Chapter summary: an overview of concepts, methods, and outcomes in the context of treatment examples involving lower levels of emotional intensity, from later phases of development of the practice of embodying emotion, and in the context of long-term treatment.
Embodiment of an emotion can be defined as the ability to expand the emotional experience to as much of the body as possible, in such a way that the person’s ability to tolerate the emotional experience and stay with it is increased. When Integral Somatic Psychology (ISP) practitioners work with our clients or ourselves to embody an emotion, we expand the body in a regulated manner to manage any extreme physiological dysregulation and stress from the emotional experience that can lead to psychophysiological symptoms. At the same time we also expand the emotional experience to as much of the body as possible, to access the emotional information more fully. We try to stay with the emotional experience for as long as possible, to create a greater capacity to tolerate the emotions so they do not get acted out in dysfunctional thought or behavior. This also helps to give the brain adequate time to process the information in the emotional experience for optimal cognitive, emotional, and behavioral implications. In pursuing this strategy, we are informed by the emerging science of embodied cognition, emotion, and behavior that expansion of the emotion to as much of the body as possible will make it not only more tolerable to be with but will also improve what we think and do in the situation that is causing the emotional difficulty.
For a quick and simple example of what we do during a piece of emotional embodiment work, let us go to an Indian fishing village on the coast of the southern state of Tamil Nadu, where I took an international team of therapists for the first time to treat the survivors of the 2004 Indian Ocean tsunami. At the end of a sweltering summer day, as the sun was mercifully setting and we were packing up to leave, a twelve-year-old boy sought our help for relief from a symptom: his heartbeat became disturbingly high and irregular every time he thought another tsunami could come.
We worked with him by having him notice that he was afraid and that the fear was concentrated in his chest. We also had him notice how his chest was constricted as though it was trying to squeeze the fear out of the body. We helped him to expand his chest by having him breathe against the physical constriction and by supporting his chest with the touch of his own palm, with the intention to expand it. We kept the emotion of fear alive by talking about how afraid he might have been of dying during the tsunami and how everyone, including adults, feels such fear during a threat to one’s life. We helped him to expand the fear from the heart to as much of the chest as possible by asking him to try to do it intentionally and by suggesting that he follow the spreading of the fear as the chest expanded with his breath and his touch. We repeated this process to help him expand his constricted arms by having him move his arms, and then we helped him expand the fear into his arms as well.
At the end of this really short intervention, he said he felt calmer, even though he still felt the fear in his chest and his arms. When we asked him if he was surprised that he did not have the disturbing heartbeat symptom, he said yes. We recommended that every time he got afraid that another tsunami could come, he should do exactly what we had done during the session. We also educated him that he might find the fear spreading to more places in the body beyond the chest and arms, and that it would be a good thing if that were to happen. In two follow-up research visits that took place three months and a year later, the boy gladly reported to our researcher that he no longer suffered from his frightening symptom.
When we go about the process of emotional embodiment, we might well find that experiences of emotional embodiment vary considerably, not only across individuals but also across time or situations for the same person. We have found that experiences of emotional embodiment can differ in terms of the level of the emotion, the intensity of the emotional experience, the width and the depth of the emotional experience in the body, and the duration of a cycle of emotional experience. Let us look at each of these variables in turn.
The level of emotion a person is generating and experiencing in the brain or body physiology can be high or low. But what is the level of an emotion? We often observe in ourselves or others that sometimes there is a lot of emotion, and at other times there is only a little bit of emotion. The level of emotion does not have to do with the level of energy or arousal. This is because some emotions, such as anxiety, are high-arousal emotions, physiologically speaking; other emotions, such as despair, are low-arousal emotions. A person might therefore report the level of anxiety as higher at higher levels of arousal, whereas a person experiencing despair might report the level of despair as increasing as the level of arousal decreases. The level of emotion is a subjective rating by the experiencer that is relative to the person’s past experiences of the emotion. It is an answer to the question: are you experiencing more or less of the emotion than before?
Can outside observers assess another person’s level of emotion as higher or lower than before? This is possible to some extent; it depends on how well the observer knows the person’s experience. It also depends on how well the person expresses the emotion verbally and nonverbally, and on how well the observer can resonate with the person’s experience. Interpersonal resonance—nonverbal communication between two bodies through electromagnetic and quantum mechanical means—plays an important role in how we communicate and regulate emotional experiences in each other (this topic is the subject of chapter 14). Assessing another person’s level of emotion would also depend on the observer’s capacity to tolerate the emotional experience. In any case, an observer’s assessment of another person’s level of emotion is subjective.
The experience of an emotion might also vary in its intensity from low to high. Intensity is defined here as the subjective psychophysiological difficulty a person has in tolerating and being with an emotion. We use the term “psychophysiological” because the difficulty in tolerating an emotion has both a psychological component and a physiological component. We know this from our experiences during physical exercises such as running. When we start to find an exercise strenuous, the more we tell ourselves it is difficult, the more physically difficult it becomes. We often say that an emotional experience is too intense when it is subjectively difficult for us to tolerate. Our assessment of how intense an emotion is does not have to do with what others on the outside might think about it, even though we might be influenced by our parents to find even low levels of emotion to be too intense. As with the level of an emotion, the assessment of the intensity of an emotion—whether by the person experiencing it or by a person observing it—has to be subjective as well.
What is the relationship between the level of an emotion and its intensity? It is reasonable to expect that a person would find the intensity of emotional experience to increase as its level increases. However, the extent to which the intensity of an emotional experience increases with its level might vary across individuals. Even though some people might consider a given level of emotion or level of intensity to be low, another person might find those levels to be unbearable. That is, a person might acknowledge that the level of an emotion is low and still find it unbearable, or a person might acknowledge that the level of an emotion is high and still find it quite bearable.
The level of emotion is only one of many factors that determine the intensity of an emotional experience. A level of emotion too intense for one person might not be as intense for another person due to many other factors, including thoughts and behaviors. A person who thinks it is bad to feel sad will find sadness more intense—at any level of sadness—than another person who does not have such a negative psychological evaluation attached to it. A person who is able to express an emotion is more likely to find an emotion less intense at any level of that emotion than another person who has difficulty expressing it. The physical fitness of a person might also have a bearing on the ability to tolerate emotional experiences. The more fit a person is, the more tolerable the emotional experience could be at any level of the emotion. Emotion can be thought of as an assessment of the impact of a situation on a person’s brain and body physiology. Therefore, we can expect an unfavorable situation to have more adverse impact on a physiology that is less healthy to begin with.
As with the level of an emotional experience, the intensity of an emotional experience in a person can also be assessed by others to some extent, but the same caveats apply. It will also be a subjective assessment, and our ability to make that assessment will depend on a number of factors, such as how well we know the other person’s emotional experiences.
People do appear to have the ability to differentiate between the level of an emotion and the difficulty with experiencing the emotion. We can infer this when they say they felt a lot of anxiety but they were okay with it or could tolerate it, or when they say they could not even tolerate a little bit of the anxiety they felt. The two variables are obviously related because they have at least one factor in common: the state of the body. The higher the level of emotion, the more change in the body one might expect. The greater the intensity, the more stress and dysregulation one might also expect in the body, because the level of stress and dysregulation is perhaps the most important factor making any body experience (including emotion) tolerable or intolerable.
Of these two variables—intensity and level—one can think of intensity as being more subjective than level, because level might have more of a physical basis than intensity. As subjective as these variables are, they can nevertheless be useful for regulating ourselves and others emotionally. We can learn to track emotional experiences along these two related dimensions in ourselves and others, so that we know when to ease up on or increase one or the other when we are working with others or ourselves.
When we are working toward embodying an emotion, the key variable we need to keep track of is the intensity of the emotion. That is, we need to stay in touch with the subjective difficulty experienced in tolerating and staying with the emotion without developing serious psychophysiological symptoms (such as the irregular heartbeat experienced by the boy in the Indian fishing village after the tsunami) and without losing connection to the emotion altogether, through defenses such as numbing and dissociation.
There are a number of ways to manage the intensity so it stays within a bearable range. One way is to manage the level of the emotion, because the level of emotion is one contributor to a person’s inability to tolerate it. We can manage the level of emotion by reducing the support we are providing it with our awareness. For example, we can put only half of our attention on the emotion inside our body and devote the other half of our attention to what we are aware of outside the body. When we do this for a while, this tends to reduce the level of emotion because what we do not pay attention to within ourselves tends to diminish.
We can also manage the level of emotion by not thinking about the situation or aspects of the situation that are triggering the emotional response, or we can think about other aspects of the situation that are less evocative of the emotion. We can also help regulate the emotional experience in the body by switching our awareness to the purely physical level. Tracking body sensations usually regulates the body back to normalcy by setting up a feedback loop between the brain and the body. Specifically, we can notice how our body and energy are doing better as a result of the hard work we have done to build more capacity for an emotion in the body.
In addition to managing intensity of emotion by managing level of emotion, we can also manage intensity by managing the other variables of emotional embodiment sessions: the width and the depth of body expansion involved, and the duration of the cycles of emotional processing. Let us now examine these variables and how they can be used to regulate the emotional experience.
The expansion of emotional experience in the body can be superficial or deep. For example, it can be superficial in the chest and involve only the musculature, or it can be deep in the chest and involve the lungs and the heart. The expansion can be wide and involve many areas or the entire body, or it can be narrow and involve only a few areas. An emotion such as grief might be present only in the chest, or it could include the face as well, or it could be felt throughout the body.
The length of time a person is able to stay with an emotion and process it can also vary considerably. Sometimes a person can stay with emotions only for short periods of time; sometimes people are capable of much longer cycles. This again can vary over time or across situations for the same individual.
Let us look briefly at how we might use the variables of width, depth, and duration to manage intensity to regulate an emotional experience and keep it from becoming unproductive. If a person has a very low capacity for tolerating an emotional experience, we might use very short cycles of emotional processing. That is exactly what I did when I worked with someone I was cautioned not to work with because she had been diagnosed with borderline personality disorder. People who have this disorder have an extremely limited capacity for emotional suffering. They tend to cope with it by either becoming extremely reactive to the world or by coming down with severe psychophysiological symptoms. We can all think of situations in which we might have these “borderline” tendencies ourselves, so it is well worth knowing how we could build more capacity for such emotional experiences in the future by manipulating the duration of each cycle of emotion during our work.
The young woman I worked with in this case wanted to work on the distrust she felt, especially toward men. In our work together, I had her recall an experience she’d had with a man that she believed had added to her distrust. But she could not feel the distrust in her body. I had her notice where her body felt bad in recalling the situation. She could feel it in the chest, but only for a few seconds. She then looked at me as though she was asking me what was next. I had her recall the details of the situation again and had her notice where her body felt bad for another short cycle of less than a minute. Feeling bad in relation to a situation is a meaningful physical reaction and therefore an emotion—and feeling bad is present as a layer of every unpleasant emotional experience. Feeling bad is what we might call a basic sensorimotor emotion, a bodily state that is a meaningful reaction to a situation. Basic sensorimotor emotions do not appear on the lists of primary and secondary emotions that we learn in psychology courses. When we cannot tolerate a familiar emotion such as sadness or fear, first contacting and developing a capacity for how bad we feel can often help in making the sadness or fear more tolerable and conscious.
In order to expand the emotional experience of feeling bad in the chest, I had her make a sound to express how bad it felt in her chest. Verbal expression expands the emotion to the structures in the throat and the face involved in the expression, and it can help in expanding the emotional experience to other parts of the body. This is because verbal expression is almost always accompanied by nonverbal expression in the body. A cycle ended when she could no longer be with the emotion and her awareness turned to the outside. In successive cycles, each of which lasted around a minute, she was able to expand her experience only a little bit, mostly in the chest area. Her emotional experience had neither depth in any place nor width involving many places in the body. That is, it was shallow and narrow in the body.
We agreed in our assessment that the level of emotion itself was low. However, as we methodically went about this process in very short cycles, important changes started to occur. The sadness started to show, instead of her habitual angry outburst, and it became tolerable. This validated the implications of scientific research showing that unconscious cognitions, emotions, and behaviors will become increasingly conscious, optimal, and regulated with growth in the capacity for embodied suffering (the subject of chapters 6 and 8). As the session progressed, the cycles got longer, but not by much; the longest cycle of staying with an emotion and trying to expand it in the body might have been about two to three minutes. But the duration of the cycles proved to be adequate for her to make the changes we were able to observe after the session. That evening, a member of the training team observed her grieving what she had lost in her life by distrusting others. In the training days that followed, we saw her processing her vulnerabilities with greater ability during practice sessions with fellow trainees, instead of her habitual conflict with them about not receiving adequate support from them.
In this example, the cycles ended because the client ended them on her own when she could no longer tolerate being with her emotional experience in the body. There are other ways to control the length of a cycle of emotional processing. We can simply suggest shifting the awareness from the emotional experience to something else: the inside of the body, such as body sensations or how the body might be feeling better from the hard work with the emotion; outside of the body, to aspects of the present environment; or the mind, to reflect on cognitions and behaviors that might have changed from the work with the emotion. This last strategy is especially useful after a very long cycle or the last cycle in the session. We can also end the cycle by reducing the support we are providing the person for the emotion and/or shifting focus away from the situation that is triggering the emotional response.
When we sense that an emotional experience is getting too intense to handle, we can also use expansion strategies to help manage the intensity to keep it tolerable without breaking the cycle. In general, the longer we stay in one place in the body, such as the chest, the deeper the emotional experience will go into the area, and the more intense the emotional experience will tend to get. So if we find ourselves in a situation where we need to manage the intensity to make the emotional experience more tolerable, we could expand to other places in the same area; for example, to the sides and the back of the chest, beginning from the front, where the emotion is initially located. We could also expand to other places in the body, such as from the chest to the arms. That is precisely what we did with the boy in the Indian fishing village. We helped him to expand his fear that another tsunami could come from the chest to more places in the chest and then to the arms, in two relatively short cycles.
Why does an emotional reaction become more tolerable when more parts of the body are recruited to share the experience? An emotion is as an assessment of the impact of a situation on the whole body, so it is harder to tolerate the experience if we confine the energy of the impact to one place. Spreading the impact out over more areas of the body makes it easier to tolerate. Still, there are times when we have to stay in one place and go deeper into the physiology there for the healing to occur, and we will discuss those cases later. In this chapter, we are looking at cases where such deep work in one place is not necessary.
The two treatments we saw in chapter 1 involved emotions that had high levels, high intensity or difficulty for the subjects, deeper and wider expansion of emotion in the body, longer cycles, and faster outcomes. I presented them first because it is through such highly intense emotional cases I started to appreciate the effectiveness of embodying emotions. However, the norm for emotional embodiment work is to see steady benefits from a slower process over a longer period of time. Although there are some advantages to embodying high levels of emotions intensely, deeply, widely, and at length, emotional embodiment work can improve cognitive, emotional, and behavioral outcomes in all therapy modalities, no matter how emotions differ with respect to any of these variables. I learned these important lessons through cases such as the ones presented next in this chapter.
In terms of the dimensions that differentiate emotional embodiment sessions from each other, the two short cases presented below could be considered to be at the opposite end of the spectrum from the cases we have already discussed. We have already seen one example of this earlier in this chapter, in my work with a borderline client. Together, these cases illustrate the benefit of emotional embodiment work, even when the level and intensity of emotion are low, or its expansion in the body is superficial or narrow, or the duration of the cycles is short—a more likely scenario in therapy as well as in life.
During the ISP professional trainings and workshops I teach, I demonstrate the different aspects of the work of emotional embodiment with training participants. In a training I was teaching in France, Sally approached me for a demonstration session. Sally suffered from asthma and wondered if we could work with it. Asthma, like many diseases, can have multiple causes, from genetic predisposition to hormonal fluctuations to allergies. It can also be psychophysiological in origin, as a consequence of defenses against emotional suffering that manifest in the physiology of breathing, especially in the lungs.
The most common physiological defense against emotional pain is holding back in the breathing muscles, such as the diaphragm and the intercostals, and in organs such as the lungs. When we are at rest, we do not need a great deal of oxygen, and the level of functioning of the lungs is lowered to the minimum through the autonomic nervous system. When the same mechanism is used to reduce breathing to lower the level and intensity of an emotional experience, breath can be inhibited to a greater degree than during rest, leading to bronchial symptoms such as asthma, especially in people who have prior genetic, hormonal, and allergenic dispositions for the symptom’s formation.
In addition to asthma, which Sally treated with an inhaler when necessary, she said her other primary symptom was difficulty in bonding with and relating to others. The autonomic nervous system and the organs it governs, which include the heart and lungs, are important in emotional experiences in general, and in emotional experiences involved in bonding with and relating to others in particular.1 So it made sense to work with a situation in Sally’s life that had to do with a disappointing relationship.
Even though Sally had been prone to asthma attacks since her childhood, the more recent and intense outbreak of it had been triggered by a breakup with a man she said she had loved more than any other in her life. It was not easy for Sally to track in her body how bad it felt and how sad it was that the relationship did not work out. Her physiological and psychological defenses appeared to be strong enough to keep the level and the intensity of emotion low and its presence in the body superficial and narrow, limited to the throat and the eyes. Sally had difficulty sensing and expanding the sadness, and she said she could barely feel it in her body or in her awareness. She needed a lot of psychological support from the outside, specifically from me and the group, to access her sadness and to stay with it, albeit for only a brief time each cycle. This indicated that she had not been given much support for her emotional experiences while growing up.
We supported her in experiencing as much emotion as possible in relation to the situation, and we suggested that she could use awareness, intention, breath, movement, expression, and self-touch as tools when she was on her own. We managed to expand the low level of sadness in her throat and her eyes to the rest of the face and to the chest, but only superficially and for very short periods of time before it disappeared. It was, therefore, more than a pleasant surprise to hear from Sally many months later that she no longer suffered from asthma since the session.
How can such apparently uneventful pieces of short-term embodiment work lead to the resolution of major long-term symptoms? The increasing tendency in the general population to form psychophysiological symptoms at rather low levels of emotional suffering—or, in other words, at low levels of emotion and intensity—offers one clue. Using emotional embodiment work to obtain even a small increase in the threshold of emotional suffering at which symptoms form could account for the outcomes observed in cases such as Sally’s.
Sally exhibited a low threshold for emotional suffering in the body as demonstrated by her high resistance to sensing the presence of sadness in her body and by her finding the limited experience of sadness in her body to be not intense (subjectively difficult) at all. Therefore, increasing Sally’s capacity for emotional suffering in the body just a little bit, by working with both her psychological and her physiological defenses, led to the surprising shift in her asthma symptoms.
Sabine, another student I taught, suffered from migraines. Three months after a difficult interaction with her boss, the migraines started to occur more often, and she started having flashbacks of her boss’s angry and disapproving face when the symptom appeared. The difficult interaction involved Sabine yelling at her boss when she got an unfair evaluation from him, and she thought of that as a good thing because when she was a child she could never speak up and defend herself to her abusive stepmother. Sabine reported suffering a lot in her childhood relationship with her stepmother, who punished her harshly and arbitrarily, both emotionally and physically. When I worked with Sabine during a demonstration in front of her class, I noticed that it was hard for her to access her vulnerability, both in relation to the incident with her boss and in relation to an incident when her stepmother slapped her for rearranging flowers in a vase.
Sabine showed a great deal of resistance to experiencing her vulnerability. Resistance to the experience of emotions can be either innate or psychological. Our brain innately resists unpleasant experiences because they imply states of stress and dysregulation in the body, which are associated with reduction in one’s physical health and well-being. On the other hand, pleasant emotional experiences imply states of reduced stress and increased regulation in the body, which are associated with improvements in health and well-being. Freud called this innate tendency to seek pleasure and avoid pain the pleasure principle. Because the generation of unpleasant emotions involves increases in the level of stress and dysregulation in the physiology of the brain and the body, we all have an innate resistance to them. There can also be resistance to pleasant emotions because the brain also innately resists the unfamiliar, so both pleasant and unpleasant emotions can run into innate resistance if they are unfamiliar.
Psychological resistance to emotional experience can have many sources. Families and cultures have a strong influence on which emotions are allowed and how they can be expressed. Concepts of the role of emotion in life and attitudes toward emotion vary by culture, and they can also vary across therapeutic modalities. The influence of the conventional wisdom that emotions always lead to irrationality in cognition and behavior can be seen not only in the general population but also in some therapeutic modalities.
Such biases against emotion are under increasing challenge by science. Recent research in neuroscience shows that cognition, emotion, and behavior are more inseparable in the physiology of the brain2 and the body3 than previously believed. Research has also found that emotion influences all aspects of cognition and behavior in every moment of our lives, just as cognition and behavior are known to affect our emotional states. In addition, emotion appears to drive cognition and behavior more than cognition and behavior drive emotion, because all aspects of our cognition that precede behavior, including attention, are influenced by our emotional state.4 The presence of emotion and its embodiment have been found to improve cognition, emotion, and behavior, and the absence of emotion impairs them.5 Emotion—an assessment of the impact of a situation on a person’s well-being—potentially involves the entirety of the brain and body physiology.6,7 We will see in chapters 6 and 8 how these findings imply that embodying emotion, or expansion of emotional experience in the body, can improve not only emotion but also cognition and behavior. Unfortunately, these findings have not yet made their way into public life or therapy modalities to a great extent, a gap this book is intended to bridge.
Improving the work we do with emotions in ourselves and our clients requires an understanding of facts about emotions such as these, which are important but not widely known. Therefore, it is always good to educate clients about the important role emotions play in our lives and about the physiology of emotions. It is important to acknowledge the innate and psychological resistance to experiencing our emotions so we can work with the resistances to overcome them. Discussing how emotion, cognition, and behavior are intricately bound together in the brain and the body, and how the body is involved in cognition, emotion, and behavior, allows clients to understand how we might compromise not only our emotions, but also our cognition and behavior, when we shut the body down to avoid emotions that feel unbearable.
Sabine, as a trainee, already knew about the important role of emotions in life and in therapy. Regardless, in her process we often had to work with considerable resistance against emotions, and we provided strong psychological support for her emotions. It turned out that for her to access, stay with, and make sense of her emotions, what she needed most during the session was the validation and support she got externally, from me and the class. This made a lot of sense given Sabine’s history. Research shows that a child’s ability to generate, access, and express emotions depends a great deal on the modeling and support provided by their primary caregivers.8 Sabine did not appear to have had a great deal of support for her emotions growing up, something she confirmed herself.
Using the images of her disapproving boss from her migraine-related flashbacks and of the stepmother during the flower vase episode from her childhood, I had her track and expand in her body the unpleasantness she experienced in those situations. We began at the sensorimotor emotional experience of unpleasantness because she could not find any primary or secondary emotions other than anger, which appeared to be her habitual defensive reaction to such situations as an adult. The level of the emotion of unpleasantness and of the reported difficulty in experiencing it (intensity) were both low, the expansion of emotion in the body was narrow and superficial, and the cycle was short; but it was enough to allow us to begin reorganizing the body somewhat. We had her redistribute the energy concentrated in her head downward toward her legs—a good direction when one is working with energetically top-heavy symptoms, such as migraine.
Toward the end of the session, when I asked Sabine what other feelings she could imagine herself having in those situations, she seemed to very briefly and lightly touch upon more differentiated emotions related to vulnerability, such as sadness, fear, helplessness, and loneliness. However, when I asked her where she was sensing those emotions in her body, Sabine quickly replied that she sensed them everywhere. To me, this seemed to be an improbably huge step compared to how limited her embodiment of unpleasantness had been, even though I knew that creating a capacity for such basic sensorimotor emotions can often lead to more differentiated and complex sensorimotor or primary and secondary emotions in clients. It is possible that Sabine merely recalled the memory of such emotions experienced in the body at some point in her past.
My skepticism of her self-report that she was feeling these emotions at all, let alone all over the body, also had to do with my observation in Sabine of a strong tendency to not appear as if she was failing or lacking in her process. As I ended the session, I thought it was possible that she had sensed them for a fleeting second in her brain or a part of her body and made the rest of it up.
Given the low level and intensity of Sabine’s rather short-lived emotional experiences, the superficiality and narrowness of their expansion in the body, and her tendency to perform that made me doubt some of her statements about her inner experiences, I did not think much change would come from that session and thought rather poorly of the work we had done together. And I had another reason to be disappointed with how the session went: no matter how much experience I have as a therapist, my ego always appears to get the better of me when it comes to demonstrations I do in front of groups, because of the tendency to equate intense and dramatic pieces of work with good work. That way the ego can remain appeased and secure.
I didn’t learn about the outcome of the session with Sabine until almost a year later, during the very last module of the training. When she went home after our work together, she started to cry. What she had experienced as a gentle drizzle of tears during some of her practice sessions prior to the demonstration session became a torrent. She cried all night long, interrupted only by fits of sleep. If I had found out the next day that she had cried all night long, I would have been concerned that she had fallen apart as a result of the session. But here is the thing: she has not had a single migraine since! Somehow the behavior of expressing her emotions through crying eliminated a severe symptom. All this came from an otherwise “unremarkable” piece of emotional embodiment work that I had so badly underestimated. I was once again pleasantly surprised to be reminded that it was not what happens and how it happens during the session that really matters. What really matters is what the outcomes are for the client in the long run.
Outcomes depend strongly on the level of suffering at which a client’s psychophysiological symptoms develop, i.e., their symptom threshold. Because people with a low threshold for suffering tend to form symptoms at low levels of emotion and intensity, they can very well have “miraculous” cures resulting from small pieces of emotional embodiment work that increase their capacity for suffering only marginally. On the other hand, among people with a great deal of capacity for suffering, in whom symptoms form at higher levels of emotion and intensity because of their higher thresholds for emotional pain, emotional embodiment work might be characterized by high levels of emotion and intensity, deeper and wider expansion, and longer cycles of embodiment. Please remember that emotional intensity refers to how difficult a person finds an emotional experience to be psychophysiologically, regardless of whether the level of emotion is high or low.
We will now look at some core ideas in embodiment work in relation to building capacity for emotional experiences. This will involve examining the relationships between level of emotion, level of intensity, symptom threshold, and level of body expansion. In general, when more of the body is open and available to participate in an emotion, lower levels of intensity or psychophysiological difficulty are experienced. When more parts of the body participate in an emotional experience, the intensity or psychophysiological difficulty will be less in every part that is involved than when fewer parts of the body are involved. Also, when more parts of the body are involved in an emotional experience, it is possible to experience a higher level of emotion even with a lower level of intensity or subjective difficulty.
With Petra and Connie, we were able to work through their psychological and physiological defenses relatively easily to expand their body to access higher levels of emotions at higher levels of intensity, and to expand the emotions widely and deeply in the body while staying with them for longer periods. With Sally and Sabine, their stronger psychological and physiological defenses would only allow us to access relatively lower levels of emotions at lower levels of intensity, and to expand the body and the emotions only to a limited extent for shorter periods of time. They also had surprisingly quick symptom relief, underscoring the point that what matters is not how much emotion, intensity or psychophysiological difficulty, expansion of body and emotion, and duration of emotion were present in the treatment; what matters is whether the client was able to work with levels of emotion and intensity just beyond their threshold or emotional capacity for suffering without forming symptoms.
The symptom threshold is the level of suffering—which is the combination of level of emotion and intensity of emotion—beyond which a person forms a psychophysiological symptom. Symptoms could be cognitive, emotional, behavioral, physical, energetic, relational, or spiritual. These symptoms form when the threshold for suffering is exceeded in a part of the body including the brain. When this happens, the body shuts down or becomes dysfunctional, which further increases the level of stress and dysregulation in the body. This in turn further increases the person’s difficulty with tolerating emotions. A psychophysiological symptom and the suffering it causes can be thought of as an unconscious compromise that a person’s psyche makes to cope with unbearable suffering. This might very well be the best one could have done in a past situation, given one’s history and one’s resources at the time. However, when these reaction patterns become habitual responses to other situations in the future, they can exact a high price upon a person’s well-being.
Psychophysiological symptoms constitute a dilemma. If the defenses were not there, the person would suffer from a lower level of functioning in the world and a higher level of stress and dysregulation. But if the defenses remain in place and become habitual, they contribute to the person’s ongoing suffering in different ways: lower functioning in the world from some symptoms, high levels of stress and dysregulation, and low threshold for the emotions defended against. The symptom threshold can be thought of as a person’s edge. In order to help clients heal, we need to be willing to help them work past their edge, or the boundary of their capacity, in such a way that symptoms do not form while their emotional capacity is expanded. This is possible when support for emotions is combined with the use of a more expanded, regulated body container. Therapists and clients need to understand that both support for emotions and work with the body are necessary for optimal outcomes, so that there is as little resistance as possible in the client as well as the therapist to do what is necessary to challenge the status quo.
Please note that a number of factors, including a person’s physical, social, and cultural environment, might determine how much of the body can be expanded, how much emotion can be generated, and how much a person can tolerate emotional experiences without forming symptoms. For instance, we often find that we have shorter fuses when we are with our parents than with our friends; or a person might have greater capacity for one emotion, such as anger, than for another emotion, such as sadness. So it is important not to think of an individual’s capacity for emotion or affect tolerance as fixed, as though it were independent of the environment or attitudes towards particular emotions.
Of all the factors that determine a person’s ability for tolerating emotions, two stand out: the attitudes we have toward our emotions that make it possible to experience, express, tolerate, and stay with them; and the support we have from others for our emotions. Within relationships, the affect tolerance of either person is a function of the relationship. Psychiatrist Daniel Siegel states that when two people come together, they form a synergistic supersystem wherein the capacity of the dyad is greater than the sum of the capacities of the two people forming it.9 So in addition to the expansion of the body container, inner attitudes and support from others have a bearing on the affect tolerance profile of an individual in a given situation.
Through treatments such as Sally’s and Sabine’s, I learned that low-level, low-intensity, short-duration emotional embodiment work with narrow and superficial body expansion can be just as effective as high-level, high-intensity, long-duration emotional embodiment work with deeper and wider body expansion, which we saw in the treatments of Petra and Connie. This realization marked the second and the more subtle phase of my learning about the power and versatility of emotional embodiment. In a way, it made sense that I learned in the order I did. We tend to give more importance and significance to more dramatic events in which a lot happens. In the belief that such events are necessary to bring about change, we might push ourselves or our clients past thresholds for suffering, which can be counterproductive. Either we can end up being retraumatized with worse symptoms, or we can shut down because of psychological and physiological defenses that arise to defend us against suffering.
As I started to realize the importance of low-level, low-intensity, short-duration emotional embodiment work and began highlighting it in my trainings, other therapists I have trained in the method started telling me about its effectiveness in similar cases. This also made sense. I had biased the therapists I trained with my own bias toward high-level, high-intensity, long-duration emotional embodiment work, a bias I had developed from learning first about its effectiveness through intense treatments such as Petra’s and Connie’s. In trying to replicate that type of treatment as a formula, I had developed such a strong filter that it could only be broken through equally quick and dramatic outcomes from low-level and low-intensity treatments such as Sally’s and Sabine’s at the other end of the spectrum.
There is a growing tendency, in life as well as in therapy, to regulate emotions away rather than deal with them because of the suffering they bring. As a consequence, thresholds for emotional suffering in the population are getting lower. This has been an important factor in the formation of increasingly more serious psychophysiological symptoms in our times, as evidenced by increasing levels of addiction in the population. Recent studies show that as many as one-fourth to one-third of medical symptoms that motivate people to seek the help of medical professionals are psychophysiological.10,11 This means therapists are going to be working more with clients characterized by a low threshold for emotional suffering. Therefore, the effectiveness of emotional embodiment even at low levels of emotion and emotional intensity makes it applicable not only for the minority who have a high capacity for emotion and its intensity, but also for the majority who do not.
All the cases we have seen so far have demonstrated the power of emotional embodiment in short-term work. But most therapeutic work takes place over the long term. The science of embodied cognition, emotion, and behavior and the empirical evidence from ISP therapists all over the world who integrate it as a complementary modality offer the possibility of reduction in the time it takes therapists in any modality to help their clients in long-term treatment to resolve their symptoms. One of the benefits of emotional embodiment work could be the reduction in the length of long-term treatment in different therapeutic modalities. Below I present a case from my practice that needed long-term treatment. I invite you to guess how long it would take a case like this to resolve symptoms; at the end of the story, compare your guess to the actual length of time it took.
Steven came to me for help in my private practice with a couple of symptoms. For one thing, he had developed a flying phobia causing him to have anxiety attacks when he flew. Because he was a musician who often had to fly to gigs out of town, it was very inconvenient that he could not fly without suffering an anxiety attack or being heavily medicated. His other symptom was that he could not sleep in a horizontal position. He could only sleep in a reclining position, as in an economy-class seat on a plane. Steven shared with me that he had developed both symptoms after the death of his mother, with whom he had had a difficult childhood.
We worked with the two symptoms and the loss of his mother, progressively taking care to ensure that the emotions involved in each step were not so overwhelming they would worsen the symptoms. In relation to his flying phobia, I had him at first just imagine a sequence of events in which he planned a trip that involved flying, taking time to embody emotions in each step. In relation to the sleeping difficulty, I had him attempt to sleep in my office with the lights dimmed. At first he was situated at the angle he was used to, and then we progressively reclined him in steps toward the horizontal position in a reclining chair. We tried to expand and embody the discomfort, the feeling of the lack of safety, the fear, the anxiety, and other emotions that arose in each step along the way in a series of sessions. We also tried to expand and embody the emotions that arose as we explored the significance of the loss of his mother as well as Steven’s childhood memories of her.
In the end, it took about six months of steady work before both symptoms resolved, allowing Steven to fly without an anxiety attack and sleep in a horizontal position. There is an interesting story around the resolution of Steven’s panic attack symptom. Steven did not fly much during the treatment; he took a break from work because he was going through so much. When he did start flying again toward the end of the treatment period, he actually had a panic attack on his first outbound flight. But he did not have any panic attacks after that. It is possible that when we work with emotions at a level of intensity close to the threshold when a symptom is triggered, the client may come down with a symptom. I have now made it routine to inform those whom I work with of this possibility so they do not have a strong negative reaction to it that derails the treatment.