Body-behaviour therapy

1. Introduction

Version followed: Maren Langlotz-Weis's Körperorientierte Verhaltenstherapie (body-oriented behaviour therapy; Munich: Ernst Reinhardt, 2019, 116 pp., ISBN 978-3-497-02850-4), as she sets it out in her 2017 lecture script for the Bavarian Chamber of Psychotherapists and as Annemarie Jost's 2020 review describes the book [source: LPT 2017 script; Jost 2020 review]. The book's own exercise series (its Part 3) is not reproduced here [uncertain]. About the name: the label "body-behaviour therapy" (German "Körperverhaltenstherapie") has no published source of its own [uncertain]. Langlotz-Weis writes "körperorientierte Verhaltenstherapie" or "körperorientierte Verfahren in der Verhaltenstherapie". Serge Sulz's behaviour-therapy books and Henn-Mertens & Zimmek's schema-therapy body techniques ("körperorientierte Techniken") do not use the label. Concentrative movement therapy (KBT) speaks of "körperliches Verhalten" (bodily behaviour), but it is a separate body psychotherapy, not behaviour therapy. Langlotz-Weis's approach is the only published, named method that builds body work into behaviour therapy, so this guide follows it. That "body-behaviour therapy" means this approach is an inference, not an established name [uncertain].

What it is. It is not a separate school. It is a way of bringing body and breath work into ordinary cognitive-behavioural therapy. Langlotz-Weis is a licensed behaviour therapist with further training in psychodrama, systemic family therapy and body-oriented therapy, and her material grew out of the training curricula of the IFKV in Bad Dürkheim [source: Jost 2020 review]. She presents it as an extension of the body tools behaviour therapy already has (relaxation training, biofeedback, body checks in exposure, body confrontation in eating disorders). It draws on George Downing's body psychotherapy (affect-motor schemas), on yoga-inspired breath and body exercises, on mindfulness, and on Grawe's general psychotherapy framework, with links to schema therapy [source: LPT 2017 script; Jost 2020 review; Freiburg workshop announcement].

How change happens (her model).

Emotions are represented in the body.
Patients keep painful feelings out of awareness through "body defence" (Körperabwehr): shallow breathing, raised shoulders, clenched teeth, swallowing down a lump in the throat, or a limp paralysis when aggression is inhibited.
Deep breathing and bodily experience intensify feelings, and sometimes make them possible in the first place. This activates the problem in the session (Grawe's Problemaktualisierung).
Because learning is state-dependent and, following Piaget, motor-based, a bodily state can open the way to memories.
New bodily experiences (being held, pushing away, being validated) work as counterconditioning or corrective "re-parenting" experiences.
The felt experience is then woven back into the verbal-cognitive level, so that it becomes understood and can be used [source: LPT 2017 script; Jost 2020 review].

2. Framework

The published sources give no phase model or a session count. Jost's review describes the book in three parts: Part 1 is theory (Downing's affect-motor schemas, differentiation learning, the Carpenter effect). Part 2, "Handwerk" (the craft), covers setting, prerequisites, basic stance, the therapist's own self-experience, handling touch, how to introduce body and breath work, and micro-behaviour analyses. Part 3, about half the book, is illustrated breathing and body exercises. The review says body and breath work is introduced within individual sessions and tied to micro-behaviour analyses. It names no phases [source: Jost 2020 review]. The Freiburg announcement and the LPT script present the body work as an addition to the ordinary behaviour-therapy repertoire, not as a separate programme [source: Freiburg announcement; LPT 2017 script]. The book's detailed table of contents is not reproduced here [uncertain]. The phases below are my own synthesis for organising the work inside a normal course of behaviour therapy. They are not Langlotz-Weis's model. [synthesis]

Format. Individual outpatient behaviour therapy in standard session lengths. The workshops also use groups. Patients wear comfortable clothing, and the room needs floor space, mats or blankets, a free wall and a sturdy cushion [source: Freiburg announcement for clothing and blankets; the rest is synthesis]. Session count: not specified in the sources [uncertain]. In Germany the work sits within the ordinary short-term or long-term behaviour-therapy allowance [synthesis].

Phase A: Assessment and indication (sessions 1–5, alongside the usual VT diagnostics).

Goal: decide whether body work fits this case formulation.
Indicated for patients with little access to their feelings, who express them through the body (somatisation) or through intellectualising. Areas covered in the book include eating disorders, depression, somatoform disorders, trauma experiences and personality disorders [source: Jost 2020 review].
Caution with emotionally unstable, psychotic or severely psychosomatically ill patients [source: LPT 2017 script].
Added screening before breath intensification or strong motor work [synthesis]: pregnancy; cardiovascular or respiratory illness (including asthma and COPD); epilepsy; panic disorder with marked hyperventilation (start very gently); recent injury or surgery; acute psychosis; severe dissociation; active suicidality; trauma that has not been stabilised; and, for touch, a history of abuse or boundary violation (this is a reason for extra care, not an automatic exclusion).
Move on when: the indication is clear, risks have been screened, and the patient has agreed in principle to try body-focused work [synthesis].

Phase B: Introduction and resource-oriented body awareness (about 2–5 sessions).

Goals: explain the rationale; set up permission and stop rules; build present-moment, non-judging body awareness; practise basic deep breathing as a calm baseline; start reconciling the patient with their own body (resource side, somatic markers) [source: LPT 2017 script; Jost 2020 review].
Move on when: the patient can notice and name sensations, can stop or reduce an exercise on their own, and stays oriented and within tolerance during short breath work [synthesis].

Phase C: Experience-activating work (the main working phase, embedded in the case formulation).

Goals: in the session, reach feelings the patient avoids, using deep breathing, attention to impulses and body defence, live micro-behaviour analysis, bonding and separation exercises, breathing combined with recalling biographical material, and touch or imagined touch where agreed [source: LPT 2017 script; Jost 2020 review].
Each piece of experiential work is followed by cognitive integration.
Move on when: the patient can feel and regulate core emotions (anger, grief, fear, joy and desire are the ones the review names), and links between body patterns and their learning history have been understood [source: Jost 2020 review for the emotion list; the criterion itself is synthesis].

Phase D: Transfer and consolidation.

Goals: carry the new bodily options into everyday life through behavioural experiments, role plays and home practice; review and end therapy [source: LPT 2017 script lists role plays and behavioural experiments; the phasing is synthesis].

Within-session arc (synthesis).

Verbal check-in and choice of focus.
Invitation to notice the body, with consent.
The exercise, with the therapist tracking breath, posture and impulses throughout.
A defined close: back to normal breathing, orienting to the room, sitting up.
Cognitive integration: what was felt, what it connects to, what it means for the treatment goals.
Agreeing any transfer task. [synthesis]

3. Guiding principles

Weave the levels together ("Verweben der Ebenen"). Keep moving between thoughts and words, feelings, inner images, body sensations and motor impulses. Practical meaning: whenever one level comes alive, ask about the others [source: LPT 2017 script].
Cognitive embedding is essential. Practical meaning: never end on raw experience. Every exercise ends with putting into words what happened and what it means [source: LPT 2017 script; Jost 2020 review].
A permitting, granting stance ("gewährend und erlaubnisgebend"). Practical meaning: you explicitly allow feelings, tears, impulses and needs the patient learned to suppress [source: LPT 2017 script].
Validate even the smallest behaviour. Practical meaning: you name and acknowledge tiny shifts (a deeper breath, a hand that moves) as real steps [source: LPT 2017 script].
Explicit observation with patient feedback. Practical meaning: you say what you see ("your shoulders just rose") and the patient confirms or corrects it. You do not interpret on their behalf [source: LPT 2017 script].
Problem activation and resources together. Practical meaning: balance evoking difficult affect with building pleasant body experience and reconciliation with one's own body (somatic markers) [source: LPT 2017 script].
Mindful, non-judging, here-and-now body awareness. Practical meaning: you invite curiosity about what is present rather than a correct sensation [source: Jost 2020 review].
Use the body's memory. Practical meaning: body states can be used on purpose to reach memories and feelings, and to set up counterconditioning experiences [source: Jost 2020 review; LPT 2017 script].
Body defence is active coping, not a fault. Practical meaning: you explore the defensive pattern with interest and respect its function. Breaking through it is not the aim [source: LPT 2017 script for the active-coping idea; the "no breaking through" emphasis is synthesis consistent with the review's mindful exploration].
Attachment and developmental grounding. Practical meaning: you read patterns of reaching out and pulling back (bonding and separation) as learned in early relationships, using Downing's affect-motor schemas, and you offer corrective experiences in the relationship [source: LPT 2017 script; Freiburg announcement; Jost 2020 review].
Clear permission before any touch, with imagined touch as an alternative. Practical meaning: there is no touch without explicit agreement, and a no-touch route always exists [source: Jost 2020 review].
The therapist's own bodily self-experience and supervision. Practical meaning: do not use exercises you have not experienced yourself, and get supervision for this work [source: LPT 2017 script; Jost 2020 review; Freiburg announcement].
Integration with behaviour therapy, not replacement. Practical meaning: body work serves the case formulation and goals; it is chosen as a method, not done for its own sake [source: LPT 2017 script].
Extra care with fragile patients. Practical meaning: with unstable, psychotic or severely psychosomatic patients, lower the intensity, keep exercises short and stay close [source: LPT 2017 script].

4. Intervention inventory

Scope and limits. Below are the interventions named in the published sources (LPT 2017 script, Freiburg announcement, Jost 2020 review). Langlotz-Weis's own exercise series is not reproduced. That is Part 3 of the 2019 book, which the review describes as precisely guided breathing and body exercises taken largely from Downing and from yoga-like methods. I do not reconstruct it [uncertain]. Where the sources give an intervention's name and purpose but not its steps, the steps below are my synthesis from standard body-psychotherapy and behaviour-therapy practice. Where another published text describes a comparable exercise in full, I say so. There are two such texts. One is Röhricht & Papadopoulos's BOPT-MUS manual (2017), a body psychotherapy for medically unexplained symptoms. The other is the publisher's excerpt of Henn-Mertens & Zimmek's Körperorientierte Techniken in der Schematherapie (Beltz, 2021), which adds body exercises to schema therapy, an offshoot of cognitive-behavioural therapy. Both are different methods. They are used here only as comparators, never as Langlotz-Weis's procedure.

Touch. Touch requires specific training, supervision, and a check of what your licence, your professional code and your jurisdiction allow. Sexual or genital touch is never a technique. The sources require explicit permission before any touch and offer imagined touch as an alternative [source: Jost 2020 review]. The full consent sequence below is my synthesis [synthesis]:

Explain what the touch would be, where, and why.
Ask, and accept a no without asking why.
Offer the no-touch version (imagined touch, self-touch or an object).
Agree a stop signal (a word, or raising a hand).
Check in during the touch.
Ask afterwards how it was, and note the patient's consent in the record.

4.1 Introducing body and breath work

Purpose / when: before the first body exercise and again whenever you start a new kind of exercise. The book gives a whole section to how to introduce body and breath work [source: Jost 2020 review]. Its content is not reproduced here [uncertain].
Steps (synthesis):
1. Link the offer to the case formulation ("feelings you keep away seem to show up as tension").
2. Explain body defence and state-dependent learning in plain words.
3. Describe what the patient would actually do.
4. Make clear that they can stop at any time and that there is no right sensation.
5. Ask for agreement.
6. Start with a short, low-intensity exercise.
7. Debrief.
Example language (illustrative): "In behaviour therapy we usually work with thoughts and behaviour. The body keeps its own record of what we learned. Shall we try a two-minute experiment where you just notice your breathing? You decide how far we go."
Watch for: embarrassment, compliance without real agreement, fear of losing control. It is working when the patient is curious, asks questions, and can say what they noticed.

4.2 Mindful body perception (here-and-now body awareness)

Purpose / when: the basic way in. It builds non-judging, present-moment attention to sensation, and the feelings, thoughts, impulses, images and fantasies tied to it [source: Jost 2020 review]. Use it early, and as the opening move of any session that turns to the body.
Steps (synthesis):
1. The patient sits upright with both feet on the floor; eyes open or closed, as they prefer.
2. Guide attention to the points of contact (feet, seat, back), then to the breath without changing it, then a slow sweep through the body.
3. Ask the patient to report sensations as they come: temperature, tension, movement, numbness.
4. Ask which feeling, image or thought goes with the strongest sensation.
5. Take 2–5 minutes; close by opening the eyes, looking around the room and naming three things.
6. Debrief.
Example language (illustrative): "Just notice where your body touches the chair… Now where in the body is there the most going on? Describe it as if to someone who can't see you."
Watch for: "I feel nothing" (see 5.2), drifting or going blank (signs of dissociation), self-criticism ("I'm doing it wrong"). It is working when descriptions become more differentiated over sessions and feelings start to get named.

4.3 Deep breathing (basic exercise and basic stance)

Purpose / when: Langlotz-Weis treats deep breathing as both a basic exercise and a basic stance. She calls it the "Königsweg" (royal road) to avoided feelings [source: LPT 2017 script]. Use it once Phase B awareness is in place, when a feeling seems near but is being held down.
Contraindications: see the Phase A screening above (pregnancy, cardiovascular, respiratory, epilepsy, psychosis, severe dissociation, unstabilised trauma, active suicidality). Hyperventilation risk is the main practical danger [synthesis].
Steps: the sources give no position, duration or count [uncertain]. Synthesis:
1. The patient sits, or lies on a mat with knees bent.
2. One hand rests on the belly. The patient breathes slowly through the nose into the belly, letting the exhalation be long and unforced.
3. Keep the pace slow. Depth matters, not speed. Do not pace the breath faster.
4. Track the face, throat, shoulders and hands, and name changes.
5. Do 3–10 minutes in short rounds with pauses to report.
6. Close by returning to the patient's natural breathing, sitting up and orienting.
7. Cognitive integration.
- Comparator: the BOPT-MUS manual builds up full breathing in stages, first the diaphragm, then the ribs sideways, then the upper chest and collarbones [source: Röhricht & Papadopoulos 2017].
Example language (illustrative): "Let the breath go a little lower, into your belly, and let the out-breath take as long as it wants… What happens in your chest as you do that?"
Watch for: tingling, dizziness, cramping in the hands (hyperventilation: slow down, breathe out longer, open the eyes, stop if needed); sudden rising tears or anger (welcome them, keep the pace slow); a stiff, held stomach. It is working when the patient reaches the emotion and stays present and in contact with you.

Comparator (a different method). Henn-Mertens & Zimmek give a deep-breathing exercise in full. The patient lies down with the feet hip-width apart. They breathe in through the nose and out through the open mouth with an audible sigh. After 10 breaths, therapist and patient talk about what was noticed, then the patient does 10 more, and the exercise ends with a debrief. A therapist's hand on the breastbone or belly is used only after preparation and with the patient's consent [source: Henn-Mertens & Zimmek 2021, publisher excerpt]. This is their procedure. Whether Langlotz-Weis's is similar is unknown [uncertain]. Mouth breathing with a sigh is more activating, so the hyperventilation checks above apply [synthesis].

4.4 Deep breathing with recollection (Wiedererinnern)

Purpose / when: combines deep breathing with recalling a memory, so that state-dependent learning and counterconditioning are used deliberately. It can be a way into biographical work [source: LPT 2017 script]. Use it after 4.3 is tolerated and when the case formulation points to formative experiences.
Steps (synthesis):
1. Agree the memory and a limit beforehand ("only up to the moment you came into the room").
2. Establish slow deep breathing.
3. Ask the patient to bring up the scene in the present tense while staying aware of the breath and of the present room (dual awareness).
4. Track body defence (breath stopping, swallowing).
5. When the feeling peaks, keep the breath going, validate, and, where agreed, offer the corrective element: the needed words, support, or a boundary (see 4.8–4.11).
6. Close by letting the image go, orienting to the present, sitting up.
7. Integrate the experience with the case formulation.
Example language (illustrative): "Keep breathing into your belly and let the scene come, as if it's happening now… Where do you feel it? … What would you have needed back then?"
Watch for: flashback quality (losing the present, a frozen look): stop, orient, ground, and treat this as a signal to go back to stabilisation. This is not for unstabilised trauma [synthesis]. It is working when affect rises and then settles, with new meaning or self-compassion afterwards.

4.5 Tracking spontaneous movements and motor impulses

Purpose / when: the sources call for attention to spontaneous movements and motor impulses, without giving the procedure [source: LPT 2017 script]. Use it at any point when a gesture, fidget or tension appears while the patient is talking.
Steps (synthesis):
1. Notice the movement (a clenched fist, a foot pushing, a hand to the throat).
2. Name it neutrally and ask permission to stay with it.
3. Invite the patient to make it slower, or slightly bigger, and to notice what wants to happen next.
4. Ask about the feeling and the image that go with it.
5. Let the movement come to rest, then integrate.
Example language (illustrative): "While you said that, your right hand closed. Would you be willing to let it close a bit more, slowly, and see what it wants?"
Watch for: feeling exposed ("stop watching me"): name the observation as an offer and accept a no. It is working when the movement leads to a clearer feeling or need.

Comparator (a different method). Henn-Mertens & Zimmek describe the therapist's sequence for body signals in four steps. Perceive the signal. Mark it with a short descriptive statement. Link body, emotion and thought. Optionally, invite an experiment by holding, repeating or intensifying the movement. A no is met with the same curiosity as a yes [source: Henn-Mertens & Zimmek 2021, publisher excerpt].

4.6 Exploring body defence (Körperabwehr)

Purpose / when: to bring into awareness how the body actively manages feelings. The examples she gives are shallow breathing, raised shoulders, clenched teeth, swallowing down a lump in the throat, and limp paralysis when aggression is inhibited [source: LPT 2017 script]. The review says the book explores body defence mindfully and pairs it with re-parenting experiences [source: Jost 2020 review]. Use it when a recurring holding pattern appears alongside avoided affect.
Steps (synthesis):
1. Point out the pattern.
2. Ask the patient to exaggerate it slightly for 20–30 seconds (pull the shoulders up more, clench harder), then release slowly.
3. Compare the two states.
4. Ask what the pattern protects against, and when they learned it.
5. Leave the choice open: keep it, or experiment with a little less.
Example language (illustrative): "Your shoulders seem to come up whenever we touch on your father. Let them come up a little further, on purpose… and now slowly let them down. What's different?"
Watch for: treating the defence as an enemy (go back to its function); a sudden flood of feeling when it releases (slow down, use 4.3 pacing). It is working when the patient recognises the pattern outside sessions and can change it by choice.

4.7 Live micro-behaviour analysis in the session

Purpose / when: a body-based behaviour analysis done in real time, so the patient learns to perceive and regulate anger, rage, grief, fear, joy and desire [source: Jost 2020 review]. Use it when a feeling or avoidance happens in the room.
Steps (synthesis, adapting a standard SORC-style chain analysis to second-by-second body detail):
1. Freeze the moment ("let's slow down right here").
2. Trace back: what was said or thought just before (trigger), then which sensation came first.
3. Trace the impulse, what the patient did with it (holding the breath, smiling, changing the subject), and what followed (relief, emptiness).
4. Mark one point where a different body response could be tried, and try it now: breathe out, put the feet on the floor, let the impulse show.
5. Note the effect.
Example language (illustrative): "Let's replay the last ten seconds. What did you notice in your body just before you laughed?"
Watch for: shame at being observed; over-intellectualising (bring it back to sensation). It is working when the patient starts doing the slow-down on their own and catching the earliest sensation.

4.8 Bonding exercises (reaching out, being held)

Purpose / when: based on Downing's affect-motor schemas from the preverbal period, which divide into bonding and separation [source: LPT 2017 script; Jost 2020 review]. Use bonding work when the formulation shows suppressed needs for closeness and support, such as depression, unmet attachment needs, or "excessive" neediness [synthesis on indication]. The book's specific bonding exercises are not reproduced here [uncertain].
Steps (synthesis):
1. The patient sits facing you at an agreed distance.
2. They notice the impulse to reach out, then slowly extend one or both arms toward you, or toward a cushion standing in for a person.
3. They track what the body does on the way: the arm getting heavy, hesitating, pulling back.
4. Explore the moment of hesitation.
5. Where touch has been agreed, receive the hand (see 4.10); otherwise use imagined contact (4.11).
6. Close by bringing the arms back slowly, then integrate.
Example language (illustrative): "Let your hand move toward me, as slowly as you like. Notice where it wants to stop."
Watch for: strong grief, shame about needing, collapse. It is working when the patient tolerates reaching and receiving and can link this to their learning history.

Comparators for closeness work without touch (a different method). Henn-Mertens & Zimmek describe three exercises [source: Henn-Mertens & Zimmek 2021, publisher excerpt]. In the approach exercise, therapist and patient stand 2–4 m apart. The patient walks toward the standing therapist and adjusts the distance while noticing bodily reactions. In the scarf exercise, both hold one scarf, which creates connection without body contact. They vary how loosely or firmly they hold it, then put it down and reflect. In the third, the patient adjusts the distance and angle of their chair until the body relaxes. All three suit patients who decline touch.

4.9 Separation exercise: pushing away (Wegschiebeübung)

Purpose / when: the separation side of the affect-motor schemas. It builds the bodily experience of a boundary, of saying no, and of the right to one's own space. It is named in her case of an anorexic, insecure patient, but the procedure is not given [source: LPT 2017 script]. Use it for unassertiveness, inhibited anger, limp collapse in conflict, and boundary problems [synthesis on indication].
Contraindications (synthesis): recent injury to the wrists, shoulders, back or neck; cardiovascular illness (avoid strong sustained straining); unstabilised trauma involving physical overpowering.
Steps (synthesis):
1. Choose the resistance with the patient. The no-touch options are a firm cushion the therapist holds against their own body, or the wall. The touch option, which needs the full consent sequence, is palm to palm.
2. The patient stands or sits with feet grounded.
3. They push slowly and steadily with the breath going out; the therapist gives matched, steady resistance, never more than the patient.
4. Add a word if the patient wants ("no", "stop", "go away").
5. Do 3–5 pushes of about 10–20 seconds each, with pauses to notice the legs, arms, breath and feelings.
6. Close by letting go slowly and standing on one's own, then integrate.
- Comparators: the BOPT-MUS manual uses firm pressing of a ball with both hands, partner pushing and yielding with a ball held between them, and strong movements to push the pain away symbolically [source: Röhricht & Papadopoulos 2017].
Example language (illustrative): "Feel your feet first. Now push the cushion away from you, slowly, as you breathe out. If a word wants to come, let it."
Watch for: giving up, collapsing or laughing it off (reduce the resistance so the patient succeeds); rage escalating beyond control (slow down, stop pushing, ground); in eating disorders, guilt about taking space. It is working when the patient's posture becomes more upright, the voice firmer, and assertive behaviour appears in role plays or everyday life.

4.10 Supportive touch (hand-holding and other functions of touch)

Purpose / when: the book treats touch as a topic of its own [source: LPT 2017 script; Jost 2020 review]. It covers:
- whether the therapist is authentically willing to touch;
- whether the patient wants, accepts or allows touch;
- worries about eroticisation;
- the functions touch can serve: support, conveying safety, comfort, holding, offering resistance, or a behavioural experiment.
- Her named example is holding the hand of a depressed patient [source: LPT 2017 script; Jost 2020 review].
- Use touch only when it serves a clear function in the formulation and the patient freely agrees. Never use it to soothe your own discomfort [synthesis].
Steps: use the six-step consent sequence at the top of section 4 [source: Jost 2020 review for explicit permission; the rest is synthesis]. Then, for hand-holding (synthesis):
1. Sit side by side or at an angle, not directly face to face.
2. Offer your open hand, palm up, resting on your own knee or an armrest, so the patient decides whether to take it.
3. Keep the contact still and light, with no stroking.
4. Check in after about 30 seconds and periodically.
5. The patient decides when to let go; you let go first only at the stop signal or if the contact stops serving its purpose.
6. Debrief the meaning of the contact, and record it.
- Touch elsewhere: an agreed hand on the upper back or shoulder blade for support is a common body-psychotherapy option, but the sources do not specify locations [uncertain]. Avoid the front of the torso, legs and face [synthesis].
Example language (illustrative): "Some people find it helps to have a hand to hold when this feeling is strong. You're free to say no, and we can do it in imagination instead. Would you like that? If you want to stop, just say 'stop' or let go."
Watch for: compliance ("if you think so"), freezing, signs of a trauma link, any sense of sexualisation on either side (stop and discuss; take it to supervision), dependency. It is working when the patient feels safer, the affect can be borne, and they can later recall the support without needing the touch.

4.11 Imagined touch and other inner techniques

Purpose / when: the no-touch alternative to 4.10 [source: Jost 2020 review; LPT 2017 script]. It rests on the Carpenter effect: watching or imagining a movement or touch produces measurable muscle activity and nerve impulses that are not visible [source: Jost 2020 review]. Use it when touch is declined or contraindicated, in remote sessions, and as home practice.
Steps (synthesis):
1. Ask the patient which kind of contact would help (a hand on the back, being held, someone standing beside them) and from whom (a real or ideal figure, or their adult self).
2. With slow breathing, they imagine it in detail: where, how warm, how firm.
3. Ask where in the body the effect shows.
4. Optional: the patient places their own hand where the imagined hand would be.
5. Do 2–5 minutes; close by letting the image fade and orienting.
6. Integrate, and agree home use.
Example language (illustrative): "Imagine a hand resting between your shoulder blades: whose hand would it be? … How warm is it? What happens in your breathing?"
Watch for: the imagined figure turning hostile or absent (switch to an ideal or protective figure). It is working when the body settles in response and the patient can use the image on their own.

4.12 Working with crying in the session

Purpose / when: one of her case examples is a patient who has to cry during the therapy conversation. The details are not given [source: LPT 2017 script]. In this model tears are a sign that avoided affect is being reached, and they call for the permitting stance [synthesis from the principles].
Steps (synthesis):
1. Slow down and allow the tears ("it's welcome here").
2. Invite breathing out fully rather than holding the breath; notice the throat and chest.
3. Ask what the tears are about only once the wave passes.
4. Validate.
5. Cognitive integration: what the crying means, and where the patient learned not to cry.
Example language (illustrative): "You don't need to stop it. Let the breath go out… I'm here."
Watch for: shame and apologising; crying that turns into panic or collapse (ground, open the eyes, feet on the floor). It is working when the crying ends in relief and the patient feels less shame.

4.13 Cognitive integration (weaving the levels)

Purpose / when: the obligatory close of every experiential sequence [source: LPT 2017 script; Jost 2020 review].
Steps (synthesis):
1. Ask in turn about sensation, feeling, image, thought and impulse.
2. Help the patient put the experience into a sentence.
3. Link it to the case formulation or schema (where the pattern was learned, what it does now).
4. Derive a concrete consequence for behaviour.
5. Record a key phrase or bodily anchor for transfer.
Example language (illustrative): "What did your body just teach you? … How does that fit what we understand about your learning history? … What would you like to try this week?"
Watch for: skipping straight to intellectualising and losing the felt sense; ending raw and unsettled. It is working when insight, feeling and behavioural intention line up.

4.14 Body check during anxiety exposure

Purpose / when: an established behaviour-therapy element she lists [source: LPT 2017 script]. It keeps body sensations in awareness during exposure, which helps reduce avoidance.
Steps (standard VT practice, my wording):
1. During exposure, at intervals, ask the patient to scan and name bodily sensations and rate their anxiety.
2. Discourage subtle safety behaviours (tensing, holding the breath, distracting).
3. Keep breathing natural.
4. Continue until expectancy is disconfirmed or anxiety reduces, following the exposure protocol in use.
Safety: use the usual exposure consent, medical clearance for intense interoceptive exposure, and caution in cardiac or respiratory illness and pregnancy [synthesis].
Example language (illustrative): "What's happening in your body right now, on a scale of 0 to 100? Stay with it; don't hold your breath."
Watch for: hidden safety behaviours. It is working when the patient tolerates the sensations and their catastrophic predictions weaken.

4.15 Body confrontation and body reconciliation (eating disorders)

Purpose / when: she lists body confrontation and "reconciliation" (Aussöhnung) with the body in eating disorders as established VT elements, and frames reconciliation as resource work [source: LPT 2017 script]. Use it in an established eating-disorder treatment, medically monitored where needed.
Steps (synthesis, following common mirror or body-exposure practice):
1. Agree the format (clothed, in front of a mirror, or in imagination).
2. Guide neutral, descriptive observation of body regions from head to foot, with no evaluative words.
3. Note emotions and urges (checking, covering) and refrain from acting on them.
4. Add a reconciliation step: notice what this body part does for you; offer an attitude of care, for example placing your own hand on it.
5. Debrief.
- Do not set weight, calorie or exercise targets.
Example language (illustrative): "Describe your arms as if you were describing a landscape, without judging… What do your arms do for you each day?"
Watch for: spikes of disgust, urges to purge or exercise, dissociation. Keep sessions short and coordinate with the treatment team. It is working when negative evaluations and checking go down and the patient can stay in descriptive contact with their body.

4.16 Relaxation training and systematic desensitisation

Purpose / when: an established body element of behaviour therapy, which she sees body-oriented work as building on [source: LPT 2017 script; Freiburg announcement]. Use it for arousal reduction, as a resource, and as a counter-response in desensitisation.
Steps (standard VT practice, my wording):
1. Teach a relaxation method (e.g. progressive muscle relaxation: tense a muscle group briefly, then release and notice the contrast), practised daily.
2. Build a graded fear hierarchy.
3. While relaxed, the patient imagines items in ascending order and signals any anxiety; return to relaxation before continuing.
Example language (illustrative): "Notice the difference between the tension and the letting go in your hand."
Watch for: relaxation-induced anxiety (keep the eyes open, keep it short, give the patient control). It is working when relaxation comes faster and the hierarchy items lose their charge.

4.17 Biofeedback

Purpose / when: listed as an established VT body tool [source: LPT 2017 script; Freiburg announcement]. Use it to make physiological states (muscle tension, skin conductance, breathing, heart-rate variability) visible and trainable, especially for somatoform and stress-related complaints [synthesis on indication].
Steps (synthesis):
1. Explain the signal.
2. Take a baseline.
3. Link the signal to thoughts and feelings with a brief stressor (mental arithmetic, recalling a stressful situation).
4. Train regulation (slower breathing, releasing muscles) with live feedback.
5. Transfer to practice without the device.
Example language (illustrative): "Watch the line as you think about Monday's meeting… now breathe out slowly and see what it does."
Watch for: perfectionism about the numbers. It is working when the patient can change the signal on purpose and recognise the state without the device.

4.18 Role plays and behavioural experiments with body focus

Purpose / when: listed among the elements she integrates [source: LPT 2017 script]. They carry bodily learning (posture, breath, voice, distance) into feared social situations. One of her cases is a patient afraid of colleagues or staff (Angst vor Mitarbeitern), with no detail given [source: LPT 2017 script].
Steps (synthesis):
1. Set up the scene (e.g. telling a colleague no).
2. Run it once as usual and note the body pattern (collapsed posture, held breath).
3. Coach one bodily change: feet grounded, breath out before speaking, upright spine, the push-away energy from 4.9.
4. Rerun and compare how it felt and the impact.
5. Plan a real-life experiment with a prediction, then review it next session.
Example language (illustrative): "This time, feel your feet first and let your breath go out before you answer. Let's see what changes."
Watch for: the patient "performing" without feeling it. It is working when the new body stance appears spontaneously and the predictions are disconfirmed.

4.19 Not covered: the book's guided exercise series

The 2019 book's Part 3 (about half the book) holds illustrated breathing and body exercises largely derived from Downing and yoga-inspired methods [source: Jost 2020 review]. Their names and steps are not reproduced or reconstructed here [uncertain]. A clinician adopting this approach should work from the book itself and from training with the author's institute.

5. Handling problems

The published sources on this approach address only these problems:

caution with emotionally unstable, psychotic and severely psychosomatic patients, with supervision and self-experience recommended [source: LPT 2017 script];
touch consent, worries about eroticisation, and imagined touch as the alternative [source: Jost 2020 review];
case examples (crying, depression with hand-holding, anorexia with pushing away, "excessive" neediness in hypochondria, fear of colleagues or staff) whose handling is not described [source: LPT 2017 script].

Everything else below is my synthesis. [synthesis]

5.1 Embarrassment, feeling silly, "this isn't behaviour therapy"

Normalise the reaction. Explain again how the exercise fits the case formulation and the learning-theory rationale (state-dependent learning, the Carpenter effect).
Shrink the exercise: eyes open, seated, 30 seconds.
Let the patient choose between two options.
Treat the embarrassment itself as material: where does it sit in the body? [synthesis]

5.2 "I feel nothing" (no access to the body)

This is often exactly the indication (little access to feelings) [source: Jost 2020 review].
Start at the periphery and with neutral sensations: feet, hands, temperature, contact with the chair.
Use contrast tasks (tense and release; one side then the other, as in the BOPT-MUS comparison of a warmed-up shoulder with the other [source: Röhricht & Papadopoulos 2017]).
Validate any small report (principle: validate even the smallest behaviour).
Never suggest what they "should" feel. [synthesis]

5.3 Overwhelm, hyperventilation, panic

Stop deepening at once.
Breathe out longer than in, at a normal depth; eyes open; feet on the floor; name five things in the room; sit up.
Speak slowly and stay close, using your voice rather than touch unless touch was pre-agreed.
Afterwards, go back to Phase B resource work and use shorter rounds.
Review the screening. Persistent cardiac or respiratory symptoms need medical assessment. [synthesis]

5.4 Dissociation or flashback during breath or recollection work

Signs: a fixed stare, slowed responses, losing the here-and-now, numbness.
Responses: stop the exercise, orient ("you are here, it's [day], in my office"), use sensory grounding (a cold object, pressing the feet into the floor), and talk about the present.
Do not continue memory work until there is stabilisation, consistent with the caution about unstable patients [source: LPT 2017 script for the caution; the rest is synthesis].

For hypoarousal (numbness, going flat), Henn-Mertens & Zimmek suggest activating the body: standing up, walking, stamping the feet, or massaging the legs and feet. After strong activation they always end in a neutral, upright, grounded sitting posture [source: Henn-Mertens & Zimmek 2021, publisher excerpt; a comparator method].

5.5 Touch-related problems

The patient declines: accept without exploring why in that moment, and offer imagined touch (4.11) [source: Jost 2020 review].
The patient accepts but freezes or complies: stop, return to verbal contact, and review consent.
Eroticisation (patient or therapist): stop all touch, name the boundary clearly and non-shamingly, document it, and take it to supervision. Do not resume touch until supervision has cleared it [source: Jost 2020 review raises eroticisation concerns; the handling is synthesis].
Dependency (wanting hand-holding every session): move to imagined and self-touch, and build self-soothing. [synthesis]

5.6 Strong anger or rage in separation work

Keep it slow and controlled (steady pushing, not hitting).
The therapist matches the resistance and never escalates.
Agree a stop word.
If anger tips into loss of control, stop, ground, and talk.
Cathartic discharge (hitting, kicking, screaming) is not described in the published sources for this approach. If you use it at all, screen as for any intense motor work (cardiovascular, injury, psychosis, impulse-control problems). [synthesis]

5.7 Strong grief, neediness, "bottomless" needs

Her hypochondria case refers to "excessive" neediness, but the handling is not described [source: LPT 2017 script] [uncertain].
Synthesis: validate the need and give it a bodily form in a limited dose (a set length of imagined holding).
Link the need to the schema or learning history.
Shift the source of comfort toward self-care and the patient's real relationships, so it does not concentrate on the therapist. [synthesis]

5.8 Eating disorders: distress in body confrontation or boundary work

Keep exercises brief and descriptive.
Monitor urges to compensate (purging, exercise).
Coordinate with the medical and treatment team.
Use pushing away (4.9) to build a sense of having a right to space. Watch for guilt and over-exertion in the pushing. [synthesis]

5.9 Somatoform and health-anxious patients who fear amplifying symptoms

Present body work as learning to read signals, not as searching for illness.
Avoid long scanning of the symptom area.
Include pleasant and neutral areas, as the BOPT-MUS manual does by attending to unaffected areas and areas of competence [source: Röhricht & Papadopoulos 2017].
Watch for body checking turning into reassurance-seeking. [synthesis]

5.10 Non-adherence to home practice

Agree tiny tasks tied to daily cues (three deep breaths before opening email), one at a time.
Use a simple record of sensations and feelings.
Look at obstacles with the same micro-behaviour analysis used in sessions (4.7).
The published sources do not specify homework [uncertain]. [synthesis]

5.11 Ruptures

Typical triggers: feeling observed or exposed, an exercise experienced as pressure, a touch that felt wrong.
Responses: name the rupture, take responsibility for your part, and return to verbal work. Use the permitting stance (the patient is allowed to refuse) and validation [source: LPT 2017 script for the stance; the rest is synthesis].
Renegotiate consent explicitly before any further body work.

5.12 Therapist-side difficulties

Discomfort with bodily closeness or strong affect, pushing too fast, or using exercises you have not experienced yourself.
Remedy: your own bodily self-experience and supervision, which the sources treat as essential [source: LPT 2017 script; Jost 2020 review].
Check your licence and jurisdiction rules on touch, and your professional liability cover. [synthesis]

5.13 Psychosis, severe instability, acute suicidality

Psychosis or severe instability: keep to grounding, orienting and simple awareness of contact points, with eyes open and in short segments. No breath intensification, no regression or recollection work, no touch except in exceptional, supervised settings [source: LPT 2017 script for the caution; the specifics are synthesis].
Active suicidality: pause the experience-activating work. Carry out a standard risk assessment and safety planning, including lethal-means counselling (safe storage and removal), and involve crisis services as needed. Resume only when the patient is stable. [synthesis]

Sources

Web sources:

Körper, Gefühl und Verhaltenstherapie: Chancen einer Einbeziehung des körperlichen Erlebens – lecture script, Landespsychotherapeutentag Bayern, 11 Nov 2017 (M. Langlotz-Weis), cited as "LPT 2017 script".
Körperorientierte Verfahren in der Verhaltenstherapie – lecture and workshop announcement, Freiburger Psychotherapie-Tage (M. Langlotz-Weis), cited as "Freiburg announcement".
Jost, A. (17 Mar 2020). Review of M. Langlotz-Weis, Körperorientierte Verhaltenstherapie (Reinhardt 2019). socialnet Rezensionen, cited as "Jost 2020 review".
Henn-Mertens & Zimmek (2021). Körperorientierte Techniken in der Schematherapie. Weinheim: Beltz – publisher excerpt, cited as "Henn-Mertens & Zimmek 2021". A different method, used only as a comparator.
Röhricht, F. & Papadopoulos, N. (2017). Manual: Body Oriented Psychological Therapy for Medically Unexplained Syndromes (BOPT-MUS), primary care version. East London NHS Foundation Trust. A different method, used only as a comparator.
Consulted only on the name question, for the term "Körperverhaltenstherapie" (none of these uses it): Heese, C. (2019). Review of S. Sulz, Gute Verhaltenstherapie lernen und beherrschen. socialnet Rezensionen; Psychosozial-Verlag flyer for S. Sulz, Heilung und Wachstum der verletzten Seele; Sollmann, U. (2011). Editorial, Psychotherapie-Wissenschaft 1(1); Thieme excerpt on Konzentrative Bewegungstherapie.

Books and papers cited:

Langlotz-Weis, M. (2019). Körperorientierte Verhaltenstherapie. Munich: Ernst Reinhardt, 116 pp., ISBN 978-3-497-02850-4. [the primary text]
Langlotz-Weis, M. (2006). Der Körper in der Verhaltenstherapie. Psychotherapie im Dialog, 7(2), 127–131.
Langlotz-Weis, M. (2013). Körperorientierte Techniken. In W. Senf, M. Broda & B. Wilms (Eds.), Techniken der Psychotherapie. Stuttgart: Thieme.
Langlotz-Weis, M. (2002). Article in Praxis der Verhaltensmedizin und Rehabilitation, 59, 216–219 (title not given in the source).
Downing, G. (1996). Körper und Wort in der Psychotherapie. Munich: Kösel. [the source of the affect-motor schemas]
Grawe, K. (1998). Psychologische Therapie. Göttingen: Hogrefe. [the framework she draws on]

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