Eva R. Reich, M.D. and Judyth O. Weaver, Ph. D.
This article was written by request of the editors of Handbuch der Korperpsychotherapie (Handbook of Body Psychotherapy), published in Europe in 2006. They very much wanted something from Eva Reich for their extensive Handbook. Eva had previously written an article with this title in Energy and Character, The Journal of Bioenergetic Research, September, 1977. She gave me permission to use her old article, change it as I felt necessary, and add my name to it.
Emotional First Aid is a term that can be used for a type of body/mind integrative psychotherapeutic process used in situations calling for immediate, direct response such as a person might need in an acute or subacute situation of distress or overwhelm. A response to such a situation must, by necessity, call into consideration as many aspects of the whole person and his/her life as possible. In long-term therapy, one may take time and move slowly from the psyche to the soma, but in an urgent situation, knowledge of various ways to work-and surely the inclusion of the physical and the energetic body-is as important, if not more important, than history and emotions.
The need for such work arises in a transient society where we may be approached for therapeutic intervention by people with whom we will not have the chance to work at length or develop a long-term relationship. This situation brings possibilities of help and also the difficulties of not having much time or the opportunity of going as deep as we might like. In such situations it is essential that we have the support and assistance of the body, sensory, and energetic aspects as they are experienced, and the realization of the resources they can afford. In fact, in severe situations the client may not be able to give us much other information.
In addition to listening to what the client does have to say, we also have the assistance of assessing the subtle languages such as posture, prosody, and gestures which are among the myriad of indicators that are in front of us. Understanding prenatal and perinatal patternings as well as other early developmental stages is very helpful in accessing the situation.
Emotional First Aid is important because it is not meant only for a specific therapeutic setting. Instead it suggests the possibility of helpful procedures in various situations where people who are under high emotional strain can be helped spontaneously and quickly. The special potential of working somatically and using the wealth of information from the body as well as the mind to create relief, without extending the work to long-term psychotherapy, is of great assistance in fast-moving, highly pressured societies as we live in today.
Emotional First Aid
In an article entitled “Emotional First Aid: Implications of Orgone Therapy to a General Medical Practice” (Reich, 1977), Eva Reich offers some illustrations of the process:
A middle aged man stops at my office ‘off the road’ because of acute pain in his stomach. Blood pressure normal, heart sounds strong, normal and regular, he looks basically well. No diarrhoea, vomiting or fever. Non-tender abdomen.
As we talk and question he says that he is just returning from the funeral of a beloved friend who had died suddenly. No, he didn’t permit himself to cry there. (‘Boys don’t cry’ !) I do a rectal examination to check on normality of prostate. His sphincter is tense. I tell him that I believe his ‘swallowed feelings’ may be causing the pain in the epigastrium, that maybe we can improve things, by letting go of the retained emotion. He is willing to try. (I am sure he does not even know what the word ‘psychology’ means. He is a labourer, gnarled hands, wearing his single outdated ‘best suit’ saved for funerals, weddings and Sundays.) I get him to breath[e] ‘all the way down and out,’ while pressing on the rib margin of his fixed, high, emphysematous chest. I encourage him to ‘make faces’ – ‘just let your face do what it wants to do by itself’ – ‘can you wrinkle and move your scalp?’ While he tries I massage his facial muscles, gently, with what I call a ‘butterfly touch.’ ‘Now open your eyes wide, like scared, and then close them tight … open wide and close tight … keep doing this.’
Then we work on his tight jaw and neck muscles – ‘can you let your voice roll out? – like singing one note – like a big out-loud sigh?’ He is embarrassed and reddens in the ‘blush area.’ ‘It’s OK to have feelings, it is better for you to own them, to allow them.’ I am the strange lady doctor, but he has placed me in authority by coming to the office. There isn’t time to work through the defenses, all the layers, all the whys and wherefores. This is an acute emergency, possibly an early heart attack? (coronary occlusion), gall bladder attack? Or acute peptic ulcer? If nothing happens soon I’ll have to sedate him (Demerol 100 mg SQ2) or admit him as an emergency to the nearby hospital (then 40 miles distant). I don’t tell him my thoughts. I try to keep a calm and reassuring manner. Very doctorial. Only I tell him ‘we are trying something new – let us see for a little while whether we are on the right track – let us see whether this helps before we use a drug.’ Now he gets pale, begins to heave, nausea. I ask him to gag himself ‘with one finger tickle the back of your throat at the end of the breath, with a sound’… ‘like this.’ I demonstrate a gag reflex which results in my upper and lower body jerking towards one another (the orgastic reflex). He tries, once, twice, three times, it is a struggle. He perspires, saliva flows into the emesis basin. He is on his side (pillow to keep head straight). He heaves, the reflex goes through, the crying comes, he cries bitterly in that racking way of one who has not cried for a long time, a lifetime.
After he subsides, I offer an antacid, a sedative. He doesn’t need it. He rises, visibly shaken: ‘Thanks Doc, yes, I feel so much better, all better, but all shook up.’ There is a ‘recovery’ bedroom upstairs, he doesn’t need it. He is ready to drive home, several hundred miles further. I write a note to his family doctor. Time -45 minutes. No follow up. …
As an intern, on the private medical service (1949) I am ordered to do a routine admission examination on a middle-aged Philadelphia housewife. She is lying on her hospital bed in a dazed state, having been given a quarter grain (15mg) of morphine a short time previous [sic] for acute back pain. Her admitting physician has diagnosed possible dislocation of a thoracic intervertebral disc. I begin to examine: the routine, head-to-toe, all-over-quickie, since she’s already well-known to her own doctor, no challenge, I’m bored and tired and exhausted, irritated at my useless routine work.
As I check her, we talk. She tells me what a hard time she has been having with her son, who has metastastic carcinoma. ‘What a pity, such a young wonderful son, just graduated from college, I can’t bear to see him suffer so, and the doctor says he will die soon.’ She states this with a flat detached monotonous voice. Her emotion has been ‘so long’ in the extreme tensions of her body. Her head, neck and thorax move as one. Her arm stays up in the air and doesn’t drop when released. Her muscles are ‘hard as a board.’ I get interested. Could it be that the acute muscle pain is directly due to the catastrophe in her life? That ‘to keep going’ she has increased the armour to the point of causing an unbearable pain-crisis? She likes me. I tell her that I am just learning about a way of releasing feelings that are repressed and causing ‘knots’ in muscles. That I’d like to help her to bear and feel her feelings. She agrees that she feels ‘up-tight’ all the time. We work. She goes into breathing, moaning, then begins to scream. She screams like a pig being pierced to roast, like a woman being murdered, like a ‘crazy in a loony-bin’ … the cry at first shrill, through tense vocal cords, begins to broaden and turns into a huge guttural moan from below the diaphragm.
There is no soundproofing in a hospital. The nurses come running. I’m reported to the administration, the private doctor is notified. … The patient is now having a tantrum on all fours, all the pent-up anger of being a victim is turning into rebellion against an inhuman medical system. … I defend her right to emote against all comers – by simply saying: ‘We are letting some repressed feelings out.’
Eventually spent, she relaxes. Having been listened to, having been given ‘permission to be herself,’ she is lying now exhausted, but relieved, real, all soft, awake and aware. The back is soft. The neck is soft. The face has become beautiful though still sad. She knows now why she created the back pain, by hiding the immensity of her own grief from herself. She is glowing, she reports tingling sensations all over, especially in her lower body! We worked a few more times. She underwent various x-ray examinations, all with negative results, and she left the hospital in a few days, feeling expanded and ready for the future. The pain did not return. How come her own physician had no knowledge of the connection between repressed emotion and muscle tension? This is not taught in Medical School.” (Reich, 1977).
Here is an essential question. How can we not acknowledge and employ both the body and the mind in treating the whole person? By integrating the entire organism and accompanying energetics and recognizing their place in the wholistic situation we are able to work more efficiently and practically and realize changes more quickly than through a therapeutic process that does not include the entire person’s experience.
Emotional First Aid might be considered the equivalent of what is called “brief therapy” in psychodynamic psychotherapy. Some of the components must be the same of course.
This work was initially called Emotional First Aid to describe the urgent need of care that could relatively quickly reach deep into the client’s soma and psyche. It might also include other quick assessment and therapeutic tools such as clarifying a trauma life line (from conception when possible), various energetic balancing and/or grounding techniques, craniosacral therapy and, especially when working with babies, “Butterfly Massage.”
Most importantly and essentially it does require a good connection to exist between the client and therapist. Trust is paramount, even for the shortest period of time. The therapist must be sure to create a situation where the client feels safe. Understanding the client’s desire is important and mutual agreement on the intention of the work to be addressed is essential. Clear boundaries and frequent eye contact will help greatly to provide these requirements.
The ability to help a person in hyper-arousal or some other crisis be more aware of their physical reactions, to come more in touch with their breathing (or lack of it), feel their feet on the ground and be able to find respite and relief in their actual somatic realization, can go far in helping them out of their crisis reactions and bringing them more to their presence. This thereby allows the person to deal with the actual situation more realistically and practically.
In these instances where a rapid survey of soma and psyche are required, incorporating knowledge of structure and function of the body, understanding of emotions and heartfelt empathy and consideration can be quickly integrated into a way of working with people in distress that could be called a genuine Emotional First Aid.
“Emotional first aid is different in each situation. There are no rules, except these: To be open minded to the possibility that very severe or acute body symptoms may be caused by acute emotional repression. To be on the lookout for clues in the actual life situation of the person who comes for help. To know that words alone cannot always relieve the energy stasis… ” (Reich, 1978).
Here we have clear, basic instruction for the formulation of a truly somatic “Emotional First Aid.”
Reich, E. (1977). Emotional First Aid: Implications of Orgone Therapy to a General Medical Practice. In Boadella, D. (ed.), Energy and Character (Vol. 8, No. 3, pp. 10-12).
— (1978). Suicide Prevention. In Boadella, D. (ed.), Energy and Character, (Vol. 9, No.2, pp. 69-71).
© 2003 Judyth O. Weaver