“Body Psychotherapy – A brief report of an experience with Subtle Touch and Calatonia at a county Health Clinic in the periphery of São Paulo“ – by Rita de Cássia Hetem Assaly

In 1991, I began to work in a county Health Unit in the south region of the suburbs of São Paulo, an area of great poverty and lack of basic resources and services. Upon starting, I hoped to rediscover psychology and break free form the academic restrictions, which would make my work impossible. 

Offering relaxation and bodywork, both individually and in group therapy, allowed for a clinical experience that was both pleasurable and versatile. My report testifies to the demand and effectiveness of bodywork in helping patients who are primarily only semi-literate, and living below the poverty line, wherein intense life conflicts exist and basic survival needs are not met. 

Initially, there was the lack of appropriate physical space, and lack of information about the nature of a psychotherapist’s work, not only by the population being served but also by some of the staff members. I had to specify the services, identify and create a clientele. As a Jungian body psychotherapist, it was important to offer bodywork in my practice. As soon as I could, I requested a camp bed in my office. 

The Health clinic was housed in a townhouse, with trash spread on a vacant lot on the left side. In the front, there were walls with old painting and a dark and humid mildew. Early in the morning, a large group of people lined up downstairs, wearing plain rubber sandals and carrying children in their arms, protesting against or thanking the staff in loud voices, causing the environment to be confusing and, at the same time, stimulating. 

My soon to be office was a small room, which accommodated closed files, and smelled of mildew. There were piles of old newspapers and discarded papers and files on the floor, no shelves or closets. Wow!
The office manager, very accessible, took the initiative to renovate my office, and during the fifteen days of the renovation I used the time to get to know the staff, the routine of the clinic, as well as the surroundings which included the daycare, the school, and churches of the area. I discovered that everyday people struggled to survive, “milking rocks”. I saw the oppression of this village, poor and violent, where survival seemed to be beyond therapy. 

Life was extrevely chaotic even surrealist, making me doubt the value of a symbolic interpretation of such a situation. Every week, someone was killed and found on the streets of the village; some children prostituted at their parents’ reques t in order to increase the family’s income; families of five or six people lived in one room, all sleeping in the same bed. In the village, the agencies and institutions were not able to abide by the rules, as some patients would threaten them with guns to guarantee their appointment in the clinic or a spot in the school. 

Those situations were not the rule, but were routine. I was never confronted with those kinds of threats and pressure, as I always treated the population with respect. In addition, I was not in the same position as a medical doctor, who had to attend to a patient every five minutes, or the staff member in charge of distributing the formula for babies, who got blamed for not having enough supply. 

Still, the doctors had a long line of afflicted walk-in patients, hoping for the luxury of an appointment. 
However, my office was ready after the renovation and it was time to work. I organized an agenda, screening day, treatment day, visits to schools and daycares, etc. What a great experience in my life!
“Psychotherapist? What is it?” people asked. “I came because the doctor told me to…” “What is a psychotherapist?”

Most staff members at the clinic did not understand what a “doctor” without a doctor’s jacket and medical devices, someone who in fact could not write a prescription, was doing at the clinic. There was not another mental health professional at the clinic, except for a social worker, who did case management only. How to explain therapy?

Soon they understood that I was a “doctor” who conversed; my appointments were longer, and – surprise – on time. Patients could come more often than once every two months; in fact, they could come weekly at the same time, without having to wait at the front desk to set up their next appointment. 

I explained the bodywork in a simple manner, and offered it in the second session. And they liked it! In the first session, I asked them to bring a bed sheet to our next session, or a towel, because the clinic could not offer that luxury. And they brought it. 

“Aren’t you going to examine me?”

“No, but in the next session, I would like to give you a relaxation. You will have to lie down and allow me to touch your feet, and I will ask you later how it felt to you.”

“But the church says we cannot be relaxed!”

“Oh, it is not about being lazy. Relaxed is different; to relax means to become calmer, without the use of medication.” 

I used mostly the Calatonia, an effective and simple technique, consisting of touches to the feet and calves, excellent for reconditioning the muscular and affective tone, among other results. 

Once, while I was telling a patient what to bring for her second session, she told me:

“I already brought it today. Here it is”, and showed me a bed sheet. It was her first session; I did not understand how she figured that out. 

“How come? Did you bring a bed sheet to the health clinic?”

“Yes.” 

“Did you know I was going to ask for it?”

“No.” 

“Do you always bring it with you?”

“No. I was ironing clothes, and it was time to come here. I said to myself, ‘I will take a bed sheet with me’, and I brought it.”

I was shocked. “Well, we will start the relaxation today, then. What do you think?” I thought such a coincidence had to be honored, and in fact, it did not seem to be a coincidence, but an intuition. 

“O.K.”, she said. 

After the Calatonia (I performed it standing up due to the height of the camp bed), I felt difficulty walking. My right hip and femur joint would not respond and even hurt a bit. I had to support myself at my desk to avoid a fall. The patient, who had sat up, observed my difficulty and commented, “Doc, I am the one suffering from an accident and you are the one feeling it?”

“Accident? What accident?”

She reported to me that she was run over with her son by her side, by the daycare driver, who was drunk, about six months ago. She told me she threw herself over her son to protect him, and suffered a fracture of her right femur and hip, having to stay immobilized for a few months. She had not told me that during the intake. 

In bodywork, there are some precious experiences. At times, the breathing or cardiac rhythm of patient and therapist resonate in tune, giving us subtle information about ourselves or the patients. It is a valuable mode of contact and learning, such as the one that happened with that particular patient. 

Slowly, case by case, I sensed the possibility of creating a group for relaxation and bodywork. The patients accepted and treasured it. Predominantly, the clientele was women, homemakers, and a couple of teenagers here and there (I had no materials to work with children). Some women asked whether their husband or children could join them in the group; however, their work schedule was a hindrance. It presented a new possibility, though. Maybe the women could work with their families, to help them relax, if they learned appropriate techniques. But, where? 

In my past explorations of the surroundings of the clinic, I came across a church nearby, whose “owner”, Mr. Onofre, was one of the positive leaderships of the village. Mr. Onofre was considered the “owner” because he had worked on getting the funds through some politicians to build the church. He then became responsible for the maintenance and management of the building. I requested the use of the church to teach relaxation groups, after receiving clearance from my supervisors, and Mr. Onofre kindly agreed to it. 

I brought a large ‘left over’ piece of my home carpet to use as a protection against the cold tile floor of the church. We were set to start our first relaxation group in March of 1992. The patients had their towels in hand, and followed me to the church, between curious and excited. For them, the group work seemed like an event. I took advantage of the opportunity to talk about the functioning of the body, showing them pictures. For instance, during a feet massage, which they exchanged among themselves, they had an opportunity to look at the pictures of the skeleton bones of the feet. It caused them a moment of awe. In due time, other ‘attractions’ were revealed: the spine, the stomach, the uterus and the position of babies inside it. Each bodywork triggered questions and vice-versa. 

Other people became interested in participating in the groups, through the word of mouth enthusiasm of former patients, and we had to adapt to the demand. I tried open groups, closed, women only, children, etc. In average, each group (or group cycle) lasted about four weeks. 

It was not easy to handle patients whose problems were so diverse. We had people who had attempted suicide, others suffering form loss of a child, preteens in charge of three of four siblings, etc. However, due to a constricted schedule, and the impossibility of opening new groups, I took the risk of working with them all in one group. Although it was not easy to keep the cohesiveness, my feeling was that it could be a healthy opportunity for all. And in fact, it was a positive experience for the majority of the patients. 

I worked at this site for two years, and the bodywork groups were a successful and treasured experience. The memories about them are very rich, varied and surprising. Many patients gained new insights and new pace in life through the bodywork, whether done individually or in group, which led to new pathways in their lives. 

I remember particularly one patient, a thirty-four-year old female, who was brought by her husband. She had lost two children, ages two and seven, to a chicken-pox that caused them meningitis, just a month prior to our appointment. She was left with a four-year-old son. Obviously, she was deeply depressed, and did not want to talk. I insisted that she participate in the group, despite the fact that she would meet some women who had been voluntarily sterilized. 

I don’t recall any specific intervention I used with her in the group. After a few months, however, she “came up with a few topics” to talk about in individual sessions, and she accepted bodywork regularly, particularly Calatonia. She began to reorganize her life. She moved to another house, started to make homemade chocolate candies to sell, accompanied her son to the school, and regained her passion for her husband. I did not have a measure of the importance of our work for her, until she brought me a dream: “I was traveling by bus in a road. Then an accident happened. When I saw, a coffin had fallen on me, the tip of it right on top of my heart. I was desperate, and could not leave or move. Then, you came and took the coffin off me.” 

I did not know what to say. She immediately began to cry (it had never happened before in our sessions) and she hugged me tightly, “God bless you.” 

I know well that I did not remove anything off anybody and that between my will to help and ingenuity I was able to utilize a resource, the subtle bodywork, of which impact is hard to evaluate and describe, at times.