Things in The Body

At the end of my communication with the boy his aunt expressed a desire to talk with me about her problems. It was an indirect sign of recognition of the connection between the session and the recovery by the boy’s relatives. A large lump of fresh cottage cheese, which I brought to Moscow to my children, seemed to me a great reward for my modest question: «What do you feel?»

When you can let happen transformations like those, described by my little patient, nothing else is necessary.

In a few other cases, the challenge is to make the sensations flow. Such transformations are the essence of therapeutic achievements.

Do not talk

To tell the truth, sometimes I almost fall asleep when the patient tries to describe in detail the story of his suffering, not hurrying to work through it. It happens not only to me. In the “Technique and practice of psychoanalysis” Ralph Grinson especially considers such cases when a psychoanalyst accidentally falls asleep during a psychoanalysis session. He recommends not to blame the patient. I can cope with it even without pinching my own hand, but I do not tend to overestimate the effectiveness of this method of psychotherapeutic session and try to warn the patient about the uselessness of just listing the facts.

To avoid this, at the first mentioning of a significant event for the patients, which left a mark in their soul, I prefer to work through the consequent of their experiences, to verify the expediency of its storage, instead of being limited to a simple listing the imprints of events in their soul. I call it the non-slip principle.

Though it is possible to talk as well

However, I must note that there is no need to impose a rather closed, non-objective language of body sensations, when a person calls for an open conversation on existential topics and the balance of their state is not in doubt. Indications for SPT method are very wide, but not unlimited. It is the way to restore the resource of a person. It is needed in almost 100% of cases, but it is not the only thing that the patient may need. Thus, the psychotherapist is not obliged to use the methods of SPT always and everywhere.

We will continue to talk about situations where the balance of the human condition still raises doubts.

The ending – to the beginning

With the time, the phase of communication between the doctor and the patient, conventionally called the “relaxation phase’, became increasingly valuable. I learned to perceive it as a kind of goal, the culmination of the process of psychotherapy,

I once noticed that I was not at all inclined to talk to a patient. Of course, I mean «conversation of minds.» Taking into consideration the importance of the influence of affective charges on a patient’s thinking, I found out that it made sense to «talk to the boss’ (unconscious), in the words of M. Erickson, and not with subordinates (thoughts of conscious mind).

It was easier to find «the boss’ by the sensations in the patient’s body.

The direct appeal to the sensations from the very beginning of the work marked the opening of a unique opportunity to change the state directly, without talking (in the usual meaning of this word). The old formula «conversation – relaxation – conversation’ was replaced by a new one: «relaxation – conversation – relaxation’.

The idea, that the analysis of the patient’s circumstances was usually given an exaggerated value, began to strengthen. In fact, not these circumstances are so important, but how the patient «stands’ in them. It is important to help a person to take a different position in relation to the circumstances, to find another their state. The further is the matter of their own life.

The second phase became the first. Conversations began to start with the analysis of a condition, instead of a situation. Somatopsychotherapy is an exceptional care for the patient’s condition.

Separation of the concepts of “patient’s condition’ and “patient’s problem’

Often the conversation with the therapist flows into the area of discussion of the patient’s problems. I think this is a minimally productive approach. But firstly, let us define what there is besides the patient’s problems.

«The patient’s problem’ is what makes the body react. The perceived information about the situation inside or outside the body, deviates from the optimal. So, the persons consider the restoration of its optimality to be their vital task. This is the basis for their concern.

What is meant to solve the problem is the patient’s state. This is the life resource, the certain configuration of sensations in the body.

Perceptions of situations and responses to them vary widely. What is a difficult problem for one, is nothing for the other; when ones react with all their beings the others can stay completely indifferent. This observation makes you think about the initial state in which a person perceives the situation, evaluates it and forms a reaction to it. The constitutional and genetic factors, the early history of the individual and so on, play an important role in the formation of the patient’s state. It is important that by the time of the meeting with the psychotherapist, the result of the life of this particular person (with his genes, personal history and education) is presented in the form of a state with a certain configuration of internal sensations.

Temperature above 39 degrees

There is a number of situations when the patient’s condition itself (for example, tension) is a problem. As the temperature in case of inflammation goes above 39 degrees. The increase in temperature is natural, of course, but not to such an extent.

Entering the psychotherapeutic room, the patients do not always know what they did it for: in order to solve their problems, or to change their condition. (The third option is the question of how to constructively apply their condition to the problematic situations without changing it a lot). In fact, the problems of the patients are solved outside the therapeutic room. They come here to rate their state of mind in which they try solving the problems and to optimize it.

Psychocatalysis of body sensations is a method of changing the patients’ state and restoring their resources. It is not about solving their problems, unless, we consider the state of their health a special problem. In this case it is a «metaproblem’, the solution of which determines the solution of all other problems.

Separation of the concepts of “psychotherapy’ and “exchange of experience’

It is known that some psychotherapists, including the most authoritative, like M. Erickson or A. Alexeichik, did not shy away from acting as advisers to their patients. There is nothing unnatural in it: a wise person shares with the other one, who is not so wise, their life experience, possibilities, and the program of actions. Such advice of the psychotherapist is distinguished by the fact that it is given technically, “with the special approach’. The instructions remain in the patient’s mind until their full implementation… But it is not psychotherapy – it is an exchange of experience in solving different problems between the experienced and inexperienced persons. The same applies to psychological “problem’ counseling.

We are going to talk about psychotherapy, about helping to change the patient’s state. With such an approach the problems of life will go beyond the brackets. In the field of our study there will be only living beings themselves. The question will be only the following: in what state do they live? In what state do they solve their problems? One of the basic beliefs of the SPT is that it is good to solve problems when the one who solves them is a calm state – which is consistent with the position expressed by Freud: responsible decisions should be taken only after analysis.

The main concern of a somatopsychotherapist is to find what the patients’ resources, their energy, and their attention are being spent for. The work of a SPA therapist can be compared with the work of a prospector. The golden nuggets, that they extract, are the «petrified emotions.» The fact, that they look more like coal, should not be embarrassing. «Gold’, hidden in this ore, is the priceless energy of life, like human life itself is.

Not in blind

Activation of “moving sensations’, such as described in the case of the twelve-year-old boy, is quite common both in the states of “psychic genesis’ and somatic disorders. It is always surprising, delighting and reassuring when the body itself specifies and solves all the issues.

Typically, the sensations themselves are mostly «blind’. As for somatopsychotherapy, the control over this process is particularly important.

First and second level questions

To find out the characteristics of what is disturbing the somatopsychotherapist can go in two directions: the questions of so-called second level require more body energy for the implementation of the reaction, because the expected response is uncertain and creative. “Where is your fear?” – “In the belly”. “What does it feel like?” – “A jellyfish.”

The «first level’ questions are less energy-intensive, and the answers are more predictable. No wonder they are called guiding questions. «Where do you your feel fear: in the head, in the chest, in the stomach, or anywhere else? Is it something big or small, light or dark, heavy or light, dense or soft, or anything else?» You can ask about more details, bringing the questions to the «zero level.» «Does it weigh a hundred grams, two hundred, three hundred, five hundred, a kilo, more, less? Does it feel like gas, liquid, mass, stone, wood, metal, or anything else? Is it an object, a plant, an animal, or anything else?» The series of questions can be continued.

However, to go «below zero’, i.e. to assert something or to impose one’s intuition, is highly undesirable. Unfortunately, this principle is often violated. (And, of course, always with the best intentions!)

“A well working patient’

Being in the “working’ process, a patient begins to understand what is required. The questions become more concise. During one session, already by the third approach (“approach’ means a complete cycle of work; there can be several complete cycles during one session), a well-taught patient can quite “correctly’ answer “simple’ questions. Where are the sensations related to that age? (This refers to the age indicated in the figure in the drawing test). And the patient says, “In the head.” “What is there?” – “Dark heavy mass.” That means that the patient does not need specifying “tips’ such as: “Where are the sensations associated with the exact age: in the head, chest, abdomen, or anywhere else? Is it something big, small, light, or dark? What is it made of…?” anymore.

But even for such an «ideal’ patient some clarifying questions can be appropriate: «Is it in the forehead, in the back of the head, in the crown, or in the temples? How many grams is it? What is its size or volume?»

Somatopsychotherapy “Debuts”

Psychotherapy works with disorders. Disorders can be acute or chronic. Usually the patients come to the first appointment to the psychotherapist when chronic disorders have been supplemented with the acute ones and their life has become unbearable. What does the therapists do at the first meetings? They react to the patient’s acute disorders. What does they do next? They respond to the chronic disorders that the patient often does not realize.

The acute disorder can again occur in the patients when their fate is changing. In general, the probability of meeting an acute state at the beginning of psychotherapeutic contact is higher than in the future.

Why do I mention this well-known to every therapist fact? Because it is related to the topic of this chapter. At different phases of work with a patient, different ’approaches’ will be preferable, different ’debuts’ will be played.

From the actual

The general pattern is as follows: at the beginning of the appointment a patient is so full of different experiences that it is not necessary to look for them, they openly come out and it is easy to work with them. The patients can be quickly turned to talk about what they are experiencing. If they describe their body symptoms, such as ‘a stone in a soul’, it will only be necessary to specify if it is large or small, heavy, or light. If they mention the overloading of their forehead with restless thoughts, you can just ask: how many of them (thoughts) have accumulated there, whether they are large or small, what they are made of in their sensation, etc.

If the patient has previously conducted internal analytical work and managed to identify their condition, they declare fear, which limits their life, or jealousy, which drives them crazy, or resentment, which they do not know how to survive. It is also quite easy to turn their attention towards the description of the body sensations. «Where is your fear: in the head, in the chest, or in the stomach? Is it big, heavy, or light?». As soon as the first answers arrive, e.g. «My fear in my stomach, and it is big», you should immediately ask clarifying questions, e.g. «How many centimeters is it in diameter?», and thus lead the situation in the direction of identifying the plastic image of the experience, located on one of the levels of the body.

The usual dynamics of asking questions is as follows. Suppose that the patient complains to the severity in the chest, or finds there the feelings associated with the experience, which they manage to qualify as an offense. It is essential that the chest area is seen as problematic, concentrating all the sensations on itself.

Without any delay we specify:

«Is the heaviness in the chest big or small?

«Big,» the patient answers.

«How many kilos?» we continue to ask without any hesitation.

It can hardly be called a traditional way. As we have already mentioned, usually a doctor, after taking note of the symptoms, begins to establish a ‘nosology form’ thinking about the pills to prescribe to mitigate the painful manifestations. A psychologist embarks on a search for the psychological conflict that caused the disorder of the client. A healer immediately determines “the influence of an evil eye’ and starts to remove the ‘damage’. We have already talked about many options for the external use of the patient’s message. SPT also offers to continue asking questions and go into more detail about what has already been said. To make it easier for the patient to concentrate, you can offer them to close their eyes.

Closing the eyes, the patient responds:

«Ten kilos.»

«Ten kilos of what: gas? fluids? mass? wood? metal? stone? anything else? What does that feel like?»

«Stone.»

«What type?»

«Marble.»

«Shape?»

«Cube.»

«Size?»

«10 × 10 cm.»

Thus, we receive the initial information.

Please, note that we find out the characteristics of what is really felt. It is not a representation of something that does not exist.

So, in acute cases there are no problems with the beginning of the work, because the experience «strikes’ the energy circuit of a person or, rather, the contour of their feelings so much, that neither the patient nor the doctor finds it difficult to identify the «theme’ for work. The locus of experience also does not require long definition. The head «rips apart’ with the concerns, the chest is «pressed by resentment’, the fear «gathers all the power’ in one’s stomach, etc.

It is not so easy to determine the location of the «threshold’ and «sub-threshold’ experiences. In these cases, some tricks may be needed in order to find them and neutralize. Either it will be a subtle conversation, revealing the «zones of indifference’ of the patient, or something like what I want to describe as a special approach in the identification of hidden problems in the patient’s experience.

From the drawing

The beginning of ‘from the drawing’ is one of the favorites in my practice. The instruction to the patient is as follows: “Draw a symbolic figure of a person of squares, circles and triangles, the number of elements in the figure is 10”. If the patient has additional questions, it can be explained that the total number of elements that make up the figure is 10, but their quantitative ratio is arbitrary. It is advisable to draw without giving it much thought. It is possible to change the size of the squares, circles, triangles.

In some cases, I propose to color the figure and almost always to denote the age of the character. We will not consider the variety of options based on the constructive drawing of the person now. This is a separate topic. Let us examine only some cases of using this beginning. I was shown this test and some of the possibilities it offers by V. V. Libin15, to whom I am grateful.

The use of this test in somatopsychotherapy is different from Libin’s expert one, in which the quantitative ratio of geometric figures in the drawing is important to make the conclusion about the main problems of a patient and his personal style.

In our case, this task is used for a completely different purpose – therapeutic. The authors of the expert system recommend asking for five drawings of a human figure at once. In our ’therapeutic system’, this does not seem appropriate. The first drawing is the last one. It means that the state, genetically related to it, is immediately subjected to study.

Subsequent (post-therapeutic) products will be new, and again one picture will be enough to fix the change. I give importance to the age of the character (it is not practiced in the original test). I also use colors for this test.

Below there will be many specific examples of using the drawings. Now I would like to focus only on general issues.

The work with the drawings becomes relevant only after the obvious distortions in the patient’s condition are worked out. Psychotherapeutic communication goes into a new phase – the phase of cleaning the consciousness of ’polluting’ formations’ in a systematic mode. When the patient is generally calm and there are no other emergency topics for work today, then they get the task to draw a symbolic figure of a person of squares, circles, and triangles.

After the drawing is made and the age of the character is indicated, attention is transferred to the sensations in the body associated either with this drawing or (more often) with the age indicated near the drawing. «Where are the feelings associated with the age of N years? At the level of the head, chest, abdomen, or anywhere else?» As a rule, sensations are detected at the level of one of the mentioned zones and it turns out that they are associated with some experience, more often unpleasant, sometimes pleasant, but always significant.

When the first episode of work ends with the patient’s calmness, ’closing’ the old experience, an alternative, more productive response in such situations can be find. As soon as the cycle of work with a separate experience is completed, the same task can be given again – to draw a figure of a person from the already known elements. To give or not to give this task again depends on, firstly, whether the patient has enough strength to do another cycle of work, and secondly, on how much time is left till the end of the session. In case the patient is not tired and there is enough time left, work cycles can be repeated an unlimited number of times. Remarkably successful patients can work out up to 5—10 episodes per hour. But the general rule is one episode per a session.

I recommend paying attention to the description of this kind of work in the Chapter «The Case». There you can see the typical ’growing’ of person from session to session.

In conclusion, I would like to say that starting the recovery process with a constructive drawing of a human figure can help a lot in a systematic work through the patient’s problems during the psychotherapeutic communication. Using the drawings can help the patients to determine what was in the depths of their consciousness delaying their free development. They help to actualize the hidden experiences that seem to belong to the past, but, nevertheless, remain in the present and continue to have a negative impact on the patient’s life. It is difficult to overestimate the usefulness of drawings as an indicator of the patient’s condition when everything only outwardly looks normal.

In cases where the patient is experiencing significant anxiety and is clearly aware of their trouble, the use of drawings becomes unnecessary, even inappropriate. With all the sympathy for them, we must realize that they are the artificial means of obtaining material for the work.

Both in case of work from a conversation that reveals the actual experience, and in case of work from the drawing, the so-called ’principle of non-slipping’ works. The first mention of a significant experience is a sufficient reason to study it. Listening to the enumeration of the patient’s troubles is a useless exercise. To deal with their consequences is much more productive.

From the dream

The starting point for the work can also be a dream. Here is one example of the work “from a dream’ in more details, as no description of this kind is further expected.

The main idea is that any dream as a whole or its elements are provided with a specific charge or their combination. For every dream there is an equivalent in sensations at the level of the body. So, the question is: «Where is the feeling associated with this dream or the dream element?» For example, the patient’s respond is ’in the head’.

The dream of patient P. was determined by the experience of betrayal, and his feelings associated with it were in his back.

From heads to tails

Patient P. is twenty-eight years old. He is not married and lives with his mother. His father, abusing alcohol, died when he was fourteen. At the age of twenty-four he went through a difficult parting with his girlfriend who was waiting for him from to resign from the Navy. He gave up his Midshipman shoulder straps for her. But after his return from military service she decided to leave him. The patient took her statement about their break-up as a blow which caused much pain.

He tried to forget her. He started dating another girl he had been introduced to. Their relations were warm but without love, and their wedding did not take place. Because of that he was very upset, and everything began «to fall out of his hands’.

Being soft and deep by his character, he used to write poetry and paint in his youth. He was also interested in philosophy. But now he has not got any special interests. He complains about «lack of spirituality’ in his life. He says that he does not want to do anything. «There is no purpose in my life. I am waiting for some fairy godmother or social worker to come and help me rebuild myself. I am still a dime. But I was thrown from the heads to the tails,» P. sums up his sad story. Some time ago because of all that background he began to drink a lot of alcohol with his friends to ’feel better’. Once he was stabbed in the heart. Fortunately, the knife hit his rib. He explains psychological gain from such behavior by ’obtaining new information’. Those ’guys’ were the only real opportunity to share experiences.

The characters in his drawings are not all standard. In response to the proposal to continue drawing after the first one was made, he gave almost abstract compositions from the given standard elements: squares, circles and triangles. The third figure in this series was subsequently decoded (Fig. 1). It turned out that it echoes the dream, which was the starting point for one of the episodes of the work. It depicts a sprawled man. «Two holes in him, in and out.»

Fig. 1