Imagine, before you, a frozen lake. Middle of winter, not a ray of direct sunlight in sight. Depression can be like this. Thirty years ago, give or take, the standard treatment was to identify the beliefs that froze our inner emotional waters, and in countering the “I’m powerless, unlovable, incapable” voices that held us up to impossible standards of perfection, “should”-ing us into a frenzy, we would melt. Become, or become again, lively and engaged, able to feel pleasure and anticipation.
Try telling that to the lake. Oh, in some cases, it worked. I’ve even seen it, with clients of my own and in hospital settings. Once, I told a client that not everyone strives for perfection, and that many people find it easier to connect with others when they see their flaws and eccentricities (and who reads about perfect people, really!). She at once felt transformed, and reported next week feeling lighter, grateful for her new awareness. Ironically, she was a massage client of mine.
Yet, cognitive work with the profoundly depressed has sharp limitations, requiring an immense amount of work on the part of the client between sessions to override her, or his, lethargy and inability to feel joy. Nor do most clinicians believe CBT, by itself, to be effective; it needs to be mixed with pharmaceuticals, the standard being SSRIs that increase absorption of serotonin, the calming hormone produced in the gut.
As I said, I was, and still am by licensure, a massage therapist, as well as a licensed clinical social worker. Initially, it was a good way of getting through school, but as I worked with my massage clients, I began to realize that I was picking up on more that just the physical manifestations of their distress. We would begin to talk, before and after the session itself, and the depth and warmth of these discussions was surprising to both them and to me. For I had earned their trust in tenderly ministering to their pain, in literally holding it, and in listening to their bodies in order to sense what to do next, I helped them to listen as well. So you can understand why, when I became a social worker, I did not leave the body work behind, but instead trained in ways that would serve the whole human.
When L. (a composite client) came into my office stating (not complaining, never complaining) she had depression, it was an understatement: her face was an emotionless mask and she held her body rigidly; regular breathwork, a standard for therapists treating anxiety, which was mixed with her depression, produced profound panic in her. She was hesitant to get on the table so at first we simply talked to build a relationship, and did some initial work to enhance what little awareness she had of her body. The work was extremely slow, even though in her dedication she did the homework of restructured thought daily and attempting to meditate and ground, although her racing thoughts made this more a practice in enduring frustration.
Finally, in a last-gasp effort, she got up during one session, walked stiffly to the table and got on, sighing “might as well give it a try.”
Before I continue, let me clarify that bodywork is a continuous negotiation, with the client’s own will always the final decider. How does it feel, what are your thoughts, your sensations, as you consider getting on the table? Once that is o.k., then notice what your reactions are when you think about me touching your feet lightly? Your head? For even face up and fully clothed, with a blanket to further protect your boundaries, many people, and especially my clients, have an aversion to touch, which quite surprises them. Whether due to trauma, or to living in a world where feelings are marginalized and only the intellect valued (my male clients particularly recognize this), my clients have often learned to separate their selves from their bodies. This “dissociation” can be useful, even necessary in abusive homes, but unfortunately, the results can linger in our connective tissue long after we’ve left. At some point, we wish not only to survive, but to feel joy and love, be in relationship and wake up to purpose that satisfies not only others, but our deepest selves. When the world hits us hard, we don’t want to turn into Pinocchio, but bend and recover, preferably the sooner the better. All of these are felt sensations, emotion-based, and I’ll be addressing these issues more in future articles; for now, however, the point is that to my clients’ frozen and dissociated bodies, even the lightest of safe touch can burn. So it must be negotiated.
Back to L. Once she progressed beyond accepting the support of the table, and could be comfortable with it, I apply the lightest of touches to her head. She sustains this touch only for a few moments before her body starts to “swim,” feels more disconnected…a sign of overwhelm. My hands removed, she can ground again, and feel herself on the table. Gradually, we build strength, and she is able, after a few more sessions, not only to accept touch but welcome it, feel nurtured by it. Now that she truly feels accompanied, she and I can explore the distress in her body, beneath the thinning ice. One day, she begins to breath deeply, as if gasping for air…and bursts into sobs. Her formerly rigid body shakes, and even after the tears soften, it trembles. We do not know yet what lay within and under the ice, all that will still take more time, and talk, even as she continues the bodywork. She returns the next week, for the first time well-rested, and smiling. I had never seen that before, and it is beautiful.
And that is why I infuse bodywork into my psychotherapy.
Thank you, Inga, for once again putting these ideas into words for all to read. As a massage therapist who works with survivors of trauma, I have seen time and again how events and emotions from the past can present in the body now, causing distress, discomfort, and dis-ease. As a survivor of trauma myself, I am still learning those connections in my own body and life and trying to heal them. I am grateful for practitioners like you who understand and share your gifts. I look forward to reading more of this series, both for my clients and for myself. – Shelly Baldwin
Submitted on 2013/03/07 at 3:50 pm
I love how you include in your process of working with clients, and hold sacred the idea that we store in our bodies the energy of feelings and experiences–and that deepest growth and resolution lies in that amazing dance of listening to the body to hear more deeply what the spirit, emotions and mind have to share. That is really powerful Inga–and one of the many things I love about working with you. – Kay Hutchinson
Inga, as always, your strengths, gentleness, and insights bring more light into the world. When people ask me what things in America I miss, I always say your name. Your knowledge and intuition of how to reach and calm the raging deeper currents that flow beneath our seemingly still surface, and your willingness to share that gift to help all within your reach, is one of this life’s greatest blessings. Thank you for touching my life and stirring the waters. – Tina Tabler
Well written, touchingly explained…thanks you so much for sharing these insights
– Kristi Johnson
Fantastic article, Inga. The warmth I feel working along side you, doing yoga along side of you and so on comes through in this article. What a gift to clients! – Denise Onofrey