Alexander Technique and Chronic Pain – New Research

Following on from the recent research on Alexander Technique and chronic back pain, new research has been done on giving lessons to help people with pain management at an NHS Pain Clinic in England. While not a full clinical trial, the research evidence further supports the effectiveness of Alexander Technique in helping people with Chronic Pain. The people who took part in the study, while self-selecting, reported improvements in their quality of life and an ability to reduce medication. The pupils who did best were those committed to self-management and therefore learning what they could from the six lessons they were given. The lead consultant commented on the effectiveness of the Alexander Technique as a ‘psychological’ intervention noting that the overall pain experienced remained constant while feelings of well being and quality of life improved.

The number of lessons involved means that it would be surprising if people whose pain was chronic experienced any reduction in pain. If that was going to happen, it would be expected to take many more lessons and for some people the reality is that chronic pain is just going to be part of their daily life. That does not mean, as this research demonstrates, that one can do nothing to help oneself; that one has to live an ever diminishing life – there is still always a choice.
That choice centres on where one places one’s attention. 

The standard pain reaction involves a move from being aware of pain to directly attending to it. What happens in that move to attending to pain is that emergency response mechanisms get activated, the body tends to stiffen, and the meaning of the pain is sought in its implications for the immediate present and then the distant future. There is a psycho-physical response of our whole being. 

Where pain is ongoing of course the habit of attending to the pain, looking for it becomes established. What every parent, with a small child in pain, knows of course is that it is important to distract the child, to encourage it to look elsewhere. So with Alexander Technique and looking at habits in relation to pain, and not just physical pain either. The necessity is to learn to become conscious of where one is directing one’s attention, the nature of that attention and how consciously learning to direct attention elsewhere, in a manner where one’s breathing releases, deepens, changes things, produces feelings of well being, as well as establishing a sense of control as a new habit is established.

If Alexander Technique were solely concerned with distraction and the control of attention, it would not differ from other psychological approaches. What it adds is that in recognition of our embodiment, in its assumption that we are psycho-physical, it encourages people to develop control of their whole response, so that the postural mal-adaptions to chronic pain are lessened through the development of a manner of using one’s self that is optimal in terms of not just pyshco-physical functioning but of physical functioning and psychological functioning, as this research helps further establish. 

Knowing How v Knowing That

I first became aware of Gilbert Ryle’s distinction between ‘knowing how’ and ‘knowing that’ while studying philosophy at Aberdeen University as an undergraduate. It is a distinction whose importance I have found myself reflecting on for a number of reasons, not least the importance Alexander placed on it in emphasising the importance of the ‘means-whereby’ we go about our business. Alexander, I think it is fair to say, was dismissive of ‘knowing that’; there are numerous accounts of him turning away from encounters with eminent people, who might have helped him promote his work, on the basis that for him their ‘use’ was obviously, shall we say, not what it might be.

I suspect that while necessary, in some senses to protect the developing use and practice of the Alexander Technique, it has rather isolated the Alexander world from developing its theory, which is there in the writings of Alexander. This is a pity, there is much the Alexander world can learn from others, equally there is much others can learn from us, in what we can observe and teach. 

I was reminded of this at the weekend when I was at Trinity College in Dublin, attending the European Personal Construct Association’s (EPCA) conference. I had the privilege of running a workshop linking my work as an Alexander Technique Teacher and as a Psychotherapist. I will spare you the full title but the workshop focused on how Alexander Technique and Conscious Control can be helpful inter-personally in getting at habits laid down in the early weeks of life. Habits that have a profound effect on how we experience ourselves and then others. 

While I think that not only did Alexander recognise a link and aim to work with it, I think that for many reasons his work and writings here are limited. Yet, they went on to inspire people like Margaret Naumburg who founded Art Therapy in the United States, Fritz Perls who started Gestalt Therapy, and through John Dewey, George Kelly who developed Personal Construct Psychology. Not enough work has been done to trace Alexander’s influence or to develop the theoretical links that would help expand his work in its practical reach.

On the ground individual teachers continue to make a difference, making links and finding people who are interested. Alexander Technique teachers have a lot to offer in terms of ‘know how’ or the ‘mean’s whereby’; we can learn to control not only our behaviour but what Alexander termed our ‘manner of reaction.’ He was explicit in his last book that people who were familiar with his work had missed the significance of his work here. 

Fortunately not everyone has missed it as a welcome bit of news in my inbox today attests to, in that Eric Donnison and Caroline Dale are organising a project to teach AT to the kids, parents and staff of Kid’s Company founded by the truly remarkable Camila Batmanghelidjh. It’s a project one can only wish well to in its proposed undertaking of offering Alexander Technique and its ‘know-how’ to people who have had a very raw start in life. 

Being Alive

Women’s Hour on BBC Radio 4 this week featured Elizabeth Walker, who at 97 is still teaching the Alexander Technique. She is the last living teacher trained by Alexander and has been teaching for seventy years. The interview contained a number of gems, the importance of taking the work seriously without being serious, the importance of the inhibition and keeping things free. Perhaps the most inspiring thing is, that Elizabeth is still working, not many 97 years old can say that. She is also still getting better at what she does, again how many people can say that at 97. The sceptically minded, who manage to listen, may think this is eulogising on the part of her student, who has come back for lessons. Yet anyone with any experience of Alexander Technique Teacher’s as they age, will recognise not just that it is plausible but it is truthful. Older teachers if they are any good, develop a clarity of intention, by stripping away all the unnecessary elements, to leave only what is necessary. It is one of the attractive features of being a teacher, you get better as you age, that’s what allows teacher to keep going through their eighties, often until ninety, doing what by any standards is a physical job. The secret of course is knowing how to use yourself, keeping yourself free, not tightening unnecessarily – this is not just true for teaching but any skilled activity. Elizabeth also made the case for her continuing to teach. It helps both her and her pupils feel alive. This is as good a reason for doing anything that I know, and it is one that George Kelly recognised as being an indication of successful therapy.

Feeling alive, a meaningful life, comes in many forms not just Alexander work – it comes from having something meaningful to do. The item following Elizabeth Walker on Women’s Hour rather reinforced this for me. It featured Rachel Wotton an Australian sex worker, who works with disabled people. It is a subject that outrages some but then I do not think they really consider the alienation and rejection that people who are disabled have when they find it difficult or impossible to find a partner. I suspect that this come in part from not wanting to think that the disabled get horny and want to have sex - just as much as the next person. 


If you want to think about this more, then a good place to start is the very funny, entertaining and touching French film Nationale 7.  I saw it a few years back and a working both as a Alexander Technique Teacher and a psychotherapist has confirmed the need for an open discussion and meaningful action here. Rachel Wotton made an intelligent case for this on Women’s Hour. Like Elizabeth Walker, her work is obviously meaningful for her and helps her feel alive; while again like Elizabeth she helps others to a better quality of life. Both women demonstrate in their lives what is existentially important, meaning, helping others and feeling alive and should be respected accordingly.

No blog for two weeks as I am away at conferences and training days. Women’s Hour is available on BBC I-Player until Tuesday 19^th June. Elizabeth Walker starts at 11mins and 55 secs, Rachel Wotton at  19mins and 20 secs. Elizabeth Walker is on You Tube here, while the website for a documentary on Rachel Wotton is here. 

Why We Need A Teacher

Alexander believed anyone could do what he did in working things out for himself; he also believed that lessons would reduce the time needed to do so. I am far from certain about the former statement, while being pretty sure of the latter. The problems in working it out for oneself are many, even if you have the excellent guide that is given by Alexander in chapter one of his third book ‘The Use of The Self.’ This account of how he worked things out is undoubtedly idealised, but in his idealisation Alexander lays out a pretty good framework for learning what he knew. 

Within that account the chief difficulty becomes apparent, namely the need to do something unfamiliar, not to rely on habit, not to rely on feeling, to allow something different to happen. All too often at the last second, we revert to the familiar, go with the habit, make our usual choice, missing the new road that is in front of us.

Alexander was well aware of this, as the most recent blog by Robert Rickover makes clear. Alexander’s practical experience of teaching both himself and others emphasised this tendency to revert, to rely on habit, to rely on old conceptions of how to go about things, even simple things like sitting and walking.

In talking of conceptions here, it is worth remembering a belief of Alexander’s, that John Dewey picked up on, namely that experience precedes conception. There are some very deep waters we could get into here about conception and what is going on in general, but from a practical point of view Alexander is right. Only when you have experience can you really begin to know, to have concepts in terms of ‘knowing how,’ which is very different from ‘knowing that.’

Getting the experiences is where a teacher comes in, where the teacher can help you gain in minutes experiences that it took Alexander months to work through. Those first experiences of difference in how you can move, how you might use yourself, are what allow you to begin to be aware of what you currently do, how you currently work, what you might stop, what might be right, what might be wrong in terms of how we function. 

We too often rely on the pre-verbal solutions of our childhood, modified haphazardly or sometimes modified consciously and badly, as our way forward. A teacher can help us correct these by making plain the implications of our patterns of use, our habits, not just verbally but through experience and words, putting the two together so we can learn the concepts for ourselves. As we do so, we develop Conscious Control for ourselves; we can use ourselves intentionally. 

Without a teacher we are liable to lose ourselves, always returning to old habits, relying on old feelings of right, that are wrong; tying ourselves in knots, missing the way forward, repeating old mistakes, following the old ways, that have led us into impasse, always, and forever will do so, unless, we first learn to stop, call a halt. With that a teacher can help, before pointing the way to a new use, new habits that can free us towards a better and more constructive use of ourselves.  

Sciatica And Semi-Supine

Exchanging emails with a friend today they told me of their plan to spend the weekend on the floor in the hope of easing their sciatica. This blog is an open letter of sorts to them about what they might do; how they might help themselves using the semi-supine procedure that I know that they have learned from their Alexander Technique lessons. 

I have a particular interest in sciatica; it was what led me to Alexander lessons in the first place. I was relatively young at 24 to suffer the severity of sciatic pain that I had; it would flair up making it extremely painful to walk and I would have to take time off work to let things settle down – anti-inflammatories after the first episode seemed to have no efficacy. I tried all sorts of treatment and became familiar with a number of different physiotherapy departments, went on the machines to have my spine stretched, even had surgery. The result was always the same, things would get better and I would go back to work; three months of thirteen-hour days (I was working as an accountant in London at the time) saw me off work again.

I only properly understood the cycle after my first Alexander Technique lesson, when I suddenly saw how the way I sat caused the pressure on the nerves that caused the pain. Now Alexander Technique did not cure the sciatica, it does not claim to, but it was the one thing that helped through, giving me control of my use and, through that, the ability to relieve the pressure.

At first, that control was only there, as sometimes happens, when I was lying in semi-supine, later it came when I was standing up, until now when I can get it pretty much almost anywhere. This allows me to live a full and active life, I can say I never cripple myself with sciatica now, if that is not tempting fate. A pain is almost always there in the background because of the way my back is, but to repeat, it does not bother me. I know enough to not attend to it, to direct my attention elsewhere, to interrupt the standard pain reaction in favour of elaborating what works.

And it is this, not the basic instructions for semi-supine (I’ll put them up on the blog sometime) that I want to tell my friend. Elaborate the orthogonal, go for the vertical, do not try and sort out the pain. You will only attend to it directly, end gain and make it worse. It is only when instead of relating to the pain directly by attending to it, that you allow yourself to begin to focus elsewhere, that things begin to work, almost by magic, except it is not magic, it’s predictable, repeatable, if you know about use and the use of the eyes.

If you can find a way to lightly focus on the ceiling, without concentration, without fixing the eyes, it will all start to work; it is a matter of getting curious and wondering. A helpful thought, sometimes, if the ceiling is too boring, the pain too distracting, is to imagine a brightly coloured mobile just above your eyes. If you allow yourself to see it, the same thing will happen, your eyes will open wide with wonder, things will start to work – you have created the awareness within which you can work with the directions. It is always the shift of attention, brought about through leaving yourself alone. When that happens, you start to breathe and things ease off. From experience, released breathing means a back that is working well; a back that is working well means released breathing. It’s chicken and egg sometimes, except in the case of sciatica, where the breathing comes first. 

Psycho-Physical Attitude and ‘The Tyranny of The Should’s’

Lessons this week reminded me how useful it can be to contrast how we use ourselves when we approach something from the perspective of ‘wanting’ to do it, rather than believing that we ‘should’ do it. Both ‘wanting’ and feeling that we ‘should’ do something are, from a psycho-physical perspective, attitudes within which certain uses of the self are embodied. 

With the former if directly expressed we will often come up into an attitude where we are focussed, freer, lengthening in stature, with our breathing released – we are properly speaking more relaxed; we are using ourselves well. In the latter, we respond to feeling that we ‘should’ do something by tightening around our faces, pulling forward, pulling down, making our movements jerky, as we force ourselves into an action, where our free choice is either denied or hidden. 

Whether we choose to do something because we want to or because we feel we should in different contexts, depends on habits that can reach back into early childhood.  Habits that we evolve in relation to how our will and spontaneity were construed by our parents and the culture we found ourselves in. 

Three caveats here, the first is that learning to recognise what we want, we are not always at first skilful at listening to ourselves, we too often carry an external threat with us, which we tighten ourselves against. Secondly, that once we can freely express what we want, it does not follow that we can freely move into carrying it out, we can try and then tighten ourselves. The freedom of thought and action, as well as the freedom in thought in action that Alexander advocates comes from sustaining inhibition through out the entire cycle of expression and action. Thirdly, to recognise what you want, to be able to express it, does not necessarily make for selfishness, egotism and the dominance of individual wishes and preferences. Rather, it allows for recognition of oneself, one’s desires, wishes, wants and the irreducibility of one’s freedom to choose for oneself and not to be slave to what psycho-analyst Karen Horney termed the ‘tyranny of the should’s.’

In developing Conscious Control of one’s own individual psycho-physical attitude here, it is worth remembering that Alexander was explicit in saying that it was not all about thinking about your head and neck, important as that is. What is important is thinking about why you are doing it, even the most unpleasant, unwished for tasks can be transformed by the change in experience that comes from recognising one’s intentionality in choosing to pursue them. A favourite formulation of this comes from Ouspensky via Maurice Nichol. This says that we have a right not to be negative and if you apply inhibition to this in its fullest and most radical sense you will soon come up!

Use – a scientific concept.

A working understanding of ‘use’ is something anybody with an interest in Alexander Technique has to acquire. A ‘working understanding’ involves practice and ability to employ oneself purposefully, and skilfully in any activity. Indeed ‘practice,’ ‘employment,’ ‘skill,’ ‘purpose,’ as well as ‘habit’ provide the etymological roots for ‘use,’ which is the founding abstraction of Alexander’s work.

That ‘use’ is foundational for Alexander work should be clear to any one, that it is an abstraction is sometimes missed, with ‘use’ being taken as something concrete. Where use is taken concretely it becomes common to accuse people with no knowledge of Alexander’s work of misusing themselves. This I think is a mistake on a number of levels, foremost of which is that the practical problem for many people is that they have no concept of using themselves at all. ‘Use’ is how Alexander began to analyse his own actions and how he analysed the actions of his pupils. ‘Use’ is therefore the unit of analysis of Alexander work. To develop a working concept of use, a person has to abstract from his or her own experience - something practical that works.

Doing so they have to abstract the ‘similarity of the difference,’ to borrow a phrase from David Bohm, that the use of themselves can actually make to their lives and the difficulties that they are experiencing. In doing this, ‘use’ comes to explain what has happened and what is happening.

‘Use’ therefore elucidates the subject matter of Alexander’s work, as well as providing the explanatory power and the unit of analysis. These three elements together, are what the great Russian psychologist Lev Vygotsky, saw as being necessary for the methodological grounding of a scientific discipline. Which is how John Dewey characterised Alexander’s work. It is a scientific discipline for each person that seeks to learn it, like Alexander, to borrow a phrase, this time from Kelly who was inspired by Dewey they are ‘personal scientists.’ 

To view people as ‘personal scientists’ is to recognise the importance of intentionality, of wishing and willing – something Walter Carrington in his published talks stressed as being necessary for success in Alexander work. 

To talk about being a ‘personal scientist’ here is to follow Dewey in ‘Human Nature and Conduct’ in saying that while we rely on habit we must also be able to use our intelligence to review habits and change behaviour as necessary.

Which is very much how Alexander came to see things. The difference between Dewey and Alexander being, as the former, I think would have admitted, is that the Alexander Technique provides the practical way of changing things, turning them around.