Barrett L. Dorko, P.T.
"Many layers of complexity cover both the integrity of ordinary people and the dissembling of cowards. In the most physical example, our relatively smooth skin hides a wondrously ordered intricacy within, from vessels and organs down to the "bare bones" of the framework. We then add cultural overlays, both physical and psychological, upon this biological barrier -- by clothing our physical nakedness (an image with deep roots in Genesis), and by masking our raw emotions with conventions of civility and decorum.
We cannot live (and society cannot function) without these covers, yet we also bemoan the sequestering of a supposedly true self."
Stephen Jay Gould, "On Common Ground"
I normally manage my patients by encouraging them to move in the way they truly desire. This sounds simple enough, but I find that many therapists struggle to sense that desire or, if they do, they don't trust it.
I've begun to use the quote above to help them understand that this handling, when successful, has reached through layers of anatomy and social convention. Our ability to do that requires understanding rather than skill, and I explain it in this way.
The first layer I deal with we might call physical decorum. In our culture there is a powerful (and growing) admonition to avoid any actual touching of strangers. Even the slightest bit of this is quickly followed by an apology from the toucher to the touchee. An equally powerful (and growing) convention is to physically pose whenever we might be observed. We feign calm when we are afraid, elevate our diaphragms though we would love to breathe freely, and hold ourselves erect even when it hurts to do so.
I feel that the only way to reach through these behaviors in others is to dispel them in ourselves. Somehow we must convey our own willingness to be touched. Beyond that, an absence of physical pretense in the therapist is essential for a presence that encourages others to be truly themselves. I find that some of my students maintain this from childhood, but that many others struggle to regain it.
Secondly, I conduct my manual care on people who are fully clothed. I do this because I found long ago that not removing the clothing promoted a willingness to move authentically that nakedness would destroy. While others insist that visual inspection and palpatory diagnosis are only adequately done while the patient is unclothed, I don't feel such testing is often reliable, valid or necessary. This is heresy, I know, but I've seen a few studies that bear this out.
In short, this "second Layer" of clothing doesn't inhibit my reaching toward the patient's center. In fact, its presence enhances my arrival there.
Although the skin is often thought of as the primary barrier to the internal organs, Montagu * reminds us that it is accurately considered the exposed nervous tissue. Since neural irritation is, in my experience, the most likely origin of pain, this last layer proves not to be something I need to traverse; I'm already where I need to go.
All that's left is to sense the instinctive correction inherent to all of us. It will emerge when therapists display a willingness to let themselves express it, and when they truly trust it to help.
*From Touching; The Human Significance of the Skin (Harper 1971)