The importance of establishing a therapeutic relationship is well known to clinicians. What is often ignored is the fundamental and essential role of body and movement patterns in forming and developing those relationships. In fact, non-verbal patterns – how we move and inhabit our bodies and world, communicate important truths about ourselves and others. They provide an essential lens for clinical work, establishing a non-verbal dance that takes place between therapists and their clients.
Why notice movement and body patterns in therapy? On a fundamental level, everyone has a body and everyone is always moving in ways that uniquely reflect and communicate all of aspect their experiences, stories and histories. In addition, non-verbal interactions are the foundation of how we understand ourselves, process our world and form relationships. Neurologically, our bodies receive and respond to non-verbal information through mirror neurons, the Vagus nerve, the Limbic system and other neurophysiological structures. From our birth, patterns of relationship we are hardwired to connect through reflexes and other early neurological patterning which promote a sense of safety, nurturance and support (Attachment Theory and Object Relations as well as Polyvagal Theory, Neurological research). Because these early experience are the foundation for future relationship patterns, infants who are not able to feel sufficiently safe, supported and nurtured develop relationships more cautiously later in life. Throughout the lifespan, the client’s movement patterns will communicate the timing and process needed to establish a therapeutic relationship.
Many therapists already intuitively incorporate this on a rudimentary level. However a more nuanced ability to work with and understand non-verbal expressions requires additional training and skill. Attuning to details such as the size or dynamic quality of the movement, the shape, and quality of how the body is held, and the phrasing of movement sequences help to establish non-verbal synchrony and promotes feelings of connection. This facilitates interpersonal rapport and trust. Alternatively, therapist non-verbal mis-attunement can impede or even block the development of therapeutic relationships
How does this look in a typical session? When clients enters my office, I immediately observe their movement patterns including the way they inhabit the space around them, and how they live in their body. I also notice their movement dynamics and the phrasing and rhythms of their movement patterns. I also notice aspects of their movement that are potential expressions of other aspects of their history and identity. Next, I compare my observations of the client’s current to their past movement patterns, as well as my own movement patterns. Finally I modify and attune my own movements to join with the client on a non-verbal level. I am learning how to dance with them, and I join by following their lead and trying on their rhythms. With more withdrawn or cautious clients, I also use empathetic attunement to adjust to their non-verbal responses, as a way to signal my willingness to meet them where they are and follow their timing. Together we are co-creating a dance. The process is iterative and takes less time to do, than to describe. It promotes therapeutic relationships more quickly and effectively than a more verbally-focused process.
As therapists, our mirror neurons also activate our kinesthetic, proprioceptive and neuroceptive responses. Using Dance/ Movement Therapy (DMT)[1] techniques, paying our own attention to our own inner responses can providing insight about countertransference, transference as well as the client’s experience of the world. (These techniques work best when the therapist is curious and honest rather than judgmental, about their own embodied experiences.) ‘Somatic countertransference,’ the therapist’s awareness of their own somatic responses to the client, is an important tool for becoming aware of and distinguishing between the therapists’ ‘body biases/prejudices’ and what they are sensing from their client’s experiences. ‘Kinesthetic empathy,’ the intentional embodiment or taking on of their client’s movement patterns, can provide clues to the clients experiences and their sense of the world. Both techniques provide insights into the non-verbal inter- and intrapersonal dynamics present in the session.
Finally, from a systemically lens, consciously or unconsciously, the therapist’s body, gestures and movement patterns are always part of and influencing the therapy session Just as therapists use words intentionally and mindfully, their embodied presence – the ‘Embodied Self-of-the-Therapist’- is also an important element that can promote therapeutic relationships. The process is a dance and following our client’s non-verbal lead and synchronize our rhythms with theirs we promote trust and safety: Won’t you join the dance?
Barbara Nordstrom-Loeb MA, MFA, LMFT, BC-DMT, CMA, PWAssoc, SEP, WoS, has a private practice and supervises in Minneapolis. She also teaches at UMN, received a Fulbright Scholarship to teach in Estonia, and has also taught in Lithuania, China, and South Korea. She has extensive diversity/multicultural curiosity and experience. As a therapist she focuses on the use of embodiment and creative expression for psychological, somatic, and spiritual transformation.
[1] Dance/ Movement Therapy (DMT) is a creative arts psychotherapy that works directly with embodied experiences as well as words to achieve clinical goals.
The above article is a Letter to the Editor. Opinions expressed in the MAMFT NEWS do not necessarily reflect the opinions of the Editors or of MAMFT.
MAMFT would like to provide the following resources for recent students of Argosy’s MFT program:
Information from the MN Office of Higher Education
I started treating OCD somewhere between 1-2 years ago. After discovering that it runs in my family, I became interested in how the treatment works and why exposure and response prevention (ERP) is almost always pointed to as the gold-standard treatment. I’d never been very interested in Cognitive Behavioral Therapy (CBT) modalities prior to this time because they struck me as automated and less personal than more relational or insight-focused types of therapy. I’d like to share more of what I’ve learned since I’ve begun treating clients with OCD about how important the therapeutic relationship actually is.
To have some background, our training doesn’t do much to help us identify OCD in clients. Recently, as I was “Konmariing” my office with the rest of America, I came across my old (OK, really old) “abnormal psychology” paperwork. Sure enough, I found the criteria for OCD, indicating that I did actually cover OCD in school. But what this class did not do for me, was to make OCD real in a way that I could understand how it shows up for people, and how I might identify it in clients.
Here is how the IOCDF.ORG website (an incredible resource) defines OCD:
“Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.”
What this description and the description I found from my old notes don’t indicate is how incredibly terrifying the obsessions can be for people who suffer from them and the intense responses that result. People with OCD can be in the middle of fight, flight, or freeze responses over and over and over, without relief. Many fears can’t be avoided as they often can with phobias, because it is thoughts that are driving the pattern.
Another very important point these brief descriptions omit is that many types of OCD include “non-observable” compulsions. The IOCDF.org does eventually go more into the type of mental compulsions I’m addressing here, which can include a sort of “heavy analysis” or excessive attempts to “figure out” an obsessive problem or situation. Here is an example. A common theme in OCD includes the obsessive thought: “What if I am a pedophile?” Importantly, this is in the absence of any actual inclination to behave as a pedophile. However, the obsessive thought feels real and terrifying to the sufferer. The compulsion arises as attempts are made to talk oneself out of the obsession. “But I’ve never wanted to hurt a child… But I love my baby…But I’ve always enjoyed children…” All these rationalizations can be countered by very creative “What ifs…”, such as “What if I am a pedophile and I’m just realizing it now?” Or the very clever: “What if I’m in denial?”. In addition to the mental compulsions/rationalizations, a sufferer might start to avoid children. This is especially sad when we think of a new mother or father avoiding their baby. To increase the isolating nature of OCD, it is not hard to imagine someone feeling hesitant to tell their therapist: “What if they report me to CPS and I lose my child?” This is a very common theme, and so common in the OCD world it is called “pedophilia OCD”, or pOCD.
Sometimes obsessions can center around more typical life problems, such as in romantic relationships (rOCD). Some sufferers worry about whether or not they are attracted to their partner. They might find themselves unwillingly focused on a perceived imperfection, then begin to try to talk themselves out of this concern. Hours can be spent in worry about if they love their partner. This issue can also bring up feelings of guilt, which the client might think will be relieved if they confess to their partner about their struggle, thereby causing the partner confusion.
Anxiety tends to be about avoidance. If I have an unpleasant feeling, I avoid that thing that I think caused it. With OCD, the difficult thought/obsession creates an unpleasant (often terrifying) feeling. The compulsion is one’s attempt to neutralize the difficult feeling and thought… and it might work initially. However, as the distressing thoughts continue to arise, more compulsive attempts are made to try to neutralize the thoughts and feelings. Over time the OCD takes on a life of it’s own.
This is where exposure and response prevention (ERP) comes in. With ERP, and the gentle help of a therapist, the client gradually “exposes” him/her/themself to the distressing thought and feeling. This experience can be both terrifying and exhilarating for clients after they have been trying to suppress the thoughts and feelings, often for years (on average it takes 14-17 years for OCD sufferers to find the support they need). The therapy process can be incredibly liberating for clients and very rewarding for therapists as clients reclaim their lives.
So what I’ve learned through treating OCD using ERP is because I am asking people to do things that cause them to feel like their lives are going to fall apart, the therapeutic relationship is crucial. A metaphor is often used for OCD that says that being in the middle of an OC cycle is like standing on a train track with a train coming toward you, but you are the only one who can see it. This is a terribly isolating picture. Consider how comforting it would be to have a therapist to step into that world with you.
– Lucy Grantz, LMFT
Hello to our beloved MFT Community,
It is with heavy hearts that we’re writing with some heartbreaking news. Brian Zamboni, a faculty member in our department since 2005, passed away last night.
For those of you who don’t know, Brian was a competitive stair climber. Brian was in Salt Lake City last weekend at a climbing event when he collapsed due to a massive heart attack. They performed CPR, got him to the hospital, and put in a stint, but he didn’t wake up. The medical team began an emergency cooling/hypothermia procedure and then warming in hopes that he would wake, but it wasn’t effective due to brain damage that extended down the brain stem. They took Brian off life support yesterday and he passed away last night. His family is in shock; Brian was the healthiest person we all knew.
They were able to gather most of his organs for donation for transplant and donation to research. As you can imagine, Brian would love that.
He was beyond supportive to our students, our faculty, and to us. He trained thousands of students between Saint Mary’s, Argosy, and the University of Minnesota. All of us who know and love Brian know how hard working he was, how much he did with his time, how he was always willing to speak up for what was right, to be helpful, and how incredibly generous and kind he was. Our last several conversations with Brian, as recently as last week, were all centered around the same theme: he was going above and beyond because he cares about students, their learning, their future clients, our community, and the colleagues he works with. Brian was a man of integrity, good humor, a fierce mind, and a gentle heart. He was always there when any of us needed him. And that’s what we’ve heard over and over again from his friends, family, and colleagues these last few days: Brian believed in me, Brian was my best friend, Brian was so vibrant and full of life, Brian loved Saint Mary’s. It’s difficult to imagine a world without him in it.
Brian’s family lives mostly in Colorado and services are expected to be offered there, but the family is uncertain if/when they will have services here in Minnesota. We will keep you updated when we get more information.
For now, please reach out to those you know who had a connection with Brian. Please hold him and his family in your prayers and thoughts. We don’t presume to know what Brian would want, but as a professional who dedicated his life to teaching and learning, we imagine a way to honor Brian would be to hold on to what you’ve learned from him and to keep learning and asking good questions. He was always great at that – – asking a question without presuming to know the response.
We value each one of you and are grateful for you.
Remembering Brian in Gratitude,
Sam and Sara
Hello MAMFT!
It is bittersweet that I get to say goodbye to my role as Pre-Clinical Representative! It has been a wonderful 4 years serving the folks who are experiencing this very important part of the journey as MFTs. I have seen so many committee members, peers, and dear friends transition through the journey from graduate school to full licensure. And what a journey that is! Thank you to everyone who has come to a gathering, event, or even just emailed to express interest in the Pre-Clinical happenings! I, too, found these gatherings and events helpful as I progressed through my licensure journey that culminated this past September when I achieved my LMFT licensure. I did not quite know what I signed up for when I put my hat in the ring for the Pre-Clinical Rep role back in 2014, but I am sure glad that I did!
Melissa Mrozek, MA, LAMFT, LADC has been appointed to complete the rest of my term for the next 2 years. She will make the role and committee her own and continue to further the interests of Pre-Clinical MFT folks in Minnesota. She can be reached at preclinical@mamft.net if you are interested in being involved or have ideas!
I have resigned from this role in order to step into my new appointment as the Legislative Co-Chair alongside Erin Pash. Anyone who knows me is aware that I am passionate about the impact of legislation on our everyday lives and the lives of our clients, especially those most vulnerable to the impacts. I have been interested in this role for many years and this is the perfect time to step into it. I look forward to serving MAMFT, our clients, and ultimately everyone in the state Minnesota in this new role.
Your (previous) Pre-Clinical Representative,
Tamara L. Statz, MA, LMFT MAMFT Legislative Co-Chair
We want to share with you an important message from AAMFT Family TEAM:
“Bipartisan legislation that would include licensed marriage and family therapists, as well as licensed mental health counselors, as Medicare eligible providers has just been introduced in both the US House of Representatives and US Senate. The Mental Health Access Improvement Act of 2019, introduced in the House as H.R. 945 by Rep. Mike Thompson (D-CA) and Rep. John Katko (R-NY) and in the Senate as S. 286 by Sen. John Barrasso (R-WY) and Sen. Debbie Stabenow (D-MI), would add MFTs and MHCs as independent Medicare Part B practitioners.
Now MFTs must encourage their Members of Congress to support MFTs and cosponsor H.R. 945 and S. 286. A strong showing of support increases the likelihood that the legislation will continue through the legislative process to become law. Tell Congress today to add MFTs in Medicare!”
FIND CONTACT INFO FOR YOUR REPRESENTATIVES HERE
Additional Resources on MFTs in Medicare
AAMFT MFTs in Medicare Fact Sheet
Press Release from Representative Mike Thompson on H.R. 945
Press Release from Senator John Barrasso on S. 286
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