The Body Knows the Way: Working with Clients Facing Illness and Dying.

Joan Klagsbrun

Becoming ill can be a disembodying experience. Often during medical treatment, the body is regarded as
an entity that is separate from the self. This perspective can induce individuals who are ill or in pain to
feel betrayed by their bodies. This loss of faith in one’s body can have negative psychological and physical
consequences that impair one’s ability to recover.
How can we counteract this sense of betrayal, the disconnection and the despair that illness can foster?
One way is by using Focusing to regain contact with, and trust in, the body. Focusing is a gentle,
respectful approach to working with illness by reclaiming the body as a source of knowing and wisdom. It
also provides a way to listen to what the body knows about small movements in the direction of healing.
It enables clients to attend to and to transform the intense feelings that arise during the course of an
illness, including the panic and anxiety that typically accompany a diagnosis, the complexity of feelings
around pain; and the grief and spiritual issues that arise with the prospect of dying.

Working with Panic

As she entered my office, Carol was panting with anxiety; she began speaking before she reached her
chair: “They said I should have surgery immediately. I mean, right now. They scheduled me for this
Thursday. I feel dizzy even thinking about it.” I encouraged her to slow down and take a few
breaths. When her breathing calmed, we sat together taking in the news —my eyes registering all that
she might be feeling. After some exchanges, I asked if she might allow herself gently to be with the
dizziness.
“It’s like there is a train speeding –– no, whizzing –– by, and I’m running beside it, trying to catch up, and I
can’t get it to stop! No matter how hard I try, it’s just a blur.” I suggested she try to be gently next to the
exhausted feeling, and to begin by imagining herself at a little distance from it so it was not so intense. I
waited for a few minutes for her to nod that she had done that. Then I suggested that she take time to
see if “exhausting” was really the right word for how she was holding the whole situation. She paused,
then replied—“no it’s more like ‘overwhelmed’ ”. I acknowledged that she had an “overwhelmed” feeling
and asked her to wait to see what it was trying to tell her.
After a long pause, she said “I’m just not ready.” She waited a while, then said, wearily, “The
overwhelmed feeling is telling me I need more time.” She let out a sigh. “Yeah that‘s it. I just need more
time”.
It became clear to Carol that that she was unprepared to rush into surgery that week. I asked her ideally
how much time she would need, and as I waited I felt some concern that she was going to say “months”.
“I need a week to get myself ready for this big fight.” After saying that, she looked more composed, with
some of the terror gone from her face. As we ended the session, I advised her to check with her doctor
to see if she would be amenable to the week’s delay. That evening, she called me back to say that the
doctor had assured her that a week’s delay would make no difference.
Waiting a week turned out to be a very good decision for Carol. During that time she had many important
conversations with friends, repeating the story of her diagnosis, her shock and reeling sensations, over
and over. Each time she told it, the story became less charged for her. She had time to appreciate how
much love and support there was for her in her community of friends, family, and relatives.

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Using Focusing, Carol was discovering a way to become an active agent in the process of her healing. Her
perception of her cancer changed from that of an unstoppable malevolent force to a challenging, but
manageable, event. And she realized that while her doctors could recommend treatments, only her
clarity and commitment could make the treatments work well for her. Carol had also discovered that by
listening to her body, she could use it as a resource for healing.

Connecting to Oneself in the Midst of Illness

Illness is commonly experienced as a loss of self-control, stability, and predictability. This altered state
increases stress and anxiety, diminishes one’s decision-making capacity and confidence, and may
disconnect a person from his or her usual social supports. (Klagsbrun 2007; Klagsbrun and Lennox 2012)
Often, feeling betrayed by our physical selves can make us develop an aversion to noticing any physical
sensations, and so we begin to live “at a distance” from our bodies. Instead of trusting body sensations,
we reject them as a threat that might undermine our sense of wellbeing. Paradoxically, keeping
connected to one’s felt sense—that conceptually vague, murky but distinctly felt experience in the body -
is critically important to the healing process. A felt sense takes time to form but when it does, it can offer
valuable insights, as well as important next steps of living. It also allows us to reclaim the body as it is
moving through and recovering from illness.
Carol learned that the dizzy sensation was more than just a panicky response to her diagnosis. Slowing
down and listening to herself gave her important information about which doctor to work with, which
support group to join, to whom she should disclose her illness and several other major decisions. When
connecting to what our body knows, we are dipping into a large pool of wisdom that includes our history,
our awareness of possibilities around us and “new steps that carry forward our life energy” (Ekstein
2012). We are using our body as a sensitive barometer and as a benevolent resource. The body is no
longer a betrayer but rather a trusted colleague and companion.

Working with Pain: Steps of movement often come directly from the felt sense
Chronic pain is often complex and resistant to treatment, and may require a variety of approaches to
reduce the suffering it evokes. At age 37, Sara had developed a persistent pain in her abdomen. During
the next six months, she had been seen by so many types of specialists that she felt as if she had lived in
doctors’ offices for half the year. Even after a number of painful diagnostic procedures, no clear medical
cause for her condition could be found. Slowly, we worked together to try to untangle all the strands that
made up her pain.
We began many of our sessions with the first step of Focusing called Clearing a Space. I suggested that
Sara direct her attention to what was between her and feeling fine that day. As I guided her in this brief
process, Sara closed her eyes and waited to discover what was in the way of feeling fine at this moment.
In one session she responded by saying, “Well, there’s the frustration I’m feeling towards my doctor. He
often sounds kind of blaming, as if this whole pain situation is my fault.” I reflected the frustration she
voiced, and suggest she take “all about how your Dr. responds to you”, and wrap it up in an imaginary
package, placing it at a safe distance from her for the moment. After Sarah confirmed that she had
“packaged” that issue with a big sigh of relief, I then asked her. “Other than that, slowly see what might
be between you and feeling fine right now.”

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What came up for her that day was some guilt about missing work due to her pain, which she felt in her
chest as a slight agitation that she placed in an imagined box outside the door, some worry about her
twin sister, which she experienced as a jagged sort of pressure on her shoulders that took a while to
place aside (she eventually wrapped the pressure in some velvet), and the pain sensation itself which
likened to a large Gorilla in the room that could crush anything in its way. It was most challenging to
figure out where to place the Gorilla and she finally chose a zoo in a neighboring town where it could be
far away behind bars. She let herself visualize the Gorilla going into the cage and hearing the gate click
closed which brought a small smile. The discomfort of the pain was real but so was the playfulness with
which she was dealing with it. Finally I suggested that she also notice her background sense—that
ongoing mood of her life that she was so accustomsed to that it was hardly noticed anymore. Sara
described her background sense as a heavy thick blue mood she was “lugging around”. She said it felt
very liberating to imagine putting it down and shaking herself off. One might think that by naming and
getting a whiff of each of these unpleasant issues, Sara would feel weighed down, but actually since
these issues were already being held in her body, she experienced relief in naming them, and imagining
that they were all at a safe distance from her. By use of the spatial metaphor of “placing each issue
outside her body at the right distance away”, she could experience more inner space than she had all
week. Her breath deepened and she appeared more relaxed. Even though this process occurred in her
imagination, it allowed her to perceive herself as an active agent in dealing with her issues.
I then suggested that she take some time just to be in this clearer space and see what it felt like to be a
person who could leave her frustration, guilt, worry, and pain at a distance. Sara spent a couple of restful
moments just being—with no pressure to do anything. Then when her breathing seemed even and
regular, I asked if there were words that captured how it felt to be in the Cleared Space. She waited and
then said, “Lightness and freedom.” I said, “You sound surprised.” She replied, “I guess I am. Because the
pain is a lot less right now. It’s not gone, exactly, but it’s – softer. Like it’s way in the background.”
In under twelve minutes, with the help of the therapist, Sara had taken an inventory of her current
problems and found herself able to “Clear A Space.” She felt liberated and freer in both mind and body
and spirit. This experience of lightness and freedom would become a dependable resource she would
return to in times of pain and discomfort.
In addition to the first step of Focusing ( Clearing a Space) the other steps of Focusing can also be useful
by helping clients discover the meaning of their pain. In one session, when I asked her to gently pay
attention to the sensation of the discomfort in a friendly way, Sarah said, “It’s pretty big. Today it has a
‘sticky’ sort of feel to it”. I asked her to check inside and notice if there was a fit between “sticky” and
the whole experience of her discomfort. Often, when one has found the right “handle” –– that is, when
a fit is achieved between the word and the felt sense –– there is a sense of recognition and a feeling of
relief. “When the right words are found, the felt sense opens; it flows forward. Where before it was
stuck, now it flows into the meaning of the words" (Gendlin 1996).
Sarah waited for a while, her eyes closed. “No,” she said, slowly “it’s not actually ‘sticky”. There’s a
jabbing kind of feeling to it – like I’m being poked by a needle.” “So you feel as if you are being jabbed—
and poked. That sounds really uncomfortable. Can we slow down and see what it is like to attend to the
whole experience just as it is?” By “the whole experience,” I meant the wealth of feelings and
associations connected to the pain. By being present to her situation, she becomes a witness to her
discomfort instead of being persecuted by it. After a long pause, Sarah said that just attending to it with
kindness had decreased the sensation. She imagined placing big wads of cotton all around the jabbing
pain until it felt fully muffled. I then invited her to revisit the pain as she felt it in that moment, to see if it
connected to anything else in her life. Sometimes pain can be purely physical but other times it carries
more complex resonances, so I checked with her to get her feel of the issue.

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I am asking her to find an embodied “felt sense,” something that is mostly still unknown and not yet
revealed, like seeing the tip of an iceberg but knowing far more of it remains submerged, waiting, under
the water. After a few minutes in silence, Sarah found that the jabbing pain evoked memories of her
demanding twin sister. She described a phone call from earlier that day when her sister, having done
something at her work place that Sarah felt was unethical, kept trying to get Sarah to agree with her, and
wouldn’t relent. “Maybe I wanted to jab her back.” Sarah suddenly smiled with recognition, and her face
softened. “That’s what the pain is like today. It’s like my sister badgering me to do something I don’t want
to do.” “So there is a part of you that feels badgered and jabbed at” I said, hoping to keep her in touch
with this connection she was making. “Yes exactly.. and that part needs more protection. It kind of
needs more padding too.” She was silent for a while, then her face lightened. “I need to protect my
energy, not give it all away. To my sister or to anyone else.”
Sarah came to understand that she needed to freshly sense whether contact with her sister was right for
her each time. Soon she discovered other examples where setting more appropriate boundaries at work
and with some intrusive relatives would also bring relief—and a sense of freedom.
For Sarah, going into her pain instead of numbing herself from it allowed her to explore its deeper
meanings. She had found a way to use a debilitating body sensation to understand herself in a new way.
Eventually, she was empowered to change her behavior, including keeping needed distance from
intrusive relatives. Over time, her intense abdominal pain began to recede. While the pain was never
medically diagnosed, its intensity slowly waned as Sara increasingly tuned in to what it might be
expressing. As she was able to notice and give voice to her true limits, it diminished even more.
Focusing is a subtle method of paying attention to how your body is feeling in each moment, and having
a conversation with this body sense. During the process of somatic exploration, the client treats herself
the way one might treat a beloved child—with gentleness, kindness, acceptance, and friendliness. By not
judging the feelings that come up—even unwelcome ones—but rather “greeting” them and making
space for them in the safety of the therapeutic relationship, defenses soften, and more of the interior
world becomes accessible. Clients feel more connected to their bodies, and to the wisdom contained
within the body. This intense and intimate connection often leaves the client with a sense of greater
agency and wellbeing.

Working with Sadness and Worry

Ellen is a 50 year old writer who came to therapy to work on her feelings of distress when her teenage
son fell into a serious depression. In therapy, she began to develop more confidence in the choices she
made as a mother. She began to feel more emotionally reslient, and began to address her own self care,
including checking out a nagging shoulder pain she had ignored for months during her son’s crisis. Sadly,
medical tests for what she thought was a minor issue revealed a serious cancer.
Ellen arrived at her session in a state of shock and denial that quickly progressed into despondency.
“How can this possibly be?” she asked. “I am a meditator. I eat well and exercise regularly.” Her
questions took on a tinge of panic—“How will my husband parent our children alone if I die? And Timmy-
-he is just recovering from depression--how will he ever be able face this?” I saw the desperation and
grief in her eyes and felt intense sadness in my own chest. “How will any of us get through this?” she said
despairingly. I listened closely in order to grasp the essence of her experience, and let her know we
would work together to absorb this shock and find ways to make this experience more manageable.

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“I feel scared” she said, “and shaky. My hands are trembling.” I wondered if she might direct her
attention toward these sensations with gentleness and lovingkindness, since how could she not be shaky
at first with such news to metabolize? By inviting her into her embodied experience rather than avoiding
it, we were addressing her elemental fear. By breathing together, being with her shakiness and not trying
to make things better, we were able to sense into her situation. Bringing mindful, compassionate
attention to her immediate experience allowed her to begin to accept and integrate it. As Gendlin notes,
“All content results from manner of living. When the manner changes (we’re gentle, we back up so as not
to get overwhelmed) what we FIND changes”. (Gendlin 1981) is this how the original appears, with caps
and brackets? And is there a word missing from the first sentence? Just want to check.
“Well”, Sara corrected after a few minutes, “It’s not shaky now, more quivery like a kite that is flying
around in the wind. I feel it could be ripped out of my hands at any moment. One minute I’m OK and
hopeful, sensing that I’ll have some healthy years with a new treatment my doctors are recommending.
The next minute I’m imagining the worst. I feel like I’m getting jerked all over the place.” I reflected this
back to her, and wondered if she might imagine herself putting the kite down in the right place just for a
moment, safely tethered for now.
“Yes” she said, “I am going to put the kite under my right foot (she stomped her foot) so it will stay in
place”. I could almost detect a half smile as she said this. Already there was a slight sense of release from
her intense feeling of fear. I went on, “now that you have a bit more distance from it, I wonder if we can
explore this shaky quivery feeling.” She was quiet again and then reported that she could sense an all-
over kind of background static, like a dark cloud of anxiety looming over her all the time. I invited her to
be next to the anxiety (and not fall into it). I asked her if there were a place in her body where she felt it
most strongly. Often finding where and how something is held in the body helps to ground the client.
Ellen replied that she felt tingly all over, a kind of prickly sensation, and that this sensation was most
strongly located in her chest. The anxiety in her chest was both for her husband and how he would
handle the weight of carrying her illness, as well as for her depressed son. As she said this, tears
streamed down her face.
“So tears come and you wonder how David will deal with it all… taking care of you and the kids too.” I
acknowledged the enormity of this worry. “That’s a huge weight to be holding. I wonder if we can place it
at the right distance away so it is not so overwhelming, and then acknowledge it as if you are saying hello
to it.” She worked on putting the anxiety in a safe place. “Well. I can breathe better,” she said “–at least
for now.”
I invited Ellen to take a minute’s vacation from the issues she had just named, asking if she could find in
her imagination a place to rest. She imagined going to a familiar beach and I could see her begin to relax
as the tension released in her face, hands, and shoulders. I asked her to describe the beach to me with all
her senses open to the smells, the taste of the salty ocean and the feel of the sun on her face.
While imagery alone can be helpful, an embodied kinesthetic experience makes for a different level of
integration. After a while, she described feeling soothed by the sun and the breeze. I invited her to stay
there for a few minutes to let that sense of being soothed enter into her body, so it would be a feeling
she could return to when she needed it.
We were then able to further explore the dark cloud of anxiety she felt that day. Her distress was
complex and intricate, with many aspects to it, but she seemed more able to investigate the different
strands of worry and anxiety without becoming overwhelmed. Her new-found equanimity was due to
connecting with the ‘spiritual’ part of herself that remained peaceful and untouched by the illness. There
was also a sense of palpable relief produced by naming and, at some level, understanding the different
aspects of her fear. Over time, these different aspects—like puzzle pieces—came to be named, known

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and accepted by Ellen. Each step in the process appeared to empower and release her at the same time.
Many times, Ellen chose to start our sessions with Clearing A Space. Sometimes, she would take an
inventory of her fears or worries in the moment, and imagine placing them aside for a few moments
before she chose one or two to discuss. For her that process “felt like removing layers of overcoats that
had been pulling me down.” It gave her some satisfaction in being able to identify and isolate each fear,
and to imagine placing each one at the right distance from herself. The act of clearly seeing and saying
what was burdening her at any moment felt liberating, and gave her a sense of both control and release.
It empowered her to then attend to the situation or relationship or feelings that needed our attention
that day. But sometimes, she skipped the Clearing a Space process and just went right to whatever was
weighing in her and spoke directly about that. She used Focusing to find what was at the heart of her
issues for that day.
By acknowledging instead of denying, by going into instead of pushing away, a different way of
metabolizing the experience of pain or illness can emerge. Acknowledging what her body was carrying
not only eased Ellen’s stress level, but also helped her to remember who she was without those burdens.
It allowed her to hold onto a sense of who she was without illness.
In a session a few months later, when she was in remission thanks to a new medical protocol, she came
in looking very tense. She sat down and said, “I just don’t know if I can do it”. She repeated that phrase a
couple of times. “So I am hearing that there’s something you can’t seem to do,” I responded, and I
wondered out loud if we might together see what that something was. It turned out to be the pressure
she was putting on herself to be an exemplary cancer patient… one who was obliged to find meaning and
joy in each day, who had to be optimistic about the future and who functioned as if free from pain. She
listened as I reflected these self-imposed, perfectionistic expectations back to her, and she actually
laughed.
“Well, this one is not just an overcoat I am putting on myself, it’s a straightjacket!” She was able over
time to let go of the image of being the ideal cancer patient, and to feel more OK about accepting
whatever she felt each day—including sometimes feeling the deep grief that she would likely not get to
see her sons grow up. “Cancer just doesn’t bring out the best in me but I am learning to be OK with that,”
she said. She had learned how to relieve herself from the burden of unrealistic expectations, “I guess I’ve
got to accept whoever shows up each day”.
On occasion when strong feelings of sadness or worry came up, Ellen noticed that there was often a big
release in acknowledging what was implicitly there—even when it was painful. As Gendlin put it: “What
is true is already so. Owning up to it doesn’t make it worse. .. because it’s true, it is what is there to be
interacted with. ... People can stand what is true, for they are already enduring it”. (Gendlin 1981)

Facing Death
Facing one’s death is clearly one of the biggest challenges we face as humans…one that brings up an
intense array of feelings including fear, sadness, anger, loss, regret, helplessness and despair. Focusing
can be instrumental in helping clients find peace at such a time by helping them to articulate the
questions they are struggling with.
Neil Friedman was a long term Focusing-oriented therapist and writer (Friedman 2007) who found
Focusing to be essential when facing his own dying. In a Focusing session shortly before his death, he
asked himself what dying felt like to him. What came was the image of leaping off a cliff. While there
was some sense that the experience could be like stepping into a void, he also knew that death might

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also lead to something quite expansive. He reports in an account of that session (Friedman 2008) “The
image was quite majestic, but as the day went by I found it less pleasing. That is, I kept checking it
against my body only to find an uncomfortableness in my belly and a growing ‘no’ inside.”
Neil came to understand that whether he got “snuffed out like a match, or hit a rock, or had a pleasant
swim”, that the sad part of dying for him was that he had to relinquish all his relationships and
attachments on the cliff and go forth alone. With that recognition came copious tears. He was saying
goodbye with no certainty of saying hello. Death was an intrinsically isolating and lonely process. Yet
naming and accepting these painful truths shifted his last week into a time of considerable peace. He
now knew what made dying so hard, and his loved ones reflected that back to him. They had some
understanding of what he was experiencing. So with that truth at least, he wasn’t alone. Articulating the
specificity of what was so hard for him allowed for a felt shift—moving him from intense anxiety to a
softening and recognition of what made his dying so difficult. With loved ones surrounding him, he sang
favorite songs with them including The Rose, that had great meaning for him, and which he sung only a
few minutes before he died. So, by going into the fear associated with dying, and naming what was so
difficult about the process, he had found ways to face the worst of it and to come to accept his felt truth.
He left the world more at peace. He had found a way to get a spiritual perspective on his passing. “You
know,” he said. “Leaping off a cliff is either falling to your death, or flying. And who knows, maybe I’ll get
to choose which.”
Focusing is an embodied approach to working with illness (Klagsbrun 1999, 2010). It helps our clients deal
with a host of intense and debilitating feelings around disease, whether it is the frantic feelings that
accompany diagnosis, the anger and helplessness around pain, or the despair and deep sorrow of losses
associated with serious illness and dying. By naming and acknowledging these feelings, and by connecting
with them in the gentle grounded approach that Focusing offers, our clients can find not only relief, but
also further steps of living and for some, even a sense of transcendance.

References

Ekstein, I. Spiritual Path in Focusing-Oriented Psychotherapy on website

Friedman, N. (2007) Focusing-Oriented Therapy. New York: iUniverse
Friedman, N. (2008) ‘Focusing on Death and Dying.’ The Focusing Connection vol 24, no 4.
Gendlin, E. T., Beebe, J., Cassens, J., Klein, M., and Oberlander, M. (1968) ‘Focusing ability in
psychotherapy, personality and creativity.’ In Research in Psychotherapy, Vol. 3. Washington: APA.
Gendlin, E.T. (1981) Focusing. New York: Bantam.
Gendlin, E.T., Grindler, D., & McGuire, M. (1984) ‘Imagery, body, and space in focusing.’ In A.A. Sheikh
(ed), Imagination and healing, pp. 259-286. Farmingdale, NY: Baywood
Gendlin, E.T. (1996) Focusing-oriented psychotherapy: A manual of the experiential method. New York:
Guilford Press.
Grindler Katonah, D. & Flaxman, J. (2003) ‘Focusing: An Adjunct Treatment for Adaptive Recovery from
Cancer.’ The Folio: A Journal for Focusing and Experiential Therapy, 18(1).
Klagsbrun, J. (1999) ‘Focusing, illness, and health care.’ The Folio: A journal for Focusing and Experiential
Psychotherapy, 18(1), 162-170.
Klagsbrun, J., Rappaport, L., Marcow Speiser, V., Post, P., Byers, J., Stepakoff, S., & Karman, S. (2005)
‘Focusing and expressive arts in therapy as a complementary treatment for women with breast cancer.’
Creativity and Mental Health, 1(1), 107-137.
Klagsbrun, J. (2007) ‘Transforming fear: what we can learn from some people with cancer.’ The Folio: A
Journal for Focusing and Experiential Psychotherapy, 20(1), 5-14.

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Klagsbrun, J., Lennox, S., Summers, L. (2010) ‘Effect of “clearing a space” on quality of life in women with
breast cancer.’ United States Association of Body Psychotherapy Journal, 49(2), 48-53.
Klagsbrun, J. & Lennox, S. (2012) ‘Clearing a space: an evidenced based approach for enhancing quality of
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