ACAT

You are here: Home > Reformulation > Summer 2017 [Issue 48] > Embodiment as a creative resource in working with split and “borderline” clients

Embodiment as a creative resource in working with split and “borderline” clients

Tim Sheard, 2017. Embodiment as a creative resource in working with split and “borderline” clients. Reformulation, Summer, pp.34-41.

Download PDF

Introduction

Including our bodily experience in psychological therapy is becoming more mainstream, particularly in the emerging trauma therapies (Ogden P et al 2006, Levine 2008, Rothschild 2000) and it is also featuring in neuroscience (Siegel 2012). However its place in CAT is unclear.

This paper briefly describes experiences in workshops with CAT therapists and trainees held over the last six years in which participants were guided to attune to their experience of their own embodiment in relation to specific instances of stuck or overwhelming therapeutic process, usually with ‘borderline’ clients suffering from developmental trauma. Many participants were surprised at how this adjustment rendered relational processes and reciprocal roles much more tangible and ‘real’ while at the same time appearing to open and free up the therapeutic relationship. Surprise extended to shock at times in the recognition of how much burden and stress they were unknowingly taking in at a bodily level while at the same time the embodied approach addressed how this might be much reduced.

It is suggested that many of the key relational processes when working with split borderline clients are mediated through what we call our bodies. If consciously included and engaged with this dimension of relating can support, even mediate, the therapeutic process. But if dismissed and ignored it can slide into unrecognised collusive reciprocation that is very likely to be damaging to the therapeutic process and the therapist.

This approach appears to ‘knit in’ very well with CAT as well as challenging an implicit mind-body dualism and power relationship in both the theory and practice of CAT.

These workshops and my broader embodied relational approach to CAT have emerged from a longstanding holistic orientation originated in my days as a medical student. I trained in body psychotherapy because I found CAT peculiarly disembodied in its way of addressing early relational developmental experience (by definition preverbal and bodily mediated). But then I found body psychotherapy rather unrelational. So over the years I have had to forge my own integration. These workshops represent a part of that and continue to mediate a continuing dialogue about embodiment with the CAT community; one that I find particularly enriching.

A note on language:

I will use the word ‘borderline’ not as a diagnosis but to indicate a way of relating characterized by splitting and acting out that can be understood to be a repetition of ‘developmental trauma’. I apply this not only to identified ‘clients’ but also to the many of us who have borderline aspects to or pockets in our relating, perhaps most obviously in intimate relationships.

By the word ‘embodiment’ I am suggesting a movement away from a narrow identification with or over-valuation of ‘rational mind’ prevalent in our culture to a position of a greater subjective identification with our incarnate selves. Through this we can begin to experience relationship with ourselves, with others and with the living world in and through what might be called ‘embodied presence’.

Borderline relating: a problem and potential opportunity:

Participants were asked to select one client, preferably a current one, with whom they felt stuck or the process was particularly difficult. It has never been a problem at the workshops for CAT therapists to come up with an example of a very difficult therapeutic process to focus on: no surprise. The clients or processes chosen would almost always be describable as ‘borderline’, with a few in more narcissistic territory. I will briefly review CAT understands the difficulty in borderline relating, then focus on the elicitation of intense, often bodily mediated, counter-transference and potential burdening of the therapist.

CAT theory names the relational ‘difficulty’ presented by borderline clients as a therapeutic opportunity. Collusive reciprocation, the elicitation of reciprocal ‘acting out’ in those around them, is understood to be the central maintaining factor. Consequently the therapist’s first (and at times possibly only) job is seen as ‘first do no harm’. In seeking to minimise collusive reciprocation we can offer the client a new experience of close relationship and of themselves.

CAT offers powerful theoretical and clinical tools to support the therapist in this endeavor. Recognition of counter-transference elicited in the therapist is seen as crucial in reducing collusive reciprocation. Ryle (1997) describes three forms of counter-transference: identifying, reciprocating and personal, very similar to earlier Jungian models (Lambert 1974). However ‘enactments’ are still likely, perhaps at times essential to the process coming alive. In CAT diagrams are used to name this, contain dialogue about it and mediate relational repair and integration. But despite these considerable clinical and theoretical resources the therapeutic process can still become overwhelmed: clients can literally get under our skin. ‘First do no harm’ can be immensely difficult to hold to. For most, if not all of us this is at times very, very difficult relational terrain.

Working with borderline clients is often very demanding and exhausting. On a narrative level we may be told terrible stories of childhood abuse and neglect and clients’ re-enactments of these in adult life, be it as victim or perpetrator. This can be traumatic for us to engage with and may be profoundly challenging to our sense of basic trust in life.

But probably even more challenging is the almost inevitable ‘acting out’ within the therapeutic relationship. This may be explicit, obvious or even gross, in which case it can be recognised, named and hopefully discussed and contained through contracts and reformulation. But quite often relational acting out and our own elicited response can be much more elusive, difficult to name and grasp, though no less powerful.

When working as therapists with borderline organisation we engage with relational fields characterised by splitting, with intense identifications and dis-identifications and concomitant disruption of healthy boundaries of personal relational space and of our very sense of self. We can feel overwhelmed by the presence of unmanageable feelings or deadened by their dissociated absence. Within this disorientating relational landscape we may experience intense pressure to reciprocate collusively (Ryle 1994) or perhaps the problem presents itself in a narrowing, stultification or even disabling of our usual relational flexibility. Our personal sense of identity and our imagined control of the boundaries of our self can feel eroded, brought into question, violated.

This can clearly be named as a counter-transference that is not only limiting the therapist in her work but also harmful if maintained. Intense counter-transference of this kind very frequently has a bodily dimension or is experienced only through the body, for example as exhaustion, muscle clenching, coughing/choking etc. Decades ago Jungians and psychoanalysts observed that unrecognised or un-integrated experience very often seeks to be found, heard, felt and included through our therapeutic bodies. (Schwartz-Salant 1982, Schwartz-Salant and Stein 1984, Field 1996, Soth 2005).

I feel this raises two profound questions:

1. How is it that counter-tranference is so often experienced on a bodily level?

2. How is it that our bodies can mediate another person’s un-integrated self states, as if we have another person’s experience for them?

I outline three possibly important aspects of the first question here and address the second later.

1. If we understand borderline relating as originating in developmental trauma then much of the acting out on children by their carers is bodily mediated. It can be an impossible absence, an abandonment and/or a violating physical/sexual abuse. The relational language is bodily: the acting out can be seen as a ‘doing to’ or ‘putting into’ the child’s body by a more powerful other of experience that cannot be contained by the perpetrator. It is put into the victim to gain relief. This is redolent of the processes described in projective identification: but in this case with the child on the receiving end. The phenomena bracketed under the rubric ‘projective identification’ are primarily bodily. The body is the medium through which the relational difficulty is ‘communicated’, through which relational healing of the bodily transmitted trauma is sought.

2. Much developmental trauma is preverbal: our developing sense of self, others and the world in relationship is mediated through embodied relationship rather than formal words or thoughts.

3. It can be argued that embodiment has been marginalised and devalued in our culture for centuries if not much longer. The body is objectified, it has become ‘other’ and any sense of identifying with it, any experience of embodied subjectivity has been lost. (I feel we need new words here to mean ‘de-subjectified’ and ‘dis-identified’). Our identification has become narrowed and restricted to being invested in a disembodied rational objective mind. This position is underpinned in perhaps only slightly differing ways by the prevailing cultural ideologies of scientific materialism and Christianity. It is as if our bodies have become marginalized repositories of what we don’t want to include in ourselves, alongside other abusive power relationships such as those around gender, ethnicity, sexual variation, poverty ……. and last but not least, borderline experience. Borderline is at the margins, where the unwanted is dumped and carried as a burden by a powerless minority. So I suggest that borderline experience and its being acted out on and through bodies has important political and cultural dimensions of power and control. Also this is not a far cry from our dis-identification with the planetary eco-system, another place we seek to dump the unwanted and unseen.

The workshops

I am drawing on experience of a number of one and two day workshops and one series of workshops held in the UK and Finland. They have been attended by around 200 CAT therapists (including some workshops for trainees), group size varying between 7 and 30.

A therapist may be fairly naturally embodied, but my experience is that this is rare in our dualistic, rather disembodied culture. It has been a struggle for me

and I am aware that we teach what we seek to learn. It is as if it is we need to learn afresh what in some (so called ‘primitive’ or ‘undeveloped’) cultures may be ‘natural’ or culturally innate. This ‘learning afresh’ is likely to be rather unfamiliar and may be challenging. It is not a simple extension of our conventional educational or cultural models in which the body is conceptualised as an object, a thing, a biological or sport machine. Learning to be more embodied is outside of our cultural ZPD. A therapist who has attended a number of workshops said it was like “soap in the bath”, she would feel that she had grasped it but when back at work it would be eluding her again!

However, partly through dialogue in the workshops, a simple (at least on the surface) model has emerged which ties in well with CAT practice.

Outline of the workshop process

Participants are asked to identify a client they feel stuck with or particularly challenged by and are informed that we will do a series of exercises that focus on their experience of trying to be in a constructive therapeutic relationship with this particular client.

The stage is then set through an exercise which could be seen as an extended version of “what is it like to be in the room with this client?” Participants are guided through a systematic survey of their responses to this client in terms of their thoughts, emotions, experiences in different parts of their bodies, their impulses. These are explored in three different contexts: being about to see this particular client, being in a session with the client and finally being in the room after the client has left.

Participants are asked to represent these responses by drawing with crayons, then share them in dyads, and then with the group if they wish. This exercise invariably reveals an all too familiar litany of difficult experiences; for example feeling profoundly invaded, nausea, tension in muscles or clenching in guts, restricted breathing, burdened/exhausted, beaten up, dread in anticipation of seeing the client, wanting literally to run away, ravenous hunger or pressure to smoke after a session, etc, etc. It is notable that these difficulties are predominantly felt in the body and its surrounding personal space, not in what we might call ‘the mind’.

This simple process of giving attention to embodied experience, representing it in images and finally spoken dialogue frequently leads to recognition of reciprocal role enactments that can readily be described in terms of embodied reciprocal or identifying counter-transference. Reformulation of key reciprocal roles ‘put on a plate’. Quite frequently there is also startled recognition of the degree of burden and strain being carried by therapists. This new clarity can be experienced as a helpful or a disturbing revelation. For some it is a complete surprise, for others it is a bringing into the foreground of something already half recognised but either ignored as irrelevant or dismissed as something to be pushed through and endured.

This mediation of reciprocal roles becoming more vivid, tangible and ‘real’ is a striking aspect of embodiment work. Dower also describes this in her reformulation paper ‘Bringing bodies into dialogue’ (Dower 2015).

This first exercise generates a lot of discussion and for some acts as a kind of ‘wake up’ to embodiment as an important dimension of therapeutic work. For the remainder of the workshop participants are guided through a series of exercises of attunement to different dimensions of their embodiment. The effect of each of these on their experience of trying to be in a therapeutic relationship with the client is explored.

Embodied attunement is introduced in three overlapping dimensions: Musculo-skeletal/vertical, visceral and energetic. I will outline these in turn.

The first exercise addresses our posture in a literal sense. An attunement to the musculo-skeletal system simply in terms of our capacity for relaxed vertical alignment. Participants are guided through an exercise of aligning the spine and head with gravity, grounding the feet and pelvis and then scanning through the musculature for tensions and seeking to relax them. They are then invited to again imagine being with their client while maintaining awareness of this vertically aligned condition.

For many, but not all, this apparently ‘only physical’ or ‘only body focused’ exercise changes their experience of the relational dynamics. Many feel more boundaried, ‘separate’ and more safe. There may be an experience of more ‘space’ to actually have a relationship with the client and a concomitant relief from oppressive invasiveness or from being impaled upon the client’s acted out emotion. It is important to stress this outcome is not even hinted at when introducing the exercise. It is conducted on a level simply of focusing attention on bodily alignment and relaxation and aiming to find a degree of relaxed vertical poise. The exercise is not about achieving a perfect posture, seemingly out of reach for many of us, but is more one of positive adjustment and an intention of being more vertically aligned. Relaxed vertical poise is sadly something many of us have lost: we carry heavy things in our hands, not elegantly on our heads …. partly perhaps because we try instead to carry in our heads relationally heavy things that don’t belong there!?

Many participants are surprised at what they experience, surprised at the emergence of strengthened boundaries and relational space without a specific intention, effort or act of will by the mind. Rather it is as if an embodied action, one of simply inhabiting a state of a degree of conscious alignment with gravity, one of beginning accurately to use the extraordinary engineering of our human bodies, co-creates or mediates an experience of boundaries. As if our boundaries and sense of self are not something of the mind but rather are integrated with the very use of our musculoskeletal system. The experience arises literally as well as metaphorically: one of definition and delineation in space, an experience of occupying space, ground and position that is both physical and relational.

This can be seen as an adjustment in therapist self to self reciprocal roles that in turn offers the client a potentially different relational presence with which to engage. If the therapist can occupy boundaried space with some ease, perhaps the client can begin to have this too. Then there may be the possibility of a space between (therapist client) and even a space within for relationship (client self to self). Conversely if we are either collapsed (under-held) or rigid (over-held) in our embodied orientation to gravity and ground we can reflect upon what we are modeling and how this posture might affect the relational presence we offer clients to engage with.

Some participants are disturbed by this exercise in that they feel as if this strengthened sense of boundaried-ness actually cuts them off from a feeling of connectedness with clients. The next exercise seeks to balance this, although this perceived loss of a familiar sense of connection may also represent a problematic relational stance on the part of the therapist (see below).

In the next exercise the vertical poise skill is repeated and then a second dimension is introduced and attuned to by guiding participants through conscious engagement with their bellies and hearts. Their attention is taken to their guts, to attune to and if possible not simply to observe from the head but actually allow one’s sense of presence to move down into the belly. Then to notice whatever sensations of presence, solidity, space or emotions they experience there. They are then invited gently to touch their guts with their breath, opening a different quality of self to self contact. This process is repeated with the heart.

They are again asked to imagine being with the client, before, during and after a session and note their relational experience.

The constraints of a day workshop prevent belly and heart being introduced separately. This would point up more clearly which relational capacities are supported by each. The impression gained is that attunement to the belly supports an empathic contact that is able to reach through the boundaries that were established and clarified in the first exercise, without their being compromised. It is as if a different relational capacity is opened or supported by attunement to our hearts. On a number of occasions participants have very movingly described how this part of the exercise enabled them to see or feel through all the layers of difficulty and acting out and feel touched by the client as a vulnerable human being. For the first time they were enabled to feel the client as a fellow human being. For the therapist it is as if feeling touched but not invaded, as if touched but not coerced or ‘made’ to have an emotion or experience. For the client one can imagine this might be a potentially pivotal healing movement from identification with being an unfelt dehumanised object to being felt as a human feeling subject.

Finally participants are guided through attuning to and engaging with what might be called an energetic dimension. I do not feel able to pin down exactly what I mean by this in a logical way, but can give indications. Perhaps the most everyday example of ‘energetic’ relational contact is eye contact. The ‘windows of the soul’ clearly convey and receive far more than is allowed for by their physiology. The eyes are marvellous organs of visual perception, versions of which independently evolved in insects, molluscs, and vertebrates like us. However for us humans they are clearly also profoundly sophisticated organs of communication and relationship.

The power and nuance of communication through eye contact, fleeting, darting, dancing or held, is familiar to us all as therapists, and perhaps known most clearly of all between parents and young children, and between lovers. Another example of energetic relating in everyday life may be the split second immediacy of ‘first impressions’, be they positive or negative or even scary with hair rising on the back of the neck. Feelings in the room of space, heaviness, oppression, lightness can also be energetic. Eye contact is not used directly in the energetic attunement exercises in the introductory workshop as it is so powerful and direct. Instead energetic attunement is explored through experiencing breath as light or energy, through activation of the hara (lower belly centre in martial arts), feeling into our energy field or aura and practising holding an energy ball between the hands. Then participants again imagine being with the client at the same time as holding attunement to this dimension and observe any changes.

At first I felt a bit shy about introducing this, it might seem a bit flaky or way out in the NHS or in Finland but I felt I needed to risk it as it has been very important as a resource in my therapeutic work and life. I have been perhaps surprised, certainly pleased, at how many have found it relevant and valuable, sometimes profoundly moving.

Some participants report feeling nothing much at all but some experience a simultaneous strengthening of boundaries and connectedness and what might be called a direct experience of ‘relational presence’. Some have found it supported a feeling of having a healthy boundary that had not resulted from the first exercise of musculo-skeletal alignment. For some it opened more of a symbolic or transpersonal dimension of the therapeutic relationship and space, including perhaps a sense of being contained or held by something bigger than ourselves.

Discussion and implications

I feel engaging with embodiment in psychotherapy opens up many avenues and questions, even when the focus is limited as now to seemingly simple aspects of our embodiment as therapists. I will briefly address some of the main points that may be relevant to CAT.

Why ‘embody’, isn’t it enough just to reflect on bodily processes?

Does inhabiting our bodies actually matter in CAT, why not just give more attention to bodily mediated experiences as useful information in guiding our work? We used this more circumscribed approach successfully in the Bristol deliberate self harm project when we developed a new CAT tool that the therapist used to monitor embodied and other counter-transference. This information was then used to guide the construction of a diagram in the first meeting (Sheard 2000). ‘Listening to’ bodily experience in this way and using it as information for the reflective mind clearly bears fruit, one example would be Orbach in her 2015 ACAT conference keynote address (Orbach 2015).

But I would suggest that this still represents a missed opportunity and is at best half hearted. It perpetuates our prevailing cultural dualism and identification with a mind based reflective consciousness, it takes relationship out of the immediate here and now and supports keeping involvement at one remove. It can be argued that this distance creates a crucial reflective space, an ‘observing I’ but in my experience it at best weakens and at worst deprives us of the immediacy and strength of relational capacities that can arise naturally through conscious embodiment. In CAT we emphasise both the ‘observing I’ and learning within the therapeutic relationship as crucial resources. The latter could be greatly supported by greater conscious embodiment. But when it comes to working with borderline relational fields, the ‘bread and butter’ of CAT, I would argue that just observing our bodies from our minds leaves us very open to the danger of subtle or hidden collusive reciprocation and bodily burdening of the therapist (see below). We deprive ourselves of a profound relational resource, like tying an arm behind our backs.

As we embody we can discover that our bodies are, as it were, relational organs that naturally support different aspects of relational capacity: boundaries, empathy, feeling and the symbolic/transpersonal. Embodying can feel like a homecoming.

Embodiment and clarification of therapists’ reciprocal roles:

It is as if embodying ourselves renders relational processes, self states and reciprocal roles more directly felt, tangible and real. This can particularly be the case with self to self reciprocal roles which can otherwise remain difficult to ‘come to grips with’ directly. It supports reflexivity. I find that working with clients’ own experience of embodying their problematic reciprocal roles not only creates a kind of living embodied diagram but also that exits and healthy reciprocal roles become much more obvious and indeed accessible (described by Dower 2015).

This sense of reformulation as direct embodied experience was evident in the workshops: the reflexivity brought out reformulation of the therapist as well as the client! The first two exercises quite often highlighted unrecognised problematic reciprocal roles within the therapists, both self to self and self to client. Quite often this took the form of a dilemma.

Quite a number of CAT therapists realised that they had been making an unrecognised and unhelpful assumption: as if in order to feel connected with their client they had to be ‘open’. This meant allowing, even inviting, the client into their personal or bodily space.

So a dilemma emerges:

It is as if either open and feeling connected with the client (caring?)

boundaried and closed off, feeling disconnected (uncaring?)

It is as if having such boundaries were somehow a bad thing, rather than a foundation for working as a relational therapist. Some participants have been shocked to realise that they have equated ‘being receptive’ with actually vacating their bellies: discovering that it is as if they have offered that interior space to their clients for a kind of containment, as a kind of therapeutic space.

This has been a very confronting but potentially vital insight (vital to their effective work and to their very vitals and vitality)! It is as if when we embody reciprocal roles we are creating and experiencing an embodied SDR in which the reality of how we relate to ourselves comes home to us and at the same time healthy reciprocal roles and exits become obvious to us. ‘Exits’ are actually introduced in the workshop: attuning to vertical poise and to our viscera supports an integrated experience that embodied boundaries and connectedness can not only healthily co-exist but indeed support one another.

Another frequent response in the workshops has been for CAT therapists to enjoy their engagement with their belly and heart and feel guilty about this, seemingly in an almost puritanical way. Dialogue around this has suggested an implicit belief that being in relationship with clients means giving all one’s attention to them and none to oneself. As if for the therapist to engage in self-holding and self-resourcing self to self reciprocal roles while in a session is somehow “taking something away from the client”! As if such healthy engagement with and resourcing of oneself is an impediment to therapy, a transgression, even perhaps a sin, rather than good practice. Again this suggests an implicit model that the therapeutic position somehow requires one to be absent to oneself rather than engaged with and inhabiting oneself in order to offer a presence (embodied) for clients to engage with. If so what are we modeling to our clients?

Dilemma:

As if either giving all attention to client and absent to (depriving of) oneself

Connected with oneself but depriving (as if absent to) the client

If I were to create a perhaps extreme caricature of the CAT therapists’ habitual problematic ‘top role’ reciprocations with their bodies that has emerged through these workshops it would be variations on:

slave driver

suffering, burdened but somehow still willing donkey

objectifying, dis-identifying, abandoning,

dehumanised, annihilated as a feeling subject, left alone, unsafe and open to violation by intruders

I realise this leaves a question hanging in the air: are these reciprocal roles and dilemmas mainly a reflection of individual therapist’s relationship with their bodies and their partly consequent problematic procedures around containment and holding? Or is this something about CAT culture and training? My hunch is a fair degree of both.

Disembodiment, collusive reciprocation and the burdening of therapists:

My sense is that these particular examples of CAT therapists being disengaged from their bodies are also part of a wider cultural disembodiment. We have split mind from body for centuries, soul from flesh for millennia. Our culture privileges and indeed idealises a disembodied rational mind, although this is now being challenged even within the intellectual traditions of philosophy and epistemology by the assertion that our metaphors, our very concepts and thinking are structured by the inescapable specifics of our bodies (Lakoff and Johnson 1999). The CAT model of psychological health is one of flexibility and breadth, connectedness and inclusivity in our identifications and our consequent sense of identity. Our splitting of mind and body and the consequently narrow identification with what we call ‘mind’ goes very much against this grain and can be argued to be not just a pity but actually damaging.

I am suggesting that being disembodied as therapists when we engage with split relational fields holds particular dangers not only for clients and the therapeutic process, but also for ourselves in the burdens we can end up carrying in our vacated bodies. I am suggesting this is an unacknowledged and damaging collusive reciprocation. It is as if dis-identifying with our bodies renders us more vulnerable to this. As if the voice of split off traumatic experience, in looking for a human homecoming, is free, or even implicitly invited, to enter the abandoned space of the disembodied therapist’s body, literally getting under our skin. If we vacate our bodily home it is no surprise when marginalized homeless, borderline experience moves in, our derelict home is squatted. As if the client’s splits will unerringly find our splits, in this case a split that we all share on a cultural level.

We are very likely to experience such a borderline relational process as a violation or some kind of assault on our integrity. Clearly this is the territory of projective identification, in this instance experienced as an ‘attack’, as a hostile and forceful putting part of oneself into the other, as originally described by Klein during the Second World War (Segal 1975, Sandler 1989).

It is as if when we don’t identify with our own bodies we leave an identity vacuum which can then be occupied by others’ experience. I find the term projective identification very accurate in a disembodied world. When we identify with something it can be peculiarly difficult to recognise as by definition it has a compelling intensity that obliterates consciousness. A kind of relational black hole that sucks light into it. Even if therapists are alive in their minds to such identification manifesting as embodied counter-transference it may well still remain embedded in their bodies. The voice, the unmanageable experience that is now stranded in the therapist’s body may need the therapist to reach out to it ‘inside’ on an embodied level to be met and included. CAT theory strongly asserts that if enactments by the therapist remain hidden and not addressed they will inhibit and quite possibly block the therapeutic process. Sustained collusive reciprocation makes us into a maintaining factor.

But embodied counter-transference, if routinely marginalised or ignored is also likely to be damaging to the therapist as well as to the therapy and client. It is likely to be an insidious drip-drip accumulation of bodily burdening that manifests as tiredness, disillusion, exhaustion, perhaps sick leave, even burn-out.

Therapeutic space and projective identification

It may seem simplistic but I find that exploring these difficult relational phenomena through embodiment makes them more understandable. It is as if embodiment renders relationship spatial, both self to self and self to other, giving a sense of where it takes place. As if there is personal space within and around the body (embodying the play of self to self), inter-subjective space between us/resonating within us (play of self to other) and transpersonal space around and through us.

It is suggested that if we are more consciously embodied the space inside and around us will be more alive with presence, with embodied relational consciousness and more conscious self to self reciprocal roles (healthy and problematic). I feel there are more than echoes here of Winnicott’s theory of transitional space, transitional phenomena and the origins of creativity and culture.

When present to ourselves in this way ‘projective identification’ by a client can be more consciously and directly perceived. The client’s split off, disowned or ‘un-voiceable’ voice may become more directly tangible to the therapist on an embodied level. It can begin to be felt, begin to be met, included, given space, digested within therapeutic space (reminiscent of Bion’s ‘reverie’. As if there can begin to be a relational space between and within in which to meet, integrate and grow rather than the potential therapeutic space collapsing down into bodily enactment lodged inside the de-subjectified therapist’s body. The relational dance can move from being collusive and violent to something creative and if things go well enough then relational space for integration can open up within the client in their healthier self to self reciprocal roles.

This movement from violence to human relatedness parallels later theoretical elaborations of the theory of projective identification in which it is understood not as a defensive attack or invasion but rather as an early attempt at communication and indeed the foundation of empathy, (Ogden 1992, Grotstein 1985). Leiman (1994) relates these different understandings of projective identification to CAT theory and qualifies Ryle’s rather disembodied, reductive model (Ryle 1994).

Crucial to this is the suggestion that the form taken by ‘projective identification’ is determined not by the client but largely by the therapist’s embodied capacity to relate creatively to it, or not as the case may be. If the therapist is out of touch on an embodied level then collusive reciprocation and burdening of the therapist are more likely. This is an understanding entirely consistent with the CAT model of co-creation of relationship through reciprocation. Also suggested is that loss of therapeutic space is something that can be perceived qualitatively, energetically, through the therapist’s embodied consciousness. It is as if embodiment can support us in shifting away from unwitting destructive enactments through an opening up of a felt sense of relational space, through which the pushes and pulls, contractions and expansions of relational dynamics can be more readily experienced and directly engaged with. As if embodiment and relational space ‘articulate’ containment and the relational theatre in which signs can be born and develop. Signs that mediate the mystery, joy and pain of our shared and separate identities.

Embodiment mediates relationship?

In this paper I am making the perhaps radical proposition that embodiment, rather than what we call our minds, mediates much of the fundamentals of what we call relationship and sense of self. Asserting that our bodies are not simply vehicles for our minds or dumb executors of our genetics and physiology, but are the unacknowledged ground or theatre of relationship. This notion runs against the prevailing dualism, ideology and power relations of our culture. It also may seem paradoxical to suggest that entering and identifying with our individual body, the very ‘thing’ that appears to define our separateness, even perhaps our nature as a soul-less biological machine, can actually enhance our capacity to relate, feel part of humanity and be touched by the transpersonal.

It is as if in quite a lot of everyday life and relating we can ‘get away’ with imagining that we live in and relate from our minds. But when we engage with borderline relational fields we meet the limits of this illusion of a separate self identified with the mind. I am suggesting that the strangeness and intensity of the difficulty we encounter in trying to offer and maintain a non-collusive therapeutic relationship with borderline clients more or less forces us to reconsider our basic assumptions. We have a largely untapped resource to hand: it is as if a movement from ‘objectifying’ our bodies to one of ‘subjectifying’ through conscious embodiment opens up spontaneous relational resources and capacities that can anchor our sense of identity and relational presence. As if consciously inhabiting our bodies opens the potential for a creative relational space in which relational signs can be born, in which we can find, and be found in, our humanity.

Afternote: For readers wishing to explore this further do contact me (timsheard1965@gmail.com) or come to an introductory workshop. ACAT have agreed to host a series of four workshops (probably starting in Autumn 2017) in which participants will have the opportunity to practise this approach and develop their own way of integrating it into their day to day work. A similar series has recently started in Finland. I would be delighted if someone wished to do some qualitative research on how this approach to therapist embodiment affects CAT practice and process.

Acknowledgements: I feel I have developed through contact and dialogue with many people over the years. For this paper I would particularly like to mention with gratitude my psychotherapy clients, the participants in my workshops, Caroline Dower and Mikael Leiman.

References

Dower, C. (2015) Bringing Bodies into Dialogue. Reformulation Winter 2014/15, 43 15-21

Field, N. (1996) Breakdown and breakthrough: Psychotherapy in a New Dimension. pp37-41 London: Routledge

Grotstein, J. (1985) Splitting and Projective Identification. New Jersey: Jason Aronson Inc.

Lakoff, G and Johnson, M (1999) Philosophy in the Flesh: The embodied Mind and its Challenge to Western Thought. New York: Basic Books

Lambert K 1974 Transference/counter-transference: talion law and gratitude. In Fordham M (Ed.) ‘Technique in Jungian analysis’, Karnac, London.

Leiman, M. (1994) Projective identification as early joint action sequences: a Vygotskian addendum to the procedural sequence object relations model. British Journal of Medical Psychology 67 97-106

Levine, P.A. (2008) Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body. Louisville: Sounds True Inc

Ogden, P. et al (2006) Trauma and the Body: A Sensorimotor Approach to Psychotherapy. New York: Norton

Ogden, T.H. (1992) Projective identification and psychotherapeutic technique. London: Karnac

Orbach, S (2015) There is No Such Thing as a Body. Keynote address ACAT Conference London: Birkbeck

Rothschild, B. (2000) The Body Remembers: The psychophysiology of trauma and trauma treatment New York: Norton

Ryle, A. (1994) Projective Identification: a Particular Form of Reciprocal Role Procedure. British Journal of Medical Psychology 67, 107-114

Ryle, A. (1997) Transferences and Counter-transferences: The CAT Perspective. British Journal of Psychotherapy, 66 249-258

Sandler 1989 The concept of projective identification. In Sandler J (Ed.) Projection, identification and projective identification. Karnac, London

Schwartz-Salant, N. (1982) Narcissism and Character Transformation pp113-132 Toronto: Inner City Books

Schwartz-Salant, N. and Stein, M. (1984) Transference Counter-transference. Wilmette, Illinois: Chiron Publications

Segal, H. (1975) Introduction to the work of Melanie Klein. p27 . London: Hogarth Press

Siegel, D.J. (2012) Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind. New York: Norton

Sheard et al (2000) A CAT-derived one to three session intervention for repeated deliberate self-harm: A description of the model and initial experience of trainee psychiatrists in using it. British Journal of Medical Psychology, 73, 179-196

Soth, M. (2005) Embodied Counter-transference in Totton, N. (Ed) New Dimensions in Body Psychotherapy. Maidenhead: Open University Press

Trevarthen, C. (2017) The affectionate, intersubjective intelligence of the infant and its innate motives for relational mental health. International Journal of Cognitive Analytic Therapy and Relational Mental Health 1, No1 11-53

Full Reference

Tim Sheard, 2017. Embodiment as a creative resource in working with split and “borderline” clients. Reformulation, Summer, pp.34-41.

Search the Bibliography

Type in your search terms. If you want to search for results that match ALL of your keywords you can list them with commas between them; e.g., "borderline,adolescent", which will bring back results that have BOTH keywords mentioned in the title or author data.

The Body in Dialogue
Burns-Lundgren, E., Walker, M., 2008. The Body in Dialogue. Reformulation, Summer, pp.18-19.

Bringing Bodies Into Dialogue
Dower, C., 2014. Bringing Bodies Into Dialogue. Reformulation, Winter, pp.15-21.

A dialogue: in response to moving on from face to face to online therapy
Cal Nield, 2020. A dialogue: in response to moving on from face to face to online therapy. Reformulation, Summer, p.15.

“Never-ending hurt”: How CAT can help inform the management of chronic pain
Dr Melanie L Davis, 2017. “Never-ending hurt”: How CAT can help inform the management of chronic pain. Reformulation, Summer, pp.16-21.

A Little Bit Of Bakhtin - From Inside To Outside And Back Again
Hepple, J., 2010. A Little Bit Of Bakhtin - From Inside To Outside And Back Again. Reformulation, Winter, pp.17-18.

Help

This site has recently been updated to be Mobile Friendly. We are working through the pages to check everything is working properly. If you spot a problem please email support@acat.me.uk and we'll look into it. Thank you.

Search

Embodiment as a creative resource in working with split and “borderline” clients

Full Reference

Search the Bibliography

Related Articles

Other Articles in the Same Issue

Help