by Halko Weiss
Depending on the stage of the therapeutic process, the Hakomi therapist uses a range of therapeutic relationships. If the therapist encourages the client to mindfully study the organization of her experience (the essence of working the transference, according to Stolorow et al., 1987), this would be one-person therapy in Stark’s (1999) schema, since the therapist is leading the client into a deeper relationship with himself. If the client is taking in a new missing experience from the therapist, it would be one-and-a-half-person therapy for Stark because the therapist is bringing her best or ideal self to the interchange. When the client is in the integrative stage of working a new element into the organization of his experience, the process may move into two-person therapy, where both client and therapist are fully present in an intersubjective way.
It should be noted that relational psychoanalysis has recently moved to encompass the body more fully in its work—something significant for Hakomi since it, too, encompasses a somatic dimension. Aron (1998a, p. xx) argues that “our self is first and foremost a body-as-experienced-being-handled-and-held-by-other-self, in other words, our self is an intersubjective-bodily self.” He likewise says, “I believe that research into and clinical study of self-reflexivity [mindfulness] (and especially the relationship among self-reflexivity, intersubjectivity, embodiment, and trauma) is among the most promising areas of psychological research and psychoanalytic investigation taking place today” (p. 4).
Intersubjective School
Stolorow (Stolorow et al., 1987) coined the term “intersubjectivity” to describe the therapeutic field as one that involves two subjects (therapist and client) as an attempt to move away from a one-way therapeutic relationship between self-object (therapist) and subject (client), and toward a more authentic relationship that includes both (Stark, 1999).
The old days are over in which it could be assumed that the therapist sees things as they are because she has been “analyzed” while the client sees things subjectively because he has not, and will only be cured when he sees in the same manner as the therapist. Both therapist and client always and only perceive things subjectively. Thus, when the Hakomi therapist perceives that the world of the client is too narrowly organized to include all that life offers, the perception must be held lightly as it is checked out collaboratively and experimentally with the life world of the client (Duncan, 2010). Since Hakomi therapy deals with transference in terms of the organization of experience in an intersubjective, collaborative manner, it is a psychodynamic form of psychotherapy.
Transference in its essence refers neither to regression, displacement, projection, nor distortion, but rather to the assimilation of the analytic relationship into the thematic structures of the patient’s personal subjective world. Thus conceived, transference is an expression of the universal psychological striving to organize experience and create meanings. This broad conceptualization of transference holds numerous advantages over earlier ones. . . . It clarified the contributions of both analyst and patient in shaping the patient’s experience of the therapeutic relationship. . . . Most important of all, the concept of transference as organizing activity, by encouraging an unwavering inquiry into the patient’s subjective frame of reference, opens a clear and unobstructed window to the patient’s psychological world, and to its expansion, evolution, and enrichment. (Stolorow et al., 1987, pp. 45–46)
This intersubjective field is continuous and mutual (Beebe & Lachmann, 2002). Advances in both psychology and neuroscience give credence to the notion of intersubjectivity and expand its relevance to all relationships. Studies of the function of mirror neurons, contagion, and right hemisphere processes delineate their roles in our ability to affect another’s brain activity and emotional state, intuit others’ possible intentions, feel empathically what another is experiencing, and our innate capacity to know another’s mind (Damasio, 2003; Gallese, 2001; Lewis et al., 2000; Schore, 2003; Siegel, 1999, 2006; Stern, 2004; Watt, 2005). Infant research sheds much light on the ways infants and adults relate and share experience as well as the role of attachment in adult relationships (Aitkins & Trevarthen, 1997; Beebe & Lachmann, 1998, 2002; Stern, 1985).
We live life in an intersubjective matrix—a matrix where we live, breathe, and move knowing from the inside what other people are doing and feeling. Distinct boundaries exist between self and other, but remain permeable (Whitehead, 1994, 1995). We can no longer view our existence as completely independent and separate. We resonate with each other; we coordinate our actions with each other; and we synchronize our experiences. These “moments of meeting” are of relatively short duration, but recur reliably (Stern, 2004). Stern (2004) considers intersubjectivity a condition of humaneness and, as such, a motivational system, like attachment or sex. It contributes to the survival of the species by promoting group formation, enhancing group functioning, and ensuring group cohesion through the development of morality.
These findings necessitate a new view of the therapeutic relationship.
Intersubjectivity in the clinical situation can no longer be considered only as a useful tool or one of many ways of being with another that comes and goes as needed. Rather, the therapeutic process will be viewed as occurring in an ongoing intersubjective matrix. (Stern, 2004, p. 78)
It is this matrix, then, that informs the therapist of relational dynamics and allows moment-to-moment, relational-corrective experiences to occur. These dyadic interchanges form the basis of the client’s healing and affect the therapist as well in the unique rhythm of the relationship of the pair (Beebe & Lachmann, 1998, 2002). “Internal processes and relational processes are inextricably coordinated, and are organized concurrently” (Beebe & Lachmann, 1998, p. 488).
This coordination is formed in the resonant emotional field, and the perception of facial expressions and resultant brain activation (Beebe & Lachmann, 1998). Wounding that occurs in relationship must heal in relationship (Lewis et al., 2000), both interpersonal and intrapsychic. “Self-regulatory behaviors of patient and analyst, such as subtle head and gaze aversions, postural orientations, and varieties of self touching, add invaluable information to the treatment when they are recognized, acknowledged, and their place in the ongoing interaction is understood” (Beebe & Lachmann, 1998, p. 505). When applied to psychotherapy, as in the Hakomi method, intersubjectivity as a motivational system yields two important consequences: (1) therapy is necessarily a cocreated process; and (2) “it is clinically helpful to view the desire to be known and achieve intersubjective contact as a major motive in driving psychotherapy forward” (Stern, 2004, p. 148).
Rogers
Rogers’s (1951, 1961, 1980) “person-centered approach,” described as the capacity each individual has for self-understanding and reorganizing attitudes, beliefs, and behaviors, has a close, though less than defining (see Chapter 12), kinship with Hakomi. The qualities required to promote this self-directed growth apply to personal growth in therapy, as well as in group leadership and teaching relationships. They are described in these basic attitudes of the therapist: genuineness, “unconditional positive regard,” and empathic understanding (Rogers, 1961, 1980).
If therapy were optimal . . . it would mean that the therapist feels this client to be a person of unconditional self-worth: of value no matter what his condition, his behavior, or his feelings. It would mean that the therapist is genuine, hiding behind no defensive façade, but meeting the client with the feelings which organically he is experiencing. It would mean that the therapist is able to let himself go in understanding this client; that no inner barriers keep him from sensing what it feels like to be the client at each moment of the relationship; and that he can convey something of his empathic understanding to the client. It means that the therapist has been comfortable in entering this relationship fully, without knowing cognitively where it will lead, satisfied with providing a climate which will permit the client the utmost freedom to become himself. (Rogers, 1961, pp. 184–185)
Rogers foreshadowed the focus on e
mpathic attunement in object relations and intersubjective forms of psychotherapy by emphasizing congruence between therapist and client (Cozolino, 2002). Rogers (1961) also describes the individual’s growth as a process of becoming, not a fixed state. He continued to develop his ideas on viewing the propensity of individuals to develop in a nurturing environment toward positive and constructive directions, not as a chance event, but rather as a
tendency which permeates all of organic life—a tendency to become all the complexity of which the organism is capable. . . . We are tuning in to a potent creative tendency which has formed our universe . . . and perhaps we are touching the cutting edge of our ability to transcend ourselves, to create new and more spiritual directions in human evolution. (Rogers, 1980, p. 134)
Hakomi shares a spiritual trajectory with Rogers (Coffey, 2008; Kurtz, 2008) as well as a focus on the full and authentic person-to-person exchange between client and therapist.
Fosha
In recent years, Diana Fosha (2009a, 2009b) has presented at a number of Hakomi events and demonstrated a very Hakomi-like dynamic way of bringing a psychoanalytic background to doing safe, compassionate, accelerated experiential work with affect within the context of a highly attuned, dyadically regulated relationship. Here positive emotions such as love, gratitude, joy, accomplishment, and strengths are not considered the end products of successful therapy, but essential components of the change process. Through tracking and contacting these positive affective experiences that arise as an integral part of healing, what Fosha terms “metatherapeutic processing,” they become the sustained focus of experiential exploration. A cascade of transformation is often released that culminates in a core state of being, a positive affective state of calm and centeredness in which integration and consolidation of change takes place and a coherent self comes to the fore. Once in a core state, empathy and self-empathy, wisdom, clarity about one’s truth, and generosity become the currency of the realm, something akin to what Eisman (2006) refers to as an Organic Self place.
The Hakomi Method
In Hakomi therapy, the therapeutic relationship is the necessary context in which self-study occurs. In whatever way the therapist offers nourishment to the client, it happens in genuine and authentic relating between two human beings. Mastery of technique comes slowly in this method, not because the techniques are in themselves difficult or complex, but because being oneself in the role of therapist using this method requires noteworthy practice. Learning to relax and be oneself, without following old habits or enacting limiting beliefs, and cultivating an ongoing state of mindfulness and loving presence requires the Hakomi therapist to practice and grow. To this end, Kurtz and the Hakomi Institute have developed numerous exercises and practices that help the therapist to identify and cultivate the self-state outlined below. Finding and developing this capacity are the very core of every Hakomi training.
Attitude of the Therapist
The healing relationship and attitude of the therapist in Hakomi are in service to the client’s self-discovery and reorganization. The therapist engages in the intersubjective field with an attitude of loving presence. Empathically, he aims to join with the client in her experience and at the same time, create a warm, open space for the client to deepen, discover, and explore her habitual responses, core beliefs, and unconscious material. The therapist is not viewed as an expert that knows best, but rather as a facilitator that leads by following (Johanson, 2009b). The client remains the expert on her experience, and an equal participant in the process (Kurtz, 1990a). The relationship between therapist and client is based on the attitude of collaboration and cocreation (Duncan, 2010). The therapist uses his own insight to shepherd the client’s awareness toward her deeper experience, not through interpretation that causes anxiety (Stark, 1999), but by tracking the client’s present-moment experience, contacting what is tracked, and creating experiments in mindfulness to help the client access and work with her core material. The client experiences the warmth and emotional understanding of the therapist, which supports her own discovery and growth (Fosha, 2009a; Kurtz, 1990a). Because the therapist leads by following and joins with the client’s authentic curiosity (Johanson, 1988), general resistance to the growth process is lessened as the cooperation of the unconscious increases (Kurtz, 1990a).
Attunement, Resonance, and Use of Insight
A therapist must be open in order to attune with the client. All notions of certainty must be held lightly. To attune to another, the therapist must be able to let go of her expectations and allow herself to rest in the mystery and uncertainty (Johanson & Kurtz, 1991) that comes with being awash with present experience (D. Siegel, 2010). Once attuned, the two can resonate with each other, making a functional whole of the two autonomous entities that is larger than the sum of its individual parts (D. Siegel, 2010). The client can feel the positive regard of the therapist; the therapist can sense and feel the inner experience of the client. Therefore, the Hakomi therapist pays attention to her own experience while simultaneously tracking the client to attune and resonate with him, moment by moment. In this way, the therapist endeavors to maintain the allostatic attunement (Sterling, 2004) with the client without disruption.
When the therapeutic alliance is resonating in place, the therapist invites the client through this attunement to study the organization of his experience (Piers, Muller, & Brent, 2007). This approach uses insight, experience, and relationship (Stark, 1999), but not interpretations or interventions by the therapist that would disrupt the client’s experience, the empathy of the therapist, or the intersubjective field. As Morgan (2013) expresses it:
Attunement and empathy is an essential foundation to therapeutic change. Hakomi therapists become skilled in tracking. This is essential for the contingent communication that activates resonating brain states and corticolimbic connections. Therapists need to be adept at tracking their own body processes, as these are vital in connecting deeply with another. Therapists need to be willing to compassionately repair empathy lapses as these repairs pave the way to self-regulation in the client. Attuning to and managing shame states allows for new growth in limbocortical pathways. (p. 55)
The Hakomi therapist seeks to lower the noise in the relational system by not giving the client anything to resist, so that the client can concentrate on how he organizes his experience and allow new possibilities to emerge (Kurtz, 1990a). This relationship is based on the therapist’s belief in the inherent wholeness and goodness of the client and his natural ability to reorganize toward increasing wholeness (Monda, 2000). However, since barriers to reorganization are normally habitual, implicit, and unconscious, the therapist tracks and contacts potential barriers, shepherding them into the client’s awareness where they can be dealt with. Thus, the therapist demonstrates trust in the client, in their relationship, and in the process itself, including fears and obstacles. The therapist is not caught between empathy and interruption, or the client’s need to be understood versus the need to understand, nor between being a good object versus being a real subject (Stark, 1999). All of these purposes are joined together in the therapeutic relationship and the full, conscious participation of the therapist.
Creating the Bubble
In the Hakomi method, the therapist constantly tends to the therapeutic relationship through the techniques of contact, tracking, and creating the bubble. The bubble is a metaphor for a palpable connection between client and therapist that is infused with warmth, presence, awareness, and attention. This is the particular flavor of the intersubjective field that the therapist fosters that is open to whatever quality is needed in relation to the kind of attachment needs the client brings (Eisman, 2005; Fonagy & Target, 1997; Fosha, 2003; Morgan, 2013). The therapist’s ability to be present, to attune, and to resonate with the client allows the client to feel “felt” (D. Siegel, 2010).
“Good therapy has a feel to it” (Kurtz, 1990a, p. 59). The therapist uses all of her faculties—cognition, intuition, awareness, emotions
, and so on—to deepen her understanding and stay in authentic contact and connection with her client. While the therapist may have a strong empathic response, as well as other subjective reactions, she does not completely believe them, but continues to be open to confirming, disconfirming, nuanced, or new forms of information. Her goal is to join in the experience with the client in order to create a therapeutic alliance of perceived safety, which inspires the curiosity of the client to study his own experience (Kurtz, 1990a). In addition to not giving the client anything to resist, safety means supporting a spaciousness that allows the client room to explore—once he is convinced the therapist is in the bubble with him, helping him to go where his inner wisdom wants to take him at the deepest levels.
Loving Presence
Loving presence is defined by Kurtz as a state of being—a state of consciousness. In this state, a person experiences an embodied sense of well-being and positive affect (Fredrickson, 2001; Fredrickson & Losada, 2005; Johnson, 2009). Loving presence implies an awareness of self and other and the interconnectedness between them. It requires a connection with one’s own sense of goodness, as well as the goodness of the other, and the goodness of life in general. Warmth and friendliness emerge with this state. Everything is welcome without bias. Such presence adds another dimension to therapy (Fosha, 1992, 2004). The therapeutic “relationship transcends itself and becomes part of something larger. Profound growth and healing and energy are present” (Rogers, 1980, p. 129).
The Hakomi therapist actively uses mindfulness to work with his own state of mind as he strives to cultivate loving presence. While great effort may sometimes be required in the practice of loving presence, ultimately it is a state of willingness rather than willfulness (May, 1982), of being rather than doing.