Body Psychotherapy

Joachim Otto

The focus in all psychotherapies is the same, no matter which orientation 
the particular therapist follows. The common aim is directed towards the process 
of well being for the client. Tranferencial issues and true feelings arising in this 
special relationship between the client and the therapist are also the same. There is, however, one significant difference between non-body-oriented and body-oriented psychotherapy. Body-psychotherapy provides an additional pathway for
 communication – the physical pathway.

The physical pathway as an additional tool

The mechanism forming the working platform in non-body-psychotherapy is the
 ‘psychodynamic process’. I am assuming that the reader is familiar with this model.
 The primary pathway of communication in non-body-psychotherapy is the verbal 
pathway. In body-psychotherapy we recognise an additional mechanism, the
’physiodynamic process’. This opens an additional pathway, the physical pathway
of communication.

The psychodynamic and physiodynamic process always work in parallel

The psychodynamic process and the physiodynamic process always operate in 
parallel to each other. We can work with these two mechanisms by addressing 
either one of them at a particular moment. We can also swap between them, and it 
is possible to move between those two mechanisms in the same session. Working
 physiodynamically will stimulate the psychodynamic process and vice versa.

Description of biodynamic therapy model

For the reader to be able to follow this introduction to body-psychotherapy, it is 
necessary to have a basic understanding of the physiodynamic process, and I
 give a very brief description of it here. I am using the ‘biodynamic therapy’ model

The biodynamic model recognises two energy planes within our organism. The 
first plane moves vertically and connects us through the two ends of our body, head
 to the cosmos, and feet to the ground. The vertical energy flow is transpersonal and 
relates to our spiritual connection, collective connections, etc. There is no time and 
space boundary on the vertical plane. The vertical zone reaches into regions before 
conception and after death.

The second energy plane moves horizontally. The horizontal energy flow is
 personal and relates to our ego consciousness, emotional expression, here and now, time and space, etc.

The vertical and horizontal energy planes are connected with each other and energy flows between them in both directions. A 
psychoperistalsis, regulates the connection between those two energy planes.

Non-body psychotherapy focuses primarily on the horizontal energy flow. For 
now, I will focus on the horizontal energy plane, to show how we can work on this plane in body-psychotherapy, and what the dynamics are in the client/therapist

Every emotional expression is carried out through physiological activity

Every emotional expression is carried out through physiological activity. In other
 words, we use our body to express emotional energy. We cannot express emotions
 without our body. We use our voice for verbal expression, our arms and legs for 
physical expression, we can use our eyes for expression of feelings we have
 towards another person, etc.

I describe these physiological activities as the physiodynamic process, which 
operates in direct parallel to the psychodynamic process.

How does the vertical physiodynamic process work?

The healthy pattern

Emotions are triggered by external stimulus through interaction with our
 environment. The stimulus can be psychodynamic, e.g. we receive some positive
 or negative attention or feedback from someone else or, physiodynamic, e.g. we 
experience pain or pleasant sensations through skin contact, taste buds, smell, etc. 
When the impulse, set off by the external stimulus, reaches the ‘limbic area’ of the 
brain, the message is passed on through the ‘hypothalamus’ to the ‘endocrine 
system’ and the emotional upsurge is triggered from the pelvis. The energy travels 
up the spine, through the hypothalamus to the brain, which in turn gives the 
instruction to the ‘motor system’ to carry out the expression, using the physical
 body to do so.

It is important to remember that during this process certain areas of the organism
 decrease their activity by a large amount. These main areas are the digestive 
system, the breathing, and the immune system. They regain their full function after
 the emotional energy is expressed and the organism has returned to a balanced 

The unhealthy pattern

In the unhealthy pattern, the response to the external stimulus is distorted or 
missing, because the energy is blocked somewhere on the pathway described in the
 healthy pattern. In worse circumstances, the pelvis is frozen and the person would 
not have a reaction to the stimulus at all, e.g. the person does not feel appropriate emotions to an external stimulus. Because the emotional energy is not fully
 released, it ‘gets stuck’ within the poison’s body. Full homeostasis does not return 
and the areas of breathing digestion, and immunity are sometimes permanently 
working on ‘low key”. This will eventually lead to illness. Depending on how this 
condition manifests in a person, it can lead to either psychological or physical

How do we work with these conditions?

All approaches of psychotherapy use verbal communication for exploration of the 
psychodynamic process, feelings and transference. In addition to the verbal 
communication, body psychotherapy uses physical communication in the
 therapeutic relationship between the client and the therapist.

Working with the motor system

Here, the work is done directly with the body through mechanical stimulation.
 Massage, bioenergetic exercises, or vegetotherapy (mattress work) are primarily 
used for this type of bodywork. The aim is to increase the flow of emotional energy 
towards expression, and to either prepare for or support the psychodynamic 

Working with the visceral system (essential level)

Therapy on the visceral level requires a substantial amount of experience and self-
development by the therapist. The area of focus is the time from zero to about one
 year of age. This time span includes conception, gestation, and birth. There is no 
language at this time in our life and the therapy is mainly non-verbal and almost 
entirely physical, which includes physical sense. Communication happens on the 
gut to gut level, which means, in ideal circumstances, therapist and client have their 
ego-consciousness surrendered during the session. The skill of the therapist is to be
 able to surrender ego-consciousness and at the same time to be able to keep the 
therapeutic boundaries.

Biodynamic theory stipulates that most psychological distortions in our adult life
 are based on overwhelmingly traumatic experiences during this visceral period. It 
is like building a house onto a bad foundation. The aim of the visceral work is to
 repair the foundation without having to knock down the house itself. Once the 
foundation is repaired, part of the badly built house will crumble and the person is 
able to re-build a new construction on the stronger foundation. This new house is 
more suitable for the person and their emotional and creative expression because 
it was re-constructed under more favourable conditions.

In the following part I will try to describe the dynamic in treatment on the visceral 

Working with visceral condition

Initial phase – Anamnesis, feedback, treatment plan

Physical examination of the body

If a visceral condition is suspected, a physical examination of the client is the first
 step in the therapeutic process. Physical examination of the body can increase a 
useful distance between the client and therapist and also allow the client to detach 
from their own body sufficiently to be able to look at it from a relatively neutral
 place. If the client is too close to their physio-psychological state, a connection to 
the emotional material belonging to the physical condition would be too 
overwhelming and threatening for the client at this point. The client would need to 
switch off completely and very little could be achieved within a working 

After the initial physical assessment of about five to ten minutes, an experienced
 biodynamic therapist will have gained an accurate picture of how the client might 
regulate themselves emotionally and where their areas of ‘holding’ or ‘leaking’ are.
 This information is an enormous asset for the therapeutic process. Because the
 therapist gains this knowledge about the client so fast, if handled wrongly, it can
 also very quickly destroy the possibility for a future working relationship. It is
 therefore very important that this information is fed back to the client in the most 
honest way possible. However, the therapist needs to regulate the amount of
 information revealed to the client at any one time. Not all of the information can 
be revealed immediately, because the client may not be ready for it. This stage is 
extremely important because it will have an influence on the whole outcome of the 
therapy. It will determine the success or failure of the therapy.

The next step is to relate the identified physical condition to how the client 
expresses themselves emotionally. During this process the client needs to gain a 
’sense of connection’ to their physical condition, or else they will not be able to 
’take it on’ (accept; the German word is ‘annehmen’. There is no equivalent in 
English). This sense of connection will ensure that the client can relate to these 
conditions as being part of themselves, rather than view them as detached clinical
 physio-psychological facts. The client will also be able to see a possible purpose
 of their mechanism, which can give an apparently negative state a positive aspect, 
with the result that the client is less likely to reject their condition. A possible peril
 here is that the client might unnecessarily emphasise the roles of helper-victim ‘You 
are ok (therapist) -I am not ok (client)’. These are projections made by the client,
 and the therapist must not unnecessarily support them by presenting the client with 
a perfect model of free emotional expression and compare that to the client’s own 
inferior mechanism.

The therapist must avoid making interpretations as to emotional connections to the
 physical conditions. It is more productive to encourage the client to reflect back to 
their own personal history, making possible connections for themselves. A phrase
 the therapist might hold during the process of investigation could be I wonder what this (physical) condition is related to’. Holding this phrase or a similar phrase 
silently in their mind will be received by the client as a permission to explore this
 area. This process is entirely unconscious and will be made possible after a good
 rapport between client and therapist has been established. In most cases this rapport 
will exist in the middle phase of the therapy.

The therapist must never lose sight of the fact that they are dealing with an 
individual and not with psychological or physiological symptoms in isolation.
 These symptoms belong to a human being and they have played an important part
 in this person’s life history.

The client’s body functions in a particular way to aid their emotional and creative 
expression. A ‘correction’ with the intention to create a ‘healthier’ condition,
 facilitating a better expression, could prevent the person from expressing
 themselves in their unique way. A thorough exploration of the present state is
 therefore necessary to determine what changes, if any, need to be made by the
 client. These changes need to be what the client wants rather than what fits a
 picture of a perfect model. The client’s awareness of their condition needs to be 
heightened, so they can make an informed choice of whether they want a change
 or not. Any change undertaken after a thorough exploration of the present state will 
lead the client to independence and well being, and fuller expression of their 

Forming the therapeutic alliance

In non-body-psychotherapy we use positive transference as the primary tool to 
form the initial therapeutic relationship between client and therapist. Working on
 the visceral level, the primary tool to form the initial therapeutic relationship is
 working through infantile material from conception to about one year of age. There
 are no words and only a minimal control of the body’s motor functions (the ego is 
not developed). The therapeutic relationship at this point is based on the client
 being the baby and the therapist being the maternal carer. The client is in an 
infantile-maternal mode, dependent, and needing to be cared for. Because the
 physio-emotional connection between the client’s emotional expression
 mechanism and their physical equivalent has been established during the initial 
step, the client is able to identify their needs and their feelings at this point as ‘old’,
 and not belonging to the present. They will not project them onto the therapist.

To facilitate an exploration of the client’s visceral world, the therapist must be able
 to empathise with the client’s psycho-physiological state. A sensitive and
 experienced therapist will be able to use their own physical body to do this. This
 means that they will be able to sense what the client might feel or not feel. The 
main peril here is counter-transference. The therapist must have sufficiently 
worked through their own material and be sufficiently trained to identify what is 
their own material and what is that of the client.

Middle phase – deepening the therapeutic relationship

In the middle phase, traditionally we will focus on techniques which will
 deliberately deepen the therapeutic relationship and transference, with the aim of
 reiterating the clients conflicts. The client at this point may be looking for the 
expression of feelings of positive or negative transference, which they develop
 towards the therapist. This will provide the opportunity to address the conflicts and
 possibly lead to their origin and resolution.
 The client, who has gone through an organic physical experience (visceral level)
 during the initial phase in the therapy, will be able to identify those feelings as 
infantile feelings (with visceral condition). The recognition and acceptance of
 those feelings by both the client and the therapist, enables the client to contain and
 embrace them, rather than projecting them onto the therapist or elsewhere outside
 the therapeutic relationship. This will facilitate a progressive development towards
 mature and realistic feelings in the relationship with the therapist.

End phase – fostering independence

In this end phase of psychotherapy, the therapist-client bond, which has developed
 throughout the therapeutic process, is dissolved. The therapist’s effort is directed
 towards the client’s independence. In traditional psychotherapy, this could
 reactivate early feelings of attachment, leading to regression to the infantile
 maternal bond, from which the client will be unable to break away, which can lead
 to prolonged dependency.

In this model, the infantile maternal area had been addressed and worked through 
at the initial stage of the therapy, and fostering independence has been a 
progressive focus throughout the therapy. The client has now reached the stage of 
adolescence in the therapeutic process. The process of separation is similar to a 
child growing up into adulthood and leaving home. Sometimes the client needs to 
project negative material onto the therapist to facilitate the breaking away. The 
therapist needs to identify those feelings for what they are, and feed them back to
 the client to facilitate a positive outcome. ‘Independent well-being’ is the 
expression used in biodynamic therapy when the client has reached a stage of
 maturity and autonomy.


Body-psychotherapy is an exciting and organic way of facilitating psycho-
emotional change through working directly with the body. Transference plays an
 equal part in this process, but not a dominant role.

I hope that with this paper. I have been able to show the reader how body-
psychotherapy can work in practice and how it might be used. I must stress that not all aspects described here apply to all types of body-psychotherapies. I have used 
the biodynamic model, because that is what I use and what works for me. Working
 on the visceral level is perhaps a technique, which is not often used in other body-
psychotherapies. while the physio-emotional process described in this article
applies to all body-psychotherapies.

The initial presenting difficulty by the client also plays a part in deciding what 
technique might be used. People with ‘psycho-somatic’ conditions (illness without 
an organic or known cause) seem to respond particularly well to body-
psychotherapy and the visceral level work.

For people with a history of physical abuse for instance, different techniques are 
used to accommodate their needs. Here, the client is encouraged to explore their 
body on their own in the presence of the therapist first. The techniques used include
 guided imagery, and gentle bioenergetic exercises, so the client can gently regain a
 physical sense of themselves before touch is introduced.

It is always difficult to describe the theory of something which is so physical as
 body-psychotherapy. This is why, in the training, such emphasis is placed on 
experiential learning. The trainee therapists need to go through the various cycles 
of body-psychotherapy themselves before they are able to facilitate these processes 
for someone else.

Joachim Otto is a founder member of the ‘Irish Institute of Biodynamic
 Therapy’ (ibt) which offers full training in Biodynamic and Transpersonal
 Psychotherapy and Massage and short courses for professionals.

For information: Telephone 091-755693, E-mail,