Atlas›Domain IV · Body-oriented psychotherapy›Guide 089
Guide IV-089

Basic Body Awareness Therapy

Jacques Dropsy, Gertrud Roxendal1960Paris, France
A 25 · L 45 · M 3016 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: Basic Body Awareness Therapy (BBAT) as currently defined by the International Association of Teachers in BBAT (IATBBAT) lineage, mainly Skjærven's Movement Quality Model and Movement Awareness Learning Cycle. The earlier Swedish group format ("basal kroppskännedom", Roxendal and Lundvik Gyllensten) is added where it gives more practical detail. Where the two differ, the text says which one it is using. [source: Skjærven thesis; Fysioterapeuten BBAT article; Gyllensten & Nilsson Ovesson 1994]

What it is. BBAT is a physiotherapy method, not a psychotherapy in the strict sense. It grew out of the movement-awareness system of Jacques Dropsy (1938–2018), a Paris-based movement educator and psychotherapist who developed it in the 1960s. From the mid-1970s Dropsy taught in Sweden and Norway. Gertrud Roxendal, a Swedish physiotherapist, brought it into physiotherapy and psychiatry in the late 1970s, first under the name Body Awareness Therapy (BAT). From the early 1980s a Swedish–Norwegian teacher group formed, and Dropsy supervised it from 1987 to 2000. The method was later renamed BBAT (Norwegian: Basal Kroppskjennskap; Swedish: basal kroppskännedom), and IATBBAT now develops it. The pairing of Roxendal and Dropsy is therefore supported. Influences named in secondary sources are Tai chi, Zen meditation, Alexander Technique, Feldenkrais, Gindler and others. [source: Skjærven thesis §1.3.1, §1.4.1; Fysioterapeuten BBAT article; Wikipedia; Gyllensten & Nilsson Ovesson 1994]

How change happens. The patient repeats simple, small, soft everyday movements (lying, sitting, standing, walking, relational movements, plus voice, massage and seated meditation) and pays attention both to doing them and to how they feel. This improves movement quality: "how the movements are performed and/or experienced according to space, time and energy". The core of that quality is postural stability, free breathing and mental awareness. The underlying assumption is that greater body awareness increases self-awareness. That in turn opens new ways of acting, coping and relating, which reflection and practice at home and at work then carry into everyday life. [source: Skjærven thesis §1.5.5, §1.4.3; Danielsson 2015 p. 6; Fysioterapeuten BBAT article]

For psychotherapists. In Scandinavia BBAT is taught to and delivered by physiotherapists, with IATBBAT-linked teacher training and university curricula. Whether non-physiotherapists can enter formal BBAT training, and under what title they may practise, was not confirmed [uncertain]. A psychotherapist can use the principles and the reflective dialogue described below. Claiming to deliver "BBAT" should wait until you have done recognised training. For hands-on parts (massage, hands-on guidance) you also need to check what your licence and jurisdiction allow. [source: Wikipedia; Skjærven thesis §1.4.8] [synthesis]

2. Framework

BBAT has no fixed sequence of numbered phases in the sources used. Its structure is a course of repeated movement-awareness sessions, framed by assessment and a treatment contract. Within each movement, the Movement Awareness Learning Cycle runs as a small process of its own. [source: Skjærven thesis §1.4.2, §1.4.5, §1.4.6; Fysioterapeuten BBAT article]

Course structure (the phase labels are synthesis; the contents are from the sources):

  • A. Assessment and contract. The physiotherapist assesses movement quality, using the Body Awareness Rating Scale – Movement Quality and Experience (BARS-MQE) where trained. Patient and therapist then agree a treatment contract in dialogue. The contract covers aims and how the patient will practise the movement principles at home and at work. Goal: a shared picture of the patient's movement habits and a person-centred aim. [source: Skjærven thesis §1.4.2, §1.4.6; Fysioterapeuten BBAT article]
  • B. Movement awareness training. Individual or group sessions. Each session works through movements in the basic positions, each followed by reflection. Goal: better contact with the ground, the vertical midline, the movement centre and the breath, with less effort and more presence. [source: Gyllensten & Nilsson Ovesson 1994; Wikipedia; Skjærven thesis §1.4.2]
  • C. Integration into daily life. Home practice, a diary, and linking what happens in session to everyday tasks and coping. Goal: the patient organises the practice and can use it without the therapist. [source: Fysioterapeuten BBAT article; Skjærven thesis §1.4.2]
  • D. Re-assessment. BARS-MQE is used before, during and after treatment to guide clinical decisions. [source: Skjærven thesis §1.4.6]

Within each movement, the learning cycle: make contact with the movement, explore it, experience it, integrate it, create meaning, master it, then conceptualise and reflect on the experience. [source: Skjærven thesis §1.4.5; Fysioterapeuten BBAT article]

Format. Individual or group. A group works on each person's own function and experience; interaction between members is not the focus. Equipment is only "a floor, a mat and a chair". In Gyllensten's format, a session can end with each participant sharing how they experienced the movements and how this links to daily life. [source: Skjærven thesis §1.4.2; Gyllensten & Nilsson Ovesson 1994]

Dose.

  • No standard number of sessions was found in primary sources [uncertain].
  • In an early Norwegian study (Skatteboe) of day-unit patients, reported experience scores kept rising beyond about 20 sessions. Observed psychomotor change appeared only after about 50 sessions (around 9 months). [source: Gyllensten & Nilsson Ovesson 1994, reporting Skatteboe]
  • Stroke trials used 20–60-minute sessions. Some ran 60 minutes once a week for 8 weeks; others ran 20 minutes 5 times a week for 4 weeks. [source: Alamer et al. 2020]
  • Practical reading: expect weekly sessions of about 60 minutes over months rather than weeks, with daily home practice [synthesis].

Criteria for moving on. None were found in the sources [uncertain]. Suggested markers [synthesis]:

  • The patient can find and describe ground contact and the midline without prompting.
  • Breathing stays free during the movement.
  • The patient can name an experience in their own words.
  • The patient can repeat the movement at home.
  • When these hold, add complexity: fewer supports, standing and walking, relational movements, then everyday tasks.
  • If you see more holding, breath-holding or distress, return to more supported positions.

3. Guiding principles

[source for this section unless tagged otherwise: Skjærven thesis §1.4–1.5; Fysioterapeuten BBAT article; Gyllensten & Nilsson Ovesson 1994; Danielsson 2015]

  • Presence in, and awareness of, movement. Attention goes both to doing the movement and to what is experienced in it. Pause the patient if the movement turns mechanical.
  • Mental presence over performance. Gyllensten warns that movements done while thinking about other things reinforce a split between body and experience. Slow down and ask for attention before asking for more movement.
  • Movement quality as the target. Observe how a movement is done (space, time, energy), not range or strength. Give feedback on flow, rhythm, effort and coordination, not on correctness.
  • Four perspectives held equally: physical, physiological, psycho-socio-cultural and existential. Ask about meaning and life context as well as sensation.
  • Postural stability, free breathing and mental awareness are the three key elements. In every movement, check the base, whether the breath is free, and whether the patient is present.
  • Relation to the ground. Let weight sink downward rather than "holding oneself up" with neck and shoulder tension. Begin by inviting the patient to feel the support under them. [source: Gyllensten & Nilsson Ovesson 1994]
  • Relation to the midline. Balance downward gravity against upward postural forces so that neither dominates, giving both stability and flexibility. Use weight shifts and small rotations around a felt vertical line. [source: Gyllensten & Nilsson Ovesson 1994; Alamer et al. 2020]
  • Movement centre. Gyllensten places it around the solar plexus, linking lower-body strength with upper-body precision. Movements are initiated from the centre and coordinated with the breath. [source: Gyllensten & Nilsson Ovesson 1994]
  • Breath integrated with movement. Gyllensten frames this as releasing "energy" previously bound in muscle tension. That is the school's explanation, not established physiology. In practice, never instruct forced breathing; invite the breath to follow the movement. [source: Gyllensten & Nilsson Ovesson 1994]
  • Flow, rhythm, energy, intention. Help the patient find a functional form in each movement through these qualities. Use rhythm cues and invite the patient to move with a clear intention.
  • Less effort; simple, small, soft movements, repeated many times. The movements involve the whole body, wherever the symptoms are. Reduce speed and size before adding anything. [source: Gyllensten & Nilsson Ovesson 1994; Wikipedia; Fysioterapeuten BBAT article]
  • Exploration, not correction. The thesis contrasts inviting exploration with external correction focused on right or wrong. Ask "what do you notice if…" rather than saying "do it like this".
  • Therapist as guide, not expert. The aim is to stimulate the patient's own search, "learning to learn". Danielsson calls this a "collaborative guide". Offer options and let the patient choose their own optimal form. [source: Gyllensten & Nilsson Ovesson 1994; Danielsson 2015]
  • Therapist moves with the patient. The therapist acts as role model, mirror and "non-verbal movement communicator", alongside verbal guidance. Do the movement yourself and keep your own presence and breath steady.
  • Imagery and metaphor are part of the learning. Use simple images tied to ground, line and centre, and check that the image helps this particular patient. [source: Fysioterapeuten BBAT article]
  • Reflection after every exploration. Each movement is followed by reflection and putting it into words. For some patients, treatment can be mainly non-verbal. Keep reflection short and concrete, and do not force words. [source: Skjærven thesis §1.4.5; Danielsson 2015 p. 6]
  • Accepting learning room. Hold an open, accepting attitude toward every experience. Gyllensten names the therapist's attitude and the group climate as determinants of effect. Normalise "nothing" and "unpleasant" as valid observations. [source: Gyllensten & Nilsson Ovesson 1994]
  • Self-regulation of load. Participants may pause whenever they need to and adapt movements to their ability. Name the right to pause at the start of every session. [source: Gyllensten & Nilsson Ovesson 1994]
  • Bridge to everyday life, coping and health promotion. Practice is contracted for home and work, and a diary supports learning. Finish each session with one concrete transfer task. [source: Fysioterapeuten BBAT article]
  • Person-centred. Aims come from the patient's everyday needs. Revisit the treatment contract regularly. [source: Fysioterapeuten BBAT article; Danielsson 2015]

4. Intervention inventory

Read this first. The sources name the BBAT movement areas and the principles that govern them:

  • movement areas: lying, sitting, standing, walking, relational movements, voice, massage, seated meditation and free breathing;
  • governing principles: ground, midline, centre, breath, flow, rhythm, intention and awareness.

They do not give the step-by-step form of the individual named movements in the BBAT repertoire, such as the 12 BARS-MQE movements or the movement sequences taught in IATBBAT courses. Those are taught in training and are described in books that are not drawn on (Dropsy; Roxendal; Lundvik Gyllensten, Skoglund & Wulf) [uncertain].

The Steps below therefore apply the published principles to each movement area. They are marked [synthesis] and are not the official BBAT movement forms; learn those in recognised training. Each block also says which parts come from the sources.

Screening before starting [synthesis; no contraindications were listed in the sources]:

  • BBAT uses gentle movement. It has no breath intensification, stress positions or cathartic discharge.
  • Screen standing and walking work for fall risk and balance limits.
  • Check for pain conditions and recent injury or surgery, and adapt positions.
  • For lying on the back in later pregnancy, offer side-lying or sitting instead.
  • With acute psychosis, severe dissociation or recent trauma without stabilisation, keep sessions short, eyes open and focused outward, and closely linked to the room.
  • Roxendal's early work was with patients with schizophrenia, so psychosis is not an exclusion in itself. [source: Gyllensten & Nilsson Ovesson 1994, reporting Roxendal]

4.1 Movement-quality assessment (BARS-MQE)

  • Purpose / when. A structured baseline and progress measure of movement quality and the patient's experience. Use it before, during and after a course. [source: Skjærven thesis §1.4.6]
  • Steps.
    • Part 1: the therapist observes movement quality across 12 standard movements and rates it on a 1–7 scale.
    • Part 2: straight after each movement, the therapist asks the patient about the experience and writes the answer down verbatim. This part is not scored.
    • Factor analysis grouped the scale into a movement dimension and an awareness dimension.
    • The items and movements are not reproduced here. Use the instrument only after training and with the official materials.
    • [source: Skjærven thesis §1.4.6]
    • An alternative used in research: the Scale of Body Connection, a self-report measure. [source: Danielsson 2015]
  • Example language (illustrative). "I'll ask you to do a few simple movements. After each one, I'll ask what you noticed. There are no right answers."
  • Watch for. These areas are named as the focus of movement assessment [source: Danielsson 2015 p. 7]:
    • relation to the ground and to the vertical axis
    • breathing
    • coordination around the movement centre
    • flow
    • mental awareness
    • Note the patient's own words as well; they become material for the treatment contract.

4.2 Treatment contract

  • Purpose / when. Agree aims and the practice plan in dialogue, at the start and whenever you review. [source: Skjærven thesis §1.4.2; Fysioterapeuten BBAT article]
  • Steps.
    1. Summarise the assessment in everyday words, for example "you seem to hold yourself up through the shoulders".
    2. Ask what in daily life the patient wants to change.
    3. Agree one or two movement principles to practise.
    4. Agree when and where in daily life they will practise them (home, work).
    5. Agree to keep a diary.
    6. Set a review date.
    • [synthesis on the sequence; elements from the sources]
  • Example language (illustrative). "What would it mean in your week to stand a bit more on your own feet?"
  • Watch for. Aims that are about performance ("to do it perfectly") rather than experience and function. Reframe these toward exploration.

4.3 The Movement Awareness Learning Cycle (the procedure for every movement)

  • Purpose / when. The basic teaching procedure, used for each movement in each session. [source: Skjærven thesis §1.4.5; Fysioterapeuten BBAT article]
  • Steps. The seven steps are from the sources; what you do at each step is synthesis.
    1. Contact: the patient takes the position and senses the support and the breath.
    2. Explore: the patient tries the movement small and slow, with variations.
    3. Experience: the patient attends to what happens during the movement.
    4. Integrate: the patient repeats it until it becomes easier and whole-bodied.
    5. Create meaning: ask what the experience reminds them of or links to.
    6. Master: the patient does it on their own, without cues.
    7. Conceptualise / reflect: the patient puts it into words and you agree how it carries over into daily life.
    • Throughout, the therapist moves with the patient as role model and mirror. Give internal feedback prompts ("what do you notice?") and, sparingly, external feedback. [source: Skjærven thesis §1.4.5]
  • Example language (illustrative). "Let the movement get smaller… what happens to your breath?" / "Is there anything you'd like to keep from that?"
  • Watch for. Signs it is working: movements become softer, more rhythmic and whole-bodied, with less effort; the breath follows the movement; the patient's descriptions become more specific.

4.4 Lying movements

  • Purpose / when. Lying is one of the basic positions [source: Wikipedia; Skjærven thesis §1.4.2]. It gives the most support, which suits contact with the ground and with the breath. Use it early on and with fatigue or pain. [synthesis]
  • Steps [synthesis — not the official BBAT lying forms, which were not found in the sources]:
    1. The patient lies on their back on a mat, knees bent and feet on the floor if that is more comfortable. Eyes are open or closed as they choose.
    2. Invite them to notice where the floor carries them and to let their weight be received.
    3. Invite them to notice the breath without changing it.
    4. Introduce a very small, slow movement and repeat it, for example a gentle side-to-side rolling of the knees or a small rocking.
    5. Invite them to notice how the movement passes through the whole body, and keep breathing free.
    6. Rest and sense afterwards.
    7. Roll to the side to come up, then reflect (4.14).
  • Example language (illustrative). "Let the floor do the holding… see whether the movement can be even smaller."
  • Watch for. Breath-holding, bracing, drifting into drowsiness or absence. If any of these happen, open the eyes, make the movement more active or move to sitting.

4.5 Sitting movements

  • Purpose / when. Sitting is a basic position [source: Wikipedia; Skjærven thesis §1.4.2]. It brings an upright midline while the chair still supports the patient. Use it when lying feels too exposed, or as a step toward standing. [synthesis]
  • Steps [synthesis]:
    1. The patient sits on the front part of a chair with feet flat on the floor.
    2. Invite them to sense the sitting bones and the feet against their support.
    3. Explore small sways forward and back and side to side, to find the point where the trunk balances over the base with the least effort (the midline).
    4. Then try small rotations around that line.
    5. Coordinate the movement with the breath, without forcing it.
    6. Rest, then reflect.
  • Example language (illustrative). "Find the place where you need the least effort to stay upright."
  • Watch for. Collapsing or rigid upright holding. Success shows as an easy uprightness and a breath that moves freely.

4.6 Seated meditation

  • Purpose / when. Seated meditation is named as a BBAT component [source: Danielsson 2015 p. 6]. It comes from the method's Zen roots [source: Gyllensten & Nilsson Ovesson 1994; Wikipedia]. Use it to train mental presence in stillness.
  • Steps [synthesis; no duration was found]:
    1. Use the balanced sitting from 4.5.
    2. Rest attention on the base, the vertical line and the breath.
    3. When the mind wanders, return to sensing.
    4. Start with short periods and lengthen as the patient tolerates it.
  • Example language (illustrative). "Just sitting, and noticing that you are sitting."
  • Watch for. Rumination, dissociation or rising anxiety in stillness. Keep the eyes open, shorten the period or return to movement.

4.7 Standing: relation to the ground and the midline

  • Purpose / when. The core of the work: postural stability through grounding and finding the centre line. [source: Gyllensten & Nilsson Ovesson 1994; Alamer et al. 2020]
  • Steps.
    1. The patient stands with feet about hip-width apart and knees soft. [synthesis]
    2. Invite them to let their weight sink downward into the feet instead of holding themselves up with the neck and shoulders. This is Gyllensten's one concrete example. [source: Gyllensten & Nilsson Ovesson 1994]
    3. Explore weight shifting and small rotations to find the body's centre line. The movements are deliberately simple and gently test the edges of stability while the patient reflects on how the body feels. [source: Alamer et al. 2020]
    4. Balance the downward giving of weight against an upward lengthening so that neither dominates. [source: Gyllensten & Nilsson Ovesson 1994]
    5. Repeat many times, then stand still and sense, then reflect. [repetition: source Gyllensten & Nilsson Ovesson 1994; rest: synthesis]
  • Example language (illustrative). "Let your weight arrive in your feet… and notice what keeps you upright without effort."
  • Watch for. Locked knees, held breath, a raised shoulder girdle. Success sounds like what Danielsson's participants described as "rooting oneself": a felt stability. [source: Danielsson 2015 p. 32] Have a chair nearby for anyone at risk of falling. [synthesis]

4.8 Movement from the centre, coordinated with breathing

  • Purpose / when. To link lower-body stability with upper-body precision, and movement with breath. [source: Gyllensten & Nilsson Ovesson 1994]
  • Steps.
    1. Start from grounded standing or sitting.
    2. Invite attention to the movement centre, which Gyllensten places around the solar plexus. [source: Gyllensten & Nilsson Ovesson 1994]
    3. Start a simple, repeated whole-body movement from there, for example a slow rotation in which the arms follow the trunk, and let the breath match the rhythm rather than lead or resist it. [synthesis]
    4. Explore flow, rhythm and intention: the same movement done more continuously, or with a clear direction. [concepts: source Fysioterapeuten BBAT article; application: synthesis]
    5. Rest, then reflect.
  • Example language (illustrative). "Let the movement begin from the middle of you, and let the arms come along."
  • Watch for. Never cue deep or forced breathing. Dizziness or tingling suggests over-breathing: return to natural breathing and stillness. [synthesis] Spontaneous yawning, sighing or stretching were reported as signs of vitality. [source: Danielsson 2015 p. 32]

4.9 Walking

  • Purpose / when. Walking is a basic position. It carries grounding, midline and rhythm into gait and into everyday life. [source: Wikipedia; Skjærven thesis §1.4.2; Gyllensten & Nilsson Ovesson 1994]
  • Steps [synthesis]:
    1. Start from grounded standing.
    2. Walk slowly and sense each foot meeting the floor and the weight passing from one foot to the other.
    3. Keep the vertical line and let the arms swing freely.
    4. Find an even, comfortable rhythm, then vary the speed and notice what changes.
    5. Stop, stand and sense, then reflect.
    6. Agree one everyday walk where the patient will practise this.
  • Example language (illustrative). "Let the floor meet each step… is there a pace that feels like your own?"
  • Watch for. Rushing, looking down, stiff arms. When it is working, the step is more even and rhythmic and the patient can name what they will take into daily walking.

4.10 Relational movements

  • Purpose / when. Relational movements are part of the BBAT repertoire. They bring movement quality into contact with another person and with the space. [source: Fysioterapeuten BBAT article; Skjærven thesis §1.4.2; Wikipedia] The specific forms were not found in the sources [uncertain].
  • Steps [synthesis, cautious, and without touch unless 4.12 consent is in place]:
    1. Start from grounded standing.
    2. Explore a movement directed outward toward the room or toward the therapist standing at a chosen distance, for example reaching out and returning, or stepping forward and back.
    3. Notice how stability, breath and presence change when attention goes to someone else.
    4. Let the patient set and change the distance.
    5. Reflect on links to their relationships.
  • Example language (illustrative). "You choose the distance. What happens to your feet and breath as you turn toward me?"
  • Watch for. Losing the ground or holding the breath when meeting another person, freezing, over-accommodating. When it is working, the patient keeps their base while in contact.

4.11 Voice exercises

  • Purpose / when. Voice exercises are listed as a BBAT component [source: Wikipedia]. Their content was not found in primary sources [uncertain].
  • Steps [synthesis]:
    1. Start in grounded standing or sitting.
    2. Let a soft, easy sound ride on the out-breath, such as a hum or a vowel.
    3. Notice where the sound is felt and how the ground and breath support it.
    4. Keep the sound quiet and unforced. This is not cathartic voicing.
    5. Rest, then reflect.
  • Example language (illustrative). "Let a little sound come on the out-breath, no effort."
  • Watch for. Shame, strain or pushing for volume. Keep it optional, and offer the option of humming alone or along with the therapist.

4.12 Massage (structured massage / touch)

  • Purpose / when. Gentle or structured massage is named as a BBAT component. [source: Danielsson 2015 p. 6; Wikipedia; Fysioterapeuten BBAT article] The specific technique (sequence, body areas, duration) is not given in the sources [uncertain]. Learn it in recognised training only.
  • Requirements. Touch requires specific training and supervision, and you must check what your licence and jurisdiction allow. In many places psychotherapists are not permitted to touch clients; if so, leave this out. [synthesis]
  • Consent steps. None are described in the sources, so all of these are [synthesis]:
    1. Before the session, explain what the massage involves, which areas will be touched and why. Touch is limited to non-intimate areas such as back, shoulders, hands and feet, over clothing.
    2. Ask explicitly and accept no without needing a reason.
    3. Offer a no-touch alternative, such as self-massage or the patient pressing their own hands into the floor or a wall.
    4. Agree a stop signal (a word or a raised hand).
    5. Check in briefly during the massage and talk it through afterwards.
    6. Document consent.
    7. Ask for consent again each session; it does not carry over from last time.
  • Steps. Use the trained BBAT protocol. Not reproduced here [uncertain].
  • Example language (illustrative). "I'd suggest a light massage over your shirt on your back and shoulders, for about the time we agree. You can say 'stop' at any point. Would you like that, or would you rather work on your own?"
  • Watch for. Freezing, holding the breath, compliance without real agreement, or a trauma history with touch. Stop if any appear, and return to no-touch work.

4.13 Movement communication: moving with the patient, demonstration, imagery

  • Purpose / when. The therapist teaches mainly by joining the patient in movement, as role model and mirror, a "tacit, non-verbal movement communicator". Verbal guidance, metaphor and imagery support this. Use it in every session. [source: Skjærven thesis §1.4.5; Fysioterapeuten BBAT article]
  • Steps [synthesis]:
    1. Stand or sit in the same position, side by side or facing the patient as they prefer.
    2. Do the movement yourself with your own grounding and free breath.
    3. Speak sparingly and slowly, in time with the movement.
    4. Offer one image at a time and drop any image that does not help.
  • Example language (illustrative). "Like a tree, roots below and growing up from there…" (check that the image fits the patient).
  • Watch for. The patient copying your form rather than finding their own. Move to verbal invitations and stop demonstrating.

4.14 Reflection and dialogue after movement

  • Purpose / when. After each exploration and at the end of the session, to put experience into words, create meaning and bridge to daily life. [source: Skjærven thesis §1.4.5; Danielsson 2015 p. 6; Gyllensten & Nilsson Ovesson 1994]
  • Steps [synthesis on the questions]:
    1. Pause after the movement.
    2. Ask an open question about the immediate experience.
    3. Follow the patient's words, then ask about the link to daily life.
    4. In a group, hold a round at the end in which each person may share. Speaking is optional; the sharing is part of the original group format. [source: Gyllensten & Nilsson Ovesson 1994]
    5. For patients who work mostly non-verbally, accept brief answers or none. [source: Danielsson 2015]
  • Example language (illustrative). "What did you notice?" / "Is that familiar from anywhere else in your life?"
  • Watch for. Interpreting for the patient, or turning the reflection into talk therapy that loses contact with the body. When it is working, descriptions become specific, embodied and personally meaningful. One patient quoted in the sources said they felt "more coherent, strong and safe". [source: Fysioterapeuten BBAT article]

4.15 Home practice and diary

  • Purpose / when. The structured practice the patient organises is reported as necessary for effect. The diary strengthens learning. Agree both from the first session onward. [source: Fysioterapeuten BBAT article; Skjærven thesis §1.4.2]
  • Steps [synthesis]:
    1. Choose one or two movements the patient can do safely on their own.
    2. Agree when and how often (short and frequent), and one everyday situation in which to apply a principle, such as standing at the bus stop or sitting at the desk.
    3. The diary records what they did, what they noticed and any link to daily life.
    4. Review the diary at the next session.
  • Example language (illustrative). "A few minutes, most days, and just a line in the diary about what you noticed."
  • Watch for. Practice that becomes another performance demand. Shrink it rather than drop it.

4.16 Group BBAT

  • Purpose / when. Gyllensten described groups for psychosomatic pain and tension conditions. Group movement therapy is also used as a main component in some programmes, for example for borderline personality disorder. [source: Gyllensten & Nilsson Ovesson 1994; Fysioterapeuten BBAT article]
  • Steps.
    1. The group moves together, each at their own level.
    2. The emphasis is on each person's own function and experience, not on interaction.
    3. Participants may pause whenever they need to.
    4. Close with a sharing round.
    • [source: Gyllensten & Nilsson Ovesson 1994]
    • Group size and session length were not found [uncertain].
  • Example language (illustrative). "Everyone finds their own version. Resting is always allowed."
  • Watch for. Comparing with others, performance pressure, an unsafe climate. Gyllensten names the group climate and the therapist's accepting attitude as decisive. [source: Gyllensten & Nilsson Ovesson 1994]

5. Handling problems

The sources name only a few difficulties. Each item below says whether it comes from the sources or is synthesis.

  • Sensing more means sensing more pain or distress. Becoming more aware of inner sensations and emotions was welcome for most people with depression but distressing for some. One participant put it as "to sense more could also mean to sense more pain". Two participants dropped out. [source: Danielsson 2015 p. 32] Response [synthesis]:
    • Tell patients in advance that this can happen.
    • Shift the balance toward stabilising work: grounding, open eyes, sitting or standing rather than lying.
    • Shorten each exploration and make the movement more active.
    • Name the distress as information, not failure.
    • Agree how the patient can ask to stop.
    • Check in briefly between sessions after a difficult one.
  • Muscle tension and effortful "doing". Named as a difficulty. [source: Gyllensten & Nilsson Ovesson 1994] Response [synthesis]:
    • Make the movement smaller and slower.
    • Go back to the ground and to less effort.
    • Invite exploration rather than correction ("what if it were half the effort?").
  • Lapses in concentration / doing movements while absent. Named as a difficulty. Gyllensten says it reinforces the split between body and experience. [source: Gyllensten & Nilsson Ovesson 1994] Response [synthesis]:
    • Stop and invite the patient to come back.
    • Use fewer repetitions with more pauses.
    • Ask a concrete sensing question ("where are your feet?").
  • Achievement culture: undervaluing rest and inner attention. Named in the source. [source: Gyllensten & Nilsson Ovesson 1994] Response [synthesis]:
    • Explain the rationale: quality before quantity.
    • Treat "I did nothing" as a valid result.
    • Avoid praise for performance; ask about experience instead.
  • Slow change; impatience or early dropout. Change in movement quality may take many sessions. In Skatteboe's data, psychomotor change appeared only after about 50 sessions. [source: Gyllensten & Nilsson Ovesson 1994] Response [synthesis]:
    • Set realistic expectations in the treatment contract.
    • Track experiential markers and diary entries so that early gains are visible.
  • Stuck clients [synthesis]:
    • Vary the position (lying, sitting, standing, walking).
    • Change the image or drop imagery altogether.
    • Return to the treatment contract and the patient's everyday aims.
    • Review whether the patient is being corrected rather than invited to explore.
  • "Resistance" or refusal of particular movements [synthesis]:
    • Treat it as information about safety or meaning.
    • Offer a smaller version, a different position, or watching first.
    • The patient chooses their own optimal form, which is a source-based principle. [source: Gyllensten & Nilsson Ovesson 1994]
  • Non-adherence to home practice [synthesis]:
    • Shrink the task to one minute or one everyday moment.
    • Link it to an existing routine.
    • Review the diary without judgement.
    • Practice organised by the patient matters for effect. [source: Fysioterapeuten BBAT article]
  • Overwhelm, panic or dissociation during movement [synthesis]:
    • Stop the exploration.
    • Open the eyes and name the room.
    • Bring attention to the feet on the floor.
    • Sit down if the patient is dizzy.
    • Let breathing return to natural; never cue deeper breathing.
    • Talk it through.
    • With patients with a trauma history, keep stabilisation work first.
    • Coordinate with the treating psychotherapist or psychiatrist.
  • Psychosis [synthesis, built on the report that Roxendal treated patients with schizophrenia; source: Gyllensten & Nilsson Ovesson 1994]:
    • Keep sessions concrete, short, eyes open and oriented to the outside world.
    • Prefer standing and walking work on ground and midline.
    • Avoid long inward-focused stillness and open-ended imagery.
  • Ruptures [synthesis]:
    • Typical triggers: feeling corrected or judged, a touch that felt wrong, a group that felt competitive.
    • Name it, take responsibility, ask what would help, and revise the contract.
    • After any touch-related rupture, return to no-touch work and ask for consent again before any further touch.
  • Group problems [synthesis]:
    • Comparison or competition between members: restate "own version, own pace".
    • One member's distress: give individual attention after the group.
    • Gyllensten makes the group climate a condition of effect. [source: Gyllensten & Nilsson Ovesson 1994]
  • Pain and physical limits [synthesis]:
    • Adapt the position.
    • Movements involve the whole body, but never push into pain.
    • Coordinate with the patient's medical care.
    • Do not present BBAT as a treatment for physical disease.
  • Scope [synthesis]:
    • If you are not a trained BBAT physiotherapist, consider referring to or co-working with one.
    • Present your work as body-awareness work informed by BBAT, not as BBAT.

Sources

Sources:

Further reading (not drawn on) [uncertain]:

  • Dropsy, J. Vivre dans son corps (Paris, Epi, 1973) [year and publisher uncertain].
  • Roxendal, G. (1985). Body awareness therapy and the body awareness scale: treatment and evaluation in psychiatric physiotherapy. Doctoral thesis, University of Gothenburg [uncertain].
  • Lundvik Gyllensten, A., Skoglund, K. & Wulf, I. Basic Body Awareness Therapy: Embodied Identity. Vulkan [year not confirmed].
  • Skattebo, U.-B. (2005). Basic Body Awareness Therapy and Movement Harmony. Oslo University College [uncertain].
  • Skjærven, L. H. et al. (2018). Consensus on core phenomena and statements describing Basic Body Awareness Therapy. Physiotherapy Theory and Practice [abstract-level only, via the thesis].
  • Albertsen, M. N., Natvik, E. & Råheim, M. (2019). Patients' experiences from basic body awareness therapy in the treatment of binge eating disorder. Journal of Eating Disorders 7 [uncertain].
← Previous · IV-088Body Awareness Group TherapyNext · IV-090 →Norwegian psychomotor physiotherapy