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advancing our field

Member driven blogs to spotlight solutions, share opinions, raise public awareness, and contribute to shaping our national mental health policy.  Stay current and up-to-date in the world of somatic psychology and practices.

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  • 23 Jun 2021 2:12 PM | Anonymous member (Administrator)

    By  Amelia H. Kaplan and Laurie Schwartz, Rutgers University and New York, NY

    Body-centered Psychotherapy (BcP) is a developing field of academic investigation. The present research employed the Pragmatic Case Study Method (“PCS Method”) for systematically studying how verbal and somatic interventions are combined in a single therapy in two 12-session cases seen by an experienced BcP therapist. Following the PCS Method, the cases begin with a presentation of the therapist’s theoretical approach, or “guiding conception,” and a description of how it is applied to each client. The data analyzed in each case include videotapes and transcripts of selected therapy sessions; pre- and post-therapy scores on standardized, quantitative measures; a pre- and post-treatment goal-setting interview; and a semi-structured, post-therapy, outcome interview. The results revealed substantial progress and statistically-significant quantitative changes in both clients. Additionally, distinctly different patterns of progress occurred, as the therapist tailored therapy in accordance with the needs of each client.

    Body-centered Psychotherapy (BcP), also known as “Body Psychotherapy” and “Somatic Psychology,” is a developing branch of psychology based on the vital connection between psychological symptoms and physiological states. Although many non-BcP therapies attend to bodily experience, what distinguishes BcP as a unique subfield within psychology is the centrality of somatic sensory experience throughout diagnosis, formulation, and treatment (e.g., see such pioneer therapists in the field as Ferenczi, 1953; Kurtz & Prestera, 1976; Lowen, 1958; Reich, 1945). Additionally, physical touch is more often used by BcP therapists, even though many BcP therapists do not use touch or only introduce it tangentially.

    The most comprehensive set of references to BcP exist on a CD-ROM Bibliography developed by the European Association of Body Psychotherapy (Young, 2002). There exists extensive literature on the healing power of touch (Field, 2001; Harlow, 1974; Montagu, 1971) and on touch in psychotherapy (Hunter & Struve, 1998; Smith, 1985; Smith, Clance, & Imes, 1998), yet Somatic Psychology has mostly been developed clinically. May (1998) conducted a comprehensive literature search over the previous 30 years and found 23 empirical BcP studies. A brief review of such studies follows.

    The first major prospective clinical trial is currently underway in Germany and Switzerland (Koemeda-Lutz et al., 2003). In this study, eight major BcP outpatient clinics are measuring clients to study the effectiveness of BcP under natural conditions. Preliminary results are promising, finding that after six months of BcP treatment (n=78), small to medium effect sizes were reported across all clinical categories.

    Ventling and Gerhard (2000) conducted a retrospective study of 319 former patients to study outcome and stability of the efficacy of Bioenergetic therapy with adults in a private practice setting. Drawing from the patients of sixteen certified Bioenergetic therapists, the authors collected data from former patients who had a mean of 91 sessions (modal 26-50 sessions), and who terminated therapy between 6 months and 6 years previously. The responses demonstrated that for 107 (75%) of the patients, Bioenergetic therapy proved effective to very effective and that the results had lasted from at least 6 months to 6 years.

    Several studies have investigated the outcome of BcP using case study designs. Bourque (2002) collected pre and post-test data on four chronic pain clients who engaged in eight weekly “Somatics” sessions and found statistically significant decreases in pain and increases in pain-free activities in three of the four subjects. Employing a qualitative analysis of a single case, Bridges (2002) found that Bioenergetic therapy addressed the client’s “somatic defenses against affect” and significantly increased affective expression in a short-term psychodynamic treatment (McCullough et al., 2003a). Finally, also studying a single case, Price (2002) examined the effects of adding an 8-week adjunctive BcP therapy alongside an ongoing verbal psychotherapy for a woman with childhood sexual and physical abuse. The client demonstrated significant improvement on such standardized quantitative measures as the SCL-90-R (also used in the present study) in such areas as depression, anxiety, and obsessive symptoms, as well as decreases in her physical symptoms. In addition, the client qualitatively reported improvement in “feelings of safety, ability to tune in to internal processes, and ability to access emotion.”

    A recent meta-analysis of massage therapy (MT) research, drawing from a wide range of sources (psychology, nursing, medicine, and kinesiology), found MT significantly effective for both physiological and psychological outcomes (Moyer, Rounds, & Hannum, 2004). Additionally, reductions in trait anxiety and depression were MT’s largest effects, similar to those found in psychotherapy meta-analyses. The authors speculate that combining massage and psychotherapy may significantly increase effectiveness more than either alone.

    The present research builds on previous systematic, empirical studies to help fill the need for many more such investigations in BcP in order to create a solid scientific foundation for the field. Specifically, this investigation includes in-depth, systematic case studies involving qualitative process compared with standardized quantitative measures to examine how BcP integrates the body into psychotherapy, as seen through the work of Laurie Schwartz, M.S, L.M.T. (Licensed Massage Therapist), a widely known BcP practitioner with 25 years of practice in the field. The main questions guiding this study include: What does BcP therapy look like? What themes in BcP therapy are unique or distinguishing? And how does BcP therapy integrate talk and touch in a unified therapy? In addition, by looking at what is distinctive about a BcP approach, this study can begin to contribute to the questions of whether it is effective to combine talk and touch in a single therapy, and if so, what are the mechanisms of change in such a therapy.

  • 22 Jun 2021 4:37 PM | Anonymous member (Administrator)


    The following is an excerpt from Dr. Stromsted's full article entitled above.

    Body work is soul work.
    Imagination is the bridge between body and soul.

    ~ Marion Woodman

    Pull Quote from Excerpt below...

    “I always try to grasp the metaphor at the root of an addiction. That varies. With food, it can be mother; with alcohol, spirit; with cocaine, light; with sex, union. Mother, spirit, light, union—these can be archetypal images of the soul’s search for what it needs..."

    ~ Marion Woodman

    Excerpt on Addictions

    Integrating shadow elements and working through addictions play a large role in Marion’s work.

    “The trouble is that we lack basic respect for our bodies. There’s a complete denial of the sacredness of matter. And that is very much connected to any addiction. That’s certainly true of eating in our culture. It’s true of workaholics, too, because they don’t pay any attention to what they’re doing to their bodies so long as they can keep working eighteen, nineteen, twenty hours a day. … I think many of us cannot face the pain of our lives. So work is an escape, or compulsive relationship is an escape, or eating is an escape, until we weep when we look in a mirror (page 20).”

    In working with addictions, Marion attends to the metaphor in the behaviors, holding a larger frame of reference in helping the addict understand the meaning of the patterns that accompany the illness.

    “I always try to grasp the metaphor at the root of an addiction. That varies. With food, it can be mother; with alcohol, spirit; with cocaine, light; with sex, union. Mother, spirit, light, union—these can be archetypal images of the soul’s search for what it needs. If we fail to understand the soul’s yearning, then we concretize and become compulsively driven toward an object that cannot satisfy the soul’s longing (page 21).”

    Marion feels that it is through contacting this deep soul longing and bringing it to consciousness, rather than simply treating the external symptoms, that our culture may be healed of the addictions that exist on such a massive scale. Her style in working with people is honest, direct, forceful, respectful, humorous, sometimes confrontational, and deeply supportive. Though Marion’s mother “had no sense of loving being a woman,” and Marion feels sad because she herself had no child, the mother archetype has been generously expressed through her work with thousands of students, workshop participants, and analysands—“un-mothered women” and father’s daughters who have benefited a great deal from the healing her work has provided them. Her own struggle with the death wish in anorexia is a testament to the work, which she models for women who wish to recognize and value their feminine being. Marion also models a feminine mode of leadership, working collaboratively with Mary Hamilton and Ann Skinner.

    Their styles weave together naturally, as each takes turns leading elements of the work as well as supporting one another in the process, seeming like mother and daughters in one moment, while at other times like sister muses as they integrate their gifts.

    Read Dr. Stromsted's full article entitled above. 

    See more publications by Tina Stromsted here.

  • 13 Jun 2021 8:07 AM | Cynthia Price

    A recent high-profile  journal, Trends in Neuroscience, put out a special issue focused on interoception. The issue includes articles written by the presenters at a NIH-sponsored 2-day meeting on the science of interoception.  The article titled Interventions and Manipulations of Interoception highlights the body-psychotherapy evidence-based approach Mindful Awareness in Body-oriented Therapy (MABT), an approach designed to teach interoceptive awareness.  MABT teaches fundamental skills of interoceptive awareness and the more advanced capacity to sustain mindful interoceptive attention to somatic experience.  This approach is particularly useful for clients who are disconnected from their bodies due to high stress or patterns of experiential avoidance, chronic pain or trauma. The non-profit Center for Mindful Body Awareness offers trainings to therapists so that they can learn to integrate this approach into practice in order to enhance client embodiment, self-awareness, and emotion regulation. The next professional training is in September 2021,  click here for information and registration. 

  • 29 Mar 2021 5:14 PM | Anonymous member (Administrator)

    In over 100 years of therapy, very little attention has been given to two elements of clinical practice: the body and positive emotions. Thankfully, somatic psychology and positive psychology have received increasing scientific recognition over the past two decades. This paper will explore ways in which somatics can contribute to the field of therapeutic healing, growth, and empowerment. 

    As humans, we are complex systems, which means that our functioning is organized through multifaceted and interdependent relationships. Through evolution, simple life on Earth manifested with a basic physiological structure, affect followed and culminating with cognitive capabilities. This evolutionary process grew out of a need to complexify adaptive responses to augment chances of survival. While cognitive analysis can be of great support to heal and grow, both the weight of physiological processes such as the nervous system and the strength of emotions and moods to influence behaviour provide important therapeutic routes for resiliency and empowerment. 

    Through its integrative approach to therapeutic conceptualization and practice, NeuroSystemics emphasize therapeutic interventions focusing on physiology, affect, cognition, and interpersonal dynamics. This paper will first briefly summarize the meta-developmental trajectory at the heart of NeuroSystemics’ conceptualization and range of therapeutic interventions. Second, a closer analysis of biological and affective dimensions of resiliency and empowerment will be described.

    A meta-therapeutic methodology

    NeuroSystemics is a clinical practice that can be applied in four settings: (i) mental training, (ii) individual therapy, (iii) group therapy, and (iv) community processes. They each correspond to the concentric circles of (i) sense, (ii) self, (iii) social and (iv) societal, respectively, in the following diagram:

    In whichever setting, we attempt to engage with all the parts of that system as well as the system as a whole. Biology and affect, as holonic fractals, can be both parts and wholes, depending on the breadth of attentional focus and practice setting.

    For example, in mindfulness practice, the emerging sensate networks of the in-out movement of the breath can be experienced as a dynamic wholeness with many interacting features. When attention is broadened, the spectrum of awareness may include. A sense of the whole body, in which the sensate rhythms of the breath would only be a part. The key here is to provide a firm foundation for understanding the interdependence of human experience, whereby any efforts towards differentiation necessarily imply consideration for integration and contextualization. 

    Baring this fundamental principle of complex functioning in mind, it is of great benefit to explore mono-developmental trajectories, where a single dimension of human experience such as physiology, affect or cognition is cultivated. The next section describes the way NeuroSystemics understands resiliency and empowerment through a differentiated lens of biology and affect.

    Biological development

    When considering the possibilities of somatic cultivation, development, and training, it is helpful to refer back to our evolutionary process. Porges’ polyvagal theory describes a fairly linear direction in terms of physiological responses to stimuli from reflexes to social engagement. See this diagram of it. 

    Reflexes are the most primal physiological responses to the environment. They arise based on sensory contact of comfort and discomfort. Freeze, a shutting-down of major physiological systems, was already a more elaborate form of response to reflexes. It increased the probabilities of survival by “playing possum” and escaping one’s prey after they become disinterested. Fight-and-flight offers more opportunities for a differentiated response to threat and social engagement and is the culmination of a multi-million-year process of refinement. This last system arises out of feeling a sense of safety and promotes curiosity, playfulness, and enjoyment.

    A first important therapeutic goal, based on this evolutionary framework, NeuroSystemics uses elaborate maps, therapeutic conditions and interventions to support the emergence of social engagement. Porges’ neurophysiological findings have demonstrated that the freeze-flight-fight and social engagement systems are aroused in inverse proportions.  

    One key practice to sustain a socially engaged nervous system state is to encourage the clients’ self-organizing impulses. These impulses, also known as Chanda in Buddhist meditative texts and Eros in Freudian meta-psychology, are generative organismic drives towards health, clarity and well-being. Supporting them implies sensing into the clients’ system as a whole, while simultaneously differentiating its parts to identify signs of arousal and deactivation: physiology (prosody, facial expressions, agitation, etc) and free-associative process, their affective variations, their bodily movements as well as their quality of presence in relation to the therapist (i.e. trust, vulnerability, appreciation).

    Intensity spectrum of physiological deactivation

    When we work with the autonomic nervous system, we are walking a fine line between increasing the nervous system's backlog, or reducing it. Our aim in Neurosystemics (somatic-centered therapy) is to reduce it by reaching gentle and enjoyable thresholds (the edge of our client's window of tolerance) and then deactivating the system. You can assess the intensity of the threshold reach by identifying the symptoms of deactivation, which are on that spectrum above: the most subtle and easeful deactivation symptoms are spontaneous breaths and soft heat, and the most intense are involuntary movements and shaking. While some of the more extreme symptoms may sometimes be inevitable in our work, in NeuroSystemics we aim to have easeful and smooth deactivations so that our clients can stay oriented to the here-and-now and have better chances of integrating this somatic process easily in their daily life.

    All these factors (and others) will provide valuable indicators to assess whether the physiological coherence and synchronicity are growing or diminishing. Therapists then adapt their interventions to provide more or less containment to shepherd a higher level of physiological resiliency.

    Complexity science has also provided a number of essential findings to support us in biological maturation. It explains that increasing levels of organization emerge from phase transitions which occur by reaching thresholds at far-from-equilibrium states. Human physiology has non-linear patterns whereby rhythmic oscillatory movements between equilibrium (homeostasis) and far-from-equilibrium states (morphogenesis) enable increasing levels of metastability.

    In terms of practice, this means that we will want to support our clients, in a gentle, progressive, and positively-valenced manner, to come into contact with physiological states which feel out of balance. By listening to the multi-faceted impulses (physiological, affective and cognitive), a cushion of resource and ease can help to soften, contain and eventually convert previously overwhelming sympathetic charge into regulating and organizing patterns of coherence and synchronicity.

    In summary, the two directions proposed by NeuroSystemics to encourage biological maturation  is to conceive of skillful means to sustain our clients’ social engagement nervous system states, as well as to ground their physiology in gentle and progressively increasing rhythmic oscillatory movements between homeostatic and morphogenetic states. These will enable greater physiological resiliency, somatic embodiment as can be indicated by heart-rate variability.

  • 16 Mar 2021 5:09 PM | Anonymous member (Administrator)

    In preparation for the interactive part of the webinar, Treating Trauma and Addiction with the Felt Sense Polyvagal Model: A Bottom Up Approach, please -

    A. Download Your Body Card and Gather Crayons 
    1) download and print out one of the following body cards most suited to you, and
    2) have at your disposal crayons to draw/write on your body card during the webinar exercise.

    Pick the body card that best represents you:

    To explore in advance elements of the Felt Sense Polyvagal Model check out these resources below. Some of them will be used in the webinar.

    B) Review "The Primacy of Human Presence: From The Small Steps of the Therapy Process" by Eugene Gendlin


    C) Familiarize yourself with The Felt Sense / Polyvagal Model
    1) Read model overview
    Download diagrams to guide sessions with clients. 
    ) Get links to get familiar with Focusing and its six steps process. 

    Read, Download and Link To

  • 15 Feb 2021 11:17 AM | Anonymous member (Administrator)

    Are you a therapist in a setting working with underserved populations? Use this mindfulness exercise and contemplation for exploring marginalization and your and others' relationship to it.

    Part 1. For this exercise notice how you organize around the statements to be read. Notice that our responses may be different based on how culture has impacted us.

    Part 2. In this exercise, it can be helpful to explore the parts of ourselves that resonate with dominant culture and the parts of us that have been marginalized by the dominant culture.

    Post Exploration Discussion Questions: 
    - Share (or journal) your experience of hearing the statements.
    - What do you imagine might be evoked from someone who is marginalized as they hear these statements?

    If you like this Demo please like it on YouTube and subscribe to our channel. Spread the healing. Share this demo with another using this link:

    There is a course we offer, in partnership with the Hakomi Institute, that further explores the topic of marginalization. It offers somatic activities to enhance your work with clients. For advanced students of Hakomi this webinar brings a fresh take on utilizing Hakomi with underserved populations. It is presented by Rebecca Lincoln, LPC-S, Certified Hakomi Teacher.

    Earn 2 CE credits when you watch and take the course, Hakomi Mindful Somatic Psychology with Underserved Populations

    You can also watch it here free... but you need to be a member of the USABP.

    Learn more about the Hakomi Institute.

    Video Credits include
    - Presenter Bio Rebecca Lincoln, LPC-S, Certified Hakomi 

    Rebecca is a Licensed Professional Counselor and board-approved supervisor in the state of Texas. She specializes in working with trauma, grief, anxiety, depression, and personal growth. She is a certified therapist in Hakomi Mindful Somatic Psychology and a certified Hakomi teacher. She has additional training in several modalities including EMDR, and spiritually integrated psychotherapy. When working with Ms. Lincoln, expect to consider the aspects of mind, body, and spirit in your healing process. Ms. Lincoln is open-minded, loves to laugh, and is interested in knowing who you are and what is important to you.

    She also loves mentoring interns. If you are an LPC intern looking for supervision for full licensure, send her a message to set-up a phone call to discuss details.

    Edited by Liam Blume, CPRA 

  • 12 Nov 2020 11:12 AM | Anonymous member (Administrator)

    In this video presentation below, we are excited to introduce to you the possibilities, value, benefits of using virtual touch. We will provide simple step-by-step instructions on how to incorporate the beginning experience of touch into your sessions or with others you want to connect with. A significant portion of the presentation will be dedicated to a demo from which you can experience and learn from.

    Coming soon! Get the Full Home Study Training for Virtual Touch  at our Somatic CE Center. 2 CE Credits will be available.

    The full method of Transformative Virtual Touch in Telehealth Care recording is free to USABP members and paid registrants.

    Expand your skills… Transform yourself.

      Visit Our Somatic CE Center 

    If you like this Demo please like us on YouTube and subscribe to our channel. Spread the healing. Share this demo with another,

    Covid-19’s arrival has disrupted one of the ways that we touch our clients, that is, physically with our hands. This loss of physical contact creates tremendous anxiety because gentle, caring touch is the bedrock of safety. It allows for and promulgates the release of oxytocin which is a critical hormone that ameliorates sensations of feeling unsafe.

    In response to this loss, we turned to the myriad of other ways we could still provide touch for our clients in order to bridge the isolation that sheltering at home was creating. We are now doing virtual sessions across the globe and have come to the recognition that virtual touch is an efficient and effective way to heal during Covid times and even when Covid becomes a distant memory. Possibilities abound!

    This post is a part of our "Insider Look" and "Somatic Self Care” Series. This episode has been brought to you in part by Joe Weldon and Noel Wight Co-Founders of the Somatic Therapy Center.

    The USABP has been integrating body and mind for effective psychotherapeutic health since 1996.

    Our USABP Somatic Continuing Education Center offers in-depth courses for health care providers. Enroll Now. It’s Free. At

    There you can take the courses from many luminaries in the field of Somatic Psychology and Therapeutic Training such as from Noel Wight & Joe Weldon Ph.D. and more. Such as Stephen W. Porges Ph.D., Babette Rothschild, MSW, Dr. Alan Schore, Judith Blackstone, Noel Wight & Joe Weldon Ph.D. Learn more about the Somatic Therapy Center work at

    Become a member of the USABP (Association) first and pay just $15 per CEU. Go to

    With membership, you'll get the next 12 webinar training programs FREE, access to our library of training programs, a subscription to our peer-reviewed somatic journal, and more.

    FREE Exercises, techniques, skills, case studies and more resources are available here on this site. Check out all our sections. 

    Subscribe to our USABP Highlights and Viewpoints email sends, at

    You'll be informed of our next posting, zoom webinars, book reviews, journal releases, research findings, case studies, and special VIP invites.

    Video Credits include -

    Presenter Bio
    Joe Weldon- Co-Director, Licensed Psychologist, Master Somatic Therapist

    Unable to walk until the age of five imbued in me a deep respect and regard for the traumatic experience of the loss of movement. In a Somatic Therapy session, I will help you differentiate your essence from the injuries that have happened to you. This will help you restore movements to your being that are necessary for you to live a life with ease, joy, and meaning. When full and free movement is restored then love becomes visible and viable. Come for a session and restore the lost, taken away, and forgotten movement that is your natural birthright.

    Thousands of clients seeking to restore movement to their bodies and transform their lives are now moving about more freely and easily because of the gentle transformative touch I have skillfully provided them. Hundreds more have learned the fine art and skill of Transformative Touch in our one-of-a-kind somatic therapy training.

    Produced, Edited and Hosted by Liam Blume, CPRA- Integrated BodyMind Therapist at
    - Director of Marketing and Content Curation for the USABP 

  • 20 Oct 2020 8:58 PM | Anonymous member (Administrator)

    Insider Look: Watch Focusing-Oriented Therapist’s Approach to Deepening a Somatic Psychotherapy Session

    This 5-minute video was created by Jan Winhall and Serge Prengel. It is based on an actual session, but the client is not visible, just the therapist. It is meant to give you an experiential sense of what a Focusing-oriented therapist might do in a session. There are different perspectives, approaches, and styles in Focusing-Oriented Therapy (FOT).

    What would you do if your were a Focusing-Oriented Therapist?

    • connecting with the clients experience
    • staying with the clients experience
    • deepening the clients experience
    • staying emotionally present
    • making space for the clients experiences
    • a felt sense emerges from the experiences
    • staying with the feast sense
    • finding a handle to express the felt sense
    • an experience that becomes an embodied resource

    View Presentation Now

    3 Types of Listening and Insights on How To Use Them. 

    You have seen the stages of a FOT session above. One key to what went in to the therapist's response above is her listening and empathy. 

    In the audio below join Kathy McGuire and Serge Prengel as they explore deeply both listening and empathy. They look at 3 forms of listening. Serge, in connection with his exploration with Kathy, conveys in his blog the following: 

    "1) Even simple listening, “passive listening” without interruptions, allow speakers to naturally begin entering into direct reference to felt experience and explication from there.

    2) Active empathic listening takes this natural felt sensing a step further, as the speaker checks the listeners words against their felt reference and articulates anew.

    3) When the speaker knows Focusing, then empathic listening helps the Focuser stay with, check, resonate and articulate their felt sense in the deepest way."

    In watching the audio below or the videos, Serge notes, "please pay attention to the central role of the pause: Notice how taking a pause opens up direct access to felt experience. In this context, felt sensing is the natural outcome of the pause. As is empathy."

    Serge goes on to note that in observing these recorded exercises you will get a sense of how deeper creativity and change can come through in relationship to another using these practices. He also goes on to say, "These skills can be also brought directly into interpersonal conflicts: Somebody who has seen our passive and active listening videos might jump in as a “third person listening facilitator.” Similarly, these skills can be used in group decision-making situations, as the Quakers do with “passive listening.”

    Listen Now

  • 20 Oct 2020 7:39 PM | Anonymous member (Administrator)

    These two video posts come to you from our "Insider Look" and "Somatic Self Care” Series found on our USABP YouTube Channel. This episode has been brought to you in part by Judith Blackstone and the Realization Process. 

    In this first video below, learn to Ground yourself so you can reduce anxiety, disentangle yourself from others, experience coherence, and connect better with others.

    This presentation teaches the Realization Process exercise: Foundational Grounding. Because anxiety is an upward movement in the body (“my heart was in my throat”), we can alleviate anxiety by settling into seven foundations in the body: the feet, pelvic floor, respiratory diaphragm, collar bone area, base of skull and jaw, eye sockets and top of head. These foundations allow our emotional life and our mental life to settle and rest.

    We do this exercise sitting and then remaining settled in the foundations while walking. 

    In the video below, learn to Center yourself so you can have a more present-day response in working with others, make deeper connections, and have the ability to stay open to more intense states of others.

    This presentation teaches the Realization Process exercise: the Core Breath. Helping you to live and breathe in the core of your being. It helps you find and breathe within the center of your head, chest, and pelvis. This can help you find a place of calm and stillness within yourself, no matter what is happening around you. The subtle vertical core of the body is experienced as your deepest connection with yourself, and your deepest perspective on the world around you. To live there feels disentangled from your surroundings and from other people, but not detached. You can still respond, even more deeply, but without getting entangled in habitual modes of reaction.

    We do this exercise sitting and then walking while remaining in the core points.

    Additional benefits of these two exercises include helping people (such as therapists, co-workers, family members, etc.) to have a more present-day response in working with others, deeper connections, and the ability to stay open to more intense states of others.

  • 11 Sep 2020 9:30 PM | Anonymous member (Administrator)

    By Sheila Rubin, LMFT, RDT/BCT

    (Adapted from my chapter "Unpacking Shame and Healthy Shame: Therapy on the Phone or Internet" in the book Combining the Creative Therapies with Technology: Using Social Media and Online Counseling to Treat Clients by Stephanie L. Brooke, editor.)


    I begin this article about the internet with the fact that my clients think I’m a Luddite. I grew up with a wall phone telephone that, by definition, was attached to the wall. At most we could stand a few feet from the wall, with a few inches of cord linking us to the phone. This was in a time even before answering machines. I came of age and went to study radio and television in college during the time of the black-and-white Porta Pak video machine that was heavy, where we actually spliced tape using our fingers—just before electronic newsgathering. Response time to a letter was a couple of days to a couple of weeks. I’m fully aware that the words I’m writing here will likely be outdated due to technology changes before this book is out in the world. I have accepted the use of a smartphone into my private practice, along with doing therapy over the phone or Skype or Zoom if I have met the client at least once in person. I have come a long way.


    Therapy on the Phone or Internet

    Therapy, on both phone and internet, is with individuals or couples. When I am not physically with a client, I find that I check more often for feelings that I might be able to sense when working face-to-face. I slow things down and tend to do more somatic work, asking clients to ground and to sense somatically for part of the session. I always ask at the end, “What are you taking from this session? What was helpful?” I also give homework after each session. For example: Make a list of the coping skills from the session and put them on your calendar day by day. Or: Take the powerful objects from this session and put them out in your room at home with a note by each to remind you what we did in the session today. If the session helped them find a vision to support the marriage, we have that symbol, like a strong tree holding both of them as they deal with difficulties during the week.


    Concerns about Technology

    What about when technology fails? When a person just revealed something they’ve been hiding and the screen suddenly freezes? A while ago, I was in the middle of a Skype session where a husband was telling his wife why he had trouble when she touched him. Suddenly the screen froze and this tender moment was interrupted with my frantically trying to call them on Skype, which would not reconnect. I had to call them on my cell phone, and by the time I reached them, the tender moment had passed and they were fighting again. I had to slow things down and gently find the words to tell them about the negative cycle their communication was in and how to do a repair to get out of it.


    As Kaufman says, shame is the rupture of the interpersonal bridge (1974, 1992). Any disruption in connection with a significant other can disconnect the person from him- or herself, or the therapist, and activate the feeling of shame. And this couple was experiencing a disruption in connection. I was eventually able to use the symbol of disconnection because of the unpredictability of the internet as a way for each of them to have a role of explorer rather than blaming each other.


    What I realized was I have to let clients know ahead of time about the constraints and the benefits of using the phone or internet for therapy. It will save them time coming to my office when they are in a difficult place, but it may not be as contained as an in-person session.


    One couple was struggling with the husband having had an online affair and the wife needing to check his phone in order to be reassured that he wasn’t meeting the woman. I spoke slowly and carefully to them to get agreement before we began to talk:

    Because we are not face to face, I can’t just interrupt you if there is shouting. I am going to do the session slowly and have you repeat what you hear the other person saying, so that I can know you heard them and they can know that you heard them. We are going to take turns. Are you both in agreement? And because the phone is not a predictable medium, and each of us is on a cell phone, if one of us gets disconnected for any reason we need to have a plan. Are each of you near a home or office line? If someone’s line dies, we will momentarily stop the session and I will wait for the call of the person who was disconnected.  Call me back on your phone and I will use my phone to accept both calls.



    Shame During the Session

    In my chapter in The Self in Performance, I write that “Shame can be right there in the shadows. It is easy for misunderstanding.”


    When I can’t see the emotion on clients’ faces, because we are on the phone or they are looking away from the screen, I don’t know what they are experiencing and truly expressing. In the book Shame and Pride, Nathanson (1992) explained that throughout life we are balancing between pride, when we are seen in a good light, and shame, when we make a mistake or are seen in a less than favorable light. Diana Fosha (1992) later wrote that we call this our “self at best” and our “self at worst.” We strive to be seen as smart or clever or helpful, but when a mistake is made and something is unclear, suddenly the person is risking being exposed and seen as self at worst. This concept is helpful to remember when a client is sharing vulnerable revelations. I know from my own vulnerability how scary it can be to be exposed at the wrong time or without kindness and support.


    Listen for Subtle Signs of Shame

    In the chapter “Treating Family Systems with Shame and Addiction Problems,” Ron Potter-Efron wrote that:

    Clients do not always directly communicate their experience of shame with their counselors. Rather, they may hint at their shame through relatively subtle cues, downcast eyes, sudden speech stoppages, avoidance of an apparently innocuous topic, unusual phrases, and so forth. They may also speak at length about other emotions regarding a particular experience without adding that they also or even primarily feel shame about it (p. 230).

    He suggests the importance of the interactive process between the therapist and client can even be more important than the client actually disclosing the feelings of shame because the client expects that the therapist will dismiss them. He explains, “Shamed clients have a specific hope, not necessarily stated, within the counseling relationship. They desire to reveal everything within them that feels dirty, disgusting, and defective. They seldom reveal all this material immediately and may never be able to share some of it” (p. 229). He explained how the therapist needs to gently layer by layer work carefully and not reject the client as they reveal more levels of shame during the sessions.


    Internet Therapy

    The good news is that the internet can serve as a bridge between family members who do not live within driving distance of one another. It can also get in the way of having the direct eye contact family members long for. It proved very therapeutic for an elder client to see her grandchild over Skype, even though she believed it would not “do the trick.” She had been hurting and reported being filled with rage because her son didn’t call her as often after his baby came, and because the other grandparent was being invited over and she was not. We role-played her talking to her son, but nothing shifted. She still felt left out, like something was wrong with her for not being chosen to spend time with the new family. We unpacked all the feelings of anger toward her son for not insisting that his wife invite her at the same time as the other grandparents, and under that was the feeling of shame. She felt ashamed to not be invited and fought with him on the phone when they did talk. I asked her to role-play talking to her son in a way that invited a solution instead of blaming him for her frustration. I invited her to role play the visit with the grandchild. She rocked back and forth. Finally, I suggested that she use Skype as a way to visit her grandchild. She told me that I didn’t understand. She wanted to pick her up and rock her in her lap in the rocking chair. I invited her to try just one phone visit on Skype with her son and grandbaby. She sat in the rocking chair at her home and rocked. She was delighted to see her grandchild recognize Grammy over Skype. This experience fulfilled her longing to visit with her grandchild. There were many Skype visits thereafter. Her feelings of shame about being left out decreased and invitations to visit increased.



    Please note that I only do sessions remotely if I have met with the client in my office and we have developed a solid therapeutic container first. When the client is in my office, I can observe a range of nonverbal cues and get a sense of his or her energy. Over the phone, there are subtle cues I may miss. There are ways I work with the absence of the visual modality. Because I am not seeing them, there are things I need to do to contain the energy of the session and the pace of the session. Because the client isn’t seeing me, there are ways I want to structure things to help them feel me where they are sitting.


    Case Example of Phone Session

    This client was feeling dark. Her boyfriend was spending time with his ex-lover again instead of going on the date they had planned.

    Client: “He’s still in the role of letting his ex-wife rely on him. I couldn’t stop crying for hours. My emotions got all wacky or something. I see his side when he’s helping his kids. But every act of his kindness is an act of affection toward his ex-wife. One day it’s good between us, and the next day I feel ignored, neglected.”

    Therapist: “How about if you choose something in your room to represent your feeling neglected and ignored.”

    Client: “OK, this plant.”

    Therapist: “Can you move it near you and look closer at it? And as you are looking at it, what does it say to you? What does it symbolize?”

    Client: “You have to pay attention to a flower. You have to water it or it dies!”

    Therapist: “So that’s a very powerful symbol of needing to be tended and cared for.”

    I wanted to pause and have her reflect on the importance of her attachment needs. She really wanted to just rush past them in the session. Choosing an object helped me direct the session to make space for that subject. The act of choosing something took her into another part of her brain where creativity was more open to her. Having a symbol can be very powerful metaphor. Having it in front of her helped her to focus on it during the whole session.

    Client: “Yes! I want to be cared for. But when I feel this way, I don’t feel like myself. It feels like I don’t exist. It’s too painful when he says he’s coming over and then he cancels because he’s with his ex-lover. Why am I punishing myself? I could go out and be in another relationship!”

    Therapist: “So there’s another part of you that doesn’t want to be punished any more, that wants to find another relationship, one where the guy is choosing you instead of choosing his ex. Can you look around the room and find an object that represents this part of you?”

    This is another place I want to pause the session and give her time to feel the power of what she just said. I want a symbol for that part so we can talk to that part as well, maybe have a conversation with both of them.

    Client: “This candle!”

    Therapist: “Can you put the candle in front of you and look at it. What does it represent?”

    Client: (Surprised) “There’s a light in it! I can attract things… People! But I’m not ready to move on.”

    Therapist: “Can you give each a voice? What does the flower say and what does the candle say to you?”

    The candle told her that she is bright inside when she’s not so depressed, worrying what is going on with this guy she’s dating. It gives her inspiration to grow herself and step out of the relationship to a real relationship where someone could really be available for her. As she was expressing this, another feeling showed up.

    Client: “I feel deep anxiety.”

    Therapist: “Where is the anxiety in your body?”

    Client: “My diaphragm.”

    Therapist: “Can you put some space around it and take some slow deep breaths?”

    Client: “I’m not being logical. I should just leave him. But I don’t want to leave him. He says kind things to me, offers to work it out. I really care about him. He’s clear about his intention that he wants to be with me!”

    Therapist: “There are a lot of conflicting feelings.”

    Because we are on the phone, I want to keep the connection and let her know that I am here and that I hear her.

    Client: “I’m scared. Lonely.”

    Therapist: “Yes, there’s a part that’s scared and lonely.”

    I want to support this part.

    Client: “It’s like a pouting child!”

    And it feels like she is putting down that part. It is like some part of her is shaming that part of her for wanting what she is wanting.

    Therapist: “I wonder… I’m curious if there is some shame around that part?”

    Client: “Yes.”

    Therapist: “Can you look around and find an object to represent the part that comes out and shames you when you talk about your attachment needs?”

    Client: (Apparently looking around her room for a few moments) “A hat.”

    Therapist: “How does a hat represent shame?”

    Client: “I put it on myself!!! I have a hard time asking him to meet my needs and I’m scared that they won’t get met again. That he’ll cancel plans with me again!”

    Therapist: “Maybe the shame comes out to put you down for feeling what you’re feeling?”

    Client: “Yes. If I’d recognize those things, logically, I would leave.”

    Therapist: “That inner conflict is so painful. So one part of you shames you for having normal wants and needs from him, and when you think he lies again or cancels plans, then that part shames you again for not leaving.”

    Client: “He told me he couldn’t have me over because he didn’t want his neighbors to think I was a homewrecker because his ex just moved out. So now I feel shame for wanting to come to his house. It’s been over six months we’ve been dating. So when is he going to tell people?”

    Therapist: “How did you feel when he said that?

    Client: “Insecure! Nerves all over my body. On edge!”

    Therapist: “What did the nerves say?”

    Client: “Run!”

    Therapist: “And what did you do when you felt that strong urge to run?”

    Client: “I’m feeling shame about my feelings. He’s good with his words, but his actions don’t match. Then I feel shame for wanting to leave.”

    Therapist: “I wonder if this current feeling of shame reminds you of anything that happened before in your life.”

    Client: “I feel so much shame in this relationship. It reminds me of my last relationship.”

    Therapist: “The one where the guy was hiding his porn addiction and hiding his other lovers?”

    Client: “Yes. That was terrible. But I want to give this guy more opportunity, more time to show me that he can make the life for us he is always promising. I want to give him the benefit of my doubts. I want this relationship to work.”

    Therapist: “Of course you want this relationship to work. Can you turn to the plant that represents your needs? What does the plant say?”

    Client: “The plant says, ‘You’re making yourself suffer!’”

    Therapist: “What does the hat say?”

    Client: “It says that I’m ashamed of my feelings. I’m embarrassed that I want him to visit me instead of his kids. That’s terrible.”

    Therapist: “What does the candle say?”

    Client: “It says that I don’t need to shame myself for my feelings. I have light inside me. I need to remember.”

    I’m wanting her to stop here and reflect and to work to understand if maybe there is something here for her to be shameful for. That would be a form of healthy shame.

    Therapist: “Sometimes shame can pull a person out of her deep knowing by cutting off the life force or the light. Sometimes there is healthy shame that tells a person that there is something he or she is doing or another person is doing that is actually shameful, that should be shameful. And there might be helpful information here if this is healthy shame. Healthy shame can help a person make new decisions or understand things in a different way. Here is some homework to do before our next session. Get out your journal at the end of the session and ask yourself, ‘What did I get from this session?’ Please write it down. And please write down some of these questions. Please do some journal writing to answer these questions.”

    • What does the plant say?
    • What does the candle say?
    • What does the hat say about how you shame yourself?
    • Listen to the shame and feel if there is something of value here or if it is just putting you down.
    • Is there part of it that is valid?
    • Is there something to listen to that is actually shaming for a reason in this situation?
    • Is there something here from a past relationship or a situation where you felt shamed?
    • Is there something you feel shy about?
    • Is there something for you to learn about shame here?


    In Dancing with Fire, A Mindful Way of Loving Relationships (2013) John Amadeo writes “Stumbling into adolescence and adulthood we may continue to hear the message that we are too selfish, needy, or flawed to be loved. The resulting isolation generates emotional suffering that is often unbearable. This begins an epic journey of scrambling to figure out who we need to be in order to win love and connection” (p.23). He writes that we lose the thread of connection with ourselves. “Shame prompts us to seek affirmation and approval rather than connection and intimacy. We look outside ourselves to sense whether we’re emotionally safe” (p 111). Many people end up looking outside themselves to find out how they feel or even what they should be doing.

    See part 2 for the continuation of this article.

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