Biodynamic Massage: A touch that respects the uniqueness of each human being

By Glória Cintra Email: gloriacintra@hotmail.com This article is part of the book “Touch in psychotherapy: Biodynamic Massage”. Org.: Ricardo “Guará” Amaral Rego Dinorah Poletto Porto, Dulce C. Amabis Maria Forlani, Sandra Ferreira Martins. The objective of this article is to show the importance of the patient’s resistance because shields have a protective role. This has been highlighted by Gerda Boyesen, who called it befriending resistance; the care not to produce a secondary shield, i.e., the resurgence of the patient’s defenses as a result of invasive therapeutic techniques. In this text, I will describe a massage technique I have named Gentle Contour and Body Limits Massage, which enables psychosomatic integration. In clinical practice, we often find patients whose fundamental trauma occurred in the very early stages of their emotional development, at a pre-verbal stage. In such cases, the interpretations based on a classic psychoanalytical model have often proved to be an ineffective treatment. Through his clinical observations and research, the pediatrician and psychoanalyst D. W. Winnicott has shown that the psyche of the infant is not completely inside his/her body at the time of their birth. This psychosomatic integration of the babies’ psyche with their bodies occurs over time and space and with a good-enough parenting by the mother, as well as with a good “holding” environment. By “parenting” we mean maternal care; the care of the mother towards the baby’s needs in an adaptive manner, respecting their rhythms, for example, the baby’s eating and sleeping rhythms. By holding environment we mean creating an emotionally stable environment (by people who care for the baby), protected from excessive sensory stimuli (light, sound, temperature, motion etc.), avoiding shock or startle reflexes that will disrupt the baby’s experience of continuity of being. (1) For Winnicott, what traumatizes the baby is the repetition of maternal failure, whether it regards the “mother-person” or the “mother-environment.” Excessive interference generates ruptures in the baby’s peaceful state by causing responses of submission or reactivity to the environment, resulting in the formation of the individual’s false “self”. Therefore, while treating regressed patients, Winnicott formulated a model to meet the needs of the human being. In this model, the therapist, like the good-enough mother, cares for the patient, paying more attention to issues of “holding” and “setting” management than to interpretations about the desires of the subject. (1) Winnicott used the term “holding” in many different meanings and contexts. “Holding” means holding the baby physically and psychologically; the “holding environment”, mentioned above; and the “holding” provided by the family and society. See more on this subject in: “A Linguagem de Winnicott” – Abram,Jan- pages 135 to 140. For this author: “The good-enough mother actively adapts to the rhythms and needs of the baby.” – This concept has generated a new form of clinical performance that has influenced Biodynamic Psychology. With its body techniques, Biodynamic Psychology has contributed to repair and recover the emotional development of the human being. It provides greater psychosomatic integration, relieves body symptoms, and promotes the elaboration of psychic processes in the body so that the individual’s true “self” can flourish. Gerda Boyesen observed that when the libidinal movement of the child is disturbed by maternal interference, the startle reflex occurs, as does the formation of “stress” patterns and symptoms, which will later become characterological reactions both in psychological defenses and in the formation of shields: muscle, tissue, and visceral shields. At birth, babies have very similar bodies. It is throughout their life history that their psyche and soma undergo changes that will form or deform their body. Biodynamic Massage can be seen as a process that seeks to repair failures in the mother’s parenting and in the “setting” as a safe and reliable place where the patient can re-live old traumas and reduce defensive reactions that disrupt his/her life course. Hence, the patient can regain his/her emotional development, experience greater psychosomatic integration and well-being in order to be himself/herself, rescuing his/her spontaneity and enjoying his/her creative potential and fulfillment in the world. Emotional illnesses – the neuroses – are maintained by defense mechanisms that operate in the psyche and in the body. Biodynamic Psychotherapy aims to work on these two aspects of the human being in an integrated manner. Biodynamic Massage is an important therapeutic tool that allows the patient to experience different sensations: being lulled, involved, protected, nurtured, contained, welcomed, and bound, repairing aspects of maternal failure, allowing for the trauma to be thawed, the maturational process to be resumed, the ego to be strengthened, the identity to be developed; allowing autonomy, self-affirmation, and self-fulfillment. A series of massage techniques are developed and described in this book. They are valuable instruments for therapeutic care to result in wellness, self-regulation, and expression of the patient’s primary personality. For this to happen, the therapist must choose a specific technique, a special way of touching each patient, since each person is unique. It is the patient, their physical and psychic constitution, as well as their personal history, who will guide the hands of the caregiver and the therapeutic process. When a patient arrives for a session, the therapist listens and accepts their state of being at that moment. The therapist thus makes a situational and existential diagnosis, proposing, if necessary, an intervention using a specific massage technique, always respecting the moment of transference and countertransference in the relationship. Some examples: – If the patient reports a sensation of numbness, lack of contact with their emotions, and severe muscle tension, the therapist might propose a massage to restore their muscle tone balance, flexibility, wellness, and contact with their feelings. – If the patient feels no sense of boundaries, and a perception that he/she lives only in his/her mind, the therapist might indicate a Contour Massage, which is intended to strengthen the body’s limits, the skin self, which differentiates the self from the other, towards the construction of a psychosomatic identity. – Another example is the Colonic massage, performed on the patient’s abdominal area. This type of massage can put the patient in touch with their entrails and emotions so that they are mobilized and can be expressed or harmonized. While monitoring the processes of ab-reaction and expression of emotional conflicts by her patients, Gerda Boyesen formulated some possibilities, namely: 1 – Strong emotional psychic discharge, which has an upward energetic direction. It consists of emotional expressions such as crying, screaming, and intense behavioral reactions; 2 – Strong vegetative discharge, which has a downward energetic direction, for instance: diarrhea, shivering, and sweating; 3 – Gentle emotional psychic discharge, with an upward energetic direction and which occurs through spoken words; 4 – Gentle vegetative discharge, with downward energetic direction and which occurs through peristalsis. Based on these ideas, Gerda Boyesen developed the method of Biodynamic Massage, in which pathogenic affections can be released and integrated into the psyche through a smooth discharge, which she termed psycho-peristalsis. Whichever the massage technique used, the objective is to open the psycho-peristalsis and promote self-regulation of the Autonomous Nervous System, which is responsible for the vegetative functions’ rhythm. When well balanced, these functions promote feelings of wellbeing, and when unbalanced, they produce feelings of malaise. For instance, a patient suffering from Panic Disorder develops serious phobias as a consequence of disruptions in their Vegetative System. When the patient’s heart beats irregularly, the patient might interpret this symptom as if they were having a sudden heart attack and, therefore, were dying. For the patient, the body’s internal environment becomes unreliable and threatening (this can be understood as lack of “holding environment”). The patient lives in a state of “stress” and in constant alarm. The biodynamic therapist, through verbal work and the use of massage, helps to restore the balance of these bodily functions (this can be understood as “good – enough” parenting), allowing this person and their psyche to dwell in a harmonious, stable, and reliable body. This is the basis that will enable a person to experience independent wellbeing, and the joy of being. Standard massage techniques applied mechanically and that do not take into account the individual patient and their life experience can stimulate defenses, abruptly break resistance, and increase it, thus bringing discomfort and suffering rather than satisfaction, relaxation, joy, and peace of mind. Biodynamic Massage constitutes a process in which the therapist is present as a person and not as a technician. The therapist does not confront the patient’s resistances and defenses. The intention is to dissolve them gradually and continuously with warmth and respecting the moment in life the patient is going through. The proposal is to befriend resistance, as it has a protective function which aims to maintain the integrity of the person. Breaking it abruptly can be perceived as an invasion that will strengthen the defense system. This is called secondary shield, which is more complex, less apparent, and, therefore, more difficult to work on. In a therapeutic massage process, the patient may experience intense changes. A patient once told me: “I feel that you massage my soul, and that you touch the deepest part of my being”. In the process of Biodynamic Massage with Winnicott’s approach, emotions are embraced and welcomed rather than interpreted. The process aims to harmonize, re-establish, restore the vital forces and the libidinous circulation; it aims to strengthen the bodily ego-motor, so that the primary personality – the true “self” – can manifest and express itself fully in the world. Therefore, Biodynamic Massage is proposed as a creative interaction, a dialogue, a communication beyond words, searching for a place of resonance and contact between the “self” of the therapist and the “self” of the patient. Gentle contour and body limits massage The purpose of this technique is to encourage psychosomatic integration processes. It is indicated when you want to provide the patient with: continence, safety, and awareness of their own body, especially of its limits. Many patients report feelings of peace, harmony, and vitality when they receive this massage. This bodywork is in line with Winnicott’s concepts on facilitating the feeling that the psyche inhabits the body (personalization, psyche becoming lodged in the body). Thus, this massage has moments of Holding and Handling. Procedures Important notes for performing the movements that will be described: a-The quality of touch in massage is essential. Actual oil is not used, it is imaginary. Therapists must imagine the texture of their hands as if they were warm oil, which slide smoothly and with viscous slowness to give the idea of something warm, with a lot of contact and warmth. The movement is gentle and uniform and there must be a lot of adhesion between the therapist’s hands and the patient’s body. b-In general, at least one of the therapist’s hands must be in contact with the patient’s body. One of the hands can still be at one end of the patient’s articulation, while the other (or both hands) slides simultaneously. c-The therapist must try to touch every structure of the patient’s body from one end to the other, i.e., touching the segment from end to end. For example, they must not touch the middle of the patient’s arm. d-Once they reach the articulations, the therapist’s hands must pause briefly for the patient to feel the contour and limits of each part of his/her own body. The therapist’s touch must be contactful and comprehensive. His/her hands should adjust to the patient’s body in a welcoming manner. e-All sliding movements must be repeated at least 3 essay times. f- I will describe below the movements with which the therapist touches segment by segment, and then, the global touch, integrating the already massaged parts, providing contour to the patient’s body as a whole. g-All movements described increase body perception, especially in the areas touched. A-Patient in supine position 1-Neck and Head Massage a-The therapist sits down behind the patient’s head and introduces his/her hands in shell sideways under the neck (with his/her fingers perpendicular to the spine). This provides support to the neck, and the therapist’s hands should remain in this position for approximately one minute. b-The therapist keeps one hand under the neck and moves the other to the occipital region, also remaining in this position for approximately 1 minute. c-The therapist slides his/her hands so that they support the patient’s head; the tips of the therapist’s fingers touch the patient’s occipital region and his/her fists are near the top of the patient’s head. After remaining in this position for approximately one minute, the therapist turns the patient’s head towards both sides a few times in an extremely slow and gentle manner. While performing this movement, the therapist might perform small tractions on the head to stretch the neck. This movement is expected to cause the patient’s breathing to flow and the patient to release his/her head into the therapist’s hands. d-The therapist raises the patient’s head for about three centimeters and returns it slowly to the mattress. This is done three times. Before removing his/her hands, the therapist slides them slowly and gently along the sides of the head, and then towards the top. 2-Face Massage: a- With his/her right hand, the therapist slides along the lateral portion of the patient’s neck, going from the junction of the neck with the torso to the forehead, past the back of the patient’s ear. The left hand supports the other side of the head so that it remains still during this movement. b- The therapist performs the same movement on the patient’s left side, changing the position of hands (left hand slides while right hand provides support). c-Using both hands simultaneously, the therapist slides the tips of his/her fingers along each side of the patient’s face, as if outlining its contours and following the edge of the forehead’s bones, the eye sockets, the nose, the zygomatic bones, jaws, jawbone, and ear cartilage. Next, he/she slides his/her hands on the lower part of the jawbone, going from the chin to the ears and outlining the mouth without touching the lips. These movements are generally performed from the center to the outer parts of the patient’s body. d- The therapist places his/her hands on the top of the patient’s head and slides them slowly along the sides of the face until they reach the area below the chin. Then, the therapist separates his/her hands, sliding them towards the ears. 3-Upper Limb Massage Note: In the following movements, every buy essay online time the therapist’s hands reach the patient’s hands, he/she holds them for 10 seconds, simultaneously giving the feeling of limits to the patient’s body. a-The therapist stands on the right side of the patient and slides his/her hands starting at the top of the head, going down the face, neck, shoulder, arm, elbow, forearm, fist, hand, until the tips of the right hand’s fingers. b- The therapist stands on the left side of the patient and repeats the same sequence, now on the left side. c- The therapist places his/her hands on the patient’s sternum, slides them along the clavicles, going down the shoulders, arms, elbows, forearms, fists, and towards the hands. d- The therapist places his/her hands on the top of the patient’s head and slides them along the face, neck, clavicles, shoulders, arms, elbows, forearms, fists and hands, in a movement that integrates the parts that have already been massaged. 4-Chest and Abdomen Massage The therapist places his/her hands on the patient’s sternal bone near the throat and slides them along the center of the chest, outlining the lower edges of the ribs, going down the flanks and outlining the iliac crests towards the center. 5-Pelvis and Lower Limb Massage Note. In the following movements, every time the therapist’s hands reach the patient’s hands, he/she holds them for 10 seconds, simultaneously giving the feeling of limits to the patient’s body. a- The therapist stands on the right side of the patient. He/she places his/her hands on the patient’s right iliac crest, sliding them along the thigh, knee, leg, ankle, and foot,going to the tip of the toes. The therapist always makes shorts pauses on the articulations. b- On the left side of the patient, the therapist repeats the previously described sequence on this side. c- The therapist places each hand on the patient’s iliac crests, left and right, and slides them simultaneously to the tip of the toes. 6-Integration Movements a- The therapist slides both hands slowly, working simultaneously. He/she begins with his/her hands on the top of the patient’s head and slides them along the upper limbs to the tip of the fingers. b-Next, also working with both hands, the therapist slides them slowly again, going from the top of the head to the tip of the toes. B-Patient in prone position 1-Head, neck, and upper limbs massage a- The patient lies down with his/her face turned right. The therapist stands on the patient’s left side. With his/her right hand, the therapist touches the patient’s forehead and with his/her left hand, the top of the patient’s head. The therapist slides his/her right hand along the face and neck, while the other hand slides along the back of the head. Without interrupting the movement, the therapist slides both hands along the shoulder, arm, elbow, forearm, fist, until the tip of the left hand fingers. b- The patient turns his/her face to the left. The therapist stands on the right side of the patient and repeats the previous sequence on this side, adjusting the position of the hands to work on the patient’s right side. c- The therapist places his/her hands on the top of the patient’s head, and slides them so that each hand goes down on one side of the body, performing the same trajectory of the previous items. Finally, his/her hands touch the patient’s hands, holding them for 10 seconds. 2-Back and Buttocks Massage The therapist slides his/her hands from the shoulders to the patient’s buttocks. 3-Buttocks, Legs, and Feet Massage a- The therapist sits down on the left side of the patient. He/she places his/her hands on the patient’s left buttock, starting to slide from there, going along the thigh, knee, leg, ankle, and to the tip of the toes b-Then, the therapist sits down on the right side of the patient and repeats the same sequence (item a) on the patient’s right side. c-The therapist now places his/her hands on the patient’s buttocks (one on each buttock) and slides them simultaneously as described above. At the end of the sliding, the therapist’s hands touch the patient’s feet, holding them for 10 seconds. 5- Global Sliding Note It is essential to always have in mind that the sliding must be performed slowly and with small halts on the articulations and bone edges, and that when the hands touch the patient’s feet or hands, they should always hold them for about ten seconds. a-The therapist’s hands slide from the top of the patient’s head to his/her hands. b-After that, the therapist’s hands slide from the top of the patient’s head to his/her feet. 6-Final Movements In order to perform the movements, the therapist asks the patient to lie down over their left side, in fetal position, and stands on their back. Then, the therapist performs the following touches (a, b, c, d), taking approximately one or two minutes in each touch. It is also important to observe if the patient’s breathing is free and flowing. a-The therapist places one of his/her hands on the top of the patient’s head and the other one on the patient’s sacral region. b-The therapist places one of his/her hands on the patient’s cervical and the other one on the patient’s sacral region. c- The therapist places one of his/her hands on the patient’s back, near the heart, and the other one on the patient’s belly, in the umbilical region. d-The therapist places one of his/her hands on the top of the patient’s head and the other one on the sole of the patient’s feet. . 7-Final sliding: To wrap up the massage, the therapist performs the following movements: a-The therapist places his/her hands on the top of the patient’s head and slides them to the patient’s feet, following the outlines and limits of the patient’s body. b- The therapist does the same sliding as before, but now with the hands very close to the patient’s body, without touching the patient’s skin. I have been experiencing this biodynamic massage technique for quite a long time with interesting results, mainly with regressed patients, diagnosed as borderline, and psychosomatic patients. We can see the clinical practice of Biodynamic Psychology under the standpoint of the theory and techniques by pediatrician and psychoanalyst Winnicott. Both Winnicott’s clinical work and his biodynamic psychotherapy allow for the patient’s regression to transference dependency because they seek to repair the patient’s “injured child” wound, as his/her traumas and failures occurred in quite early stages of hid/her emotional development. Regressing in order to progress: the patient can obtain a facilitating environment from the therapist, a good-enough mother, for their maturing process to develop. This occurs by repairing traumas occurred in a dependency phase, when the child is entitled to exist and be safe and nurtured, towards independence, when the child is entitled to being autonomous, being loved, to giving and receiving, and to finding independent well-being or the ability to be on their own. Both Gerda and Winnicott have a quite positive view of human being; they believe there is something intrinsically fine inside each person, and they called it the person’s primary personality or true self. Both professionals do not focus on the pathology, but on the possibility of updating human potentials of emotional maturing through the therapeutic process. When I read articles by Winnicott and Gerda, I am impressed by their passion for research and clinical practice, their love for their patients, their availability, and their compassion for human suffering. Winnicott speaks of the mother’s importance, who maintains the continuity of the baby’s line of existence. Likewise, the good-enough therapist contains and keeps the continuity line of the patient’s therapeutic process, through his/her psychosomatic integrity and constancy both in his/her attitudes and in the setting. Some biodynamic massage techniques, such as the contour massage, can be valuable instruments to re-establish the patient’s feeling of continuity of being and to enable the repairing of impaired mother-child bond. In order to illustrate the importance of continuity, I will repeat here a story told by Dean Ornish (1998) in his book Amor e sobrevivência, a intimidade que cura (Love and Survival, intimacy that cures): “There is a tribe in Eastern Africa where the art of true intimacy is fostered even before birth. In this tribe, a child’s birthday is not counted from their date of birth, or from the moment of their conception, as in other primitive cultures. For this tribe, the date of birth is counted from the very first moment the child becomes a thought in his/her mother’s mind. Aware of her intention of having a child with a given man, the mother leaves her house and sits alone under a tree. She sits there, attentive; until she hears the song that belongs to the child she intends to conceive. When she hears the song, she goes back to her community and teaches it to the father so that they might sing it together and then, make love, inviting the child to join them. After the child is conceived, she sings it to the baby in her womb. Then, she teaches the song to old women and mid-wives in the tribe so that the child is welcomed with this song during labor and at the miraculous moment of birth. After the child is born, all residents of the tribe learn the new community member’s song and they sing it to the child when he/she falls down or gets hurt. This song is sung in moments of triumph, or during rituals and initiations. This song becomes a part of the wedding ceremony when the child grows and, at the end of his/her life, his/her loved ones gather around his/her death bed to sing the song once again.” Imagine the feeling of intimacy for someone who grows in a family and in a community where they are so utterly seen, heard, and loved! The love song in the story above might be considered the transitional object that symbolizes the mother and the connecting thread that ensures continuity, the unity of self, and the psychosomatic integration in the child’s life. A cohesive community works as a supporting net (holding), and by singing the song, they acknowledge the individuality and identity of each person in the tribe. Both Winnicott and Gerda nurture this intimacy that cures with their patients, a love that leads to survival and to a better living. “If we grow with hard blows of life, we can also grow with gentle touches on our souls. (Cora Coralina) Bibliography: ABRAM, Jan , A linguagem de Winnicott. Rio de Janeiro,1996, Ed. Revinter André Samson, A Couraça Secundária. Revista Reichiana 3, São Paulo, 1994, p. 44-51. Anzieu, Didier, “O Eu-Pele”, Ed. Casa do Psicólogo, 2a. edição, São Paulo, 2000. Boyesen, Gerda, “A Personalidade Primária”, artigo publicado no” Cadernos de Psicologia Biodinâmica vol.3″, págs. 7 a 12, Ed. Summus, São Paulo, 1983. BOYESEN, Gerda, Entre Psiquê e Soma, São Paulo, Editora Summus, 2ª ed., 1986 Cintra, Glória , “Rematernagem: uma experiencia de simbiose construtiva” – artigo publicado na Revista Reichiana , numero 7, São Paulo, 1998 Cintra Glória, “Gerda Boyesen a mãe suficientemente boa descrita por Winnicott” , artigo publicado na Revista Reichiana numero 11, São Paulo, 2002. Cadernos de Psicologia Biodinâmica, vols. 1, 2 e 3, São Paulo, Editora Summus, 1983. Winnicott,D.W., Holding e interpretação, São Paulo, Editora Martins Fontes, 1991. Winnicott,D. W., Natureza humana, Rio de Janeiro, Editora Imago, 1990. Winnicott, D.W., O ambiente e os processos de maturação, Porto Alegre, Editora Artes Médicas, 3ª ed., 1979. Winnicott, D.W., Os bebês e suas mães, São Paulo, Editora Martins Fontes, 1988. Winnicott D.W., “O desenvolvimento emocional primitivo” (1945), em Textos selecionados da Pediatria à Psicanálise, Rio de Janeiro, Editora Francisco Alves, 1ª ed., 1978. Versão em português