A Feel for the Organism:
Cultural and Methodological Contexts of Trauma Psychology
from a Somatic-Energetic Perspective

Philip M Helfaer

Abstract
The author, an experienced practitioner and teacher of bioenergetic analysis, a therapy based on a somatic-energetic point of view, considers this perhaps the most appropriate approach to work with sequelae of traumatic stress, addressing as it does mind, body, emotions, and energetic states. He finds a peculiar split in the therapeutic world, wherein virtually all institutions (medical, academic, veterans), do not utilize somatic-energetic work, while at the same time increasing numbers of practitioners and experts outside these institutions do recommend somatic-energetic approaches. He states this split has meaning. Exploration of these meanings reveals that cultural and sociological aspects of institutional life and of the society play the largest role in determining treatment modality, including what comes to be considered “evidence based” treatments. The author suggests that attitudes and approaches based on thinking and perceiving influenced by dissociation and society’s capacity to recognize and deal it, the very phenomena being studied, underlie a restrictive way of examining the actual phenomena. He states that what is needed is the methodological underlay characterized in biology as “a feel for the organism,” based on careful, caring, detailed observation. Naturalistic observation is missing from many approaches; it is inherent to the somatic-energetic point of view. Therefore what is required to institute this practice more widely in institutional life involves deep changes, socially and culturally, within the institutions, their values, and the culture of their professed scientific methodologies.

Key Words: Bioenergetic analysis, trauma, therapy, somatic-energetic, a feel for the organism, methodology in psychology, scientific method and culture, dissociation, self as body.

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1. A Question

Where is the body in current therapies of trauma?
My observations and questions are based on forty years of clinical experience working in a somatic-energetic therapy, bioenergetic analysis. From my experience, I have gained a degree of understanding, a capacity for observation, and a set of conceptual and analytic tools. Searching for answers to this question led me to some observations having to do with the culture and institutions within which research and treatment of trauma occurs.
Two observations about the surface of our cultural situation:
1.
The professional context, both in Israel and the U.S., is characterized by a peculiar split. The somatic therapies are not taught or practiced in academic, veterans, or medical institutions. Two recent handbooks on PTSD, edited by essentially the same people, make no mention of somatic oriented therapies.
2.
At the same time, somatic approaches are advocated by a growing number of practitioners and by a growing number of recognized experts. working outside these institutions. The International Institute for Bioenergetic Analysis has a membership of about one thousand members from Europe, North and South America, Israel, and New Zealand.
Bioenergetic analysis is distinguished by providing the conceptual and perceptual tools for a thorough analysis of the somatic-energetic aspects of personality, by a developmental perspective, and by a dynamic and functional conception of character and personality. It is thus a comprehensive (as well as the oldest) approach to the study of individual functioning in terms of somatic-energetic process. There are other significant somatic (not necessarily energetic) approaches.
To those of us who work with and understand the somatic oriented therapies, nothing could be more self-evident than that this is most often the most appropriate approach to working with trauma spectrum disorders. Clinical outcomes are positive. From a theoretical perspective, traumatic memory is commonly understood to be encoded as sensation, body feeling, and other sensory experience. The most direct approach to these “unconscious” memories is through the senses and energetic processes. Empirical evidence of efficacy for bioenergetic analysis is slowly developing.
3. And a preliminary conclusion: Introducing somatically oriented therapies for trauma into these institutions means changing their culture. It is not simply a matter of establishing empirical evidence supporting the approaches. And from here I find that:
4. The scientific literatures around evidence based practices show revealing distortions. And most importantly:
5. What I believe is the missing element in understanding and developing trauma treatment is what in biology has been named “a feeling for the organism,” and in psychology we could combine that with “a feeling for the person.” These observations (1-5) developed from learning to look, observe, experience, and see.



2. The Split Is Meaningful

I believe that this surface split is meaningful. It has implications for how trauma and its effects are understood. It has implications for the meaning of establishing evidence based treatments. It means that the introduction into institutional and professional life of somatic-energetic approaches to treatment entail social change – change in institutions and culture, more so than science.
At a superficial level is the consideration that most institutional offices are not set up to accommodate the movements or sounds (even deep crying) that might ensue from a patient working through traumatic memories in a somatic-energetic therapy. Further, to work with the body in a therapy inevitably means to be in the presence of intense emotion. To be comfortable with these expressions requires training and experience, including of one’s own deep emotions. This is not everyone’s cup of tea, especially in the professions. A third, surface aspect, has to do with status in the professions; and the body approaches do not establish status in the institutions. These observations reflect the culture and sociological characteristics of the milieus in which trauma studies tend to occur and in which professionals reside.

3. Deeper aspects: Who and what are we treating? And is it a treatment?

A treatment in bioenergetic analysis begins with observation of the patient, and he or she is a co-explorer in the process. Cognitive behavioral approaches, for the most part, begin with a model of what the disturbance is, and proceed with the protocol for it. Prolonged Exposure Therapy for PTSD (PET) is a paradigmatic example. The model is based on the idea of the “fear structure.” It is not my purpose to criticize this therapy, but to contrast it with the significantly different approach of bioenergetic analysis.
In a bioenergetic analysis, I want to know who the person is and exactly how the trauma spectrum disorder is functioning in his or her person. This is a demanding process for both therapist and patient. However, it offers the possibility of the widest range of opportunities for (posttraumatic) growth. In addition, it offers the widest range of opportunities for learning about trauma spectrum disorders: actually what they are in terms of how they effect the individual, how they function in the individual, how they arise in the first place, and how they develop over time. The first questions are still, Who is the person and how is he or she functioning?



4. An Ironic Question: Why is somatic-energetic therapy not the primary model for treatment?

There are two “cases” to consider in relation to this question.
1. The cognitive-behavioral therapies were widely adopted amongst academic psychologists. Jonathan Shedler, an American psychologist and psychoanalyst, describes the eagerness with which the academic community, excluded for so many years from organized psychoanalysis, greeted news of the efficacy of non-analytic techniques; and they promulgated the notion that psychodynamic therapy was not supported by “scientific evidence.” It is not surprising, as well, that “the body,” especially the body-as-the-person, has not found much place in the curricula of academic psychology departments.
2. The “case” of psychoanalytic tradition is more complex. Somatic-energetic therapy grew out of early psychoanalysis, specifically originating with Wilhelm Reich (1897-1957). While many of his colleagues followed Reich in his development of character analysis, they did not follow him into the somatic realm. However, amongst perhaps the majority of psychoanalytic writers, the self is considered as the body.
W. W. Meissner, a senior psychoanalytic scholar in Boston, U.S.A., wrote an important series of articles about the body in psychoanalysis. His statement that the self is a body-self is appropriate for a bioenergetic textbook:

.... Both of these aspects (self as subject and self as object) are inextricably immersed (sic) in bodily functions, so that any comprehensive theory of the self has to connote the embeddedness and intimate integration of the self as inherently bodily. I will argue .. that all psychic functions are inherently involved in bodily processes of one sort or another.

In its entirety this is as clear and eloquent a statement as there can be, and it could be taken as the first premise for a theory of bioenergetic analysis. So what happened? Simply, this is not how psychoanalysis developed. As Meissner states,

On the couch bodily manifestations continue unabated. ...
If these behavioral manifestations are important as direct expressions of bodily processes, they must take a backseat to the specifically verbal behavior that constitutes the core of observational data in psychoanalysis.

In other words, we see, but we do not make use of these data in psychoanalysis; they are not the basis for determining therapeutic interventions. Meissner reflects the accepted analytic posture. Psychoanalytic theory encompasses a conception of self as body-self, and at the same time bodily, somatic-energetic interventions are not a part of the technique. This is how it stands! Might we not find it strange? Fereneczi and, much more so, Reich, pointed the way to a technique with a somatic orientation. Their lead was not followed, even though, for over one-hundred years now, there have been, as Meissner comments, two bodies in the therapeutic consulting room. How and why did somatic-energetic technique and theory become split off from psychoanalysis?


5. Confusion of tongues

I cannot claim a definitive answer to this question. I believe, nonetheless, that the question is worth asking. In any case, given the differences in technique and theory, I believe it was necessary and advantageous for bioenergetic analysis to develop separately and in its own milieu; perhaps this is still the case. Now, however, I also believe there would be great gains, especially in the treatment of trauma, if bioenergetic analysis and other somatic-energetic therapies were to find a place within various institutional worlds. For this to happen, the question needs to be pursued.
Recently, when I spoke with another professional therapist about the somatic-energetic approach, she said, “You are talking a different language.” Really? Is there something about bringing the body into the psychotherapy field that introduces a new language? As if “the language of the body” were not a part of “regular” language? Do we enter a different land, a different culture? I consider that her response is quite characteristic of a number of people I have spoken with recently.
It is certainly true that we introduce a new perspective, or as I have been calling it, point of view. It is also true that we talk about different phenomena, bodily and energetic. However, these, as indicated in the discussion of Meissner’s writing, are not phenomena that are not observed in other therapies. In our therapy, they are looked at differently, and they are put into their (rightfully, as I see it), core place in the therapy.
Sandor Ferenczi (1873-1933) was one of Freud’s closest collaborators. Like Reich, he was original and creative, and like Reich he returned the idea of sexual trauma to being the central etiological factor in neurosis. He wrote a remarkable paper called “Confusion of Tongues” (1932). I find in it a reflection of my colleague’s comment, “You are talking a different language.” Ferenczi is referring to the radical difference between a child seeking or expressing warmth, love, and tenderness to a parent or other adult, and the adult responding with adult sexual passion. They do not speak the same language.
Is it possible that the intrinsic difficulty, avoidance, shame, and horror of facing traumatic sequelae are at work in the avoidance and rejection of the body in the field of psychotherapy? I am inclined to believe so.
Disassociation and denial are somatic-energetic phenomena: they always involve the denial or disassociation from specific bodily experiences, sensations, or emotions related to them. In the case of complex developmental traumas, denial and disassociation readily become embedded in characterological developments. For people who become therapists, including somatic-energetic therapists, this kind of development, in my experience, is hardly uncommon. Inevitably, they themselves avoid aspects of their own body experiences. In this and other ways, the profession itself can become complicit in supporting a prevailing social ethos of denial, even of disassociation. Identifying and working with disassociation, denial, and “forgetting” remain challenges, as do the whole range of traumatic sequelae, despite their long history in the field of psychotherapy.

6. Methodological Disarray

Methodological disarray is another aspect to this picture, also reflective of the current ethos in psychological research. While cognitive-behavioral techniques of various kinds are often considered state-of-the art, evidence based techniques, there are several different approaches within the larger cognitive-behavioral domain, and these approaches continue to evolve. In some clinical settings, the therapeutic paradigm involves an amalgam of various protocols. The field is quite fluid, and paradigms are shifting.
The clinical process by which choices are made between various approaches and various aspects of different approaches lies outside the protocols of the specific therapies which make up the amalgam. What is the theoretical basis for these choices and the therapeutic process other than the clinician’s sensitivity, creativity, and experience? A somatic-energetic understanding of the person can fill this gap, encouraging a more holistic process.
In addition, “Third wave” cognitive-behavioral techniques are being developed which frankly include or are based on, not learning theory, but on conceptions such as mindfulness and acceptance. These practices are in fact embedded (in theory and in practice) in bioenergetic analysis.
Of even more interest is the state of “the state of the art” research evidence. Shedler’s review showed psychodynamic therapy having efficacy comparable to important cognitive behavioral approaches (DBT), and longer lasting effects.

... the available evidence indicates that effect sizes for psychodynamic therapies are as large as those reported for other treatments that have been actively promoted as “empirically supported” and “evidence based.”

This is significant because until very recently, psychodynamic therapy has been considered an unsubstantiated modality. Like bioenergetic analysis, its goals are the development of the whole person, as a self.
Shedler’s survey has further significance. He reviewed studies of cognitive behavioral approaches in which the effectiveness of the treatment did not result from the cognitive behavioral concept, but when its application involved characteristics of psychodynamic therapy!

It indicates that the (often unacknowledged) “active ingredients” of other therapies include techniques and processes that have long been core, centrally defining features of psychodynamic treatment. ...

I am not trying to invalidate cognitive behavioral approaches. I believe they are important and useful. However, the methodology from which empirical evidence supporting the efficacy of these approaches does not get into the grain of the process of the therapy, nor, in fact, into a deeper understanding of the psychobiological processes involved. Further, the therapeutic protocols may themselves be influenced by their amenability to a research design. These inadequacies are supported within institutional culture and practice.


7. A Feel for the Organism

In psychology the drive toward “evidence based” treatments, “proven to work,” has evolved out of a particular culture and has aided in creating that culture. I am not against empirical research, nor consensual validation. What is happening, however, is that what may be good research may be poor psychology, and even an utter lack of a psychological and observational feel for the issues of treatment.
The phrase, “a feel for the organism,” is used in a particular way in biology, for example in reference to the work of the Nobel prize winning geneticist, Barbara McClintock and, of course, to Charles Darwin. It refers to “theoretical ideas guiding and aided by keen observations of meticulous details, (and) excellent knowledge of natural history”.
The development of a therapeutic approach must be based on a feel for the organism, and, since the organism is the human being, it must be supplemented by a feel for the person. These are acquired by observation, “guided by theoretical ideas and aided by keen observation of meticulous details.”
Observation is the first and last essential of scientific method. In the therapeutic situation, it is the first and last method of the therapist. The somatic-energetic point of view is essentially a set of conceptual and perceptual skills based in experiential training to guide the therapist’s observation of the patient.

Notes

P.M.Helfaer, Sex and Self-Respect, The Quest for Personal Fulfillment, Bioenergetics Press, Alachua, FL, 1998/2006.
2 1.) E. Foa, E.B., Keane, T.M., Friedman, M.J., Cohen, J.A., eds., Effective Treatments for PTSD. Practice Guidelines from the International Society for Traumatic Stress Studies, Second Edition, Guilford Press, NY, 2009. 2.)M.J.Friedman, T.M.Keane, P.A. Resick, eds.,. Handbook of PTSD. Science and Practice. NY: Guilford Press, 2007.
3 I do not consider EMDR a body therapy.
4 For example: 1a.) R.Scaer, The Body Bears the Burden. Trauma, Dissociation, and Disease, The Haworth Medical Press, Binghamton, NY, 2001 and 1b) The Trauma Spectrum. Hidden Wounds and Human Resiliency, W.W.Norton & Co, NY, 2005. 2a) B.van der Kolk, A.C. McFarlane, L.Weisath, Traumatic Stress. The Effects of Overwhelming Experience on Mind, Body, and Society, The Guilford Press, NY, 2006 and 2b.) B. van der Kolk, ‘The Body Keeps the Score: Memory and the Emerging Psychobiology of Post Traumatic Stress,’ Harvard Review of Psychiatry, 1(5), 1994, pp.253-265.
5 P. A. Levine, Waking the Tiger, North Atlantic Press, Berkeley, CA, 1997. P. Ogden, K. Minton, C.Pain, Trauma and the Body. A Sensorimotor Approach to Psychotherapy, W.W. Norton, NY, 2006.
6 M. Koemeda-Lutz, M. Kaschke, D. Revenstorf, T. Scherrmann, H. Weiss and U. Soeder, ‘Preliminary Results concerning the Effectiveness of Body-Psychotherapies in Outpatient Settings – A Multi-Center Study in Germany and Switzerland,’ The US Body Psychotherapy Journal, vol. (4) 2, 2005, p.13-32.
7 E.B.Foa, E.A.Hembree, B.O.Rothbaum, Prolonged Exposure Therapy for PTSD. Emotional Processing of Traumatic Experiences. Therapist Guide, Oxford U. Press, New York, 2007.
8 J.Shedler, Jonathan, ‘The Efficacy of Psychodynamic Therapy,’ American Psychologist, vol.65. No. 2. 2010, pp. 98-109.
9 W.W.Meissner, 1.) ‘The Self and the Body: I. The Body Self and the Body Image,’ Psychoanalysis and Contemporary Thought, vol, 20, no.4, 1997, pp. 419-48, (2.) ‘The Self and the Body: II. The embodied self – Self vs non-self,’ Psychoanalysis and Contemporary Thought, vol. 21. no.1,1998a, pp. 85-111, (3.) ‘The Self and the Body: III. The body image in clinical perspective,’ Psychoanalysis and Contemporary Thought, vol. 21, no. 1, 1998b, pp. 113-146, (4.) ‘The Self and the Body: IV. The body on the couch,’ Psychoanalysis and Contemporary Thought, vol. 21, no. 2, 1998c, pp. 277-300.
10 W.W. Meissner, ibid., 1997, pp. 420-421.
11 W.W. Meissner, ibid., 1998c, p.281.
12 W.W. Meissner, ibid., 1998c, pp 278-79.
13 Van Haute and Geyskens, 2004.
14 J. Stern, Denial, Harper Collins Publisher, NY, 2010. In this personal memoir, Stern explores the ethos of denial in relation to the effects of sexual violence and abuse in the United States in the latter part of the 20th century and the beginning of the 21st. She believes her observations are relevant to understanding the problem of PTSD of returning veterans. Stern is known for her work on terrorism and terrorists.
15 1.) V.M. Follette, K. M. Palm, M.L. Rasmussen Hall, ‘Acceptance, Mindfulness, and Trauma,’ in Mindfulness and Acceptance. Expanding the Cognitive-Behavioral Tradition, S.C. Hayes, V.M. Follette, M.M. Linehan, (eds), The Guilford Press, NY, 2004, pp. 192-208. (2.) C. M. Monson, M.J. Friedman, H. La Bash, ‘A Psychological History of PTSD,’ in Handbook of PTSD. Science and Practice, M.J. Friedman, T.M. Keane, P.A. Resick, 2007, Guilford, NY, 2007, pp. 37-52. (3.) J. Shedler, ‘The Efficacy of Psychodynamic Therapy,’ American Psychologist, vol.65. no. 2. 2010, pp. 98-109.
16 V.M. Follette, et.al., ibid., 2004.
17 C.M. Monson, et. al., ibid., 2007, p.47.
18 V.M. Follette, et.al., ibid., 2004.
19 J.Shedler, ibid., 2010, p.107.
20 J. Shedler, ibid., 2010, p. 107.
21 E.F.Keller, A feeling for the organism: The life and work of Barbara McClintock, W. H. Freeman, San Francisco, 1983.
22 E. Szathmary, ‘Darwin for All Seasons,’ Science, vol. 313, 2006, p.306, retrieved at www.sciencemag.org, Published by AAAS.
23 E. Szathmary, ibid., p. 306, 2006.

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_____, ‘The Self and the Body: IV. The body on the couch,’ Psychoanalysis and Contemporary Thought, vol. 21, no. 2, 1998c, pp. 277-300.

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Ogden, Pat, Minton, K., Pain, C., Trauma and the Body. A Sensorimotor Approach to Psychotherapy, W.W. Norton, NY, 2006.

Scaer, Robert, The Body Bears the Burden. Trauma, Dissociation, and Disease, The Haworth Medical Press, Binghamton, NY, 2001.

_____, The Trauma Spectrum. Hidden Wounds and Human Resiliency, W.W.Norton, NY, 2005.

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Szathmáry, E, ‘Darwin for All Seasons’ Science, vol. 313, 2006, p.306. Also retrieved at www.sciencemag.org Published by AAAS 2006.

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Philip M Helfaer, Ph.D., originally from U.S.A., resides with his wife, Vellie, in Israel, where he has been coordinating trainer for the Israel Institute for Bioenergetic Analysis. He has studied, practiced, and taught this discipline for forty years, and continues to seek to understand the nature of traumatic experience and its effects in the individual and society. Contact at <pmhelfaer@hotmail.com.> Further references for author at