Functional relaxation

1. Introduction

Version followed: Funktionelle Entspannung (FE; Functional Relaxation, FR) after Marianne Fuchs, as presented by the Arbeitsgemeinschaft Funktionelle Entspannung (AFE) and in Herholz, Johnen & Schweitzer (eds.), Funktionelle Entspannung: Das Praxisbuch (Schattauer 2009). Where session formats are given, they come from the manualised group versions used in German RCTs (Lahmann et al. 2017: 10 × 90 min; Walter et al. 2022: 12 × 45 min). The research manual itself is not published and was not seen. Fuchs's own monograph (Funktionelle Entspannung, Hippokrates, several editions; cited by Lahmann et al. as Fuchs 2013) is not drawn on here, so the step-by-step detail below is thinner than for manualised therapies. Gaps are marked [uncertain] or [synthesis].

FE is a German body-oriented psychotherapy, described as psychodynamically based, developed by Marianne Fuchs (died 11 March 2010, aged 102). It began in the early 1940s. Her one-year-old son had treatment-resistant spastic bronchitis and threatening asthma, and his outbreath was obstructed. She laid her hand on his chest, supported the yielding outbreath and accompanied it with a soft "puh" sound. Over about a year of frequent repetition he learned to join in and to regulate his breathing rhythm himself. Her first publication on breath therapy and relaxing body work for vegetative disorders appeared in 1949 [source: Reinelt & Gerber 2011]. Historical sessions took place in Erlangen, and today the method is used in individual and group settings in clinics, counselling centres, schools and hospices, mainly in Germany, Austria and Switzerland [source: Herholz et al. 2009 front matter; Lahmann et al. 2017].

Core idea of change: the organism regulates itself. Psychological conflict can show up as disturbance of autonomic functions, which the Praxisbuch calls "Abwärtseffekte". By sharpening self-perception, called the "sixth sense", FE restores what the sources call a "Wohlordnung" (good order) of neurovegetative functions. The AFE defines FE as "Merken des bisher Unbemerkten", noticing what was previously unnoticed in the body [source: Reinelt & Gerber 2011]. The main lever is the breathing rhythm, especially the relaxed outbreath. Very small, hardly visible joint movements are made during the outbreath, and the client notices how body feeling changes as a result. These felt experiences are then put into words (symbolisation), which links them to an emotional "leibliches Unbewusstes" (bodily unconscious) [source: Herholz et al. 2009; Lahmann et al. 2017]. The autonomic and "rebalancing" explanations are the school's own theory and are not established physiology. FE is offered as a complement to medical care, never as a replacement for it.

2. Framework

FE has no fixed phase model in the sources. The Praxisbuch names several formats: crisis intervention, short interventions, longer courses of therapy, and a closing separation phase ("Ablösungsphase") [source: Herholz et al. 2009 front matter]. The formats documented in the sources are:

Single brief intervention: about 5 minutes of elements of FE, given in acute asthma in children and adolescents (Loew et al. 1996). What these elements contained is not described in the abstract [uncertain].
Manualised group course for stress: 10 weekly sessions of 90 minutes. Session 1 covers expectations and questions. Session 2 adds muscle tensing/relaxing alongside psychoeducation. Session 3 is not described [uncertain]. Session 4 is an imaginary journey with a shoulders/pelvis focus. Session 5 focuses on the heart (warmth, "energy flow", heartbeat). Session 6 covers neck, head, lower jaw, mouth, teeth and shoulders. Session 7 covers the sitting bones, lower back and spine as inner support. Session 8 covers the three parts of the back. Session 9 covers different ways of sitting on a chair. Session 10 is a closing discussion. Every session opens with "contact to foundation". The therapists were certified by the AFE and had supervision after sessions 4 and 8 [source: Lahmann et al. 2017].
Manualised group course in somatic care: 12 weekly sessions of 45 minutes, groups of about 3–10, delivered by an FR-certified physiotherapist trained on the manual. It can be inpatient or outpatient [source: Walter et al. 2022].
Individual therapy: open-ended, with crisis, short-term and long-term variants [source: Herholz et al. 2009].

The working stages below are my synthesis for an individual course; they are not a published FE phase model [synthesis]:

Assessment and contract (1–2 sessions). Take the history of symptoms and of the body, and screen medically and psychiatrically (see 5). Explain the method: small movements, the outbreath, noticing and naming. Agree on touch (see 4.6). Move on when: the client can sit or lie for a few minutes and report at least one bodily sensation.
Getting to know the body (about sessions 2–5). Work on contact to the foundation, the outbreath, minimal movements in single joints, and comparing before and after. Move on when: the client notices differences on their own and can describe them in their own words.
Region and symptom work (middle phase). Work on the body regions linked to the client's symptoms: back and the three "crosses", shoulders and pelvis, jaw and neck, chest and heart. Use sounding and sitting postures. Link sensations to feelings, situations and conflicts (symbolisation). Move on when: the client can use FE elements on their own in daily life and in symptom episodes.
Transfer and separation (Ablösungsphase; the term is in the sources, its content is my synthesis). Work on self-chosen practice, such as the bedtime ritual and short exercises in situations that trigger symptoms. Review progress and say goodbye.

Session format [synthesis, based on the group manual]: arrive and say how things are, then contact to the foundation, then one or two exploration sequences with sensing questions, then rest and noticing what has changed ("Nachspüren"), then a short verbal reflection, then optional self-practice. Typical lengths are 45–50 minutes for individual sessions and 45–90 minutes for groups.

3. Guiding principles

These principles are drawn from Herholz et al. 2009 (front matter and Fuchs interview), Lahmann et al. 2017 and Reinelt & Gerber 2011 unless tagged otherwise.

Self-regulation. The organism can reorder itself. In practice: you create conditions for change and do not impose a correct pattern.
Working through the outbreath (Ausatem). The yielding outbreath is the way in. In practice: time movements and sounds to the relaxed outbreath, and never ask for deep or forced breathing. Breath intensification is not part of FE.
Minimal movement. Movements of small joints are "hardly noticeable to observers" (Lahmann et al. 2017). In practice: smaller is better. If you can clearly see the movement, invite the client to make it smaller.
Own rhythm. The aim is "finding of one's own rhythm" (Lahmann et al. 2017). In practice: never count breaths or set a pace. The client finds the timing.
Linking breath and movement. Rhythm and the connection between breathing and moving are named as a principle in the manual (Lahmann et al. 2017). In practice: each movement rides on one outbreath, followed by rest while the breath comes back by itself.
Noticing the unnoticed. In practice: the outcome of an exercise is a new perception, not a correct performance.
Difference as information. Clients observe differences in body feeling triggered by the movements. In practice: always compare before and after, or one side with the other.
Asking, not instructing. Questions aimed at bodily sensation (Spürfragen) are a central tool. The Praxisbuch gives "Wie fühlt sich das körperlich an?" ("How does that feel physically?") [source: Herholz et al. 2009]. In practice: phrase prompts as open questions about sensation. Avoid suggesting what the client should feel [synthesis].
Contact to the foundation. Every session starts here (Lahmann et al. 2017). In practice: first let the client notice what carries them (floor, chair, wall) before anything else.
Inner support (spine). The spine is treated as "inner support" (Lahmann et al. 2017). In practice: explore uprightness from inside, not by correcting posture.
Symbolisation and words. FE seeks verbal understanding of body experience, which distinguishes it from purely non-verbal body therapies [source: Herholz et al. 2009]. In practice: reserve time in every session for the client's own words and images.
Psychodynamic frame. Symptoms are understood as expressions of relationship and conflict, and a "bodily unconscious" is reached through bodily experience rather than recall. In practice: listen for associations, memories and transference that arise from the body work, and work with them in the usual psychodynamic way.
Patience, no forcing. FE has no dramatic breakthroughs and no forced techniques [source: Herholz et al. 2009]. In practice: stop at the client's limit, and do not push for catharsis or emotional release.
Respect for the symptom. Symptoms and sensations are handled carefully. In practice: explore the symptom with curiosity and do not try to remove it in the session.
Body empathy. The therapist attends to subtle nonverbal changes in the client and in themselves. In practice: notice your own breath and tension as information, and keep your own outbreath relaxed while guiding.
Client's own answers. The client develops their own self-care. In practice: home practice is chosen by the client, not prescribed.
Contact through the hand. "Therapeutisches Anfassen" (therapeutic touch) and the hand as a means of contact appear in the Praxisbuch's chapter titles. The technique itself is not described in the sources [uncertain]. In practice: touch is optional, agreed in advance, and requires FE training (see 4.6) [synthesis].

4. Intervention inventory

What this section rests on: the sources name the interventions and their aims, but they do not give full scripts. Every intervention below is named in a source (cited per item). Step sequences that go beyond the source wording are marked [synthesis] and keep to the stated FE principles: outbreath, minimal movement, own rhythm, comparing and naming. Get FE training before using the method. Certification is through the AFE, and research therapists were AFE-certified and supervised [source: Lahmann et al. 2017; Walter et al. 2022].

General screening before body work. The sources give no FE-specific contraindications [uncertain]. FE uses gentle, non-forced breathing and minimal movement, so its risk profile is low. Still, check the following [synthesis]:

Acute, unstabilised medical states (an asthma attack, chest pain, recent surgery or injury in the area worked on) need medical care first. FE is only a complement.
In acute psychosis, severe dissociation, active suicidality or recent trauma without stabilisation, keep exercises short, eyes open and grounded, and stabilisation-oriented. The Praxisbuch covers trauma stabilisation as an application, but its content was not seen.
Severe panic about breathing: start with movement and contact, not with attention to the breath.
Pregnancy, pain or limited mobility: adapt positions, never move into pain.

4.1 Contact to the foundation (Kontakt zur Unterlage)

Purpose / when: opens every session in the manualised group course [source: Lahmann et al. 2017]. It grounds the client, gives a first chance to perceive, and gives a baseline to compare against later.
Steps [synthesis]:
1. The client lies on their back on a mat (knees bent if more comfortable) or sits on a chair with feet on the floor.
2. Ask the client to notice where the body touches the support: heels, calves, pelvis, back, shoulder blades and back of the head; or feet, sitting bones and back against the backrest.
3. Ask which parts feel well carried and which hold themselves up.
4. Leave 1–2 minutes of silence for noticing.
5. Ask for a short report. This is the "before" picture for later comparison.
Example language (illustrative): "Notice where the floor is carrying you. Where does it carry you completely, and where are you still holding on a little?"
Watch for: clients who report "nothing". Treat that as a valid finding and ask about temperature, pressure or size instead. Watch for clients who rush to relax "correctly"; remind them there is nothing to achieve. It is working when they spontaneously report more contact or weight later in the session.

4.2 Following the relaxed outbreath and one's own rhythm (Ausatem)

Purpose / when: the base of all FE work. The client lets the outbreath give way and finds their own breathing rhythm, without manipulating it [source: Lahmann et al. 2017; Herholz et al. 2009; Reinelt & Gerber 2011]. The founding experience was supporting an obstructed, yielding outbreath [source: Reinelt & Gerber 2011].
Steps [synthesis]:
1. In lying or sitting, ask the client to notice the breath without changing it.
2. Invite the client to let the outbreath "go" or "fall" on its own, softly, through a slightly open mouth if that feels good. The "puh" or "f" sound comes from the origin story [source: Reinelt & Gerber 2011]. Its use as a standard instruction is [uncertain].
3. After the outbreath, wait until the next inbreath comes by itself. The pause after exhalation is commonly described in FE, but the sources do not confirm it [uncertain].
4. Repeat a few times, then return to ordinary breathing and notice any difference.
Example language (illustrative): "Let the breath go out as far as it wants to by itself, without pushing. Then wait and see when the next breath comes in on its own."
Watch for: forced long exhalations, breath-holding, dizziness or tingling. Stop, return to normal breathing and shift attention to contact. Never cue deep breathing or hyperventilation. It is working when the breath becomes quieter and more even, with longer natural pauses, and the client reports ease.

4.3 Minimal joint movements in the outbreath (core technique)

Purpose / when: the central FE technique. "Minute movements of small joints, hardly noticeable to observers, are performed during relaxed expiration," and the client observes the differences in body feeling that the movements trigger [source: Lahmann et al. 2017; also Walter et al. 2022]. Use it in every session, applied to the body region under exploration.
Steps [synthesis within the source description]:
1. Choose one joint or region: fingers, wrist, ankle, jaw, the head-neck junction, pelvis or sacrum. Sessions 4–9 of the group manual each focus on one region (see 4.8–4.13).
2. Take a "before" perception of this region (4.4).
3. On a relaxed outbreath, the client makes a tiny movement: a slight letting-go, a small rocking, a minimal bending or straightening. It should be so small that an observer would barely see it.
4. On the inbreath, do nothing and let the joint rest.
5. Repeat over several outbreaths. The sources give no number of repetitions [uncertain]; about 3–5 is a practical choice [synthesis].
6. Stop and notice what has changed (Nachspüren), then compare with the other side or with "before".
7. Ask for words (4.5).
Example language (illustrative): "As the breath goes out, let your right ankle make a very small movement, so small that I could hardly see it. Then let it rest while the breath comes in. … Now stop. How does the right leg feel compared with the left?"
Watch for: movements that become large, gymnastic or effortful. Ask for "half as much". Watch for movements timed to the inbreath or held breath. If the client is in pain, move to a neighbouring joint or simply imagine the movement [synthesis]. It is working when the client reports clear sensory differences: warmer, wider, heavier, more connected, "more there". These differences often spread beyond the joint that was moved.

4.4 Sensing questions (Spürfragen) and comparing

Purpose / when: the main verbal tool. Questions direct attention to bodily sensation and invite comparison, before and after or left and right [source: Herholz et al. 2009; Lahmann et al. 2017]. The Praxisbuch presents "Wie fühlt sich das körperlich an?" as the key question when work stalls [source: Herholz et al. 2009].
Steps [synthesis]:
1. Ask before an exercise, then again after it.
2. Keep questions open and sensory: where, how big, how warm, how heavy, what contact.
3. Ask for a comparison: "Is there a difference?"
4. Accept any answer, including "no difference" or "unpleasant".
5. Mirror the client's words back without interpreting.
Example language: verbatim from the source: "Wie fühlt sich das körperlich an?" (Herholz et al. 2009). Illustrative: "Compare your two hands. Is one different from the other?" or "Where in your body do you notice that right now?"
Watch for: leading or suggestive questions ("Doesn't it feel lighter?"); questions that turn into instructions; and clients who answer with thoughts instead of sensations. Gently redirect them to the body. It is working when answers become more differentiated and the client starts asking themselves.

4.5 Putting experience into words (Verbalisierung, symbolisation)

Purpose / when: FE aims at verbal understanding of body experience and links it to feelings and conflicts. This is what distinguishes it from purely non-verbal body therapies [source: Herholz et al. 2009]. Sensations may be expressed non-verbally or explicitly in the therapeutic interaction [source: Lahmann et al. 2017]. Use it at the end of every sequence and every session.
Steps [synthesis]:
1. After Nachspüren, ask for a word or image for the sensation.
2. Explore associations: when the client knows this feeling, and in which situations.
3. Link it, where it fits, to the presenting symptom or a relationship theme. Use psychodynamic technique for what emerges, such as memories, affects and transference.
4. Note the client's own words and reuse them in later sessions as anchors.
Example language (illustrative): "If that feeling in your shoulders had a name, what would it be?" and "When else in your life do you know this kind of holding on?"
Watch for: intellectualising, which needs a return to the body; strong affect, which needs a slower pace and contact to the foundation (see 5); and premature interpretation by the therapist. It is working when body language and life themes start to connect spontaneously.

4.6 Hand-supported outbreath (therapeutic touch, "Anfassen")

Purpose / when: this is the founding intervention. Fuchs laid her hand on her son's chest, supported the yielding outbreath and accompanied it with a soft "puh" [source: Reinelt & Gerber 2011]. The Praxisbuch lists "therapeutisches Anfassen" (therapeutic touch) and the hand as a means of contact as topics, but the technique is not described in the sources [uncertain]. Use it to make the outbreath tangible, for clients with little body perception, and in breath-related symptoms.
Consent steps (the sources give none, so all of these are [synthesis]):
1. Explain what you would do, where your hand would rest (for example the side of the ribcage, the upper back between the shoulder blades, or the upper chest below the collarbones) and why.
2. Ask explicitly and accept a no without discussion.
3. Offer a no-touch alternative: the client places their own hand there.
4. Agree a stop signal (a word or a raised hand).
5. Check in during the exercise and afterwards.
6. Record consent.
7. Never touch breasts, the genital area or other intimate areas.
8. Touch requires specific FE training and supervision, and a check that your licence and jurisdiction allow touch in psychotherapy.
Steps [synthesis based on the origin account]:
1. The client lies on their back or sits.
2. Place your warm, flat, resting hand at the agreed spot, without pressure, and wait for a few breaths.
3. Follow the movement of the ribcage. On the outbreath, let your hand go along with the yielding without pressing.
4. Optionally, add a soft "puh" or "f" sound on the outbreath, made by you or by the client.
5. After a few breaths, lift your hand slowly at the end of an outbreath.
6. Leave time for Nachspüren and compare how the area feels with and without the hand.
7. Talk it through.
Example language (illustrative): "May I put my hand here on the side of your ribs? I won't press, I'll only go along with your breath. Say 'stop' at any time."
Watch for: freezing, holding the breath or startle, which can signal a trauma history; stop and return to self-touch. Watch also for pressure or rhythm being imposed by your hand, and for transference reactions to touch. Discuss these in the session and in supervision. It is working when the outbreath lengthens on its own and the client reports a felt sense of "letting go" or support.

4.7 Sounding (Tönen)

Purpose / when: uses voice to carry and feel the outbreath and its vibration. The Praxisbuch interview names vowels spoken with rising volume, humming, purring like a cat, singing or simply "tönen". Sounding can be combined with gentle swaying of the upper body and can help people relax into sleep [source: Herholz et al. 2009]. Use it with clients who find silent breath work too abstract, with children, and before sleep.
Steps [synthesis]:
1. Sit upright on a chair or stool, or on the floor.
2. On a relaxed outbreath, the client lets out a soft hum or a vowel, such as "o" or "u", for as long as the breath lasts without pushing.
3. Let the inbreath come by itself.
4. Over a few repetitions, try different vowels, rising volume, or purring.
5. Add a small swaying of the upper body in the rhythm of the sound if wanted.
6. Stop and notice where the vibration is felt (chest, head, belly, back) and how the body feels now.
Example language (illustrative): "Let a quiet hum come out with the breath, as long or short as it wants. Where do you feel it vibrating?"
Watch for: embarrassment. Make the sound together with the client, or let them hum very quietly. Watch for straining to make the sound longer or louder, which runs against FE's no-forcing principle. It is working when there is felt vibration, a calmer breath and a softer voice.

4.8 The three "crosses" / three parts of the back

Purpose / when: the Praxisbuch interview refers to attention to the three "Kreuze" (crosses) as regions of the back and spine, and session 8 of the group manual focuses on "the three parts of the back" [source: Herholz et al. 2009; Lahmann et al. 2017]. Exactly which three regions are meant is not defined in the sources [uncertain]. A plausible reading is the low back/sacrum ("Kreuz"), the shoulder-girdle area and the neck/back of the head [uncertain]. Use this for back pain, posture-related tension and stress, and for experiencing "support from behind".
Steps [synthesis]:
1. The client sits on the front of a chair, or lies on their back.
2. Take a "before" perception of the whole back.
3. Take one region at a time. In the low back, a minimal tilt of the pelvis on the outbreath. In the shoulder area, a minimal sinking or widening of the shoulder blades on the outbreath. In the neck, a tiny nod at the head-neck junction on the outbreath. Do a few outbreaths per region, followed by Nachspüren.
4. Then sense how the three regions connect, or fail to connect.
5. Close with verbalisation.
Example language (illustrative): "Now let the movement be in the lower back, just a hint, as the breath goes out. … How does your back feel now, from the bottom to the top?"
Watch for: pain flare-ups, which call for smaller movement or imagined movement, and for straining into "good posture". It is working when the client reports the back as more connected, more present or supportive.

4.9 Sitting bones, lower back and the spine as inner support

Purpose / when: this is the content of group session 7: "sitting bones, lower back, spine as inner support" [source: Lahmann et al. 2017]. It is an experience of being upright from within rather than holding oneself up. Use it for collapse/slump or rigid holding, low self-support, and fatigue.
Steps [synthesis]:
1. The client sits on a firm chair without leaning back, feet flat.
2. They locate the two sitting bones, for example by a minimal rocking left-right or forward-back on the outbreath.
3. Let the spine build up from the sitting bones without effort. On the outbreath, minimal movements in the low back let the spine "find" its way upward.
4. Compare with slumped sitting, then with stiffly upright sitting.
5. Ask where the client feels "held from inside".
Example language (illustrative): "Feel the two bones you are sitting on. … Is there a way of sitting where your back carries you, without you having to hold it?"
Watch for: military posture or tension at the back of the neck. It is working when the client finds an upright position with less effort and associates it with feelings such as steadiness or self-confidence.

4.10 Different ways of sitting on a chair

Purpose / when: group session 9 [source: Lahmann et al. 2017]. This transfers FE to the most common everyday posture at work, in school or in meetings.
Steps [synthesis]: Explore 3–4 ways of sitting in turn: at the front of the chair, leaning back, legs crossed, slumped, upright. In each one, notice the contact to the chair and floor, the breath and the mood, with a minimal movement in the outbreath. Then compare. The client chooses one way of sitting to try in daily life.
Example language (illustrative): "Try sitting the way you usually sit at your desk. What happens to your breath? Now try another way."
Watch for: judging postures as right or wrong; the aim is to perceive them. It is working when the client notices, outside therapy, how they sit and adjusts it themselves.

4.11 Shoulders and pelvis

Purpose / when: focus of group session 4, together with an imaginary journey [source: Lahmann et al. 2017]. This works on the two "girdles". Use it for neck-shoulder tension, pelvic or low-back holding, and stress.
Steps [synthesis]: In lying or sitting, take a "before" perception of the shoulders and pelvis. On the outbreath, let the shoulders sink a minimal amount or the shoulder blades widen, over a few outbreaths. Pause. On the outbreath, make a minimal pelvic tilt or rocking, over a few outbreaths. Then do Nachspüren, compare the two areas, notice whether they connect, and verbalise.
Example language (illustrative): "As the breath goes out, let the shoulders go down just a fraction more than they want to by themselves … no, even less."
Watch for: active pulling down of the shoulders, which is effort rather than letting go. It is working when the client feels the shoulders as wider, lower or warmer, with breath reaching further down.

4.12 Head, neck, jaw, mouth and teeth

Purpose / when: group session 6 covers neck, head, lower jaw, mouth, teeth and shoulders [source: Lahmann et al. 2017]. Use it for tension-type headache (headache syndromes are a chapter topic in an early FE text; see Sources), jaw clenching or bruxism, and stress held in the face.
Steps [synthesis]:
1. In lying, notice the contact of the back of the head with the floor.
2. On the outbreath, make a tiny nod or a tiny turn of the head, over a few outbreaths, then Nachspüren.
3. On the outbreath, let the lower jaw drop a minimal amount, with the lips loosely closed or slightly open, and notice the teeth and tongue.
4. Compare with before and verbalise.
Example language (illustrative): "Let the lower jaw sink a tiny bit as the breath goes out, as if it had nothing to hold. What happens in your face?"
Watch for: dizziness with neck movement, which calls for keeping the movement imagined or very small. Watch also for emotional reactions around the mouth and jaw, such as anger or suppressed words, and work with these verbally. It is working when the client reports a softer jaw, less pressure in the head and a freer outbreath.

4.13 Heart region: warmth and heartbeat

Purpose / when: group session 5 focuses on the heart, described as "movement of warmth, energy flow and heart beat" [source: Lahmann et al. 2017]. "Energy flow" is the manual's experiential language and is not a physiological claim. The Praxisbuch lists somatoform cardiac complaints, hypertension and anxiety as indications [source: Herholz et al. 2009]. Before working with cardiac symptoms, make sure they have been medically assessed [synthesis].
Steps [synthesis]:
1. In lying or sitting, the client may rest their own hand on the breastbone, if they wish.
2. On the outbreath, make a minimal movement in the ribs or shoulder girdle, over a few outbreaths.
3. Let attention rest on warmth and on the heartbeat, if it can be felt, without trying to change it.
4. Close with contact to the foundation and verbalisation.
Example language (illustrative): "Notice the area under your hand. Is there warmth anywhere, or movement? You don't need to find your heartbeat; just notice what is there."
Watch for: in clients with cardiac anxiety or panic, attending to the heartbeat can increase fear. Shift to the hands or feet, or to contact with the support, and come back later [synthesis]. It is working when the client can notice heart sensations without alarm and reports warmth or calm.

4.14 Basic adult positions: sitting on the floor, leaning against the wall, "climbing up" the wall

Purpose / when: named by Fuchs in the Praxisbuch interview as basic exercises for adults [source: Herholz et al. 2009]. Their exact procedure is not described in the sources [uncertain]. Use them to explore support from behind (the wall) and from below (the floor), and the move from sitting to standing.
Steps [synthesis, within FE principles]:
1. Sitting on the floor: sit on a mat or cushion, legs comfortably bent or crossed, and explore contact and the sitting bones as in 4.9.
2. Leaning against the wall: sit or stand with the back against a wall, and notice which parts of the back touch it. On the outbreath, let the back give a minimal amount more weight into the wall, then compare.
3. "Climbing up" the wall: exact form not known [uncertain]. One possible version is to come from sitting at the wall to standing while keeping back contact, slowly, with the outbreath, stopping at any point that feels unsafe. Mark it clearly to the client as an exploration.
Example language (illustrative): "Let the wall take a little more of your weight as you breathe out. What does it feel like to be supported from behind?"
Watch for: knee or back strain when rising, and pressure to perform. It is working when the client experiences "Halt" (support) and transfers this to everyday standing.

4.15 Sleep positions and a "good night" ritual

Purpose / when: Fuchs describes lying with the knees drawn up, half-prone or on the side with the back allowed to "hang", together with a deliberate "Gute Nacht" and a sequence of positions before sleep, as a self-chosen self-regulation aid. Sounding (4.7) can help people relax into sleep [source: Herholz et al. 2009]. Use it for sleep disorders (a chapter topic of the Praxisbuch) and as a home practice.
Steps [synthesis]:
1. In the session, try the positions on a mat. Notice in each one where the back can let go and how the breath moves.
2. The client chooses a personal sequence, for example on the back with knees drawn up, then on the side.
3. Add one or two minimal movements or a quiet hum on the outbreath.
4. Close with an inner or quiet spoken "good night".
5. Review the experience in the next session.
Example language (illustrative): "Which position lets your back feel like it can hang, like it doesn't need to hold anything any more?"
Watch for: turning the ritual into a sleep-performance task, which can raise arousal. Keep it as an offer. It is working when sleep onset feels easier and the ritual feels like the client's own.

4.16 Brief FE elements in an acute symptom episode

Purpose / when: a single 5-minute introduction to elements of FE was given to children and adolescents in acute asthma, alongside a comparison with standard medication [source: Loew et al. 1996]. The components were not described in the abstract [uncertain]. This always complements medical treatment and never replaces rescue medication or emergency care.
Steps [synthesis]: Only for clients already familiar with FE, and only once acute medical needs are met.
1. Sit with support at the back.
2. Make contact with the support (4.1).
3. Let the outbreath yield, without effort, possibly with a soft "f" or "puh" (4.2), or with the client's own or the therapist's hand on the side of the ribs (4.6, with consent).
4. Add a minimal movement of the shoulders or hands on the outbreath.
5. Then take time to notice and name what has changed.
Example language (illustrative): "Don't try to breathe in more. Just let the breath go out, as softly as it can."
Watch for: any worsening, which calls for medical care at once. It is working when the client feels less panic and a freer outbreath. The client should also have a written medical action plan.

4.17 Manual add-ons in the stress group: tensing/relaxing muscles and an imaginary journey

Purpose / when: the stress-reduction manual included "tensing and relaxing muscles" (session 2) and an "imaginary journey" (session 4) [source: Lahmann et al. 2017]. These are integrated elements of that adapted manual, not described as core FE technique, and their content was not specified [uncertain].
Steps [synthesis]:
- Muscle contrast: briefly tense a muscle group, then release it on the outbreath, then compare. This is mainly useful as a bridge for clients who cannot yet perceive minimal movement.
- Imaginary journey: a short guided imagery through the body region of the session, such as shoulders or pelvis, ending with contact to the foundation.
Example language (illustrative): "Make a fist for a moment … and let it go as you breathe out. Compare the two hands."
Watch for: strong tensing, which is against FE's no-force stance. Keep it brief and light. It is working when it leads into finer perception in later sessions.

4.18 Group frame: opening and closing rounds, self-practice and relatives

Purpose / when: in group courses, the first and last sessions are reserved for discussing expectations, questions and wishes [source: Lahmann et al. 2017]. Groups of about 3–10 meet weekly, and relatives may take a certified FR course [source: Walter et al. 2022]. Self-chosen practice supports self-regulation [source: Herholz et al. 2009].
Steps [synthesis]:
1. Session 1: introductions, expectations, an explanation of the principles (small, slow, outbreath, noticing) and the group rules (no comparing performance, the right to stop and say no).
2. In each session, a short round after the body work, where each person gives a word or sentence about what they noticed.
3. Encourage, without prescribing, one small exercise per week chosen by each member.
4. Final session: review, which elements each person will keep, and goodbyes.
Example language (illustrative): "There is no right or wrong here. Whatever you noticed, or didn't notice, is welcome in the round."
Watch for: comparison and competition, and members who stay silent. Allow them to pass. It is working when members bring back their own experiences from daily practice.

5. Handling problems

What the sources say: when work stalls, often because of resistance, fear or defiance, switching to a body-focused question can open a new path ("Wie fühlt sich das körperlich an?"). The therapist should let go of expectations of quick results, let change unfold at the client's pace, and stay patient, without forcing techniques or chasing breakthroughs [source: Herholz et al. 2009]. In research groups, non-adherence was defined as attending 3 or fewer sessions, and a telephone contact line was kept open [source: Walter et al. 2022]. Everything else below is my synthesis and is tagged as such.

"I don't feel anything." Treat it as a finding, not a failure. Make the comparison coarser: left hand vs right hand after moving only one, or a brief muscle contrast (4.17). Shift to contact and temperature, which are easier to notice than breath. Use the client's own hand as an aid (4.6, no-touch variant). Lengthen Nachspüren. [synthesis]
Stuck or stagnating course. Use a body-focused sensing question [source: Herholz et al. 2009]. Then change the region or position, for example from lying to wall or chair (4.10, 4.14), or move from silent work to sounding (4.7). Review the contract and the client's own goals, and take the case to supervision. [synthesis beyond the first sentence]
Resistance and defiance. Read them psychodynamically as meaningful, and possibly as transference toward an "instructing" authority [source: Herholz et al. 2009 names resistance, fear and defiance as causes of stagnation]. Respond by giving more choice. Let the client decide the joint, the position and whether to do the exercise at all. Explore the "no" in the body ("Where do you feel the no?"). [synthesis]
Trying too hard or performing. This shows as large movements, forced exhalations, or asking "Am I doing it right?". Name it kindly, ask for "half as much", and stress that there is no right result. Model a relaxed outbreath yourself. [synthesis]
Breath-focused anxiety, panic, dizziness or tingling. Stop the breath focus at once. Open the eyes, take contact with feet and floor, and orient to the room. Let breathing return to normal without instructions. Later, approach the breath only indirectly, through movement or sound. Never use deep or rapid breathing. [synthesis]
Overwhelm, emotional flooding, flashbacks or dissociation. Stop the exercise. Ground with eyes open, contact to the foundation and naming objects in the room; sitting up is often safer than lying. Shorten the exercises and keep them peripheral (hands, feet) rather than trunk or pelvis. Have trauma-specific stabilisation in place before body exploration. The Praxisbuch covers trauma stabilisation as an FE application, but its content was not seen [uncertain]. [synthesis]
Touch-related problems. These include a client who agreed to touch but freezes, an erotic transference, or a client who cannot say no. Withdraw the hand, return to self-touch, and discuss it verbally. Re-confirm consent at every session. Document. Seek supervision. Never continue touch in the presence of sexualised transference. [synthesis]
Pain or a symptom flare. Use smaller or imagined movements, a neighbouring region, or a different position. Arrange medical review for any new or worsening physical symptom. FE is a complement only, never a substitute for medical treatment (for example asthma medication) or for diagnosis. [synthesis]
Non-adherence to self-practice. Practice is self-chosen in FE, so do not prescribe. Explore what got in the way, and shrink the practice to one minute, or attach it to an existing routine such as bedtime (4.15) or sitting at the desk (4.10). [synthesis]
Ruptures, such as feeling pressured, criticised for "wrong" perceptions, or touched without enough consent. Name the possible rupture, take responsibility for your part, validate the client's perception, and renegotiate the pace and touch agreement. [synthesis]
Suicidality or severe depression emerging. Pause the body work. Carry out a standard structured risk assessment, collaborative safety planning, lethal-means counselling (safe storage or removal) and involvement of support persons, and coordinate with psychiatric care. Resume FE only as a stabilising adjunct. [synthesis]
Group-specific problems. Comparison and competition, or one member's strong reaction unsettling the others. Keep the group rules: the right to pass and no evaluation of anyone's perceptions. Offer individual follow-up for strong reactions. Use supervision, as in the research model, where supervision followed sessions 4 and 8 [source: Lahmann et al. 2017]. [synthesis apart from the supervision schedule]
Modality-specific: psychosomatic "proof" expectations. Some clients expect FE to cure a physical illness, and some therapists may present it that way. Clarify that FE supports self-perception and self-regulation alongside medical care. The autonomic "rebalancing" and "energy flow" language is the school's own model. [synthesis]

Sources

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