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Stephen Johnson, PhD
(415) 642-8778
Email Stephen

910 Church St.
San Francisco, CA 94114

445 Burgess Dr.
Menlo Park, CA 94025

Books & Workshops

YOUR BODY OF WORK IS NEVER DONE.
Barack Obama

CURRENT WORKSHOPS:

APRIL 17-18, 2010   ALAMEDA, CA:
A THERAPIST TO THERAPIST WORKSHOP: TREATIING THE ATTACHMENT DISORDERS WITH STEPHEN JOHNSON PH.D AND BILL SAY MA.

RECENT WORKSHOPS:

OCTOBER 9-11, 2009:
CHARACTER STYLES: THE ISSUES OF ATTACHMENT. LONDON, UK. UKAPI TRAINING PROGRAM

CONSULTATION GROUPS:

• SAN FRANCISCO: WEDNESDAYS, BI-MONTHLY: 12 NOON-2PM.
• SACRAMENTO: FIRST FRIDAY, MONTHLY: 10AM, 1PM, 3:15PM

BOOKS AND PAPERS:

• CHARACTER STYLES: INTRODUCTION
• THE SYMBIOTIC CHARACTER: INTRODUCTION
• HUMANIZING THE NARCISSISTIC STYLE: INTRODUCTION
• STARS INTO STONE: A CLINICIAN'S GUIDE TO MASOCHISM

When I hear my client has been stuck in a bad job or bad marriage for years and can’t or won’t change it or get out; when I see righteous self-denial; when I feel maddening impatience with the interminable stuckness of the person in front of me; when I experience my failure to make any impact no matter what I do, my Masochism File pops up.

The conscious mind does, in important ways, work like a computer. Many files can be stored in nonworking memory and then, when called upon, immediately emerge into working memory. With the Masochism File in hand, I can go to the understanding or intervention files. In understanding, I will find what I know about the general characteristics of this category (e.g. history, relationships, attitudes, emotions, responses of others, etc.) I can then begin to check out how this client does or does not fit this general profile.

If I go to the intervention files, and my understanding was correct, I will find the likely issues of treatment, the expected transference and counter-transference tests, and advance information on the kinds of knowledge, experience, and learning that could help this person. Perhaps most significantly, the files also remind me of the likely pitfalls of therapy with this client, and suggest, caution against, or disqualify certain therapeutic techniques. This is diagnosis—understanding the pain, appreciating the persistence of the dynamics that sustain it, and preparing to help my client relinquish the patterns and the pain.

Character as Listening Perspective

The conscious mind can easily forget that it has used these categories to navigate a more complex reality. Then, the map becomes the territory and it can seem more important than what is really out there. One must keep her eyes on the road, not on the map. But, it is foolish to throw the map away; the conscious mind needs its help, particularly in new territory or when it gets lost. In using the categories of Character, I find it useful to view them merely as “Listening Perspectives” (Hedges, 1980). With the Masochist, this perspective helps me listen for blocks to flow, empathize with the pain of immobility, tolerate the passive-aggressiveness, remember to avoid directives, power struggles, etc. This set also helps me remember that I am not dealing with a “masochist”; rather I am using a model to listen and respond to a person. Another character issue may well arise at any moment and I may need to visit my Schizoid or Narcissistic files to better listen and respond at that
time. Listening Perspective also reminds me not to split (i.e. my map is good, yours is bad). It is just a map and good for therapy only insofar as it is useful.


Character in Dimension

In my work, best summarized in books (Johnson, 1985; 1987; 1991; 1994), I have used only seven Character Styles to map personality and psychopathology. In order of the proposed developmental sequence, these categories are Schizoid, Oral-Dependent, Symbiotic, Narcissistic, Masochistic, Obsessive-Compulsive, and Hysterical. In practice I will sometimes use two more, Psychopathic and Paranoid, to further my understanding. I am aware of the unfortunate pejorative connotations of these words, but no other vocabulary I’ve tried has really worked. These categories are the result of the last century of psychiatric and psychological thinking and research. For many years, I have seen them as labels for universal, existential life issues (Johnson, 1985). Life presents predictable dilemmas, and their resolution leads to Character adaptations along a continuum, soon to be introduced.

It is obvious that things as complex as human personality and psychopathology need more elaboration. Seven to nine categories cannot begin to model all this complexity. Obviously, not all Masochistic Characters are alike! So, I use a dimension that goes a long way to map this greater complexity. It is the dimension of psychic structure. It could be called ego-strength, or emotional maturity, or level of personality organization. The dimension is a continuum. I have labeled three points along that continuum to facilitate its understanding and use. These points are Personality Disorder, Character Neurosis, and Character Style.

Personality Disorder

To explain personality disorder as used here, I employ Kernberg’s concept of Borderline Personality Organization. Kernberg employs four characteristics of such organization: 1) Ego Weakness, 2) Primitive Defenses (mostly based on splitting), 3) Disturbed Object Relations, and 4) Primary Process. For simplicity, I subsume the fourth characteristic within the first three.

Ego Weakness: In Personality Disorder there is often a breakdown of ego functions. This is especially true under stress. Dysregulation of affect and disinhibition of behavior are examples of such ego weakness. Breakdowns of critical judgement, regression to primary process, or breakdown of self-esteem regulation represent other examples.

Primitive Defenses: In the psychoanalytic-developmental literature, some defenses are seen as developing earlier and being less mature than others. Splitting, dissociation, and projection, for example, are seen as developing earlier and being less mature than repression, suppression, intellectualization, or rationalization. People with Personality Disorders tend to use more primitive, less reliable defenses whose breakdown can lead to even more primitive states.

Disturbed Object Relations: In borderline organization, there is typically a history and contemporary manifestation of disturbed interpersonal relations. Abuse (psychological, physical, or sexual) appears common in the histories of those with this more primitive psychic organization. These pathological relational structures are internalized such that internal object relations are chronically disturbed (e.g. see Fairbairn, 1952; 1974). As a result, there is impairment in the formation of an integrated self-concept. Identity diffusion is a common characteristic. Similarly, a stable, realistic understanding of others as they relate to the self, has not been developed. Others may be related to as “part objects”, seen only as they can serve the fragmented self rather than for the separate, whole individuals they really are.

In personality disorders, there is usually a disruption in the flow of body, emotional, and other-person awareness into consciousness. The person is often dimly aware of herself in the body—mind connection. She may be overly identified with her false self, for example, or unaware of her automatic propensity to avoid contact, or unaware of her ambivalent tendencies toward attachment. She often doesn’t know herself as she relates to desires, motives, hostilities, ambivalence, etc. Her “emotional intelligence” is often quite impaired. Relationships in the real world often reflect the internal difficulties described above. Such things as entitlement, splitting, part object perceptions, grandiosity/worthlessness, and idealization/devaluation can severely disrupt adult relationships. In DSM IV, most Personality Disorder descriptions emphasize the factors described here. While it is quite an over-simplification, it is heuristic to note that those with personality disorders give both themselves and others a lot of trouble. As one moves up the structural functioning continuum to Character Neurosis, the individual may still give himself a lot of trouble but, in general, he will create less pain for those around him.

Character Neurosis and Character Style

As one moves up on this developmental-structural continuum, these more primitive qualities tend to mature. Defenses are more mature, relationships are more two-sided, ego strength is more reliable, the “observing ego” is more available, and identity is more stable. In the Character Neurosis range the character issues represent complexes, internal conflicts, neurotic compromises, etc. There is more responsibility for one’s suffering and for solving one’s own problems. Therapy is easier, the alliance is less often disrupted, and there tends to be much less primitive enactment, projective identification, and torture in the relationship. Active, evocative therapy techniques may be used with less caution because there is far less concern about ego breakdown. Indeed, such active techniques are often needed to access feelings that have been buried under rigid defenses.

When we approach Character Style, we are approaching the normal range of these existential life issues. Here we can become more aware of the resources inherent in any given characterological adaptation. Diagnosis may be more positive, prescribing the use of these strengths for developing personal growth. Character Style is, in a way, the goal of treatment.

I find that this model of personality and psychopathology works well a good deal of the time, particularly when I use multiple categories and the dimension of psychic structure. I get excited when the model does not work. Then, I find I have to build an even more customized model for the individual case. Even here, however, the general structure of Character model building helps. This involves the use of history, development, and the structural continuum to first, understand the character of the person sitting across from me. Then, this understanding can facilitate knowing what could help or hurt that person. If one remembers the spirit of the diagnostic endeavor, one cannot really go very wrong.

The Masochistic Story

Seeing a psychotherapy client for the first time is a challenge. Some, who don’t really know have called most of our clients “the worried well.” No! People willing to spend the time and the money, and risk the personal vulnerability required in this endeavor are almost always hurting deeply. And, so often, there is nowhere else for them to go. We are obliged to understand what’s wrong—that’s diagnosis. It is not labeling, criticizing, or distancing. It is understanding that pain--preparing to help.

In considering what follows, try to remember that there is no such thing as a “masochist”. This is merely a category--a listening perspective--to help our limited conscious minds to understand and structure our work.

When you see someone who is dealing with masochism, you see deep suffering. Yes, the masochist is attached to her pain and she has learned to use it for some unfortunate advantages. Yes, she is often sadistic with it making others suffer as well, but she is deeply injured and she is involuntarily stuck in her misery. The enterprise of diagnosis is there to give you, the therapist, neutrality, not superiority. So, lets think now about how to identify masochism. Let’s begin at the clinical beginning, forgetting about judgements—either of diagnosis or of masochism.

“I’m standing knee deep in yesterday’s rain.” This wonderful line from an America Country Western song* succinctly describes all functional psychopathology. But, it is especially true and poignant for the masochist. He or she is stuck knee deep, or deeper, in a solution to a tragedy that happened long ago. All character adaptations are solutions to an old problem. They are not “character flaws”; they are elegant
solutions, based on the resources possessed at the time of their creation. For adults, they have usually outlived their usefulness and are now far more trouble than they are worth. But, because they solved a problem of epic proportions, they persist. These solutions were always painful, of course, but today the pain is so much greater than any gain that still might be realized. And yet, they just won’t quit.

*Yesterday’s Rain; written by Toby Kieth and Scotty Emerick

Good enough psychotherapy helps people relinquish these hurtful solutions and find new ways of being.

All psychopathology is self-defeating but the masochist has it down to an art form. So much so, that his behavior is often comically pathetic, even to him. One of our clients, after 12 years of therapy and 15 years of anti-depressants, and still caught in his web, would say, “My family: we fail and laugh about it. My family’s coat of arms was ‘Hold back and Censor’. My personal bankruptcy was inevitable given my personality.”

The pain is excruciating but the masochist has learned to live with it, to mock it, to use it for all it’s worth. What distinguishes the masochist from other character adaptations is the perverse pleasure taken in the pain. As Reik (1931) elucidated a long time ago the masochist’s suffering is displayed for all to see. The masochist will be the first to admit what a jerk he is and has been. He is usually self-effacing, welcoming criticism, and, seemingly willing to be one down. He is solicitous of your opinions and advice. But, your responsive offerings will almost never change anything. The masochist’s pain has, unfortunately, become a kind of “badge of courage”, a symbol of survival, a cherished friend, a treasured part of his identity. When you understand the etiology of masochism, this all makes perfect sense; but that’s for later.

Another characteristic of masochism is that the pain is inflicted on others unintentionally, and non-consciously. Typically, the masochist makes others feel responsible for his pain, while at the same time, making them feel totally inept at relieving it. As psychotherapists, we are especially likely targets of this passive-aggressive behavior. In general, the masochist will make you feel frustrated, inept, and furious. And, at least initially, you may feel quite helpless and inarticulate in face of this insidiously veiled aggression. Worse still, you may feel guilty for having these “untherapeutic” feelings. The person before you is hurting and you hate them. Often, you wish that they would just go away. Have no shame; this is the counter-transference you need to identify and work through the masochistic problem. Such counter-transference reactions are as useful as anything to tell you to pull up your masochistic files--your masochistic listening perspective.

Before explaining the typical etiology of this painful solution, let¹s briefly review seven other signs or signifiers of the masochistic process. A much more extensive elaboration of these characteristics is available in Johnson (1994, pp. 213-218).

Subservience: The masochist often presents as inferior, treating you as Superior--the one who knows and can provide the answers. Outside your relationship, the person may play roles of accommodation, forbearance, and even servitude. But what you begin to sense in this behavior are attitudes of moral superiority, subtle put-downs of others, and veiled resentment. In this servile position there is an identity--the injustice of the downtrodden. There is a sense of nobility in this suffering--a possession of the morally highest ground. In a perverse way, there is pride and enhanced self-esteem in occupying the oppressed position.

Delay: Nothing ever moves. These clients often come to therapy religiously and, at least superficially, seem to comply with the process. But, the compliance is false, half-hearted, not collaborative. You get the sense that this person wants you to do something to him. But, that something always fails to make any real impact or difference. Your contributions can never be taken in, incorporated, or truly owned. They remain something outside; something that has failed him yet again. Repeatedly you see a person locked in stone, immune to even the best interventions. Until you catch on to the pattern you¹re locked in with him. This is how it should be. As the therapist, you have to get caught. If you can get free, you may be able to help the client achieve freedom as well. This mutual enactment (Stark, 2000) is necessary for recognition, mutual working through, and eventual repair.

Victimization of the Self: The masochist is truly “his own worst enemy.” He will seemingly do anything to sabotage, humiliate, and defeat himself. This can reach absurd, even comic, proportions. He will often laugh at these things and attempt to get you to laugh along with him. Don¹t. The joke is on him, and it is a cruel and tragic one. It is the lock on the stone.

Negative Success Reactions: Sometimes things do move, or begin to. Perhaps there is pleasure, a little break-through, some good fortune, a win. But, as surely as night follows day, there is a price to pay. The dark clouds roll in, guilt arrives, there may even be an "accident." Goodness can¹t last. It¹s as if the individual can¹t tolerate the good; it is antithetical, not his due. Truly, the good is very threatening. And this, of course, is supremely tragic.

Problem Flooding: The masochist will often present many problems
simultaneously, flooding herself and anyone who listens empathetically. Or, failing that, as soon as you seem to be making some headway in understanding or dealing with one problem, another will emerge. This is not unlike the Negative Success Reaction, but this pattern is more emergent in the therapeutic dialogue--verbal and non-verbal. It defeats success pre-emptively. Again, you will have to get caught in this pattern—truly experience it¹s frustration--before you can free yourself from it.

Provocation: Masochists provoke anger, rejection, punishment, abandonment and even hatred from others. The provocation is so maddening, in part, because it is done non-consciously, passively, and deniably. Others often have a hard time recognizing or articulating the provocative pattern, even to themselves. Often the provocation comes in an accumulation of many small doses leading the other to “blow up” at the masochist over the last trivial incident in the series. Then the provocateur can assume his favored role of the abused innocent and make the other wrong. This, too, is often done in a passive and deniable manner. Because the pattern is so often hard to label, the other will often feel guilty over their loss of temper or rejection. And, of course, this guilt serves as another provocation in a new series. No matter what the masochist may say about the incident—and they can be overly apologetic—they telegraph that “Who Me?” attitude that is, once again, provocative.

Provocation is a good example of how masochists behave so as to take their internal world and impose it on their external reality. It is an example of projective identification when the other is provoked and accepts the masochist’s covert invitation to beat him.

Generalized Anhedonia: This classic descriptor goes much deeper than I once thought. Herein lies the core, the essence, of masochism. If you deeply understand the dynamics of this category, you will comprehend why the solution is so engrained and so hard to change. With that, helping change occur will become more possible.

Implicit in all that is described above is how disallowed pleasure and success have become. The masochist is the Anti-hedonist. There is a commitment, always non-conscious, but sometimes also quite conscious, to this “philosophical” position. There is often a combination of both envy and disdain for those who seem to enjoy success and even life itself. Not infrequently, this is incorporated in a kind of political position emphasizing self-denial. This anhedonic commitment is a critical part of the masochist¹s identity.

One client I saw in a demonstration format spoke with pride of how he drove a twenty-five year old Volkswagen which was constantly breaking down, seriously affecting his business and family life. And, he proudly wouldn’t get a cell phone even though he, his career, his clients, and his family suffered sorely because of it. The excuse of insufficient funds for this purpose dissolved quickly. He was committed to a life of frugal simplicity. Even the indulgence of a mid-day coffee was withheld on principle, and it was clear he deprived himself of much contact with his beloved children. Deprivation was a life style, a badge of courage, a noble calling.

I recall hearing individuals¹ say, “Well, I don¹t watch television; I would never fly first class, no matter what; I always recycle.” These seemingly harmless, politically correct sentiments went deeper into character, however, as revealed by the facial expression, voice tones and context in which they were given. They said, in effect, “I¹m better than you because of my chosen deprivation.” Reik¹s (1931) last chapter in his tome on Masochism was titled, “Winning Through Losing.” The examples above could be titled “Superiority through Denial and Inferiority.” It is this basic personal identity achieved through denial of pleasure that has proven so resistant to change. To embrace pleasure, success, and fulfillment would risk causing the whole structure, including the values that uphold it, to collapse. We all resist identity change for then we face the possible panic of not knowing who we are. With the masochist, this fear is the stone that locks the star.

Narcissism and Masochism: Whenever I have done a demonstration clinical interview with a masochistic client, some thoughtful soul in the audience will say, “I thought he was a Narcissist.” I always say, “You’re right.” There is narcissism in masochism as outlined, in part, above. Developmentally, both of these structures form during the period when the separate self is created. They are both deeply affected when there is serious damage in the attachment periods of development which precede this period of self-construction. Both structures involve the issue of self-esteem and the polarities of grandiosity-worthlessness and inferiority-superiority. In both, the false and real selves are key concepts for understanding and helping clients find their true destiny.

The category of Masochism adds very valuable differentiation for clinical purposes. It postdicts and predicts to improve our critical understanding of the dilemmas faced, the nature of the specific solution, the likely resistances, transferences, counter-transferences, etc. The category adds tremendously differentiating material, even though there is much essential similarity.

The Gifts and Risks of Diagnosis

Body therapists, like their cousins in Gestalt, Humanistic, and Existential Therapies, are often suspicious, if not downright hostile, to diagnostic categories. They may argue, quite rightly, that diagnosis oversimplifies, emphasizes the pathological, can separate the client from the therapist, and tends to become reified.

While all these risks abound, they are the products of the limits of consciousness, not inherent in the project of classification. The categories of diagnosis can serve to give the conscious mind a useful map of a very complex territory. The map does simplify, and attempts to highlight what is most relevant. Where the map serves to guide the moment-to-moment work of psychotherapy, it must be simple and limited to a few categories.

Now, before going into the specifics of masochism, I want to offer a brief history lesson emphasizing the emerging synthesis of Character Analysis, Object Relations, Developmental Psychology, Ego and Self Psychology, Neurobiology, and Relational Psychoanalysis. These threads synthesize into what, for lack of a better label, I will call “Contemporary Character Analysis.” I will then offer a brief integration of these fields of knowledge and a table summarizing Character Issues and Levels of Psychic Structure. Then, we will go head long into understanding and treating one structure—masochism.

The Model

Historical Origins
The model, “Contemporary Character Analysis”, has its most profound origins in the work of Wilhelm Reich (1933, 1972, 1961) and Alexander Lowen (1958; 1967). Like many of the pioneers of psychotherapy, they were so right about so much. But the models we use today can be informed and continually corrected by research and the related theoretical development.

In addition to the further development of the Characterological approach (e.g. Horowitz, 1987; 1991; Johnson, 1994; Shapiro, 1965; 1989), the model I present here has been informed by developmental theory and research (e.g. Ainsworth, 1978; Mahler, 1968; Mahler, Pine and Bergman, 1975; Sroufe, 1996; Stern, 1985; Tronick, 1989) and most recently, neuroscience (e.g. Damasio, 1994; 1999; Schore, 1994; Siegel, 1999). A number of psychotherapeutic theories have also contributed; namely, Object Relations (e.g. Fairbairn, 1974; Kernberg, 1967; 1984, 1975, Klein, 1946; Masterson, 1976; 1981; Winnicott, 1965; 1971), Ego Psychology (e.g. Blanck & Blanck, 1974; A. Freud, 1936; Hartman, 1950), Self-Psychology (e.g. Gedo & Goldberg, 1973; Kohut, 1971; 1977, 1984), and Relational Psychoanalysis (e.g. Mitchell 1988; Mitchell & Aron, 1999; Ogden, 2000).

The resulting model is a synthesis of a number of classical and contemporary approaches to understanding personality, psychopathology, and the healing art of psychotherapy. The theory rests solidly in the canon of psychotherapy. At the same time, it is uniquely suited to an emphasis on interventions that include the emotional realm, the body, the non-conscious, the nonverbal, and the relational realm. As we practitioners know, a model is worthy, not because of its repectability or its elegance, but because of its usefulness. In the craft, the art, of therapy we ask, “does this work?”

In this spirit, I reproduce the map of personality and psychopathology that I first published in my first book of the series on character styles (Insert Table 1 about here).

This table is much simpler than it might first appear. It merely maps character on two axes that have already been thoroughly described. On the vertical axis, seven basic Character Issues are listed. On the horizontal axis, the dimension of psychic structure or ego strength is plotted.

The map can be used, first, to characterize a person in general. In most cases two or more categories along the vertical axis will be required to construct a complete picture of the person. In general, more pathological individuals will require more categories to fully describe their personality and psychopathology.

The map can also be used to describe someone at a certain point in time. For example, many individuals who exhibit an oral-dependent personality typically operate in the Character Neurosis range. But in the midst of a divorce, for example, they may dip into borderline states. This occurs, of course, because the situation triggers the internal abandonment issues and this overwhelms the more neurotic defenses, leading to the experience of unusual borderline states.

Now with the whole map in front of us, let us move to the final two considerations for this clinician’s guide to masochism--etiology and treatment. If you decide your client exhibits the masochistic structure, inquiry about personal history, past and present relationships, and critical incidents has revealed a typical masochistic story or some variation of it. For the masochist, here, essentially, is what happened “yesterday”.

Etiology

From the earliest to most recent clinical observations of masochism, there has been great consistency in the reports of its functional etiology (Reik, 1931, Reich, 1933, Lowen, 1958, Johnson, 1994 more). This character solution is so obviously “man made”, so contrary to biological nature, so diabolically insidious, that it leads anyone to look for functional causes. Even the most resistant masochistic client will often ask, "What would cause someone to behave so self-destructively?”

Please recall again that we are discussing a continuum in this character structure along the dimension of ego strength or psychic structure. Individuals who exhibit the Personality Disorder usually report the more horrific histories combined with disruptions in earlier attachment. Still, all along the continuum, there is commonality in the family and social histories of people who self-defeat. Most common in these histories is a very controlling family. Sometimes, this is complemented by an equally controlling community. In the horrific stories, this control is sadistic, sickenly pathological and ultimately overpowering.

Still, every family that produces a masochist is, in some fundamental way, a dictatorship. Rebellion is very difficult, if not impossible. The individual is forced to go underground to express his separate self. Rebellion, defiance, individual expression is punished--hard. This is so even in the most “liberal” of such homes—deviance may be mocked or made subtlety, even politically, incorrect. As a consequence, rebellion has to be disguised, hidden, and deniable. As in Nazi Germany, sabotage has to look like an accident—otherwise the whole village will be wiped out. In the childhoods of my clients, I have seen the tyranny of the radical left as emotionally severe as the tyranny of the fundamental right. The former just looks better.

When you are in such a family, there is only one way to assert yourself and retain your self-respect—Masochism. You self-sabotage in rebellion and self-expression and you display it for all to see. You hurt others by hurting yourself. At least symbolically, you induce guilt in others by being miserable yourself and making it passively, but abundantly, clear that you suffer because of them. You don’t get angry, you get even. And you perfect that one insidious solution until it is automatic, almost entirely unconscious, totally deniable, and absolutely maddening to anyone who cares about you.

I’ve always loved the title of Otto Kernberg’s book, Internal World, External Reality. It so succinctly describes Object Relations Theory. We construct our internal world to correspond to our early external reality. Once constructed, that internal world helps us understand and cope with what’s out there. We construct the best coping strategies available at the time to manage that external reality. But, this internal world based on an early external reality, and the coping strategies of that earlier time, have become fixed. Then we go through life seeing the external world through our internal world-view. We will do extraordinary things to get that external reality to match our internal world. We keep on coping with external reality as if it hasn’t changed. And, we don’t acknowledge the change in ourselves. Operating with this outdated map and the strategies that complement it, we can get into a lot of trouble.

Now, when it comes to Masochism, I could tell you many variations on the story; “I’ll beat you ‘til you cry and then I’ll beat you for crying.” But I don’t think that is really necessary. What is outlined above is the essence of the masochistic etiology. So what is there to do?

Treatment and Body Psychotherapy

Because this is a book on body psychotherapy, I need to take a little time to explicate how my ideas on the treatment of masochism fit within the body therapy tradition.

What is Body Psychotherapy?

My friends, laymen, sophisticated in psychotherapy, and other therapists (sometimes even body therapists) often ask this question: “What is body psychotherapy?” Like most people, my first associations to this question involve specific techniques that are absolutely unique to bodywork. I see Alexander Lowen directing someone to do something with her body; or I see Gerda Boyson, stethoscope around her neck, with her hands on someone’s tummy. And, yes, these are examples of body psychotherapy. Yet, these associations don’t even come close to telling the whole story.

Then I remember my attendance at the Congresses of both the American and European Body Therapy Associations. I recall who was there and what they did. In addition to those who represented very specific types of body psychotherapy, there were many others who represented and taught about a wide range of psychotherapeutic ideas.

Psychoanalysts, Martha Stark and Laurence Hedges were there. Neuroscientists, Alan Schore and Bessel van der Kolk were there. Child Development researchers, Edward Tronic and Annie Brook were on the program. Well known philosopher-therapists who embrace various active techniques were teaching and demonstrating (e.g. Alan Pesso, John Pierrakos, and Ron Kurtz). Topics taught included borderline personality organization, transference and counter-transference, attachment theory, the therapeutic relationship, Gestalt Therapy, Yoga techniques, couple’s therapy, and Object Relations. And I was there, invited to teach my synthesis of character and psychotherapy in its post-modern expression.

Clearly, this is not your father’s “body psychotherapy.” Perhaps the most distinctive part of each conference was the dance with a live band that each conference sponsored. I go to many conferences and such dances are unheard of. And, I noticed, these people can dance—even the northerners.

So, what is body psychotherapy? Well, we live in the post-modern era where complexity can be embraced and answers can be provisional—works in progress. I think it can be said that body psychotherapists are now more like other therapists than they are different. They are more secure than before—not needing to aggressively differentiate themselves or prove that they are better. They bring orientations to the therapeutic project that bear serious consideration.

Maybe, just as there is no such thing as a masochist, there is no longer any such thing as a body psychotherapist. Still, these body psychotherapists emphasize very valuable orientations. One of these is Body Awareness: The body therapist pays attention to her own body; she does embodied psychotherapy. She knows what and where she feels things. She can de-center from herself, and in an empathic state, she can feel much of what her client feels. At the same time, she can confidently “own” her own body, feel what she feels and represent that with a differentiated awareness. The “body psychotherapist” is also supremely cognizant of the client’s body. He is aware of things like breathing, posture, movement--flow or block—eye contact, social distance, bodily tension, body armor, etc. He is thinking, yes, but he is also feeling, empathizing, relating, and ultimately, he is centered in his own somatic reality.

Finally, I would like to briefly catalogue four other basic orientations that body psychotherapists bring to the project. I will restrict the elaboration of these factors only because of constraints on the space that I am allowed to take here.

Focus on Affect: Body psychotherapists typically go directly for accessing and releasing emotion. They orient to the body blocks, the tension or defensive armor that stops the natural flow of affect and promote the release of the underlying feelings. Many body therapy techniques pull directly for certain affects. For example, hitting and yelling elicit aggression, the eyes wide open together with the arms in a defensive posture, and deep breathing elicit fear, etc. These processes are then attached to elements of the internal world and external reality. There is now much research that confirms the efficacy of such processes (e.g.).

Grounding and Centering: Many body therapy techniques help people come “out of the head” and into “grounding in the body.” Breathing deeply, feet on the ground, legs energized, etc. all re-center the experience of the self in a more “grounded, body-centered” way.

Transforming the Abstract into the Concrete: I cherish how concrete are the body therapy processes. Boundaries are transformed into distance, pushing the other away or pulling them in, etc. Many core psychological principles are made concrete with these “body therapy” processes (e.g. trust, differentiation, self-activation, re-enactment of childhood dramas, traumas, etc.).

Body Focus as Altered State: For many of us, whose sense of self is typically located somewhere between the eyes, body therapy techniques bring our focus down to the body and the reality of affective experience. In doing this, they can elicit an altered state of consciousness. In this altered, hypnotic-like state, non-conscious, automatic learning becomes more possible.

With this background, let us now return to the treatment of masochism secure in the knowledge that “body psychotherapy” is, first and foremost, psychotherapy, complemented by these valuable orientations and useful processes.

TREATMENT

The therapist with a need-to-cure and the patient
with a need-to-fail establish one of the most stable
and enduring and unchanging pairs in the civilized world.
Herbert Gross, 1981

There is only one way to succeed with the masochist. You mustn’t care much about succeeding. At least initially, the masochist will try every trick in the book to get you to take responsibility for her pain. She will hook you into that; and being hooked is necessary for you to understand the pattern. But to help, you must free yourself from the drama. You must not need to cure, to succeed, or to help. You must be the warrior of the Bhagavad Gita, effective because you are unattached to the outcome. You must realize in your gut, this is not your problem. Otherwise, it doesn’t really matter how brilliant your technique. The masochist is expert at defeating. Your technique will be her latest victim and you both will suffer now, once again.

It is with this character structure that this truth is most poignant: diagnosis is everything. Once you and your client know what you are up against, technique is the easy part. What do you know, and what does your client know, about freeing her from the bonds of this particular solution. What do you know, and what does she know, about coping with the inevitable anxiety and pain that will come from giving all this up? These solutions must be tailor-made, coming from you and her. No text can prescribe them, though lots of therapeutic training and experience can give you a broader menu from which to choose. And, the broader the menu, the better.

With the Buddha, welcome the unwelcome. There will be resistance, as in every case, but here, more so. You would be cautious too if you had been repeatedly betrayed and crushed. This is what your client must overcome, so give him a break. Be patient, insofar as possible, be enlightened. Except when you’re not. Then be relational. Show the maddened response to control and paradox that your client could not. Then work it out—repair. And, with knowledge of the dynamics of this person, use your body techniques, your expressive techniques, your insight, your person. Enjoy the gains; display your enjoyment, but don’t take the defeats personally. They have virtually nothing to do with you. They are repetition of the old relations and old coping strategies, that’s all.

I can’t characterize the masochistic resistance better than I did before (Johnson, 1994), so I will repeat it here: “You will never conquer me. I am indomitable. I have fooled you. You think you have suppressed me, but just you wait. You think you have beaten me, but just you wait. I will get even. And you won’t even see it coming. Vengeance will be mine if it takes forever. You will pay for this. My spirit will be avenged. I can wait as long as it takes. You have taught me forbearance; some day you will regret it. I will never give in, I will never trust you or love you again. I will defeat you if it kills me.”

So, that’s the deal; get used to it; deal with it. And, do your best therapy. Whatever you know will work or fail based on your appreciation of the dilemma of the masochistic character. Herein lies the value of the characterological approach to psychotherapy.

References: In Progress