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Tuesday, May 30, 2006

 

Bioenergetics and other explanations

I have been meaning to blog a bit more about bioenergetics. I wanted to comment about my belief that clients who engage in this techniques do feel better and may even stay better. I was going to talk about how different theoretical perspectives all have success stories and many have limited data showing successful outcomes. Then I came across Judd Marmor's response to Alexander Lowen's speech at the Evolution of Psychotherapy convention in 1997 (published by Brunner/Mazel). In his speech, Lowen described his three years of character analysis with Wilhelm Reich and subsequent study with him. Reich was in Freud's inner circle for awhile. Lowen broke with Reich when Reich began exploring orgone energy (a kind of life energy that is in everything and emanates from living cells. Adherents claim to be able to see a blue aura around people and analyse it). Point for Lowen.

Lowen ended his speech with this summary:

My evolution has brought me to where I understand that the body will heal itself if one surrenders to it. The surrender to the body means feeling it fully from head to feet. It means sensing all the chronic muscular tensions in the body, understanding their history, and their function in the present. It means feeling one's pain and sorrow and crying. It means being able to protest the loss of one's innocence and one's joy...It means to have faith in the body, for it is the abode of God, and to trust its feelings because they express your truth. I had to learn this before I could teach it to my patients. And I have to learn it again and again, because my narcissistic ego still thinks that it knows best (p. 144-145).

Following Dr. Lowen's speech, psychiatrist Judd Marmor gave the reaction. The whole thing is worth reading (145-148). This quote is about how I feel about bioenergetics:

I have no doubt that Dr. Lowen is an excellent psychotherapist. I see him...as a warm, caring, passionate man with powerful convictions who unquestionably inspires strong feelings of positive transference in most of his patients. However, I do question his explanation of why his patients respond positively to his therapeutic method.

Dr. Marmor goes on to describe how relaxing and directly working on the body may bring some relief but does very little to address specific problems in the absence of other more accepted methods (talking, interpreting, etc.)

Marmor summarized: "...it is not what he does to or with his patients but what takes place between them in their relationship that helps them to make progress."

This summarizes my thoughts about Richard Cohen and bioenergetics. Several of his supporters have contacted me to let me know that Richard is a caring person. In my dealings with him, I have found this to be true as well. However, liking someone on a personal level does not preclude vigorous disagreement about other matters. Being of the same faith does not preclude such disagreement either.

I think the fact that a therapist is caring and charismatic can attract clients who seek personal dynamism. Motivational speakers are called this because they use the strength of their personality and communication skills to motivate. I believe many "therapies" rely on the relationship the therapist can create to motivate change a person was already capable of making.

On point, here is a segment from an interview with Lowen:

GG: How do you respond to the critics of bioenergetics who say that touching a client's body is unethical?

AL: A therapist is in some ways a substitute parent. He is not simply a guide. One doesn't get into transference relationships with a guide. Can one be a good parent if one is afraid to touch his children? But one can be a very bad parent (destructive) if touching a child is sexual. That is sexual abuse. The therapist who cannot control the way he touches a patient should never touch one.

I do not think that you can convince critics because they are projecting their anxiety about touching into the situation. Bioenergetics is a very powerful technique, and it involves doing a lot of things that other people would not do. Not all therapists are really fully qualified to be body therapists. It is unfortunate. One of the reasons is that it takes half a lifetime to be a good therapist. There are a lot of life experiences that are needed: working on yourself, working on your problems, and learning how to do bioenergetics.

If patients can trust you, then touch is not a breach of trust. If you are not trustworthy, then don't touch them! I don't always have perfect results with my patients, but they know I am sincere, straight, and doing the best that I can.

Much the same could be said for coaches. Therapists that create paternalistic transference reactions can expect strong positive and sometime negative reactions. The strong reactions may lead to transference cures or actual breakthroughs as a client begins to make the learning his own. However, the risk for negative reactions seems greater than those therapy styles that are more collaborative and egalitarian. If you can get the therapeutic benefit generated by a warm, trusting, and yes, emotive, therapy relationship without the baggage of the parental role and invasive touch, then why not do it? I believe Marmor is correct. If research on this point is accurate, most change in therapy occurs due to the therapeutic relationship and the application of common factors (learning, change, emotion) that most therapies share. Figure out how to apply them properly and you've got something.

Comments:
As I posted on another email, I think the t.v. show on Richard Cohen took delight in showing his unorthodox methods and not his other methods.
I also quoted Alan Medinger, who said his son wanted to lay his head on his manly, hairy chest and a man told him: "I'm not really after sex. If I could only lay my head on some strong man's chest..."
 
Dear Dr. Throckmorton,
I found this piece on Marmor and Lohen to be enlightening. It gave me insight into how two colleauges can disagree respectfully as they search from answers. I wish that there were more of this kind of dialogue within the psychotherapeutic community when it comes to the subject of SSA.

Regarding holding and touch I would like to add the following based on my own experience.

Healthy touch for men dealing with SSA also allows them to reframe their beliefs about physical intimacy with men. By being held by another man they can learn both cognitively and experientially that physical and by extension emotional intimacy between men does not have to equal sex, nor is it shameful. This paradigm shift creates an opportunity for the man to look beneath the physical attraction/desire and seek to understand what it is that he is really looking for; usually connection and affirmation.
 
My experience is the exact same thing can be done without touch coming from a therapist. In fact, not gratifying the wish can bring it into sharper focus much more quickly in my experience.
 
George -- don't know whether you can answer this, or whether you're just speaking for yourself.

At your best guess, what proportion of (for want of any better term) exgay men begin with that confused connection between physical contact with other men and sex/shame?

(I'll add that in our experience it is generally some straight men who make this connection rather than gay men. Hence their hang-ups.)

To us this points more to an issue with boundaries etc, rather than anything to do with the sexuality per se.

Given that, it seems counterproductive for a therapist to therefore encourage a physical relationship with a client. While the client might like it, it's again steeping into blurring a correct boundary.

(Is that part of the reasoning, Warren?)
 
Dear Dr. Throckmorton,
and so there perhaps we have it. Both methods, based on our anecdotal experience, seem to work. Obviously study and documentation is required and in the absence of hard evidence it is perhaps best that we keep an open mind and not label either method as invalid or icky.
 
Grantdale -
I can't speak for ex-gay men, because I don't really know who they are. The men I know, like myself, rarely if ever self-identified as gay and have questioned or are questioning their sexual options; we/they don't see "gay" as a viable choice for many and varied reasons.

My experience, both personal and observed, is that many of us want a deep connection with men but didn't or don't know how to achieve that without sex. Once we achieved intimate, non-sexual connection with men (physical and emotional) then the desire for sex with men decreased significantly.

I am not suggesting that this is the only factor that allows a man to achieve resolution to conflicted sexual desires, but it has been signficant for me and others.

I would agree with you that many "straight" men have a real issue around male/male non-sexual intimacy, and I believe that they would benefit from exploring and getting past their "hangups" on the subject.

As for men who self-identify as gay, I would imagine that there are many who separate sexual intimacy from non-sexual intimacy in a healthy way; I can't imagine that there are many, if any gay men who want to have sex with every man they meet.

As to therapeutic boundaries, I am in agreement with you and with Dr. Throckmorton. I think a therapist must be careful, and follow ethical guidelines and boundaries. As I stated in an earlier post, if the methods are valid, then an ethical and safe way can be found to deliver them.

Thanks for the questions, they were thought provoking.
 
George: You went way beyond what I have been saying when you wrote: "Both methods, based on our anecdotal experience, seem to work."

Traditional psychotherapy has been thoroughly evaluated and found to be effective. Asking clients to put their feelings into words, and reflect on feelings instead of gratifying them is a tried and true means of addressing these issues.

Bioenergetics (and touch therapy specifically) takes a combination true but irrelevant observations (we live in a body, unhappy people have muscular tension) along with false assertions (traumatic memories reside in the body and need released through direct touch) and constructs an elaborate set of techniques that probably convey to the receiver some of the common factors that lead to a therapeutic relationship.

What we are addressing is the placebo effect. Just making an appointment brings some relief to about 65% of clients. Should we construct a therapy of simply having clients make appointments week after week with different therapists? Placebo is powerful and should be exploited for a client's good but it is generally not enough, nor is it necessary to use invasive, potentially harmful techniques to achieve it.

Grantdale: Agreed. Boundaries in psychotherapy are crucial for it to be psychotherapy. Otherwise, it becomes one of number of other wish-fulfilling relationships we could have (friend, physical therapist, hair stylist, parent, bartender, etc.). Just because therapeutic (read: helpful) things happen in a relationship doesn't make the relationship therapy. For therapy to have impact beyond what these other relationships can have, it needs to be something different from what these other relationships can be.

I hope to have another post on this soon.
 
Dear Dr. Throckmorton,
I respectfully disagree that I have gone "way beyond" what you have been saying.

Your anecdotal experience says that a congnitive approach works. My anecdotal experience says that an approach that includes touch (not necessarily from a licensed therapist and not exclusively touch) works. Your experience is supported by extensive research. My experience is backed up by much less research. In my judgment our anecdotal evidence is irrefutable and equal, what is required in my opinion is on-going research and documentation.

To that end, as a clinician and researcher, how much anecdotal evidence would you need in order to justify the formation of a hypothesis, and complete study of the issue?
 
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