THE FOLLOWING ARTICLE APPEARS IN THE THERAPIST (magazine of California MFTs) July/August 2020. PGS.18-22
By MARGRET ELSON
The underlying premise for integrating psychomotor interventions in traditional psychotherapy is based on the mounting evidence that emotional and physical processes underlie our cognition, and that those processes are not necessarily accessible through conscious thought or talking. In fact, non-verbal interventions can provide inroads into the unconscious with an immediacy that directly leads to changed perspective, physiological re-wiring and life changes (Damasio, 2005; Levine, 2008; Porges, 2011; Van der Kolk, 2014)
Therapists who incorporate non-verbal interventions such as movement, calming exercises and sensory awareness as important adjuncts in their cognitive/verbal therapy, will greatly enhance the therapy process for their clients. Using those approaches often provides short-cuts not only to uncovering what is unconscious, but also to discovering answers to challenging, troublesome questions, and to enhancing the beauty and creativity in clients’ lives.
Movement is currently being explored in wonderfully innovative ways in a multitude of arenas. One example is the exploration of dance in helping understand complex scientific principles (JohnBohannan, 2011; Flink and Odde, 2012). Another is the military’s use of yoga as therapy to combat the effects of stress (Steinhauer, 2019). And if you have seen the British production of “War Horse,” it won’t surprise you that the creators of the life-like horses embarked on that project by first studying dance. “We must move to survive…(movement) is not optional; it is essential“ (Pointzer, 2019).
Evolution and biological facts reinforce the importance of such methods. The importance of movement to our survival is evidenced by the fact that, of the 100 billion neurons in our brain, fully half are found in the cerebellum, the area of the brain that coordinates movement and balance. It is the oldest part of the brain, developed 300 million years ago. The cerebral cortex, a relative new-comer in the evolutionary development of the brain, developed somewhere between 4 and 12 million years ago, and was stimulated in its growth when mankind became bi-pedal, that is, when mankind started becoming more mobile (Pontzer, 2019).
Movement plays a vital role in our overall physical and emotional health. It provides oxygen to the brain, increases the number of cells in the brain, enhances focus and concentration as well as the ability to recall. In fact, neuroscience continually provides evidence of the powerful connection between movement and cognition and learning. (Pillay, 2016). In addition, movement lowers cortisol levels which is extremely important in countering stress, because stress stimulates the release of cortisol. In trauma, a person’s perceived sense of danger when none is present, triggers and maintains cortisol in the blood, thereby lessening that person’s ability to think clearly, act rationally and feel safe.
Changes in brain response to stressful situations happen so quickly that people aren’t aware of them. The wiring is so efficient that the amygdala and hypothalamus, the emotional parts of the brain, start this cascade (of physiologic responses) even before the brain’s visual (and other sensory) centers have a chance to fully process what is happening (Harvard Medical School Brochures, May 2018).
With stress, psychic energy is restricted. The emotional brain overwhelms the cognitive brain; healthy fantasy and healthy aggression are restricted, may make you forget what you really know. It is at this point where non-verbal modalities can provide the essential ingredient for releasing the frozen energy and, when appropriate, discovering the underlying causes of stress. I say, when appropriate because the therapist must judge when dealing with the actual causes of stress is itself therapeutic. Sometimes the release from the aftermath is sufficient. And as I discovered, movement can unlock answers in unexpected ways.
The Teacher That Didn’t Know Best
I experienced my first encounter with the power of movement when, after teaching piano for a few years and thinking myself quite accomplished, I was confronted with a talented university student who wished to learn a few piano pieces in order to pass an exam. At every lesson, as I endeavored to give him a broader musical experience than merely learning a few pieces, he challenged me. The more challenged I felt, the more entrenched I became in my method. Lessons became painful for both of us.
I sought the help of a music therapist, Suzanna, who I knew from the music school at which I was then teaching. I briefly explained the situation before she led me in role-play. First I played myself teaching Suzanna, role-playing my student. Then we reversed roles, and I played my student to Suzanna’s playing me. Within minutes, she turned, and candidly confronted me. “Why are you asking him to do anything besides what he wants from you? He was clear about his goals from the beginning. What are you trying to accomplish?”
The result was instantaneous. From a simple, relatively short role-playing exercise, came a cascade of insights: first, I saw that I was in a power play, that whenever he challenged my judgment I fought to salvage my self-worth as a teacher. Simultaneously, I realized that music lessons are much more than the study of music, but about the interpersonal dynamic between teacher and student as well. Most importantly, I realized that, if we bring our full selves, which includes ego, to every situation, I needed to learn a whole lot more about who my full self was.
That one role-playing session – mostly action-based, and little in verbal give-and-take – were immediate and life-changing for me. I changed my approach to my student at the very next lesson, and he successfully passed the music exam. I also began what was to become my second career, a therapist. Needless to say, that one session with Suzanna did not occur in a vacuum. I had had wonderful traditional talking therapy before, through which I gained tremendous self-awareness. But, this session resulted in awareness AND an immediate release of energy, which culminated in my changing at the very next lesson. (Elson, 2017.)
Thanks to my recalcitrant piano student I wound up with two practices, and over the years of teaching and psychotherapy have come to see music and psyche as soul mates, sharing the same compartment in our souls in which emotions are lodged. That is to say, we experience both music and psyche below the threshold of conscious analytic thought; neither readily lends itself to verbal expression. The power of music derives from its direct impact on our nerves, needing no further interpretation, just like the direct and unmediated impact that preverbal, preconscious experience has on the body. I love the following quote from Van Der Kolk who quotes behavioral neurobiologist Damasio: “All feelings of emotion are complex musical variations on primordial feelings.” (2014)
In teaching, I found myself using movement increasingly as a means of exploring musical issues. One example: Cassy was learning a Schubert Impromptu that opens with a cascade of running notes that end briefly in a chord and short rest before the cascade repeats. Cassy felt stuck musically, “I don’t get how to play that chord” and asked me how to interpret it. Rather than showing by playing it for her, I asked her to walk away from the piano and move to the phrase as she sang it. After moving, it took her seconds to realize she’d been playing that moment as an ending of the cascading phrase, landing on the chord rather than feeling how that chord moved the music forward into the next phrase. When she next played, that moment had continuity, rather than a sudden feeling of ending. As everything that happens in music can be construed as a metaphor for life (Barenboim, 2008), a musical moment like that one can be likened to the ways we feel unrelated in life, not clear how to move forward. Especially when stressed we “forget” that there is another way of feeling.
Using Movement in Therapy
Clinicians who are not used to incorporating non-verbal modalities in their work may experience some discomfort when they first introduce such interventions. But there are many occasions when one can quite easily and seamlessly do so with both client and therapist seated. As always, your judgment is your best guide
When your client talks about any state of being from which she seeks relief – depression, anxiety, fear, fights, loneliness, self-hatred, to name only a few we encounter in our practice – you might say something like: “I hear what you’re saying, and I’m wondering if you could actually show me what that feels like by letting your body become that feeling of worthlessness? Show me with your body what your feeling less-than-worthy would look like if it were a statue or someone painted it.” If the client says, I don’t understand, you can always add: “Well, in the past when I felt that way, this is what I probably looked like” or, “If I felt worthless, I think I’d look like this” and take a pose yourself. When we as therapists show our own humanity, clients are apt to respond very positively, and feel better understood. In any event, after exploring with the client how that feels internally, and talking about what comes up while in such a stance, the next obvious intervention is, “How will your body look when you have attained a sense of worthiness?” Reinforce that second pose by bringing in sensory awareness: how do you look in a typical day feeling worthy? What does your skin feel like? What do you hear?
If the client demures from doing this exercise, you can always start by asking her to visualize the situations instead. Afterwards you can segue into asking your client to show you how they looked in the visualizations. I have found that, once someone has experienced the effects of such moments, she is increasingly open to future such suggestions.
Walking Interventions
Paula, a client with a writing project she had to complete, was stuck. “I need to finish writing a proposal, but every time I think of going to my desk, where all my material is, I get immobilized. This is a very important job, I can’t afford to lose it…” When I probed, she wasn’t able to come up with any reason for her inability to get to her desk. Paula agreed to trying a walking exercise. I asked her to walk slowly from one end of my studio to the other which represented where her desk was, taking a step forward only when she was comfortable doing so. She took a few steps forward then stopped. “What’s happening, Paula?” With a surprised look, she said: “What comes up is I’m imagining walking to my desk and to get to my desk I have to pass my husband’s desk…and he’s been getting me to help him with his work recently and I really don’t want to…in fact, it makes me furious that he expects me to help him when I am working so hard on my own stuff. I’ve been helping him for years… ”
What initially seemed like a personal block in her work was revealed to be part of deep-seated marital issues. It was to those that we next turned.
Another simple walking exercise entails walking backwards into one’s life, rather than forwards as with Paula. “My life is crazy now,” Nat, who was 52, declared. “I don’t have a handle on it, I don’t see what’s important, what’s not, my family is always complaining that I’m in my own world…I have no idea how to sort out what to do. And needless to say, I’m miserable.”
After he reluctantly agreed to trying something different, I asked Nat to go to the far end of the room, at which point he would be himself as a much older man. He’d walk back towards this moment in his life and see what it looked like from that perspective. With a sober look on his face, he stood and walked to the far end of my studio and commenced walking back. “I’m eighty now, I’m looking at the life I led when I was 52.” Another tentative step. “I see myself in the house looking out at the backyard… my family is on the lawn, my son is tossing a ball around, my wife is smiling, lying on the lawn with my daughter…I feel so lonely. I wonder if they even want me to join them…” I asked Nat to see what happens if he walked out of the house to join them. “I’m afraid…” he said. “Then you needn’t,” I assured him. “Stay where you are, watch, and see what happens.”
“But I really want to join them,” he said as he took a tentative step towards this scene. “If I don’t, I’ll never know what could’ve been…” I’m going out now, I’m walking toward them – my wife is sitting up and gesturing me to come over. My daughter is waving….my son throws the ball to me…It feels like they’ve been waiting for me…this feels so important…my family is the most important thing in my life, and I kept thinking my work was… be the perfect husband, provide for the family, but I was never happy. I’m smiling in this picture, just tossing the ball…I can’t remember when I smiled last.” Needless to say, there was still a lot of figuring out left for Nat to do. But his walking, back into his own life helped clarify in the space of 20 minutes what that life could be about.
The Necessary Balance
In life as in music, it is important to have balance between states of resting/calm and of moving/flow. Ideally, there is fluidity between those two states.
Knowing how to self-calm is of utmost importance. I created a modified version of a breathing technique originally for people suffering from performance anxiety. It is aimed at immediate release of body tension, and re- focusing of one’s thoughts at the first feeling of stress. I now find myself introducing it to most clients at some point in our work together. I emphasize that the exercise needs to be practiced in moments of calm to become the default physical response when needed (Elson, 2002).
Taking time, you breath to your abdomen watching yourself do so until you feel your body become calm and peaceful. Then imagine a soothing image, such as a calming light, a tree, lying on cool sand, whatever feels soothing, at the spot in the abdomen to which you are breathing. That image serves as your “cue” for whenever you need to de-stress. As soon as you feel anxious, you breathe to your cue, which, after practice acts like any cue in life to which you have become habituated with a physiological response – such as hearing/smelling someone preparing food and feeling hungry; a typical Pavlovian association. In this case, your conditioned response is that your body relaxes, and you re-focus.
Caveat: Know thy client. Sometimes, fully breathing can be risky; it can make one feel more present and visible, the fear of which often an indicator of early childhood trauma. If a client becomes afraid as a result of fully breathing, it can be wise to segue into any kind of movement – walking, jumping, yoga poses – to dissipate the energy associated with past trauma that has been ignited. However, it could also provide the inroad to dealing with the trauma, depending of course on the client’s response.
Couple and parents entangled with partners and/or children can use the cue-to calming to abort situations that normally escalate. Be sure to coach these clients in session on how to use this in actual situations. As with learning any new behavior, practice is essential, so I make it a point to practice in session using the cue-to-calming breathing technique, and create a script to employ when calm is gained to avoid re-starting the arguing (Elson, 2017).
My Special Exercise
And finally, I have a special exercise I use for many different types of occasion, especially ones of feeling trepidation, fear, frozen, dejected, hopeless. It is – like music – based on the metaphor of continuity and speaks to the reality that time and life move forward, and often there are surprises ahead. I use this whenever I’m preparing for anything challenging.
I take a pose as if I were a statue that represents how I’m feeling in the present moment. Maybe my arms are folded and I’m looking in the distance with brows raised. (What’s ahead?) Then I assume a second pose that represents my life up to that point. Maybe my left foot steps back and my arms reach left. From there I let my body take me to the third pose, representing all the moments after this present one. I find myself standing upright, looking ahead, arms reaching out.
Then I animate the three posed-statues, and start moving, letting the three discrete stances become more of a continual movement, until I’m moving in a fluid, very original “dance,” letting past, present and future flow into each other. The results are uplifting: as we have seen, physically moving in itself can be a powerful antidote to anxiety. And the continuity of movement can give a needed perspective of how nothing in life is static – an important reminder when someone is stuck, or feeling hopeless.
The important point is to let your clinical expertise, your common sense and your imagination coalesce to offer your clients dynamic and vital strategies for alleviating suffering. Nature gave us both physical and mental tools – like walking, breathing, our senses, imagination, an ability for joy, for surprise, just to name a few – that can be harnessed in service to our clients. And as the providers of such, we benefit as well.
References
Barenboim, D. (2008). Music quickens time. New York: Verso
Bohannon, J. (November, 2011) Dancing helps explain science. TED Talk. JohnBohannon2011x-480p.mp4
Damasio, A. (2005). Descartes’ error: Emotion, reason, and the human brain. London: Penguin
Elson, M. (2002). Passionate practice: The musician’s guide to learning, memorizing and performing. Oakland: Regent Press
Elson, M. (2017). The piano and the couch: Music and psyche. Oakland: Janowski-Tell
Flink, C. and Odde, D.J. (December, 2012). Science + dance = bodystorming.. Trends in cell biology. 22(12), 613-616.
Leppert, R. (1993) The sight of sound: Music, representation, and the history of the body. Berkeley: University of California Press
Levine, P. (2008). Healing trauma: Restoring the wisdom of the body. Boulder: Sound True
Pillay, S. (2016, March 28) How simply moving benefits your mental health. Harvard Health Publishing https://www.health.harvard.edu/blog/how-simply-moving-benefits-your-mental-health-201603289350
Pontzer, H. (2019). Evolved to exercise: Why humans – unlike our ape cousins – must stay active to be healthy. Scientific American, 320(1), 22-29.
Porges, S.(2011) The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: Norton
Siegel, D. (2020) The developing mind: How relationships and the brain interact to shape who we are. New York: Guilford
Steinhauer, J. (2019, Jan. 20) When your commanding officer is your breath. New York Times, 14.
Van Der Kolk, B. (2014). The body keeps the score. New York: Penguin
Van Der Kolk, B. (2007) Traumatic stress: The effects of overwhelming experience on mind, body and society. New York: Guilford