feelings of loneliness and solitude. He desired a long relationship with a partner and we started to work through the body in that direction.
Feelings of inadequacy, shame and rejection in his childhood started to being evoked, past memories of events long forgotten.
The process hereby presented reassumes the first year of work with Eran, in which the symptoms of lower back pain were due to his feelings of isolation and withdrawal from social interactions.
© Aviva Lodan, M.A. Group Leadership through the Arts and Holistic Body-Mind Balancing Psychotherapist.
© מאת אביבה לודן, M.A בהנחיית קבוצות בשילוב אומנויות ופסיכותרפיסטית גופנית הוליסטית.
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Loneliness takes many forms and expressions in the body. This article gives the relative theoretical background on the reasons why loneliness is a difficult aspect in a person's life. The case study here presented is a summary of a year treatment through body-mind balancing psychotherapy.
In order to stress the difficulties a person encounters while he or she feels lonely, it is important to explain the importance of interpersonal relationships.
?Interpersonal relationships are the foundation and theme of human life, most human behavior takes place in the context of the individual?s relationships with others? (Reis, Collins & Berscheid, 2000; p. 845), therefore, it influences human behavior and life span development, that is, it changes the individual?s mental, physical and spiritual properties and their developmental course.
The essence of an interpersonal relationship lies in the interactions (Cohen, 2004) that take place between the relationship partners, while by interaction is meant influence; each partner?s behavior influences the other partner?s subsequent behavior (Berscheid & Reis, 1998).
Social interaction is necessary for a relationship to exist, but it is not sufficient, there has to be mutual influence on each other?s behavior for an extended period of time and for which the partners? mental representations of the relationship are idiosyncratic to the relationship along several dimensions (Reis, Collins & Berscheid, 2000): identity domain which includes reflexivity and motivation as keys to internal self standards and external self relevant feedback (Riley & Burke, 1995); attachment domain (Bowlby, 1979, 1982) characterized by proximity maintenance within a protective relationship; a hierarchical power domain, characterized by use and recognition of social dominance; a coalitional group domain, which concerns the identification and maintenance of negotiation of matched benefits with functional equals; and a mating domain concerned with the selection and protection of access to sexual partners (Bugental, 2000).
Each domain differs functionally from the others by differing sensitivities to certain social cues and by different operating principles. These domains provide a systemic approach to relationships; this perspective argues that ?from the moment of conception, individuals are nested in social relationships that influence the nature and operation of the many hierarchically organized biological and behavioral systems each individual encompasses; each relationship is itself nested in a social environmental system and in a physical environmental system, which together represent each relationship and together (the systems) are simultaneously evolving and influencing each other over time? (Reis, Collins & Berscheid, 2000; p.850).
Thus, a relationship is a system, in which feedback loop is provided through patterns and transference, such as in single therapy and in group-dynamics, which in this respect can be considered a system, as well. Feedback loops represent system processes and patterns of organization.
Social interactions and relationships are important because they appear to have strong consequences for successful survival, physical and mental health (Cohen, 2004) due to the adaptive value of social relationships (Perry-Smith & Shalley, 2003) that facilitate the formation and maintenance of social bonds, relationships are people?s most frequent source of both happiness, distress and needs about quality of life (Hansson et al., 2003).
Morbidity and mortality are substantially influenced by the formation and disruption of ongoing relationships across specific manifestations, such as social isolation and rejection, frequency of social contact (Cohen, 2004), network size (Katz et al., 2004), social relationship dissatisfaction such as: marital dissatisfaction, divorce and bereavement, which are linked with the onset, course and treatment of adult psychiatric disorders, including depression, anxiety disorders and psychosis (Whisman, Sheldon & Goering, 2000).
Baumeister & Leary (1995) as stated in Reis, Collins & Berscheid (2000) theorize that humans developed a ?need to belong?, a drive to form and maintain at least a minimum number of lasting, positive and significant interpersonal relationships. Fulfillment of this drive requires that the individual engage in frequent and affectively pleasant interactions (Casciaro, Carley & Krackhardt, 1999) with at least a few other people.
The evidence to this theory is that people in virtually every known society belong to small, primary groups that involve face to face interactions; that people universally appear to respond with distress and protest to the end of a relationship; and that interpersonal concerns and relational structures strongly influence cognitive processing (Reis, Collins & Berscheid, 2000).
Sociality remains central to human health and well-being. Social support refers to a social network?s provision of psychological and material resources intended to benefit an individual?s ability to cope with and buffer stress (Helgeson, 2003) through social group membership and networks (Cohen, 2004; Katz et al., 2004), which are important for the mental health of the individual. Such groups provide the necessary support to its members during their life cycle in general and in particular in times of crisis (Bloch & Singh, 1997).
Efforts to understand how adult relationships form from a superficial stage to deeper and more interdependent levels of involvement have brought forth enhancing behaviors: self-disclosure is one behavior for which members of an ongoing relationship generally establish reciprocity; intimacy, another characteristic of relationship development; shared self-understanding and responsiveness to nonverbal cues (Reis, Collins & Berscheid, 2000); commitment and satisfaction (Perry-Smith & Shalley, 2003).
It is important to note, nonetheless, that relationships change and are dynamic, since human capacities, needs and activities change across the life span and influence over individual?s quality of life (Hansson et al., 2003). Some of these changes are voluntary, when individuals have relatively robust capacities for selecting, maintaining and terminating social contacts. Others are the result of life circumstances and lower capacities, which may cause co-morbidity and mental disorders.
In this respect, it is relevant to stress that ill individuals? social networks tend to be negative, that is spread disease and the opportunity for conflict, exploitation, stress transmission and feelings of loss and loneliness (Davidson et al., 2001; Cohen, 2004; Katz et al., 2004).
Social networks are important for individual?s physical, as well as, mental health, therefore it is not surprising that people with psychiatric disabilities have fewer social contacts than others and that the number of people with whom they have regular contact, between six to twelve, is significantly lower compared to the general population (Davidson et al., 2001). In addition, the few relationships that people with psychiatric disabilities do have, they have been described as ?uni-directional? rather than reciprocal, in that they appear to receive more support, than they are able to give. As a result, family members appear to represent the primary source of social support for many individuals, and they tend to report feeling overwhelmed by the needs of their disabled relatives (Mueser et al., 2001; Berglund & Vahlne, 2003).
Patients report difficulties that are due to the nature of their disorders, including deficits in social skills and judgment; thought disorder; lack of attention, concentration and communication difficulties; hypersensitivity to negative affect and interpersonal conflict; loss of self and anxiety (Davidson et al., 2001).
Recently, clinical investigators have begun to attribute to the social isolation of individuals to the nature of the disability itself, citing such factors as social skills deficits, affect dysregulation, asociality and anergia as reasons for why it appears to be difficult for people to establish and maintain reciprocal, caring relationships.
Consequently, the lack of social support experienced by lonely people is seen as having been brought about primarily by the ravages of the disorder itself, leaving the person isolated, apathetic but still desiring companionship or interpersonal relationships (Davidson et al., 2001), but lacking the capacity of attaining and maintaining them over time.
The Importance of Social Support
Social support relates to different aspects of social ties: information, emotional support (Helgeson, 2003), which involves the expression of empathy, caring, reassurance and trust; it provides opportunities for emotional expression and venting (Cohen, 2004); practical support, companionship, close confiding relationships, engagement in communal activities, objective and subjective assessment of such supports and satisfaction with it. The term ?support? implies that all such relationships are by definition beneficial (Green et al., 2002).
Lonely people have deficits in social and leisure involvement and an absence of meaning in their lives compared with people socially involved.
Furthermore, inaccurate perception (Bonito, 2002) is found in most of the conditions, but the nature of the failure varies considerably. In this context body-mind balancing psychotherapy in single therapy and/or group-dynamics provide a setting of imitative situations (Yalom, 1995) of real life within the session, which is directly concerned with the patients? social behavior through the body. Our body is the endeavor in which we sense, feel and act, the body memory stores our past and present experiences thus projecting them into the future. Focusing on the body memory allows change in time, through due process, these patterns, and it allows to overcome loneliness, anxiety, depression and other disorders, by finding in the body sources of strength and energy that were dormant.
An Interpersonal Approach
Interpersonal Relationships can be considered a ?configuration made up of two or more people, [in which] they collaborate towards the achievement of a common goal?, thus creating meaningful communication about contexts of experiences. (Sullivan, 2000).
Aristotle referred to man as a ?social animal? and he considered ?man?s affiliative needs to be a source of strength? (Rutan & Stone, 2001, p. 8). Therefore, the process of socialization is necessary to men for the satisfaction of their needs such as: the need to associate to others for work, for play, for sexual satisfaction, for the transmission of knowledge; and the need to be part of a group. Complete isolation is unbearable and incompatible with sanity (Fromm, 1947).
The progress of body-mind balancing psychotherapy theory led on the relationship of man to others, to nature and to himself through the body. It was assumed that this relationship governs and regulates the energy manifest in the passionate strivings of man. One of the pioneers of this view was H.S. Sullivan (1932) defined the basic formula of all psychotherapy is that of interpersonal relations.
Sullivan perceived mental health as influenced by all of the socioeconomic and cultural factors involved in the relationship of human beings with each other and their world. He attributed to expressions of anxiety and hesitancy or even resistance to growth, that almost all people show some difficulty in living and cooperating with each other, and many have severe dysfunctions.
Sullivan (1953) described human development in the effort to satisfy needs in a social and cultural world, developing relations to others, and learning language within social interactions, there lies the infant?s learning, during activity situations with primary caregivers, in which fundamental perceptions of the self and the self in relation to others are formed. Through the child?s daily interactions through his body a sense of the self is formed (i.e. the good me) together with the boundary areas of insecurity and anxiety (i.e. the bad me); the anxiety thus aroused by the variety of life most people keep at bay.
A person learns to disrupt situations that provoke anxiousness by placating or misleading or distancing others than to communicate with others within the positive satisfaction of needs. The personal anxiety system described by Sullivan (1953) finds its corrective recapitulation of the primary family group (Yalom, 1995), during single therapy and group dynamics.
?Sullivan?s formulations are exceedingly helpful for understanding the therapeutic process, both in single therapy as in group dynamics. [?] Sullivan contends that the personality is almost entirely the product of interaction with other significant human beings. The need to be closely related to others is as basic as any biological need and is, in the light of the prolonged period of helpless infancy, equally necessary to survival? (Yalom, 1995; p.19).
These interactions influence over the development of the self based on the perceived appraisals of significant others. The process of constructing our self-regard on the basis of reflected appraisals is based on the subject development cycle. Sullivan claimed that these interactions may be distorted, which occurs in an interpersonal situation when one person relates to another not on the basis of the realistic attributes of the other, but on the basis of a personification existing chiefly in the person?s own fantasy (Sullivan, 2000).
Furthermore, Yalom (1995) contends that interpersonal distortions tend to be self-perpetuating; Sullivan (2000) view is that these distortions are modifiable through consensual validation; that is, through comparing one?s interpersonal evaluations with those of others. This concept is important in therapy, where it occurs that a person alters his/hers distortions after sampling the other member?s views (Yalom, 1995).
Therefore, Sullivan?s (2000) therapeutic process is the study of processes that involve or go on between people. Treatment should be directed toward the correction of interpersonal body distortions, thus enabling the individual to lead a more abundant life, to participate collaboratively with others, to obtain interpersonal satisfactions in the context of realistic, mutually satisfying interpersonal relationships. (Sullivan, 2000), since ?people need people - for initial and continued survival, for socialization and for the pursuit of satisfaction? (Yalom, 1995; p.21). It is not surprising to find that Yalom (1995) views interpersonal relationships as one of the therapeutic factors for interpersonal learning.
Body-mind balancing psychotherapy focuses on the patient's body through movement, self imagery focusing, self touch and touch, correlating in the adult patients senses, emotions and understanding.
The transitional space in which patients engage in body-mind balancing psychotherapy, is an intermediate area, it offers a setting in which they receive the support they need using their body as a means of stimulation of creativity, self-knowledge and understanding through this process they achieve competence and control, thus lowering anxiety about feelings of vulnerability, anxiety and isolation.
The Support and Benefits of Body-mind balancing Psychotherapy treatments
The therapist comments on the social behavior of the patient, in the hope that patients will profit from belonging to a friendly and supporting environment, and thus will be able to try out new social techniques in the safe environment the treatment provides. (Bion, 1961; Johnson, 1994; Yalom, 1995).
The meeting is viewed as a therapeutic environment (Chazan, 2001) in which the affective component consists of learning to identify and express feelings, finding safe and appropriate outlets for avoided feelings and defenses (Bowins, 2004) and tolerating high levels of emotion without becoming overwhelmed (Wise, 2003) through the body.
Single therapy shares features similar to social skills training and are often structured and task focused to promote social functioning, interpersonal relations, cognitive functioning, and problem solving skills (Ahmed & Boisvert, 2003), therefore social relationships can help to buffer the effects of stress and anxiety on mental health (Helgeson, 2003; Cohen, 2004).
Body-mind balancing psychotherapy role is to establish a frame work that include rehabilitative activities in order to maintain the locus of control achieved by each patient and creating a supportive environment in the hope to achieve consensuality, cooperation and competence (Bazerman, 2001).
The Use of the Body
The patient body experience is a tangible vehicle; it connects to the present and a particular place, even if the subject matter refers to the past. The body expression understanding helps to see that our troubles do not have to be ?so scary?. Body-mind balancing psychotherapy helps us to open up verbally; it is a vehicle of communication. It connects the inside and outside world, it makes the therapeutic process visible as a guide to universal qualities of the senses experience (Johnson, 1994).
Body-mind balancing psychotherapy provides a connection in which primary creativity and objective perception based on reality testing is allowed, through the body expressions of sense, feelings, emotions and memories.
Winnicot (1971) assumes that the task of reality acceptance is never completed, that no human being is free from the strain of relating inner and outer reality, and that the relief from this strain (which otherwise raises anxiety) is provided by an intermediate area of experience, which is in direct continuity with the play area (p. 13).
Winnicot (1971) called this area ?potential space?, the area between the infant and the mother, between therapist and patient and between the group members and the group leaders. In other words, ?it is play that is universal, and that belongs to health: playing facilitates growth and therefore health; playing leads into relationships; playing can be a form of communication in body-mind balancing psychotherapy and lastly, psychoanalysis has been developed as a highly specialized form of playing in the service of communication with oneself and others?, (p. 41) since an important feature of playing is the freedom to be creative in an environment that promotes emotional development, through creativity and expression of feelings about their lives (Hannah, 1992). Winnicot (1971) states that it is creative apperception more than anything else that makes the individual feel that life is worth living, it also provides a reason for working together and to gain confidence in their abilities (Hannah, 1992).
Patients lack any feeling of worth in life, they relate to despair, anxiety, hopelessness and fear, they feel that life is not worth living, they live uncreatively and for Winnicot such ?a way of living in the world is recognized as illness (p. 65). Therefore, creativity belongs to being alive.
Karterud & Urnes (2004) clinical experiences reports that ?patients may learn from exploring and playing with feared situations in safe surroundings and appreciate non-verbal modes of exploring and expressing contents of the mind.
Body-mind balancing psychotherapy is a non-verbal mode of exploration at first, it evokes a deeper connection to ones body, images, memories, feelings and emotions, the verbal part of the session connects the response from patients and the therapist to their production, helps them understand and reflect upon the content of their own mind in comparison and contrast with their body.
Case Study
Case History
Background Information
(Identity details have been modified in order to protect the patient privacy).
Eran (alias name) was born and raised in Jerusalem, Israel. His father, who died when Eran was 36 years old, was a locksmith. His mother was a homemaker. Neither of his parents finished high school. Eran is 52 years old and has been working as a taxi driver for a local company for the past 30 years. He reports that he likes his job and enjoys interacting with people.
Eran has a younger sister who lives in the United States, where she lives with her family. Eran has very seldom any contact with her.
Eran has been unmarried his entire life, he never developed permanent lasting relationships. He reports that the relationships that he had where sporadic and short. The longest relationship lasted 4 months and Eran has very little insight on why it ended.
He lives a celibate life in the past few years, with the exception of occasional sexual encounters, which in recent years have become rare, Eran self-image is low, he reported to feel unattractive since he gained weight. In the past 10 years he kept gaining weight Eran believe that his job as a taxi driver is quite sedentary and since he no longer as the energy to work out he keeps gaining weight and feeling unattractive.
Eran used to be involved in Tai Chi and Chi Kong but he no longer practices it. During the past three years coworkers have noticed a gradual change in Eran. While he always seemed cheerful and fun to be with, he started to withdraw from his social interactions, he spent his time on his own, he stopped going to after work meetings, to his Tai Chi group. He blamed his back for this ailment. He went to several doctors who found nothing physiologically wrong with him. But, Eran was in constant pain, it was difficult for him to bend without feeling his lower back. He started spending his free time at home, laying down, watching TV at all times.
Eran work as a taxi driver has no movement and is quite sedentary; during his free time he is quite passive in his activities and become uninterested in engaging in his previous social life.
His self-image began to deteriorate, his lower back pain was getting worst and he was on the on set of depression. All he could manage was work and the basic necessities to run his home.
At the urging of his orthopedist Eran sought help to relieve his lower back pain which has become unbearable and debilitating.
II. Intervention
The therapeutic process lasted two years in which Eran worked through his depression and disruptive body-image, in time he found the energy to renew his social life.
Eran body had a lot to say, we worked through his lower back pain for months, and slowly he started to realize that he had a hard time relaxing his back-muscles, he understood that he lacked the feeling of being able to lean on somebody, having always taken care of himself, he could not rely on anyone but himself.
At the same time he could not let anyone else lean on him, since he was able to sustain only himself, women needs for companionship were too much for him, hence his intimate relationships were short and quite a part from each other.
In time Eran was able through touch and guided imagery to relax his lower back muscles, the more freedom from pain he felt the easier was for him to move.
After 4 months, the therapist suggested to Eran to engage in a sport of his choice, he felt this was too much for him, through a verification process the suggestion of swimming was proposed to Eran. He loved to swim as a child, and decided to give it a try.
He registered to his area country club and began swimming twice a week regularly, after two months he made it to three times a week. Slowly he started to feel better and to meet other people at the club.
The trainer suggested to him some basic work out with weights and a visit to the club dietitian.
Eran physical state was improving steadily, this opened up issues regarding his feelings of loneliness and solitude. He desired a long relationship with a partner and we started to work through the body in that direction.
Feelings of inadequacy, shame and rejection in his childhood started to being evoked, past memories of events long forgotten.
The process hereby presented reassumes the first year of work with Eran, in which the symptoms of lower back pain were due to his feelings of isolation and withdrawal from social interactions.
© Aviva Lodan, M.A. Group Leadership through the Arts and Holistic Body-Mind Balancing Psychotherapist.
© מאת אביבה לודן, M.A בהנחיית קבוצות בשילוב אומנויות ופסיכותרפיסטית גופנית הוליסטית.
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© מאת אביבה לודן, M.A בהנחיית קבוצות בשילוב אומנויות ופסיכותרפיסטית גופנית הוליסטית.
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