Research as a Communitarian and Bottom–up Process

Introduction – Some Considerations

Rolfing Structural Integration (SI) is the “Philosophy, Science and Art of integrating the human body structure in space/time and gravity” (Maitland and Sultan 1992). Ida Rolf gave us this gift that we have been using and teaching for over fifty years now, yet how much do we know about it? How have we developed the ‘science’ part of it? In our practices, we see each day empirical evidence of its value. Still, in terms of furthering the evolution of Rolfing SI, establishing a solid basis for its validity with reliable arguments that communicate its value to society, we are still just crawling forward.

Rolf and her first followers (Julian Silverman, Valerie Hunt) rolled up their sleeves and launched research projects, back in the early 70s. This was followed by a series of research initiatives (Robert Weinberg, Stephen Porges, James Oschmann, John Cottingham, among others) toward showing the value of Rolfing SI and the conditions in which it best happens, which, in turn, suggested more areas to investigate. We continue to need more research efforts, and we all remain eager for more palpable results that will validate our work to a larger audience..

Science is a collective event. To generate a significant body of research, we need an educated group of practitioners holding a scientific attitude. While we may work individually or collaboratively, the results of our efforts, be they clinical, intellectual, or experimental, need to be available for others to leverage in their own studies to serve Rolfing SI and the community as a whole.

The task is thus:

• generate communities to support research efforts
• foster a scientific attitude in Rolfing students and practitioners
• find a methodology
• honor the theoretical paradigm
• communicate our results

I believe these complex elements can be woven into an intricate web that will provide the ground for our evolution. Below I will investigate some of these aspects in more detail and consider other topics relevant to our inquiry.

Developing Communities That Foster Research

I’d like to share an example of community building for research from Brazil, as I believe it provides useful elements for consideration. The organization known as NAPER [The Center for Treatment, Research and Education in Rolfing (SI)] is a a branch of the ABR [Brazilian Association of Rolfing (SI)] and is composed of a nucleus of Rolfers™ with a common goal of combining study, Rolfing practice, and research.1 Over fifty Rolfers have passed through the program, which has been stable and continuous since 1998.

Clients in the program are not the individual Rolfer’s clients; rather, they came to the Institution – ABR/NAPER – to become clients in the NAPER program. Based on need, we generated a set of forms to establish records on each client that would be available in future, whether for clinical use or for research purposes.

• Initial Inteview: This form tells us what we need and want to know about the client.
• Rolfer’s Report: This form gives the practitioner’s experience.
• Client’s Report: This form gives the client’s experience of the process.

The exercise of building these questionnaires was a piece of research in itself. We were studying and learning as we analyzed the results of the questions and asked ourselves questions like, Did they bring in the information we wanted? Should we rephrase a question? In this process, we discussed cases, organized the questionnaires, and built a databank with the results of the answers. We now have over 1500 client records in this databank.

The NAPER group is lively. Members meet, study, work, and discuss cases and individual research projects. Our research format is case studies, and the methodology applied is ‘action research’ (Thiollent 2005), which comes from the field of social sciences, in which we learn as we investigate. A phenomenological stance grounds the description of the experiences of both Rolfer and client.

NAPER’s forms have been translated into English and were presented to the Rolf Institute® of Structural Integration (RISI) faculty in 2006 and at an annual meeting of the International Association of Structural Integartors (IASI) in 2007. They have been used in cultures other than Brazil, as well as in classroom settings. We have also developed shorter versions for  simplified use.

We hope our efforts and documentation serve as stimulus for our community to build a common language for talking about our work. A useful reference from our endeavor is Documentation for Clinical Practice and Research: Guide for Students, Practitioners and Instructors (Prado 2009). Our work is alive to further elaboration; continuous updates are made periodically, with input from the NAPER group.

Thus, NAPER is a collective effort, produced by some and available to many – as a base to which to add their data, and as a reference tool to use in generating their own research.2 As more participate, collective experience gets utilized. This is research, this is community building, and this is ground off of which individuals can leverage their own research projects.

Fostering a Scientific Attitude and Research Study in RISI Classes

My fellow Rolfing instructors Valerie Berg and Duffy Allen and I insisted on adding research with the case-study method into the clinical-practice work done in Phase III of the basic Rolfing training. In a class I co-taught with Allen in 2004, we taught this as a scientific method and reinforced this attitude throughout class instruction.3 As a research project, each student would choose one of his clients and organize a case study to present to the whole class. We supervised the initial interviews and followed up with supervised presentations after sessions three, seven, and ten of the Ten Series. We found that this practice encouraged students to observe with greater detail; to organize and understand the different systems and techniques used; and to learn the care and analytical restraint needed for this methodology as they explored their understanding of their cases, dealt with questions that arose, and observed their results. This pilot project brought great classroom results, so it was expanded to all phases of our training in Brazil with a growing level of complexity, and eventually elements were formally added to the RISI U.S. curriculum.

Having taught in all levels of our Rolfing curriculum, from Phase I to Advanced Training, and having used this procedure in all layers of our teaching, I can say that students’ level of reflection increases as they get further along in their education and have more experience. I’m therefore now lobbying that we create post-advanced classes with specialization in different perspectives on the work. My belief is that this would continue to raise the level of inquiry in our community and our level of expertise in generating competent researchers.

By using the case-study method in classrooms we bring science to our educational program, we continue to develop a common language using universal protocols, we stimulate students’ curiosity, form their scientific attitude, and allow and encourage individual talents to further pursue more sophisticated research.

Academic Studies

Turning to another project we have underway in Brazil, I’d like to look at how the dialogue between our Rolfing community and society at large benefits from more integration of our work into academia. With this in mind, ABR developed, and I am coordinating, a post-graduate specialization course (equivalent to a master’s degree program) in partnership with Uniitalo, a major university in São Paulo. The degree program requires the student to write an academic paper in the form of a case study.

I have supervised more than thirty papers generated through this program.4 These Rolfers, with scientific methodology, have explored many directions of our work: the themes are as varied as one may imagine, showing the richness of our pursuit. Some of the papers derive from structural analysis, others from a more functional point of view, others from a psychobiological perspective, and yet others reflect energetic approaches. Often they combine perspectives and try to observe and consider two or three perspectives simultaneously. The holistic stance, the multidimensional nature of our vision of the human being, is present – if not in the quantitative data, then in the discussion of the case, weaving elements in a search for a way to explain what we observe.

Some students turned out to be natural researchers in the academic world, developing master’s and PhD papers.5 Again, the vision is that if we train the right mindset, we can do research at many levels, from elaborating a case study to research that has more complex and controlled methodology and involves more subjects.

My Personal Journey with Research

Personally I’ve always been very interested in exploring the psychobiological perspective of Rolfing SI, and did both my master’s (in 1982) and PhD (in 2006) theses around this theme. In my master’s thesis I explored how Ida Rolf’s perspective could help work with posture in body-oriented psychotherapy. It was a theoretical piece that helped expand the theories of Wilhelm Reich and discriminate Rolfing SI from this, defining a space where Rolfing SI could be seen as a psychological methodology.6
In my PhD thesis I wanted to explore experimentally the presence of the psychobiological domain in Rolfing practice. I used the NAPER databank compilation of answers from 715 NAPER clients and 160 classroom client reports from Brazil and the United States to analyze quantitatively as well as qualitatively the presence of the psychobiological dimension of Rolfing SI in client responses. This was a big project and the thesis ended up having more than 200 tables and charts and over 500 pages of data that went through analysis of pain, quality of life, emotional changes, and an immense quantity of testimonials from both Rolfers and clients that showed the presence of the psychobiological domain from both the client’s and Rolfer’s perspective.7

I learned a lot through this process, and all of the Rolfers involved in the building of the questionnaires also gained a scientific ‘attitude’. We were building the questions as they were observing their efficiency and clinical phenomena – an example of ‘action research’. And of course we were simultaneously building a community, teaching a scientific stance, generating material that can be used for other research, focusing on a specific theme, and opening up the psychobiological domain for future research to happen.

The Ida P. Rolf Library of Structural Integration (accessed at either www.iprlibrary.com or http://pedroprado. com.br), a virtual library that houses all of these papers and more, was yet another development, a sub-product of my PhD thesis. As a result of my need to find material about Rolfing SI, I collected all issues of the main periodicals in the field of SI, past and present (Bulletin of Structural Integration, Rolf Lines, Structural Integration: The Journal of the Rolf Institute®, IASI Yearbook, Notes on Structural Integration), as well as all academic papers available at the time. Many issues were missing, so work had to be done to try to complete the collections. Then, with RISI’s initial financial support, I converted them into an electronic format and organized a databank with a search mechanism. My initial thought was to build the collection as a support for future researchers, but it has ended up being a resource for the whole SI community. It is now being reformulated to reach the general public, levering science as a communiarian product. “Just one bird does not a summer make.”

From Small to Big

I see Rolfers entering research in a staged process. We can do small things in the classroom, like using validated scales with controlled application, developing interest and skills that can later lead to more academic research projects. The continuum could go like this:

• opening students’ minds to scientific reasoning
• training how to observe, how to relate observations to results, how to think
• engaging case studies in the classroom
• encouraging faculty and membership to build task-oriented clinical and research communities
• teaching and academically framing writing about our experiences with clients
• writing, sharing, and proposing theses for research projects with more rigorous controls

All of these aspects are ‘science’, and all of it can be done by any one of us. Whether as part of our training or at an academic level, we work with many different layers that are all congruent with science and of general value. It’s a matter of framing what you do, and then growing in it. You don’t need a billion dollars to think and research; there are simple ways we can engage, and these may lead to larger projects using validated criteria.

In the NAPER forms we included a VAS (visual analog scale) for pain. This is a simple, reliable, before-and-after set of questions and pain evaluation on a scale of 1-10. That simple systematic set of questions gives us data for elaborating on pain, then we cross these results with other questions about location, periodicity, duration, etc.
Another example of a simple procedure that can be used is the World’s Health Organization Quality of Life scale – WHOQOL-BREF.8 This has been validated in more than twenty languages, and the twenty-six questions are easy to apply. We have used this at NAPER, in classroom case studies, and in many of the post-graduate case studies at UNITALO. As a result, we have more than 1000 answers to use for comparative study. The results have been consistent and statistically significant. (I included an analysis of this in my PhD thesis and have written about it in this Journal.9) If we collectively engage in a procedures like this (of course, eventually followed up with more specific studies), we will have a good basis to communicate about our work to the larger society, in this case about the way Rolfing SI consistently seems to enhance quality of life.

Such methods are not complicated, but they require communal effort. The procedures are available already, and with some care to methodology we could produce quite a lot, and very quickly. Such a communitarian project would require neither a big budget nor uncommon talent.

Conclusion

Our main challenge in engaging science and research is finding a way to cover the whole phenomenon of Rolfing SI. As we come from a holistic paradigm, our results need to be observed and described from different perspectives (all different taxonomies) and their interplay. Our community is engaged in considering the mindsets and methodologies that would serve this. This endeavor toward research is part of being able to ‘walk our talk’. It’s a slow process as most of us – clients, students, practitioners, and instructors alike – still operate most of the time from a Cartesian mindset. Developing a holistic framework for research may involve our own transformation as well.

It’s possible to create a community that can carry this forward, beginning with using our educational curriculum to teach about science and research, nurturing the potential researchers among us. The case-study method is a humble start whereby we can slowly bring our observations to clarity. This is already happening in our curriculum and in organizations like NAPER, in specialized courses, and in individual academic writing. This is reality, not a dream.

The next steps are to improve in certain areas:

1. We instructors need to ‘buy’ the curriculum and really do it. Above all, we need to train ourselves to carry the curriculum forward in a cohesive voice of unison.
2. RISI faculty need to layer into the curriculum information about research at all levels of training.
3. Existing questionnaires and forms such as those used by NAPER can develop another level with more participation and feedback from all.
4. The NAPER databank can grow into a more sophisticated electronic form, capable of receiving data from other Rolfers. To support this, we need training and supervision available to students and practitioners worldwide and the development of instruction manuals.
5. We need to teach case studies in all phases of the curriculum and develop this methodology and practice in both academic and non-academic settings.
6. We need a more clear and consistent curriculum in science that is not dependent on the particular instructor’s interest or background.
7. We need to communicate the research results we already have, first to the RISI membership itself, and then direct the best pieces to other publications that have more public visibility.

Personally, I think I have walked my talk. I’ve produced a lot, I hope to do more, and I hope there are many others to pass the baton to as we move forward as a community. Research is a communitarian and a bottom–up process.

Pedro Prado’s research focus and signature approach to the clinical practice and teaching of Rolfing SI concern how best to build bridges among the structural, functional, and psychobiological perspectives. A clinical psychologist and former professor of somatic psychology, Pedro has been teaching Rolfing SI for over twenty-five years in in the U.S., Latin America, Europe, Japan, South Africa, and Australia. He is a member of the Advanced Rolfing and Rolf Movement faculties of the Rolf Institute and an Advanced Instructor for the Somatic Experiencing® Trauma Institute. Since he became a Rolfer in 1981, Pedro has established and nurtured practitioner communities of Rolfing SI and Somatic Experiencing in his native Brazil and throughout the world.

Endnotes

1. For background information on NAPER, see Mattoli, P. Jan 2001, “Reflections on the São Paulo Ambulatory Project” in Rolf Lines 29(1):5-7; Prado, P. Dec 2010, “The São Paulo Ambulatory Project” in Rolf Lines 29(1):8-10 (January 2001); and Prado, P. Dec 2010, “The NAPER Clinic: A Vehicle for Continuing Education and Professional Development in Brazil” in Structural Integration: The Journal of the Rolf Institute® 38(2):20-21. These articles are available at The Ida P. Rolf Library of Structural Integration (http://pedroprado.com.br.)

2. Articles have been published periodically sharing information from the NAPER databank, as listed here:Mattoli, P. and Bocaletto Y. 2003, “Perfis do nûcleo de atendimento, educacão e pesquisa em rolfing.” Reunião Annual da Associaçao Brasileira de Rolfing. São Paulo: Associação Brasileira de Rolfing.

Bocaletto, Y. 2005 “Avaliações e perfis do núcleo de atendimento e pesquisa em Rolfing.” Congresso Internacional de Psicoterapia de Abordagem Corporal, No. 7, 2005, São Paulo: Resumos . . . São Paulo: Universidade Paulista.

Bocalletto, Y. 2007 Dec.  “Profiles and Evaluations of Rolfing Clients in the Núcleo de Atendimento, Pesquisa e Educação em Rolfing (NAPER) Brazil. Structural Integration: The Journal of the Rolf Institute® 35(4): 26-32.

Baía, R.M. 2012 Feb. “Naper divulga pesquisa de 11 anos de trabalho.” Rolfing Brasil 12(34):19-22.

3. Allen later published an article to help Rolfers do research, “Overview of Research Designs for Rolfing Structural Integration” in Structural Integration: The Journal of the Rolf Institute® 32(4):17-19 (Dec 2004), Vol: 32, pp 17-19. See also Allen, D. and P. Prado, “Co-Laborare” in Structural Integration: The Journal of the Rolf Institute® 33(1):25-28 (Mar 2005).

4. All case studies since the 2010 inception of the Uniitalo program are available in pdf format (in Portuguese, with abstracts in English) at the Ida P. Rolf Library of Structural Integration (www.pedroprado. com.br), listed individually by author in the Publications section under the Academic category. They are also available at the ABR’s library in São Paulo and in a special collection of postgraduate program papers at Uniitalo. You will find brief comments on some of these papers in the three articles listed below:

Prado, P. 2011 Dec. “The Case Study Method.” Structural Integration: The Journal of the Rolf Institute® 39(2):33-35, including descriptions of these papers:

Ruggi, A. “The effects of Rolfing SI and its holistic approach on chronic adhesive capsulitis.”

Gilioli, A.M. “The effects of Rolfing SI and its holistic approach on chronic low back pain in an elderly client.”

Rossi, C. “Rolfing SI as one component of a multidisciplinary approach to the treatment of bipolar disorder.”

Bretones, H. “The process of Rolfing SI as a therapeutic relationship between two people.”

Bronze, J.H. “Rolfing SI both ameliorates symptoms and enhances quality of life for a client suffering from the correlated conditions of temporomandibular dysfunction and plantar fasciitis.”

Nascimento, M., “Effects of postural changes and enhanced body awareness from Rolfing SI on the body image and structural and functional organization of a professional acrobatic artist.”

Orlando, M.H. “Rolfing SI as an agent of integration among posture, behavior and quality of life.”

Freitas, M.L. “How perception of the Rolfing® SI line enhances well-being.”

Cintra, M., “Applying by analogy the psychoanalytic concept of autotomy in the practice of Rolfing SI.”

Moretto, M., “The effects of Rolfing SI and its holistic approach on idiopathic low back pain.”

Mattar, M., “Rolfing SI enhances quality of life for a client suffering from cervical and lumbar pain.”

Caspari, M., “The contribution of Rolfing SI to the treatment of temporomandibular disorders.”

Rebouças, T., “Rolfing SI enhances quality of life for a multiple sclerosis patient.”

Higa, A.T., L. Merlino, M. Ayako, R.M. Baía, and R.S. Takashima Sept 2012. “Resumos das monografias UNIITALO Turma de 2011.” Rolfing Brasil 12(35):9-14, including descriptions of these papers:

Merlino, L. “Integração Estrutural Rolfing® EOConceito De Experiência” (Rolfing structural integration and the concept of experience).

Ayako, M. “Integração Estrutural Rolfing® No Tratamento Da Limitação De Amplitude De Movimento De Ombro Em Paciente Submetida À Ressecção De Câncer De Mama” (Rolfing structural integration in the treatment of range-of-motion limitation in the shoulder of a patient who underwent breast cancer surgery).

Baía, R.M. “Contribuição Da Integração Estrutural Rolfing® Para O Equilíbrio Postural, Na Locomoção E Na Qualidade De Vida

De Adulto Portador De Paralisia Cerebral” (Contribution of Rolfing structural integration for postural balance, locomotion and quality of life of an adult with cerebral palsy).
Takashima, R.S. “Os Benefícios Da Integração Estrutural Rolfing Em Adultos Vitimas De Abuso Sexual Na Infância” (The benefits of Rolfing structural integration in an adult victim of childhood sexual abuse).

Higa, A.T. “A Contribuição Da Integração Estrutural Rolfing No Tratamento De Dor Crônica Associada À Escoliose Não Estrutural” (Contribution of Rolfing structural integration in the treatment of chronic pain in non-structural scoliosis).

Prado, P. 2015 Mar. “The Case Study Method: The Latest from the ABR/Uniitalo SI Postgraduate Program.” Structural Integration: The Journal of the Rolf Institute® 43(1):47-48, including descriptions of  these papers:

Bronzato, S.R. “The Benefits of Rolfing® Structural Integration for the Postural Stability of an Elderly Person.”

Whitaker, M.B. “The Benefits of Rolfing® Structural Integration for Regulation of a Child’s Ideopathic Hypotonicity.”

Novaes, L.M. “The Effects of a Single Session of Rolfing® Structural Integration in Two Clients Suffering from Acute Lumbar Pain.”

Uezono, C.L. “The Effects of Rolfing® Structural Integration on a Japanese Woman’s Perception of Self and Environment.”

Forlani, T.M. “The Benefits of Rolfing® Structural Integration in the Three Stages of Adhesive Capsulitis of the Shoulder.”

Freiberg Neto, J.C. “Form and Individual Identity, Explored through Rolfing® Structural Integration.”

5. Some of these research papers are listed bellow:

Motta, R. 2003. “Avaliação da imagem corporal durante o processo de rolfing.” Dissertação (Mestrado em Educação Física), Universidade Estadual de Campinas (Brazil).
Merlino, M.L.M. 2005. “O Rolfing como agente restaurador da comunicacão entre corpo e ambiente: a conquista do chão.” Dissertação (Mestrado em Comunicação e Semiótica), Pontificia Universidade Católica de São Paulo (Brazil).

Stal, P. 2009. “Estudo de Pacientes com Síndrome Fibromiálgica Tratados pelo Método Rolfing de Integração Estrutural.” University of São Paulo (Brazil).

6. Master’s thesis: Prado, P.O.B. 1982. “Contribuições do pensamento e obra de ida p. rolf para o trabalho com postura em psicologia.” Dissertação (Mestrado em Psicologia Clinica), Instituto de Psicologia, Universidade de São Paulo (Brazil).

7. PhD thesis: Prado, P. 2006. “Estudo exploratório da dimensão psicobiológica do Método Rolfing® de Integração Estrutural: criação, desenvolvimento e avaliação de questionários.” Pontifícia Universidade Católica, São Paulo (Brazil).

8. WHOQOL-BREF – The World Health Organization Quality of Life Instruments. See “WHOQOL-BREF: Introduction, Administration, Scoring and Generic Version of the Assessment.” Geneva: WHO, 1996. Available at www.who.int/mental_health/media/en/76.pdf.

9. Prado, P. 2010 Dec. “Does Rolfing SI Enhance Quality of Life?” Structural Integration: The Journal of the Rolf Institute® 38(2):43-47.

Bibliography

Maitland, J. and J. Sultan 1992. “Definition and Principles of Rolfing.” Rolf Lines 20(2):16-20.

Prado, P. 2006. Documentation for Clinical Practice and Research: Guide for Students, Practitioners and Instructors. Available at http://pedroprado.com/br.

Thiollent, M. 2005. Metodologia da pesquisa-ação, 14th. ed. São Paulo: Cortez.  ■