Affect-focused body psychotherapy

1. Introduction

Version followed: affect-focused body psychotherapy (ABP) as described by Adrienne Levy Berg in her Karolinska Institutet thesis (2010) and the trial paper Levy Berg, Sandell & Sandahl (2009): individual weekly sessions for one year with adults with generalised anxiety disorder (GAD). The thesis says ABP is essentially Kirsti Monsen's Psychodynamic Body Therapy (PBT, developed in Norway in the late 1980s), renamed to put affects rather than transference at the centre. Body procedures are filled in from PBT and Norwegian psychomotor physiotherapy (NPMP) sources, and affect work from Monsen's Affect Consciousness model. No published ABP treatment manual was found or opened [uncertain]. [source: Levy Berg thesis via ResearchGate; KI Open Archive record; Lima de Faria & Moberg 1994]

What it is: an individual, psychodynamically informed treatment that combines hands-on and movement-based body work with structured exploration of affects. It rests on two "cornerstones": NPMP, which treats the body as a functional unit and sees breathing, muscle tension and posture as tied to emotional reactions (Braatøy and Bülow-Hansen), and the Affect Consciousness model of Jon and Kirsti Monsen, which covers awareness, tolerance, emotional (nonverbal) expression and conceptual (verbal) expression of affects. The thesis also cites Reich (muscular armour) and Lowen (inhibited breath goes with inhibited feeling), Freud's body ego, Ferenczi, Winnicott, Anzieu, Buber, Rogers and Kohut, and Tomkins's affect theory. [source: Levy Berg thesis]

How change happens, in the authors' terms: anxiety follows when affects such as shame and fear go unaccepted. Body work (stability first, then freer breathing and loosened muscle tension) and affect exploration help patients contact feelings, thoughts and behaviour through physically felt experience. They learn to tolerate affects, anxiety included, and to read them as meaningful signals about themselves, and their picture of important others and of themselves reorganises. Treatment is framed as a learning process: the aim is that patients go on exploring affects on their own. The ideas of muscular armour and of tension "holding back" feelings come from the school's theory (Reich, PBT) and are not established physiology. A PBT source sums up the view as every muscular tension state holding the story of its own origin. [source: Levy Berg thesis; Lima de Faria & Moberg 1994]

Who delivers it: in the trial, four clinicians who had recently completed PBT training; the author was one of them. In Sweden PBT was taught from 1990 as a 40-credit postgraduate course at Karolinska Institutet. Hands-on work requires specific training and supervision, and you should check that your licence and jurisdiction allow therapeutic touch and massage. In Scandinavia this work grew out of physiotherapy. [source: Levy Berg thesis; Lima de Faria & Moberg 1994] [synthesis for the licence check]

2. Framework

ABP has no published session-by-session protocol. The trial gives the dose (weekly for about one year), and the sources describe a sequence of emphases rather than fixed phases. The phases below put that sequence in order; the phase labels are [synthesis], and their content is sourced.

Format. Individual sessions, weekly for one year in the GAD trial. Earlier PBT/NPMP studies with pain patients averaged about 33 treatments, and PBT clinicians expected 20–40 treatments even in milder cases before change was stable. Session length for ABP itself is not reported [uncertain]. In the related NPMP structure (Bunkan 2001), a session is about 45 minutes of treatment, 10 minutes of rest and 5 minutes of closing, and frequency tapers from weekly to monthly or less. Treat this as a reference point, not as the ABP standard. [source: KI Open Archive record; Lima de Faria & Moberg 1994; Bunkan 2001]

Phase A: Assessment and alliance (roughly sessions 1–3) [synthesis for timing]

Goals: take a history (anamnesis); do the resource-oriented body examination (ROBE: posture, reactions to passive movement, palpation of skeletal muscles, breathing, plus the patient's overall reactions during and after); and judge needs, resources, burden, motivation, capacity for reflection and psychosocial situation. Together these decide how body techniques are tailored. [source: Levy Berg thesis; Lima de Faria & Moberg 1994]
Screen for risk of psychotic breakthrough, long-standing pain and large deviations in body findings. NPMP holds that large deviations usually rule this treatment out. [source: Bunkan 2001]
Explore what the patient prefers and how they view their body. The thesis found ABP may suit patients interested in mind-body unity, and that outcomes were better when the treatment experience was mainly positive. [source: KI Open Archive record]
Move on when there is a shared, explicit agreement on body work (including touch), a working focus, and enough stability to start.

Phase B: Stability and control

Goals: give the patient a firm base through contact with the legs and floor, a sense of control, and safety with touch. Relaxation is reduced deliberately in this phase. For high-burden patients the focus stays on confirmation, more body contact and stability, and talk centres on feeling seen and being less limited by symptoms. [source: Levy Berg thesis; Bunkan 2001; Lima de Faria & Moberg 1994]
Move on only when the patient has "gained the feeling of stability and control" (thesis, paraphrased criterion). NPMP puts the principle as never releasing more feeling than the patient has legs to stand on and a back to carry. Observable signs [synthesis]: the patient can stay present during touch, can return to steady breathing after a stir-up, can report sensations and feelings, and leaves sessions settled.

Phase C: Flexibility, breathing and affect contact

Goals: loosen thoracic and other habitual tension so breathing becomes slower, deeper and less controlled; build body awareness; and reorganise breathing. This often brings the patient closer to feelings, which are then explored in detail with the affect consciousness focus (scene, affect, attention/tolerance/expression). [source: Levy Berg thesis; Bunkan 2001; Monsen & Solbakken 2013]
Move on when affects come up during body work and the patient can tolerate, name and link them to daily-life scenes [synthesis].

Phase D: New ways of acting and relational patterns

Goals: practise new responses in movement (for example, expressing pain or pushing a painful stimulus away instead of withdrawing into silence). Identify recurring script patterns and defences. Explore current relationships and views of significant others. ABP focuses on present relationships and daily life rather than transference. [source: Levy Berg thesis; Monsen & Solbakken 2013]

Phase E: Consolidation and ending

Goals: the patient continues affect exploration independently and generalises emotional experiences to daily life. In the affect consciousness model, readiness to end is indicated when the patient can represent experiences across all six levels (scene, affect, affect awareness, script, self-other, expansion). Taper frequency as in NPMP [synthesis for applying the tapering to ABP]. [source: Levy Berg thesis; Monsen & Solbakken 2013; Bunkan 2001]

Phases overlap and recur. Monsen & Solbakken describe the representation levels as a coordinate system for orientation, not a fixed sequence. If anxiety or destabilisation rises, return to Phase B. [source: Monsen & Solbakken 2013; Levy Berg thesis]

3. Guiding principles

Stability and control before going deeper. Do not open breathing or emotional work until the patient feels grounded and in charge. [source: Levy Berg thesis; Bunkan 2001]
No more release than the patient can carry. Measure each session's opening against current resources ("legs to stand on, a back to bear it"). [source: Bunkan 2001]
Resource orientation. Adjust techniques to the resources the examination and each session reveal, and use the ROBE to find strengths as well as problems. [source: Levy Berg thesis]
Breathing is the dosing guide. Watch the breath continuously and ease off when it locks, holds or goes shallow. [source: Bunkan 2001]
On the patient's terms, and it takes time. Do not push the pace. Expect change over months. [source: Lima de Faria & Moberg 1994]
Sensitive, individually dosed touch. Touch with a "sensitive hand", friendly and empathic. Adjust pressure to the person, and remember touch can evoke memories of abuse. [source: Lima de Faria & Moberg 1994; Bunkan 2001]
Affects are signals, not symptoms. Help the patient treat anxiety and other affects as meaningful information about themselves, including anxiety, which the thesis calls a natural emotion. [source: Levy Berg thesis]
Empathic attunement is central. Acknowledge the patient's emotional state; the thesis calls attunement the core of the cure. [source: Levy Berg thesis]
Let yourself be moved, and use your body as an instrument. Notice your own bodily reactions as possible information about what the patient feels, and check guesses with the patient rather than imposing them [synthesis for the checking]. [source: Levy Berg thesis]
Active and supportive therapist. Encourage direct exploration and expression of feelings rather than waiting neutrally. [source: Levy Berg thesis]
Present relationships, not transference. Anchor affect exploration in current daily-life scenes and relationships. [source: Levy Berg thesis]
Validate first, then invite further. Acknowledge a feeling before asking the patient to stay with it or deepen it. [source: Monsen & Solbakken 2013]
Meet the patient at their current level. Work from the level the patient is at (concrete scene, named affect, awareness, pattern) rather than applying techniques mechanically. [source: Monsen & Solbakken 2013]
Specificity: one affect at a time. Break mixed, undifferentiated states apart and follow the most strongly activated affect. [source: Monsen & Solbakken 2013]
Defences as low affect integration, not resistance. Address the feeling inside a defence before naming the defence itself. [source: Monsen & Solbakken 2013]
Repetition builds integration. Go through the same focus sequence (scene, affect, bodily attention, tolerance, expression) again and again, so the patient learns to do it alone. [source: Monsen & Solbakken 2013; Levy Berg thesis]
Keep talk anchored in the body, and return questions to the patient. Start from how the patient is now, reflect, and ask what they think themselves; encourage the patient's own solutions. [source: Bunkan 2001]
Acknowledge pain without amplifying it. Over-focusing on pain may increase somatisation. [source: Bunkan 2001]
Mind-body unity and curiosity. Encourage a curious attitude to the body. In the patient interviews, patients who met their bodies with curiosity tended to reframe their anxiety. [source: KI Open Archive record]
Collaborate and refer when needed. Involve a psychiatrist or clinical psychologist when indicated, and accept that another therapy may suit some patients better. [source: Bunkan 2001]

4. Intervention inventory

The sources name the interventions below but give few positions, hand placements or repetition counts. Where a step is operationalised beyond the source it is marked [synthesis]. Do not treat any added detail as part of the ABP method itself. Example language is illustrative throughout.

Touch consent procedure (applies to every hands-on item below). The sources stress sensitive, individually dosed touch and warn that touch can evoke memories of abuse, but none of the sources sets out a consent procedure. The steps below are therefore all [synthesis], following standard body-psychotherapy ethics. (1) Before any touch, explain what you will do, where your hands will go, why, and what the patient might feel. (2) Ask explicitly, and accept a no without any pressure. (3) Offer a no-touch alternative: the patient's own hands, a movement or self-massage, or attention and breathing only. (4) Agree a stop signal (a word, or raising a hand) and confirm that stopping is always fine. (5) Keep clothing on and touch only non-intimate areas: feet, legs below the knee or over clothing, back, shoulders, arms, hands, upper chest/rib area only with specific consent. Never touch breasts, buttocks or genitals. (6) Check in during touch ("How is this pressure?") and watch the breath. (7) Afterwards, ask how it was and whether to change anything next time, and note consent in the record. Re-ask consent at each new area or technique and whenever the patient seems frozen or limp. Touch requires specific training (in the Swedish context, the PBT course), supervision, and a check of what your licence and jurisdiction allow.

4.1 Anamnesis and treatment-fit conversation

Purpose / when: First session(s). Gather the history and current life situation and gauge the patient's burden, motivation, capacity for reflection and attitude to body-based work. [source: Levy Berg thesis; Lima de Faria & Moberg 1994; KI Open Archive record]
Steps: (1) Take a history of symptoms, onset, course and situations that worsen or ease anxiety or pain. (2) Ask about current relationships and daily-life stressors. (3) Ask about earlier experiences of touch, body treatments and any history of violence or abuse [synthesis]. (4) Ask what the patient hopes for and how they feel about their body being part of therapy. (5) Screen for psychotic history and risk, and for medical issues (see 5.9) [source: Bunkan 2001] [synthesis for the medical list].
Example language (illustrative): "In this work we pay attention both to what you feel in your body and to the feelings that come with it. How does that sound to you?"
Watch for: Strong reluctance about the body, or a firm preference for talking therapy only. The thesis linked treatment preferences and experience to outcome, so discuss these openly and consider a different therapy. [source: KI Open Archive record]

4.2 Resource-oriented body examination (ROBE)

Purpose / when: Early in treatment, and again later if useful [synthesis]. Map posture, breathing, muscle tension and movement reactions, and how the patient reacts to being examined, to tailor body work. ROBE is an NPMP instrument; the thesis names its four parts but not its procedures, and the formal instrument requires NPMP training. [source: Levy Berg thesis; Bunkan 2001]
Steps: (1) Get touch consent (procedure above). (2) Observe posture, standing and sitting [synthesis for positions]: alignment of feet, knees, pelvis, chest, head; habitual extreme positions (for example, locked or flexed knees with the head pushed forward). (3) Passive movement: with the patient lying or sitting, gently move a limb and notice whether they can let it go or hold, help or brace [synthesis for positions]. (4) Palpate skeletal muscles for firmness and tension. Look for hidden tension (jaw clenching, tongue pressed to the palate, abdomen or pelvic floor held), but observe rather than palpate intimate areas: jaw and abdomen by observation or with the patient's own hand [synthesis for the restriction]. (5) Observe breathing: where it moves, its rhythm, holding, whether exhalation is free. (6) Note overall reactions during and after (anxiety, relief, dissociation, curiosity). (7) Talk through what you saw in plain, non-pathologising language. [source: Levy Berg thesis; Bunkan 2001]
Example language (illustrative): "I noticed your breathing stays high in the chest and pauses when I move your arm. Did you notice anything?"
Watch for: Large deviations from good body function (Bunkan: usually a reason not to proceed with this treatment), marked dissociation, or rising fear during the examination. Also look for resources, such as areas that soften easily or moments of curiosity.

4.3 Affect consciousness assessment

Purpose / when: Baseline and later re-assessment of how well the patient perceives, tolerates and expresses specific affects. The thesis measured affect consciousness before and after ABP; the instrument is assumed to be Monsen's Affect Consciousness Interview, which is not drawn on directly [uncertain]. [source: KI Open Archive record; Monsen & Solbakken 2013]
Steps: (1) If trained, administer the licensed interview according to its own manual; its items are not reproduced here. (2) Clinically, for each of the eleven affects the model covers (interest, joy, fear, anger, contempt, disgust, shame, sadness, jealousy, guilt, tenderness), explore concrete recent situations. Note how the patient notices the affect (bodily and mentally), tolerates it, shows it nonverbally and puts it into words. (3) Use the profile to pick a focus, for example affects with low tolerance, such as shame or fear in GAD. [source: Monsen & Solbakken 2013; Levy Berg thesis] [synthesis for clinical use without the instrument]
Example language (illustrative): "Think of a recent time you felt ashamed. How did you notice it in your body?"
Watch for: Global or blurry answers (low differentiation), or affects described only as anxiety. These are focus targets.

4.4 Grounding and stability exercises (legs and base)

Purpose / when: Phase B and whenever the patient destabilises. Strengthen contact with the legs and a firm base so the patient feels stable and in control before deeper work. [source: Levy Berg thesis; Bunkan 2001]
Steps: (1) Usually in standing [synthesis for position]: feet about hip width, weight over the whole foot, knees soft and neither locked nor bent forward, joints stacked in alignment. NPMP stresses alignment in every joint and stable axes, especially at the knees [source: Bunkan 2001]. (2) Gentle leg movements to train smooth, flexible coordination of the leg muscles, for example small weight shifts or slow knee bends and straightening [source: Lima de Faria & Moberg 1994; specific movements = synthesis]. (3) The patient attends to contact between feet and floor and lets the breath move freely. (4) A few slow repetitions, then rest and notice; no repetition counts are given in the sources [uncertain]. (5) Talk through what changed. In PBT the patient's own stability exercises get less space than in Basal Body Awareness Therapy, so keep them short and combine them with hands-on work [source: Lima de Faria & Moberg 1994].
Example language (illustrative): "Let your weight sink down through your feet. What do you notice in your legs now?"
Watch for: Locked knees, held breath, swaying or dizziness. Working signs: steadier stance, slower breathing, the patient saying they feel more solid or in control.

4.5 Stabilising massage grips to the legs

Purpose / when: Phase B. Hands-on support for contact with the legs and a firm base. [source: Levy Berg thesis]
Steps: (1) Consent procedure. (2) Patient lies on a treatment bench or sits, clothed [synthesis]. (3) Use firm, calm, even grips along the lower legs and feet, or the thighs over clothing [synthesis for sites], at a pressure agreed with the patient. (4) Watch the breath and ease off if it locks. (5) Invite attention to the felt contact and weight of the legs. (6) End by resting your hands still for a moment, then removing them slowly [synthesis]. Talk through it.
Example language (illustrative): "I'm going to place my hands on your lower legs now; tell me if you'd like more or less pressure."
Watch for: Bracing or startle, which means you should slow down or move to a no-touch option. Working signs: legs feel heavier and more present, breathing deepens.

4.6 Whole-body massage (PBT core)

Purpose / when: Throughout, adjusted to phase. PBT sources describe whole-body massage as the core of treatment. Massage is generally expected to reduce anxiety and support self-reflection. [source: Lima de Faria & Moberg 1994; Levy Berg thesis]
Steps: (1) Consent procedure, including which body areas are agreed. (2) Patient lies clothed, or as agreed, on a bench, with covers available [synthesis]. (3) Use friendly, empathic touch with a "sensitive hand", dosed to the individual; mostly pleasant, never forceful [source: Lima de Faria & Moberg 1994; Bunkan 2001]. (4) Work region by region (back, shoulders, arms, legs) [synthesis for order], watching the breath as a continuous guide. (5) Pause now and then so the patient can exhale passively [source: Bunkan 2001]. (6) Leave room for words: many patients need to talk during treatment, especially in its second half [source: Bunkan 2001]. (7) Rest period, then closing talk.
Example language (illustrative): "You don't need to do anything. Just notice what happens in your breathing as I work here."
Watch for: Memories of abuse or emotional injury evoked by touch [source: Lima de Faria & Moberg 1994]; freezing, going limp or blank (dissociation) [source: Bunkan 2001]. Stop, orient and talk (see 5.3).

4.7 Thorax-loosening grips for breathing

Purpose / when: Phase C, once stability is established. The thesis describes special massage grips that loosen stiff muscles around the thorax so breathing becomes deeper and less controlled. [source: Levy Berg thesis]
Steps: (1) Consent procedure; rib-cage and upper-chest work needs specific consent. Prefer the back, sides of the ribs and shoulders, avoid breast tissue, and offer the patient's own hands as an alternative [synthesis]. (2) Patient lying on their back or side [synthesis]. (3) Use gentle grips and small stretches on the muscles between and around the ribs, shoulders and neck, following the breath (work on the exhale, pause on the inhale) [synthesis for timing]. (4) Let the breath change by itself, without instruction to breathe deeply [synthesis, consistent with Bunkan's point that a full yawn cannot be commanded]. (5) Pause for passive exhalation. (6) Ask what the patient notices, including feelings.
Example language (illustrative): "Let the breath come and go however it wants. Has anything changed?"
Watch for: Freer breathing can bring feelings closer quickly; this is expected, but dose it (5.2). Hyperventilation signs such as tingling or dizziness mean slowing down and returning to grounding [synthesis].

4.8 Gentle stretches and movements to invite inhalation

Purpose / when: Phase C. Movements and gentle stretches that stimulate deeper inhalation. Freeing the breathing muscles is said in PBT to increase emotional openness inward and outward (the school's theory). [source: Lima de Faria & Moberg 1994]
Steps: (1) Sitting or standing [synthesis]. (2) Slow, small stretches the patient does themselves, for example lengthening the side of the trunk or opening the arms on an in-breath [synthesis for specific movements]. (3) A few repetitions with rests [uncertain: counts not given]. (4) Notice the breath and any feeling. Closing talk.
Example language (illustrative): "Let the movement be small. Notice whether your breath wants to follow it."
Watch for: Forcing or performing; ask for less effort.

4.9 Small muscle stretches added to massage grips

Purpose / when: Later in treatment. Reconnect muscle function and breathing by adding small stretches to the massage grips. [source: Lima de Faria & Moberg 1994]
Steps: (1) Consent procedure. (2) During a grip (for example on the forearm or calf), add a slight lengthening of the muscle and wait for the breath to respond [synthesis for sites]. (3) Release, pause, notice, talk through.
Watch for: A breath response (an in-breath, a sigh) suggests reconnection; holding the breath means reduce.

4.10 Brief reaction-revealing grip and pain-expression practice

Purpose / when: Only with stable patients, from mid-treatment [synthesis for timing]. NPMP uses a brief grip that gives a small, very short pain impulse to make the patient's habitual response to discomfort visible. The thesis describes ABP exercises that help patients express pain and push the painful stimulus away instead of withdrawing into silence. Linking the two is the author's reading [synthesis]. [source: Bunkan 2001; Levy Berg thesis]
Steps: (1) Consent procedure, explaining specifically that this grip is briefly uncomfortable and why, and that the patient may refuse or stop at once. (2) Give the brief grip on a muscle (site not specified in sources) [uncertain]. (3) Watch the reaction: clenching, breath-holding, stiffening, curling up, or going limp or dissociating. (4) The ideal response is a clear in-breath and an emotional release on the out-breath (such as an "ouch"), with a motor response (moving away, stretching); invite these. (5) If it hurts more than briefly, reduce intensity at once and invite a sigh. (6) Talk about the habitual pattern ("stay silent and hold") and practise the new one: saying "ouch", pushing the hand away, saying stop. [source: Bunkan 2001; Levy Berg thesis]
Example language (illustrative): "When that pinch came, you held your breath and went still. What would it be like to let a sound out, or push my hand away?"
Watch for: Omit this grip with patients with major body findings, personality problems, high anxiety, a history of violence, or a negative reaction [source: Bunkan 2001]. Also omit it with trauma survivors for whom pain from another person may re-enact abuse [synthesis].

4.11 Breath-guided dosing, pauses and the invited sigh

Purpose / when: Throughout all hands-on and movement work. In NPMP, breathing is the continuous guide for how much to do; the out-breath is the natural phase of letting go. [source: Bunkan 2001]
Steps: (1) Keep part of your attention on the patient's breath at all times. (2) If the breath holds, rises high or speeds up, reduce pressure or pace. (3) Build in short pauses with no input so the patient can breathe out passively. (4) After any discomfort, invite a sigh. (5) Do not tell the patient to breathe deeply [synthesis, consistent with source].
Example language (illustrative): "Let's pause here. Let the air go out by itself... you might allow a sigh."
Watch for: A spontaneous deeper in-breath and longer out-breath, which show the dose fits.

4.12 Allowing "primitive reactions" (yawn, stretch, deep breath)

Purpose / when: Phase C onward. Braatøy described full yawning, stretching and deep breathing as signs that the body is letting go. [source: Bunkan 2001]
Steps: (1) Do not ask for a yawn. Bunkan notes the full yawn does not come from asking for it; it appears when the body has enough flexibility. (2) When a yawn, stretch or deep breath starts, make room for it: pause, wait, and let the patient follow the movement fully. (3) Then ask briefly what they noticed.
Example language (illustrative): "Go ahead and follow that stretch as far as it wants to go."
Watch for: Patients who stifle yawns out of politeness. Normalise it ("that's welcome here").

4.13 Posture and alignment work

Purpose / when: Throughout, alongside grounding. Reduce habitual extreme positions; NPMP treats posture as one connected whole in which a change in one area affects others. [source: Bunkan 2001]
Steps: (1) Point out one habitual pattern from the examination, for example locked knees with the head pushed forward. (2) Invite a small adjustment (softening the knees, letting the weight settle over the feet) and notice what changes higher up, in the neck and breathing [synthesis for the specific cue]. (3) Hold it briefly and notice any feeling. (4) Talk through it. Ergonomic or habit-based problems usually change more easily than emotionally rooted tension [source: Bunkan 2001].
Example language (illustrative): "Let your knees soften a little. What happens in your neck?"
Watch for: Feelings such as exposure, defiance or collapse when the posture changes. These are material for affect work (4.18–4.23).

4.14 Movement exercises for new ways of acting

Purpose / when: Phases C–D. Practise in the body a response the patient habitually avoids: expressing pain, refusing, taking space, instead of withdrawing into silence. [source: Levy Berg thesis]
Steps: (1) Identify the habitual pattern from body work and daily-life scenes. (2) Choose a small, safe action that embodies the alternative, such as a pushing-away movement of the arms against air or against the therapist's palms with consent, a step back, or saying "no" or "stop" with an exhale [synthesis for specific actions; the source gives the principle and the pain example]. (3) Repeat a few times at a level the patient can control. (4) Rest, notice the sensations and the affect (for example anger, relief or shame), and connect it to the daily-life scene.
Example language (illustrative): "Instead of going quiet, try pressing my hands away and saying 'stop'. How is that?"
Watch for: This is not cathartic discharge: no hitting, kicking or screaming is described for ABP. Keep the action contained and under the patient's control [synthesis]. Watch for shame after expression (5.6).

4.15 Rest period and closing talk

Purpose / when: End of every session. Let reactions settle and connect the session's experience to words. In NPMP the session ends with about 10 minutes of rest and 5 minutes of closing. [source: Bunkan 2001]
Steps: (1) Stop active work. The patient rests, covered if lying, without input. (2) Have them sit up slowly and orient to the room [synthesis]. (3) Ask what they noticed in body and feelings and what they take with them. (4) Check their state before they leave [synthesis].
Example language (illustrative): "Take a few minutes just to rest... What are you aware of now, in your body and in your mood?"
Watch for: Spaciness or agitation at the end. Add grounding (4.4) before the patient leaves.

4.16 Reading affect signals, including the therapist's own body

Purpose / when: Continuously. Read verbal and nonverbal affect information (breathing, posture, bodily reactions) and use your own bodily reactions as a source of information about what the patient may feel. [source: Levy Berg thesis]
Steps: (1) Notice shifts in breath, colour, posture, voice and gaze. (2) Notice your own body (tightness, heaviness, an urge to move). (3) Offer a tentative observation and let the patient confirm or correct it [synthesis for the tentativeness].
Example language (illustrative): "When you spoke about your sister, your breathing seemed to stop for a moment. Did you notice that?"
Watch for: Projecting your own state onto the patient. Hold guesses lightly.

4.17 Body-anchored opening check-in

Purpose / when: Start of each session. In NPMP the therapist usually opens with a question about how the patient is and keeps the conversation anchored in the body. [source: Bunkan 2001]
Steps: (1) Ask an open question about how they are and how the time since the last session went. (2) Ask where they notice that in the body. (3) Choose today's focus together (body region, affect or scene) [synthesis].
Example language (illustrative): "How have you been since last time, and how is your body today?"

4.18 Scenic exploration (concrete episodes)

Purpose / when: Whenever an affect or anxiety appears. Ground it in a concrete daily-life scene: what happened, who was there, in what order, whose experience is in the foreground (level 1 of the affect consciousness model). ABP links affects to daily-life scenes and relationships. [source: Monsen & Solbakken 2013; Levy Berg thesis]
Steps: (1) Ask for one specific recent episode. (2) Slow it down: the sequence, who said or did what. (3) Keep it concrete rather than general.
Example language (illustrative): "Take me to one moment this week when the anxiety came. Where were you, and what had just happened?"
Watch for: Shifting to generalities ("I'm always like this"). Gently return to the scene.

4.19 Naming and differentiating affects

Purpose / when: After the scene is clear (level 2). Identify which affects are present, which dominates, and how they change during the scene. Break up undifferentiated clusters and follow the most activated affect. [source: Monsen & Solbakken 2013]
Steps: (1) Ask what the patient felt at each point. (2) If they say only "anxious" or "bad", explore what else might be there among the eleven affects (for example shame, anger, sadness) without leading. (3) Pick the strongest one to stay with.
Example language (illustrative): "Underneath the anxiety, was there anything else, maybe irritation, or feeling small?"
Watch for: In GAD, anxiety often covers shame or fear that the patient has not accepted, in the thesis's account. [source: Levy Berg thesis]

4.20 Affect attention: noticing the affect in the body

Purpose / when: Level 3, attention aspect. Help the patient notice the bodily and mental signs of the chosen affect, during dialogue or during hands-on work. [source: Monsen & Solbakken 2013; Levy Berg thesis]
Steps: (1) Invite attention to sensations now, while the patient recalls the scene or while you are touching them. (2) Ask about location, quality and movement. (3) Ask about the mental side (thoughts, mood).
Example language (illustrative): "As you remember that, where do you feel the shame right now?"

4.21 Affect tolerance: staying with and understanding the affect

Purpose / when: Level 3, tolerance aspect. Let the affect affect the patient, accept it, and understand what it signals and how they usually handle it, so that it becomes a meaningful signal rather than only an anxiety state. [source: Monsen & Solbakken 2013; Levy Berg thesis]
Steps: (1) Validate first. (2) Invite the patient to stay a little longer with the sensation, combined with grounding or the therapist's steady hand if agreed [synthesis for the combination]. (3) Explore what the feeling is "telling" them and what they normally do with it (suppress, flee, worry).
Example language (illustrative): "It makes sense that this is unpleasant. Can you stay with it for a few breaths? What might it be telling you?"
Watch for: Flooding. Return to stability (5.2).

4.22 Emotional (nonverbal) expression

Purpose / when: Level 3, expression aspect. Help the affect show in body language, voice, face and posture, adjusted to context. [source: Monsen & Solbakken 2013]
Steps: (1) Notice a suppressed expression (tight jaw, held breath, a fist). (2) Invite a little more of it: letting the sound out on the exhale, letting the face show it, straightening up. (3) Explore how this would fit real situations (context-adjusted expression).
Example language (illustrative): "Your hand is closing. Let it do a bit more of that... what feeling goes with it?"

4.23 Conceptual (verbal) expression

Purpose / when: Level 3. Find precise words for the emotional side of an experience, words that would convey it to another person. [source: Monsen & Solbakken 2013]
Steps: (1) Ask the patient to describe the feeling in their own words. (2) Refine it together ("angry" or "humiliated"?). (3) Rehearse saying it as they might to the person involved [synthesis].
Example language (illustrative): "If you were to tell him what you felt, what words would fit?"

4.24 Working with script patterns and defences

Purpose / when: Phase D (level 4). Identify automated ways the patient organises experience, including defences such as worry, holding the breath or going silent, and the bodily form they take. Address the feeling inside a defence before the defence itself. [source: Monsen & Solbakken 2013; Lima de Faria & Moberg 1994]
Steps: (1) Point out the repeated sequence across scenes and in the body (for example: the shame signal, then holding the breath, then worrying). (2) Explore the feeling the defence protects against. (3) Only then name the pattern together.
Example language (illustrative): "It seems that whenever you start to feel hurt, your breath stops and the worrying starts. What is the hurt like, before the worry takes over?"

4.25 Exploring significant others and current relationships

Purpose / when: Phase D (level 5). Explore formative scenes and significant others, the patient's own part in recurring patterns, and their view of important others; ABP aims to reorganise these representations. ABP keeps the focus on present relationships and daily life rather than on transference (the general affect consciousness model also uses the therapy relationship) [uncertain about how far ABP uses the here-and-now relationship]. [source: Levy Berg thesis; Monsen & Solbakken 2013; Lima de Faria & Moberg 1994]
Steps: (1) Link today's affect and body pattern to a current relationship. (2) Explore earlier, formative versions if relevant. (3) Look for a more realistic view of the other and of oneself.
Example language (illustrative): "Who in your life now brings out that holding back? Does it remind you of earlier times?"

4.26 Expansion: new experiences beyond the old pattern

Purpose / when: Phases D–E (level 6). Support experiences that go beyond the old script, such as relationships that feel vitalising and handling old situations in new ways. [source: Monsen & Solbakken 2013]
Steps: (1) Notice and explore instances in which the patient acted differently. (2) Recall the body state that went with it. (3) Plan a next step in daily life [synthesis].
Example language (illustrative): "You told her you were disappointed. What was that like in your body?"

4.27 Linking bodily symptoms with psychological factors and generalising

Purpose / when: Throughout. In PBT the therapist helps the patient see links between bodily symptoms and psychological factors, generalise emotional experiences and understand present reactions psychodynamically. [source: Lima de Faria & Moberg 1994]
Steps: (1) Together, track when symptoms (tension, pain, anxiety) appear and what situations go with them [source: Bunkan 2001]. (2) Formulate the link in the patient's own words. (3) Look for the same pattern in other areas of life.
Example language (illustrative): "Your shoulders tighten before meetings with your manager. What do you make of that?"
Watch for: Pain should be acknowledged but not over-emphasised, which may increase somatisation. [source: Bunkan 2001]

4.28 Returning questions and fostering the patient's own solutions

Purpose / when: Throughout. Reflect what the patient says and hand the question back ("What do you think yourself?" is Bunkan's example), encourage the patient's own solutions and responsibility for choices. [source: Bunkan 2001]
Example language (illustrative): "What do you think would help in that situation?"

4.29 Confirming, supportive mode for high-burden patients

Purpose / when: When psychosocial or bodily burden is high. Focus on confirmation, more body contact (if consented) and stability, and talk about feeling seen and being less limited by symptoms, rather than deep emotional opening. [source: Lima de Faria & Moberg 1994; Bunkan 2001]
Steps: (1) Keep sessions predictable. (2) Prioritise stabilising grips, grounding and rest. (3) Validate and support everyday coping. (4) Coordinate with other carers. In the thesis interviews, supportive as well as reflective interventions were experienced as helpful. [source: KI Open Archive record]

4.30 Cultivating curiosity and reframing anxiety as a signal

Purpose / when: Throughout, especially early. Treatment begins by building interest and curiosity about affects. In the patient interviews, curiosity about the body went with patients reframing their anxiety. [source: Levy Berg thesis; KI Open Archive record]
Steps: (1) Meet sensations with interested rather than alarmed questions. (2) Explore what anxiety signals about needs or other affects. (3) Note out loud when the patient becomes curious [synthesis].
Example language (illustrative): "Instead of trying to get rid of the anxiety for a moment, let's be curious about it. What is it like right now?"

4.31 Ending: independent affect exploration and tapering

Purpose / when: Phase E. The goal is for the patient to continue affect exploration independently. Readiness is suggested when they can represent experience across all six levels. [source: Levy Berg thesis; Monsen & Solbakken 2013]
Steps: (1) Review the body and affect changes together. (2) Have the patient lead the scene, affect, body and expression sequence themselves in session. (3) Agree on a few brief self-practices, such as grounding stance or attention to breath and affect, in daily life [synthesis]. (4) Taper frequency (as in NPMP) and plan a follow-up [synthesis for ABP]. (5) Talk about feelings about ending, such as sadness or fear [synthesis].

5. Handling problems

The ABP sources say little about problem management. Items are tagged by source; everything else is [synthesis].

5.1 Shame and loss of control during body work

The thesis interviews raised shame and control as themes in patients' experience of ABP [source: KI Open Archive record]. Responses [synthesis]: give the patient explicit control over every step (pace, position, clothing, touch or no touch, stop signal); describe what you do before doing it; normalise bodily reactions (tears, sounds, yawns, stomach noises); treat shame itself as an affect to explore gently (4.19–4.21) rather than something to push past; and let the patient keep their eyes open and sit up whenever they wish.

5.2 Overwhelm and too-rapid opening

Sources: never release more feeling than the patient can stand on and carry; do not overdose; go slow and gentle with patients with major body findings, personality problems, high anxiety or a history of violence; establish stability and control before going deeper [source: Bunkan 2001; Levy Berg thesis]. Concrete response [synthesis]: stop the current technique; have the patient sit up with feet on the floor and eyes open; orient to the room; do grounding (4.4) and allow passive exhalation (4.11); name what happened without interpreting; go back to Phase B work for the next sessions. Signs of hyperventilation (tingling, dizziness, tight hands) mean slower, quieter breathing and grounding, never further breath work.

5.3 Dissociation, freezing or going limp under touch

NPMP lists dissociating and going limp as habitual responses to discomfort that the therapist watches for [source: Bunkan 2001]; touch can evoke memories of abuse [source: Lima de Faria & Moberg 1994]. Response [synthesis]: remove or still your hands; speak the patient's name; invite them to open their eyes, push their feet into the floor and look around; check consent again before any further touch; switch to no-touch work for a while; and explore later, at the patient's pace, what came up. Recurrent dissociation calls for a stabilisation-first trauma approach and, if needed, a referral.

5.4 Stuck: talk without body contact, or body work without affect

Response [synthesis, using sourced tools]: if the patient intellectualises, move from general talk to one concrete scene (4.18) and then to bodily attention (4.20). If body work stays mechanical, ask what feeling goes with a tension or breath change and link it to a daily-life scene (4.27). If anxiety is the only affect reported, explore what lies beneath it (4.19). Monsen & Solbakken's levels can show at which level the patient is stuck (scene, affect, awareness, script, self-other) so you can address that level [source: Monsen & Solbakken 2013].

5.5 Resistance and defences

The affect consciousness model treats defences as signs of low affect integration, to be worked with by first exploring the feelings within the defence [source: Monsen & Solbakken 2013]. Response: validate the function of the defence (for example, holding the breath kept the patient in control), explore the feeling it guards, then name the pattern together. Do not confront or try to "break through" muscular holding by force; that contradicts the stability and dosing principles [synthesis, consistent with Bunkan 2001].

5.6 Shame or regret after emotional expression

Response [synthesis]: in the closing talk, acknowledge the courage it took; explore whether the expression felt too much or too exposing; agree a smaller step next time; check in at the start of the next session (4.17).

5.7 Patient does not want touch, or wants talk only

The thesis found that treatment preferences and attitudes to the body matter and that ABP may suit especially patients interested in mind-body unity [source: KI Open Archive record]. Response [synthesis]: respect the refusal fully; offer the no-touch parts (grounding and posture, own movements, attention to breath and bodily affect, verbal affect work); revisit only if the patient raises it. If the body focus as a whole is unwanted, consider referral to a mainly verbal therapy; Bunkan notes other therapy may suit some patients better [source: Bunkan 2001].

5.8 Non-adherence to self-practice

The sources describe PBT as giving less space to the patient's own exercises than Basal Body Awareness Therapy [source: Lima de Faria & Moberg 1994]. Response [synthesis]: keep home practice minimal (one short grounding or attention exercise); tie it to an existing routine; explore with curiosity what got in the way, since it may involve affects such as shame or anger; do not make adherence a condition of the work.

5.9 Contraindications and screening (body work)

Sourced: risk or history of psychotic breakthroughs should be assessed; large deviations in body examination findings usually rule out this treatment; extra caution and omission of the brief pain grip for patients with major body findings, personality problems, high anxiety, a history of violence or a negative reaction [source: Bunkan 2001]. Added [synthesis]: medical clearance for recent injury, surgery, fractures, osteoporosis, clotting disorders or anticoagulant use (massage and stretching), pregnancy (positioning, and no deep abdominal work), uncontrolled cardiovascular or respiratory illness, epilepsy (avoid strong breathing changes), skin conditions in the area touched; and caution with severe dissociation, active suicidality, acute crisis, or recent trauma without stabilisation. Assess suicide risk with standard practice at intake and when distress rises, and coordinate with psychiatric care [synthesis]. ABP and PBT are psychological treatments; do not present them as treating physical disease, and refer bodily symptoms for medical assessment.

5.10 Ruptures in the relationship

Attunement is central to ABP [source: Levy Berg thesis]. Response [synthesis]: notice withdrawal, compliance or cancellations; raise them openly and without blame; acknowledge your part (for example, going too fast or touching too firmly); adjust; and invite the patient to say directly what did not fit. The thesis also found that mainly negative treatment experiences went with poorer outcome [source: KI Open Archive record], so check the patient's experience of the treatment regularly.

5.11 Pain flare or symptom focus

Acknowledge pain but avoid over-focusing on it, which may increase somatisation; explore when and in what situations it comes and what helps; encourage shifting attention and taking responsibility for choices [source: Bunkan 2001]. If a grip causes pain, reduce intensity at once and invite a sigh [source: Bunkan 2001].

5.12 Boundaries of touch and the therapist's own reactions

The therapist is meant to be moved by the patient and to use their own bodily reactions as information [source: Levy Berg thesis]. Response [synthesis]: use regular supervision for touch-based work; keep touch strictly therapeutic and non-intimate; document consent; and if strong personal reactions (attraction, rescuing, irritation) arise, take them to supervision and do not act on them. Any sexual touch is a serious ethical violation and never part of treatment.

Sources

Sources: