Atlas›Domain IV · Body-oriented psychotherapy›Guide 076
Guide IV-076

Concentrative movement therapy (KBT)

Helmuth Stolze1958Munich, Germany
A 29 · L 33 · M 3831 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the psychodynamic KBT (Konzentrative Bewegungstherapie, English "Concentrative Movement Therapy", CMT) taught by the German and European associations (DAKBT, EAKBT) in the Stolze–Gräff line. It is described here through two 2006 Lindau lectures by KBT trainers (Christine Gräff, Renate Löffler), a Lindau lecture on trauma work (Ulrike Schmitz), the DAKBT's own English and press pages, and reviews of current textbooks (Schreiber-Willnow 2016; Schmidt 2016; Stippler-Korp & Schüller Galambos 2023; Backmann 2021). There is no single treatment manual. The textbooks are known only through publisher-independent reviews. [uncertain]

KBT is a body-oriented, psychodynamically based psychotherapy, used in individual and group settings, inpatient and outpatient. It is a standard part of multimodal treatment in German psychosomatic clinics. The pressroom page counts 92 clinics and about 260 outpatient therapists in Germany, and KBT is an officially recognised psychotherapy method in Austria. [source: DAKBT press kit; DAKBT CMT page; socialnet Lexikon]

Origins (verified). The roots are in Elsa Gindler's Berlin gymnastics and body-awareness work of the 1920s. In Gindler's work, movement was to be perceived and felt rather than performed to an ideal. Her student Gertrud Heller used the work with psychiatric patients. Through Heller, the Munich psychiatrist and psychotherapist Helmuth Stolze came to the method, used it in his practice, and presented it as "Konzentrative Bewegungstherapie" at the Lindau Psychotherapy Weeks in 1958. The DAKBT English page instead says the method was developed in the "mid-1950s". The German association was founded in 1973 according to the DAKBT press kit, or 1977 according to socialnet. [source: DAKBT press kit; Wikipedia; DAKBT CMT page; socialnet Lexikon] [uncertain on exact dates]

How change happens. Here-and-now perception is always mixed with stored biographical experience, so how a person lies, stands, takes space, handles an object or meets a partner shows their learned patterns. Attending to this concentratively, in action and in the relationship, makes implicit (body-stored) experience available. Verbal reflection then links what was grasped by the hand with what is grasped by the mind. Trying out new ways of moving and relating gives new experiences that can loosen fixed patterns, inhibitions and tensions. Movement is meant in three senses: moving oneself (sensorimotor), being moved (affect), and being on the way (development). [source: socialnet Lexikon; Gräff 2006; DAKBT CMT page; Wikipedia]

2. Framework

Session structure (core unit). Every session alternates an experience space (nonverbal: an Angebot, or offer, followed by the client's own exploration) with a reflection space (verbal: reporting, deepening, dialogue). The order can vary, and in individual work talk and offers may alternate several times. [source: Löffler 2006; DAKBT CMT page]

The typical group sequence (Löffler) is:

  1. Arrive, and choose a place with one's blanket.
  2. The therapist makes an offer.
  3. Experience phase.
  4. A short report of what was perceived.
  5. Optional partner work.
  6. Group talk.
  7. Further work through creative design (painting, laying out space) or movement. [source: Löffler 2006]

Schmitz's trauma-group sequence is:

  1. An opening round to gather mood and themes.
  2. A movement offer.
  3. Building or arranging with materials.
  4. A return to the starting posture.
  5. An "as-if" play phase.
  6. A closing reflection. [source: Schmitz 2006]

The Stippler-Korp textbook, as reviewed, stresses verbal reflection especially at the end of the session. [source: socialnet review 32041]

Five fields of experience (Gräff). Gräff names five areas that offers draw on. Use them as a planning checklist:

  • space and time;
  • one's own body (Leib);
  • other people;
  • objects;
  • conversation and verbalisation.

[source: Gräff 2006]

Course phases. The DAKBT describes four phases:

  1. Building the alliance and learning concentrative sensing.
  2. Exploring old patterns.
  3. Trying out new movements and behaviours.
  4. Ending. [source: DAKBT CMT page]

For psychosomatic or psychogenic movement disorders, Schreiber-Willnow describes three phases:

  1. Early: understanding and empathy.
  2. Middle: measured challenge and encouragement, and exploring the symbolic meaning of the symptom.
  3. Final: placing the illness in the life story, and encouraging the patient to become active. [source: Schreiber-Willnow 2009 abstract]

Dose and format.

  • Outpatient courses average about 40 sessions, with a range of 5 to 300. [source: DAKBT CMT page, drawing on the Seidler et al. practice survey]
  • Inpatient group KBT usually runs 5–10 weeks, about 10–20 sessions. [source: DAKBT CMT page]
  • Inpatient work is most often done in groups. Gräff and Löffler favour individual sessions for biographical memory work and for touch-based work.
  • One trauma workshop capped its group at 12–14 participants. [source: Schulze abstract]
  • Session length is not given in the sources. [uncertain]

Criteria for moving between phases. The sources give no formal criteria. [uncertain] Usable markers drawn from the phase descriptions [synthesis]:

  • Phase 1 → 2: The client can stay with an offer for some minutes, report sensations in their own words without judging them right or wrong, and tolerate eyes-closed or lying work without flooding. A working alliance is in place.
  • Phase 2 → 3: A recurring pattern has been named in both body terms and life terms (e.g. "I always take the smallest space"), and the client links it to biography.
  • Phase 3 → 4: New movement or relating options can be produced on purpose in session, and transfer to everyday life is reported. The ending is then prepared over several sessions.

3. Guiding principles

Each principle is followed by what it means in practice.

  • "Konzentrativ". Fully accepting a task and staying in contact with it, and leaving out what blocks present awareness. → Give one simple focus per offer and allow time to stay with it. [source: DAKBT press kit; Gräff 2006]
  • Presence (Gegenwärtigkeit). The aim is awake, sensory presence in the moment. → Ask "what do you notice now?" before asking "why?". [source: Gräff 2006]
  • No right or wrong. Following Gindler, the client decides what feels fitting (stimmig). Löffler calls this taking one's own experience as true (Für-Wahr-Nehmen). → Never correct posture or movement towards a norm. Never praise a "good" performance. [source: Gräff 2006; Löffler 2006]
  • "Üben ohne Übung" (practice without exercise). Attention goes to one's own doing and to the dialogue of action, not to drilling an exercise. → Offers are invitations to explore, not routines to master. [source: DAKBT press kit]
  • Gestaltkreis. Stolze took over Viktor von Weizsäcker's idea that perceiving and moving form one unity. → Change can be started from perception, movement, thinking or acting. Pick whichever channel is open. [source: DAKBT press kit; DAKBT CMT page; Gräff 2006]
  • Grasping links to understanding. Bodily Greifen is linked with mental Begreifen. → Every experience phase is followed by verbalisation. [source: Gräff 2006; DAKBT press kit]
  • Offer, free choice, respected resistance. Offers are suggestions. The client may decline, change or ignore them, and resistance is taken seriously. → Phrase everything conditionally (see the language rules below). [source: socialnet review 32041; Löffler 2006; Schmitz 2006]
  • Biography lives in the body. Current perception carries the person's learning history, and basic postures show this. → Read how the client does a task (e.g. takes the last, smallest place) as biographical material. [source: socialnet Lexikon; Wikipedia]
  • Relationship as a central factor. Transference and the balance of closeness and distance are worked with. Stolze told colleagues not to fear transference, and later practice gave the relationship more weight. → Track who the client makes you into in the movement scene. [source: Gräff 2006; socialnet review 32041]
  • The therapist's body as an instrument. The therapist uses their own bodily and emotional resonance, and the next offer grows from bodily countertransference and the therapist's own reading of the situation in movement terms. → Notice your own tension, breath and impulses before choosing the next offer. [source: Gräff 2006; DAKBT CMT page; Schmitz 2006]
  • Translation work (Übersetzungsarbeit). Translate the client's problem into the body and action level as quickly as possible. → When a client describes a conflict, look for an offer that stages it (e.g. a choice, a boundary, a distance). [source: Gräff 2006]
  • Balance regression and autonomy. Encouraging regression (lying, eyes closed, holding) and encouraging autonomy (standing, choosing, pushing) cannot both happen in the same moment. Set the emphasis by client, group and problem. → For fragile clients, favour upright, eyes-open, autonomy-building offers. [source: Löffler 2006]
  • Adapt to each person. Löffler quotes "KBT ist immer anders!" (KBT is always different), and Gräff says the method must be reinvented for each patient. Clients with ego disturbances need a different pace and kind of offer. → There are no fixed scripts; adjust the tempo continuously. [source: Löffler 2006; Gräff 2006]
  • Meaning comes before interpretation. Instead of psychoanalytic interpretation, explore the Be-Deutung (meaning) of what happened in the client's life context. Take image language and metaphors literally and reflect them back. → Repeat the client's own image ("armoured", "tin soldier") and explore it. Don't replace it with theory. [source: Löffler 2006]
  • Objects carry layers of meaning. An object can be a real object, a means of self-experience, a symbol, a means for staging a scene, a transitional object, or an intermediate object between people. → Let the client's use of an object show which layer is active. [source: Gräff 2006; socialnet Lexikon]
  • Ethics. The Stippler-Korp textbook, as reviewed, grounds the work in four principles:
    • beneficence;
    • non-maleficence;
    • autonomy;
    • justice.
    Backmann's book addresses sexuality, sexual transference and the therapist's own sexual script in body work. → Reflect on touch and erotic transference in supervision. [source: socialnet reviews 32041 and 29312]
  • Therapist self-care. Stay an accompanying observer who shares feelings but remains separate from them, and keep tracking your own body's resonance so you don't sink into the group's mood. [source: Schmitz 2006]

4. Intervention inventory

How to read this inventory. KBT has no fixed exercise catalogue. Its sources describe offers (Angebote) built from a few elements:

  • basic positions: lying, sitting, standing, walking;
  • space;
  • objects;
  • partners and the group;
  • touch;
  • talk.

The items below are the offers actually described in the sources, grouped by area. Durations are rarely given in the sources. Where a duration appears, it is marked [synthesis] unless cited. [source: socialnet Lexikon; Löffler 2006; Gräff 2006]

Standard materials.

  • Typical objects: balls of various sizes and hardness, sticks or rods (including bamboo), ropes, wool thread, small sandbags, blankets, stones, shells, marbles, wooden blocks, roots, feathers, cans, beach finds.
  • Symbolic objects: dolls, puppets, plush animals, small figures.
  • Painting materials.

Gräff prefers materials with few fixed meanings. Each group member usually has their own blanket. [source: Gräff 2006; Löffler 2006; DAKBT CMT page; socialnet Lexikon]

Language rules for all offers (Löffler).

  • Use voice, rhythm and pauses deliberately. Watch small changes (shifting, restlessness, eyes opening) and pace your pauses to them.
  • Phrase offers openly and conditionally, e.g. "wenn Sie mögen" (if you like), "wenn es für Sie stimmt" (if it fits for you).
  • In regressive positions (lying, eyes closed), Löffler speaks in the first person ("I feel the floor") so the client can stay fully with themselves.
  • Use the formal or informal form of address deliberately, to regulate distance.
  • Avoid technical terms. Prefer plain everyday words, and verbs (lying, walking) over nouns (position, gait), because verbs keep the client in experience. [source: Löffler 2006]

Screening and contraindications. The sources name no formal contraindications. [uncertain]

What the sources do say:

  • Clients with ego disturbances need a different pace and kind of offer. [source: Löffler 2006]
  • Indications listed in secondary sources range from neurotic and psychosomatic disorders to early (structural) disturbances, trauma, addiction, eating disorders, depression, chronic pain and even psychoses. [source: Wikipedia; DAKBT CMT page]
  • DAKBT reports disorder-specific curricula for trauma, personality disorders, eating disorders, pain, somatoform, anxiety, depression, addiction and child/adolescent work. [source: socialnet Lexikon]

Screening for this guide [synthesis]:

  • Before regressive offers (lying, eyes closed, holding), check for current psychosis, severe dissociation, active suicidality and unstabilised recent trauma. With these clients, stay upright and eyes-open, use objects rather than the body as the focus, and keep offers short.
  • Before pushing, balance or nudging offers, check for pregnancy, recent injury or surgery, osteoporosis, vertigo and fall risk, epilepsy, and cardiovascular or respiratory illness. Adapt the offer or leave it out.
  • For eating disorders and body-image disturbance, avoid offers that invite judging body size. Focus on contact, weight-bearing and support.

Touch: applies to every offer below that involves touch (therapist, partner, self or object-mediated).

What the sources describe:

  • KBT uses self-touch, touch via objects (balls, sandbags) and touch by the therapist or group members. [source: Gräff 2006; DAKBT CMT page]
  • Gräff gives objects a bridging role between self-touch and being touched by others. [source: Gräff 2006]
  • Gräff holds that clients should also be able to touch the therapist, not only be touched. [source: Gräff 2006]
  • The therapist asks clients to notice what they like or reject and what feelings arise. [source: Gräff 2006]
  • Backmann (2021) treats touch, sexual transference and the therapist's sexual script at book length. Not drawn on beyond the review. [uncertain]

No step-by-step consent procedure is given in the sources. The following steps are [synthesis]:

  1. Explain what the touch would be, where, by whom, and why.
  2. Ask explicitly, and accept no as a full answer.
  3. Offer a no-touch alternative, e.g. the client uses the object on themselves, or an object is placed rather than a hand.
  4. Agree a verbal and a nonverbal stop signal.
  5. Check in during the touch ("still fine?") and afterwards in the reflection talk.
  6. Never touch the chest, buttocks, groin or genitals. Avoid the front of the torso unless clearly agreed and clinically justified.
  7. Document consent.

Touch requires specific KBT training, supervision, and a check of what your licence and jurisdiction allow. [synthesis] DAKBT training is a part-time further training for qualified health, medical, psychology or education professionals, with group self-experience, individual self-experience, seminars and supervision. [source: socialnet Lexikon; DAKBT CMT page]

A. Arrival and basic positions (Grunderfahrungen)

A1. Arriving and choosing a place with the blanket

  • Purpose / when: Opens every group session. It shows how much space the client takes and where they position themselves relative to others. [source: Löffler 2006]
  • Steps:
    1. Each person takes their blanket and looks for a place in the room. No instructions are given about where.
    2. Allow time. Observe who waits, who goes first, who takes a corner or the middle, and how close each person settles to others.
    3. Ask them to settle and notice how this place feels.
    4. Take up the choice in the talk phase if it seems meaningful.
  • Example language (illustrative): "Take your blanket and find a place in the room that fits for you today. Take your time."
  • Watch for: Löffler's case: a client waited and took the last, smallest place. This opened the theme "how much space do I allow myself?" [source: Löffler 2006] It is working when clients start to notice their own choosing, not just the result.

A2. Concentrative sitting (arrival awareness)

  • Purpose / when: A first offer for beginners, and a grounding opener in any session. [source: Gräff 2006]
  • Steps:
    1. The client sits on a chair, eyes open or closed as they prefer.
    2. Guide attention in sequence: how they are sitting; whether the feet are in contact with the floor; whether they hold themselves up or let the chair carry them.
    3. First accept how it is right now. Then invite any change they want to make, and notice what the change does.
    4. Exchange briefly with a neighbour or the group about what was noticed. [source: Gräff 2006]
    5. Duration: a few minutes. [synthesis]
  • Example language (illustrative): "Notice how you are sitting right now… Where do your feet meet the floor?… Are you holding yourself, or can the chair take some of your weight?… If you'd like to change something, do it, and notice what changes."
  • Watch for: Clients who start correcting their posture to look "right". Repeat that there is no correct way. It is working when reports shift from evaluations ("bad posture") to sensations ("my left foot is barely there").

A3. Lying and feeling the floor

  • Purpose / when: Contact with ground and support, letting oneself be carried, and noticing the body schema. A core offer from Stolze's early training. It is regressive, so it is not for every client (see screening). [source: Gräff 2006; Löffler 2006; socialnet Lexikon]
  • Steps:
    1. The client lies on their blanket on their back. Side-lying or sitting with back support is offered as an alternative. Eyes may close.
    2. Guide attention to where the body touches the floor and where it doesn't, and to how the floor carries the weight.
    3. Leave longer pauses. Speak slowly, possibly in the first person (Löffler).
    4. Close by inviting gradual movement, opening the eyes, and coming up in one's own way and time.
    5. Reflection talk follows.
  • Example language (illustrative): "If you like, let your eyes close… Where does the floor carry you?… Where are there gaps?… In your own time, begin to move a little and come back to sitting."
  • Watch for: Restlessness, eyes opening, holding the breath, freezing or spacing out. Offer eyes-open or sitting, and give an orienting cue (name the room, feel the feet). Working: the client describes ground, weight and support in concrete terms.

A4. Standing: "bewegtes Stehen" (moving standing) and right–left comparison

  • Purpose / when: Stability, standing one's ground, and permeable rather than locked joints. Use it for themes of having to be strong, of support, and of self-assertion. [source: Löffler 2006]
  • Steps:
    1. The client stands, feet roughly hip-width apart, eyes open. Eyes may close briefly if they are steady.
    2. Invite small swaying, letting the joints (ankles, knees, hips) stay soft so the standing is "moved" rather than rigid.
    3. Invite comparison of the right and left side: weight, size, warmth, presence.
    4. Close by walking a few steps and noticing any change.
  • Example language (illustrative): "Let the standing be a little bit alive, a small sway forward and back… Do your knees want to lock or stay soft?… Is there a difference between right and left?"
  • Watch for: Fall risk (keep a wall or chair nearby). Rigid "tin soldier" standing is material to explore, not to correct. [source: Löffler 2006]

A5. Walking (with variations)

  • Purpose / when: Explore rhythm, direction, pace and one's way through space. [source: Löffler 2006]
  • Steps:
    1. The client walks through the room at their own pace.
    2. Variations from the sources: walking with eyes closed at times (only with space cleared and the therapist watching); a right–left comparison of the feet; walking in a circle. [source: Löffler 2006]
    3. Invite them to notice pace, breath and what they look at.
    4. Let them discover alternatives themselves (slowing, stopping, looking up).
  • Example language (illustrative): "Walk at the pace that fits right now… Notice your breath… Is there another way of walking you want to try?"
  • Watch for: Löffler's case: a depressed mother running faster and faster in a circle felt breathless, which mirrored tasks "growing over her head". She then discovered stopping and looking up as options. [source: Löffler 2006] Stop if breathlessness becomes distress, and check for cardiac or respiratory issues.

A6. Balancing and standing on one leg

  • Purpose / when: Body-schema disturbance, a disowned limb, dependence and autonomy themes. [source: Gräff 2006]
  • Steps:
    1. Compare the two legs by self-touch (A9).
    2. Feel the floor through different materials under the feet.
    3. Balance, then try standing on one leg, the other, and back to both. A chair or wall is within reach.
  • Example language (illustrative): "Let one foot carry you for a moment… then the other… What is it like to stand on this leg?"
  • Watch for: Gräff's case Frau A. felt her left leg as an "appendage". Work on that leg linked to her dependence on her parents. [source: Gräff 2006] Screen for fall risk.

A7. Lying on a stick (yielding)

  • Purpose / when: Experiencing yielding and adaptation, i.e. how the organism adjusts to a situation. From Stolze's early training courses. [source: Gräff 2006]
  • Steps: Only the bare outline was found: the client lies with a stick under the body and notices how the body adapts and yields around it. Placement, duration and closing were not found. [uncertain] If used [synthesis]:
    1. Use a smooth rod placed lengthwise along one side of the spine, or across the upper back, never directly on the spine.
    2. Keep it short (a few minutes), with an exit at any time.
    3. Afterwards, lie without the stick and compare.
  • Example language (illustrative): "Let the stick be there under you and notice what your body does around it… Whenever you like, take it away and notice the difference."
  • Watch for: Pain or bracing. Stop at once. Not for clients with back injury or osteoporosis [synthesis].

A8. Space experience (Raumerfahrung), including vertical space with a rod

  • Purpose / when: A sense of one's inner and outer space, directions and boundaries. Useful for depression and feelings of falling or of losing ground. [source: Gräff 2006]
  • Steps:
    1. The client senses the space inside and around the body: in which directions it can widen, and where the limits are (people, chairs, walls, windows, floor).
    2. Bodily sensations of space are noticed.
    3. Then talk with a neighbour.
    4. Vertical variant: the client reaches up with a stick until it touches the ceiling, and notices being "eingespannt" (spanned) between floor and ceiling.
    5. Gräff's depressed patient opened up the space above through watching birds and clouds, the rod touching the ceiling, and a sense of an upward pole. [source: Gräff 2006]
  • Example language (illustrative): "How much space is around you right now? In which direction could you take more?… If you like, take the stick and reach up until it touches the ceiling."
  • Watch for: Shrinking versus expanding. It is working when the client can actively claim a direction.

A9. Self-touch and side comparison (Selbstberührung)

  • Purpose / when: Differentiating body perception, and a first, self-controlled step towards touch. Useful for body-schema disturbance and fear of touch. [source: Gräff 2006; DAKBT CMT page]
  • Steps:
    1. The client explores one limb (e.g. a leg) with their own hands: shape, temperature, firmness.
    2. Then the other limb.
    3. Compare: weight distribution, how present each side feels.
    4. Talk it through.
  • Example language (illustrative): "With your own hands, find out about this leg… Now the other… What's different?"
  • Watch for: Shame or avoidance of particular body areas. Do not push, and let the client use an object (ball) instead of the hand.

A10. Weight perception (object on the back of the hand)

  • Purpose / when: Fine perception, and noticing the small adjustments the body makes. A good low-threat entry offer. [source: Gräff 2006]
  • Steps:
    1. Place a small object (e.g. a watch) on the back of the hand.
    2. Notice the subtle movements made to sense its weight.
    3. Compare it with other objects or the other hand. [synthesis]
  • Example language (illustrative): "Let the watch rest on the back of your hand… What does your hand do to find out how heavy it is?"
  • Watch for: Intellectual guessing of the weight versus sensing it.

B. Work with objects (Arbeit mit Gegenständen)

The DAKBT names five levels of object work:

  1. Sensory and real experience of the object.
  2. Memories the object evokes.
  3. Body perception through the object.
  4. The object as an intermediate object in relationships.
  5. The object as a symbol of parts of the self, affects or life constellations. [source: socialnet Lexikon]

Objects also help clients who find body perception harder than object perception. [source: Gräff 2006]

B1. Exploring an object as itself (Realerfahrung), including exchange

  • Purpose / when: Sensory precision and staying with the thing rather than the label. An entry offer, and also diagnostic: who describes only properties, and who associates. [source: Gräff 2006; socialnet Lexikon]
  • Steps:
    1. The client chooses or receives an object (stone, shell, wood).
    2. They explore its form, material, surface, temperature and weight, with eyes open and then closed if they wish.
    3. Exchange variant: receive an object from a neighbour, explore it, and notice the difference from one's own.
    4. Report what was perceived, not what the thing is called.
  • Example language (illustrative): "Let your hands find out about this object as if you'd never met one before… Is it warm or cool? Where is it rough?"
  • Watch for: Naming and categorising instead of sensing. Memories that arise (level 2) can be taken up in the talk.

B2. Ball over the body (eyes open, then closed)

  • Purpose / when: Body perception through an object, with touch that the client controls. A bridge to touch work. [source: Löffler 2006; Gräff 2006]
  • Steps:
    1. The client chooses a ball.
    2. They first handle it with eyes open, in the hands only.
    3. Then, eyes closed if they wish, they guide the ball over their own body from the feet up to the head, at their own pressure and pace.
    4. Close by putting the ball down and noticing the after-sensation.
    5. Reflection round.
  • Example language (illustrative): "Now, if you like, let the ball travel over your body, starting at the feet… as much pressure as feels right… Leave out any area you'd rather not."
  • Watch for: Löffler's group showed three responses: an intellectual participant described only the ball's qualities; a closed-off woman experienced opening at her feet; a mother spoke of her lack of care. [source: Löffler 2006] Respect the areas clients skip.

B3. Choosing from a counted set (stones or balls)

  • Purpose / when: Making wishes, entitlement, envy and rivalry visible. Use in groups. [source: Löffler 2006]
  • Steps:
    1. Lay out a set of stones or balls numbering exactly the group size, or fewer. The exact count used is not specified in the source. [uncertain]
    2. Each person chooses one.
    3. Notice the sequence and the feelings: wanting, hesitating, giving up, guilt.
    4. Talk through.
  • Example language (illustrative): "Here are some stones. Each of you may take one. Notice what happens in you as you choose."
  • Watch for: Löffler's client chose the most beautiful stone, then feared hurting others or appearing selfish. [source: Löffler 2006] Shame can rise fast, so normalise all choices.

B4. Objects as symbols and staging (Symbolarbeit, scenic laying-out)

  • Purpose / when: Representing self-parts, affects, relationships or the family, and showing distances and positions in space. Useful when words are hard or conflicts are hidden. [source: Gräff 2006; Löffler 2006; socialnet Lexikon; Schulze abstract]
  • Steps:
    1. Invite the client to choose objects for themselves and for important people, feelings or parts of themselves.
    2. They place the objects on the floor or a blanket at the distances and positions that fit.
    3. Explore: look at the arrangement from different sides, hold an object, sense each one's weight and texture.
    4. Optionally let them change the arrangement and notice what changes.
    5. Talk through, using the client's own words for the objects.
  • Example language (illustrative): "Choose something that could stand for your mother… and something for you… Put them where they belong for you… What do you notice as you look at them?"
  • Watch for: Gräff's examples: a woollen chick chosen for the mother and a large wooden club for the father; a snail shell for the self beside a distant, pale marble. [source: Gräff 2006] Avoid interpreting the choice for the client.

B5. Shaping one's space with ropes, sandbags and objects (Raumgestaltung, boundaries)

  • Purpose / when: Making boundaries tangible and changeable. Use it for feeling hemmed in, boundary and closeness themes, and trauma work. [source: Löffler 2006; DAKBT CMT page; Schulze abstract]
  • Steps:
    1. The client lays a rope (or objects) around their place to mark their own space, at the size and shape they want.
    2. They sit or stand inside it and notice.
    3. They can widen, narrow or open the boundary.
    4. Partner or group variant: another person approaches, and the client indicates where to stop.
    5. Löffler used sandbags as a containing boundary on the body for a client whose chest felt "ohne Halt" (without hold) on one side. [source: Löffler 2006]
  • Example language (illustrative): "With the rope, mark out the space that's yours right now… How is it inside?… Would you like it bigger, smaller, more open?"
  • Watch for: Boundaries laid very tight or not at all. When sandbags are placed on the body, the touch protocol applies: the client places them, or agrees to their placement, and can remove them at any time.

B6. Transitional object to take home (Übergangsobjekt)

  • Purpose / when: Carrying a session experience into daily life. Used with early-disturbed or anxious clients. [source: Gräff 2006]
  • Steps:
    1. Agree with the client on an object from the session (a blanket, a small stone).
    2. They take it home for an agreed period. Gräff mentions about six weeks.
    3. It is returned later, and its use is discussed. [source: Gräff 2006]
  • Example language (illustrative): "Would you like to take this stone with you until we meet again in a few weeks, and bring it back then?"
  • Watch for: Gräff's examples: a woman wrapped herself in the blanket at home when she felt "löchrig" (full of holes) and later bought her own nicer blanket; a small stone helped another woman overcome fear of fainting in shops. [source: Gräff 2006] The object being replaced by the client's own is a sign of internalisation.

B7. Creative shaping after the experience (painting, laying out)

  • Purpose / when: Deepening, letting associations come, and making hidden themes (rivalry, envy, jealousy) visible through colour, form and the division of space. Löffler describes shaping as anxiety-reducing and inviting playful association. [source: Löffler 2006]
  • Steps:
    1. After a body or object experience, offer paper and colours, or materials to lay out.
    2. The client shapes the experience without aiming for good art.
    3. Talk through the product: what it shows, and what the client notices.
  • Example language (illustrative): "If you like, put on paper what you just experienced, in colours or shapes, however it comes."
  • Watch for: Perfectionism. Repeat that there is no right way.

C. Partner, group and interaction offers

C1. Partner treats the back with a ball

  • Purpose / when: Receiving and giving care, and touch mediated by an object. [source: Löffler 2006]
  • Steps:
    1. In pairs, one partner sits or lies. The other rolls a ball over the partner's back with agreed pressure.
    2. The receiver gives feedback.
    3. Swap roles.
    4. Talk through as a pair, then in the group.
  • Example language (illustrative): "Let your partner know what pressure is good and where not to go… Givers, keep checking."
  • Watch for: Touch protocol: agree areas in advance (back only), a stop signal, and the right to watch instead. Over-adapting receivers who never say "less".

C2. Back to back with a large ball, then separating

  • Purpose / when: Closeness, support and separation. [source: Löffler 2006]
  • Steps:
    1. Two people stand or sit back to back, holding a large ball between their backs.
    2. They sense the shared support.
    3. They separate deliberately and slowly.
    4. Each notices the after-effect.
    5. Verbal exchange in the pair.
  • Example language (illustrative): "Find a way to hold the ball together between your backs… Notice what it's like… Now, slowly, each of you move away."
  • Watch for: Partners often experience the separation very differently, e.g. "left alone" versus "the pressure eased". The verbal exchange is needed to clarify this. [source: Löffler 2006]

C3. Standing while being nudged (Anstoßen)

  • Purpose / when: Standing firm, yielding, and recovering balance. Use for over-control and "having to be strong". [source: Löffler 2006]
  • Steps:
    1. One person stands, as in A4.
    2. The partner gives light nudges (e.g. at the shoulder, after agreement) so the stander sways slightly.
    3. The stander notices how they respond: rigid, yielding, recovering.
    4. Swap roles.
    5. Talk through.
  • Example language (illustrative): "Partners, a light push at the shoulder, only as much as agreed… Standers, notice how you meet it."
  • Watch for: Löffler's client experienced swaying as failure ("tin soldier"). Behind this lay being the eldest of nine siblings who had to be strong. [source: Löffler 2006] Touch protocol applies. Screen for fall risk, pregnancy, vertigo and injury [synthesis], and keep nudges light.

C4. Rope connecting people (intermediate object)

  • Purpose / when: Relationship regulation: holding on, letting go, pulling and following, mediated through an object. [source: socialnet Lexikon]
  • Steps:
    1. Two people each hold one end of a rope.
    2. They explore: tension and slack, moving together, one leading, letting go.
    3. Talk through.
  • Example language (illustrative): "Each take one end… Find out together what the rope between you can do." [synthesis on steps]
  • Watch for: Pulling hard enough to cause a fall. Agree a gentle intensity.

C5. Body dialogue: regulating closeness and distance

  • Purpose / when: Making unconscious interactional movement conscious, and practising the regulation of distance and closeness. [source: DAKBT CMT page]
  • Steps:
    1. Two people (or client and therapist) start at a distance.
    2. One approaches slowly. The other signals "stop" with the hand or a word when it is close enough.
    3. Explore further steps: coming closer again, stepping back, turning sideways.
    4. Swap roles.
    5. Talk through. The specific sequence is [synthesis]; the sources name only the aim.
  • Example language (illustrative): "Let your partner come towards you slowly, and say stop when it's near enough for you right now."
  • Watch for: Clients who cannot say stop, or freeze. The therapist then models it or takes the approaching role more slowly.

C6. Graded ball throwing (soft to hard)

  • Purpose / when: Aggression and its containment: whether forceful throws can be caught safely. Used in trauma groups. [source: Schmitz 2006]
  • Steps:
    1. Two participants throw to each other, starting with a soft ball.
    2. Move step by step to harder and heavier balls.
    3. Each notices force, catching and fear.
    4. Talk through.
  • Example language (illustrative): "Start with the soft ball… When you're ready, try a firmer one… How hard can you throw so that it can still be caught?"
  • Watch for: Schmitz's Frau B. had an "Aha" experience when her firm throws were caught safely. [source: Schmitz 2006] Ensure space, use non-injurious balls, and stop if throwing becomes uncontrolled discharge rather than contact [synthesis].

C7. Obstacle building and "as-if" play (trauma group)

  • Purpose / when: Externalising what blocks the client and trying alternative perspectives and solutions. [source: Schmitz 2006]
  • Steps:
    1. Participants choose materials (bamboo sticks, rope, a crate with cloth, wool thread, a ball) and build an obstacle that blocks them.
    2. They step back until they feel the obstacle directly in front of them, and notice what changes in the body.
    3. They go around it, varying perspective, distance and orientation (back turned, facing). They imagine it already overcome.
    4. From this playful "as-if" state, the therapist asks what could be changed about the obstacle or the approach.
    5. Return to the starting posture and notice.
    6. Closing reflection.
  • Example language (illustrative): "Build something that stands for what is in your way… Step behind it… What does your body do?… Now walk around it, as if it were already behind you."
  • Watch for: Schmitz's Frau A.: her bamboo structure kept collapsing and tangling. When she moved the sticks away, she built a bridge, and her sense was that she had to go outward again. [source: Schmitz 2006]

C8. Containing a threatening figure and building a path to firm ground (trauma group)

  • Purpose / when: Gaining control over a threatening inner object, and building a symbolic path to safety. [source: Schmitz 2006]
  • Steps:
    1. The client represents the threat with an object or figure. They decide where it goes and whether it is hidden (e.g. in a crate).
    2. They look at it from a safe height and distance. In Schmitz's case it was placed on a podium at about 30 cm eye level.
    3. They act on it to set limits. Schmitz's client tied the figure's hands with wool.
    4. Variant: build a raft or bridge of sticks and rope and walk over it to "firm ground".
    5. Talk through.
  • Example language (illustrative): "You decide where this figure goes and how close it is… Is there something you want to do so that it stays where it belongs?"
  • Watch for: Rising arousal or dissociation. Keep the client in charge of the distance at all times. Use only within stabilised trauma work. Intrusions linked to self-directed aggression were handled in Schmitz's individual sessions. [source: Schmitz 2006]

C9. Direct touch by therapist or group (Fremdberührung)

  • Purpose / when: Corrective experience of touch, holding and boundaries. Used in individual work and in groups, directly or indirectly via balls and sandbags, or through shared movement and play. Clients may touch the therapist too. [source: Gräff 2006; DAKBT CMT page]
  • Steps: No procedural detail is given in the sources. [uncertain] Minimum procedure [synthesis]:
    1. Follow the full touch protocol above.
    2. Start indirect: an object between hand and body.
    3. Use neutral areas only (hands, forearms, shoulders, upper back, feet).
    4. Keep the client in control of pressure, location and duration.
    5. Invite the client to notice what they like or reject [source: Gräff 2006].
    6. Discuss afterwards.
  • Example language (illustrative): "Would it be all right if I put my hand on your shoulder blade, or would you rather the sandbag? You can say stop at any moment."
  • Watch for: Fear of touch, erotisation, merging, and post-session shame. Bring any doubt to supervision [source: socialnet review 29312; synthesis]. Requires KBT-specific training, supervision, and a check of licence and jurisdiction.

D. Verbal and process interventions

D1. Accompanying naming (begleitendes Benennen, after Stolze)

  • Purpose / when: Keeping experience and words close together in the moment, and sharing perceptions in the group. [source: Löffler 2006]
  • Steps:
    1. During an offer, clients say briefly what they notice.
    2. The therapist repeats it aloud so the others can perceive it too.
  • Example language (illustrative): Client: "cold in the hands." Therapist: "Cold in the hands."
  • Watch for: Repeat without adding interpretation.

D2. Reflection talk (Gesprächsphase): concretising, taking images literally

  • Purpose / when: At the end of every experience phase. It turns felt experience into conscious experience and connects it to the client's life. [source: Löffler 2006; Gräff 2006; socialnet review 32041]
  • Steps:
    1. Start with a short report of perceptions only. Gräff notes early groups shared perceptions only; reflection came later.
    2. Ask concretising questions (where, how, what exactly) until the sensation is precise.
    3. Take the client's images and metaphors literally and reflect them back, including facial expression and gesture.
    4. Explore the meaning in the life context ('Where else do you know this?'). Don't impose interpretations.
    5. Clarify differing experiences between partners verbally.
  • Example language (illustrative): "You said one side felt 'armoured'. What is that like, armoured?… And the other side, without hold… Do you know this from anywhere else in your life?"
  • Watch for: Löffler's case: a client's images of one side as "gepanzert" (armoured) and the other as "ohne Halt" (without hold) led to themes of boundary-setting and surrender. [source: Löffler 2006]

D3. Free movement association

  • Purpose / when: The body equivalent of free association. The client responds spontaneously in movement to an offer or situation. [source: DAKBT CMT page]
  • Steps:
    1. After an offer, or as the offer itself, invite the client to follow whatever movement impulse arises, without planning.
    2. The therapist observes the nonverbal process.
    3. Talk through. Specific steps are [synthesis].
  • Example language (illustrative): "Let your body do what it wants to do next, and follow it… I'll be here watching."
  • Watch for: Embodied memories surfacing. Pace the talk so the client can integrate them.

D4. Exploring the body symptom with benevolent neutrality

  • Purpose / when: Psychosomatic and psychogenic movement disorders (e.g. a gait disorder, vertigo). The aim is to understand the symptom's symbolic meaning. [source: Schreiber-Willnow 2009 abstract]
  • Steps:
    1. Guide attention to the affected body part.
    2. The client describes precisely what happens there, with an attitude of benevolent neutrality and without fighting the symptom.
    3. Implicit memory content may emerge. It is verbalised together with its affect.
    4. Over the phases, move from empathy, to measured challenge and encouragement, to placing the symptom in the life story and encouraging activity.
    5. Mixed-diagnosis groups are recommended, so that other members' healthy capacities support the client. [source: Schreiber-Willnow 2009 abstract]
  • Example language (illustrative): "Let's look at your leg together without wanting it to be different right now… What exactly happens when you put weight on it?"
  • Watch for: Rule out or co-manage organic causes medically before treating a symptom as psychogenic [synthesis]. KBT is one part of multimodal care for these patients. [source: Schreiber-Willnow 2009 abstract]

5. Handling problems

The sources touch on obstacles: shame, rejection of one's own body, clinging to familiar sensations, freeze and collapse, and over-intellectualising. They give few concrete management steps. Each item below is tagged. [source: Gräff 2006; Löffler 2006; Schmitz 2006]

  • The client only describes and intellectualises (e.g. lists the ball's properties). This is a pattern to notice, not a failure. [source: Löffler 2006]
    • Shift from nouns to verbs and from "what is it" to "what do you notice in your hands". [source: Löffler 2006 language rules]
    • Use small, concrete offers (A10, B1). [synthesis]
  • Habitual perception resists new experience ("nothing's happening", "same as always"). Gräff notes body self-discovery takes time and that change comes through repeated new experiences. [source: Gräff 2006]
    • Repeat the same simple offer across sessions with small variations (eyes open/closed, other side, other material).
    • Name "nothing" as information. [synthesis]
  • Shame about the body, rejection of the body, fear of touch. [source: Gräff 2006]
    • Begin with objects rather than the body (objects are easier for some clients).
    • Then move to self-touch via an object, then self-touch, and only later touch by others. [source: Gräff 2006]
    • Allow clothing and blankets, keep the eyes open, and let the client choose the distance. [synthesis]
  • Resistance or declining an offer. Free choice and respect for resistance are principles. [source: socialnet review 32041]
    • Accept the no.
    • Offer a smaller version or a watching role.
    • Explore what the no protects, in the talk phase. [synthesis]
    • Never repeat the request as pressure. [synthesis]
  • Overwhelm, flooding, dissociation, freeze or collapse (especially in lying, eyes-closed or trauma-related offers). Schmitz responds to collapse and heaviness in the group with careful activating movement or by starting self-soothing. [source: Schmitz 2006] The Dresden workshop combined KBT with anti-dissociative skills and resource activation. [source: Schulze abstract]
    • Stop the offer.
    • Eyes open, sit or stand, feet on the floor.
    • Name the room and the date; give an object to hold (stone, ball).
    • Use slow, rhythmic movement, and talk about the here and now.
    • Plan stabilising offers before any confronting work, and shorten offers. [synthesis]
    • Use the regression/autonomy balance: fragile clients get upright, autonomy-building offers. [source: Löffler 2006]
  • Ego disturbance, psychosis, severe personality disorder. These need a different pace and type of offer. [source: Löffler 2006]
    • Keep offers concrete, short and reality-based (real object experience rather than symbol work).
    • Avoid eyes-closed and regressive work.
    • Keep structure high. [synthesis]
    • KBT with chronic schizophrenic patients is reported in the literature (Bayerl 1998). [uncertain]
  • Suicidality and self-directed aggression. In Schmitz's trauma group, warning signs of self-directed aggression were worked on in individual sessions, not in the group. [source: Schmitz 2006]
    • Assess suicide risk with a standard structured assessment.
    • Draw up a safety plan.
    • Do lethal-means counselling (safe storage, removal).
    • Coordinate with the treating team.
    • Suspend confronting offers until the client is stabilised. [synthesis]
  • Group dynamics: rivalry, envy, scapegoating (e.g. surfacing in B3 choices).
    • Make them speakable in the talk phase.
    • Shaping work makes such themes accessible with less anxiety. [source: Löffler 2006]
    • Protect individuals from being exposed by the group. [synthesis]
  • Partners experience the same exercise very differently, leading to misattunement or hurt. Use the verbal exchange to clarify each person's experience. [source: Löffler 2006]
  • Ruptures in the relationship; transference and countertransference. The therapist's bodily resonance and transference are part of the method, and Stolze advised not to fear transference. [source: Gräff 2006]
    • Name the rupture in here-and-now terms ("something changed between us when I suggested lying down").
    • Ask about it, and adjust distance and offer.
    • Take your own countertransference to supervision. [synthesis]
  • Erotic or sexual transference, and touch boundary problems. Backmann (2021) addresses sexual transference and the therapist's sexual script. [source: socialnet review 29312]
    • Stop touch work.
    • Discuss the feelings verbally, within the frame.
    • Return to object-mediated work.
    • Consult a supervisor.
    • Never act on it. [synthesis]
  • Non-adherence and transfer. There is no homework protocol in the sources, apart from transitional objects taken home. [source: Gräff 2006]
    • Agree a small daily attention task (e.g. noticing the feet on the floor when anxious).
    • Lend an object as a reminder.
    • Review it at the next session. [synthesis]
  • Somatic risk during movement (falls, pain, breathlessness). This is not addressed in the sources. [uncertain]
    • Check medical status.
    • Offer chair-based versions.
    • Keep supports near.
    • Stop on pain or chest symptoms.
    • Psychogenic symptoms only after medical assessment. [synthesis]
  • Therapist fatigue or being pulled into the group mood. Schmitz stresses therapist self-care and an accompanying observer stance. [source: Schmitz 2006]
    • Track your own breath and posture.
    • Name the mood before making an offer, and receive it without reacting at first. [source: Schmitz 2006]

Sources

Sources

Further reading (not drawn on)

  • Stolze, H. (Hrsg.) (1984). Die Konzentrative Bewegungstherapie: Grundlagen und Erfahrungen. [uncertain on exact title]
  • Gräff, C. (1983). Konzentrative Bewegungstherapie in der Praxis. Stuttgart: Hippokrates.
  • Becker, H. (1981). Konzentrative Bewegungstherapie: Integrationsversuch von Körperlichkeit und Handeln in den psychoanalytischen Prozess. Stuttgart: Thieme. [uncertain on subtitle]
  • Schreiber-Willnow, K. (2000). Körper-, Selbst- und Gruppenerleben in der stationären Konzentrativen Bewegungstherapie. Gießen: Psychosozial-Verlag.
  • Schreiber-Willnow, K. (2016). Konzentrative Bewegungstherapie. München: Ernst Reinhardt.
  • Schmidt, E. (Hrsg.) (2016). Konzentrative Bewegungstherapie: Grundlagen und störungsspezifische Ansätze. Stuttgart: Schattauer.
  • Stippler-Korp, M., & Schüller Galambos, S. (Hrsg.) (2023). Konzentrative Bewegungstherapie: Psychotherapie mit Leib und Seele. Stuttgart: Kohlhammer.
  • Backmann, U. (2021). Sexualität in der Konzentrativen Bewegungstherapie. München: Ernst Reinhardt.
  • Seidler, K.-P., Schreiber-Willnow, K., Hamacher-Erbguth, A., & Pfäfflin, M. (2002). Die Praxis der Konzentrativen Bewegungstherapie (KBT): Frequenz – Dauer – Setting – Behandelte Störungsbilder.
  • Cserny, S., & Paluselli, C. (2006). Der Körper ist der Ort des psychischen Geschehens: praktisches Arbeits-Lehr-Buch für KBT. Würzburg: Königshausen & Neumann.
  • Pokorny, V., Hochgerner, M., & Cserny, S. (1996). Konzentrative Bewegungstherapie. Wien: Facultas.
  • Bayerl, B. (1998). KBT bei chronisch schizophrenen Patienten – eine Kasuistik. In Röhricht & Priebe (Hrsg.), Körpererleben in der Schizophrenie. Göttingen: Hogrefe.
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