Helping patients with eating disorders reawaken their bodies by connecting with their feelings is critical to their recovery. People with eating disorders have shifted their life focus to make it about food, weight and the physical body. The challenge of therapists is to shift the focus back to the more natural way of living that includes experiencing feelings. Ignoring internal states amounts to burying feelings and the burial site exists in the body itself. Since feelings may fester underneath the body’s surface and erupt when they become intolerable, it behooves us to help our patients develop a stronger relationship with this vital part of themselves (Kleinman & Hall, 2006).
In order to facilitate experiences that help our patients experience and “move” their feelings, we need to not only be able to move our own feelings, but to understand how to do this without losing our therapeutic balance. Essentially, maintaining appropriate boundaries is necessary in order to balance attuning to our patients while simultaneously attuning to ourselves (Bloomgarden, Mennuti, and Cohen, 2003, p.9-10). Gerstein, Botwin & Kleinman (2004) state that “exquisite attunement to one’s self can permit therapists to sift through and discard feelings that indicate that they may be over-identifying with patients, while still allowing for the possibility that they may be also tapping into the patient’s issues in an embodied, less conscious, fashion.”
Marsha was concerned about mysterious feelings and sensations that were causing her to feel “out of control.” As she moved between two chairs to reach the chair she would sit in, she suddenly froze and her back leg became paralyzed. She was unable to move in any direction. Her back leg was so tense that her whole body began to shake. I tried to ground her and help her remain calm. Although she looked very frightened, I wanted her to regain her composure, if possible, so I moved closer to her, established direct eye contact and stretched out my hand. She took it and together we began a kind of “dance,” moving forward, backward, sideways, breathing together in a shared rhythm. Although I seemed to be guiding her, I was actually being guided by both her overt and very subtle movements, as well as the very direct eye contact we maintained. I used my voice to softly remind her that she would be OK. After a few minutes, I felt a slight shift as she loosened her grip on my hand, moving out of the space that had been like “quicksand.” She breathed more deeply and sat in the chair to rest. She was aware that it was “something psychological” that affected her physically in such a way that she became paralyzed. When I’d moved with her, she said, she’d instantly felt safer because she wasn’t alone (Kleinman & Hall, 2006).
Techniques that emanate from concepts underlying dance/movement therapy, emphasizing one’s inner experience, allow therapists to use their own feeling states to understand on a body level what their patients are experiencing. These concepts include rhythmic synchrony, kinesthetic awareness and kinesthetic empathy.
- Rhythmic Synchrony personifies the ability to be in tune with, and cultivate relationship and connection between ourselves and our patients. This could occur by walking with the patient, breathing in the same rhythm, or even speaking at a pace that duplicates their rhythm. When therapists are not in rhythm with their patients, they may try to progress too fast, request too much information, or speak too quickly. This could trigger patients to need to detach if they become overwhelmed.
- Kinesthetic Awareness is the therapist’s ability to sense herself / himself physically on both an internal and an external level. For example, a therapist might ask his or her patient a question and simultaneously, focus on his or her own inner feeling states. When therapists rely on the language of the “cognitive mind” only, and are detached from listening to their body, their interventions may reflect their lack of connection to themselves. Therefore, it is likely that their patients will respond with the same degree of detachment.
- Kinesthetic Empathy represents the ability of therapists to foster shared expression. Their responses could include conscious awareness of their own sense of the patient based on the feelings they experience. This is clearly seen in the example involving Marsha (see above). Pallaro (2007) says that “the recent discovery of mirror neurons may indicate that the ability to respond to another’s feeling states and understand them is, in fact, a result of bodily based kinesthetic empathy” (p. 183).
Techniques emphasizing these concepts challenge therapists to expand their own boundaries, without losing their therapeutic balance, in order to think with their body as well as their mind. When therapists hone these skills, they can pass them onto their patients.
Focusing on accessing the language of the body, and facilitating expression of feelings and thoughts that underlie the presented problems, is critical to challenging patients with eating disorders to explore how they feel living in their bodies, a central ingredient for genuine change, This, in turn, affects how they live their lives, the real sign that recovery has occurred and that the patient is on a pathway into fuller, more meaningful and productive life experiences. (Ressler, A. & Kleinman S., 2006).
In contrast, when we try to be in control, we initiate planned, forced actions and interventions, causing us to feel tense, burdened, and alienated from our ability to trust ourselves. Likewise, those we are attempting to reach may also sense the strain, and respond accordingly. However, when we allow ourselves to be in charge, we yield to our authentic life forces, creating a natural flow from within that is empowering. Therefore, it is critical that we, as therapists, take the lead to help our patients trust themselves to discover their own natural flow.
One patient, Mary, explained how these skills were important to her in terms of being in charge versus being in control.
When we are in control, we don’t allow life to just happen. Being in control means that we spend so much of our energy and so much of our time trying to attain perfection in every sense of the word that we miss out on day-to-day life. We miss out on everyday simple things. We miss out on the happy, magical, mysterious things. The unfortunate thing is attempting to be in control usually leads to more things being out of control. Life then becomes stressful, and all of our attention becomes focused on controlling the stress in our lives. Giving up control, little by little, will lead to much happier, healthier, beautiful lives. I want to eventually be able to feel as if I don’t need to be in control of everything. I want to be in a place where I am okay with allowing life to happen as it should. I want to enjoy the everyday moments.
Being in charge allows our lives to be care-free, yet not care-less. Not chaotic. We are able to trust our instincts and trust our feelings, and this leads to feelings of confidence. When you are confident, you understand how vital being in charge really is, and that in turn leads to even stronger self-confidence. When you are in charge, you trust your authentic, true self. You know that your true self is okay and you know that you can trust that inner part of you in every aspect of your life. How wonderful that must feel. That is something I strive for – to be able to trust myself enough to want to be in charge.
In summary, using our whole self is, in essence, our greatest therapeutic tool. Experiential understanding begets cognitive understanding and connecting with feelings can be translated into insightful cognitions. There is always communication present. When therapists can connect with and utilize their own feelings as part of the therapeutic process, they can help their patients decode their own inner experiences and transform them into opportunities for growth.
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This article is adapted from Becoming Whole Again: Dance/Movement Therapy For Those Who Suffer From Eating Disorders, in The Art and Science of Dance/Movement Therapy: Life is Dance. Routledge: NY (in press).
Susan Kleinman is a dance/movement therapist at The Renfrew Center of Florida, a women’s mental health center that specializes in eating disorders, depression, anxiety and trauma.
This article was originally published on Eating Disorder Hope, and is republished here with permission.