Online Breathing Using The ISIKÀRIS Method During The Age Of Covid

The ISIKÀRIS method is a new interpretation of Schultz’s Autogenic Training developed in light of the most recent research in Evolutionary Psychology and Neuroscience. It has been described in the book “Intercorporeità” in its pre-Covid face-to-face mode.

The following paper was written in order to introduce online tools to the Karis method of learning Schultz’s Autogenic Training. In fact, given the current state of the pandemic, it has been necessary to introduce the use of videos into the training course. 

Article 21 of the Code of Ethics of the order of Psychologists: 

“The teaching Psychologist shall inculcate in the student’s interest in the ethical principles and allow his professional practice to be inspired by them. He shall recognise as his duty to ensure his conduct conforms with the content of the training he imparts.

The Psychologist shall refrain from setting up, either personally or through others, educational activities which have the aim of using instruments or practices that are the exclusive preserve of the Psychologist for persons outside the profession except for teaching students on Psychology degree courses and post-graduate courses in psychological matters”. 

The Karis team, who for the last thirty years has been focusing on the education of fellow psychologists and psychotherapists in Autogenic Training, as explained in article 21 of the Code of Ethics above, wishes to make a contribution, albeit minimal, to the global epidemiological health emergency that has hit us, that we are still in the grips of and which is involving epochal transformations and changes. 

Article 21 of the Code highlights the importance of Autogenic Training as a technique learned in a therapeutic relationship where the psychologist, or even better (in our opinion) the psychotherapist, possesses the legal requirements and specific skills that are necessary in order to achieve more effective results. 

In this threatening and iatrogenic phase, during which the virus affects our ability to breathe, it is all the more necessary for psychologists to possess the knowledge of breathing itself and of the techniques that allow it to expand and change in order to reach a new bodily awareness, breathing re-education and a healthier self-regulation so that we can protect and strengthen our immune system.     

FOREWORD 

“It is what it is!” and during these months that we are forced to take a break, a so-called “lockdown” or “chained”, what we have at our disposal in order to meet is a screen. We meet online. Moving around becomes a crime. Greeting two people on the street could be seen as a gathering and slipping your mask under your nose could be considered a serious offence. It is compulsory to #stay at home (#restare a casa). 

Beyond political evaluations, in Italy, as in many parts of Europe and the world, citizens are forced into a situation where corporeal movements are forbidden. The pandemic makes the whole world panic. Nothing is the same as before. The health emergency, just like a big intercontinental earthquake, forces everyone into resiliency by changing their breathing patterns and their movements as well as their physical boundaries with the consequent extraordinary opportunity for a new and necessary mentalisation. This is a scientific concept suggested by Peter Fonagy that, even though it derives from the psychodynamic area, refers to the capacity to represent our own mind, that of others and to internally represent mental states in relation to ourselves and other people. This is a scientific concept that gives value and innovation to the most popular and widespread concept of good education. 

In George Downing’s Video Intervention Therapy, this is usually considered in terms of a theory of mind regarding parenting skills with the aim of allowing the development and growth of the child. When, using the video, a lack of these skills is observed, parents are encouraged and then supported while learning specific techniques and procedures that have the aim of improving the child’s well-being and treating any developmental disorders.      

In this moment of shock, what counts the most is our sense of physical integrity, of rootedness and of belonging to the Earth and our own kind. The use of the term “social distancing” as the primary mediatic antidote to the emergency is the worst and most saddening choice that could have been made. In fact, “social distancing”, as well as being wrong, evokes ideas of social classism and social disintegration instead of belonging and integration and obscure feudalism as opposed to enlightened democracy. Distancing as a necessary defence against contamination can only be corporeal and as such it has changed spatial boundaries to physical protection. 

As we have to stay away with our bodies, we should be even closer in fraternity. This represents a new Intercorporeality in which emotional motor schemata of contact and of differentiation are remodelled with a new and necessary opportunity to mentalise other people. 

Another person is someone who could harm us but, at the same time, the other individual becomes someone to protect and respect, the other person is an indispensable presence of life. What a shame the correct words were not used!

As a matter of fact, in this time of threatening health emergency, the freedom to move to and towards other places is blocked and our bodies are glued to chairs. I would never have thought, given my nature and age, to have to access technological devices in order to conduct therapy. Even less so to teach Autogenic Training and relaxation. Yet, in being surprised, it is also necessary to let ourselves be guided by actions which come most naturally over time, being realised contextually. 

Now that the initial moment of surprise has passed, I feel I should reflect on the change that has taken place, analysing the differences between clinical work and Autogenic Training formation face-to-face as opposed to that carried out using a screen, even if I am certain that the intentions and competences of therapists and trainers will guarantee the effectiveness of contact through the use of the most varied means. 

Although a sceptic in the virtual world, as a good digital immigrant, I preserve the Marcusian confidence that technology can help humanity when combined with common sense and love. Technology can help therapeutic relationships when a conscious co-creation is full of curiosity and trust towards the other person and, even more so, when a common threat looms in the background and the screen becomes the only vector of aida . *( Aida is a concept developed by Japanese philosopher Bin Kimura that refers to the manifestation of the self through the concreteness of intersubjective and interpersonal contact. The most important principles of Gestalt phenomenology are in his book which is translated by GTK books, directed by Giovanni Salonia …)    

In this article, I will firstly attempt to elaborate on some issues that arise when taking into consideration the differences between the concept of Intercorporeality through a screen and the same concept in a face-to-face setting. I will not do this to conduct an obsolete and sterile diatribe but to further explore some advantages and disadvantages that come with the use of a screen while also taking into consideration recent research results. This will primarily be aimed at Autogenic Training formation online for colleagues who want to become Autogenic Training instructors. In particular, this article is intended to be a necessary addition to the 2015 edition of “Intercorporeità”, which mainly deals with Intercorporeality in face-to-face training of future Autogenic Training teachers. 

Secondly, I will try to reflect on the importance of breathing and its boundaries as a figure and background, as a problem and treatment for the pandemic emergency we are experiencing. 

“Breathing culture” is not only a treatment for worrying and post-traumatic anxiety but also prevention aimed at psychophysical well-being and self-regulation. Moreover, by improving the awareness of the body and its boundaries, “breathing culture” can turn individual awareness into a universal human consciousness where respect and love for the Earth and its guests act as driving forces and as carriers. Psychologists and psychotherapists, first and foremost, are called with honour to take on this great responsibility.                           

There is no doubt that the Coronavirus emergency (which has yet to end!) represented and still represents a trauma for all of us, a constant health threat with global apocalyptic scenes of death and a lack of treatment for everybody. The incessant and traumatizing environment we all suffer daily has already made our primary defences and our defensive corporeal memory surface. Breathing is blocked and motor functions react in various ways: ‘attack’, ‘escape’ or ‘camouflage’ in forced or limited defence movements. 

If we are not aware of all of this then the risk of getting sick is very high. Getting ill is inevitable anyway but awareness, which is already a treatment, can guide and help us. 

In this age of Covid health emergency, I believe in the literacy and diffusion of breathing and body techniques not only as a treatment but also as a prevention of illness. These can support our right to well-being and body awareness, which are the vital basis of our orientation and our adaptive decisions. 

I have worked with the Karis Institute preparing Autogenic Training instructors for 30 years, revisiting Schultz’s technique in the light of the most recent research in Evolutionary Psychology and by giving Autogenic Training a deeper psychotherapeutic role instead of a simple breathing technique. This is the main thought that led me to this adventure with the screen. If the screen becomes the only possibility of encounter and contact, then so be it. It is a necessity, not a comfort as where there is too much comfort there is no risk and where there is no risk there is no possibility for contact or growth. 

My transfer to the screen has been part of me risking and moving my boundaries during this pandemic. In line with my style of practical experience and connected theoretical reflection, I wanted to quickly read up on the subject. How does the principle of Intercorporeality change through a screen? What are the limits and advantages of making a virtue out of necessity? Because it is indeed a necessity! No technology can ever replace the intercorporeal therapeutic encounter as it limits too many senses and actions.  At the same time, though, we cannot deny the great importance of therapeutic encounters taking place through a screen. 

At the beginning of this forced break, the need to support people already in therapy and not to leave them alone in such a difficult and surreal moment, as well as the personal need to react to such a forced passivity, led me to experience the screen. For the first time, a co-creation where therapist and patient are against the same surreal emergency background, takes place. 

The Practical Experience:  Surprise, energy and trust filled the first psychotherapeutic sessions. Almost a necessary euphoric aspect, aimed at mitigating the anxious, depressive atmosphere of the pandemic situation. However, I never thought that I would also experience Autogenic Training online. I would have gladly left it to younger digital natives who had already experienced it in some situations. However, requests made by the 16th group of formation in Autogenic Training teaching, who had already attended six meetings in presence, made me feel duty-bound to overcome a certain rigidity and risk something new like online Autogenic Training.  

Now, at the end of my experience, I would like to write about it in the hope of contributing to a constructive reflection on the use of a screen in Autogenic Training learning and on the Intercorporeality linked to it. This, as a gift for all colleagues already trained in Autogenic Training, those training and in particular those of the 16th course.    

INTER-CORPOREALITY: IN PRESENCE AND THROUGH A SCREEN

After thirty years of in presence training of Autogenic Training instructors, and in the light of the reflections on Intercorporeality already elaborated, can we still talk about this concept, Intercorporeality, when we refer to an interaction taking place through a screen? 

The existing definition is certainly not the most appropriate. Perhaps it is better to talk about Inter-subjectivity where phonetically “corporeal” is not mentioned. Maybe this consideration would be enough to highlight the full difference between face-to-face therapy and online therapy and face-to-face relaxation and online relaxation. Perhaps this is why the definition of Intercorporeality has never been very popular, too specific and evocative! 

Carlino (as cited in Russell), the first psychoanalyst to write a book about non-presence treatment, deals exhaustively with all the topics related to distanced communication. In summary, regarding face-to-face presence, he highlights the importance of the psychoanalytical quality of dialogue and the fact that the other aspects concerning the therapeutic contract may be sufficient to equate the sense of presence. He focuses on the concept of “communicative presence” and therefore (as a good psychoanalyst who distances himself from the importance that Freud gives to the body, see the case of Dora or the more popular “The Ego is above all a corporeal ego”) does not consider the presence of the human body. 

Essig, another important psychoanalyst who focused on the differences between the two methods cited, speaks about them in terms of “risks” and “fullness”, and, this is what we are concerned about in this reflection, “relational corporeality”.

Essig states that being together in the flesh and imagining it is different. In fact, he alerts us to the confusion between the rapid cognitive inference elaborated on the basis of interactive, reliable and available information produced through separate channels and the direct corporeal experience of being with another individual (Essig, 2012 cited in Russell, 2017).

As an expert in Body Therapy and a Gestalt therapist, used to working with the body and not being fond of screen devices (of which I am still wary today), I was initially scared and had several perplexities. However, I found that they were mitigated by the excitement for something new, the surreal emergency and above all, by the immediate and continuous confirmation that therapy was still working and that therapeutic relationships were growing stronger. I only needed now to venture into the literature available on the use of a screen! Nevertheless, book stores were closed and movements to and from places were restricted. However, thanks to globalisation, that on the one hand causes contagion but on the other remedies, magically, a book from Amazon arrived on my doorstep. A book, randomly chosen, but the right one, that was about to broaden the intellectual horizon of my lockdown. 

In fact, some of the thoughts outlined in this article are inspired by the book by psychoanalyst Gillian Isaacs Russell.

Some important factors of Intercorporeality are: 

  1. JOINT ATTENTION

In the 2015 edition of this book, in the second chapter, I extensively talked about joint attention as an essential aspect of Intercorporeality and of interaction in Autogenic Training. Regarding the use of this with a screen, there are obvious restrictions. The lack of shared senses, in addition to the kinaesthetic limits, contribute to the resulting limits to the concept of shared attention and to the difference between presence and the use of a screen. 

Many studies show that even just sharing a perceptual field, can promote a transformative experience in itself for the patient (Goldberg as cited in Russell). In fact, the lack of a common ground to share may prevent the development of that sense of trust necessary for every effective relationship. This can hinder the idea of “breathing together” that is connected to the primary evolutionary experience, particularly in Autogenic Training. By breathing together, the patient and the therapist share a wave of emerging breath that allows the following and resulting transference to the sharing of attention and to the introduction of the external objective element. At the same time, this enables the shift to symbolisation and mentalisation. 

  • EYE CONTACT

An important aspect of Intercorporeality is eye contact. 

There is a wide variety of studies and research that prove how important eye contact already is at the beginning of a child’s life (Beebe, Lachmann, 2002). In fact, eye contact through a screen is not exactly mutual as looks do not meet. 

The relevance of eye contact is the first source of information for human communication and is vastly studied and researched in Evolutionary Psychology. It is well known that the eyes are the mirror of the soul and, therefore, the inability to make eye contact can compromise our capacity to identify the emotions of the person who is in front of us (Baron Cohen, “La scienza del male”, 2011). 

At present, from a technological point of view, reaching gaze reciprocity seems to be impossible. Furthermore, the image on the screen is restricted to the head and shoulders while the head and eyes of the other person appear to be enlarged. My online experience has confirmed this. 

Indeed, particularly during group meetings I was not able to look the learners in their eyes. The use of Zoom, as opposed to Skype, lessened this feeling of blindness towards face expressions. Still, a sense of loneliness was present as it was impossible to look at each other. When using Skype, particularly during relaxation, I was not able to see all of the other people’s bodies and sometimes not even their faces, so it became difficult for me to follow and join their breathing pattern. I compensated for that personal and induced counter-transferential sensation of concern, trusting that they could manage by themselves as we had already had some face-to-face meetings. Moreover, Autogenic Training is quintessentially training to achieve independence and autogeny.

  • ACTION POTENTIAL

The face-to-face intercorporeal relationship between the therapist and the patient includes the possibility of a connection that can be a risk (both positive and negative) for the therapist and the patient. This risk does not exist when the connection is made through a screen.  

I remember the symbolic gesture I made during a psychotherapy session on Skype, of offering a patient one of the tissues I had on my desk while she was crying. My action created an empathic proximity between us as we were both saddened by the distance but also relieved to be sharing the feeling. At the same time, we were also sharing the acceptance of this limit and we were both trying to avoid falling victims to “the trap of simulation”. Because it actually was a limit, as every corporeal gesture performed through a screen, for better and for worse, can only have a symbolic meaning as it cannot be expressed in a tangible way. 

By talking about “the trap of simulation”, Essig wanted to indicate the moment in which the clinician is so involved in the technological simulation that he or she forgets that what is being reproduced does not actually correspond to reality. This is just like the periphrasis used by my co-therapist, Gianfranco Silvetti, when he talks about an experience that has been excessively confluent: “It isn’t the same film… You thought you were in the same cinema… But you were actually in a multiplex!”. Furthermore, according to Essig, as reported by G. Russell, therapists trapped in simulation, not taking into consideration the intrinsic limits to intimacy mediated by a computer, tend to avoid touching past states because they cannot be treated effectively at a distance. 

As a Gestalt therapist, on a more positive note, I must say that in this case the patient and therapist who co-create a connection they both co-regulate, is working. 

One cannot but agree with Essig on the inevitable limitations to the quality of the relationship brought about by the exclusion of action potential when using a screen, particularly, when working on and with the body. This is even if, gestaltically speaking, the creative adjustment found by the therapist-patient couple is reliable. 

  • A SAFE SPACE 

As already mentioned, the setting for Autogenic Training should be a safe, simple and quiet space with good lighting which is shielded from any intrusions. The therapist must guarantee this safety so that letting go into deep breathing encourages the assimilation and recovery of deep self-regulation. This co-regulation between the therapist and the patient may allow the recovery of pre-verbal movements and sensations. By breathing using a screen this is not possible as no place is less safe. The best internet connection and the most advanced computer may ensure the safety of a contact but the therapist cannot guarantee adequate protection with their presence. Letting this happen is conditioned by not being able to offer a safe place. In this case, it is the patient who has to immediately and independently (and not after a transitional phase), create their own safe space. The possibility of being alone while being with another is missing.  This is the exact same feeling of profound relaxation a child experiences when in a safe space in the presence of his or her mother. This is why “breathing online” guidelines and precautions for the patient to follow are provided, so that breathing through a screen can be as close as possible to the breathing pattern that is created in an incubator. 

As mentioned before, the need for this to happen in the therapist-patient relationship, is an essential condition for the learning of Autogenic Training. “Breathe, accept, observe” are the three crucial actions to acquire while learning Autogenic Training. 

When “breathing online”, there is a risk that the therapist may become excessively focused on the screen as there is a lack of a full intercorporeal connection. This leads to a lack of the flow of feelings which is easier to achieve in a shared space. It is difficult to completely let go when the other’s presence is not a certainty. 

The ideas of shared trust and a safe space take us back to Winnicott’s thoughts on the importance of giving a child a place to explore alone but in the presence of his mother (caregiver) which is essential for the child’s growth. 

As an expert in George Downing’s Video Intervention Therapy, I have had the possibility of seeing the sophistication of this consideration in many videos. This is, again, connected to the unavoidable intercorporeal connection in evolution between the body of the child and the body of the mother which has the function of creating safety for the child and enabling it to build its boundaries. When a mother is non-intrusive, she allows her child to build its independence safely without harassing him or her with inappropriate and excessive stimuli. This type of mother knows how to change her own boundaries in order to support the child’s exploration of its own limits. The same thing happens in the therapeutic relationship and during relaxation. 

As Winnicott states, therapy in presence can be considered a shared space where the patient can begin to distinguish what is internal from what is the external reality, a space for games and creativity, a transitional space called “the third area” in which creativity and symbolism can be accessed. Furthermore, this space is for learning, self-regulation and belonging. This is also a peculiarity of team Karis as its aim is to make Autogenic Training not only about learning self-regulation skills but also a process about relational learning. I can self-regulate on the basis of who is with me. 

The most important and recent research on being and self-regulation processes based on other people, was carried out by Beatrice Beebe. The fascinating results reached show that what happens in a child at 4 months, on the basis of the variables of “self-regulation” and “being projected towards another person”, is a predictor of the type of attachment style and what the psychopathological framework will be like at 1 or 2 years old. In sum, considering our aim, it seems that children need a good amount of self-regulation but also need to be projected towards others in order to achieve a positive development. In fact, an excess of self-regulation does not imply a healthier development.

Undoubtedly, we must take into consideration the fact that during the pandemic, social distancing can become a safe space. Paradoxically, a great amount of people may feel that, as opposed to the fear of contamination, an interaction taking place using a screen is a safe space. This is why we have to be careful not to fall into the “trap of simulation” and avoid not being able to notice the difference in the quality of connection. 

  • IMPLICIT MEMORY 

Many years ago, a lovely conference organised by the HCC Gestalt Institute was held in Syracuse on “What is implicit and what is explicit in Psychotherapy” (L’Implicito e l’Esplicito in Psicoterapia). All the most celebrated proponents of the numerous psychotherapy approaches attended. Daniel Stern was among these important guests. 

All of the academics, with various comments, agreed that, in sum, implicitness plays an extremely important role in a therapeutic relationship and in the effectiveness of the cure.  

If implicitness is of such great importance, how can we compare an online session with one that takes place in person? This is why we are, even more so, interested in the main means of implicitness in the therapeutic relation: “breathing”. 

By observing and learning about inhalation and exhalation during Autogenic Training, we can become an implicit cause for the patient’s change. This is possible by paying attention to his or her breathing pattern and by being with them even online (even if disempowered by other important factors of implicitness). 

The physical experience of moving in a space is linked to learning, mental processing and memory. Research shows that experiencing a complex movement improves cognitive performance and affects memory. The episodic autobiographical explicit memory, which is linked to words, is much more fragile and less reliable than the implicit memory that is not verbal and has its origins in the body (Clyton, 2007 as cited in Russell: 107). Merleau Ponty has already written about perception, movement, body and memory in the Introduction of this book. 

Perls and, as of today, all the main proponents of Gestalt psychotherapy identify the effectiveness of therapy in the opportunity to act out a new experience of change in the contact with the therapist. The aim is to transmit a healthier relational habit. Contact and action can change affective-motorial schemes and the memory linked to them. 

George Downing gives a specific contribution to implicit corporeal memory with his new concept of Body Organising. 

Here we would like to assert the importance of psychotherapy in presence as an implicit assimilation of change between two bodies as opposed to that taking place through a screen. Particularly, we will provide guidelines in order to enhance the experience of breathing online so that, even if it remains different to what happens in presence, we can avoid turning it into a simple tutorial. 

Recent research has proven that memory is deeply and physically connected to our way of perceiving and codifying space (Moser and Moser, 2014 as cited in Russell). The three Nobel prize winner scientists believe that our sense of direction and our ability to move in a physical space is intimately linked to the way we shape and store our memories. The concept of “motorial emotional schemata” had previously been introduced by George Downing in the 90s to describe an interaction between sensorial, motorial, emotional and cognitive levels. These are based on innate skills shaped, mirroring primary Intercorporeality, during social interactions which go on to form rudimentary representations of the self and of objects in the form of a generalised control. According to Downing, these experiences produce an assessment that appears in the form of motorial beliefs as a kind of “active implicit knowledge”. Downing discerns between affective motor schemata of connection and affective motor schemata of differentiation through which the needs and feelings related to proximity and distance in interpersonal interactions are regulated.

It is worth reporting what Gillian states at page 112: “scientists have discovered 2 types of neurons in the brain, place cells and grid cells, that allow us to place ourselves and move in the outside environment.  These cells, also known as our internal GPS, give animals and human beings the essential ability to survive and to find their own path in the physical world by knowing where they are, from where they are coming and where they are going. These researchers believe that the same algorithms and neural systems build the support necessary to explore the physical world and for memory’s mental journey… Basically, while it builds mental maps to help us navigate, our brain overlaps these with the same maps of memories of experiences and smells… “.

TIME IN GESTALT AND ITS STAGES: FACE-TO-FACE AND USE OF A SCREEN 

In Gestalt psychotherapy human beings are seen as social animals. The quality of bodily awareness of the corporal boundaries may change but relational intention and the crucial need for contact remains the same. 

In Gestalt, the three concepts of experience, relationship and time are intimately connected. Time and its phases are crucial aspects of the quality and of the meaning of experience. The conception of time in the Gestalt perspective is useful when reflecting about presence and attendance as opposed to “through a screen”. Every experience, from the simplest to the most complex, has a beginning, during; at first preparatory then a peak and an ending, with a relative pause. It has a specific time to pass. It also implies a direction or an intention. Consequently, we can compare each experience to the moment in which an arrow that vibrates, following a trajectory towards its target, is shot. When the arrow does not hit its objective, it is important to look for the reasons at the beginning of its journey. 

The moments of contact are divided into 4 phases: pre contact, contact, final contact and post-contact. We will now try and describe the dissimilarities of time between a psychotherapy experience in presence as opposed to one that takes place through a screen. 

PRE-CONTACT

The famous click of a computer immediately throws us into a level of virtual experience, as if there is no time to imagine the journey and the moment of arrival or the opportunity to think a thought, feel a sensation or live the moment. Perception through a click throws us into the view of another that we invade and are invaded by immediately. The movement towards a place is lacking. The inability to move in space removes the experience of intentional action within the patient-therapist relationship in a shared setting. And, as previously mentioned, the lack of the possibility to perform corporeal movements, prevents assimilation. 

We already well know how physical movements anchor thoughts and how much action motions in therapy are the main elements that sustain change because they are essential for learning and mental processing (Hannaford, 2007 as cited in Russell). 

Gestalt therapists, following Perls’ ideas, support action in therapy as without it, change is not efficacious. Particularly, during group therapy (but also during individual sessions) patients are encouraged to move, to stand in front of someone because going forward corporeally, intercorporeally is already a change. It is already differentiation, reorganisation of adaptive but neurotic corporeal defensive mechanisms. Our own evolution begins when we decide to stand up and move. During a Skype session there is not much opportunity to move. It takes a lot more courage to walk in and out of a therapists’ study than clicking a button.

I would like to mention Turkle’s thoughts in Russell: “We can be free to work anywhere but an interrupted connection inevitably leads to new loneliness. We rely on technology to fill the void but while technology progresses, our emotional life regresses”. 

CONTACT

The phase in which contact takes place represents the moment of action’s manipulative state but also as satisfaction and fullness. How can contact online be distinguished from face-to-face contact? Specific attention needs to be given to the central part of the online experience. If we can already predict the way things will go when the arrow is fired, we can say that the final contact could be conditioned by the fearful idea of letting something that is not fully controllable and directional happen. This is how the fear of past and dissociative aspects could limit the direction of the path. As Gestalts, we trust in organismic co-regulation. Patients and therapists will move how they can for what they can although it is intrinsically realistic that there is a clear limit to physical work online. 

For years, it has been my fervid, solid position to avoid learning Autogenic Training online. I still stand by my original position even if I now understand the importance of its use in emergency situations provided that guidelines for online Autogenic Training are followed.

POST-CONTACT 

Similarly, during online post-contact, the time for assimilation and separation is reduced. Alas, by following the formation of a group of good active and competent colleagues, I was surprised to see how the hour they had to dedicate to Autogenic Training was fitted in between one click and another, a role and then another, from one state to another. This really helped me think about my multi-tasking roles which I too have. Albeit I do not use the computer very much…! 

There is no time to move and the consequential assimilation may result qualitatively deteriorated by a lack of complete pleasure and gratification. 

During group psychotherapy, particularly at the end of a period of residential care, my co-therapist Gianfranco Silvetti and I give patients some rules to follow when organising the time that follows the end of their treatment. The same happens during therapy when, at the end of the session, we take an interest in what the patient is thinking about doing afterwards. 

In the following guidelines we also provide some recommendations that are also useful for online Autogenic Training. 

INDICATIONS AND SUGGESTIONS

Far from taking sides in a sterile diatribe between online and face-to-face relaxation, with the aim of giving our contribution to colleagues who intend to begin using this relaxation technique and, in light of what has been mentioned above, all thanks to the experience of this special time of lockdown, it becomes important to list a series of indications and suggestions for all the colleagues who want to prepare to administer Autogenic Training online. 

We do not wish for Autogenic Training to become a mere technical competency, a tutorial, Siri or Alexa, but we hope that teaching this technique online can represent an occasion for deep awareness and corporeal rooting and for a healthy and better self-regulation, aware of the fact that a positive “contact” has to do with the intention and the aim that goes beyond the means used for it to take place! We are also aware that only intercorporeal regulation in a sufficiently suitable interpersonal environment, with regular meetings, can create those corporal emotional and cognitive experiences that can change implicit and relational knowing and by doing so, support the implicit and procedural representation of new interaction schemes. And this is, as we know, the strength of corporeal psychotherapy which is difficult to carry out during the pandemic. 

  1. Complement online and face-to-face sessions – Firstly, we would like to highlight that, when possible, it is preferable to have face-to-face sessions, especially at the beginning of therapy. The Psychoanalytic Association also suggests this as well as providing the patient with correct and ethical information about the differences between the whole process online and in presence. 
  • Analysis of the patient’s request – In this situation, in Gestalt psychotherapy, it is suggested to consider analysing the patient’s needs. 

With the exception of a pandemic and of emergency situations, why would a person prefer to build an Autogenic Training relationship through a screen rather than face-to-face? Is this person perhaps used to doing a thousand things and believes that they would be saving time? Is this person perhaps phobic and fears physical proximity? Or maybe (even worse) they believe that face-to-face and online therapy are the same? 

To successfully assess the needs of an online Autogenic Training patient, we suggest, in order to promote an in-depth therapeutic relationship, conducting an anamnestic interview, thoroughly analysed in the first chapter, in two separate moments. We also propose adding the specific question “why online?” to verify that the student is not a computer technician or a person who uses a screen for work. We highly discourage learning Autogenic Training online for people who use a computer to work and live for the computer (I get this from Downing’s work with Video Intervention Therapy where the use of this technique is not recommended for people who abuse the video or, worse still, have been victims of violence online). 

  • Stable setting – The students and trainer are encouraged to keep the same setting in order to protect the concept of safe space. This gives the possibility to the other people to have an unchanging and common vision even if it cannot be shared. 
  • Timing and pre-contact – Concerning the concept of time and its phases regarding pre-contact, I really appreciate the idea of my colleague Eleonora Savino, who suggested the students prepare an infusion before the experience of Autogenic Training online. She had the idea and suggested it in connection to the solar plexus formula but I am certain that this suggestion can be an important one for every Autogenic Training meeting. An appropriate action intrinsic of bodily intentionality and relational contact. 
  • Timing and post-contact – Regarding post-contact, we suggest some rules to follow in order to make the best use of relaxation: Taking some time to be alone with ourselves and avoid scheduling demanding commitments. Above all, staying away from the computer for a while is advised. In the case of a group session we recommend keeping contact between members. 
  • Number of participants – In the case of group online Autogenic Training, a maximum of six participants is recommended. 

In presence, in order to organise a protective setting and to stay safe without having to wear a mask, a distance of at least 150 cm is required. Consequently, the number of participants has to be established on the basis of the room’s capacity. 

In any case, common sense and norms will prevail with smaller groups. During face-to-face training it is best to use a well aired and sanitised room. Each participant should bring their own blanket, cushion and mat. If needed, a roll of paper to cover the bed should be available. 

If scientific proof for this is necessary, we can reference the interesting research conducted in Evolutionary Psychology that proves that a child learns quicker if they are clean and in a non- decayed environment. This is always true, regardless of Covid. 

  • Internet connection- Obviously, a good internet connection and an efficient computer are essential so that a sense of continuity within the contact can be assured.  An efficient preparation in the use of computers is also necessary. 

I personally want to thank my colleague Ileana Ramasco who acted as my safe space at the beginning of this adventure by ensuring correct computer function for online Autogenic Training. Speaking of a safe space as a means of preventing disconnection or other issues, we suggest giving out precautionary guidelines about what to do in the case of disconnection. 

With reference to Downing’s work with trauma: while searching for a safe place when a situation becomes difficult and unbearable, he suggests looking for said place in an image, an object or in the therapist with the aim of reducing the anxiety and then starting the journey of the therapeutic process once again.

  • Breaks – The use of breaks is important. The screen tires eyes. It’s best to have a 15-minute break every 45 minutes of therapy. 
  • Positioning of the screen – Participants should be asked to locate the computer in the same position with the webcam possibly focusing on the higher part of their body during the relaxation position. The trainer is also encouraged to keep the computer in the same position and to not alter the setting, or rather what is visible through the webcam. This is to benefit the continuity of mental representations inherent to the safe zone. 

CONCLUSION 

In conclusion, three reflections emerge from the theoretical elements and the physical experience of a mixed Autogenic Training formation course, both “online” and “face-to-face”. 

1) The undeniable relevance of screens in our culture and how their use during a health care emergency situation, with its countless and essential occasions for contact, has proved extremely fruitful. 

2) The essential need to notice the differences between face-to-face and online contact. 

3) The strong need, in this age that is conditioned by Covid, to pay more attention to the physiology, the mechanisms and the deep significance of breathing. 

1) Man is a social animal of contact and needs this so much that different research has shown that we tend to see intellect even where there is not one, in a robot or in a technological programme (Mitchell, 2009 as cited in Russell), like when we automatically answer the computerised voices of the GPS or motorway toll booths. 

Isolation is the worst condition. We do not exist without others, without the earth, without nature. The world wide web widens the countless possibilities for connection but we know that during the experience of connection, quantity is not always a synonym of quality. 

2) In order to achieve a full connection of growth, awareness has to have many qualities. As good Gestalts, we confide in a sufficiently functioning co-regulation but we are also convinced of the unavoidable and special difference corporeal presence gives to the quality of the connection, contact! It’s common sense and a simple concept that is best to reiterate. 

If I have no qualms declaring to be a digital immigrant, I should have none being a witness to the immeasurability of being present in body compared to being present virtually, and particularly in the psychotherapeutic rational experience. The therapist needs to know these differences and inform the patient in the case of psychotherapy and the case of relaxing techniques like Autogenic Training.

3) Now more than ever, a relaxation technique such as Autogenic Training that teaches us how to breath and how to feel our body is essential. 

Sensations are, indeed, the force that drives our guiding compass and our common sense, both harmonically directed and integrated by our frontal lobes. 

During the sudden and threatening atmosphere of pandemic contagion, we had to rapidly and efficiently put our defensive system into action. As well as practising physical distancing and rigorous hand hygiene, we have to protect ourselves with masks in order to avoid our lungs from getting infected. Forced always to wear them, it is as if we are living in an operating theatre and because of this we are anesthetised and terrified. 

In order to avoid making the solution worse than the cure, it becomes necessary to know the different ways of breathing, its significance and its importance in our healthy self-regulation.

If I am forced to wear a mask for a long time (not just for work) it, thus, becomes important to establish moments for “free breathing” through a temporary isolation and distancing: I take off my mask and with my chest and abdomen I allow myself to take long low recovery breaths in order to support a healthier self-regulation. Otherwise, simply while with others, I maintain a distance of 2 metres (a corporal, not social distance) and as good education teaches us, with trust, I breathe. If I need to cough, a tissue, my elbow or the correct distance will safeguard the hygiene of communication. A mask should be a helpful instrument and should not turn into something iatrogenic. 

Far from political considerations, that are outside this article, and while waiting for scientific research that can corroborate these arguments, I am confident that awareness of our body and our personal boundaries plus the learning of some good breathing techniques, can guide towards a healthier and more efficient creative adjustment during this pandemic. 

Never as in this pandemic time has the awareness of our body, its boundaries and our way of breathing been able to help us live and reflect. The pandemic is pointing us towards an epochal transformation everyone is part of. It is an extraordinary moment of mentalisation and civil re-education. The viral threat forces us to protect and defend ourselves but also to protect and defend others by revising our corporal boundaries. It forces us to shift the attention we give to the earth that hosts us and towards all its “guests”. 

Breathing is obstructed by fear and reducing the potential for breathing, subconsciously feeds into the state of alert and terror. Coronavirus attacks our breath. Let us, thus, stop blocking our breathing and start learning about it. 

In order for this shift to take place, we need to feel rooted in our bodies, in the earth that supports us, in the air that feeds us and in the love that makes us feel the sense of belonging to something. This virus attacks our breath but from our breathing we can start again, to protect it, as it is an extraordinary instrument for growth, belonging and evolution. Remodelled breathing and physical boundaries hold concrete hope for a better future. I hope that Autogenic Training will not be used as a simple technological instrument or as a quick tutorial, (Siri, Alexa), but that it will be re-evaluated in the way team Karis suggests. I also confide that, thanks to the professional skills of numerous colleagues that use it, it can contribute to the development of a more advanced and wider bodily awareness and of its boundaries. 

In order to promote a culture of wellness and to prevent illnesses, psychologists and psychotherapists, now more than ever, are called with competencies and responsibility not only to appease anxieties and distress of the different traumatic disorders caused by Covid but also to sustain constructively, trustingly people’s full awareness.

“Online breathing” is possible and necessary, constantly paying attention to making online learning a means for growth and not just technical skills. Even if taking place through a screen, with its given differences, Autogenic Training can become a unique occasion for re-elaborating the original attachment: respectful, confined and without judgment, a healthy belonging to “breathing with” as a basis for a civic spirituality. 

In conclusion, an etymological thought. The word “spirituality” comes from the Latin word “spiritus” that means “vital breath”. Spirituality, just like the air we breathe, is connected to our breath. If something in the universe is globally threatening our ability to breathe and our life, we cannot not think about the direction our society is going in, a warning for our spirituality: we need medication, treatments and vaccines but also to reflect and prevent. 

Four centuries before Christ, the Greeks had already identified one of deepest and essential aspects of human beings in the act of breathing. Our first breath represents our birth and the deeper it is, the more vital it is. Let us not underestimate or downgrade breathing to simple survival. Socrates was the first author to put breath, the vital breath and the soul together. Bringing air into our lungs represents an opening towards the other, life itself, to confirm that the Self cannot exist without others, even if the necessary differentiation between taking in and pushing out (basic characteristics of our primary defensive schemes of estrangement and contact): taking what is good and necessary, while moving away from what harms us. 

We have to defend ourselves from the virus without forgetting what we need to fully live. We can reclaim the wisdom of antique myths. Thanks to Athena’s divine breath, Achilles was able to dodge Hector’s deadly bolt. Thus, thanks to Athena, the goddess of knowledge with military and strategic gifts, we can transform this deadly bolt called Covid-19 into a new, deep and conscious occasion for breathing, in order to achieve an epochal shift that can lead to more love and respect for ourselves, for Creation and all its guests.  

Article 21 of the Code of Ethics of the order of Psychologists: 

“The teaching Psychologist shall inculcate in the student’s interest in the ethical principles and allow his professional practice to be inspired by them. He shall recognise as his duty to ensure his conduct conforms with the content of the training he imparts.

The Psychologist shall refrain from setting up, either personally or through others, educational activities which have the aim of using instruments or practices that are the exclusive preserve of the Psychologist for persons outside the profession except for teaching students on Psychology degree courses and post-graduate courses in psychological matters”. 

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