Growing up, many of us learned a disembodied way of living. It’s a tragedy really. The rich world of embodied awareness is severed from our way of experiencing. We then miss out on all manner of feelings, sensations and intuitions which would otherwise add to the richness of life. The implications are huge: without embodied awareness we are left wearing a kind of cognitive straightjacket which prohibits our authenticity without us even knowing. Deep down, we might feel like something is missing. Big decisions can be difficult, as we attempt to make sense of the world, who we are and what we want, through compensatory processes. We might over-rely on thinking, and often unknowingly privilege the preferences of others and society in general. For this reason, the compensation may look very successful, but it’s a functioning that misses key information. Our felt needs, our emotional longings and our deepest desires aren’t things we deduce cognitively. We need to feel them in our bodies. Indeed, without that embodied awareness, we miss out on a sense of self.
Children are born connected too, even immersed in, this embodied and free-flowing state. As development takes hold, the environment and sometimes traumatic experience, can sever that connection. When in therapy, embodied awareness is rekindled, it can be a truly wondrous thing. It’s an internal blossoming that often leads to profound changes in living.
I was certainly someone who needed to recover from this culturally normalised disembodiment. Through psychotherapy training and other professional development, I began to learn that consciousness dwelled in the body. And, as I undertook various modes of trauma work, my embodied awareness didn’t just return, it continued to increase and to deepen. Eventually, I began to realise that authentic spirituality was an embodied experience.
But as I grew to know this injury to greater degrees, an injury I’ve come to know as the body/mind split, I learned also how complex and far-reaching an injury it is. And that it doesn’t just affect individuals. It is also an injury to group, institutional and collective consciousness.
yet another psychotherapeutic divergence
While the body/mind split in psychotherapy has historical roots, it was always, to some degree, a caricature. The post-Freudian analytic tradition became progressively more verbal, more interpretive, more disembodied; the body was implicitly demoted to a vehicle for the mind’s more interesting contents. Austrian psychoanalyst Wilhelm Reich was marginalised partly because he refused that demotion, insisting that character was held in musculature, that the body was not backdrop but text. What followed looked like a clean divergence: talking cures on one side, body-based approaches on the other. But the picture was never that simple.
Body-based psychotherapies have a particular place in my heart. But as I developed my practice toward trauma therapies, Stephen Porges’ polyvagal theory and Pat Ogden’s sensorimotor therapy showed me something unexpected. I began to find these approaches were both developmentally aligned and could be integrated with analytic thinking.
Getting past caricatures of Psychoanalytic approaches similarly resolves. Californian analyst Thomas Ogden’s work sits squarely in the analytic tradition yet is saturated with bodily presence — the analyst’s reverie, the texture of the session, what is felt before it is thought. I’ll explore some other analytic theories later; but suffice to say analytic work can be filled with embodiment. And, to be fair to critics, I’ve seen more than a few occasions when it is anything but.
While locating embodiment within analysis, and linking embodied approaches to analytic theory helped me personally and clinically, I am curious about the stubbornness of the body/mind split in therapy culture.
Based on all I’ve said you won’t be surprised to hear generalisations like “I’m a bottom-up therapist” don’t sit well with me. Indeed, I am particularly riled when, because I work analytically, I am assumed to be in some “mind first” camp. But it’s curious when someone operating from another paradigm makes that assumption.
This got me thinking some more: about moments when we don’t know, but think we do. Discussing this with a mate offered a suggestion: “You’re talking something akin to an AI context window. When an AI gets something completely wrong, it’s often because you knew something implicitly, but the AI had no idea”.
It’s a helpful analogy. And it raises a broader question for psychotherapies; what if every therapy tribe has an unavoidable context window? What if over application of top/down, bottom/up dichotomies amplifies context window bias? To challenge a popular therapy meme about the truth of the body, what if sometimes, the body lies?
when certainty opposes wisdom
The desire for simple answers is prolific in our culture. When it comes into psychotherapy practice, it can be a seeking of a particular kind of comfort zone. It might be diagnostic (“I know what’s going on”) or methodological (“I know what to do next”). Such certainty usually runs out of road, even if for a time, we do know.
Certainty can mean laziness. There’s a comfort of having a philosophic or clinical framework which we slip on easily, like a comfy shoe, which might sanctify our diagnostic and methodological prowess. It’s the kind of certainty that leads to a case being labelled “clinically resistant”, or us taking a case to supervision baffled as to how it’s all become so stuck. In such cases, it might just be that our context window is missing something key, and that our own certainty has played a part.
To my mind, human psyche’s are complex and often contradictory. Holding onto certainty, session after session, or case after case, can lead to a hyper-certainty which can prevent a more free-flowing process in the room. And the deeper one is working in a relational process, certainty may well hold back the work. Instead of certainty, we need wisdom, alchemy, life force, whatever you want to call it, to bring to the surface that which is quite often, completely unexpected.
Coming back to the body, what if like any approach, the “wisdom of the body” has to have its shortcomings? What if approaches which centre the body, could also benefit from considering other ways in, to achieve a robustness of view?
to regulate or not to regulate
So I’m going to step through some examples of approaches which might stifle a deepening of the relationship.
The first one comes up a lot: “I ground and regulate my client before any work can start”. Sounds good, right?
Well, if applied dogmatically, this thinking could overlook many underlying dynamics. From an analytic perspective, the client may be stuck in a pre-oedipal transference, one where the well meaning regulation of the therapist, might keep the client stuck in dependence. The impulse to heal may be present: where the therapist’s intervention is driven by their own parallel anxiety. This might mean the attempt to assist may be sending a message that the unbearable feeling is indeed unbearable.
In difficult developmental environments, clients might “learn” to use dysregulation as a way of attaining care. This might sound strange, but in some family systems, this approximation for love, a concerned carer, might have been all that was available. In such a case co-regulation or other problem solving can be evoked from the therapist in order to avoid growing up into their own self reliance. But those difficult feelings, and methods of self regulation, might actually need to be encountered by the struggling individual, so a more autonomous ego can develop.
And yet, sometimes when our patients are particularly regressed or dysregulated, we do need to help them find solid ground — especially where safety is in doubt. To never do so may be a dogma in itself. The practitioner then has to plot a course which accounts for all this.
you can’t always “trust your gut”
Consider a fictitious example: imagine a client facing a decision about leaving a relationship. The “gut feel” — the embodied sensation when the decision is faced — might be pointing to fear, which the client’s interpretation is to leave the relationship. Unpacking and exploring that sensation might reveal a flight response, related to a projection rather than anything to do with the client’s partner at all. The feeling, if followed without separating from the projection driven response, could be reinforcing an old attachment dynamic.
Another example, a client who is dissociating. At face value this might result in numbness, or a sense of day-dreaming — interpreted literally, the client is simply changing their mind or having a pause. But combined with information within the relational field (dissociated states often evoke altered states in the countertransference), or the thoughtful mind of the therapist who tracked the trigger point, a deeper understanding can emerge. The pause, when thought about, can be seen as a different sort of wisdom: the body-mind’s trauma response. Developmental trauma states often became dissociated, precisely because attentive care wasn’t available. In that environment, dissociation was a kind of wisdom.
As a final example, imagine a client who feels compelled to dance in the session, believing it is a way of expressing and “clearing” their trauma. While such expression might clear a particular affect state in a particular moment, the practitioner working with complex trauma may examine their countertransference to understand what’s taking place beneath the surface. A compulsion to dance or move, especially with vigour, might point to a manic defence, or some other form of autoregulation developed in infancy. Healing such states requires a very different approach. If the impulse is taken at face value and not thought about, the developmental trauma may remain in place.
Of course, we all work differently — based on our own clinical development, our training and our supervision. It’s not my place to encourage a singular way of working; that would fly in the face of integrative practice. My case is more to advocate against the type of methodological certainty which makes us uncurious. And as is my bias, I’m particularly interested in stoking curiosity about relational depth.
what the theory already knew
Bion’s concept of beta elements — raw, unprocessed experience that hasn’t yet found symbolic form — is useful here, as a way which links relationship and dissociated material. Pre-symbolic material sits in the body because at the time of the original experience, the mind wasn’t yet capable of receiving it. The therapeutic task is to create conditions in which that material might eventually become thinkable.
But knowing this conceptually isn’t the same as being able to work with it. The theory describes the territory and that certainly helps. But the practitioner’s own depth of personal development — whatever form that takes — is what gives the relationship access to this material in the room.
Winnicott described what he called primitive agonies — the unthinkable anxieties of very early life: falling forever, having no relationship to the body, complete disorientation. States lived through before there was a self capable of knowing they were being lived through. The autonomic nervous system is active from very early life — there are threats here, but they are of a different order entirely. Not environmental danger in the ordinary sense but the raw archetypal dread of existence itself: annihilation, dissolution, the infantile terror that Klein mapped as paranoid-schizoid experience. Pre-personal territory, prior to any coherent self that could be regulated back to safety. What this material requires is a particular quality of containment — a mind capable of holding what the infant’s mind could not yet hold for itself.
This matters to our discussion. A client carrying something like falling forever is very unlikely to arrive with that as a reported experience, sensation or symptom. It might appear as a particular quality of absence in the room — an intuitive pull in the therapist toward something formless and as yet, unthought. Detection requires something closer to what Bion called reverie: a receptive quality of attention that can hold what hasn’t yet become experience. As I say, that capacity develops through the practitioner’s own depth of personal work — through having sat with their own unformed material long enough that formlessness becomes recognisable. And in my experience, it’s greatly informed by the therapist’s own embodied awareness.
Once detected, the work can draw on whatever the material actually needs. Pat Ogden’s reorienting technique — guiding the client toward a felt sense of ground in the body — can offer a genuine resolution of the specific somatic content of the agony. This is a corrective experience in the most literal sense: not uncovering ground that was always there, but providing, perhaps for the first time, the experience of being held. For that very young part, the ground wasn’t there. The somatic intervention gives it what was genuinely absent.
neither top/down nor bottom/up
None of this is an argument against somatic work, or polyvagal theory, or careful attention to nervous system states. The question is what we’re doing when we reach for them — whether the material calls for it, or because something in us needs the steadiness of a known technique.
Every modality has a shadow. The analytic practitioner who stays in the head. The somatic practitioner who stays in the body. The polyvagal-informed therapist who keeps their client within the window of tolerance so carefully that growth can’t happen. These aren’t criticisms of approaches. They’re descriptions of what happens when a way of working becomes a protective strategy. And we should be cautious: we don’t always know from outside a paradigm what a paradigm is actually doing. The need for humility applies to us all.
Attending to our countertransference is perhaps where this integration is most alive in practice. What arrives in our body in the room — the tightening, speeding up or being drawn in, the sudden tiredness, the unexpected image — is neither top down nor bottom up. It is both simultaneously. When we are attuned to ourselves, cognition and sensation co-arise. This is key. It’s when we hold that position, we’re at the precise point where clinical wisdom can get in.
Every context window: be it a framework, a paradigm, or AI chat, has its limits. What we can’t see from inside, we simply can’t see. The solution isn’t a better framework, it’s a willingness to notice that stuckness, to get curious, to notice ourselves, to move the relational stance.
Wisdom isn’t top down — a mind directing an unruly body. Nor is it bottom up — sensation rising to be decoded by a thinking mind. The body contains the mind. The two were never separate. Wisdom is what becomes possible when we stop insisting on the distinction — when we can receive what arrives through the whole instrument. And without holding onto whatever “sort of therapist” we might be trying to be.
Of course, that capacity develops slowly, through depth work and reflection. Through supervision and clinical “mistakes”. It’s a confidence that doesn’t need certainty. Simply, a willingness to remain present to what arises and follow it, wherever it needs to go.
Thanks for reading. If you’re an integrative psychotherapist in London and interested in deepening your practice around the topics discussed in this post, you might be interested in “Unlocking Transference and Countertransference”, a workshop I am running in April as part of my Relational Depth series.
For further details visit https://jaredgreenpsychotherapy.com/integrative-practice-workshops-in-london/.
Really great piece Jared