Body Awareness Group Therapy

1. Introduction

Version followed: Basic Body Awareness Therapy (BBAT) run as a closed group, in the Dropsy–Roxendal tradition as the International Association of Teachers in BBAT (IATBBAT) network describes it today, with Skjærven's "movement awareness learning" cycle. Session count follows the 12-session course in Gyllensten, Hansson & Ekdahl (2003). The Norwegian day-hospital "body awareness group therapy" for personality disorders (Leirvåg, Pedersen & Karterud, Nord J Psychiatry 2010) may be a related programme. Its programme description is not drawn on, so it is not described separately here [uncertain].

What it is. Body awareness group therapy is not a separate school. It is the group form of BBAT, a physiotherapy method used in mental health care. Jacques Dropsy, a French movement educator and psychotherapist, developed the movement awareness approach in the 1960s. Gertrud Roxendal, a Swedish physiotherapist, brought it into physiotherapy at the end of the 1970s; her Gothenburg doctoral thesis came out in 1985. It was developed in Norway at about the same time. Since then IATBBAT has led most of its quality work and research [source: Fysioterapeuten 2016]. Its listed influences include Alexander Technique, Feldenkrais, Elsa Gindler's work, Zen meditation and tai chi [source: Wikipedia, secondary].

How change happens. The client practises simple everyday movements (lying, sitting, standing, walking, relational movements, voice) with attention to how they are done. That means movement quality: how a movement uses space, time and energy, and how it feels. Three elements are woven into each movement: postural stability, free breathing and mental awareness. As they come together, movement becomes more functional, and clients describe feeling "more coherent, strong and safe" [source: Fysioterapeuten 2016]. Talking over the experience afterwards turns it into meaning and coping strategies that carry into daily life. In a group, members practise side by side and reflect together [source: Fysioterapeuten 2016; group-specific mechanism = synthesis].

Scope note for psychotherapists. BBAT is taught as a physiotherapy specialisation through the IATBBAT network and university programmes, for example the Basic Body Awareness Methodology studies at Western Norway University of Applied Sciences, Bergen [source: Wikipedia references]. A psychotherapist should get BBAT training, or co-lead with a BBAT-trained physiotherapist, before running groups. Massage and touch need specific training, supervision and a check of what your licence and jurisdiction allow [synthesis].

2. Framework

[source: Fysioterapeuten 2016; Gyllensten et al. 2003 abstract (Lund portal); world.physio 2025 seminar page; sequencing details = synthesis unless tagged]

Setting and materials. You need only a floor, a mat and a chair per person [source: Fysioterapeuten 2016]. Use a quiet room big enough for everyone to walk in a circle and to stand at arm's length from each other [synthesis].

Phase 0: Assessment and contract (individual, 1–2 sessions).

Goals: decide whether BBAT suits the client (the sources say it "is not for everyone" and call for clinical reasoning), take a baseline, and agree a treatment contract [source: Fysioterapeuten 2016].
Tools: the Body Awareness Scale (BAS; Roxendal 1985) has an observational movement part and an interview part (BAS-interview) on symptoms and attitudes to body and movement. The newer Body Awareness Rating Scale – Movement Quality (BARS-MQ; Skjærven et al. 2015) rates movement quality from observed movement. Both are licensed or trained instruments: use them only after training, and they are not reproduced here [source: Gyllensten et al. 2003; Fysioterapeuten 2016 ref list; Wikipedia].
Screen for: active suicidality, acute psychosis without a stable treatment frame, severe dissociation, recent trauma without stabilisation, and physical limits on lying on the floor or getting up (recent surgery or injury, pregnancy positioning, balance disorders) [synthesis].
Contract: the client's own goals in everyday terms, attendance, confidentiality in the group, a daily practice diary, and the right to sit out any movement [source for contract and diary: Fysioterapeuten 2016; content details = synthesis].

Phase 1: Contact and foundation (about group sessions 1–4).

Goals: build safety in the group. Take contact with the body through lying and sitting movements, the contact with the floor and chair, and simple breath awareness. Introduce the diary and the reflection round.
Matches the first learning-cycle steps, "taking contact" and "exploring" [source for the cycle: Fysioterapeuten 2016; mapping onto sessions = synthesis].

Phase 2: Exploration and integration (about sessions 5–9).

Goals: standing and walking, coordinating the centre and the breath, and relational movements with space and with others. Add voice and partner exercises only once the group feels safe.
Learning-cycle steps: "experiencing", "integrating", "creating meaning" [synthesis mapping].

Phase 3: Mastery and transfer (about sessions 10–12).

Goals: each member runs their own short daily sequence. Link the movement principles to home and work situations, review the diary, plan for after the group, and close.
Learning-cycle steps: "mastering" and "conceptualising and reflecting on the experience" [synthesis mapping].

Course length and format. Gyllensten et al. (2003) gave 12 BBAT sessions over about three months as an add-on to usual psychiatric outpatient care. The abstract does not say whether these were group or individual sessions [uncertain]. A practical default is one session a week, about 60–90 minutes, with about 6–10 members and one or two leaders [uncertain: not stated in sources]. The 2025 World Physiotherapy seminar used a short format: 10 minutes of introduction, 40 minutes of guided practice with demonstration, then a closing reflection. That suggests a similar arc for a session [source: world.physio 2025, secondary].

Suggested session structure [synthesis, consistent with the principles in Fysioterapeuten 2016]:

Arrival and a short check-in round (5–10 min).
Guided movement sequence (30–50 min). Usually start lying or sitting, then move to standing, walking and relational movements as the course goes on. Keep pauses between movements to notice their after-effect.
Reflection round on the movement experience (15–20 min).
Home practice agreed and diary noted (5 min).

When to move on between phases [synthesis]:

Members can stay present through a 20–30-minute sequence without overwhelm or dissociation.
They can describe at least one bodily sensation in their own words.
Diary entries show home practice.
Movement quality looks visibly more stable (better contact with the ground, a freer breath, less effort). Repeat the BAS or BARS-MQ at the end of the course to check.
If a member is not ready, keep them at the earlier level of movements inside the same group. Members do not all need to move forward together.

3. Guiding principles

[source: Fysioterapeuten 2016 unless tagged otherwise]

Movement quality, not exercise. The aim is how a movement is done, not how strong, fast or fit the client gets. Practical meaning: never push repetitions or load; ask "how did that feel?", not "how many?". The method is not aimed at physical training, though clients may later take on more demanding activity.
Four perspectives held equally. Physical, physiological, psycho-socio-cultural and existential aspects are all weighed in assessment and treatment. Practical meaning: a stiff neck is also a breathing pattern, an emotional stance and a way of being in the world, so ask about all four.
Postural stability, free breathing and mental awareness. These are the three core elements in every movement. Practical meaning: in each exercise, check that the base is stable, the breath is not held and attention is present.
Presence in movement and awareness of movement. This is the core of the therapy. Practical meaning: slow down until the client can notice what they are doing while they do it.
Small, soft, simple movements. Practical meaning: pick the least demanding version that still lets the client feel something; less effort is the goal [source: Fysioterapeuten 2016; Wikipedia].
Everyday movements as the medium. Lying, sitting, standing and walking. Practical meaning: teach movements that can be done in a kitchen or at a desk, not ones that need a gym.
Person-centred and health-promoting. The work builds on resources and coping. Practical meaning: start from what already works in the body, not from a list of faults.
Therapist as guide. The therapist links each therapy situation to the client's everyday life and needs. Practical meaning: end each exercise by asking where in the client's week it could be used.
Movement communication. Learning passes from therapist to client largely through moving together. Practical meaning: do the movement with the group, at their tempo, rather than only explaining it.
Metaphors and imagery. Practical meaning: use simple images (roots, a tree, a wave) to bring out a quality. Let clients find their own images.
Experiential learning cycle. Seven steps: taking contact, exploring, experiencing, integrating, creating meaning, mastering, conceptualising and reflecting. Practical meaning: do not explain the point of a movement before the client has felt it.
Reflective dialogue. Talking about direct movement experiences deepens learning and insight. Practical meaning: always leave time to put words to the experience after moving.
Transfer and self-organised practice. Clients with anxiety, depression or PTSD described their own structured practice as necessary for benefit. Practical meaning: agree a small daily practice and review the diary every week.
Contract and diary. Practical meaning: write down goals together and use the diary as shared material.
Clinical reasoning; not for everyone. Practical meaning: reassess suitability whenever reactions are strong or the client shows no engagement.
Small steps tuned to reactions. Turning attention to the body can be frightening, so pace sensitively and work closely with the treating psychologist [source: Ekerholt et al. 2014, about Norwegian psychomotor physiotherapy, a related tradition].
Group principles [synthesis]: each member attends to their own experience, so there is no comparison and no "right" feeling. Taking part is voluntary moment by moment, and watching counts as taking part. What is shared in the group stays in the group.

4. Intervention inventory

Sourcing note. The sources list BBAT's components and principles: lying, sitting, standing and walking movements, relational movements, voice, massage, free breathing, the learning cycle, the treatment contract, the diary and reflective dialogue [source: Fysioterapeuten 2016; Wikipedia]. The 2025 World Physiotherapy seminar adds grounding, breath awareness, slow arm raises and gentle spinal rotations, exploring postures, and everyday patterns such as sit-to-stand and reaching [source: world.physio 2025]. None of the sources gives the named BBAT movement sequences step by step; those are taught in IATBBAT training and in Roxendal's and Skjærven's texts, which are not drawn on. The steps below are therefore a clinician's working version built from the published principles [synthesis]. Treat exact sequences, repetitions and names as [uncertain] until checked against BBAT training. No named BBAT movement has been invented here.

Default starting position for any movement: shoes off or flat shoes, comfortable clothes, mats in a circle or a horseshoe facing the leader, a chair beside each mat. Anyone may do any movement sitting [synthesis].

4.1 Assessment with the Body Awareness Scale or BARS-MQ

Purpose / when: before the group and at its end, to judge suitability, set a baseline and see change in movement quality and in body-related symptoms and attitudes [source: Gyllensten et al. 2003; Fysioterapeuten 2016].
Steps: (1) Do it individually, not in the group. (2) Explain that you will ask the client to do some simple movements while you watch how they move, and that nothing is a test of fitness. (3) Run the observed movement tasks and the interview as your training sets them out; the items are not reproduced here. (4) Afterwards, ask the client what they noticed. (5) Turn the findings into one or two goals for the contract [steps 2, 4 and 5 = synthesis].
Example language (illustrative): "I'm going to ask you to lie, sit, stand and walk for a bit. I'm watching how you do it, not how well. Afterwards I'll ask you what you noticed."
Watch for: distress at being watched (a common theme for clients with eating disorders or trauma). Offer to talk it through before you start [synthesis]. Working when: scores and the client's own account change in the same direction.

4.2 Treatment contract

Purpose / when: at the end of assessment. It turns body findings into everyday goals and agrees the frame [source: Fysioterapeuten 2016].
Steps [synthesis]: (1) Ask what the client wants to be different in daily life (sleep, tension, feeling calmer, walking with less pain). (2) Write 1–3 goals in the client's own words. (3) Agree attendance, punctuality, group confidentiality, the diary and a small daily practice. (4) Agree that they may sit out or modify any movement, and how they will signal this. (5) Sign or keep a copy each.
Example language (illustrative): "If this course went well for you, what would you notice on an ordinary Tuesday?"
Watch for: goals that are about appearance or weight. Reframe them towards function and experience [synthesis].

4.3 Movement diary

Purpose / when: throughout the course. It supports learning and affects outcome [source: Fysioterapeuten 2016].
Steps [synthesis]: (1) Give a simple notebook format: date, what was practised, how long, one word for the body before and after, one everyday situation where it was used. (2) Ask for a few lines a day. (3) Invite one diary observation in each check-in round. Members choose what to share; the diary itself stays private.
Example language (illustrative): "Just a line or two: what you did, and one thing you noticed."
Watch for: perfectionistic or self-critical entries. Model curious, non-judging wording. Working when: entries move from "did it / didn't" to describing sensations and situations.

4.4 Reflection round (verbalising the movement experience)

Purpose / when: after every sequence. Reflective talk about direct movement experience deepens learning and insight [source: Fysioterapeuten 2016].
Steps [synthesis]: (1) Let everyone sit or lie still for a minute after the last movement. (2) Ask an open question about sensation first, then feeling, then meaning or everyday use. (3) Go round the circle; passing is allowed. (4) Reflect back each person's own words without interpreting, and link them to the movement principle (ground, centre, breath, awareness). (5) Close with one practice idea for the week.
Example language (illustrative): "What do you notice now, compared with before we started?" / "Where in your week could that be useful?"
Watch for: members telling others what they should feel; intellectualising; long trauma narratives. Gently bring the talk back to present bodily experience (see 5). Working when: members use their own sensory words and link them to daily life.

4.5 Guiding through the movement awareness learning cycle

Purpose / when: the teaching method behind every movement [source: Fysioterapeuten 2016 for the seven steps].
Steps [synthesis applying the cycle]: (1) Taking contact: introduce the movement with little explanation, and do it yourself. (2) Exploring: invite small variations (slower, smaller, with or against the breath). (3) Experiencing: invite a pause to notice. (4) Integrating: link it to the three core elements. (5) Creating meaning: the reflection round. (6) Mastering: the client does it alone at home. (7) Conceptualising: the client puts into words what the movement teaches them and when they will use it.
Example language (illustrative): "Let's just do it a few times first. We'll talk about it afterwards."
Watch for: explaining too much too early, so clients perform the "right" result instead of finding their own.

4.6 Breath awareness and free breathing

Purpose / when: in every session, starting in session 1. Free breathing is one of the three core elements [source: Fysioterapeuten 2016]. Observe the breath without changing it first, then add gentle breathing exercises [source: world.physio 2025].
Steps [synthesis]: (1) Lying on the back with knees bent, or sitting. (2) Hands resting on the belly or lower ribs if the client wants. (3) For 1–2 minutes, notice where the breath moves, without changing it. (4) Then let the out-breath finish fully and wait for the in-breath to come by itself, for 5–8 breaths. (5) Return to ordinary breathing and notice any after-effect. (6) Later, notice the breath during movements (does it stop when lifting an arm?).
Example language (illustrative): "No need to breathe in any special way. Just notice where the breath moves." / "Let the out-breath finish, and wait for the next one to arrive."
Watch for: this is not breath intensification, so never ask for fast or forced breathing. Dizziness or tingling means slow down and breathe normally. Focusing on the breath can raise panic in people with panic disorder or PTSD: keep eyes open, rest attention on the feet or hands instead, shorten the time [synthesis]. Working when: the breath gets slower and moves more freely during movement, without effort.

4.7 Lying movements (contact with the floor)

Purpose / when: early sessions, and later whenever members need rest or a stable base. Lying is one of the everyday positions BBAT works with [source: Fysioterapeuten 2016; Wikipedia].
Steps [synthesis; exact BBAT sequences = uncertain]: (1) Lie on the back on the mat, knees bent, feet standing on the floor hip-width apart; a cushion under the head if needed. (2) Notice which parts touch the floor and let the floor carry the weight. (3) Very small, soft movements: let the knees sway a little to one side and back, then to the other, a few times. Or gently roll the head a little side to side. Or gently tip the pelvis forward and back. (4) Keep the breath free and the movements slow. Stop before any strain. (5) Pause and notice the after-effect. (6) Get up by rolling onto the side first, then coming up through all fours or sitting.
Example language (illustrative): "Let the floor do the work of holding you." / "Make it smaller than you think it needs to be."
Watch for: lying on the back with eyes closed can feel exposed or unsafe for trauma survivors. Offer eyes open, lying on the side, or sitting instead. Watch for fixed staring or no response (possible dissociation; see 5) [synthesis]. Working when: less muscle holding, a slower breath, and the client says they feel carried or heavier.

4.8 Sitting movements

Purpose / when: an accessible base for everyone, including those who cannot lie on the floor; useful at work [source: Fysioterapeuten 2016; Wikipedia list sitting].
Steps [synthesis]: (1) Sit towards the front of the chair, feet flat and hip-width apart, hands on the thighs. (2) Feel the sitting bones on the chair and the feet on the floor. (3) Rock gently forward and back over the sitting bones, getting smaller each time, until you find the point where the upper body balances with the least effort. (4) Let the head rest on top of the spine. (5) Optionally, gently turn the upper body a little to each side around the vertical line, a few times. (6) Pause, then talk it through.
Example language (illustrative): "Find the place where you can sit with the least work."
Watch for: slumping or holding stiffly upright as the "correct" posture. The aim is balance, not a posture held by effort.

4.9 Grounding (contact with the ground)

Purpose / when: at the start of standing work, and as a self-help skill when anxious. It builds stability and presence through attention to where the body touches the floor [source: world.physio 2025; postural stability is a core element per Fysioterapeuten 2016].
Steps [synthesis]: (1) Stand with feet parallel, hip-width apart, knees soft (not locked), arms hanging. (2) Notice the soles of the feet: heels, the outer edges, the balls of the feet, the toes. (3) Let the weight shift very slightly forward and back, then side to side, getting smaller until you feel a centre over the feet. (4) Notice the floor pushing back up through the legs. (5) Stay for 30–60 seconds with a free breath. (6) The same can be done sitting.
Example language (illustrative): "Notice how the floor holds you up." / "Let the movement get smaller until it almost stops."
Watch for: dizziness or poor balance. Stand next to a chair or wall. Working when: sway steadies, the knees unlock and the client reports feeling steadier. They start using it in stressful moments (check the diary).

4.10 Standing: centring and postural awareness

Purpose / when: after grounding. It finds the body's vertical line and a balanced centre, and lets clients notice how posture relates to mood and pain [source: world.physio 2025 (postural awareness); centre and stability concepts per Fysioterapeuten 2016].
Steps [synthesis]: (1) From the grounding stance, notice the body's line from the feet up to the top of the head. (2) Rest attention for a moment low in the belly, the area below the navel, as the centre of movement. (3) Explore two or three postures for 20–30 seconds each, for example slightly collapsed, then stiffly upright, then balanced. Notice how breath, mood and pain change with each. (4) Return to the balanced stance. (5) Talk it through.
Example language (illustrative): "Try standing the way you stand on a bad day. Now notice what changes when you find your feet again."
Watch for: postures that bring up strong memories. Keep each one short, and let the client choose how far to go. Working when: clients can find their way back to balance on their own.

4.11 Slow, attentive movements (arm raises, gentle spinal rotation)

Purpose / when: once grounding is in place. Simple movements done with full attention to sensation and quality [source: world.physio 2025].
Steps [synthesis]: (1) Stand, or sit, grounded. (2) Arm raise: slowly lift the arms forward or to the side to a comfortable height, in time with the breath, then let them come down. Repeat 5–8 times, slower each time. (3) Spinal rotation: with the feet still, let the arms hang and gently turn the trunk from the centre, a little left and right, letting the arms follow loosely like a pendulum. Repeat 8–10 times, getting smaller, then come to rest. (4) Pause and notice.
Example language (illustrative): "Let the movement start from the centre, and let the arms come along."
Watch for: shoulders hitching up, the breath held, effort or speed creeping in. Ask for a smaller, slower movement. Spinal rotation is not for people with acute back pain or after recent spinal surgery [synthesis].

4.12 Walking

Purpose / when: from mid-course on. Walking is one of BBAT's everyday movements and shows clearly how someone relates to the ground, rhythm and space [source: Fysioterapeuten 2016; Wikipedia].
Steps [synthesis]:
1. Walk at your own pace in a large circle, or freely around the room.
2. Notice the feet meeting the floor: heel, then sole, then toes.
3. Notice the arms swinging with the walk, and the breath.
4. Explore the tempo: a little slower, then a little faster, then back to a comfortable pace. Notice which tempo feels like your own.
5. Explore space: walk towards the middle of the room and out again. Notice how close to others feels comfortable.
6. Stop, stand grounded, notice the after-effect, and talk it through.
Example language (illustrative): "Let each step land." / "Find the tempo that feels like yours today."
Watch for:
- Rushing, looking at the floor, stiff or absent arm swing.
- Anxiety about crowding. Let people walk at the edge of the room.
Working when: the gait becomes more rhythmic and less effortful, and members describe a tempo they recognise as their own.

4.13 Everyday functional patterns (sit-to-stand, reaching, carrying)

Purpose / when: the transfer phase. Applies the principles to daily tasks with efficiency and ease [source: world.physio 2025; transfer principle per Fysioterapeuten 2016].
Steps [synthesis]:
1. Choose a task the group names, such as standing up from a chair, reaching to a shelf or lifting a bag.
2. Do it once in the usual way and notice.
3. Do it again slowly: grounded first, the movement starting from the centre, the breath kept free.
4. Compare the two and talk it through.
5. Plan where to try it at home or at work.
Example language (illustrative): "How little effort can standing up take?"
Watch for: turning this into ergonomics drills. Keep the focus on experience. Working when: diary entries mention using it in real situations.

4.14 Relational movements

Purpose / when: after members feel safe in their own movement. Explores the relation to space, objects and other people: boundaries, contact, giving and receiving [source: relational movements named in Fysioterapeuten 2016 and Wikipedia; specific forms = synthesis, uncertain].
Steps [synthesis]:
1. Space: standing grounded, reach the arms slowly out to the front and the sides to feel your personal space, then bring them back to the centre.
2. Distance: in pairs, A walks slowly towards B, and B says "stop" or raises a hand when the distance feels right. Swap roles.
3. Mirroring without touch: in pairs, A makes slow movements and B follows. Swap.
4. Talk it through: what was it like to set a limit, to lead, to follow?
5. Hand contact between members only with explicit consent from both, and always with a no-touch option. Many groups use no member-to-member touch at all.
Example language (illustrative): "You decide where 'close enough' is. There is no wrong distance."
Watch for:
- Freezing, giggling or over-compliance (letting the partner come too close). Signs that boundaries are difficult; work on this slowly and talk it through.
- Members with trauma histories may need to watch first.
Working when: members can say "stop" with their voice and body, and talk about the experience.

4.15 Voice exercises

Purpose / when: from mid-course on. Voice is listed among the BBAT components, linking breath, centre and expression [source: Wikipedia, secondary; not listed in Fysioterapeuten 2016, so its place in the core repertoire is uncertain].
Steps [synthesis]:
1. Stand or sit grounded.
2. Let a soft hum come out on the out-breath, for 3–5 breaths.
3. Notice where it vibrates (chest, face, belly).
4. Let it become an open vowel sound at a comfortable pitch and loudness.
5. Optionally, say a short word together as a group, or each person speaks their own name.
6. Return to silent breathing and talk it through.
Example language (illustrative): "Just let the out-breath carry a little sound. It doesn't have to sound like anything."
Watch for:
- Embarrassment. Do it all together, and allow humming silently or just listening.
- This is not cathartic shouting. Keep volume moderate, and never push sound towards emotional release.

4.16 Massage (touch)

Purpose / when: massage is part of the BBAT repertoire [source: Fysioterapeuten 2016]. It supports contact with the body's boundaries and relaxation. In groups, offer it individually and by agreement, or as self-massage. How the source tradition does BBAT massage is not drawn on [uncertain].
Training first: touch requires specific training, supervision, and a check of what your licence and jurisdiction allow. Psychotherapists not licensed for manual therapy should use only self-massage, or bring in a BBAT-trained physiotherapist [synthesis].
Consent steps: none are given in the sources, so all of these are [synthesis].
1. Explain beforehand what you would do, where (for example hands, forearms, shoulders or back, through clothing), and why.
2. Ask for a yes each time, and make clear that no is fine.
3. Offer a no-touch alternative: self-massage, or using a ball against a wall.
4. Agree a stop signal (a word or a raised hand).
5. Check in during the massage and again afterwards.
6. Record consent in the notes.
Steps, self-massage version [synthesis]:
1. Sitting, rub the hands together.
2. With the palms, firmly stroke down the opposite arm from shoulder to fingertips, 3–5 times, then the other arm.
3. Then the thighs and lower legs, stroking down towards the feet.
4. Then tap or press gently along the shoulders.
5. Pause and notice the body's outline, then talk it through.
Steps, therapist touch, by consent [synthesis]:
1. The client sits or lies clothed.
2. Use calm, firm, slow strokes, or still contact of the hands on the shoulders or back for 1–3 minutes.
3. Stay within the agreed areas.
4. Never touch the chest, buttocks, groin or inner thigh.
5. Never use sexual or genital touch.
Example language (illustrative): "I'd like to put my hands on your shoulders, over your clothes, for about a minute. Is that OK? You can say stop at any point, or we can do it as self-massage instead."
Watch for: flinching, holding the breath, going "away", or saying yes while looking frozen. Stop, return to grounding, and offer self-massage.

4.17 Movement communication, imagery and demonstration

Purpose / when: this is how every movement is taught. Learning passes through moving together, helped by metaphors and imagery [source: Fysioterapeuten 2016].
Steps [synthesis]:
1. Face the group and move with them at their tempo.
2. Use few words, and say them slowly in rhythm with the movement.
3. Offer one image at a time, for example roots under the feet, a tree swaying, or the breath like a wave.
4. Later, ask members for their own images.
5. Gradually do less yourself, so that members carry the movement alone (supports mastery).
Example language (illustrative): "Like a tree in a light wind, the roots stay, the top moves a little."
Watch for: images that don't fit a person's culture or history, for example water images for someone afraid of drowning. Let people drop any image.

4.18 Home practice and transfer to everyday life

Purpose / when: every week. Movement principles should carry over to home and work, and clients described their own structured practice as necessary for benefit [source: Fysioterapeuten 2016].
Steps [synthesis]:
1. At the end of each session, each member chooses one movement from the session.
2. Agree how long and when, for example 5–10 minutes after waking or before bed.
3. Agree one everyday cue for using it, for example grounding while waiting in a queue.
4. Note it in the diary.
5. Review it in the next check-in.
6. By the end of the course, each member writes down their own short personal sequence.
Example language (illustrative): "Which one movement from today do you want to take home?"
Watch for: too large a plan. Make it smaller rather than drop it (see 5).

4.19 Ending the course

Purpose / when: final 1–2 sessions [synthesis].
Steps [synthesis]:
1. Repeat a movement from the first session and compare the experience now.
2. Each member reviews their diary and contract goals.
3. Repeat the BAS or BARS-MQ individually.
4. Each member names their personal practice and a plan for setbacks.
5. Close with a shared grounding in a circle.
6. Agree follow-up or further referral.
Example language (illustrative): "What will you take with you from here, in your body?"

5. Handling problems

The sources say little about managing problems. Two points come from them: body attention can be frightening, so go in small steps adjusted to the client's reactions; and some clients cannot manage combined treatment, so it is paused or not started [source: Ekerholt et al. 2014, Norwegian psychomotor physiotherapy, a related tradition]. They also note that BBAT is not for everyone [source: Fysioterapeuten 2016]. Everything else below is [synthesis].

Overwhelm, panic or flashback during a movement

Stop the movement for that person, not for the group.
Invite eyes open, feet on the floor, and looking around the room to name objects. Sit on the chair.
A co-leader sits nearby without touching unless consent was agreed beforehand.
Resume with a smaller, more external-focus version (feet or hands rather than breath or belly) or let them watch.
Debrief individually after the session.
Hold the next sessions at the earlier phase level for that person.
Example (illustrative): "Let's open the eyes and feel the chair under you. You're here in this room with us."

Dissociation (blank, frozen, delayed responses, "not here")

Prefer sitting and standing to lying, eyes open, and short movements with frequent pauses.
Use rhythmic walking and contact of the feet with the floor.
Check in by name during the movement.
If dissociation is frequent or severe, BBAT should run alongside trauma-focused psychotherapy with an agreed communication route between therapists, mirroring the collaboration Ekerholt et al. describe. Or defer the group until the client is stabilised.

Stuck: "I feel nothing"

Normalise it: noticing nothing is also a finding.
Make the contrast larger: compare before and after, or the left side with the right after moving only one side.
Use clear sensory anchors such as pressure of the feet or the weight of the arms.
Shorten the reflection question to a single choice: "heavier or lighter?"
Keep sessions predictable. Awareness usually builds over weeks, not in one session [uncertain].

Performing, comparing or self-criticism

Remove demonstrations of an "ideal".
Say explicitly that there is no right way to look.
Ask about experience, not about correctness.
Avoid mirrors.
For eating-disorder or body-image clients, never comment on body shape or weight. Keep the focus on function and sensation.

Resistance or scepticism ("How does standing help my depression?")

Don't argue. Invite a short experiment and ask about its effect.
Link to the client's own contract goals.
Allow watching for a session.
Explain that the method works on how one meets everyday situations through the body, and that results come from practice.

Non-adherence to home practice

Make the task smaller: one minute, attached to an existing habit.
Plan the when and where in session.
Problem-solve obstacles without blame.
Use the diary entry "didn't practise, noticed…" as valid material.
The developers' literature reports that clients' own structured practice matters for benefit [source: Fysioterapeuten 2016], so treat it as central, not optional.

Ruptures with the leader or between members

Name the tension briefly in the group.
Repair individually (e.g. after a touch or exercise that felt intrusive): acknowledge, apologise for your part, and agree what will be different.
Protect boundaries in relational work: no one is required to pair with a specific person.
If conflict between members dominates, return to individual-focused movements and discuss it in the reflection round.

Pain or physical limitation

Every movement has a sitting or smaller version.
Stop at pain that increases.
Get medical clearance after recent surgery, injury, in pregnancy, or with balance or cardiovascular problems.
BBAT is not a treatment for physical disease; refer physical symptoms for medical assessment.

Psychosis

BBAT has been used with people with schizophrenia [source: Fysioterapeuten 2016 citing Hedlund & Gyllensten].
Keep instructions concrete and brief, eyes open, and avoid inner-imagery work.
Prefer grounding, walking and everyday patterns.
Coordinate with the treating psychiatric team.
Do not admit someone during acute psychosis.

Emotional release (crying, anger) in the group

Allow it quietly. Offer grounding and a pause.
Do not amplify. BBAT is not a cathartic method; do not encourage hitting, shouting or forced breathing.
Afterwards, ask what the person needs from the group.
Inform their treating therapist if it is significant.

Suicidality or acute crisis disclosed

Follow your service's standard risk-assessment procedure the same day: ask directly, assess intent and plan, protective factors, and access to means (counsel safe storage or removal), safety plan and handover.
Pause group participation until stable.

Group composition problems

Screen out clients who would dominate or be harmed by others' material.
Keep groups closed after session 2.
Mixed diagnoses are possible, but the group needs a shared goal and level.

Scope and competence

A psychotherapist without BBAT training should not present this as BBAT.
Get training, co-lead with a BBAT physiotherapist, or describe it as "body awareness exercises inspired by BBAT".
Seek supervision for touch and for trauma-related reactions.

Sources

Sources:

Further reading (not drawn on) [uncertain]:

Roxendal G. (1985). Body awareness therapy and the body awareness scale: treatment and evaluation in psychiatric physiotherapy. Doctoral thesis, University of Gothenburg (repository blocked access).
Skjærven L.H., Kristoffersen K., Gard G. (2008). An eye for movement quality. Physiotherapy Theory and Practice, 24(1).
Skjærven L.H., Kristoffersen K., Gard G. (2010). How can movement quality be promoted in clinical practice? Physical Therapy, 90(10).
Skjærven L.H., Gard G., Sundal M.A., Strand L.I. (2015). Reliability and validity of the Body Awareness Rating Scale (BARS-MQ). European Journal of Physiotherapy.
Skjærven L.H. et al. (2019). Consensus on core phenomena and statements describing Basic Body Awareness Therapy. Physiotherapy Theory and Practice, 35(1).
Leirvåg H., Pedersen G., Karterud S. (2010). Body awareness group therapy versus psychodynamic group therapy (day-hospital continuation treatment). Nordic Journal of Psychiatry.
Hedlund L., Gyllensten A.L. (2010, 2013). BBAT in schizophrenia. Journal of Bodywork and Movement Therapies.
Danielsson L., Rosberg S. (2015). Opening toward life: experiences of BBAT in persons with major depression. Int J Qual Stud Health Well-being.
Probst M., Skjærven L.H. (eds.) (2018). Physiotherapy in Mental Health and Psychiatry: A Scientific and Clinical Based Approach. Elsevier.

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