Working Across Difference in Structural Integration: Expanding Perceptual Awareness and Observational Skills

By Phoenix L. Quetzal DeLeón, Basic Rolfing® Instructor
February 2024

Abstract Phoenix L. Quetzal DeLeón explores the concept of working across difference as an expansion of perceptual awareness and observational skills. She reflects on Rolf’s question about attitudes towards change, and the possibility of evoking change through better understanding cultural influences and social memberships. DeLeón introduces the ADDRESSING model in the context of structural integration, and cites evidence that social context and mindsets are critical aspects of therapeutic relationship that can significantly affect clinical outcomes.

“What Is Your Attitude toward Change?”

Ida P. Rolf, PhD, was often asked “does [structural integration] hurt?” She responded with the question, “What is your attitude toward change?” And she would continue with an assertion that “humans resist change . . . conservatism, the tendency to maintain and protect the status quo, to avoid the unknown, to avoid change, is universal” (Rolf 1977, 275). As structural integrators know, and as Rolf insisted, change is a fundamental aspect of our work; without change, transformation is not possible. We encourage our clients to explore and examine tendencies, patterns, and beliefs about their embodiment as we guide them through a potentially transformative experience. When asked by new clients if structural integration (SI) is painful, many of us explain that our work is about change in the structure and function of the body, that change can sometimes be uncomfortable, and that the potential end result is less chronic pain and more freedom of movement, which can be worth the possible discomfort.

Over the last eighteen months there have been profound changes in the world, including a global pandemic, which have impacted each of us individually, as well as our families, schools, practices, and communities. Many of the changes that have occurred during this time have led to deep social and political divides, highlighting the resistance to change that Rolf names. Yet these changes have also brought people together and demonstrated the incredible adaptability of human beings in myriad ways. Equity and equality have become focal points of transformation in the world, with many voices speaking up to center the experiences of the most marginalized, oppressed, and vulnerable bodies in society.1 Because SI is rooted in embodied change and transformation, SI practitioners are uniquely situated to support and contribute to the equity and equality of all bodies.

Our work as structural integrators requires us to develop and maintain skills of heightened perception, observation, touch, and a functional anatomical knowledge, as well as effective communication in therapeutic relationship. A major facet of our work is to evoke change in the body that facilitates transformation, which can only be accomplished with people willing to be present and engage with the process. Similarly, working across difference, a concept to be defined and explored throughout this article, requires a willingness to be present and engage with the process. It is a skill that needs to be learned, cultivated, and practiced in order not to cause harm, just like any other skill in a structural integrator’s toolkit. This article is an invitation to get curious about developing this skill in SI practice and to explore the ways in which effectively working across difference offers the opportunity for change and transformation in ourselves, our practices, and our profession.2

Figure 1: The ADDRESSING Model (adapted from Hays 2016, 8).3

Contextualizing ‘Difference’

The phrase working across difference is used in a variety of contexts, from universities and corporations to the fields of somatics, psychotherapy, psychology, sociology, and more. In the context of this article, working across difference refers to engaging in an authentic, effective therapeutic relationship across cultures, identities, social locations, and systems of knowledge (White and Lorenz 2016). The term difference is used to indicate socially constructed categories and social relationships that reinforce inequity, dominance, and oppression, including biophysical and behavioral norms (Howard and Rawsthorne 2019; Howson 2013).


Pamela Hays, PhD, psychologist, psychotherapist, and author of Addressing Cultural Complexities in Practice, describes the ADDRESSING model, which highlights nine cultural influences, or social memberships, that are often marginalized in Western society (see Figure 1; 2016). As Hays points out, cultural influences and social membership can change from region to region; for example, a minority group in one part of the world can be a majority group in a different part of the world. Biophysical and behavioral norms can vary widely depending on the specific cultural and societal context. The groups given as examples in Figure 1 are oriented towards societal norms in the United States, but can be adapted to represent dominant and minority groups in other social and geographical contexts (Hays 2016). And, while this model offers a range of examples, it is not a comprehensive listing, rather, it is an initial step toward considering difference and the impact it has on embodied experience.  

At this point, some readers may be wondering about the relevance of this model and the concept of working across difference in SI. Questions such as the following often come up in this exploration:

How does difference, and the ADDRESSING model, apply to SI?

We all have bodies, and that’s the focus of our work, so why does this stuff matter?

We’re not psychotherapists; isn’t this beyond our scope of practice?

Doesn’t our work transcend cultural influences?

These questions, and more, lead to the primary inquiry and exploration of this article:

Why is the ability to effectively work across difference important in SI?

Structures and Relationships

Rolf said that “in any plane, physical or non-physical, structure implies relationship” (1977, 30). A basic premise in SI is that when one part of a body is not able to function well due to heightened tension, pain, or injury, it impacts the entire structure/system, because every part of the body is in relationship with every other part. In our field it is often noted that we work to liberate the body from the oppressive experience of a difficult relationship with gravity by facilitating healthier and more functional interactions through the entire structure (Rolf 1977).

Bryan S. Turner, PhD, sociologist, founder of the journal Body & Society and author of The Body and Society, asserts that “embodiment is not an isolated project of the individual; it is located within a social world of interconnected social actors” (2008, 245). While society is not a physical body, it is a structure, a system, and an interwoven web of relationships. If conditions of oppression are inherent to society – such as the social conditioning that creates the dominance of some social memberships over others – then the embodied experiences of all the people living within that society are reflective of that oppression, regardless of whether the body belongs to a minority group or a dominant group.

Leticia Nieto, PsyD, liberation psychologist and coauthor of Beyond Inclusion, Beyond Empowerment, states that “Whatever social memberships we hold, oppressive social conditioning limits our ability to be fully human . . . it limits our emotional range, reduces the depth of our empathy, and often keeps us from speaking, listening, and loving fully” (Nieto et al. 2010, 2). When we develop the ability to effectively relate with a wider range of embodied experiences, we disengage from the limitations of oppressive social conditioning and create new opportunities for our profession, our clients, and ourselves.

Addressing Mindsets

What new opportunities may arise from integrating the ability to effectively work across difference with clients? How might the ADDRESSING model, and considering the effects of cultural influences and social memberships on embodiment, offer new possibilities to structural integrators?

There is a growing body of research in the medical community that focuses on the influence of practitioner mindsets and the impact of a practitioner’s words on patient health outcomes. Mindsets are “lenses or frames of mind that orient an individual to a particular set of associations and expectations” and are “biased or simplified versions of what is right, natural, or possible” (Crum and Zuckerman 2017, 2063). Much of this research has been focused on physicians and patient outcomes in the context of medical visits; however, it is relevant across the spectrum of healthcare professions and manual therapies, including SI. There is an increasing amount of evidence that “medical diagnoses and treatments are never isolated from patient mindsets and social context,” and that “rather than being incidental to outcomes, psychological and social elements play crucial roles in determining clinical outcomes” (Crum, Leibowitz, and Verghese 2017, 1). While this research is ongoing, it has been demonstrated that assurance from a medical provider can lead to positive health outcomes for patients, including a reduction of physical symptoms (Leibowitz et al. 2018).

People seek out SI for a variety of reasons, from wanting better posture, to feeling more comfortable in their bodies, and to support recovery from injuries, surgeries, or functionally inefficient movement patterns. In many cases, SI is a last option for clients seeking help with a particular issue and who have exhaustively explored treatment with medical professionals, physical therapists, and other practitioners. While structural integrators are not doctors, and we do not diagnose, we are trained to assess functional and structural issues in the body and address them in our sessions with clients. Whatever the reason a client seeks us out, our words and communication styles have the potential to deeply impact our clients, positively or negatively. If we take the time to better understand our own mindsets, including how our personal cultural influences and social memberships may impact our ability to work across difference, we open to the possibility of more nuanced therapeutic relationships with our clients. This reduces the potential for causing harm and can lead to higher levels of efficacy in our work.

Hays notes that there are two broad categories of engaging with the ADDRESSING model: personal work, which involves “introspection, self-exploration, and understanding of cultural influences on one’s own belief system and worldview” and interpersonal work that is focused on “learning from and about other cultures, which usually involves interaction with people” (2016, 11). The following two sections are a further invitation to the reader to examine their own social location, the mindsets they hold, and ways in which structural integrators can explore learning more about how to effectively work across difference.

Identifying Social Location

Social location, or positionality, can be defined as a combination of factors including, but not limited to, gender, ethnicity, race, social class, age, ability/disability, religion, sexual orientation, body shape/size, nationality, and geographic location (Brown et al. 2019). This is one way in which the ADDRESSING model is a useful tool; it can be a starting point in considering one’s own social location, and social memberships in dominant and minority groups. In his groundbreaking article How Does Your Positionality Bias Your Epistemology, David Takacs, PhD, asks the question “How does who you are shape what you know about the world?” (Takacs 2003, 27). Any structural integrator interested in becoming a more effective practitioner can benefit from this personal inquiry. Because our mindsets and communication styles can greatly influence the outcomes of our work, we have a responsibility to both ourselves, and our clients, to ask this question and seek the answer. Identifying and understanding our personal social locations helps us to examine how our own beliefs and ideas about ourselves, our clients, and the world, may limit our ability to work effectively with clients whose social locations are different than our own, and even lead us to unknowingly cause harm.

As an example, an SI practitioner may inhabit a social location that encompasses both dominant and minority groups, such as an able-bodied, secular, gay, European American man.4 Because of his membership in a sexual minority group, this practitioner may have insight into and experience with the particular biases and oppression faced by people who are also a part of this minority group, and how this impacts a client’s embodied experiences. However, this insight does not necessarily translate into understanding the embodied experiences of other non-dominant groups, such as women, various religious affiliations, people of color5, or people with disabilities. If most of his friends, family, and colleagues belong to similarly privileged or dominant groups, it is likely it will take some effort for this practitioner to gather information about effectively working with people who have different, non-dominant social memberships. Left unexamined, the privilege that this SI practitioner experiences due to his dominant social memberships can distance him from clients who are members of social minorities, and limit his ability to understand the impact of cultural influences he is not subject to. If a young, disabled woman who identifies as a Mormon Pacific Islander comes to his practice, this practitioner will need to examine ways in which this client’s social memberships impact her embodied experience, and how he can work with skill and sensitivity to fully support the safety and dignity of this client in the context of SI.

Questions that may come up here are: Don’t we already do this – create safety and support for our clients? Isn’t that what therapeutic relationship involves? The answer to both questions is yes and no. Yes, because of course structural integrators are trained in therapeutic relationships, how to create safety for clients, gaining consent for touch, staying in communication with clients around comfort, boundaries, and more. Yet, the answer is also no. Generally we are not trained to consider the nuances of embodied experiences from a variety of social locations, or how social membership in non-dominant groups may impact client embodiment. Non-dominant social memberships can add layers of vulnerability to embodiment. A lack of awareness around oppressive social structures and their impact on minority groups makes the harm that results from them invisible to SI practitioners who do not hold these group memberships. Fortunately, all structural integrators have an awareness of an invisible force that deeply impacts client bodies: gravity. Understanding oppressive social structures makes their embodied impact more visible. Knowing our own and our clients’ social locations, and the embodied implications of cultural influences and social memberships, are important expansions of our heightened perceptual awareness and observational skills. Takacs points out that:

. . . simply acknowledging that one’s views are not inevitable – that one’s positionality can bias one’s epistemology – is itself a leap for many people, one that can help make us more open to the world’s possibilities. When we develop the skill of understanding how we know what we know, we acquire a key to lifelong learning (2003, 28).

Engaging Across Difference and Not Causing Harm

How can we as structural integrators incorporate and practically apply this knowledge in our work? What are ways in which we might cause harm to our clients, and how can we avoid causing harm?

The answer to the first question, as discussed in the previous section, is knowing our own social locations as a good first step. A great second step is remembering that this is a beginning, rather than an end, to the inquiry of how to effectively work across difference. Reading relevant books, and articles, and watching relevant videos and movies, are also ways to continue this inquiry; however, while these activities are important, they are not a substitute for professional and accredited education, training, and practice in well-facilitated settings. Engaging in the interpersonal work that Hays refers to is an excellent way to learn practical applications of heightened perceptual awareness and observational skills (2016). There is great value in participating in a training or class setting with a diverse group of people who are also invested in learning these skills, and a resource list for organizations offering somatically-oriented trainings will be provided at the end of the article.6

In answer to the second question, this section will offer some examples of ways to avoid causing harm. One common way that people who hold dominant social memberships cause harm to people who hold non-dominant social memberships is through microaggressions: “verbal and non-verbal interpersonal exchanges in which a perpetrator causes harm to a target, whether intended or unintended . . . perpetrators are often unaware that they have caused harm” (Sue and Spanierman 2020, 8). A single microaggression may be minimally impactful, but there is a cumulative effect over time likened to ‘death by a thousand cuts’ (Nadal et al. 2011).

Microaggressions can occur as unintentionally offensive comments or questions, in subtle or overt body language, and facial expressions. As an example, some European Americans believe that saying “I don’t see color” is a way to affirm that “we’re all the same,” often with the intention to be comforting, neutral, or even to demonstrate allyship in a conversation about race/ethnicity.7 However, rather than being affirming, neutral, or indicating allyship, the impact of these statements is actually an erasure of difference that minimizes the lived, embodied experiences of people of color. Sonya Renee Taylor, somatic activist and author of The
Body is Not an Apology
, notes that “proposing that humans are all the same leaves the idea of the default body uninterrogated in our subconscious and firmly in place in our world, forcing all other bodies to conform or be rendered invisible” (2018, 32). The harmful implicit bias being communicated by saying “I don’t see color” is that race\ doesn’t affect me, so why can’t we just ignore our differences and get along? (Sue and Spanierman 2020).

Examples of nonverbal microaggressions are when European Americans automatically clutch their belongings or cross the street as a person of color is approaching.8 In these instances, there is an implicit bias of criminality based on a person’s race, and an assumption that the person is dangerous or a threat because they are a person of color. A harmful impact on the target of these behaviors is the constant message that they are dangerous, a criminal, and do not belong. These are just two of many examples, and, microaggressions are not limited to race or ethnicity. They can occur around gender, sexual orientation, social class, religious affiliation, and any other non-dominant social membership (Sue and Spanierman 2020).

In the context of SI, consider, how might a body subjected to multiple, daily microaggressions present in a session? How might that body respond if the practitioner commits a microaggression? How might that body respond if the practitioner is aware of the potential consequences of that client’s social memberships, and approaches the client accordingly? For example, in what ways might a structural integrator support a person of color who is constantly trying to make himself seem unthreatening to the people around him? Or a client who is continuously shamed about the size of her body? What about a client struggling with gender dysphoria – distress that can occur in people whose gender identity differs from their assigned sex – or a client who identifies as non-binary?

These and so many others are cases where a deeper awareness of cultural influences and social memberships will make all the difference in the therapeutic relationship, and the client’s experience of SI. Working from this level of awareness is not providing therapy, as some might argue. Rather, it is bringing heightened perceptual and observational skill to our work as structural integrators, and preventing us from harming our clients out of ignorance. This in turn supports our ability to facilitate change and transformation in our work with clients. Hays states that “the more we recognize the complexity of human experience and identity, the more able we are to understand and build a positive therapeutic alliance” (2016, 12). This is another way the ADDRESSING model becomes a valuable tool. It can be used as an entry point into asking a broader range of relevant questions about our clients and their embodied experiences, and support structural integrators in considering how to avoid microaggressions and work more effectively.


Rolf often referred to the evolutionary potential that lies within all human beings, even naming the final chapter of her book “Evolution is the Expression of Internal Events” (1977). Structural integrators often talk with clients about the potential discomfort that comes with change; a willingness to engage with the process is essential for any client interested in the transformative potential of our work. This is a moment when we as human beings, and as structural integrators, can make a choice to engage with change, despite the discomfort we may feel.

There is immense transformative potential in the integration of working across difference in SI. Developing a conscious awareness and working knowledge of our own social locations and mindsets is an opportunity to connect with our ‘internal events’ in new ways. This expansion of our perceptual and observational skills builds our capacity to better understand clients who inhabit different social locations, and to work more effectively. When we learn to recognize how oppressive social structures impact embodied experiences, we are better able to serve clients from all backgrounds with new awareness and skill.

Tracking and integrating the cultural influences and social memberships our clients hold reduces the potential to cause them harm, and can create new levels of safety in therapeutic relationship. As we free ourselves from the limitations of unrecognized oppressive social conditioning, we gain access to more empathy, compassion, and meaningful dialogue with a wider variety of people. In this way we can support and contribute to the equitable treatment of all embodied experiences. At the core of these possibilities is the potential for SI to reach a broader spectrum of people and communities, touching on Rolf’s vision that our work might transform the world one day. The question remains, what is your attitude towards change?

Resources for Further Study

Websites and Events

Embodied Social Justice Summit

Kai Cheng Thom’s free conflict resolution workbook at Arise Embodiment:


Chang, S. C., A. A. Singh, and I. M. Dickey. 2018. A clinician’s guide to gender-affirming care: Working with transgender and gender nonconforming clients. Oakland, CA: New Harbinger.

brown, a. m. 2019. Pleasure activism: The politics of feeling good. Chico, CA: AK Press.

Clare, E. 2017. Brilliant imperfection: Grappling with cure. Durham, NC: Duke University Press.

Herman, J. L. 2015. Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. New York, NY: Basic Books

Strings, S. 2019. Fearing the black body: The racial origins of fat phobia. New York, NY: NYU Press.

Organizations That Offer Somatically Oriented Classes and Trainings

Education for Racial Equity

The Embody Lab (Offers an Embodied Social Justice Certificate program as well as other classes).

The Rooted Global Village

Generative Somatics


1. ‘Centering the experience’ refers to repositioning social narratives, in this case, bringing the experiences of non-dominant social groups to the foreground. It shifts the focus from mainstream, dominant social group perspectives towards integrating the knowledge and perspectives of marginalized communities (Atallah, Bacigalupe, and Repetto 2021).

2. This article is offered as an introduction to the concept of working across difference and how it is relevant to SI work. It is not meant as a substitute for education and training to develop this skill, rather, it is an invitation to explore how and why this skill is important to integrate into the field of SI. Working across difference needs to be learned and practiced in an appropriate context to avoid causing harm. See the resources section for recommendations for trainings that facilitate learning this skill.

3. This table has been adapted from the original for use in this article.

4. This example is adapted from Hays (2016).

5. The use of the phrase “person/people of color” is a stylistic and identity choice for this article rather than using other terminology or acronyms such as BIPOC (Black, Indigenous, People of Color). As described by Efrén Pérez in his July 2, 2020 Washington Post article: “Identifying as a ‘person of color’ means viewing oneself as an interchangeable member of a shared group, where one’s unique identity as Black, Asian or Latino is nested under a broader POC category.” The author acknowledges that people of color are not a monolithic group, and that this is not the intended meaning of using this phase. Rather, the author’s social location and identity as a mixed-race person of color inspired this choice over other options. The author further acknowledges that others may have different identities and stylistic preferences when referring to people of color, and that this phrase is only one of many valid choices.

6. The author would like to clarify that facilitated trainings, classes, and groups are guided interpersonal work in settings that are designed for such work in a safe environment. This is different from engaging with other individuals such as clients, friends, family, and community members without facilitation. It is important for individuals who hold dominant social memberships to take responsibility for educating themselves around difference without causing harm. Specifically, there should not be an expectation of people who hold non-dominant social memberships to educate others about their experiences; this can be a form of microaggression.

7. This example is adapted from Sue and Spanierman (2020).

8. These examples are adapted from Sue and Spanierman (2020).

The author would like to acknowledge the many writers, researchers, and activists whose work made this article possible; their time, energy, and passion is a great gift to the global community. She humbly offers her gratitude to the colleagues and friends who contributed to the development of this article. Thank you for all of the consultation, and the reading and rereading of drafts. Your support throughout the process facilitated this contribution to the SI Journal.

Phoenix L. Quetzal DeLeón is a Certified Advanced Rolfer®, Rolf Movement® Practitioner, and Certified Massage Therapist. She has studied Rolfing® SI and Rolf Movement in the United States, Brazil, and Indonesia with a variety of teachers. Phoenix has been in private practice for sixteen years, and her practice in Santa Cruz, CA, has been open since 2007. In 2018, Phoenix became a faculty member at the Dr. Ida Rolf Institute® (DIRI), where she teaches Phase II and III of the Basic Rolfing Certification Program. Her teaching career has spanned multiple subjects, contexts, and age groups over the last twenty-six years. She has found great joy in teaching SI. Phoenix recently graduated from the California Institute of Integral Studies with a Master’s degree in Counseling Psychology with an emphasis in Somatic Psychotherapy, and is pursuing licensure as a somatic psychotherapist. She is actively engaged in equity work in the fields of somatic psychology and SI, and is a member of Liberation Somatics and the DIRI Committee for Diversity and Anti-Racism focusing on equity, inclusion, and belonging.


Atallah, D. G., G. Bacigalupe, and P. Repetto. 2021. Centering at the margins: Critical community resilience praxis. Journal of Humanistic Psychology 61(6): 875-905.

Brown, T.L., C. M. Bryant, D. C. Hernandez, E. G. Holman, M. Mulsow, and K. Y. Shih. 2019. Inclusion and diversity committee report: What’s your social location? National Council on Family Relations. Available from

Crum, A. J., K. A. Leibowitz, and A. Verghese. 2017. Making mindset matter. British Medical Journal 356:j674.

Crum, A. J. and B.  Zuckerman. 2017. Changing mindsets to enhance treatment effectiveness. Journal of the American Medical Association 317(20):2063-2064.

Hays, P. A. 2016. Addressing Cultural Complexities in Practice: Assessment, Diagnosis, and Therapy. Washington, DC: American Psychological Association.

Howard, A. and M. Rawsthorne. 2019. Everyday community practice: Principles and practice. Oxfordshire, UK: Routledge.

Howson, A. 2013. The body in society: An introduction. Cambridge, UK: Polity Books.

Leibowitz, K. A., E. J. Hardebeck, J. P. Goyer, and A. J. Crum. 2018. Physician assurance reduces patient symptoms in US adults: An experimental study. Journal of General Internal Medicine 33(12):2051–2.

Nadal, K. L., M. A. Issa, J. Leon, V. Meterko, M. Wideman, and Y. Wong. 2011. Sexual orientation microaggressions: “Death by a thousand cuts” for Lesbian, Gay, and Bisexual youth. Journal of LGBT Youth 8(3):234-259.

Nieto, L., L. C. Smith, M. F. Boyer, L. Goodwin, and G. R. Johnson. 2010. Beyond inclusion, beyond empowerment: A developmental strategy to liberate
. Olympia, WA: Cuetzpalin Publishing.

Pérez, E. July 2, 2020. “’People of color’ are protesting. Here’s what you need to know about this new identity.” Accessed on November 13, 2021.

Rolf, I. P. 1977. Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-being. Rochester, VT: Healing Arts Press.

Sue, D. W. and L. Spanierman. 2020. Microaggressions in everyday life, 2nd edition. Oxford, UK: Wiley.

Takacs, D. 2003. How does your positionality bias your epistemology? Thought & Action 19(1):27-38.

Taylor, S. R. 2018. The body is not an apology: The power of radical self-love. Oakland, CA: Berrett-Koehler Publishers.

Turner, B. S. 2008.  The Body & Society. London, UK: SAGE Publications.

White, M. and K. Lorenz. 2016. “Working across differences: A necessity for students, employers, and society.” Diversity and Democracy 19(1): Available from ■

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