Can Shiatsu support psychotherapy? (Dr. Eduard Tripp)

Translation: Oliver Scheuvens

The answer to the question whether psychotherapy can be supported by Shiatsu seems easy to be given at first, as Shiatsu is founded – finally, as the whole traditional occidental philosophy and medicine – on a holistic approach that understands body, soul and mind as an unseparable unity. A separation between psychotherapy and somatic medicine as we know it in western medicine was totally unknown in the traditional Far East. The energetics of Yin and Yang, and also the manifestations of the Five Transformations include all phenomena – somatic, emotional, mental and social. Everything is connected to everything else, causes everything, influences each other and has its roots in the same causes. Whether such an energetic imbalance manifests in mental or somatic symptoms and ailments does thus not really change the fundamental approach of the traditional treatment.

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The mental aspect of the Transformations also describes their psycho-emotional side. The Lungs thus stand for sadness and sorrow, the Water (Kidneys) is related to fear and the Wood (the Liver) with frustration and aggression. It would however be quite an oversimplified approach to use Shiatsu as a quasi-psychotherapeutic instrument in such a way as to treat fear by the Kidneys, sadness by the Lungs and aggressions by the Liver. Or we take into account – a bit more differentiated, if one also observes the interplay of the Elements and organs which leads to a symptomatic as depression e.g. – beyond this, whether the symptomatic may (additionally) be caused by a general emptiness.

In this case, the unspecific filling and strengthening of the whole organism would be of at least supplementary meaning.

Yet still, as tempting as this model appears, experience shows that the treatment in practice is not that easy to handle. The attempt at treating an anorectic patient e.g. simply by the Middle Warmer does, from experience, not succeed. The best herbs are not enough here and the problem is also not easy to be solved with acupuncture. And even if Shiatsu would be a good way (what it is under certain circumstances – at least as a supplement), so it is either the lacking willingness of the patient (treatments are not being started at all or suddenly stopped) or the practitioner suddenly finds her- or himself entangled in an awkward relationship – a phenomenon which has been termed transfer and counter-transfer by psychotherapy. The problem of anorexia that keeps the person who is to be treated “under control”, is not however not being solved by this. It is rather probable that another injury adds to the former experiences (and this possibly also on the side of the Shiatsu-practitioner).

On the other hand – and we can also experience this daily in our praxis – Shiatsu also has a strong, mentally balancing, stabilising and enriching effect. The questions that arise in this context are therefore: By what and in which way does Shiatsu work? and How can we support psycho-emotional processes in the best possible way with Shiatsu?

By what and which way does Shiatsu work?

The first question touches western, especially psychoanalytical/psychotherapeutic scientific approaches and models of explanation, which can be looked at for comparison with Shiatsu. In relation to this it is to be said that there are no considerable empirical or theoretical papers on the effect of Shiatsu. We thus step on unsecured ground in answering these questions.

A further approach at understanding the broad psychological spectrum of effects of Shiatsu lies in the psychoanalytical theories and models on the fundamental meaning of the early childhood in relation to the later development, which have also been enriched and supported in many aspects by the modern research on sucklings (see also Daniel N. Stern). At this phase of early childhood, the experiencing is in general still undifferentiated and therefore also more global. René Spitz calls this the coaenesthetic world of experiencing in which the physical contact through the body and the skin, vibration, rhythm, tension and relaxation, posture, temperature and pitch of the voice – and thus the plain musculature and the autonomous nervous system, i.e. sympathetic and parasympathetic – are most important. A separation between physical sensations and a mentalo-psychological world is hardly present yet. The infant understands – and literally grasps – her or his world to the highest grade physically, and her or his communication is especially physical and holistic.

In this early stage of development (according to the psychoanalytical understanding basal-narcissistic) and differentiation of the suckling, Günther Bartl mainly differs three qualities, which have a major effect here: warmth, rhythm and constancy.

The adequate experience of warmth that the mother (the referential person) conveys to the child, due to her love and affection, founds the early basis for having confidence in the world, for the emotional openness to the world, for ‘geborgenheit’ (i.e. security) and the ability to enjoy. The adequate experience of rhythm again gives security and hold and enables the experiencing and development of limits and delimitation. Together, warmth and rhythm form at the same time content and form, as well as the basis for the experiencing of the own body and thus for the self-perception as a whole, fulfilled and independent being.

Constancy as the third fundamental quality fastens the experiences of warmth and rhythm, makes them enduring. Constancy forms the solid basis of original confidence after Erikson, enables us to bind ourselves later and leads to continuity and endurance in the complex emotional relationships and bindings, which form part of a rich and fulfilled life.

Early physical and therefore actually holistic experiences, thus especially the experience of warmth, rhythm and constancy form in this way the basis of our psycho-physical core and regulate the understanding of ourselves and our self-esteem. In the later, greater differentiation between body and psyche/mind (de-somatisation after Max Schur) this basal (narcissistic) core coins the way in which we encounter the world; how we communicate with it, live in and with it.

And exactly on this early non-verbal level of encounter with immediate physical (coaenesthetic) communication is it that we move onto with our Shiatsu and have hence the possibility to tie to early experiences (potentials, resources as well as conflicts and deficits) and to stimulate processes of development. An essential pre-condition therefore is, however, that the respectful social intercourse with the client is given, that the attention given to and the communication with the client happens in a sensitive way. Of special importance here is the attentive dealing with the client, which should be adapted to her or him, to be authentic (congruent) with her or him as well as with oneself as a practitioner. Fundamental pre-condition for this is a high amount of self-perception and self-experience in order to be able to perceive and pay attention to the deficits, conflicts and limits of the client.

Important are thus the skills of the Shiatsu-practitioner in terms of self-perception and the perception of others, which can and should be enhanced and taught by specific settings, as well as the skills and possibilities of the Shiatsu-practitioner to design her or his life in a satisfying way. From the psychotherapeutic practice it can clearly be seen that a high degree of unfulfilled wishes, of frustrations and longings from the side of the therapist (Shiatsu-practitioner) leads to prominent distortions of the perception – and hence to crossing boundaries and injuries on the side of the clients.

The mechanisms which underlie these processes in a major part are being described as transfer and counter-transfer by the psychoanalytically oriented therapy and bring along a big danger of acting, the danger of unconsciously living out wishes and fantasies which do not have their origins in the present situation.

In the work with people, self-experience and self-reflection therefore constitute the basis of professional acting. Without reflected experiences a differentiation between the different impulses and motives that become active in us is hardly possible. Only the personal experience and the becoming aware of own potentials of conflict, fears and deficits protect us and our clients from the often hurting and painful neglect of boundaries, overwhelming and getting entangled in transfers and counter-transfers.

The own psycho-hygiene, the perception and reflection of own needs, issues and “blind spots” (e.g. in self-experience and supervision) is therefore equally important for the Shiatsu-practitioners – especially when they are working with Shiatsu in the psycho-emotional area – as the emotionally satisfying design of their own life-situation, in order not to get too much under emotional pressure.

How can we support psycho-emotional processes in the best possible way with Shiatsu?

As to the second question which is about how we can support the psycho-emotional situation as well as possible I want to point out in advance that Shiatsu is not a form of psychotherapy, as an additional therapeutic education would be needed for this, as well as a respective legal frame.

As a supplement however, as a support of psychotherapy – and not as a subsidiary for it – Shiatsu is well suitable. Through the mobilisation of the flow of energy, the experiencing of the physical relaxation & letting go, the inclusion of physical self-perception, the diving into a deep, coaenesthetic level of communication (under inclusion of basal principles like warmth, rhythm and constancy), the experience of closeness and limits and other similar things more, Shiatsu can support the psychotherapeutic work quite well (also see Ze’ev Bergman et al.). We have to be aware, though, that the Shiatsu-practitioner is confronted with a sensitive situation of encounter. It is of great importance that the Shiatsu-practitioner understands the therapeutic process and does not start to “act” with the client. The therapeutic treatment would be rendered more difficult by this or under especially difficult conditions even become impossible. Important are furthermore clear (personal and regarding to treatment) limits, an if possible stable, appreciating empathic basic attitude and maybe even – after having talked to the client – contact with the treating (psycho-) therapist, as to be able to adapt the Shiatsu-sessions better to the treatment course or also to better understand a momentary situation of the client and be able to support her or him more effectively.

I only want to take some examples out of the multitude of possible approaches to Shiatsu as a company to professional psychotherapy. Shiatsu can help some patients e.g. to make important experiences of letting go, letting happen, being passive, accepting and relaxing. Beyond this, Shiatsu has the potential to transmit fundamental qualities like warmth, rhythm and constancy, on which the further development will draw back from, in a non-verbal encounter – and this strengthening supports the therapeutic way on a basal, non-verbal level, sometimes in a really essential way.

A further important aspect of Shiatsu consists in the physical self-experience, the immediate experience of physical limits as well as the perception of superficial and deeper structures of the body. In brief, Shiatsu promotes an intense experiencing of the own body and the formation of a differentiated image of the body.

To say it once again, in the work with Shiatsu as a support for psycho-emotional developments, as well as for the work on conflicts, a high degree of maturity and (self-) experience is necessary besides a needed understanding of mental illnesses as structures of communication. Otherwise we run the risk to load the own problems in the sense of transfer up on the client. And we should not forget that the work with Shiatsu sometimes requires a high degree of carrying capacity, the ability of being able of supporting and bearing also difficult encounters without losing the open and empathic attitude towards the client.

Quoted references

  • Bartl, Günther: Der Umgang mit der Grundstörung im Katathymen Bilderleben. In: J.W. Roht: Konkrete Phantasie. Verlag Hans Huber, Bern 1984.
  • Bartl, Günther: Strukturbildung im therapeutischen Prozess. In: G. Bartl & F. Pesendorfer: Strukturbildung im therapeutischen Prozess. Literas Universitätsverlag, Wien 1989.
  • Bergman, Ze´ev, Eliezer Wizum und Tamar Bergman: When Words Lose Their Power. Shiatsu als a Strategic Tool in Psychotherapy. In: Journal of Contemporary Psychotherapy Vol. 21, No. 1, 1991, S. 5 – 23.
  • Spitz, Rene A.: Diacritic and coenaesthetic organizations. In: Psychoanal. Rev. 32, 1945.
  • Spitz, Rene A.: Vom Säugling zum Kleinkind. Verlag Klett-Cotta, Stuttgart 1992 (10. Auflage). Originalausgabe: The First Year of Life, 1965.
  • Stern, Daniel N.: Die Lebenserfahrung des Säuglings. Verlag Clett-Cotta, Stuttgart 1992 (2. Auflage).


© Dr. Eduard Tripp, Shiatsu Senior Teacher, Psychotherapeut und Supervisor ( This article is part of the congress volume „European Shiatsu Congress Kiental 2004“.