Case Example: The Felt Sense Can Release Physical Symptoms

Doralee Grindler Katonah, Psy.D., M.Dv.

There is so much we don’t know about physical disease. If we begin with the assumption that we are one whole organism that is an interaction with environment, culture, and spirit then physical disease is also in interaction as well. I want to highlight in this case example what can happen when we treat a physical symptom as a Felt Sense; i.e. the physical symptom carries bodily felt meanings that imply further living.

A 45-year-old man I will call John has been learning Focusing. He has recently returned from Arizona, where his father died and was buried. He is married with two children. He begins the session.

Client 1:  I didn’t feel like coming today. My chronic bronchitis is acting up again. I am so stuffy I can hardly breathe.  I’ve been living with this all day at work. I’m tired. I just want to go to bed.

Therapist 1:  So it’s important to allow that tiredness and stuffiness to be…to acknowledge in a gentle way that your body has been carrying this all day. And you are wondering whether you should have even come today…

Client 2:  Yes…(silence)…(deeper breaths, deep sighs)…It feels a little better just being with it.

In Client1 he is describing uncomfortable physical symptoms but he hasn’t yet brought his awareness into his body. In order to create an inner sense of being with his body as it is, I invited him to notice and acknowledge how it is in his body. Just this inner act brings a gentle movement or a shift from being stuck or static to an easing and more of an opening. In Client 2 the deep sighs and the deeper breathing express this easing. I notice this bodily communication, which tells me he is ready for a Felt Sense to begin to form.

Therapist 2:  Could you describe what that whole thing is like; living with this stuffiness - the chronic bronchitis…

In phrasing my question in this way, I am broadening the empathic field to include not only physical sensations and physical states, but also what it is like to live with the physical symptom. This will have many intricate aspects to it — his history, how it impacts his relationships, his daily living and much else. I am opening up the possibility that the physical symptoms have an edge, which will become a Felt Sense; in other words, I do not assume that this is purely a physical state but that it can also carry meaning. I phrase my invitation such that he can move from just talking about the physical distress to noticing what it is like to live with the chronic bronchitis. This phrasing points him towards his Felt Sense of “all about that.”

Client:  Well, I feel this tightness all up here (pointing to the sides of his nose) and I feel constrained here (placing arms over upper chest area)…it’s hard to breathe…

(SILENCE with a focused attention on chest area)…. And there is a kind of despair. 

I’ve had this problem ever since I was in junior high. It interfered with my playing sports…and…I just wish it would go away.

Therapist:  So there is this acute awareness of the physical tightness and constriction in breathing and then there is a kind of despair about how long you’ve been struggling with this…how it affected you as a youth…

Client:  (Nodding in silence, eyes closed)

Notice the movement that emerged as he attended in a nonjudgmental way to the physical symptom. He says: “And there is a kind of despair.” Notice his use of “kind of” — this phrasing expresses that he can sense there is a ‘more’ there beyond the single word ‘despair.’ This more that the word points to is the Felt Sense. This is concretely felt in the body but at first conceptually vague — there are no words yet. 

Therapist:  So we want to keep company with all of that…This is important. You first have to just be with the Felt Sense — the whole feel of it without words. And then more begins to come.

Client:  Yeah…and I think of my dad — he wasn’t around much back then and now he is dead. (There is sadness in his face and some tears.) He died so soon after I felt we were getting to know each other better.

Therapist:  So as you attend to your physical distress it brings up your dad…and sadness about his distance from you as a child and now about his death.

Client:  yeah…(deep breathing)…

He begins to connect his bronchitis to a longing for a better relationship with his dad as a child and now how his death is especially sad because they were finally becoming close. All of this is still just the beginning. What is felt on a bodily level still contains more than what has been said so far.  I want to help him continue to stay with the bodily Felt Sense…not just talk. Asking an open question is one way to invite the Felt Sense to speak, to form into words or images.

Therapist:  As you are sitting with your sadness and the tightness and difficulty breathing…perhaps you could sense into the tightness right now, asking inside what more is in the tightness and sadness now.

Client:  (Silence)…

Usually after asking an OPEN question, there is a time of waiting while attending to the Felt Sense…The Felt Sense opens in a slower time zone. The usual way we think fast doesn’t enable a Felt Sense to open.  A slowing down and just ‘being with,’ with no pressure for ‘answers’ is necessary for something to emerge from this felt level of experiencing.  

Client cont:  Oh, (deep sobs)…I’m remembering being in the hospital room and seeing how emaciated my father was…(sobs)…I didn’t want to see that… he used to be so strong and big… (sobs)…I felt so scared seeing him like that… This is my father… (deep sighs)…  (silence)…WOW!  I can’t believe all that came just now…I had to hold all that back before while at the hospital.  I knew I had to be strong for my family — my mother and children — so I blocked all that out…

T7:  Such relief now to let yourself really acknowledge what you felt seeing your dad so emaciated…seeing him dying…

C8:  Yes… (eyes brighten and for the first time he looks out at me)…I can’t believe it. My sinuses are all clear now.

Here a whole new experience emerged into full consciousness — but this doesnt say it quite, because until it emerged just now, he hadnt really been able to live this experience. It had been carried in his body but not known.  By letting it constellate as a Felt Sense and attending to it in such a way that language emerges directly, the body releases.  He is living this deeper meaning and breathing freely.

Excerpted from:  Grindler Katonah, D. 2006.  The Felt Sense as Avenue of Human Experiencing for Integrative Growth. In:  Hoshmand, L. T. (Editor).  Culture, psychotherapy and counseling Critical and integrative perspectives.  Sage Publications, Thousand Oaks, CA.  pp. 81-84.