This has probably happened to you on more than one bodywork session.
The client comes in and says:
- “I’m uncomfortable with people seeing my body.”
- Or, “I’m sure you’ve worked on people with a lot better bodies than mine.”
- Or, “I really dislike my (body part) and don’t want you working there.”
During the session they may say:
- “My body isn’t what it used to be. You should have seen me in college.”
- Or, “I’m sorry you have to work on me because I’m so fat.”
- Or, “I’m thinking about some plastic surgery. What do you think?
After the session they share past experiences of being shamed or being emotionally or physically traumatized.
Massage and other manual therapists as well as clinical somatic psychotherapists and others who work with the body such as conventional medical practitioners (nurses and physical therapists), personal trainers, yoga instructors, and dance therapists have all been taught to work on the body, but not that to do so is to work on the client’s consciousness as well. The body IS consciousness which means its owner experiences it as filled with meaning from life events, personal history, injuries, and the like.
What Is Body Image?
Body image is a cornerstone of personal identity and a very powerful motivator for behavior.
The most common model of embodied consciousness is the body schema/image. This is a unified experience—like two sides of the same coin—but divided by functional differences. The body schema is the actual experience of your body: feeling it, sensing it, seeing it, etc. Body image is the higher-order evaluation of that experience and what it means to the person. Body image is based on cognitive judgements, emotional responses, and behavioral actions.
As the above model clearly illustrates, body image and its many influences and dynamics can be an exceedingly complex concept. This model includes the cultural conditioning we receive regarding the male and female bodies and how they should be and act. Interpersonal influences are very powerful particularly the mother-daughter relationship along with family, friends, and intimate partners. The actual condition of the body including its strengths and weaknesses is a central component. Then there is the individual personality and how he or she perceives and judges their body. The lower half of the model shows the dynamics of what happens when having a particular experience related to the body image and how it is processed cognitively, emotionally, and behaviorally.
The body image is extremely sensitive, fragile, and easily changed. It often fluctuates throughout the day and a person may wake up feeling beautiful in the morning, but feel like the ugliest person on earth by bedtime. It all depends on many factors; both external and internal to a person.
The Vulnerability of Body Image to Dissatisfaction and Distortion
People are exposed on a daily basis to an endless parade of media images and social interactions reminding them about how their bodies deviate from the youthful, physically fit, and slim ideal. Depending on the ego-integrity and psychological resiliency of the person along with other mediating factors, the body image is affected leading to body image dissatisfaction or, worse, body image disturbance. Health body image is linked to a variety of positive emotions and behaviors. Unhealthy body image is linked to a variety of negative emotions and behaviors. These include general unhappiness, anxiety, depression, compulsive body-related behaviors, disordered eating, perfectionism, exercise dependence, “bigorexia” (muscle dysmorphia), sexual dissatisfaction, chronic pain and chronic health issues, posttraumatic stress disorder, body alteration, substance abuse, non-suicidal self injury, and suicide.
What Can You Do to Support Your Client… Without Going Out of Scope of Practice?
Honoring Scope of Practice
People talk about their bodies. What they are really talking about is their Body Relationship. The Body Relationship is the experience of having a body yet being somewhat separate or apart from it. The relationship comes about from the natural ability of human consciousness to self-reflect; to perceive a part of itself as an object. Listening to a person talk about their body and asking questions for them to elaborate further is a common occurrence. There is no therapeutic relationship for this activity. It’s just a conversation, but it is valuable for you as the body therapist to better understand the client’s Body Relationship. The problem becomes how to explore the relationship without going outside of scope of practice. Here are some essential rules. If you violate these, you are probably acting outside scope of practice.
- You are NOT a clinical somatic psychotherapist. You are a listener and witness.
- Don’t interpret, analyze, or diagnose.
- Don’t make any claims or promises.
- Do listen, question, and suggest helpful behaviors.
- Refer the client to a licensed health professional if you suspect there is a serious problem.
If you wish to go further, you can be a supportive coach, but this is a new professional relationship and should be presented and conducted accordingly. Outside of the bodywork session:
- Inform your client of the new service.
- Distinguish it from manual therapy relationship in writing.
- Conduct the coaching at a different time and place to keep it separate from the regular bodywork relationship.
Tools for Contemplating the Body Relationship
- Body Focusing Exercises
- Shavatraya 61-point body scan from Yoga.
- Mindfulness-Based Stress Reduction body scan.
- Somagram
- Hand-drawn picture of the person’s body with experiential issues marked in color.
- Self-Affirmations
- Positive body affirmations by Louise Hay are useful.
- Appreciation and Gratitude Exercises
- Body positive activities, guided imagery, meditation
- Breathing
- Yoga or qigong methods
- Stretching and Moving
- Yoga poses and Tai Chi Ch’uan movements
- Journaling exercises
- Body Image Discussion Group
Supporting your client’s healthy Body Relationship can be done on either a formal or informal level. It all depends on the amount of time you wish to devote to it.
Forthcoming
This topic and other related issues along with a larger exposition of scientifically-verified techniques is in process of being developed. If you are interested in learning more, please let us know so we may contact you when the more detailed work is available.
Paul Shane, Ph.D., LMT
Director, Academic Content
References
Cash, T. (2006). Body image and plastic surgery. In D. Sarwer, T. Pruzinsky, T. Cash, R. Goldwyn, J. Persing, & L. Whitaker (Eds.), Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery: Clinical, Empirical, and Ethical Perspectives (pp. 37–59). Philadelphia, PA: Lippincott Williams & Wilkins Publishers.