Holistic Pulsing in
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Updated April 2017

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The breath of life: a Holistic Pulsing case study with a client with asthma.

by Peta Joyce

 

 “The most powerful thing the therapist does for us is provide a setting, a nourishing womb, in which our lives can unfold”

(Johanson & Kurtz, 1991, p. 99)

 

The following case study was carried out as part of the requirements for the Postgraduate Certificate in MindBody Healthcare from Auckland University of Technology.

 

Introduction.

My client, Clare (not her real name) was a woman in her 50’s with long-term asthma. She had tried a variety of treatments, mostly medical, and was currently using an inhaler and taking homeopathic medicine. Clare liked to view her life and work from an integral perspective, including the transpersonal and environmental, and was looking forward to exploring the body-mind aspect of her asthma. The context for our work was my body-mind practice in Holistic Pulsing, and the case-study contract as a postgraduate student of AUT. Clare came for a total of nine sessions.

           

Holistic Pulsing is a form of bodywork that involves the hands-on imparting of gentle rocking and stretching movement to the physical body of the clothed client accompanied by dialogue. It is a client-centred approach that explores how the person is, in relation to themselves as a whole, using the ‘window’ of body awareness. Largely an integrative approach, it does however privilege the client’s present moment somatic awareness on the grounds that the ‘client on the table’ is a microcosm of the macrocosm. In order to widen the integrative approach, I used more verbal, cognitive and background information gathering than is usual in the Holistic Pulsing approach.

What is happening with the client, what I think I’m doing.

            My aim was to facilitate Clare’s stated wish to “explore, understand and become more conscious about the relationship between asthma, stress, emotional and physical states – to learn to understand and heal”. My focus was to practise using as integrative an approach as I could within the context of Holistic Pulsing, and the time available. I used touch, movement and dialogue to encourage Clare to be physically present to her embodied experience, to use that to explore her asthma, to facilitate experiences of greater ‘wholeness’ and to connect to the bigger picture, ‘story’ or ‘meaning’ of asthma in the context of her life as a whole.

 

Initially, it took Clare quite a long time during the pulsing to become fully aware of her body. As the sessions progressed, this became quicker, and she reported a greater degree of physical awareness outside of sessions. I was aware of Clare’s capacity for ‘working hard’ and ‘suffering’ and invited her to experience physical enjoyment and a purely restful, nurturing session when she was particularly exhausted. I saw this as a means of offering Clare greater ‘wholeness’ by engaging with less habitual aspects of herself (she didn’t often take up the invitation, although she did report feeling deeply relaxed after each session).

 

I noticed times when Clare ‘disappeared’ (I experienced this as an energetic feeling of absence, ‘nobody at home’, or being distracted myself) and checked in with her, encouraging her to notice where I was working in her body when she ‘drifted off’. Together we became more aware of her tendency to dissociate, which often happened when I approached her chest and throat area. She often related to parts of her body as ‘it’ (as though they were separate from her self) and I encouraged her to experiment with saying, for example, ‘I’ feel raw, instead of ‘it’ (her throat) feeling raw, to encourage integrating with her physical body.

 

Carroll (2005, p.25) defines dissociation as “the inability to integrate bodily, emotional and relational-contextual information.” Dissociation is a defensive strategy often associated with trauma. Carroll (2005, p.27) outlines the neurological processes involved, saying, “it may be that the ‘mind-body split’ is in effect a ‘right-left’ split, with left-brain activation overriding the right-brain assimilation and regulation of sub-cortically generated emotional states.”

 

Because of her history of sexual abuse, I was mindful of the potential to re-stimulate Clare’s traumatic experience. She was keen for me to work in the area of her throat and chest in order to explore what might lie beneath her physical experience of asthma. Working in this area brought up intense feelings of fear and panic, and familiar images of drowning and gasping for breath. When Clare was in this experience, I focussed on being fully present and available to her, with one hand gently pulsing her throat and the other hand supportively under her neck, gently encouraging her to express herself through sound and movement. I also reminded her that she had a choice as to whether to stay in the experience or not, and a couple of times suggested we ‘take some space’, reverting to a pulse at her shoulders or upper chest which she found especially enjoyable and comforting. Clare did once have brief flashbacks to the rape that happened when she was about 9 or 10, which she put down to awakened ‘body memory’ when I was working in her throat area.

 

Practitioners who specialise in working with trauma point out the need to ‘build resources’ or ‘apply the brakes’ (Ogden, 1993; Rothschild, 2000). I was mindful of developing the ‘resource’ of pleasurable sensations through pulsing that we could use to de-fuse the intensity of the trauma. I completely trusted Clare’s ability to process her experience, but was concerned that her eagerness to engage so fully with her somatic experience would accelerate the trauma in a detrimental way, although in fact this never happened.

Many theorists point out the need for adequate containment when working with trauma (Carroll, 2005; Rothschild, 2000). Clare felt that her ability to be with her panic and fear and to breath through it was greatly enhanced by the sense of holding from my presence and physical touch. The intensity in her throat area decreased with each session.

 

The correlation between asthma and breathing became very strong for Clare. The birth of Clare’s first grandchild “was a primal life/death experience” partly because his birth was difficult and traumatic. It triggered huge emotional issues around her own first child who was given up for adoption, around her adopted son, and giving birth to her other son where Clare and he “nearly died”. According to Chiozza (1998, p.35) “In clinical practice, we observe that the difficulties patients experience when undergoing situations of change whose characteristics evoke the birth trauma are frequently expressed by respiratory disorders”. Clare was not particularly aware of any connection with her own birth except that she was born at home, without help, and her mother didn’t enjoy the process, feeling alone and panicky. Her ‘fantasy’ was the connection between her own birth and asthma was about ‘not being held’ or wanted as a child. Both she (her parents wanted a boy) and her brother (her mother tried to abort him) were unwanted and are the only siblings to have asthma.

 

I was struck by the strong association for Clare between birth experiences, and wondered if there was any connection between birth, breath, and spirituality. As Chiozza (1998, p.30) says, “A relation between respiration and all that is spiritual can be traced to classical antiquity and is seen in literature and mythology, as well as in etymology or ordinary language.” On exploring a possible connection between Clare’s asthma and spirituality she immediately felt tearful and sad, realising she was ‘disconnected from source’ when she found it hard to breath. She also made the connection about breathing in the pain and suffering of the planet, an experience she often had.

Overall, Clare felt she was slowly unlocking her tendency to hold her breath to get through things, was becoming more and more able to connect with her body and work consciously with her embodied experience without dissociating, and learning to breath through her asthma, lessening the panic and anxiety associated with it. Clare’s neck and throat felt less restricted and she cut down on her asthma medication. She was amazed she hadn’t had an asthma attack despite many potential triggers. She was also aware of a new sensation of breathing through the back of her throat rather than the front. In the past an asthma attack felt like an anaphylactic response and her tendency would be to tighten up in the chest and throat area. Now she felt her body “knows how to be with this”.

 

Carroll (2005, p.23) believes “Working with impulse, breath, movement and sensation are all effective ways of enhancing the client’s self-regulation quite directly.” and, “Body-work may be a ‘way in’ to a process that has been sealed off from awareness, buried in muscular armour and lack of connectivity with the brain.” Schore (1996) suggests that the therapeutic relationship can help to transform negative implicit memories into positive ones through a new ‘encoding’ within the synaptic connections of memory. Juhan (1998, p.275) believes that bodywork can have a positive effect on traumatic engrams, “the cortex’s means of learning new skills and behavioural patterns”, through the sensory evocation of, for example, the feeling states of pleasure, softness, lengthening and relaxation, via touch. Levine (2005) emphasises the fundamental somatic-emotional component of anxiety. Panic and anxiety are a type of ‘freezing’ response to the inability to escape a dangerous or life-threatening situation, and can be relieved by ‘unlocking’ the physical responses that would otherwise have happened at the time.

 

What came up for me, the pulser.

I was aware at the beginning of our sessions of over-emphasising my practitioner role as a way to create boundaries because of our multiple roles with each other. It is possible that Clare picked this up and responded by being helpful (being a core behaviour for her) because the question “is Clare being a ‘good’ client?” sometimes surfaced for me. In supervision I discovered this was a projection of my insecurity about being a ‘good’ practitioner, especially as I had made a note to check with Clare that she was getting what she wanted from her sessions!

 

A common dilemma for me is how to manage the balance between acceding to the client’s wishes and holding the ‘container’ of the session as well as, to use an aeroplane analogy, the ‘angle of entry’ (not going in too deep too fast and crash-landing, or coming in too shallow and only touching the surface). On the one hand, the humanistic belief that we are equals in the therapeutic encounter and the client is in every way involved in choices about the process, on the other hand holding the wider perspective of the session or series of sessions and the journey involved. It’s a delicate dance of when to lead and when to follow, and at its best, client and practitioner are so attuned that the session flows effortlessly, with neither leading or following. This dilemma arose for me in the first session with Clare when she requested work with her throat and went into very deep process (where my aim was a gentle introduction to pulsing!). Because she was a psychotherapist, I trusted Clare to know what she was doing and what she could handle, which in this instance was probably appropriate, but in other situations might not be.

 

There is a deeper issue here related to my strong philosophical bias towards equality and sensitivity to power dynamics. My bias has a positive side (I strongly believe the client has a right to participate on an equal basis in their healing journey) and a shadow side. In the therapeutic encounter I sometimes defer to the client’s wishes (in the name of equality, or the client knows best) where offering my guidance based on insights, wisdom and experience might better serve them. The therapist/client interaction is a delicate balance between equal and expert, between empowerment and responsibility. Sometimes I noticed an incongruity between what Clare requested, and what I ‘felt’ from her body. For example she was keen that I pulse her abdomen and chest, slowly moving towards her throat. When I moved to the middle of her chest, I had a strong impression of resistance, experienced as an energetic ‘pushing away’ through my hands. When I checked with Clare, she reported experiencing both wanting to proceed and wanting to push me away, and chose to ‘breath her way through it’. This is a familiar experience for me as a practitioner, as if the client’s ‘mind’ is saying one thing, while her ‘body’ says another. From an integrative perspective, the body and mind are not separate, but experientially the two responses are qualitatively different, so what is going on? Could this be Staunton’s (2002) explicit and implicit memory where ‘body’ memory is the unconscious, implicit memory? Or is it an example of Carroll’s (2005) mind-body or right-left brain split? I usually handle the dilemma by bringing my perception to the client’s attention and helping them to make a choice, although proceeding in the face of physical resistance feels dishonouring of the principles of Holistic Pulsing for me.

 

This brings up the issue of embodied, or somatic countertransference. Soth (2005, p.55) believes that “…the therapist’s conflict – both as a person and as a professional – frequently reflects the client’s inner world as a parallel process. The therapist’s subjective body/mind process therefore contains information about the ‘other’.” Totton (2003) likens somatic countertransference to other theorist’s concepts like somatic ‘resonance’, ‘empathy’ or ‘dreaming up’, and sees it as a very important tool. Browning (2004) refers to this in Holistic Pulsing as the ‘two-way’ process. I think I used this to good effect with Clare, particularly noticing when she was dissociated and for becoming more attuned during the pulsing.

 

Conclusions.

Benda (2005, p. xl) makes a distinction between integrative and integral medicine. He says, “Integral medicine … is a dynamic, holistic, life-long process that exists in widening and deepening relationships with self, culture, and nature. Integral medicine is about transformation, growth, and the restoration of wholeness.” Clare explored the body-mind aspect of her asthma, learning to integrate more with her embodied self, beginning to release the panic and anxiety associated with breathing, and gaining some insight into the psychological, social, environmental and spiritual aspects of her asthma. The therapeutic encounter is never a one-way process; at the same time I got to learn more about myself, my competence and growing edges, and to begin expanding my integrative approach into the psychological, social, spiritual and environmental realms. My sincere thanks go to Clare for her willingness to enter this journey with me.

 

REFERENCES

Benda, W. (2005) in Schlitz, M, Amorok, T and Micozzi, M. Consciousness and healing: Integral approaches to mind-body medicine. Missouri: Elsevier Churchill Livingstone.

 

Browning, T. (2004). The power of softness: Holistic pulsing. Kidron, Israel: Innana

 

Carroll, R. (2005). Neuroscience and the ‘law of self’, in N. Totton (Ed.) New dimensions in body psychotherapy. Maidenhead: OUP.

 

Chiozza, L. (1998). Hidden affects in somatic disorders. Connecticut: Psychosocial Press Madison.

 

Johanson, G. & Kurtz, R. (1991). Grace unfolding. Psychotherapy and the spirit of the tao-te ching. New York: Bell Tower.

 

Juhan, D. (1998). Job’s body: A handbook for bodywork. New York: Barrytown.

 

Levine, P. (2005). Panic, biology and reason, in N. Totton, (Ed.) New dimensions in body psychotherapy. Maidenhead: OUP.

 

Ogden, P. (1993). Hakomi Somatics. Unpublished trauma workshop notes. Coromandel: Mana Retreat Centre.

 

Rothschild, B. (2000). The body remembers. The psychophysiology of trauma and trauma treatment. New York: W.W. Norton.

 

Schore, A. (2001). Minds in the making: attachment, the self-organizing brain, and developmentally-oriented psychoanalytic psychotherapy. British Journal of Psychotherapy, 17 (3).

 

Soth, M. (2005). Embodied countertransference, in N. Totton, (Ed.) New dimensions in body psychotherapy. Maidenhead: OUP.

 

Staunton, T. (2002). Body psychotherapy without touch: applications for trauma therapy. Body psychotherapy. New York: Brunner-Routledge.

 

Totton, N. (2003). Body psychotherapy. An introduction. Maidenhead: OUP.

 

 

 

 

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