In the end, we will remember not the words of our enemies, but the silence of our friends.
Martin Luther King, Jr.
Words have power. Words incite nations, entice people to action, calm people when heated, and so much more. When we as healers approach our clients, mindful communication will not only support healing, the therapeutic relationship can help redefine a client’s relationship with his or her self, inside and out (Corwin 2015 Jul). When I went through my training as a Rolfer over ten years ago, I found my teachers borrowing many words and ideas from psychology. This adoption of language from a field that focuses on the mind, when we work explicitly with the body, acknowledges we are always working with the ‘bodymind’, also known as somatic work. This infusion of psychology is useful to create healthy elements within relationships as well as to understand how relationships form and evolve. One such element is boundaries. Webb (1993, 1997) defines “boundaries in relationships as establishing cultural, physical, emotional, intellectual and spiritual limits.” Many of us as Rolfing® Structural Integration (SI) practitioners may have found ourselves in relationships with clients through which we intuitively felt that a client was in need of psychological help alongside our work. We do not replace psychologists or talk therapy. Some of our clients will need more than just our help to make the life changes they desire beyond SI. Notwithstanding, our work can always benefit from clear communication, mindful intention, and understanding of how some therapeutic relationships operate. This article will explore some useful tools defined and used in psychological application that can support a healthy relationship with our clients including intake process, transference and countertransference, forming clear boundaries, dual relationships, and how touch is complicated.
First Contact
The foundation of each relationship with our clients begins at our first contact. Each of us has a way in which we like to vet our clients prior to the first session. This investigation is crucial to discover if any red flags exist when moving forward to hands-on work. Technology has offered us some options in how we communicate and book our clients, which may also pose distinct challenges in vetting clients. For example, many of us allow or encourage clients to reserve sessions online versus establishing a relationship through a phone call. Through your scheduling form or during that first communication, you might include questions about why the client is seeking the work, the anticipated goals and outcomes, and any limiting factors such as health challenges (e.g., diabetic, autoimmune, psychological diagnosis) to understand how to best support the client. This investigative background gathering not only informs how we work together and suggests the client’s tolerance level for the intensity of work, but also builds the foundation for emotional attunement.
Emotional attunement occurs when one person is able to accurately sense and respond to another’s experience. The results of emotional attunement are often feeling heard and seen, which is the cornerstone of a healing and healthy relationship. The trust that is inspired from listening allows the work we do in our sessions to flourish and potentially increase the rate at which clients are able to integrate the physical work. Ways to engage, informed by emotional attunement, include open- ended questions that allow the client to express what he/she/z feels is pertinent to the work done together. I often ask, “What brings you to Rolfing work?” and “What hopes do you have for our work together?” and, my favorite, “If I could wave a magic wand, what would happen through our work today?” Throughout the client’s response, I practice active listening. Smith and Fitt (1982, 247) define active listening as, “the listener (receiver) of the message attempts to confirm what the message is, by putting his understanding of the message into a tentative statement in his own words, and feeding it back for the sender’s verification.” Dr. Carl Rogers is the psychologist who codified active listing when he discovered the profound impacts of this therapeutic technique. By combining emotional attunement and active listening, I have found that I gain a better understanding of the layers of the hopes and challenges that are in the work we embark on daily with our clients. At the same time, I enjoy a deep connection with my clients. A note of caution: for clients who are less secure or nervous, slowing your tempo and being mindful to serve the needs of the client through checking in with the person, rather than intimidate through active listening, is important. What I mean by this is, since active listening involves a form of repetition, there exists a risk of patronizing or overwhelming the client. Overall, I have consistently found the benefits of active listening and emotional attunement outweigh what might be an extra five minutes of my time; most notably because clients who feel heard will return again and again.
Transference and Countertransference
Over time, we build relationships with our clients based in trust and communication. Because of the depth of our relationships with clients, feelings can come out on both sides of the relationship that surprise us. Sometimes, our clients will have reactions to our work that we do not see coming, which can fall into the category of transference. Freud (1924) coined this term and defined it as the patient displacing feelings from the patient/self to the therapist. (For our discussion, I will now use the term ‘practitioner’ rather than ‘therapist’ since we are speaking of this in the context of the Rolfing therapeutic relationship.) This concept has evolved to clients’ feelings about a significant person in their lives being projected onto the therapist/practitioner, as if the therapist is that significant person. This process is not a conscious one. As such, identifying the problem as transference can be tricky.
Some elements would need to be in place for both the client and practitioner to be able to detect if transference is occurring. For example, in order to identify the origin of the feelings, awareness is required. Most people just feel the feeling and do not stop to think, “This reaction may be out of proportion with the current relationship and situation.” Transference is not occurring if the feelings are of an appropriate intensity based on events and interactions that have taken place within the client/Rolfer relationship. In contrast, transference commonly feels disproportionately fierce in regards to the power of the feelings being displayed by the client. If a client is honest, and shame or embarrassment does not override the ability to examine what feelings are presenting and why, on rare occasions a client is able to realize that unresolved feelings about a mother, sister, brother, ex, etc., have somehow come into this relationship now. I would not encourage any person who is not trained in psychotherapy to name an event as transference to a client, even if you think that is what is happening. As Rolfers, we can attempt to name what is happening in any given moment from our perspective. This might sound like, “I’m feeling some big feelings in this room and want to acknowledge that.” If you feel like the client is trying to make you feel a certain way, you might name that as well if you feel doing so would be valuable because you don’t understand how your behavior merited this reaction. Although attempting to address this issue might be tempting, this is an ideal opportunity to remind yourself and your client that people are available to help address interpersonal styles of communication, such as talk therapy or a somatic psychologist. Lifelong relationships and ways of communicating require time and support to make any conscious changes in ways of being.
Articulating what is happening in the room sounds like an easy directive; it is not. This recognition that the client/ Rolfer relationship is off balance can trigger the client into all sorts of behavior reminiscent of the significant relationship on which the transference is based. At the risk of repeating myself, I offer a word of caution: most of the time, I would not suggest introducing to your client the idea that transference might be happening. Instead, you can simply name that some of the relationship needs to be adjusted to accommodate your boundaries, which takes responsibility for your needs in the relationship. Psychological diagnosis is not in our purview or anyone’s best interest. Nevertheless, knowing that transference exists and why is a useful tool when working with people to support healthy and lasting relationships.
Avoiding taking transference personally is hugely difficult. We can’t read people’s minds to determine the source of the outburst or behavior directed at us. Ultimately, when played out, transference can erupt into a personal attack that simply feels terrible. The ferocity of the attack is not congruent with the depth of actual personal connection because the attack is born from a history with another human being, not you. Of course, an attack is not always inevitable, but some sort of reckoning is usual during transference, which is based on unresolved feelings that have nothing to do with you and everything to do with the significant person in the client’s life. So how do you know if the problem in the relationship is transference or another cause? If you are able to discern that the reaction from the client seems to be disproportionate to the interaction (informed by history of your relationship together), transference is a likely cause. What can also make this process complicated is that we, the client and the practitioner, are unwittingly involved in roles in which we did not know we were cast. Sometimes people remind others of the significant people in their lives. Remember this if a client says, “You remind me of my mom” or whomever. This information could be informative if interpersonal relationship challenges occur later.
I am also reminded that emotions lay in wait in the body for a safe time to be expressed (Corwin 2015 Mar). Bodies can be a minefield of triggers, and as we are working directly with the body, various unexpected responses can be elicited.
Let us now look at an example to depict transference. A past client of mine, we will call her ‘Jane’, came to me with a long list of psychological diagnoses and trauma. I am not a licensed marriage and family therapist, even though I have a PhD in clinical psychology. However, the implied understanding of my knowledge often calms skittish clients and draws to me challenging clients. Jane wanted to work on trust through touch and to help align her body to feel better about herself. With her permission, I conferred with her psychotherapist to be involved in a support team for Jane. After a short amount of time, I became aware that Jane was treating me with kindness and generosity beyond what seemed to be appropriate for our relationship duration and scope. She was giving me expensive items at her insistence, offering to help with childcare, and many more generous, but disproportionate and inappropriate, suggestions. Because I am a human being, I was at first deeply touched by the generosity of these acts and offerings, but I began to recognize that these gifts could not be accepted when the little voice in me recognized that this was not a mutual relationship. What made this relationship more complicated was that countertransference was also taking place. Countertransference is when the therapist’s feelings regarding a significant person are superimposed onto a client. In the case of Jane, I was entangling emotions about my mother (who I had always wanted to be this generous and kind) with Jane. So, here we had Jane’s feelings of transference layered on top of my feelings of my mother (countertransference), making a complicated and potentially volatile situation.
What makes transference and countertransference so problematic is the relationships we superimpose on people are commonly unhealthy and dysfunctional. So, when we endow people with these traits that may or may not actually exist in those people, the result is a recipe for disaster. I wish I could tell you that I knew from the beginning with Jane that I was engaging in transference and countertransference, but I cannot. Jane’s therapist began asking me questions, because he was aware of potential transference on Jane’s part. As soon as he began investigating my relationship with Jane, and I began naming events of gifts and offered time, I was utterly surprised at the revelation that I was engaging in countertransference. The psychotherapist reminded me that we all have ways of being that serve how we operate in the world. To recognize what is not helping us in any relationship gives us the opportunity to make choices. Knowing what I was doing helped me decide how to move forward in a healthy way, which is the best we can hope for in any circumstance. Here was my opportunity to advocate for the boundaries needed to maintain a healthy Rolfer/client relationship.
The next time I saw Jane, I was able to name some things happening for me with countertransference. I told her that she was treating me like the mom I wished I had, but that I could not continue with that behavior. I defined our roles together, underlining how much I enjoy her and our work together. Asking Jane about any transference would not have helped Jane, so I left that piece for her psychotherapist to address. For the work between Jane and I to be effective, we needed to stay in the roles of Rolfer and client. When transference or countertransference occurs with our clients, what serves us as Rolfers is taking responsibility for what we are putting into the relationship that does not belong in the relationship. In my case, naming my mom issue with the client was helpful so she could clearly identify why my behavior changed and what I needed to acknowledge to move forward in our relationship. However, Jane was thrilled that I had cast her as my ‘good mother’ – so much so, that she wanted me to continue with that. When I explained that doing so would be hurtful to us both, she was disappointed. Ironically, I recognized that in her transference she had cast me as someone whom she wished would appreciate her generous nature, which complemented my countertransference: a perfect storm. These complicated relational dynamics are why having clear boundaries and roles is supportive of healthy relationships.
Dual Relationships
Sometimes we push boundaries by having more than one relationship with our clients, also known as dual relationships or multiple relationships. Expanding a therapeutic relationship to a dual relationship requires thought and intent, as well as respect for any professional and legal codes involved and consideration of standard practice in one’s profession. Particularly, one should never consider any romantic relationship because that type of relationship would breach ethical restrictions. With this in mind, let’s look at dual relationships and when those might occur.
Through my Rolfing practice, I have had the great fortune of meeting inspiring, compassionate, and impressive people. Some rare clients inspire dual relationships where a therapeutic relationship might expand to include a friendship, a teaching relationship, etc., but doing so can open the door to blurred lines with false expectations of the dual relationship by either party, particularly in regard to boundaries. Forging a friendship beyond our professional alliance can be natural, but it requires deliberation and alignment with the guidance in the Rolf Institute® Code of Ethics. Specifically in the Code of Ethics (Rolf Institute 2006), we will not “induce [any client] to enter into other therapeutic, commercial, sexual or social relationships with us; nor do we engage in relationships with our clients that are likely to interfere with or be detrimental to the Rolfing Structural Integration process.” If a client and I decide to explore a friendship, I always weigh the possibility of losing the client and the friend. Please note the likelihood of a relationship withstanding a dual relationship is far lower than a pure singular relationship, because the layering of relationships exponentially opens up miscommunication possibilities and incongruent expectations in both people. This weighing of pros and cons when adding a personal relationship to an existing professional relationship is necessary.
For transparency, if I feel the professional relationship might withstand the expanse to include a personal relationship, discussing my reservations will always make me feel better and address some potential boundary challenges within the dual relationship. For example, my cancellation policy requires twenty-four hours’ notice or the client pays the session fee in full. If ‘Toni’ and I are friends and have dinner now and then, does being friends presume a leniency on my policy if Toni forgets our appointment? I may not think that our friendship includes this shift of understanding professionally, but Toni might because that’s how she treats friends. Again, expectations of a relationship drive communication and miscommunication. The key to a thriving and successful dual relationship is stating clear boundaries as needed, ideally prior to the challenge occurring so you both can have clear expectations about events. This communication will also help foster an understanding of how you both wish to be treated in the relationship moving forward while offering the opportunity to discuss the contract of friendship in light of the therapeutic relationship already established.
To be clear, the relationship that is already present is one-sided where you as the caretaker listen and give your expertise based on the client’s needs. This uneven relationship does not offer the bedrock of a fair or balanced friendship. Consequently, growing this one-sided relationship into a friendship may not, in the end, appeal to the client because the inequity may have been what was appealing to the client to pursue a friendship. This assessment may sound cold and selfish, but it is accurate. This last point can also be challenging because when it is discovered that a one-sided position cannot occur in the friendship, the dual relationship is likely to deteriorate. If the friendship fails, shifting back to Rolfer/ client is almost impossible.
Other complications can easily arise. The Rolfer is commonly viewed as the healthcare expert. If you both go drinking and one becomes inebriated, what happens then? This is one of many possible scenarios. Where do the boundary lines form? Where does the intersection of being human and being the expert occur?
Some questions to ask yourself prior to entering a dual relationship include the following. (These questions are not comprehensive but might shed light on what is motivating you to layer your relationship with this client.)
Key Dynamics in the Therapeutic Relationship
Level of Dress
We have not yet mentioned a power dynamic in the Rolfer-client relationship that does not exist in many relationships: that is that one person has clothes on, the other has clothes mostly off (as most Rolfing clients will be in underwear or else attire like a sports bra and sports shorts rather than full street clothes). When I was training to become a Rolfer, a suggested guideline was to encourage and follow the client’s comfort level to thereby determine what the client wears in the sessions. This will be more or less significant for the relationship depending on considerations of gender, the client’s level of modesty, the client’s cultural background, and other factors.
Touch
Yet the weightiest relational element is that the client receives touch. This is the most profound element of the Rolfer – client relationship. Touch is complex and spans many types of relationships, but in our work the Rolfer gives and the client receives touch. Touch is controversial in the healthcare industry; most healthcare professions in our culture avoid the use of touch as much as possible, and medical practitioners are taught to avoid physical touch, even when counseling critically ill and terminal patients diagnosed with cancer (Armstrong 2015). In clinical psychology, touch is taboo; psychologists often suggest to patients to look for hands-on work outside of sessions (Harrison 2012). Touch can mean so many things to so many people that some psychotherapists do not wish to breach the gaping hole of mixed messages, triggers, and unintended consequences.
Thus, touch makes the relationship of bodyworker and client unusual from other healthcare relationships, and it is what we are paid for. Physical contact is usually the point of our work together – physical change through direct physical contact. As Rolfers, we hold the power of helping people engage in healthful, healing, and kind touch, which is particularly important when we consider that a significant percentage of people have been victims of physical aggression, violation, and misuse of touch. Yet there are challenges. Although Rolfing work is a direct form of manipulating tissue that is not often associated with sensual pleasure, it might unintentionally elicit a sexualized response from someone who does not differentiate sensual and sexual feelings. For some clients, touch in general evokes a sexualized engagement. I found this prevalent throughout my eighteen years as a massage therapist, but thankfully not during my time as a Rolfer. While massage therapists commonly work with a client unclothed under a sheet, Rolfers work with clients in underclothes or clothing, depending on the clients’ preferences – this is a small but profound difference that perhaps simulates the relationship of a physician and patient.
Trauma and Body Armor
Sadly, thepowerdynamicinthe Rolfer-client therapeutic relationship can sometimes bring forth childhood trauma in the form of molestation, incest, or more. When someone comes for bodywork, the possibility that there is a trauma history that will be touched is in a sense an undeniable factor. William Reich, a protégé of Freud, was the first psychologist who deduced that the body builds ‘armor’ because of experiences united with psychological events. “Reich determined that the etiology of early childhood trauma had to be elucidated first through recognition, understanding and loosening of barriers that he named character armor – a protective psychological attitude and muscular tension reflecting the body component” (May 2018, 40). All trauma fosters armor in the body, and by touching the body, and particularly the fascial system that shapes the body, we are touching body armor.
Peter Levine’s book In An Unspoken Voice (2005) explores how the body wishes to let go of stored trauma through acknowledgement of impulses stifled at the time of the traumatic event to heal the holes in our souls. The age and severity of the trauma will have an impact on the pace and locations of the work you do together. When you feel a client ‘leave’ the room or ‘vacate’ his/her body, dissociation is occurring. Dissociation is when a person cannot tolerate the moment and disengages with it by separating from a sense of self, identity, and memory in the current moment. Dissociation is often seen as a coping skill for many children, and adults, who have survived traumatic events. However, when dissociation occurs in our sessions, pausing hands-on work to verbally check in with the client is necessary.
I recognize when dissociation happens in session with my clients because I feel alone in the room; I also get uncomfortable in my skin because the energy shifts. Whenever I have any feeling that raises a warning for me, I pause the session. I ask about the client’s experience, to describe what she/ he/z is noticing. I ask if the client is having any sensations that would alert me to the nervous system being triggered (sweating, cold, trembling, shaky, etc.). If the client and I have already discussed past trauma, I might ask if she/he/z feels present or in another place (dissociated). Offering the client water or sitting up and placing feet on the floor can help a person come back to the present moment; this is also known as grounding. We can elaborate that grounding is when the practitioner supports a client to tolerate living in the present moment fully and wholly while feeling connected to the earth (or whichever element seems most centering to the client). As a Rolfer, a leading principle is to help foster health, tolerance, and alignment in the client’s body. Since the mind echoes the body, we are helping our clients evolve into better versions of themselves, which in turn facilitates health and well-being in their families and communities.
Conclusion
When beginning my path as a Rolfer, I did not intend to change people’s lives through this work. The fact that we can and do every day is miraculous. By borrowing ideas and language from the field of psychology, we can better understand mechanisms of how people operate, define how we would like to interact with clients, and discover ways to support our clients without taking on any endeavors that remain out of our scope of practice. Knowing that the body reflects the mind (Hanna 1970), we can rest assured that we do not need words to help people make profound change in their lives. Knowing about, and engaging in, emotional attunement and active listening can help you engage in a healthy relationship and identify and maintain clear boundaries for you and your clients. Understanding that transference and countertransference can and do exist will allow you to better understand how a situation ignited so quickly into an event that you did not see coming. Trauma exists in all of us; being mindful of moving forward will help us identify if dissociation occurs so we can ground our clients in the present moment. Naming the parts of your experience can and does help you and your client orient to the situation, to best determine how to move forward.
We are ambassadors of health, working in the vast vulnerabilities of the human body, complicated by the complexities of the human mind. In closing, I leave you with the wisdom of Ida Rolf: “. . . no situation exists in a human which a psychologist would diagnose as a feeling of insecurity or inadequacy unless it is accompanied by a physical situation which bears witness to the fact that the gravitational support is inadequate.” Let us be the support we wish to witness in the world.
Heather L. Corwin holds a PhD in clinical psychology with a somatic concentration from The Chicago School of Professional Psychology and an MFA in acting from Florida State University/Asolo Conservatory. Currently, she is the Head of Movement for actor training at Northern Illinois University working with graduates and undergraduates. As an actor for over twenty years and a theatre arts professor, she examines behavior through the lens of psychology, allowing the flaws of being human to unite us through creative expression. Corwin is a Rolfer, a belly laugher, married to the love of her life, a mother to an energetic seven-year-old, and a fan of historical romance. To read more publications and learn more, please visit BodybyHeather.com and HeatherC.com
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