Are you happy with your body? Happy with your body as it is now, with how it functions, how it looks, how it feels? If the answer is yes, that’s brilliant, read no further. If you answered with a resounding ‘no’ or had to have a think about it, you are far from unusual. Some clients come to counselling because of difficulties that they consider to be about their bodies: perhaps the effects of illness or injury; concerns with bodily health (including feeling tired, lethargic, agitated or tense) and, what is often more difficult to talk about for fear of sounding vain, unhappiness with the look of their bodies. Many clients who come for counselling to explore other difficulties come to focus on their bodies as a major source of their emotional discomfort.
In therapeutic circles it was for a long time commonplace to treat anxiety or unhappiness about the body as a symptom of something else (a response to an unhappy event, perhaps, or generalised anxiety or depression expressing itself in the body). While mental, emotional and physical wellbeing (or lack of) are intimately connected, there is a danger in being too quick to overlook the meaning of body anxiety, or simply the meaning of the body, in pursuit of the ‘real issue’ which we might assume lies somewhere else. We need to pay close attention to what it means for a client when he or she feels his or her body isn’t right, good enough, attractive, acceptable or trustworthy.
In her compelling book Bodies, the psychotherapist Susie Orbach makes two bold assertions which have helped me to pay attention to the bodies as well as the minds of my clients. First, that our bodies are ‘made’ by our cultures and our experiences of those cultures in the same way that our minds are shaped by our experiences. That is, bodies are not ever or anywhere something ‘natural’, apart from or prior to social meaning. How we are handled, fed and clothed from birth according to the norms of our families and societies will ‘shape’ our experience of our bodies before we are conscious of shaping our bodies ourselves. Our bodies, Orbach writes, ‘belong to a specific time and place’ (p.134).
Her second contention is that in our time and across a vast number of places, bodies are being shaped in particular ways (by global commerce, visual culture, technological and medical innovation). The consequence for bodies in our time, she argues, is that expectations throughout the world about how they should look and behave are becoming narrower. While we are led to believe that all things related to the body (its health, its shape, its adornment) are our individual choice and responsibility, commercial and other pressures mean that we have less freedom than ever to feel at one with our own bodies.
What might seem to be abstract ideas are borne out in the intensification of ‘body problems’ being presented in counselling rooms; these problems cut across generations, genders, classes, races and cultures. Eating disorders, which at the most extreme end are undoubtedly disturbances of the mind, have a close relationship with more ‘low level’ discomfort around eating which many people feel and which represent a dissatisfaction with the body as it is. This is fuelled in part by the two-headed monster of the diet and food industries. Such dissatisfaction is played out on the body in many other ways. Self-harm is not overtly an attempt to reshape the body through disfigurement, but to inflict pain on the body for emotional release tells us that the distress is emotional and bodily.
As counsellors, we shouldn’t simply ‘bypass’ the body to get to emotion, or regard concern with the body as ‘about’ something else, a metaphor for the ‘real’ distress. Our role is to provide as much space and acceptance for the bodies in our consulting rooms as for the people who inhabit them.
 Susie Orbach, Bodies, Profile Books, 2010