It is with pleasure I respond, as a psychiatrist and a psychoanalyst in training to the two lovely case studies Gal has brought us. Gal's helping profession is in movement, the body itself, where the primary unconscious processes are the dominant ones. I did my first bout of Alexander Technique when 16, not a child but not an adult yet, and since then have worked with the Technique as a student for various but long periods of time. I still carry in my mind the comment from an observer about how fast my basic posture changed during that first series, although (or perhaps because?) then I never understood anything about the Technique. As an adult my unconscious processes are both more protected from conscious intervention, and more deeply ingrained – after a new “letting go” my unconscious holding of the body snaps back quickly into “the correct place”. I am convinced my conscious use of direction, while helpful, does not compensate for the greater accessibility of childhood. These cases bring us a large measure of hope in helping children like Maor and Hagit, and illustrate some common basic principles of the helping professions.
Among Gal's explanation of his use of the Technique are precise descriptions of the absolutely necessary and basic elements of psychic help. He writes: I must stress that I do not work with the intention to achieve direct results, but with a clear view of the conditions which make it possible to reach results, a view that is centered on processes and not on results. This basic principle is keeping the principles in mind, or in a psychic sense -keeping the primary direction in mind. It is all too easy to lose it under the details of living and working. The second basic principle underlying the help is a firm trust of the therapist in a inherent drive toward health and maturation - in Alexander Technique it would appear to be “the primary control or direction” whose free expression is lost as part of the reaction to the external world. The third principle is the acceptance and the interest in the child as he is, not in his problem. “ The trust must enable the child to feel that he will continue to be o.k. in the eyes of the adult who is working with him, that is to say, that he will continue to be loved and accepted as he was before he agreed to write in the new way, even should he fail” (My emphasis) . Implicated in this sentence is the understanding that the child must feel loved and accepted as he is, and not feel that in the eyes of the adult working with him, he is a problem to be fixed. When a patient or child feels this, he can trust that the basic intentions of the helper are for his personal good, and not for the good of a principle or person other than himself. This is stated again in the story of Maor, a heart wrenching story. The situation of children exposed to medical care from very early on is well known to pediatricians. The “White Coat Phobia”, was sufficiently common for pediatricians to have stopped wearing white coats as a matter as course. Maor took the phobia one step more, becoming phobic to all touch thereby cutting himself off from the holding he needed to grow happily.
Having said “holding” I will continue and say that Gal's case work brings very clearly to mind Winnicott's work, most especially the concept of the non- impinging environment. In this environment the child is free to develop in line with his inner potential without reacting overly to the environment. Gal tells us how gently, with no hurrying at all, attentive to the mother's and child's pace, “when they seemed comfortable” he started his work. This waiting for the time to intervene when it is appropriate for the child is crucial – this is the non-impinging intervention (fourth principle). This way the child can accept the touch of the other as something that need not be defended against automatically but may be perceived neutrally, and may perhaps accepted, perhaps not, allowing the child freedom. Thus Maor could accept Gal's touch, and give himself the experience that not all touch is painful.
With hopes that all of us experience touch without pain, I thank Gal Ben-Or and Paul Cook for inviting me to contribute to this fascinating exploration of clinical work.
Sarah Kandel Katzenelson, MD