The Author acknowledges Mrs. Lea Schwarcz for the English Translation of this paper from its original publication in:

* Ciência e Cultura, 37 (12), Dezembro 1985: 2007-2012 
Journal of The Brazilian Society for the Advance of Science. 
Sao Paulo, Brazil.

ABSTRACT. The Calatonia method in psychotherapy. Calatonia is a method of relaxation proposed by Sandor that makes use of soft touches applied upon the patient’s skin, in association with psychotherapy. The three Calatonia techniques are briefly described and commented emphasizing its relations with the analytical process, the psychophysiological reorganizations and the posture alterations. The Calatonia induced responses are partially due to the kinesiological factors mobilized by the soft touches as thou to the sensations, affects, images and ideas arisen by tactile stimulation. In any of these categories, the patient’s reactions to the method cannot be viewed only as psychophysiological reconditionning but foremost as an holistic existencial reavaluations.

History

Calatonia is a relaxation method proposed by Sandor (7, 8) consisting of three techniques to be used in association with psychotherapy. Sandor started to elaborate his method from observations in Red Cross hospitals, before and during II World War. The method was further developed and influenced by his clinical experience in Brazil .

The method’s basic .technique, also known as ‘calatonia’, was first presented to the public during an event held by the Sociedade de Psicologia de Sao Paulo , in 1969.

Although the basic technique was being then publicly shown for the first time, it had already been applied by several professionals in Sao Paulo . Thus, an the same occasion, Mauro (2) and De Santis (3) presented their clinical experiences using the technique an adults associated to psychotherapy. More recently, the latter also demonstrated the use of Calatonia in child psychotherapy (4). Following the same line, Penna reported the case of a five year old girl, whose excessive oral tension had resulted in a grave temporo-mandibular articulation syndrome from which she recovered through Calatonia applied together with Jungian psychotherapy. The same author has proposed some principles for the evaluation of Calatonia within a theoretical context in its basic modality (5).

Although reports published so far represent a very small number of the clinical experiences conducted by professionals who use the method, there are at present several other cases being reported orally. During the last years, the method has been divulged through specialization courses (6) and study groups, held by Sandor or by his collaborators, in the university as well as in private clinics.

The Method’s Objective

In a wider scope, the method’s aim is to reach an ample existential revaluation and was planned to achieve this in integration with psycho therapy. Seen from an operational angle, the method’s objective is to regulate the psychomotor tonus, seeking the patient’s psychophysiologic reconditioning through light tactile stimulation applied upon certain parts of the body.

Its effects may be observed on posture planning, which results from the regulation of visceral and skeletal muscle groups, as well as liberation of body motion and the expansion of proprioceptive sensibility. With a better knowledge of his body, the subject may then reevaluate his bodily expressions and elaborate a language of his symptoms. According to Sandor (7), the unconscious contents associated to psychophysiological disorders appear as images, memories and dreams, reflecting the present moment of a person’s life. Whenever they appear, these products of the deeper layers of personality are attended to and worked in the analytical process, without guiding or forcing them into pre-established interpretation patterns, giving them an adequate dimension of depth.

Calatonia enables thus the widening of the inner world and an opening for reception of the symbols of body representations. The intellectual and ideative functions are also set in motion, resulting in an ample process of transformation directly manifested in the improvement of interpersonal relationships.

At present the method consists of three techniques. The first one, originally introduced as ‘calatonia’, and two other, which should be considered as extensions of the basic technique: Fractioned Decompression, and Readjustment Touches an Points of Support. All three techniques have in common the light manner in which the tactile stimulation is applied, besides the general principle of its use in the analytical process. However, within certain ethical criteria, the basic technique has also been used in medical practice, phonoaudiology and physiotherapy, as well as in rehabilitation and occupational therapy (personal reports) Also, several experiments are being presently developed with this technique in community centers (prisons, nurseries, schools, and hospitals) where reports (personal) indicate very promising results.

The Basic Technique

The use of Calatonia in its basic modality, consists of a sequence of nine light and monotonous touches, applied on the body’s extremities skin. Following therapeutic criteria, eitheir the area of feet and heels, or the area of hands and wrists may be chosen. Preferably, Calatonia is applied an the distal extremities, following the rules described by Sandor. (8)

To apply the method, the patient should lie on his back with arms lying loosely along the body. It is suggested that he close his eyes, however they may be kept open if the patient wishes. The therapist asks him to accept the changes that may occur in his general condition, trying not to interfere, just “let things happen”. The therapist sits at the foot of the couch and, very gently, touches the patient’s feet neither massaging, nor moving or pressing, just keeping up a subtle touch. The contact area is located on the distal phalanges, more precisely at the basis of the nail, placing the thumb on the back of the toe, upon the pulp. Each contact is made simultaneously on both feet, in a quiet and uniform manner, for approximately three minutes. To return from the state of relaxation, we ask the patient to move his fingers, sway his head slowly, open and close his eyes, take a deep breath and stretch himself before rising.

The effects produced by Calatonia in its basic modality, already clinically studied, show that its peculiarity lies in the range of the tactile stimulation of the feet, performed within a therapeutic relationship. This condition emphasizes the empathic qualities of the light touch upon the skin, besides the symbolic aspects of the feet in the body image. We consider that the feet, being the lowest part of the human body, may be analogous to the basic contents of the personality, along with the legs and pelvis. On the other hand, the feet have been regarded as the symbol of the human soul (9) and the place where projection of the child contents (10)occur. Such symbolisms are widely spread and it may be observed that the contents projected upon the body’s lower extremities are also present in the myths of Saci Perere, Curupira and Mapinguaris which, in Brazilian folklore, are considered nature’s protective entities (11).

On the other hand, space holds symbolic connotations resulting from the analogy we establish between parts of our body and the environment. These elements of psychic nature are at the origin of the perceptive processes and the relationship created by human beings with the main spatial dimensions. This fact has already been used in several tests, such as: the Drawing of the Human Figure, the Tree Test and the Rorschach. The feet connect the human being to the ground, with the earth, which not only supports him, but attracts him downward.

It is of course up to the therapist to define the individual or collective reach of the contents which originate from the calatonic stimulation. Whichever way he chooses, however, his interpretation is a privileged moment of the session. It may not be always opportune to interpret the images obtained during relaxation, and in some cases the mere verbalization by the patient is sufficiently elaborated, being also a victory over his resistance.

Fractioned Decompression

Fractioned Decompression, as well as Readjustment Touch on Supporting Points, was planned to be used in sequence to the basic technique. Its objective is also to demobilize the nucleii of corporal tensions and stimulate self-regulation at psychophysiological levels, contributing simultaneously to the manifestation of underlying affective and ideative contents. While the basic technique stimulates the subject starting from his extremities for nearly half-an-hour, in this modality stimulation can be made in practically all parts of the body, over a short period of time in each area.

The therapist keeps up a certain pressure with the palms of his hands or fingertips upon selected points of the person’s body, modulating this contact during subject’s nine breathing cycles. Pressure is applied so that the patient is clearly aware of the contact during three expirations. At the fourth, decompression begins during three more full breathing cycles. Finally, without removing his hands completely, the therapist maintains for three further cycles a lightly perceptible touch.

The patient’s breathing should be carefully watched at each moment of decompression in order to apply it when the patient is exhaling. The therapist must also be very conscious of his own state, so as to relax the tension levels, particularly of arms and hands.

The effects of Fractioned Decompression are usually a loosening of the areas where the touch was applied and, generally, surrounding areas, followed by a sensation of warmth. Frequently the memory of former contacts on the same areas and a desire to fulfill those incomplete or frustrating experiences may arise. These conditions are sometimes spontaneously projected upon the therapist, while the patient creates certain expectations which normally disappear in the course of the treatment. It should always be kept in mind that at the same time the therapist applies the touch he is also being touched, though apparently in a passive way. His reactions, at least potentially, may be analogous to those of the patient. This is partly due to the quality of proximity and immediacy of tactile stimulation which subjects the two persons involved to similar processes of identification and projection.

Readjustment Touches on Points of Support

Readjustment Touches on Points of Support are applied very lightly, preferably on body articulations, for approximately three minutes.

Depending on the articulation, contact is made with one or more fingers, or both hands, touching simultaneously parallel areas of the patient’s body. For instance, the touch on the knees is performed by placing the fingertips of each hand around the kneecaps. The patient remains in a sitting position with legs stretched out while the therapist, seated in front of him, applies the touches softly, watching the subject’s reactions.

The most evident effect of this type of contact is to loosen the mobile articulations (amphiarthrosis and diarthrosis) causing a gradual loosening of postural supporting points. By reducing tension levels in the stimulated articulation, a predominance of the gravitational pull will be felt, causing a still greater relaxation. For this reason, there is always a couch or some cushions near the patient, so that if necessary he may peacefully relax.

It is the patient’s former tensional state that shall determine the necessary postural readjustment. However, it is possible to observe a reflexive respiratory response after the touch, followed by the relaxation of groups of fibers, or even whole groups of muscles. These reactions lead to a partial liberation of the body in space, and symmetrical parts recover their balance and align themselves more harmoniously. On other occasions, when readjustment reaches more extensive muscular areas, we may practically observe a “melting” of posture, the whole body loosens up and the patient falls in a state of deep relaxation. It is common in such moments to occur a certain perception of the readjustment process which is proposed to the patient’s mind through various images, sometimes in shades of light or darkness upon the body areas involved.

The Method Applied in Psychotherapy

It is usual to start a session by listening to what the patient has to say, receive his contents and observations and then apply Calatonia. The responses emerging from Calatonia are correlated with the formerly verbalized contents. During relaxation, the person may observe himself from a different standpoint and receive the message his unconscious wishes to tell him on the verbalized subject. Generally this inner vision brings forth memories and present sensorial images, intense past body experiences connected to the present moment.

Quite often, touches on the feet stimulate images of movement or balance alterations, when the subject perceives himself in different positions from that which he is actually in. Other memories spring forth relating to the first steps, falls, running, dancing, already experienced moments which come to the subject not only as reminiscenses, but accompanied by the corresponding affective contents.

The Skin

From a subjective point-of-view, our relationship with the skin places it as a bordering portion of the Self. It stands in the frontier, between the inner and outside worlds, a sensitive dynamic, mutating frontier, that expands and contracts according to the psychophysiological states. The skin isolates us, protects us as well as contains us.

According to specialists, the skin is considered an organ of the senses, holding a singular position among these. Its embrionary origin is the same as that of the nervous systems. These characteristics enable it to perform the functions of reception and emission, which are the skin’s peculiar activities. The skin apparently emits signs to an extent not found in any other sensorial organ, although some of these signs may only be perceptible when there is close contact between the emitting and receiving agents. When alterations occur internally, they are taken to the body’s peripheric region and transformed into vasomotor alterations such as capilary erection, sudoresis, change in the electric conductability and others, constituting authentic communication signs. Calatonia usually produces ectodermal stimulation, however the mesodermic layers may also be activated by the light pressure touches.

In this method, silence and the absence of visual control contribute to enhance the skin as the medium as well as the message of the established relation. The therapist’s hands may then represent a point of contact with the external world that enable the subject to accomplish the transition between the state of wakefulness and relaxation. To this effect, the hands perform an analogous’ role to those of “transitional objects” mentioned by Winicott (12), facilitating the introspective plunge and assuring the constructive return of the libido. Transitional objects provide protection and avoid anxiety, that can naturally be enhanced by the contents aroused from the unconscious which could disorganize the identity of the ego. The therapist’s hands may be perceived as an object mid-way between the objective and the subjective, which are then partially incorporated during the experience of decontraction. In the course of the individual’s development, he may create real objectal relationships by processing his experiences in the state of relaxation.

On occasions when neurovegetative reactions are also mobilized, a desire to cry or a pleasant wish to laugh may be felt besides other physiological expressions charged with emotional significance, such as joy or sadness. The ‘return to earth’ which this ‘melting’ causes, brings the patient close to often untouched unconscious zones, producing archetypal experiences where the somatic and the psychologic are as yet, neither dicotomized nor differentiated. The psychic energy may then be consciously perceived flowing into the body, without voluntary control, at times generating fear and anxiety or pleasure and joy.

Gravitational Energy – The Force of Gravity

Gravitational energy’s participation is central in the three mentioned procedures. When we stimulate the feet the many sensorial and motor resources developed by the species in order to receive and respond to ‘mother earth’ in the course of human adaptation are therapeutically integrated. The skeleton, muscles and organs have been structurally and functionally developed so as to adapt themselves to the terrestrial environment. Thus postoral balance and harmony are correlated to this functional adaptation. To this effect, when relaxation dissolves the nucleii of muscular tension, the force of gravity attracts downwards. After this planned ‘fall’ occurs, it is easier for a person to perceive in what manner he organizes his position in the world and afterwards, be able to stand on his own feet in a more harmonious way.

During Fractioned Decompression, the body is touched in ways that hardly occur in routine social relations. Besides, compression is part of the stimulus received by the mass of the body which, upon moving, causes changes in weight relations and pressure. These alterations are constantly exerted by the earth’s gravity on different areas of the body.

The Readjustment Touches are applied with the patient either standing or sitting, promoting an even more evident effect of gravitational force. During these touches the meaning of the Greek term ‘Khalaó’ is fully accomplished according to the author’s intention when choosing the word to name his method. This verb, which literally means ‘relaxation’, may be used in other senses as well, such as: ‘let go’, ‘free oneself from a state of anger or violence’, ‘open a door’, ‘tear down the veils’, ‘undo the ties of a wine-skin’, ‘remove the veil from the eyes’, ‘feed oneself’ and also ‘to forgive one’s parents’.

We know that defenses are created in order to resist to the natural forces that are inside and outside the body. Neurosis is structured in the muscles, especially in the posterior ones, through which it is expressed symbolically by a proud and tough posture; on the other hand, this shows an enormous difficulty in relaxing, in letting-go, following the flow of one’s energy. To know when to be active or passive, according to the circumstances, is a life style and not merely a question of Physiology or Kinesiology. Aware of the importance of these aspects, the objective of this psychotherapeutic work that associates light touches with the analysis of the unconscious, is the integration of the physical, emotional and cognitive levels of human experience.

Calatonia may be applied in all cases where reorganization is aimed. According to Sandor (13), its use is not recommended in acute psychotic cases when application could not follow the planned light procedure. On the other hand, in grave somatic illness, psychosomatic syndromes and confusional states, it is advisable that the therapist should work.under senior supervision and also keep in touch with the patient’s doctor in case medicinal treatment is required. During treatment with drugs that cause alterations in the state of consciousness, and corticoids, the method should be applied with careful attention.

Summing-up, ethical criteria and indications may only be adequately considered and weighed if and when the therapist himself has already experienced the interventions he intends to perform.

References:

DE SANTIS, M. I. 1969. A integração do animus na metanóia e no relaxamento. Boi. Psicol., São Paulo, 21:57 e 58.

DE SANTIS, M. I. 1976. O discurso não-verbal do corpo no contexto psicoterápico. Dissert. Dep.Psicol. PUC, mimeog., Rio de Janeiro.

MAURO, B. 1969. Anima e inconsciente racial no relaxamento e nos sonhos; Bol. Psicol., São Paulo, 21:57 e 58.

PENNA, L. 1976 . Observações sobre um caso de psicoterapia infantil com relaxamento. Anais do II Cong Interam. Psicol. Clínica ,São Paulo.

PENNA, L. 1979. Calatonia: a sensibilidade, os pés e a imagem do próprio corpo em psicoterapia. Dissert. IP-USP , mimeog., São Paulo.

PENNA, L. 1979. Calatonia: body image, feet and sensibility in psychotherapy. Dissert. IP-USP, mimeog., São Paulo.

PENNA, L. 1983. Os pés em relação com a terra. Cadernos da PUC, São Paulo No 15.

SANDOR, P. 1969. Calatonia. Boi. Psicol., São Paulo: 21, 57 e58.

SANDOR, P. 1974. Técnicas de relaxamento. São Paulo, Vetor.

SCHILDER, P. 1950. The image and appearance of the human body. Nova York, John Wiley and Sons.

WINICOTT, D. W. 1958. Transitional objects and transitional phenomena. Coll. Papers: Through Pediatrics to Psyco-Analysis. Londres, Tavistock Publishers.