Psychotherapy is a very complex process with norms, rules, and a basic theoretical frame of reference that guides the therapist’s activity, behavior, feelings, and both verbal and non-verbal interpretations. I shall refer to these points aiming at calling attention to a subject which, to my understanding, was relatively neglected in our dynamic approach to psychotherapy. How do we use our body and how do we have corporal, physical contacts with the persons who come to us seeking treatment ?.

Ammon stated clearly how enthusiastic we shall be in our therapeutic endeavor : "The therapist has to be engaged and interested and, to a certain degree, enthusiastic about the offered nonverbal basic program with multidimensional therapeutic methods such as music therapy, dance therapy, theater therapy, horse-back riding therapy, painting therapy, milieu-project therapy, and working therapy"... "The therapist has to concentrate on his patient as a human being, on his needs, wishes, feelings and anxiety."... Ïn other words, our attempt will be to change the basic structure of a person in its roots instead of being preoccupied with the treatment of symptoms " .(Ammon, 1994).

Every one of the proposed therapies do imply, in one way or another, body participation , and we look at it more carefully, some body contacts . The structural concept of dance therapy ,deserves an analysis in the sense of not only body expressions, (Berger, 1994 ) ,but also in regard to body contacts and its fantasies about it.The same I could say about theater therapy.

Perhaps it is necessary to remind Freud who stated very clearly how the Ego is really a corporal ego : "A person’s own body, and above all its surface, is a place from which both external and internal perceptions may spring. It is seen like any other object, but to the touch it yields two kinds of sensations, one of which may be equivalent to an internal perception. Psychophysiology has fully discussed the manner in which a person’s own body attains its special position among other objects in the world of perception. Pain, too, seems to play a part in the process, and the way in which we gain new knowledge of our organs during painful illnesses is perhaps a model of the way by which in general we arrive at the idea of our body."

"The ego is first and foremost a bodily ego;it is not merely a surface entity, but is itself the projection of a surface " (Freud, 1923 ) .

I am aware of how much the above mentioned statement can be distorted in some interpretations . But as I said in many other opportunities, we can not be dogmatic and we should understand that a dynamic view of personality, considering ego-structures and ego-functions, should not deny the biological component of the ego in general.

The French philosopher Gabriel Marcel, used to say : "I am my body and I have my body ". (Marcel, 1955). There are many studies on how important is the body,both in health and disease. There are books and contributions on the need to consider the body and bodyness as essential parts of the human being. (López Ibor & López Ibor Aliño, 1974). The link between body and the transference situation was studied from classic psychoanalytic points of view by several authors. ( Calvo,Riterman et al. , 1979).

Ashley Montagu , physician and anthropologist , considers that the skin is , probably after the brain , our most important system of organs . No doubt it is the largest organ of our body structure , and its functions are of paramount importance in health and disease. (Montagu , 1986). Krieger went very far and very enthusiastic with her concept - and practice - of the "Therapeutic Touch " ( Krieger, 1982 ) .

Many of the above citations may just be considered as a demonstration of the interest in our body and the extensive possibilities that those studies can bring to our psychodynamic view of psychotherapy .

The first contact a person who seeks consultation , once the encounter is settled , is, according to cultural habits , looking at each other , and afterwards, shaking hands - at least in this part of the world - and initiating both a verbal and a nonverbal (body) communication . This is what we usually call the "first interview " . The therapeutic consultation started. I do study this piece of relationship very carefully , both in my own practice and in supervising my students , and I was able to describe what I called " Relational modality " which when known is of great help for conducting the initial contact and later on for the way our encounters will develop.

When shaking hands we notice difficulties, the so called "fishy hands " , and avoidance of a frank , open , looking , we may be prepared for a sort of schizoid , paranoiac or phobic initial relationship . Of course this is only one example , but I do hope it could illustrate what I mean .

In our country, Brazil, the first and furthers encounters with an adolescent girl ,will not be by shaking hands - that is for adults - but will be by cheek kissing , two or three kisses according to circumstances . If she would not act in the mentioned manner , we may already consider that something is very wrong with her . On the other hand ,listening to a case report of a French psychoanalyst with a 16 years old patient , I noticed he was calling her"Miss Maria" (for instance) , and she called him "Monsieur le docteur ". I asked him about such a formality with an adolescent and he told me that if he would call her just by her name ( as we do in many countries ) it could be considered offensive .

During sessions, the body language becomes really important and it is worthwhile to be aware of it. Moving the body towards the therapist or away from the therapist has some meanings . According to circumstances a physical approach can be necessary. Needless to say that it is the therapist responsibility to keep these kind of approaches within strict ethical and therapeutic setting.

I was treating a young colleague for depressive and some paranoid feelings. The history of his archaic structure was sad , but he worked hard for seeking to get out of his troublesome problems . Once he missed two sessions - which was really unusual - and when he returned to therapy he remained quiet without uttering one word.After some twenty minutes - I "felt" I should not ask anything - he said in an apparently calm tone of voice : "I did not come because my father died": afterwards,he remained silent for a few minutes and said : "I better go "...and stood up, looked at me , approached to me and hugged me crying. I accepted this sad, emotional, contact and I am convinced I acted therapeutically. No words.Just feelings and corporal communication.Therapy went on in regular sessions and this episode was reminded as a positive experience , practically at the end of treatment .

It is necessary to understand that many corporal manifestations can be therapeutic tools. All of them could be analytically interpreted maintaining physical distance and using only words . To my understanding and experience this attitude puts the therapist in an idealized position and in a sort of a non-social being. Therapy is a partnership in Dynamic Psychotherapy , an exchange of feelings, words,and nonverbal conducts within a strict scientific frame of reference.

For me, the avoidance of corporal contacts is a resistance in regard to accepting our own bodyness, our corporeal sensations , and perhaps it happens because we sexualize in a genital level what could be considered a mere erotic experience , in a broad sense of this concept, which really starts in our intrauterine life , and certainly develops intensively during the first years of life. The "Symbiotic phase " of development is a true corporeal contact , and as we learned in Dynamic Psychiatry , the basis for future health or disease , within the forming ego-structures and ego-functions.

The importance of the recognition of the body and specially the skin as a perceptual organ is being stressed . The Freudian concept of the ego as an essentially a bodily ego is reminded and citations about corporal contacts, therapeutic effects of touching, and body links in therapy , are presented.

Clinical examples of corporal contacts during individual dynamic psychotherapy are hereby described. It is pointed out the need to know what is being done, and to keep this possibility within strict ethic and scientific considerations.

Some hypothesis of why there is strong resistance to use the body as a therapeutic tool are also put into consideration. Corporeal contacts, when necessary, are recommended because they belong to the well known ideas of Dynamic Psychotherapy.

Ammon, G. (1994).- Man as a multidimensional being in health and illness. Dyn. Psychiat. (München); 27 (5/6): 307-314.-

Berger, M. (1994).- Psychological studies concerning human-structural dance. Dyn. Psychiat. (München); 27 (1/2): 50-66.-

Calvo, I., Riterman, F. et al. (1979).- "Cuerpo-Vínculo-Transferencia" . (Buenos Aires), Amorrortu.-

Freud, S. (1923).- "The Ego and the Id" . (London). The Standard Edition of the Complete Psychological Works of Sigmund Freud; Vol. XIX, The Hogart Press (1962).-

Krieger, D. (1982).- "The Therapeutic Touch: How to Use Your Hands to help or to heal". (Englewood Cliffs, N.J.), Prentice-Hall.-

López Ibor, J.J. & López Ibor Aliño. (1974).- "El Cuerpo y la Corporalidad" . (Madrid), Gredos.-

Marcel, G. (1985).- "Être et Avoir" ; (Paris), Montaigne.-

Montagu, A. (1986).- "TOUCHING - The Human Significance of the skin" . 3rd. Ed.; (New York), Harper & Row.-