spring 2007 article

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The Principles of Working with Chronic Conditions

Bill Palmer

was one of the founder members of the Shiatsu Society and has also studied Psychotherapy and Developmental Movement Therapy. He developed a style of Shiatsu in which the client is more active, the therapist assisting them to become aware of chronic emotional and physical patterns through detailed sensation of the body and helping them to process and change their issues through busy movement. In 1986 he formed the School for Experiential Education, which runs postgraduate training courses in Movement Shiatsu, as his style became known. His work has become most popular in Spain and Holland, where he teaches regularly. It has also become part of some Gestalt Psychotherapy trainings in the UK.

By Bill Palmer MRSS (T)

This article is a short precis from part of a forthcoming book, entitled The Tiger in the Grove: Developmental Process Therapy, by Bill Palmer. Bill specialises in working with chronic conditions where processing emotional stuckness is as important as dealing with the physical aspect of the issue. This article includes a very short case history to illustrate the principles; you can read a longer case study on the web at www.seed.org/cases/sueb

All our chronic conditions are etched into the way we use our bodies. But the body is very tangible and you can learn to move consciously. However intractable and problematic a life issue is, if you can discover how it is embodied, then you have a handle on how to experiment, to loosen up, to become unstuck and to move within the body you are.

Ideals like ‘health and balance’ take us away from the present experience of who we are; they dilute our present struggle to live fully now by making the present feel deficient and focusing on a dream of future perfection. The future may be too late. I believe it is better to learn to live fully as you are than to waste time trying to reach an ideal state.

Chronic problems are like prison, and the sufferer needs to overcome the phenomenon of institutionalisation. A prisoner during a long sentence may desperately long for freedom but, on his release, finds that freedom is frightening and upsetting. He starts to long for the security and familiarity of his cell, and may re-offend, in an unconscious attempt to regain it.

Sufferers from chronic conditions are faced with a similar dilemma. They want to be free of the problem but their body and personality have adapted so much to the condition that they find change difficult and frightening. It is not enough just to help such a person back into balance, because they will be inevitably drawn back into their familiar, but problematic, state. Instead of trying to move a client’s energy into a particular state, I find it more helpful to have no aim and no diagnosis but to trust the client’s developmental process to do the work. My role is an assistant to the client’s process, and three principles help me to keep this focus:

PRINCIPLE ONE: Start from Direct Experience

Transform story to sensation

When a client enters therapy they usually present a story. This is a description of their problem and can be physical, emotional or historical. Most of our consciousness of ourselves is in the form of stories and, just as stories have a plot, so these stories contain an implicit agenda. Chronic problems are stuck energy and often the energy is stuck because the agenda of the person’s story is different from the way in which their energy wants to move.

I find that, if I help the client continuously to feel sensation and to express energy from that sensation then they get a direct experience of themselves rather than the ‘fixed’ description of their stories. I believe that there is no point in looking for deeper causes from an expert’s point of view because it doesn’t help the client to have more choice. Unless clients can make the connection themselves, it only transforms the client from being a victim of the condition into a being dependent on the therapist.

To liberate the client’s energy their stories need to be brought into the present. The therapist focuses first on awareness of sensation because sensation is one of the best vehicles for coming into the present.

Let the bodywork emerge from the client’s awareness

Clients want to be free of the problem but their body and personality have adapted so much to the condition that they find change difficult and frightening

Awareness of sensation initiates authentic movement. If the client learns to be aware of the direction they want to move, then they also become aware of their blockages and disconnections. The focus of the bodywork emerges from this. There is no need for an expert, mysterious process of diagnosis. In fact, diagnosis is liable to further distance the practitioner from the present by creating a ‘diagnostic story’

"clients want to be free of the problem but their body and personality have adapted so much to the condition that they find change difficult and frightening"

For instance, David, a 42 year old man came to me to deal with depression. He had, as a youth, lots of ambition and plans but none had come to fruition. In middle-age crisis he, felt powerless and frustrated. Bringing this ‘emotional story’ into sensation, he felt very busy in his head, chest and arms and weak and empty in his abdomen. When I suggested he push against me with his legs, he felt energised by the exercise and started to spontaneously kick and shove with his feet but he gave up immediately I put up determined resistance.

David felt this and was deflated because, yet again, he could not persist in the face of difficulty,he felt afraid of conflict. I could have expressed this in Shiatsu terms by talking about the Liver energy, but I don’t see how this could have practically helped him. He might have felt I was clever but, if anything, this would have diminished his confidence. What helped him most was to feel for himself the process of ‘giving up’ and to be able to locate it physically, with the help of bodywork, in his deep core muscles such as the psoas and deep pelvic muscles. I certainly used the Liver and Gall Bladder meridians to help him to feel these but did not use the Shiatsu language because it would have taken him away from his direct experience of himself.

PRINCIPLE TWO: Confirm New Skills through Practice

Devise exercises to incorporate change: The direct physical work described above has generated awareness of energy issues in the client and given them an experience of how to liberate these issues. However, the old habits and stories have not gone away.

Real change requires the client to consciously practice new ways of being. Sometimes this can take the form of physical exercises like yoga; sometimes they are specific experiments to strengthen a behaviour or physical connection.

In David’s case, what actually helped him was learning to feel his core muscles and learning exercises to strengthen them. He felt he was in control of himself rather than dependent on me. Once he had been strengthening his core through exercise for a while, we tried the pushing experiment again and he could feel how to stand up for himself. He felt he was doing something pro-actively to change and this had an effect on his whole personality.

Energy can change fast, the body takes longer: This period of practice is as essential to therapy as it is in sport, and for the same reasons, The sense of self is founded not only in memory but also in our posture, out habitual ways of moving and out total body shape. A really new sense of self needs unfamiliar muscles to be activated and strengthened and for neural pathways to change. This take time.

PRINCIPLE THREE: Integrate with Normal Life

Stabilising the state

Although the client may be learning to incorporate new and more choice-full ways of being during the therapy session, they often find it difficult to maintain or use this awareness in the rest of their life.

Each person with which they are in relationship has their own reasons for being in the relationship. A change in the client may mean that the pay-back that their friends have enjoyed is no longer available and their friends unconsciously try to sabotage the change. Peer pressure is very strong and it is difficult to maintain one’s new found clarity while your friends are clamouring for you to return to your familiar old neurotic self!

Our sense of self is largely produced by the way we fit into our web of relationships. In fact, this web could be called the ‘extended self’. A change of self is not fully complete until it continues into a change of role in these relationships and thus changes the extended self. Only then can someone continue in the new state without relapse or interruption. I consciously help clients to transfer the changes they feel in the shiatsu sessions into changes they can make to unsatisfactory relationships in their lives.

For David, the physical ability to stabilise and be firm in his core had profound effects in his normal life. Firstly, he found it easy to give up smoking, which increased his self-confidence. He started running several times a week and, as he got fitter, found his creative energy returning and people started treating him differently, having fun with rather than being dragged down by him. I hope and expect that he feels more fulfilled in his life now.

Postscript:

I have been working this way for years but it was only when I formulated the three principles above into words that I realised where I had instinctively learnt this style. They are, in essence, the ‘Three Principles of Garab Dorje’, the basis of a spiritual tradition called Dzog-Chen, which I have attempted to practice under the wry guidance of Namkhai Norbu Rinpoche for a large part of my life. This makes me very happy, it integrates my life, no longer do I have one philosophy for personal practice and another for professional therapy, I realise, with gratitude, that Dzog-Chen has seeped, unnoticed, into the way I do everything.

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