Working Experientially and Somatically with Couples
From The Journal of Couples Therapy
Working experientially and somatically with couples is a powerful method of accessing, exploring and transforming both intrapsychic issues and interactional patterns. In this article, a number of methods of working experientially will be described, along with their underlying rationale. Basic assumptions about the nature of coupleís difficulties and the role of the therapist will also be explored along with an integrated approach to assessment that provides a solid basis for these dramatic interventions.
Jane began the session complaining that she could not rely on Mike. She held herself stiffly, her neck extended above her shoulders like a small girl being a good little soldier. Mike sat nearby looking helpless. She said, "I just can't lean on him." I said, "Let's find out. Let's see what happens if you have an opportunity to actually lean on him. You want to try?" She indicated that she would be interested in this, so I said, "Okay lets actually have you physically lean against him, and letís find out what comes up inside of you - feelings, thoughts, sensations in your body, beliefs, memories, images, tensions or relaxation, or nothing at all. Why don't you take a moment inside so that you can notice any subtle changes that occur when you let yourself lean on him. And Mike you can notice what it is like to be leaned on."
After a bit of negotiating, she found a way to do this. She let her head slowly come to rest on his shoulder. After a minute she looked at me and said, "I can't stand this!" I asked her what was so uncomfortable about it. She told me that it brought up memories of her past boyfriends, and her tendency to give herself up in relationships. She said that she had sworn never to let herself do that again. Even though she wanted to lean on him, that was the last thing in the world she would permit herself to do.
I asked her if I could help protect her from losing herself in the relationship. I offered to support the part of her that advised her not depend on any man. I could also see her body pulling away from him even as she leaned on him, so I also offered to assist her in not leaning. I sat next to her on the couch gently pulling her arm so that she could not manage to lean against him fully. I also whispered in her ear her own words, "Never depend on a man again". As I did this, I could feel her very gradually begin to lean more towards him. My support for her defense allowed her to feel the impulse underneath it. As we continued with this experiment, she experienced more and more of her desire to be taken care of, and more ability to actually let in available nourishment from her partner. It became less and less necessary to hold her away from her partner. At this point I wanted to check in with Mike to see what was like for him to be in the uncharacteristic role of supporter. He grinned and said that he finally felt useful to her.
A number of experiential interventions were used in this session. These include the use of mindfulness, physicalizing a psychological dynamic, and supporting defenses both verbally and physically. They will be discussed later in this paper in greater detail.
There is a big difference between watching National Geographic on television and going to Africa to watch the giraffes come to the watering hole at dusk. There's a difference between discussing chocolate cake and eating it, between thinking about sex and having it. By working with live experience, one performs psychotherapy in vivo as opposed to in vitro. People develop psychological difficulties not just as the result of polite conversation but because of the impact of real experiences. Therefore it is very important to access real experiences in psychotherapy as opposed to simply talking about them. Psychotherapy comes to life when working experientially. When working this way, both therapist and client no longer need to guess about motivations or possible interpretations for behavior. Instead, they are engaged in developing the client's ability to be connected with him or herself in such a way that this kind of information becomes available in a direct fashion. Rather than discussing change, clients can take actual risks with trying out new behaviors and beliefs immediately in the session.
There are a number of assumptions that underlie this approach to experiential psychology. These are useful to understand and consider, even if you do not agree with them.
The Problem: What, in general, are the causes of the difficulties that couples experience? This question, of course, can be answered in many different ways depending on your theoretical orientation. One possible answer to consider is the following: Each individual in a couple learns early in childhood to adopt certain character strategies in order to cope with difficult situations and people. The strategies were intelligent and creative adaptations to situations that were often hurtful in many profound ways. Over time, however, the very method that once protected the spirit, becomes its prison. It becomes limiting and depriving. For instance, if you grew up in a household where no one was paying attention to you, you may have learned that the only way to be noticed was to become intense active, colorful, and have big problems that are difficult to ignore. This strategy, in fact, may have worked in your family to garner at least a modicum of attention. In an adult relationship, however, this same strategy might overwhelm an intimate partner leading him or her to turn their attention away from you. This, of course, reinforces the underlying belief that no one is interested in really listening to you. Unfortunately, according to the wisdom of the strategy, being ignored is the cue to intensify your expression, thereby unwittingly further alienating your partner.
Bear in mind, however, that people are, in fact, no more their character strategies than they are the cars that they drive. No one is a 1936 Histrionic 230 SX, or a 1952 Borderline convertible with split leather seats. If you fail to recognize this, your relationship with your clients will be limited by your misunderstanding. Your pathologizing of them will substantially effect the intersubjective field between you, and their level of trust and self-disclosure can be impacted.
Unfortunately, the character strategies that we learned as children usually become overgeneralized. What we learned in our family of five becomes generalized to the rest of the world. What was once adaptive becomes limiting and calcified. For instance, Jane learned to be self-reliant and not to depend on anyone when she was still very little because no one is her family attended very closely to her needs. This continued to play itself out in her later relationships with men. She would portray herself as self-reliant and not needing anything. The intimates in her life would consequently treat her accordingly. This, in turn, would prove her core belief that no one was really interested in helping her. Neurosis is maintained with a little help from our friends.
Character strategies are maintained in the present through the interaction with our intimates partners in circular, self-reinforcing dynamics involving both people. The symptoms, which distressed couples present in psychotherapy, are often a precipitate of these circular patterns.
People are holographic. Their character strategies are revealed in their tone of voice, their pace, their gestures, their posture, their style of doing any small act. Therefore it is possible to see the evidence of character, core beliefs and childhood wounds in something as small as the inflection of a woman's voice, or the way in which a man looks at his partner.
People want to change desperately, while at the same time wholeheartedly resisting change. We long for freedom from the self-imposed limitations of our character, yet our defenses usually inform us that they are our allies, and we would be fools to come out from behind their protective cover.
Role of the Therapist:
In order to intervene effectively, one must be able to assess accurately what is going with a couple. Every theoretical orientation also has its own approach to assessment. From an Object Relations point of view, for instance, one might look for transference, projection, projective identification, and the interaction of characterological defenses. From a Family Systems point of view one might look for self-reinforcing, circular relational dynamics. From a Narrative point of view one might look for the problem saturated stories and the unique outcomes. From a Strategic point of view one might look for how the ways in which a couple tries to solve their problems actually maintains and exacerbates them. From a Bowen point of view one might notice where this couple is on the continuum from fusion to differentiation. From a Cognitive Behavioral point of view, one might notice how each person's cognitive distortions and interpretations of the other's behavior lead to distress. Each system examines a couple through different lenses. As far as I can tell, despite claims to the contrary, no system has an exclusive relationship with the truth. It seems useful to be able to assess a couple from a variety of angles and not try to fit a couple into the limitations of one particular lens.
As a way of integrating these many divergent points of view, I believe that it is important to assess a couple by noticing both the systemic as well as intrapsychic elements that keep the difficulties in place. For instance, if Laurel is angry with Henry because he is so withdrawn, one might notice a circular quality to their interaction. The angrier she becomes, the more he responds with withdrawal. The more he withdraws, the angrier she becomes. Their interaction is self-reinforcing. It is also extremely important to examine the intrapsychic elements that underlie each partnerís position in this dance. Where is it that Henry learned about withdrawal? What is familiar about it? How does it protect his heart? What in Laurel is triggered when she notices his unavailability? Has this happened before? Do the wounds from the past intensify how she perceives and feels about Henry when he withdraws? Each person comes to relationship with a history that is replayed in the present in circular self-reinforcing ways. Diagnosis and assessment are most useful when they take into account both these elements. Accurate assessment of the couple's dynamics leads to appropriate and effective interventions.
There are many experiential techniques that one can apply to assist a couple in deeply accessing, exploring, and transforming their internal and interpsychic dynamics. Working with experience brings therapy to life and presents the opportunity to work deeply with the place inside of people where their psyches are still malleable. Below, I will try to expand on the standard repertoire of experiential techniques by including a number of categories of working with experience such as:
I will briefly describe each of these and provide short vignettes of how they are applied. Please note that this list is not exhaustive. If a therapist is well grounded in assessment procedures, then working experientially is limited only by their own creativity and imagination. Being able to conceptualize what is transpiring in a coupleís dynamics leads directly to appropriate interventions. One can borrow from a variety of other orientations such a psychodrama, art therapy, movement therapy, and other adjunctive methods to generate possibilities for working with live experience.
The approach I am proposing is derived primarily from an experiential psychotherapy called the Hakomi Method of Experiential Psychology (Kurtz, 1992). This method was developed by Ron Kurtz as an individual psychotherapy and has been applied to couples therapy by myself and others. In addition to its deep dedication to working with live experience, two of its most distinguishing features are the use of mindfulness, and the belief that supporting defenses is more effective than opposing them. This method is also very aware of power imbalance between therapist and client and the potential for harm and violence that can subtly, or not so subtly, be inflicted on clients.
Experiential and somatic approaches to psychotherapy have a long history starting with Freud's use of transference (an intense experiential event occurring in the session). Virginia Satir worked with family sculptures and stressed the nonverbal aspects of communication. In Peoplemaking (Satir, 1972) she writes, "Whenever you say words, your face, voice, body, breathing are talking too." (p.60.) Minuchin asked clients to reenact scenes from their lives outside of therapy. Fritz Perls worked only with people's immediate awareness. Keith and Whitaker wrote, "We presume it is experience, not education that changes families."(Keith and Whitaker, 1982) Napier and Whitaker (1978) wrote, "This approach assumes that insight is not enough. The client must have emotionally meaningful experience in therapy, one that touches the deepest levels of his person."(p.283) . Milton Ericksen and others have also continued to expand upon this tradition. Alexander Lowen (Lowen, 1958) believed that the body was an expression of character: "The character of the individual as it is manifested in his typical patterns of behavior is also portrayed on the somatic level by the form and movement of the body. The sum total of the muscular tensions seen as a gestalt, that is, as a unity, the manner of moving and acting constitutes the ĎBody Expressioní of the organism. The body expression is the somatic view of the typical emotional expression is seen on the psychic level as ĎCharacterí."(p.15) The new crop of body psychotherapies such as Integrated Body Psychotherapy, Bodynamics, Core Energetics, Formative Psychology and others are all making their contributions as well.
Any of the techniques from these orientations applied to couples psychotherapy may be useful, provided that they are based on careful assessment and are not simply accessing experience to create drama. Dramatic therapy is not always good therapy. These techniques can also be particularly effective if they make use of the principles and the techniques of mindfulness.
The Use of Mindfulness
Prior to introducing any experiential intervention, I ask the couple or the individual involved to become mindful. For instance, I might say, "Take a moment to go inside, to turn your attention inward, so that you can notice any thoughts, feelings, sensations, changes in your breathing, tension or relaxation, memories or images that might spontaneously arise". I slow my voice down, and sometimes close my eyes in order to model turning my attention inside. This provides a frame in which we can all become curious and nonjudgmental about the inner workings of the couple or individual. Once mindful, we can then, on purpose, evoke a variety of experiences that can be collaboratively explored.
For instance, I might notice that it is difficult for a wife to listen to her husband complain about her. I might ask them to repeat a small portion of this interaction in mindfulness so that they can notice the subtleties of 1) what occurs inside of her when she hears his complaint, and 2) he can notice the place inside him from which the complaint originates . In one couple I saw, this was just the case. He would complain and she would either defend herself or cross-complain. In order to explore this further, I asked him to repeat only one sentence of his complaint. One sentence is a sufficiently small dose so that the partner does not become so overwhelmed that they lose their observing ego. I asked her to receive this sentence in a state of mindfulness. She didnít have to justify herself, agree or disagree with anything. She could simply study her own automatic reaction to his complaint. In essence they conducted their interaction in slow motion. Instead of defending herself, she noticed how intolerable it was for her to disappoint him. As she stayed with this feeling she remembered how her parents had never punished her. They just said, "We are so disappointed in you." It was very unlikely that she would have recognized these underlying feelings unless she was in the state of mindfulness. More information becomes available to the conscious mind when mindfulness is utilized.
Any interaction in which the couple engages can be studied in a state of mindfulness in order to bring unconscious material into awareness. If one sets up evocative experiments without mindfulness, the amount of unconscious material that becomes available is limited.
The therapist also needs to be a state of mindfulness. He or she needs to pay attention not only to the ever-changing internal experiences within him or herself, but more importantly to the moment-to-moment internal experiences of each member of the couple. Tracking internal experience is a major key to working experientially. In addition to tracking the content and themes of session, it is extremely important that the therapist notice nonĖverbal communications such as changes in posture, gestures, energy level, breathing, coloration, the presence of beliefs, feelings, pace, volume, the style of walking, sitting or talking, to name just a few possibilities. Tracking these elements allows the therapist to join with the client and encourage whatever unfolding is trying to take place from his or her psyche. If, for instance, a tear rolls down the cheek of one partner, the therapist might say simply, "Sad, huh? This is simple intervention promotes contact and connection between therapist and client. If a man looks agitated while he listens to his wife complain about him, the therapist might say, "It's hard to hear this, huh?" Carl Rogers taught us to reflect back the meaning of what people say. This kind of empathic mirroring is an essential therapeutic technique. Contact statements go one step further and reflect back people's immediate internal experience. This is very intimate, and lets clients know that the therapist is present with them in a deep way.
Once mindfulness is present, the therapist can design opportunities for the couple and the individuals within it to explore how they are organized psychologically around each other. It is important to take into account each personís characterological contribution to the process as well as the selfĖreinforcing, circular nature of the interaction in designing these opportunities for study.
Experiments with Posture
Experiments with Gestures and Movement
Using Somatic Signals
A similar experiment is to ask a couple to draw or mark a boundary around each person to symbolize their experience of their personal space. Once drawn, the partner can move into or away from the otherís personal space and notice the effect. This helps to elucidate each personís organization around his or her personal boundaries. From here, the couple can explore each personís history around their boundaries and later negotiate how they would like to organize themselves around their own and their partnerís boundaries.
Physicalizing the Interaction
When intense feelings arise in coupleís therapy, the therapist can become torn about whether to work in a focused fashion with the individual with the feelings, or to remain concentrated on the coupleís dynamics. I have found it useful to work for short periods with one individual in front of their partner. This tends to increase empathy and understanding in the relationship. If, however, the listener is too impatient or narcissistic to listen and witness for a while, this needs to be explored as well. Leaning how to listen to oneís partnerís feelings is an integral component of intimacy. Modeling this skill, and exploring it with the couple in therapy is useful and demonstrates that feelings are not to be feared, but can be held by therapist and partner alike as deep expressions from the self. Feelings, given an environment that is nonjudgmental and safe, will unfold themselves. As long as the client is not falling into the vortex of retraumatization, the expression of feelings provide a vehicle for rapidly deepening a relationship.
A couple can also be instructed to come up with a verbal metaphor for their interaction. A metaphor should have a representation for each person, as well as for the interaction between them. Here is an example from my practice: Sylvia was irritated that Harry for being so emotionally unavailable. The more irritated she became, the more withdrawn he became. When asked to come up with a metaphor for this interaction, she came up with the following: "I'm walking across a windswept plain and I see a small cottage. I go to the door and knock. "Is anybody home?" I hear a voice on the inside say, "Go away!" I asked what she does then. She smiled, "Then I try to break down the fucking door!" I asked him what he would do in that situation. He replied that he would barricade the door even further. We then began to develop a new metaphor. In this story she walks across the same windswept plain and sees the cottage. She knocks on the door. She hears a voice say, "Go away!" She responds, "I have come with a truckload of mortar and bricks to help you build the walls of your cottage even stronger". I asked him what he would say then. He said, "I'll be right out!" This became a new reference point for the possibility of a different kind of relationship in which she was not so invested in tearing down his defenses thereby permitting him to come out of his withdrawal more readily.
Everyone enters relationships hoping that their partner will finally provide the specific kind of emotional nurturance that they did not have as a child. We are all very disappointed when this does not occur. If the therapist, with her knowledge of her clients, can come up with a sentence that distills the words of grace that each person would most like to hear, they an experiment can be constructed in which their partner can say those very words. Again, it is important to invoke mindfulness prior to beginning. While verbal statement is potentially nourishing, the most common result is that the defense to the nourishment is clearly evoked and can be explored in vivo.
Verbal experiments can be constructed to explore any area in the coupleís relationship. Either the therapist or intimate partner can deliver a short and simple sentence that is potentially nurturing to the other partner who is in mindfulness. This is different from an affirmation in that the expected result is often disbelief, suspicion or opposition to the statement. The purpose of this is to provide an opportunity to explore an individual's or a couple's resistance to nourishment. Some other examples might be: "It's OK to be vulnerable", "You can show your anger", "Your sexuality is welcome", "You're safe here", or "You don't have to do anything for me to love you".
"You're killing yourself Jack," said Sally, "I want you to quit smoking." Jack replied, "It's my life, and I'll do whatever I want to do!" So the discussion began in the session. I turned to Jack and said, "This is a fight for freedom, huh?" He nodded. I asked him to close his eyes for a moment. For the next five minutes his girlfriend and I assembled around him an army of sand tray figures that would be his soldiers in his fight for freedom. There were lions, Darth Vader, soldiers, fierce demons, Sumo wrestlers and even a bride. I asked him to open his eyes and told him that this was his army and it also included at least two other people, his girlfriend and me. We, too, would fight for his right to be free. Carefully he picked up each figure, one at a time, slowly turning it around in his hand and replacing it on the couch. Finally he spoke to his girlfriend, "I've got what I wanted, now what do you need?" She had become his ally.
Supporting defenses can be verbal or it can be physical. For instance, if a client is crying while hiding her face in her hands, I might ask her boyfriend or partner to help her hide her face. This is an example of physically supporting the defense. The support can even be metaphorical as in the story of the woman who brought a truckload of bricks and mortar to support the walls of her husbandís metaphorical cottage against intrusion. It can also be verbal. In one verbal experiment I started by saying to the couple, "It's OK to be vulnerable to each other". They mindfully tracked what came up inside. He reported that "The committee" said, "Why should you be open to someone who has hurt you like that?" We continued the session with her asking him to open up to her again. I sat next him, and with his permission, supported the part of him which advised against being open. I told both of them that the purpose of this exercise was to find out more about "the committee". After a while he turned to me and said, "I don't want to listen to you any more. This is not how I want to live my life." By externalizing the defense, he gained a new perspective on it and how much it limited him. He exercised his right to not defend.
Breaking the Trance of the Transference:
Here is an example: Joanne was upset at Harry: "I say let's go to movies, but you say no. I say lets have Chinese food, but you say no. I say let's make love, but you say no. I just can't stand it anymore." I was wondering if she was asking in a way that was alienating him, so I suggested that she bring the argument into the present and ask him for something she would like right now. I could then see clearly that when she did ask for something she wanted, she was not particularly demanding or offensive, but that he was triggered. I asked him what it was like hearing her request. He said, "She's just trying to control me". I suggested he take a moment just to stay with that feeling and notice if there is anything familiar about it. Were their other people he felt this way about? I asked him to imagine all the people that tried to control him positioned behind her, and I asked her indulgence to be all those people. Once assembled, it included everyone from Adolph Hitler to the multinational corporations raping the rain forests, from his grandmother to the Bible. They were all symbols of oppression. I told her that the good news was that he was in bed with Adolph Hitler not her! She did not need to take his rejection personally. We then gave him an opportunity to speak directly to all these people through their representative, and to experience the satisfaction of finally completing his communication, "You can't control me!"
Insight, however, is rarely enough for transformation. Understanding how one limits oneself through the constraints of character strategies and their attendant beliefs and models of the world is an important first step in transformation. Bringing insight into live interaction with one's intimate partner involves taking what is usually perceived as a risk. It is the risk to show oneself in a more vulnerable fashion than one's defenses would habitually allow. This is not for the faint of heart! The job of the therapist is to look for opportunities in which these risks can gently be taken in small increments, and to provide the support necessary for each client to step over this threshold into greater differentiation. In the opening vignette, for instance, Jane can expand her psychological repertoire by experimenting with leaning on Mike. This is a risk. Her character strategy informs her that it would be unsafe to do so, yet her self-reliance is compromising her ability to take in nourishment from the relationship. In the sanctity of the session, she can experiment by taking a risk to let herself be more supported by her partner than she usually permits.
The termination phase of therapy begins when positive changes begin to stabilize and the destructive patterns that brought a couple into therapy have decreased both in intensity and in frequency. Intimacy is enhanced and can be tolerated by both partners on an ongoing basis. At this point it is important to review and continue to integrate the changes that have already. Integration techniques such as those mentioned above fill the bulk of the session. The couple can role play difficult situations in the session and apply what they have learned in order to further stabilize the new interactional patterns. The therapist and the couple can discuss possible places in which they could have difficulty and review what they have leaned that would be useful in these occurrences. Much of couples therapy can be organized around exploring the deficits in the individual and in the couples psychology. In the termination phase, it is important to also reinforce their strengths and resources as well as explore further how they can deepen their closeness.
In summary, working with immediate experience provides both the therapist and clients with the opportunity to access core material more readily. Prior to engaging in any such interventions, however, because of the power of these techniques, it is important to take time to accurately assess both the intrapsychic and the systemic aspects of the couple's interactions. While there are many possibilities for experiential interventions, using mindfulness is particularly important in accessing deep psychic material. It can be used in conjunction with any other experiential approach. How the therapist positions herself in relationship to the client's defenses can also spell the difference between success and failure in psychotherapy. The recommendation here is to find ways in which both the therapist and the intimate partner can support rather than oppose defenses. Working with experience can generate immediate change in the couple's relationship. The format of coupleís psychotherapy lends itself to experiential interventions because an important element of each client's life, their intimate partner, is actually in the room with them. Existing intrapsychic and systemic elements can be explored in vivo. Opportunities to try out different interactional styles and new beliefs are omnipresent.
Rob Fisher, MA, MFT is a psychotherapist and consultant in private practice in Mill Valley, California. He teaches marriage and family therapy at John F. Kennedy University, and the theories and techniques of body oriented psychotherapy at the California Institute of Integral Studies in San Francisco. He also teaches couples therapy at the post graduate level in many agencies around the San Francisco area. He has just completed a book for Zeig/Tucker, on working experientially with couples. He has been a presenter at numerous conferences including a master presenter at the annual C.A.M.F.T. conference, and most recently at the USABP conference. He is the publisher of the Couples Psychotherapy Newsletter and the director of the Mount Tamalpais Center for Psychotherapy.