The evidence base for Body Psychotherapy

In this section
Bibliography

Preamble

Psychotherapy research in general terms is a relatively young and fairly controversial scientific discipline; the questions as to whether the notion of “Empirically Supported Treatments / ESTs” or even “Evidence Based Treatment” can be applied remains a subject for intensive debate within the psychotherapy community.

Lambert (2011) emphasised major goals of psychotherapy research as an applied clinical science, namely, “protecting and promoting the welfare of the client by identifying the principles and procedures that enhance positive outcomes”.  The literature on the history of psychotherapy research usually distinguishes between four phases, beginning with the systematic case study approach introduced by Sigmund Freud in the 1920s.  The first systematic outcome studies were conducted by Carl Rogers and team in the 1950s with an emphasis on psychotherapy processes, as well as conceptual issues in psychotherapy.  From 1970 onwards, the focus shifted towards establishing specific effects of psychotherapy interventions in treatment-outcome studies, culminating in the famous ‘Dodo-Bird-Verdict’: “At last the Dodo said, ‘Everybody has won, and all must have prizes” (from Alice in Wonderland). This verdict considers decades of large-scale, so-called “meta-analytic” studies, suggesting that although psychotherapy is effective, no single approach is consistently more effective than another (Luborsky et al., 1975; Smith & Glass, 1977; Wampold & Imel, 2015). Other researchers, predominantly those representing Cognitive-Behaviour Therapy, concluded their studies as supporting modality specific evidence (e.g. Chambless & Ollendick, 2001).  From about the mid-1980s however, the perspectives in psychotherapy research shifted, and is now characterized by an intensive effort to distinguish general and specific psychotherapy process and change factors in the context of mixed-method (qualitative and quantitative) research approaches (see Laska et al., 2014).

The contemporary discourse in psychotherapy research has therefore emphasized the importance of context factors such as: intercultural issues, client-therapist interaction, the matter of choice (matching of therapist-client perspectives), as well as the transfer of experiences from psychotherapy into day-to-day life.  From a perspective of Body Psychotherapy (BPT), it is furthermore important to acknowledge the growing influence of a theory paradigm shifts towards a notion of embodied cognition in psychology, philosophy and corresponding findings in (affective) neurosciences (e.g., Panksepp, 2004) and neuropsychology (e.g., Schore, 2012), emphasizing the crucial role of creative, embodied engagement as well as emotional regulation and corresponding resource-oriented, approaches in psychotherapy.

Some additional dimensions have to be considered for BPT: the embodied and experiential nature at the core of the psychotherapeutic process in BPT, the interactive, participatory therapeutic relationship as well as the interface between subjective feeling states/affect regulation and movement behaviour – all these aspects, specific for the work in BPT, make it difficult to apply EST criteria to determine an evidence-base for efficacy and effectiveness.  Tantia (2019) accordingly suggested to extend the research perspective in Body Psychotherapy and introduce a “somatically informed paradigm”.

For the purpose of this EABP website section, we however decided to group the literature according to a standard approach, because we came to the view that the EABP website, as an outward facing information platform, and for those who are not familiar with the specific Body Psychotherapy modality, will benefit from a summary that can be compared with other psychotherapy modalities.

We would like to however clearly state, that we agree with the critical appraisal of the state of the art in psychotherapy research, i.e. supporting the notion that a wider and methodologically equivalent perspective should be considered whilst determining as to how and to what extent Body Psychotherapy “works” for the people that come to seek support and help provided by our Body Psychotherapy colleagues. After all, and as emphasised by Leichsenring et al. (2014): “Plurality and Diversity Matters”, not only in psychotherapy research but also for clinical practice.

Frank Röhricht (on behalf of the EABP Science & Research Committee (SRC))

Introduction & Background

There are very many different types (methods or modalities) of Body (or Body-Oriented) Psychotherapies and/or Somatic Psychotherapies: [[1]] some of these are ‘intervention’ techniques or body-therapies that have added on (or integrated) a psychotherapy training component and not many of these Body Psychotherapy methods or modalities have been subjected to any form of proper ‘scientific’ evaluation (i.e., their ‘efficacy’ and ‘effectiveness’ has not been established), but this does not mean that they are not effective or efficacious: these have yet to be established.

However, Body Psychotherapy itself (as a mainstream branch of psychotherapy) has been validated as a scientifically validated and sufficiently ‘grounded’ form of psychotherapy by the European Association of Psychotherapy (EAP); and several of the Body Psychotherapy modalities have also independently gone through the EAP’s “Scientific Validation” process. [[2]] This ‘scientific validation’ process involves making substantive answers to the EAP’s “15 Questions on Scientific Validity”. [[3]]

The current ‘evidence-base’ of Body Psychotherapy (as shown here) does not differentiate between the different types of Body Psychotherapy [[4]] – although some studies refer to just one (e.g., Bioenergetic Analysis); nor does it differentiate between qualitative or quantitative research or different types of research: both can be valid, if the design is appropriate and applicable to Body Psychotherapy.

‘Science’ requires the establishment of measurable standards and values. [[5]]  Nearly all the different theories, methods and modalities of Body Psychotherapy (in Europe) now have similar standards of training (see EABP Training Standards [[6]]), with increasingly ‘core’ elements in their curricula, common theoretical grounds and underpinning (see: Marlock, Weiss, Young & Soth, 2015), and they are also developing similar professional competencies.

The listing of ‘The Evidence-Base of Body Psychotherapy’ here is a result of an extensive and informed search strategy of members of the EABP’s Science & Research Committee (SRC) with submissions from EABP members and others; it is not based upon a systematic review of all available literature and we may have therefore missed out some publications.  There are – obviously – many more other Body Psychotherapy research articles ‘out there’ (many in non-English languages; many confined to specific universities or training schools); so – if anyone reading this is aware of any other similar studies that may be relevant and have been over-looked or left out of this listing – then we ask you to send us the details and then we can / will check them out and add them in to this ‘evidence-base’.

[1]  It should also be noted that all the methods or modalities of Body Psychotherapy are all very different and distinct from the wide variety of (bodily-oriented) physical therapies (e.g. massage, yoga, Feldenkrais, Rolfing, Alexander Technique, Hellerwork, etc.), which do not incorporate any training in psychotherapy.

[2]  For generalized information about the Scientific Validity of Body Psychotherapy (in accordance with the EAP’s 15 Questions about Scientific Validity) (see here): and for the (1999) responses from EABP about the Scientific Validity of Body Psychotherapy – as a mainstream branch of psychotherapy (see here). 

[3]  EAP’s 15 Questions on Scientific Validity: https://www.europsyche.org/app/uploads/2020/06/EAP_15_Questions.pdf

[4] Some of the different Body Psychotherapy modalities include: Ola Raknes’ ‘Character Analytic Vegetotherapy’; Reich’s ‘Orgonomic Therapy’; Alexander Lowen’s ‘Bioenergetic Analysis’; John Pierrakos’ ‘Core Energetics’; David Boadella’s ‘Biosynthesis’; Gerda Boyesen’s ‘Biodynamic Psychotherapy’; Ron Kurtz’s ‘Hakomi’; Charles (Chuck) Kelley’s ‘Radix Therapy’; Jay Stattman’s ‘Unitive Psychotherapy’; Paul Boyesen’s ‘Psycho-Organic Analysis’; Ilana Rubenfeld’s ‘Rubenfeld Synergy’; Lisbeth Marcher’s ‘Bodynamic Psychotherapy’; Jack Lee Rosenberg’s ‘Integrative Body Psychotherapy’; Pat Ogden’s ‘Sensorimotor Psychotherapy’; Peter Levine’s ‘Somatic Experiencing’; Christine Caldwell’s ‘Moving Circle Psychotherapy’; Susan Aposhyan’s ‘Body-Mind Psychotherapy’; Nick Totton’s ‘Embodied Relational Psychotherapy’; the Chiron Centre’s ‘Contemporary Body Psychotherapy’; etc., etc.

[5] Theoretical propositions consist of relationships between abstract constructs.  Testing theories (i.e., theoretical propositions) require measuring these constructs accurately, correctly, and in a scientific manner, before the strength of their relationships can be tested.  Measurement refers to careful, deliberate observations of the real world and is the essence of empirical research.  While some constructs in social science research, such as a person’s age, height, weight or something’s size, may be easy to measure, other constructs, such as creativity, prejudice or alienation, may be considerably harder to measure.

[6] EABP Body Psychotherapy Training Standards: https://eabp.org/training-standards

Collected and collated by: Courtenay Young & Frank Röhricht (EABP SRC): Sept. 2021.

  1. It should also be noted that all the methods or modalities of Body Psychotherapy are all very different and distinct from the wide variety of (bodily-oriented) physical therapies (e.g. massage, yoga, Feldenkrais, Rolfing, Alexander Technique, Hellerwork, etc.), which do not incorporate any training in psychotherapy.
  2. For the (1999) responses from EABP about the Scientific Validity of Body Psychotherapy as a mainstream branch of psychotherapy (see here).
  3. EAP’s 15 Questions on Scientific Validity: https://www.europsyche.org/app/uploads/2020/06/EAP_15_Questions.pdf
  4. Some of the different Body Psychotherapy modalities include: Ola Raknes’ ‘Character Analytic Vegetotherapy’; Reich’s ‘Orgonomic Therapy’; Alexander Lowen’s ‘Bioenergetic Analysis’; John Pierrakos’ ‘Core Energetics’; David Boadella’s ‘Biosynthesis’; Gerda Boyesen’s ‘Biodynamic Psychotherapy’; Ron Kurtz’s ‘Hakomi’; Charles (Chuck) Kelley’s ‘Radix Therapy’; Jay Stattman’s ‘Unitive Psychotherapy’; Paul Boyesen’s ‘Psycho-Organic Analysis’; Ilana Rubenfeld’s ‘Rubenfeld Synergy’; Lisbeth Marcher’s ‘Bodynamic Psychotherapy’; Jack Lee Rosenberg’s ‘Integrative Body Psychotherapy’; Pat Ogden’s ‘Sensorimotor Psychotherapy’; Peter Levine’s ‘Somatic Experiencing’; Christine Caldwell’s ‘Moving Circle Psychotherapy’; Susan Aposhyan’s ‘Body-Mind Psychotherapy’; Nick Totton’s ‘Embodied Relational Psychotherapy’; the Chiron Centre’s ‘Contemporary Body Psychotherapy’; etc., etc.
  5. Theoretical propositions consist of relationships between abstract constructs. Testing theories (i.e., theoretical propositions) require measuring these constructs accurately, correctly, and in a scientific manner, before the strength of their relationships can be tested. Measurement refers to careful, deliberate observations of the real world and is the essence of empirical research. While some constructs in social science research, such as a person’s age, height, weight or something’s size, may be easy to measure, other constructs, such as creativity, prejudice or alienation, may be considerably harder to measure.
  6. EABP Body Psychotherapy Training Standards: https://eabp.org/training-standards

 

References to above:

Chambless, D.L. & Ollendick, T.H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52(1), 685-716.

Lambert, M.J. & Barley, D.E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357.

Laska, K.M., Gurman, A.S. & Wampold, B.E. (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy, 51(4), 467.

Leichsenring, F., Abbass, A., Hilsenroth, M.J., Luyten, P., Munder, T., Rabung, S. & Steinert, C. (2018). “Gold standards”, plurality and monocultures: The need for diversity in psychotherapy. Frontiers in Psychiatry, 9, 159.

Lipsey, M.W. & Wilson, D.B. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 48(12), 1181–1209.

Luborsky, L., Singer, B. & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that everyone has won and all must have prizes? Archives of General Psychiatry, 32(8), 995–1008.

Marlock, G., Weiss, H., Young, C. & Soth, M. (2015). The Handbook of Body Psychotherapy & Somatic Psychology. Berkeley, CA: North Atlantic Books.

Panksepp, J. (2004). Affective Neuroscience: The foundations of human and animal emotions. Oxford University Press.

Schore, A. (2012). The Science of the Art of Psychotherapy. New York: W.W. Norton & Company.

Smith, M.L. & Glass, G.V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32(9), 752–760.

Tantia, J.F. (2019). Toward a Somatically-Informed Paradigm in Embodied Research. International Journal of Body Psychotherapy, 18, 134-145.

Wampold, B.E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277.

“The heterogeneous field of Body Oriented Psychotherapy (BOP) provides a range of unique contributions for the treatment of mental disorders.  Practice based clinical evidence and a few empirical studies point towards good efficacy of these non-verbal intervention strategies.  This is particularly relevant for those disorders with body image aberration and other body-related psychopathology, but also for mental disorders with limited treatment response to traditional talking therapies, e.g. somatoform disorders, medically unexplained syndromes, PTSD, anorexia nervosa or chronic schizophrenia.  However, the evidence base is not yet sufficiently developed in order to get BOP recognised as suitable mainstream treatment by national health services and their commissioning bodies.  Strong academic links are urgently required in order to support practitioners in their efforts to evaluate the clinical work in systematic research.  The field would greatly benefit from the development of international higher education training in integrated clinical body psychotherapy, enabling practitioners to obtain a master’s degree.  From a scientific perspective, projects on the interface between neuroscience and psychotherapy research should be conducted in order to understand more fully the therapeutic processes in BOP, particularly with regard to emotional processing, movement behaviour and body- & self-perception.  Qualitative research is needed to further investigate the specific interactive therapeutic relationship, the dynamics of touch in psychotherapy and the additional self-helping potential of creative/arts therapy components.  Provided that these requirements will be fulfilled, BOP could be established as one of the main psychotherapeutic modalities in clinical care, alongside other mainstream schools such as psychodynamic, cognitive-behavioural and systemic.”

(Abstract in (3) Frank Röhricht, 2009)

 Note: Currently, we cannot store copies of all available texts on the EABP website.  So, Links (are to another website’s listing), Abstracts and Downloads (to an abstract or download of the full text): these are – of course – dependent on another organisation’s website maintaining accessibility to these references.

The List

You can download the list at The Evidence-Base for Body Psychotherapy Dec 2022 (Update)