Psychodynamic body therapy

Domain IV · Body-oriented psychotherapy · Kirsti Monsen · 1987 · Norway

What it is

It is an individual treatment, usually delivered by a physiotherapist with added training in clinical psychology and psychodynamic method. Each session combines body treatment (whole-body massage, stretching grips, and movements integrated with breathing) with psychodynamically oriented…

Format

• Format. Individual sessions of one hour, weekly. In NPMP the hour runs roughly 45 minutes of treatment, about 10 minutes of rest and about 5 minutes of closing; frequency is later reduced to monthly or less. In PBT each session combines body work and conversation. Even milder cases typically need…
• Phase A: Assessment and test treatment (sessions 1 to about 3). Goals: a body examination (posture, breathing, movement, muscle consistency and resources), a history, a judgement of motivation and of how much strain the patient can carry, and a test treatment to see how the body and the person…

Who practises it, and how they are trained or regulated

• Phase D: Integration, generalisation and tapering. Goals: the patient applies the links between symptoms and psychological factors in daily life, symptom-focused thinking decreases, and session frequency is reduced. End when: self-regulation in daily life is reported and maintained across longer gaps between sessions.
• What it is. It is an individual treatment, usually delivered by a physiotherapist with added training in clinical psychology and psychodynamic method. Each session combines body treatment (whole-body massage, stretching grips, and movements integrated with breathing) with psychodynamically oriented conversation. It grew out of NPMP because physiotherapists needed more psychodynamic competence for patients with…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Patients who never object may be complying (see 5.6).
• The patient is calmer and steadier and comes regularly. Do not mistake this mode for failure.
• A patient who is spacey, tearful or unsteady at the door needs more time to orient before leaving.
• Bracing, eyes fixed on the door, or the breath held when lying down. These are signs to change position.
• Splitting (one therapist idealised, the other devalued), or material shared in one setting being avoided in the other.

Problems the guide addresses

• Stuck: no change after many sessions
• Resistance: tension, guardedness, "nothing happens in my body"
• Overwhelm, flooding, dissociation
• Intellectualising ("talking and talking")
• Non-adherence: missed sessions, no practice between sessions
• Compliance masquerading as cooperation
• Ruptures, transference and boundary problems
• Selection, contraindications and medical safety
• Suicidality and acute crisis
• Strong releases: crying, shaking, laughter, yawning

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.