Real World Clinical Social Work Blog: Invisible Bodies

by Dr. Danna R. Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way  

     Sometimes when I get dressed in the morning, I run through my day in my mind. I think about my 1:00, 2:00, and 3:00 clients. Then I hit my 4:00 and my plan for my outfit changes entirely. I think, to myself, “I can’t wear that in front of that client,” or “I wore that last week and my client will remember it.” What is going on with these thoughts? There are so many different variations of them, and really, they are quite overwhelming. I believe that these thoughts are the byproduct of the very complicated and paradoxical experience of having a body and being a clinician.

     During my second year placement, I had a psychotic client who seemed extremely enraged at me all the time. She would often ask me to look away from her, would complain about the fact that I was an intern, and rail against her perception of my judgment of her. During one session, she said to me, “How can I be expected to sit here and look at you when you have such an ugly double chin?” On one hand, I was devastated. On the other, I just chocked her comment up to her psychosis and dismissed the pain. I brought it up in supervision, and my supervisor suggested that my client’s ability to experience rage and aggression in the safety of the clinical relationship was promising progress. Maybe that was true. But what about me? What about my body? And what about her impact on my body?

     While clinical social work is clearly the meeting of two minds, it is also the meeting of two intricate bodies. And for every single body, there is a mind having a complex experience of that body’s existence. No one feels completely at ease in his or her body and no one has complete mastery over how to deal with that dis-ease. However, the more we focus on creating a cure that is exacted through talking, the more dis-associated from the fact of our bodies we can become.

     So, here’s the thing for me. Throughout my day, I go through a million different experiences of my body. Sometimes it feels too big. Sometimes it feels just right. Sometimes I feel fidgety. Sometimes (oftentimes) I need to yawn. Sometimes I feel hungry. Sometimes I want to eat, even if I am not hungry. Sometimes I want to crack my knuckles or play obsessively with my ring on my right hand.

     Sessions require a lot of sitting still, and in this stillness, I experience a tremendous amount of discomfort, preoccupation, and metaphoric itchiness. I spend a lot of time, in session, trying to get rid of these feelings by ignoring them. I try to stifle my yawn or plan to snack later. Ironically, the minute a session ends, the need for the yawn, snack, or scratch goes away.

     In session, my clients talk quite a bit about their own bodies. This is great and also essential. The weird thing is that they often talk about their bodies as if the body isn’t in the actual treatment room. We will talk about how sex felt, how feeling fat feels, how exhausted they are. But there is something about the reflections that often feels disembodied, somehow. They talk about having felt tired at work, fat at a dinner party, enjoying sex on a recent date. It becomes secondary to bring their bodily experiences into the room.

     I know that there are a lot of interventions that now focus on this, specifically mindfulness and anything that calls on us to bring awareness to something. But, truthfully, these interventions don’t dominate and also don’t acknowledge the complexity of the reality of there being two bodies in the room together and what that feels like.

     There is a lot of fear about talking about the experience of two bodies in the room, because this can inevitably lead to feelings of transgression, overstimulation, and shame. If a client is talking about recently having had sex in a fairly provocative way, can we ever really say, “Wow, I can really feel what you are saying in my body”? Certainly not. Despite this, there has to be some way to be together, bodies included, without the levels of bodily dissociation that we tend to occupy.

     I have no answers to how to do that, but I have given it a lot of thought. I am currently working hard on making sense of my bodily experiences as central clinical data. And I want to be clear that I am trying to interpret this data as co-created information about what is happening between two people, not only what is happening for my client. For example, let’s say that I do start to feel really fidgety in a session. I am working to become curious about what that means and to engage my mind with my body. Am I feeling fidgety because there is information coming from the client that I find to be particularly triggering? Am I feeling fidgety because there is something that is not being fully psychologically articulated and is instead being physically felt?

     It can become terrifying to think about how clinical material becomes lodged in the body, but I think it is much more terrifying to work toward keeping bodies out of the room. I hate it when a client brings up something sexual and I can actually feel it in my body. It makes me feel so ashamed. It makes me feel like I am doing something wrong. At the same time, isn’t it so important to make sense of why my body is reacting the way it is? Isn’t there a way to value the information that my body is communicating, rather than shutting down the messages contained in the sensation?

     It really bothered me to be told that I look like I have a double chin. From some angles, maybe I do, but not all angles. Why did that client see me from that angle? What did that mean? What did it mean that I was hurt and couldn’t say something? Or that I was able to dismiss her because of her psychosis? Wasn’t my refusal to respond really a way of saying to her that she has no impact on another being, rendering her feeling invisible herself? My erasure of my physical experience led to the erasure of her sense of impact and reality.

     One of the central goals of excellent clinical work is the integration of the mind, body, and soul. It is also the integration of affect, thought, and behavior. The more we separate these entities in ourselves and in our clients, the more we are communicating that there is some sort of danger in integration. We communicate that there is real threat and danger in becoming whole. We need to risk the exact opposite possibility, by valuing our own bodies and the information given to us by them. We need to consider that once we are whole (as clinicians and clients alike), we are more alive and therefore more safe and in control of our lives.

Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way. Get the book at Amazon.com.