REVIEW ARTICLE

published: 20 May 2014

doi: 10.3389/fpsyg.2014.00472

The mind–body relationship in psychotherapy: grounded

cognition as an explanatory framework
Nuwan D. Leitan and Greg Murray*
Department of Psychological Sciences and Statistics, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia

Edited by: As a discipline, psychology is defined by its location in the ambiguous space between
Wolfgang Tschacher, Universität Bern, mind and body, but theories underpinning the application of psychology in psychotherapy
Switzerland
are largely silent on this fundamental metaphysical issue. This is a remarkable state of
Reviewed by:
Claudia Bergomi, University Hospital
affairs, given that psychotherapy is typically a real-time meeting between two embodied
of Psychiatry – University of Bern, agents, with the goal of facilitating behavior change in one party. The overarching aim
Switzerland of this paper is to problematize the mind–body relationship in psychotherapy in the
Johannes Michalak, University service of encouraging advances in theory and practice. The paper briefly explores various
Hildeshiem, Germany
psychotherapeutic approaches to help explicate relationships between mind and body from
*Correspondence:
Greg Murray, Department of
these perspectives. Themes arising from this analysis include a tendency toward dualism
Psychological Sciences and Statistics, (separation of mind and body from the conceptualization of human functioning), exclusivism
Faculty of Health, Arts and Design, (elimination of either mind or body from the conceptualization of human functioning), or
Swinburne University of Technology, mind–body monism (conceptualization of mind and body as a single, holistic system). We
John Street, Hawthorn, VIC 3122,
Australia
conclude that the literature, as a whole, does not demonstrate consensus, regarding the
e-mail: [email protected] relationship between mind and body in psychotherapy. We then introduce a contemporary,
holistic, psychological conceptualization of the relationship between mind and body, and
argue for its potential utility as an organizing framework for psychotherapeutic theory
and practice. The holistic approach we explore, “grounded cognition,” arises from a long
philosophical tradition, is influential in current cognitive science, and presents a coherent
empirically testable framework integrating subjective and objective perspectives. Finally,
we demonstrate how this “grounded cognition” perspective might lead to advances in the
theory and practice of psychotherapy.
Keywords: embodiment, embodied cognition, psychosocial treatments, psychotherapy, naturalism, phenomenol-
ogy, mind–body, grounded cognition

INTRODUCTION programs rarely require a competency around this ontological

As a discipline, psychological science is “mounted above the philo- issue, suggesting that the discipline may have relegated it to the“too
sophical gap between mind and body” (Tschacher and Haken, hard” basket. Contemporary research across multiple disciplines,
2007, p. 1). The inherent challenges of this position are clearly however, suggests that the case should be re-opened.
seen in psychology’s primary application, psychotherapy (the use Recent research in philosophy (Clark, 1997; Lakoff and John-
of psychological science to improve mental health and wellbe- son, 1999), cognitive science (Brooks, 1991; Chemero, 2009) and
ing). The theoretical foundation of psychopathology (the study of psychology itself (Barsalou, 1999; Glenberg and Robertson, 1999)
the nature and treatment of mental disorders) has been described advocates a fundamental reappraisal of the relationship between
as akin to that of biology’s before Darwin (Frances and Egger, mind and body. The “embodied cognition” research program has
1999), and arguably, the elephant in the room is the lack of many strands, but all commence with a rejection of the dualistic
consensus, both implicit, and explicit, about the relationship separation of body and mind (Shapiro, 2011). Here, we propose
between mind and body (Kendler, 2008). Whether expressed grounded cognition as an embodied, psychological framework
as human versus natural sciences, hermeneutic versus positivist which provides a holistic conceptualization of body and mind.
methods, or understanding versus explanation, Cartesian or sub- It is our position that articulating the relationship between body
stance dualism (mind and body are two types of substance) is yet and mind from a psychological perspective will provide a con-
to be resolved in psychopathology and psychotherapy. The field sensus position and an organizing framework for the mind–body
is consequently characterized by polarized schools of thought, relationship for psychotherapy research and practice. We contend
identifying it as an immature science in Kuhnian terms (Kuhn, that this will encourage practitioners to reflect on their assump-
1962). tions about cognitions and how they conceptualize body and mind
In the absence of a consensus position on the mind–body rela- in treatment, leading to a better understanding of the tensions
tionship, psychotherapists juggle tangible and intangible features between psychotherapy theory and practice and the identification
of their clients without integrative models (Murray, 2011). It is of gaps in existing therapies and consequently an expansion of the
noteworthy that international guidelines for psychology training range of therapies offered to the patient.

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Leitan and Murray Mind–body relationship in psychotherapy

The paper is structured in four sections. First, we briefly con- However, the body also figures strongly in psychoanalytic the-
sider a range of approaches to psychotherapy through the lens ory. For Freud, structures of the mind (e.g., id, ego, superego)
of their apparent assumptions about mind–body. Themes aris- arise out of tensions between the organism’s bodily drives and
ing from this analysis include a tendency toward an uncritical societal structures (Muller and Tillman, 2007). This is reflected
dualism (separation of mind and body from the conceptu- in the psychoanalytic conception of psychosomatic illness, which
alization of human functioning), exclusivism (elimination of was the idea that emotions and unconscious desires caused bod-
either mind or body from the conceptualization of human func- ily symptoms; for example Gregor Groddeck, a psychoanalyst
tioning), or mind–body monism (conceptualization of mind who developed Freud’s ideas about psychosomatic illness pro-
and body as a single, holistic system) and we conclude that posed that a tumorous abdominal growth could result from a
the psychotherapy literature, as a whole, does not demon- warded-off unconscious wish to be pregnant. Furthermore it has
strate consensus, regarding the relationship between mind been suggested that the “ego,” in psychoanalysis, commences as
and body. We propose that an organizing framework for an embodied entity, and emphasizes the continuity between ani-
the mind–body relationship, underpinned by a holistic con- mals and humans, suggesting a monist, or holistic mind–body
ceptualization of the relationship, would benefit psychother- conceptualization (Muller and Tillman, 2007).
apy research and practice. Second, philosophical accounts
which portray a holistic mind–body relationship from phe- BEHAVIOR THERAPY
nomenological and objective perspectives are outlined. Third, Traditional behavior therapy arose in an American setting in the
we propose that these perspectives are integrated, psycholog- early 1950s and saw a shift from the psychoanalytical ideas of
ically, by “grounded cognition,” constituting a comprehen- studying the mind to the pragmatic, evidence-based study of
sively articulated, empirically informed, organizing framework behavior (Dowd, 2004). This shift was triggered by J. B. Wat-
for conceptualization of the mind–body relationship in psy- son’s criticism of subjectivity and mentalism as the subject matter
chotherapy. In the final section we consider how the applica- of psychology and his advocacy of the objective study of behav-
tion of psychological science in psychotherapy might advance ior. This was followed by the advent of “modern learning theory,”
through a thoroughgoing consideration of “grounded cogni- which referred to the principles of classical and operant condi-
tion.” tioning. These early ideas underlying traditional behavior therapy
were exclusivist, rejecting the notion of mind and cognition, on
MIND–BODY ASSUMPTIONS UNDERLYING CURRENT the grounds that they are unobservable entities and therefore unfit
PSYCHOTHERAPIES for scientific study (Wilson, 2008; Zinbarg and Griffith, 2008).
There is no agreed taxonomy of psychological therapies (e.g., However, later theories stemming from behaviorism devel-
Kahl et al., 2012; Tschacher et al., 2014), but to achieve an oped a more complex account of the mind–body relationship.
adequate coverage of existing approaches for the present pur- For example, Bandura (1977) spoke of a reciprocal determination
poses, we categorise psychotherapies into five fuzzy-bordered between behavior and the environment, stating that “it is largely
groups: psychoanalysis, behavioral therapies, cognitive therapies, through their actions that people produce the environmental con-
mindfulness-based therapies, and body psychotherapies. Each of ditions that affect their behavior in a reciprocal fashion” (p. 345).
these has many branches and extensive literatures – thus, in this Bandura also seemed to encourage conceptualization of the mind
brief review we aim only to explore different ideas regarding the as a part of the same system as behavior and environment, for
relationship between mind and body from within each approach, example, “. . .experiences generated by behavior also partly deter-
and across approaches, rather than attempting to assign particu- mine what individuals think, expect, and can do, which in turn
lar conceptualizations of the mind–body relationship to particular affects their subsequent behavior” (p. 345).
approaches. This holistic conceptualization of the mind–body relation-
ship is also apparent in popular behavior therapies for children
PSYCHOANALYSIS with autism spectrum disorder, such as music therapy, Floor-
Although psychoanalytic theory and practice have fallen out of time, rhythm therapy, and reciprocal imitation training which
favor in contemporary psychological science, aspects of Freud’s are broadly underpinned by behavioral and functional develop-
thinking can still be discerned in current psychotherapy (Dowd, mental approaches (Greenspan and Wieder, 1999; Ingersoll and
2004). An important aspect of psychoanalytic theory is the Schreibman, 2006; Overy, 2008; Vismara and Rogers, 2010; Srini-
“cognitive unconscious,” or the “unconscious mind.” In oppo- vasan and Bhat, 2013). For example, reciprocal imitation training
sition to the popular enlightenment view at the time, Freud teaches children the spontaneous social use of imitation, which
argued that behavior is driven by unconscious motivations as targeted at attention, language and communication cognitions
and drives, rather than rational choice (Luborsky et al., 2008; (Ingersoll and Schreibman, 2006) and Floortime utilizes child-
Wolitzky, 2011). As discussed by Luborsky et al. (2008), cen- led playful interactions, experiential problem-solving interactions
tral therapeutic strategies of psychoanalysis include free asso- and motor, sensory and spatial play, which is targeted at language
ciation (expressing any thoughts which come to mind during and other cognitive skills (Greenspan and Weider, 1997).
therapy), therapeutic listening and responding (examining the
content and emotion of thought), and interpretation (draw- COGNITIVE THERAPY
ing inferences about unconscious underpinnings of conscious With the advent of the cognitive revolution, pure behavioral ther-
experience). apies begun to fade out in favor of cognitive therapies, which

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Leitan and Murray Mind–body relationship in psychotherapy

followed the prominent model of human functioning at the time; body is seen as the reference point for awareness. Thus changes
computational theory (Hayes et al., 1999). Computational the- in cognitions (e.g., restricting rumination) following mindfulness
ory conceptualized the body as an “input-output device,” or the practices are bought about by becoming more aware of the body,
“hardware,” and the mind as the “central processor,” the “software,” without referring to cognitive dominion (i.e., conscious thought)
or the “controller” (Shapiro, 2007). Due to their concurrent rise, to bring about this awareness (Burg and Michalak, 2011). It is
articulation of the relationship between mind and body in cogni- difficult to articulate the relationship between mind and body
tive therapy has been influenced by this computational perspective implied by mindfulness-based psychotherapies due to two rea-
(Dowd, 2004). sons. First, awareness is not conceptualized as a cognitive feature,
Cognitive therapies are defined by their elevation of the cog- but may still be a feature of the “mind.” Second, the body is
nitive system in the adjustment of information processing and not conceptualized as a physical agent of change like behavior
initiation of positive change (Beck and Weishaar, 2008). This is assumed to influence cognition in cognitive behavior therapy
perspective is fundamental to a family of theories underpin- (CBT); rather it is awareness of the body which is the agent of
ning cognitive therapy, including those of Ellis (1962) and Beck change in mindfulness-based therapies. These questions illustrate
(1967). Beck’s (1967) cognitive theory remains one of the most some of the issues which arise when dualistic thinking is reflected
influential to this day, in particular his major contribution to upon carefully.
cognitive therapy, the cognitive model (Triad) of depression.
This model suggests that depression is underpinned by auto- BODY PSYCHOTHERAPY
matic, negative thoughts about the self, others and the world. Body psychotherapy (BP) refers to a variety of schools (e.g.,
Beck contends that these negative cognitions also activate nega- dance/movement therapy, analytical body psychotherapy, con-
tive motivational, behavioral, emotional, and physical symptoms centrative movement therapy etc.) which share the aim of
(Beck and Weishaar, 2008). Thus, for Beck and his contempo- enhancing self-awareness, modifying behavior, and facilitating
raries, it is implied that the mind should be the primary target of insight-oriented psychological problem solving via a mode of
psychotherapy. action concerning perceptive/self-awareness, affective-cathartic,
One of Ellis’ major contributions to cognitive therapy was interactive, and/or movement oriented therapy (Röhricht, 2009).
the A-B-C method used in his rational emotive behavior ther- Although, there have been randomized controlled trials (RCTs)
apy (REBT). The A-B-C method challenged the assumption that conducted for some schools of body psychotherapies, they are
when a consequence (C) follows and activating event (A), A not empirically supported to the same extent that cognitive
causes C. Ellis posited a cognitive construct, beliefs (B), which and behavioral therapies have been (Röhricht, 2009). In prac-
he argued was the greatest determinate of (C). Thus, the idea tice, BP primarily works on releasing and re-shaping somatic
was that (C) could be modified by (B), even if (A) remains memories in order to release associated psychological constraints
stable (Dowd, 2004; Ellis, 2008). Ellis’ REBT explicitly consid- (Totton, 2003). The theoretical foundation for BP has been
ered the importance of content of the “mind” (i.e., thinking, explained as the way “core beliefs are embodied, and that until
feeling, wanting etc.), and of operations of the “body” (i.e., we begin to experience the pain held in them directly through
behavior). However, the relationship between mind and body our bodies they will continue to run our lives” (Staunton, 2002,
was conceptualized in terms of cognitive modification to change p. 4).
behavior or behavior change to modify thought (Ellis, 2008). Thus, The practice of BP implies a very close relationship between
despite acknowledgment of both mind and body, REBT, akin to body and mind, to the point that they are seemingly undifferenti-
Beck’s cognitive therapy, implies a dualist conception of their ated during therapy. BP has been described as being fundamentally
relationship. underpinned by an explicit theory of mind–body functioning
which assumes a functional unity between body and mind in which
MINDFULNESS-BASED PSYCHOTHERAPIES there is no separation or hierarchical relationship between the two
Recently, there has been an influx of so-called “third wave” psy- (www.eabp.org).
chotherapies which have their roots in learning theory and are
held together by their subordination of content-oriented cogni- SUMMARY
tive interventions (Kahl et al., 2012). One of the key features of This brief review exposes a lack of consensus, both implicit
some of these psychotherapies (e.g., Acceptance and Commitment and explicit, regarding the mind–body relationship across psy-
Therapy, Mindfulness-Based Cognitive Therapy etc.) is their focus chotherapeutic approaches. Themes arising from this analysis
on “mindfulness.” One of the features of mindfulness as applied in include a tendency toward dualism (separation of mind and
psychological therapies is to develop an awareness of the present body from the conceptualization of human functioning), exclu-
experience by self-regulating attention to momentary sensations, sivism (elimination of either mind or body from the con-
thoughts, and feelings (Keng et al., 2011). Thus, in contrast to ceptualization of human functioning), or mind–body monism
standard cognitive and behavioral therapies, one of the aims of (conceptualization of mind and body as a single, holistic sys-
mindfulness-based psychotherapies is to increase awareness of the tem). It is our position that psychotherapeutic research and
body. practice would benefit from an organizing framework for the
Awareness is contrasted with “thinking” during mindfulness mind–body relationship, which could be applied across all
exercises such as breathing meditation (Michalak et al., 2012). psychotherapies. Recent research in philosophy (Clark, 1997;
Awareness is not about cognition but more about feeling; and the Lakoff and Johnson, 1999), cognitive science (Brooks, 1991;

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Leitan and Murray Mind–body relationship in psychotherapy

Chemero, 2009) and psychology itself (Barsalou, 1999; Glenberg DEWEY’S PRINCIPLE OF CONTINUITY
and Robertson, 1999) suggests that this framework should be In contrast to Merleau-Ponty’s phenomenological approach, an
underpinned by a holistic conceptualization of the mind–body alternative holistic account of the mind–body relationship starts
relationship. from an objective position. American pragmatism offers an objec-
Embodied cognition offers a psychological framework under- tive, philosophical account of a holistic mind and body in the
pinned by a holistic conceptualisation of the mind–body relation- form of naturalism (Johnson, 2006). As Horst (2002) explicates,
ship. Some of the abovementioned psychotherapies which have there have been various definitions and strands of naturalism.
implied a holistic mind–body perspective have already started The account we refer to in this section aligns with the Darwinian
to draw on embodied cognition and related ideas. For exam- paradigm and, more specifically with physicalism, emergence, and
ple, Totton (2009) has recently highlighted the utility of drawing supervenience (Harbecke, 2013; Montero, 2013; McLaughlin and
on embodiment from a social perspective to enhance the prac- Bennett, 2014).
tice of body psychotherapy, while Michalak et al. (2012) has This form of naturalism is committed to an account in which all
described how embodied cognition could describe some of the things in the world, including body and mind are natural or nat-
processes involved in mindfulness. Before describing the psy- urally emergent (Horst, 2002; Aikin, 2006). In turn, it posits that
chological framework of embodied cognition, it is important all explanation should be causal and reducible to natural explana-
to briefly examine its philosophical underpinnings which form tions and is consequently committed to the study of the person as
the foundation for its conceptualisation of a holistic mind– an object and the natural evolution of all human functions (Aikin,
body relationship, from both phenomenological and objective 2006; Johnson, 2006). One account of naturalism, from this emer-
perspectives. gent, supervenient perspective is Dewey’s “principle of continuity”
(Dewey, 1981, 1991).
HOLISTIC MIND–BODY PHILOSOPHIES The principle of continuity posits that there is no break in
MERLEAU-PONTY’S LIVED-BODY experience between the processes of perceiving, feeling, mov-
Edmund Husserl developed the philosophical approach of phe- ing, and thinking; instead they are levels of organic functioning
nomenology as a reaction to his concern that the assumptions from which higher function emerges. It describes three levels
of naturalistic, Western science about the nature of the mind, of organization: the “physical” level of inanimate material pro-
body, and world had caused it to miss fundamental questions cesses; the “psycho-physical” level of living things which have
about human nature (Marcum, 2004). He argued that primary needs, interests, and satisfactions; and the “mental” level of organ-
consideration should be given to the subject’s experience in the isms which can perform higher level cognitions. The principle
world, before studying the mind, body, and world objectively explains the progression from the physical level to the level of
(Marcum, 2004; Gallagher and Zahavi, 2007). Husserl’s argu- the mind without introducing new ontological entities, struc-
ment was progressed by Merleau-Ponty, who proposed that this tures, or forces. Dewey argues that new organization is the
would both uncover the subjective element of knowledge, which reason that organisms with minds can do things which psycho-
was being overlooked by naturalistic sciences, and provide a physical entities cannot do, and why psycho-physical entities
stronger framework for its enquiries (Gallagher and Zahavi, 2007). can do things which physical entities cannot do. Thus, accord-
Thus, phenomenology does not provide a mechanistic account ing to Dewey, what we refer to as “mind” is a complex new
of mind in the vein of naturalism, or psychological and biolog- organization of what we refer to as “body,” but they are in
ical accounts because it focuses on giving a proper description essence the same entity. According to the principle of continuity,
of humans’ experience in life, rather than attempting to forge an what is termed “mind” and “body” are simply ways to iden-
objective account of mind (Gallagher and Zahavi, 2007; Marshall, tify aspects of the organism–environment interaction which have
2008). arisen from an organic process (Dewey, 1981, 1991; Johnson, 2006,
Merleau-Ponty’s phenomenology argues for the prioritization 2007).
of the subjective, lived-body in cognition and more specifically
that cognitions cannot be understood without reference to the PHENOMENOLOGY AND NATURALISM AS COMPLEMENTARY
body which engages with the world (Merleau-Ponty, 1962, 1965; APPROACHES
Marshall, 2008). Merleau-Ponty provides a comprehensive theory Phenomenology is committed to describing subjective experience,
of the “lived-body,” or the “subject-body,” contrasting it to the which is where meaning putatively arises for humans, while nat-
“thing-body,” or the “object-body” (Merleau-Ponty, 1962, 1965; uralism as characterized here provides an objective explanation
Marshall, 2008). The subject-body can be considered the body of how meaning arises ontogenetically, organically and biologi-
experienced from a first-person perspective which acts on the cally, independent of the personal experience of the individual
world, whereas the object-body can be considered the body as an (Gallagher and Zahavi, 2007; Marshall, 2008). As Aikin (2006, p.
object of the world experienced from a third-person perspective. 326) puts it “Lovers may love, and pains may pain, but the nat-
Merleau-Ponty emphasizes the subject-body in cognition, imply- uralistic perspective can attend only to the lovers, not their love;
ing that humans fundamentally are, and thus should be studied to the pains, but not their feelings of pain.” Similarly, the phe-
as embodied beings who form cognitions via interaction in the nomenological perspective can attend only to the love, not the
world with their bodies, rather than cognition as an activity of lovers and to the feelings of pain rather than the pains. Thus,
the “mind” which utilizes the object-body (Merleau-Ponty, 1962, phenomenologists can provide to naturalists, psychologists and
1965; Borrett et al., 2000; Matthews, 2004). neuroscientists a more precise model of the phenomenon which

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Leitan and Murray Mind–body relationship in psychotherapy

they attempt to explain than they would if they were to start only with morels forms different conceptualizations of it. However,
with an “objective” scientific theory of cognition (Gallagher and these concepts are not determinate: for example, if Lucy grows
Zahavi, 2007). Thus, phenomenology and naturalism are con- up to become a mycologist, her concept of a morel would be
trasting, but complementary approaches (Aikin, 2006; Zahavi, more similar to Sally’s. Furthermore, it is important to note
2010). that there is nothing stopping Sally, Charles, and Lucy from
Accordingly, the different directions from which Merleau- having the same concept for a morel, it is simply their differ-
Ponty’s phenomenology and Dewey’s principle of continuity ing bodily interactions with the morel which has determined
approach the question of the relationship between mind and body their conceptualizations. Finally, it can be assumed that they
are complementary, providing ultimately a more comprehensive, have the same visual conceptualization of a morel; they all know
pluralistic understanding of the holistic mind–body relation- one when they see it. However, if Lucy were to have been born
ship. Merleau-Ponty’s phenomenological account can inform blind, she would never be able to obtain the same concept of
Dewey’s objective account of how a person experiences the holistic a morel as Sally and Charles. Thus, grounded cognition aligns
mind–body described in his theory. with Merleau-Ponty’s phenomenology by emphasizing the impor-
Thus, a philosophical integration of these perspectives may be tance of subjective body-in-the-world experience for cognition
possible (Zahavi, 2010), but our aim here is to provide a frame- (Johnson, 2006).
work for psychotherapeutic research and practice. Therefore, it The second major assumption of grounded cognition is that
is necessary to provide a psychological account which integrates the body’s relationship with the world is represented in the brain
subjective and objective perspectives of a holistic mind–body rela- (Barsalou, 2008). Theories within grounded cognition differ on
tionship. We propose that grounded cognition provides such a how these bodily interactions are represented in the brain, with
framework. some theories positing “image schemas” of bodily interactions in
the world which are proposed to underpin abstract conceptual
GROUNDED COGNITION AS A PSYCHOLOGICAL knowledge (Lakoff and Johnson, 1999). However, most grounded
FRAMEWORK REFLECTING A HOLISTIC MIND–BODY cognition theories propose “simulations,” which are neural recon-
RELATIONSHIP structions of experience using representations contained in modal
Embodied cognition is a research program consisting of a num- systems of the brain (Glenberg, 1997; e.g., the sensorimotor sys-
ber of accounts and topics, held together by the underlying tem; Barsalou, 1999; Gallese and Lakoff, 2005). Thus grounded
assumption that the body functions as a constituent of the mind cognition is also consistent with Dewey’s principle of continuity
rather than a perceiver and actor serving the mind, thus being in that from an objective, neuroscientific perspective, cogni-
directly, and subjectively involved in cognition (Borrett et al., tions are emergent from, and inextricably intertwined with the
2000; Shapiro, 2007). Different accounts of embodied cogni- body.
tion provide various models of this underlying assumption, so In sum, grounded cognition implies that cognition is emer-
it is useful to focus on one to explore the holistic conceptual- gent from and inextricably tied to the subjective, lived, experience
ization of body and mind and how it aligns with the principles of the body-in-the-world. Thus, “mind” and “body” only func-
of Merleau-Ponty’s phenomenology and Dewey’s principle of tion as labels attached to properties of human functioning which
continuity. we perceive as originating either mentally or physically. Con-
“Grounded cognition” reflects the underlying embodied cogni- ceiving of the relationship between body and mind from this
tion assumption by proposing that cognition is derived from, and holistic, psychological perspective can be expected to have a
dependent on, bodily interactions with the world which are rep- number of important implications for psychotherapy theory and
resented in the brain (Barsalou, 2008). Grounded cognition has practice.
been comprehensively articulated and critiqued in the literature
(Barsalou, 1999, 2008), has a strong empirical foundation (e.g., IMPLICATIONS FOR PSYCHOTHERAPY THEORY AND
Schubert, 2005; Chandler and Schwarz, 2009; Jostmann et al., 2009; PRACTICE
Natanzon and Ferguson, 2012 etc.) and most importantly, clearly First, a holistic conceptualization of the mind–body relation-
explicates the holistic relationship of body and mind, aligning with ship leads to a better understanding of the tensions between
both Merleau-Ponty’s phenomenology and Dewey’s principle of psychotherapy theory and practice. When the mind–body rela-
continuity as considered next. tionship is conceptualized from a dualist or exclusivist perspective,
Grounded cognition is underpinned by two major assump- a tension is created between the phenomenological needs of the
tions, namely that cognition is dependent on the body’s interaction patient who is present mind and body and the emphasis on
with the world and that these interactions are represented in either mind or body according to the theoretical assumptions
the brain (Barsalou, 2008). Grounded cognition’s first assump- of the psychotherapy practiced by the therapist. One exam-
tion is illustrated neatly by Shapiro (2011) in considering the ple of this is the de-emphasis of the body during the practice
concept of a morel mushroom for Sally, a mycologist, Charles, of psychotherapies whose underlying theory disembodies the
a provencal chef, and Lucy, a young child. Sally conceptual- mind. During such therapies (e.g., cognitive therapy), touch is
izes a morel as an epigenous ascocarp, Charles conceptualizes a purposefully excluded from therapeutic practice since the mind
morel as a delicacy to be sautéed with butter, and Lucy concep- is conceptualized as the agent of change, even though thera-
tualizes a morel as the yucky thing she has to eat before being peutic practice could possibly be enhanced by touch (Feltham,
allowed dessert. Thus, each according to their bodily experiences 2008).

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Leitan and Murray Mind–body relationship in psychotherapy

Second, a psychologically articulated, holistic framework for a broader language around psychopathologies as disorders of
the mind–body relationship encourages theoretical reflection the “system,” whether the symptoms are perceived as mental or
about this relationship by challenging dualist and exclusivist physical. This will encourage the patient to focus on the holis-
assumptions inherent in some psychotherapies. In turn, this helps tic nature of their symptoms during treatment, as opposed to
to clarify some of the points of difference between the psychother- the idea that some treatments are behavioral/bodily and oth-
apies described above. Numerous psychotherapies discussed in ers are mind/cognitive. This is but one example of changes
“Mind–Body Assumptions Underlying Current Psychotherapies,” which may come of reflecting on the mind–body relationship in
have similar theoretical background and similar therapeutic prac- practice.
tices. An example of this is traditional behavioral therapy and Finally, a new perspective on the mind–body relationship will
body psychotherapy. Both emphasize the body and conceptualize guide the identification of gaps in existing therapies and conse-
it as the agent of change and as a consequence, both prioritize quently promote an expansion of the range of therapies offered to
the body in therapy. One of the primary differences between the patient. For example, grounded cognition implies that one way
the two can be ascertained by reflecting on the mind–body rela- to change cognitions is through the subjective, lived, bodily expe-
tionship. Traditional behavior therapy is very much exclusivist, rience of the individual. Encouraging practitioners to reflect on a
dismissing the mind and cognition and emphasizing the body and holistic mind–body approach may result in a wider range of thera-
behavior, both methodologically and theoretically. Contrastingly, pies they can offer their patients stemming from this idea. Further
body psychotherapy recognizes cognitions whilst treating them via development of these ideas may also result in the creation of new
the body, thus implying a holistic conceptualization of mind and and innovative therapeutic methods to augment those already in
body. existence.
Third, a holistic conceptualization of the mind–body rela-
tionship has the potential to further de-stigmatize mental illness CONCLUSION
(Thomas, 2013; Ungar and Knaak, 2013a,b). Ungar and Knaak Psychological science sits awkwardly between mind and body,
(2013a) suggest that dismissive and blaming attitudes toward and its application in psychotherapy inherits this awkwardness
mental health issues can be attributed to the absence of an in a lack of clarity about how therapists should conceptualize
organic explanation for most mental health issues. Thomas their patients. By reviewing how mind and body are tradition-
(2013) suggests that promoting mental illness to non-psychiatric ally understood in major psychotherapies, we have attempted to
health professionals as an interaction between cognitive, behav- underscore some of the tensions in this area. By introducing and
ioral, emotional, biological, and environmental factors would outlining grounded cognition as a holistic psychological approach
reduce dualistic thinking around mental health issues and help consistent with both radically subjectivist (Merleau-Ponty) and
with de-stigmatization in these settings. The psychologically objectivist (Dewey) philosophical approaches, we hope to have
articulated, holistic conceptualization of the mind–body rela- proposed a new way forward for theorists and practitioners of psy-
tionship presented here elaborates on Thomas’ idea by con- chotherapy. This new way forward throws light on the relationship
ceptualizing cognitive, behavioral, emotional, biological, and between existing psychotherapies, the relationship between theory
environmental factors as part of the same functional system, and practice, and highlights opportunities for new approaches to
implying that “organic” causes are inseparable from “mental” psychotherapy.
causes. Thus, we propose that the holistic conceptualization
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Zinbarg, R. E., and Griffith, J. W. (2008). “Behavior therapy,” in Twenty-First Century Copyright © 2014 Leitan and Murray. This is an open-access article distributed under
Psychotherapies, ed. J. L. Lebow (Hoboken, NJ: John Wiley & Sons), 8–43. the terms of the Creative Commons Attribution License (CC BY). The use, distribution
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