Distress About the Body and Body In Distress – Psychodynamic Approaches to Struggles with Body-Image and Body-Functioning
One of the primary concerns that bring individuals from all walks of life into therapy is a problematic, at times painful relationship with their physical self. In some cases we may hate our bodies, or parts of it, subjecting them to harsh criticism, restrictions, and exhausting demands for performance; in others, people may feel betrayed by the body’s capricious states, or by its aging, sickness, injury, “grossness,” and so on. Some of us become anxious, even panicked, when thinking about the physicality of our being, becoming unbearably aware of life and death.
Some of the richest perspectives for examining our relationship with our body can be found in psychoanalysis. Certain analytic/dynamic approaches focus on the infant’s body as the first site for connection with the other, an unmediated space for sensing love, warmth, calm, and nourishment, but also loneliness, coldness, stress, and hunger. Our body is our early tool for acting out sadness, joy, need, and anger. From this point of view, the way our early environment interacts with our body and its needs would play a very important role in our own experience of the physical self, as well as in our physical being and health.
Other analytic perspectives may emphasize the body’s innate drives, such as drive for life, love and creativity - Eros, and the drive for death, aggression and destruction - Thanatos. These psychobiological states exist in us always and we live our life trying to navigate them, handling what is within us and what is outside. Early dynamics with caregivers and society shape how these drives are expressed ultimately, alongside various genetic and existential factors. Health can be seen as a state in which love trumped hate in their ongoing conflict.
Therapy is the space where our complex relationships with the body can be deeply felt, examined, renegotiated, and even changed. Together with the therapist – a physical being herself – the client has the opportunity to deepen insight into the function of their symptoms and find new ways to express feelings and needs. We may gain insight into obsessive worries about health, compulsive checking or undoing behaviors meant to prevent illness, dysmorphic perceptions of the body, poor habits that impact health, and recurring health concerns. While the goal is not to ignore other, medical perspectives on the body, analytic approaches seek to shed light on the mindbody unison and ways in which the psychological and physiological can alternate or parallel to communicate something that is within.
While therapy is meant to be a health promoting intervention, it is also a courageous entry into the unknown. In some cases, starting the process of getting in touch with different aspects of ourselves can bring up new, perhaps painful emotions that we have not been consciously in touch with before. The impact of uncovering such difficult-to-digest states of self on the body can not be predicted, and both therapist and client need to remain vigilant to the client’s physical self’s response to this emotional exposure. The therapeutic alliance and therapist’s ability to maintain openness, curiosity, receptivity, creativity, containment, and boundaries as part of the therapeutic relationship are of great importance.
Written by: Lilia Berkovich