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MSNBC / MSN Health
 
Returning soldiers struggle to find therapists
Waiting lists grow as military trims payments for mental-health care
June 10, 2007
WASHINGTON - Soldiers returning from war are finding it more difficult to get mental health
treatment because military insurance is cutting payments to therapists, on top of already low reimbursement rates and a tangle
of red tape.
Wait lists now extend for months to see a military
doctor and it can takes weeks to find a private therapist willing to take on members of the military. The challenge appears
great in rural areas, where many National Guard and Reserve troops and their families live.
To avoid the hassles of Tricare, the military health insurance program, one frustrated therapist opted to provide an hour of therapy time a week to Iraq and Afghanistan
veterans for free. Barbara Romberg, a clinical psychologist in the Washington, D.C., area, has started a group that encourages other therapists to do the same.
“They’re not going to pay me much in terms of
my regular rate anyway,” Romberg said. “So I’m actually feeling positive that I’ve given, rather than
feeling frustrated for what I’m going through to get payment.”
Joyce Lindsey, 46, of Troutdale, Ore., sought grief counseling
after her husband died in Afghanistan last December. The therapist recommended by her physician would not take Tricare. Lindsey
eventually found one on a provider list, but the process took two months.
“It was kind of frustrating,” Lindsey said.
“I thought, ‘Am I ever going to find someone to take this?”’
Roughly one-third of returning soldiers seek out mental
health counseling in their first year home. They are among the 9.1 million people covered by Tricare, a number that grew by
more than 1 million since 2001.
Fragmented, inadequate benefits
Tricare’s
psychological health benefit is “hindered by fragmented rules and policies, inadequate oversight and insufficient reimbursement,”
the Defense Department’s mental health task force said last month after reviewing the military’s psychological care system.
The Tricare office that serves Fort Campbell, Ky., and Fort
Bragg, N.C. — Army posts with heavy war deployments — told task force members that it routinely fields complaints
about the difficulty in locating mental health specialists who accept Tricare.
“Unfortunately, in some of our communities ... we
are maxed out on the available providers,” said Lois Krysa, the office’s quality manager. “In other areas,
the providers just are not willing to sign up to take Tricare assignment, and that is a problem.”
Tricare’s reimbursement
rate is tied to Medicare’s, which pays less than civilian employer insurance. The rate for mental health care services
fell by 6.4 percent this year as part of an adjustment in reimbursements to certain specialties.
Since 2004, Tricare
has sped up payments to encourage more doctors to participate, said Austin Camacho, a Tricare spokesman. In some locations,
such as Idaho and Alaska, the Defense Department has also raised rates to attract physicians, he said.
“We are working
hard to overcome those challenges,” Camacho said.
Jack Wagoner is a
retired military officer and psychologist and psychiatrist in private practice who also works for a Tricare contractor. He
told defense mental health board members last December that in general, Tricare pays “considerably lower” than
private health insurance plans.
According to data
from Tricare’s Medical Benefits and Reimbursement System office, Tricare pays mental health providers
as much or more than a corporate plan would pay a therapist for treating a patient — although in some cases it is lower.
There are different
coverage plans within Tricare, and the amount paid to providers varies by plan, location, specialty and services performed.
Psychologists who treat active duty troops are paid 66 percent of what Tricare
views as the customary rate. So a psychologist eligible for a customary rate of $120 per hour would be paid $79.20 for the
hour by Tricare, even if the psychologist’s standard rate is $150 per hour.
Active duty troops
use Tricare Prime, a managed-care option maintained by private contractors. Their mental health care is free. Guard and Reserve
troops and their families frequently use Tricare Standard, a fee-for-service plan. They pay an annual deductible and 20 percent
of the amount Tricare pays the therapist.
John Class, a retired
Navy health care administrator who now advocates on health issues for the Military Officers Association of America, said Tricare
Prime contractors insist that the lower reimbursement rates has made it tougher to maintain a network of providers.
‘Starting
to see the pinch’
“We are already starting to see the pinch,” Class said.
In a limited study
by Tricare released earlier this year, about two out of three civilian psychiatrists in 20 states were willing to accept Tricare
Standard clients among their new patients, the lowest acceptance rate for any specialty.
Any additional cuts
in Tricare payouts could mean that “some really good psychologists who specialize in this treatment and are experienced
will be seeing less of (military families),” said clinical psychologist Marion Frank, a widow who is president of the
Philadelphia Chapter of the Gold Star Wives of America, a support group for military widows.
In parts of Montana,
some families drive two hours to see a physician of any kind that will take Tricare, said Dorrie Hagan, state family program
director for the Montana National Guard.
“When you get
away from a city of any size then you start struggling for providers, and they’ll tell you flat out it’s because
of the rate of pay,” Hagan said.
source: MSN News online
From Time Magazine Online:
A victory for mental-health advocates
By Laura Fitzpatrick
Buried in October's financial bailout package was a landmark provision, 12 years in the
making, that for the first time requires insurance companies to provide equal coverage for mental and physical health. Bipartisan
advocates say the new law could improve care - and reduce stigma - for the 80 million Americans suffering from mental illness
and substance abuse. Many insurers largely favor the requirement, in part because research suggests a strong link between
conditions such as untreated depression and physical ailments.
Tallying Mental Illness' Costs
By Kathleen Kingsbury
Friday, May. 09, 2008
It's
a debate with which the U.S. workplace has yet to come to grips:
should employees'
mental and physical health be considered equal in importance?
Corporate America's answer
has traditionally been unambiguous, with few employer-backed health plans offering any coverage for workers' mental conditions.
But that line has been shifting recently - a change that could save the U.S. economy billions of dollars in lost income, a
new government-funded study suggests.
Serious mental illnesses (SMIs),
which afflict about 6% of American adults, cost society $193.2 billion in lost earnings per year, according to findings published
in this month's American Journal of Psychiatry. Surveying data from nearly 5,000 participants, researchers determined
that people suffering from a SMI — defined as a range of mood and anxiety disorders, including suicidal tendencies,
that significantly impaired a person's ability to function for at least 30 days over the past year - earned at least 40% less
than people in good mental health. "The results of this study confirm the belief that mental disorders contribute to enormous
losses of human productivity," says Ronald Kessler, a Harvard professor of health care policy and lead author of the study,
funded by the National Institute of Mental Health.
Researchers arrived at that
figure using data from the 2002 National Comorbidity Survey Replication, a nationally representative study designed to gauge
the overall mental health of Americans, and extrapolated it to the general population. Kessler and his colleagues determined
that a person suffering from SMI had earned $23,000 on average in the previous year. Those respondents without SMI averaged
nearly $40,000. The researchers attributed 75% of that difference to the person's mental illness. The other 25% was attributed
to a greater likelihood that a mentally ill person would not have worked at all, thus earning nothing - Kessler says, for
example, that very few participants with autism, schizophrenia or other chronic illnesses were included in the $193 billion
figure.
Though these figures may seem
high, Kessler and his colleagues caution that they are likely too conservative. For one thing, the study's conclusions are
based on data from 2002; today, Kessler says, the rate of mental illness is likely higher due to a variety of causes, including
the Iraq war starting in 2003. But, more importantly, lost earning potential is only one of the many indirect costs of mental
illness in American society. Social Security payments, homelessness and incarceration add to that economic burden, as well
as direct costs such as medications and physicians' care. "The actual costs are probably higher that what we have estimated,"
Kessler says.
What's more, Kessler's report
considers only severe mental illness in its calculations. Yet more than one in four American adults suffers from shorter-term,
but clinically diagnosable mental disorders in a given year - including depression or an eating disorder - and such disorders
are the leading cause of disability among U.S. workers under age 45. In 2005, research by Kessler showed that 60% of Americans
with a mental disorder got no treatment for their ailment at all.
One longtime barrier to psychiatric
care has been reluctance by insurance companies to consider mental illnesses on par with physical ones and thus not pay as
well to treat them. Only 6.2% of current U.S. health care spending is devoted to the treatment of mental disorders. Federal
lawmakers may soon change that. Following the lead of many states, the U.S. House of Representatives in March passed legislation
that would require equal health insurance coverage for mental and physical illnesses, when policies offer coverage for both.
"Mental illness and drug addiction are every bit as real and serious as physical illness," said Congressman Joe Courtney,
a Democrat from Connecticut, of his vote in favor of the bill. "And by providing intervention and early treatment we may be
able to prevent more serious and costly conditions down the road."
The Senate passed a narrower
version of the bill last September, and the two houses are currently working on a compromise to send to President Bush. Both
the drug industry and large insurers have been vocally opposed, saying the legislation could result in higher premiums for
customers. "[The bill] would offer more generous mental health benefits to Americans," said Sonya D. Sotak, director of federal
affairs for drugmaker Eli Lilly, "but it risks doing so on the backs of the sickest and poorest Americans." Rep. John Sullivan,
a Republican from Oklahoma, admitted the changes could adversely affect the pharmaceutical (a clause in the House bill could
force drugmakers to lower prices) and health care industries but decided to support the bill anyway. "Each year the economic
cost of untreated mental illness is staggering - over $100 billion on untreated mental health disorders and $400 billion on
addiction disorders," Sullivan said. "Our country cannot afford to continue losing $500 billion a year to these treatable
diseases."
source site: click here to travel over to Time Magazine Online
Senator Pete Domenici on Mental Health
By M.J. Stephey Friday, Oct. 10,
2008
When Congress approved the $700 billion rescue plan, it also
passed one of the most significant mental-health bills in U.S. history — the Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008. It requires group insurance plans to cover mental illnesses the same way as
physical ones (no more higher co-pays, deductibles and limits on hospital stays).
For more than a decade, Senator Peter Domenici pioneered the
fight for such legislation. Last year, the 76-year-old Republican announced he suffers from a degenerative brain disease and
would not seek another term. One of his final votes led to the bill's long-awaited passing. TIME spoke with Senator Domenici
about the legislation's history, the state of mental health care in the U.S. and his hopes for the future.
Why do you think there is such a difference in
the way insurance companies cover physical illnesses like heart disease and mental illnesses like schizophrenia?
First of all, it's pretty easy to see that people kind of frown on mental illness. If your neighbor has a heart condition,
it's, "Gee, poor Jane, she has to take care of her husband." But if the neighbor has a manic-depressive son, you're kind of
mad at them because the kid misbehaves. Unless you're a very, very considerate neighbor that's gotten close to the family,
you can't quite understand why Johnny can be such a mean little child, why he does dangerous things. Well, the mom next door
gets pretty frustrated, she doesn't know what to do and pretty soon, Johnny's in jail.
Parity of insurance is almost
a civil-rights issue. We take care of people with heart trouble, we operate on them, we have great learning centers where
we study all there is to know about the heart. And insurance companies have paid for all those surgeries. And yet, if you
have schizophrenia, which is an illness of the brain instead of the heart, because we started off early on saying it wasn't
an illness, we kept it and they wouldn't let us change it.
How did you feel when
you found out the bill had finally passed?
You know, I'm
going to be dead-honest with you, it dragged on so long that I didn't act like I normally would have. I wasn't like me. I
[usually] get excited, passionate, but I didn't have any of those feelings
because I was thinking it can't be real. It was more like, "It's finally over." It got so close and yet so far so many times.
It's amazing, not only because we got it done, but because, for a nation, it has taken us so long.
Even in America in 2008, there
are more people who are housed in jails that have a mental illness than there are facilities
with trained help that were built to take care of them. By virtue of the fact that nobody else is going to do it, most police
departments know that they're going to have them in their custody so they now train police in how to deal with the mentally
ill. But it's all makeshift compared with what was intended when the Kennedy commitment was made way back yonder when he said let's open up these dungeons, where we had the mentally ill housed like beasts, and
let the country build local facilities to treat them. America still hasn't faced up to it.
One of your major allies has
been the advocacy group The National Alliance on Mental Illness (NAMI). Tell me about how you first got involved
with them.
The Alliance has been the
instrument of many, many good things. Our daughter was 17, going on 18, when she began showing symptoms of [schizophrenia]. We started stopping by their meetings after work and we quickly found out that,
in spite of us having a child who had problems, there were so much more serious ones than ours. We ran into parents with two
children who are schizophrenic, and they tried desperately to keep them at home and take care of them, and they went broke
and the kids are in jail.
That's when I first started
finding out about the issue, how parents were losing control of their children physically, and they were in jails because
there wasn't any place to put them ultimately. If it's some average worker trying to find a place for their kid to spend a
week or something for treatment and medicine, it's pretty damn expensive.
How does this bill
address those problems?
This bill targets
insurance plans that cover more than 50 employees. About 113 million people, we figure, are in group insurance plans that
have, as part of their health care, mental health coverage. All of those, now, will have imposed on their insurance policy
by operation of law that the insurance company will pay for mental health treatment in exactly the same way they cover physical
ailments - the same amount of days in the hospital, the same amount of co-pay, and all the other technical words will be equal.
And that's not what it used to be, and not what it is today. Insurance companies were already moving in that direction, but
now we've made it so they can't slide backwards.
How do you think perceptions,
both in Congress and among your constituents, have changed since you first introduced this issue in 1996?
Now when I'm finished
with a speech and I'm mingling around - even if the meeting were oil and gas operators in Dallas, Texas - almost always somebody
will come up and say, "Hey, keep with it, Pete, I've got a nephew..." Or, "My uncle Billy had this..."
In other words,
it is more prevalent than you think. Out of almost any crowd somebody will tell you a story about their family. Those kinds
of things are always coming up. Even President Bush spoke to me personally and very eloquently about it. He said, "You don't
have to convince me, I'm over that hurdle." Every time we got close [to passing the bill], he'd ask about it.
Strangely enough, when I would
speak to this among a group of Senators, it took more time than I thought to get some of them to come up and join me and say,
"I want to work on this because I have a relative or a friend." But eventually, four or five Senators came up to me and said,
"We got to work on this, Pete, because it's real." It took many a month until that first bill got to the floor. Then we just
rolled it through the Senate. That was the first bill in 1996. And that's when it died in the House the first time.
How did you react when
you found out the House had killed it?
Well, it wasn't
like they killed it overnight. It was a lingering death. Until recently, we had a lot of trouble in the House at the top level
under the Republican leadership, and as a Republican, I acknowledge that. And I was upset.
How
did the vote on the $700 billion rescue plan affect the bill's passage? Were you worried it would get sidelined?
I had no concern.
The economy is in bad shape in a number of ways, and it may be that we're going to have trouble finding out how to solve it,
but at the same time life goes on, you know. Businesses are beginning to know that they have in their employment people who
are mentally ill, people who have manic-depression, who have depression, who have schizophrenia,
who suffer from alcoholism.
And businesses
are finding out that they are better off giving them treatment and buying insurance that covers their treatment because if
you can keep them well and get them their medicine, you add to their productivity and to your workforce productivity.
This
is your last term in Congress. How do you hope your colleagues will take up this fight after you leave?
There are many things that I would still love to be doing, which makes my
departure so hard. I would think the next thing to do is to introduce national legislation to start a program for a 50-50
match, where the federal government matches the local government in the construction of facilities that would be a local place
for the mentally ill to be taken care of.
We're a nation that is really hell-bent on trying to do more and more for humankind
all the time. I went to a clinic that handles little tiny babies that are born premature and they showed us what new equipment
they have and how the baby can be saved and nourished at even a pound and a half.
We spend hundreds and hundreds of thousands of dollars to save little premature babies
and that shows a real commitment on our part. And then we turn right around and, for the mentally ill, we have made it so
difficult for so long to even say it's an illness that you just can't quite figure it out. We can do better.
source site: click here to travel over to Time Magazine Online
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What is EFT?
EFT is based on a new discovery
that has provided thousands with relief from pain, diseases and emotional issues. Simply stated, it is an emotional version
of acupuncture except needles aren't necessary.
Instead, you stimulate well
established energy meridian points on your body by tapping on them with your fingertips. The process is easy to memorize and
is portable so you can do it anywhere. It launches off the EFT Discovery Statement which says...
"The cause of all negative emotions is a disruption
in the body's energy system."
And because our physical pains and
diseases are so obviously connected with our emotions the following statement has also proven to be true...
"Our unresolved negative emotions are major contributors
to most physical pains and diseases."
source site: click here
More info right here at the emotional feelings network of sites! Click here
EMDR, or Eye Movement Desensitization and Reprocessing, is an
innovative clinical treatment that was developed to deal directly with the effects of trauma. Since 1988, EMDR has helped
over two million trauma survivors.
"EMDR is the most revolutionary, important method to
emerge in psychotherapy in decades."
Herbert Fensterheim, Ph.D.
Cornell University
Fourteen published, controlled studies support the efficacy
of EMDR, making it one of the most thoroughly researched methods ever used in the treatment of trauma. Most people treated
for single trauma find relief from post-trauma emotional symptoms within three or four sessions of EMDR.
"EMDR was found to be an efficacious treatment for
PTSD."
Practice Guidelines
The International
Society for Traumatic Stress Studies
"The speed at which change occurs during EMDR contradicts
the traditional notion of time as essential for psychological healing."
Bessel A. van der Kolk, M.D., Professor of
Psychiatry
Boston University School of Medicine
EMDR integrates many of the successful elements of a range of
therapeutic approaches in combination with eye movements or other forms of rhythmical stimulation (such as hand-tapping).
Once it has been determined which traumatic memory to target first, the clinician asks the person being treated to hold different
aspects of that event or thought in mind and to track the therapist’s hand with his eyes as it moves back and forth
across his field of vision.
As the session progresses, an innate self-healing mechanism
is activated, and he is able to begin to cognitively and emotionally process the traumatic memory and disturbing feelings.
"EMDR provides a way for people to free themselves
from destructive memories, and it seems to work, even in cases where years of conventional therapy have failed."
ABC News "20/20"
Once this mechanism is set into motion, the person undergoing
treatment typically begins to spontaneously associate other memories, thoughts, and feelings with the originally targeted
trauma. The result is a chain of associations, each of which the clinician may select as a target for additional EMDR therapy.
By the time the various chains of association come to an end, the trauma has lost its negative charge and no longer maintains
its destructive hold. It becomes simply another event in the history of the survivor’s life.
"EMDR is one of the most powerful tools I’ve
encountered for treating post-traumatic stress. In the hands of a competent and compassionate therapist, it gives people the
means to heal themselves."
Steven Silver, Ph.D.
Director of the PTSD Unit, Veterans Admin. Medical Center, Coatesville, Penn.
The precise mechanism by which EMDR works to resolve traumatic
stress is unclear, in part because we still know so little about how the brain processes intense memories and emotions. However,
a number of neuropsychologists believe that EMDR enables the person undergoing treatment to rapidly access traumatic memories
and process them emotionally and cognitively, which facilitates their resolution.
"We believe that EMDR induces a fundamental change
in brain circuitry similar to what happens in REM sleep -- that allows the person undergoing treatment to more effectively
process and incorporate traumatic memories into general association networks in the brain. This helps the individual integrate
and understand the memories within the larger context of his or her life experience."
Robert Stickgold, Ph.D.,
Harvard Medical
School
By accessing these memories in the context of a safe environment,
the hypothesis is that information processing is enhanced, with new associations forged between the traumatic memory and more
adaptive memories or information. These new associations result in complete information processing, new learning, elimination
of emotional distress, and the development of cognitive insights about the memories.
"EMDR quickly opens new windows on reality, allowing
people to see solutions within themselves that they never knew were there. And it’s a therapy where the client is very
much in charge, which can be particularly meaningful when people are recovering from having their power taken away by abuse
and violation."
Laura S. Brown, Ph.D.
Past Recipient of
the American Psychological Association Award for Distinguished Professional Contributions to Public Service
After successful treatment with EMDR, affective distress is
relieved, negative beliefs are reformulated, and physiological arousal associated with stress is reduced.
source site: click here
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What is body-mind therapy?
Body-mind therapy combines
the strengths of “talk” therapy with bodywork, such as touch, postural alignment, or exercises to increase body
awareness. Also known as mind-body or somatic therapy, it helps people “become deeply aware of their bodily sensations as well as their emotions, images and behavior. Clients become more conscious of how they breathe, move, speak, and where they experience feelings
in their bodies.” (United States Association for Body Psychotherapy). This increased awareness about how the body holds physical stress and emotional injury informs and directs the therapy process, allowing clients to work through patterns of limitation that
are not often resolved on the level of the mind alone.
As the one of the innovators
of body-mind psychology explains it, “Unacknowledged feelings from past experiences are stored in your body and then unconsciously have a powerful effect on who you are, how you behave,
and how you feel about yourself. Using the body as the gateway to awareness, buried feelings and memories can surface, freeing you from old patterns and energy blocks that keep you feeling stuck and
unable to live life to its fullest. Your mind may avoid certain emotions and memories, but your body remembers it all.”
(What is Rubenfeld Synergy?)
Body-mind therapies vs. body work?
Bodywork seeks primarily to improve physical health and functioning.
Schools of bodywork such as the Alexander Technique, Rolfing, and the Feldenkrais Method are examples of postural and structural
body mechanics treatments. Though these systems also affect the emotions and mental states of the client, they are not overtly
designed to work on psychological issues.
Body-mind therapy is a psychotherapeutic process that works
on the relationship between the body and the emotional processes of the client, and is intended to address emotional concerns
that are not as likely to be resolved through talk therapy alone.
source site: click here
Somatic Experiencing
Dr. Peter Levine developed
Somatic Experiencing (SE) by observing how animals regulate and discharge high levels of energy when encountering life-threatening
situations in the wild.
Unlike humans, who have been
trained to use the rational faculties of the mind to cope with stressful situations, animals exhibit an innate ability to restore themselves to equilibrium after being attacked. They do not hold
in their bodies the intense energy they needed to temporarily mobilize for survival.
Thus, they do not get traumatized
as people do are after a frightening trigger event. As Dr. Levine puts it, “Traumatic symptoms are not caused by the
dangerous event itself. They arise when residual energy from the event is not discharged from the body. This energy remains
trapped in the nervous system where it can wreak havoc on our bodies and minds.”
Dr. Levine argues that humans
also possess this energy-releasing ability, and can learn how to employ a body awareness he calls felt sense
to renegotiate and heal the trauma. Learning how to access this felt sense in the moment and release residual tension is the
basis of SE. The procedures are taught through face-to-face interactions between practitioner and client.
SE is considered valid for
both shock trauma - single-episode traumatic experiences such as war, rape, or natural disasters - and developmental
trauma, which refers to interruptions in the predictable psychological stages of growth.
Certified Somatic Experiencing
practitioners, who are often psychotherapists, have completed a three-year training program through the Foundation for Human
Enrichment, established by Dr. Levine. To find a qualified SE practitioner in your area, go to the Foundation’s Practitioner’s Registry.
The Hakomi Method
Hakomi is a method of gentle,
body-centered therapy that operates from a core of five foundational principles:
- mindfulness
- unity
- mind-body-spirit holism
- non-violence
- organicity
It was developed by psychologist
Ron Kurtz, a practicing Buddhist and body-mind practitioner who wanted to develop a less harsh way of accessing body awareness.
Hakomi is a Hopi Indian word that can be translated as “Who are you?”
The Hakomi Method works on
changing those aspects of our core material - memories, body impressions, emotional imprints, habitual thoughts,
beliefs, and attitudes - that were developed in response to challenging situations, but which limit our options when carried
into adulthood beyond their usefulness.
At the root of Hakomi is Mindfulness
- a deep listening to oneself, facilitated by the therapist guiding the client to stay totally present to what is
happening inside during the therapeutic session. The past is referenced, but only as it needs to be for healing and completion,
organically, as the flow of the moment dictates.
Hakomi does not try to change
someone, but allows a person’s natural authenticity and self-knowing to emerge. It involves going beyond who you think
you are, to being able to discover who you truly are - not through the intellect, but through the non-verbal wisdom of the
body. This experience of being oneself cannot be thought; it must be experienced directly. The therapist is not an authority
in this journey, giving advice or making suggestions, but a calm presence creating safety for self-discovery.
Briefly put, the Hakomi method
can be summarized in three stages:
- Establish a relationship in which it is safe for the client
to become aware
- Notice or evoke experiences that lead to the discovery of organizing
core material
- Seek healing changes in the core material
Hakomi therapists often help
increase clients’ awareness of habitual patterns of behavior by sharing observations about their “body language”
in a non-threatening way. These observations then form the basis of engaging in safe, mutually-agreed upon experiments that
bring core material into awareness, such as practicing responding with different body language to a statement that reflects
a deeply held belief.
Hakomi advocates the use of
touch when appropriate, but only with the consent of the client. This distinguishes it from most traditional therapies, in
which there are strict prohibitions against therapist-client contact. Certified Hakomi Therapists can be found through the Hakomi Institute’s website.
Sensorimotor Psychotherapy
Pat Ogden was a student of
several body therapies and an apprentice to Ron Kurtz in the 1970s, when she decided she wanted to form a synthesis between
body therapy and psychology, specifically the Hakomi Method she was studying. The result was Sensorimotor Psychotherapy.
Like Hakomi, Sensorimotor
Psychotherapy uses a gentle approach to increase awareness of client’s underlying beliefs and attitudes. In this approach,
the distinguishing emphasis is on its study of the relationship between trauma and developmental issues. Dr. Ogden was particularly
interested in the dissociation from the body exhibited by many of the people she was trying to help, and through working with
them discovered that:
- Developmental injury
occurs from dysfunctional family dynamics that lead to the formation of limiting psychological belief systems; and
- Traumatic injury
is due to perceived life-threatening events that overwhelm boundaries and leave victims feeling helpless and out of control
Sensorimotor Psychotherapy
is known for differentiating between these two kinds of injuries and working with the interface between them. The methodology
used is very similar to that of Hakomi therapy. It is founded on the same tenets of mindfulness, non-violence, organicity,
unity, and holism.
The body’s sensations
and cues are constantly referred to throughout the sessions, and establishing safety and respect is considered the first priority
in the client-therapist relationship. A list of Certified Practitioners is available through the Sensorimotor Psychotherapy Institute’s
website.
Rubenfeld Synergy Method
The Rubenfeld Synergy Method
is a ‘hands on’ therapy that uses light touch and verbal processing to sense the movement of energy in the body,
in order to help clients release stored emotions and blocks to more vital living. It was developed over thirty years ago by
Ilana Rubenfeld, a Julliard School of Music graduate whose conducting career was sidelined by a debilitating back spasm.
Through seeking her own healing,
she discovered a way to synthesize bodywork, psychotherapy and intuition into a method of ‘talk and touch.’ Ms.
Rubenfeld describes the process on her website:
Emotions and memories stored
in our beings often result in energy blocks, tensions, and imbalances. The Rubenfeld Synergy Method uses many avenues, including
verbal expression, movement, breathing patterns, body posture, kinesthetic awareness, imagination, sound, and caring touch,
to access these reservoirs of feeling. Together, synergist and client make room for emerging feelings, integrating them with
present experience. (www.ilanarubenfeld.com)
The first ten principles and
theoretical foundations of the Rubenfeld Synergy Method are:
- Each individual is unique. Rubenfeld
Synergists approach clients and their sessions with this principle of honoring their uniqueness.
- The body, mind, emotions and spirit are
dynamically interrelated. Each time a change is introduced at one level, it has a ripple effect throughout the entire
system.
- Awareness is the first key to change.
By bringing the unconscious into awareness, clients have the opportunity to explore alternate choices and to develop possibilities
for emotional, physical and psychophysical change.
- Change occurs in the present moment.
Clients may experience memories of the past and fantasize about the future, but change itself can occur only in the present.
- The ultimate responsibility for change
rests with the client. Rubenfeld Synergists can support clients to recognize dysfunctional behavior and guide them
to try new ones. They cannot force clients to change.
- Clients have the natural capacity for self-healing
and self-regulation. Innate healing ability already exists in clients, waiting to be actualized. Rubenfeld Synergists
do not "cure" or "correct" but rather facilitate clients' healing.
- The body's energy field and life force
exist and can be sensed. Rubenfeld Synergists use gentle touch to sense energy, its pulsations and movement. When
tight holding patterns in the body/mind are released, there is a marked change in the energetic quality.
- Touch is a viable system of communication.
Rubenfeld Synergists develop "listening hands" to dialogue with clients, thus opening new gateways to their unconscious mind.
- The body is a metaphor. Clients'
postural positions and movements may represent emotional issues in their lives.
- The body tells the truth. Often
what clients communicate verbally is not congruent with their body's story. Rubenfeld Synergists guide their clients to listen
to their body's message.
Sessions are typically 45-50
minutes and are conducted with the client fully clothed, usually lying on a table, although sitting and moving may also be
called for at times. The Synergist guides the client in creating a dialogue between body, mind, emotions, and spirit. Repressed
emotions such as grief, anger, and sadness are often re-experienced and given expression. According to the Rubenfeld Synergy
Method website, the benefits of a Rubenfeld Synergy sessions can include:
- Resolution of painful issues and experiences
- Increased inner peace and calm
- Greater self-esteem
- Recovery from physical and/or emotional trauma
- Maintenance of physical and emotional health and well-being
- Better management of stress
- Living more from conscious choice than from habit
A certified Rubenfeld Synergist can be found on the Locate a Practitioner page on the Rubenfeld Synergy Method website.
Integrative Body Psychotherapy
Integrative Body Psychotherapy
(IBP) is an in-depth psychology based on the view that life is most fundamentally a somatic experience
(somatic meaning “of the body”), and that the only way to truly understand oneself and the questions of life is
through developing somatic intelligence. This intelligence could be summarized by the statement “the body always knows.”
Every insight gained in therapy must be accompanied by a felt somatic experience in the body, a core experience of self. Psychological
problems arise when the connection to the body’s basic guidance system gets interrupted.
IBP therapists help clients
“track” three types of mind-body interruptions to the body’s basic guidance system:
- Primary Scenario—emotional
patterns and beliefs developed in early childhood that habitually distort present experiences;
- Character Style—our protective
defenses; and
- Agency—how we abandon our
core selves for love and approval
IBP does not employ physical
touch in the therapeutic sessions, favoring more subtle means of putting clients in touch with their somatic intelligence.
The basic tools used are awareness, breath, movement, and self-release
techniques that empower the client to distinguish between disruptive psychological patterns, acted out in different
arenas, and their core sense of self. Without this understanding that we are not our patterns, nothing can
get resolved.
IBP also recognizes the difference
between psychological and existential issues; the IBP therapist helps the client separate what are compelling
personal patterns of emotion and behavior from the universal questions of being. These “bigger picture” questions
of existence can also be understood through accessing the deeper wisdom in the body.
IBP uses the term fragmentation
to describe what happens when a trigger event in life activates unconsciously held beliefs and emotional patterns, causing
one’s world view and judgment to become distorted, and leading to hopelessness and pervasive negativity. Fragmentation
is not seen as something that we can “think” our way out of, but an integrated body-mind-emotion response to past
impressions imbedded in us. IBP offers quick-acting “steps out of fragmentation” that bring back balance and inner
stability.
Integrative Body Psychotherapy
was developed by Jack Rosenberg, Ph.D. in the 1970s and has grown to include eleven international institutes.
Focusing
Simply put, Focusing is “direct access to bodily knowing.”
It is a practice that takes a person towards a state of conscious perception that goes far beyond knowing something on a mere
conceptual level. As with Somatic Experiencing, Focusing refers to this bodily knowing as a felt sense. As
the Focusing Institute’s website explains, “You can sense your living body directly under your thoughts and memories
and under your familiar feelings. Focusing happens at a deeper level than your feelings.
Under them you can discover
a physically sensed ’murky zone‘ which is concretely there. This is a source from which new steps
emerge.” This murky zone “opens” as you learn to stay with it longer. Being with it increases the ability
to sense feelings behind words or images, even when those are not yet formed. Eventually, you can learn how to let a deeper
bodily felt sense come in relation to any problem or situation. It is a subtle process, hard to define in words. It needs
to be experienced.
Focusing was developed by the philosopher Eugene Gendlin in
the late 1960s and early 70s, while he was working with the famed psychologist Carl Rogers. The process is widely taught to
anyone who wants to learn it. It does not require a degree or certified professional to conduct, though you can find a Certified Focusing Professional through the Focusing Institute’s searchable database.
Neo-Reichian therapy
Wilhelm Reich, a psychoanalytic contemporary of Sigmund Freud,
believed there was more to the process of resolving emotional issues than talking about them.
According to the Orgonomic
Institute, “Reichian therapy was one of the earliest forms of body-mind therapy, combining dialogue, breath and movement
to decrease body armoring.” Reich’s theory was that suppressed emotional traumas create physical tensions (protective layers he called “body armoring”). The premise of Reichian
therapy is that specific physical movements, deep breath work, and physical manipulation can release both the physical and
emotional tensions.
There are several forms of
Neo-Reichian therapy that were developed in the 1960s by students of Reich. Their basic purpose is to free rigid muscles and
patterns of movement in the body, which then allow the emotions to be freed, and the individual to live a more spontaneous
and fulfilling life. The best known Neo-Reichian therapies are:
- Radix – developed by Charles
Kelly, a vision psychologist who used the Bates vision method. Starts with muscular tension in the face and head, and moves
downward through the body. Techniques are applied according to individual needs; for example, a person who never cries has
a different process than someone who tantrums like a small child. Certified Radix practitioners are often, but not necessarily,
licensed mental health professionals, and all take a two-year training program. Radix practitioners can be located on the Radix International website.
- Bioenergetics – developed
by Alexander Lowen, who became a medical doctor after training with Wilhelm Reich. Starts with the pelvis and moves upward
through the body. Uses yoga-like postures, stretching, breath work (sometimes with a “breathing
stool” – a padded bench over which the person stretches backwards, to open the chest and spine).
Active well into his 90s, Lowen wrote 14 books, including The Language of the Body. Certified Bioenergetic practitioners engage
in a two-phase training over the course of 4-6 years and are required to be licensed psychotherapists. Certified Bioenergetic therapists can be located on the International Institute of Bioenergetic
Analysis website.
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