by Halko Weiss
The therapist may also lead the client toward accepting nourishment once deemed impossible. Again, simplicity and economy are the Hakomi way (Kurtz, 2006). With an experienced client, the therapist may simply extend her hand, or hand out a tissue, then let the hand linger to see if the client looks longingly or reaches out. Asking, in this instance, might force the process toward some kind of neocortical decision, for example: “What should I say?” or “If I say no, will I hurt her feelings?” By asking with the hand and leaving it open, we can speak at the limbic level, and allow the process to unfold without neocortical intervention that calls attention away from the experience.
Another approach would be to use the voice in a suggestive way. For example, “Would a hand feel good right now? . . . Just a soft hand on your shoulder to let you know that there is someone here with you . . . to tell you that you have someone in your corner.” Here is a sentence that starts out sounding like a question but transforms into an evocative suggestion, and ends up as a nourishing offering. In Hakomi, life is the ultimate healer, which means we need to take in the nourishment it offers. Instead of avoiding gratifying a client as in classical psychoanalysis, gratification is offered experimentally, where it is either mindfully integrated in a nourishing manner or barriers to taking in gratification are evoked for further exploration and processing.
With words like those in the paragraph above, spoken artfully and at the right time, actual touch might not be necessary. The voice can be made to reach out and touch. But when it is appropriate and safe, touch may be offered and either accepted or explored. After giving the client some time to sense into a touch, the therapist might use the situation to move toward meaning. “What does that hand say to you?” or “If my hand were using words, what might it be saying?”
Finally, in integration the actions can be so natural and subtle that one hardly recognizes them as some kind of deliberate work or leadership skill. We have often marveled at Kurtz’s genius at creating a little game to encourage a client to try out a new growth step. For example, he might set up a game in which he plays the client’s father. It might go something like this: “Okay, you be yourself and I’ll be your father. I’ll say, ‘Don’t speak until you’re spoken to!’ just like your father did, only maybe I’ll exaggerate a little. Then you give me a great big old raspberry! Shall we try that?” These invitations can be so appetizing that the client has a hard time refusing. Kurtz then typically overacted the part enormously, with just enough reality to conjure an image of the stern and disapproving father. The client would respond with a big raspberry (which, in itself, might be a new experience), and then Kurtz would fall over in a heap as if blown away by a great gust of wind (Pesso, 1973), and both would join in a conspiracy of hilarious laughter to celebrate this newfound pluck, holding their sides as they rolled around the floor.
Conclusion
Every act of knowing brings forth a world.
HUMBERTO MATURANA AND FRANCISCO VARELA, The Tree of Knowledge, 1992
Life, at its best, is a flowing, changing process in which nothing is fixed. In my clients and in myself I find that when life is richest and most rewarding it is a flowing process. . . . I find I am at my best when I can let the flow of my experience carry me in a direction which appears to be forward toward goals of which I am but dimly aware.
CARL ROGERS, On Becoming a Person, 1961
While Hakomi resonates with the humanistic ethos of nondirective client-led therapies, it is not a derivative of Rogerian therapy, and it would be inaccurate to describe it as nondirective in the Rogerian sense (Raskin, 1948). It differs from Rogerian therapies in its preference for the implicit, its use of the body and nonverbal communication, and its attitude toward leadership. Unlike the so-called nondirective approaches, Hakomi does not avoid or advocate the abolition of leadership from the therapeutic alliance.
By a similar token, one might question the use of the word “nondirective” to label Rogerian therapy or the approaches of its predecessors, Jessie Taft (1933), Otto Rank (1936), and Frederick Allen (1942). While these pioneers did much to liberate therapy from the power inequities in what has been called “Freud’s fundamentally authoritative orientation” (Raskin, 1948), they consistently overlook their own exercise of influence in their confinement of therapy to an explicit and verbal dialogue. They do not seem to recognize that they unwittingly assert a subtle, yet very powerful, form of leadership that channels awareness away from attention to the body, body sensations, and subtleties of felt sense experience—and the wealth of information that is accessed through nonverbal channels. The magnitude of that oversight has been underlined through the discoveries of Kurtz in the late 1960s and the subsequent development of Hakomi from 1970 to the present (Barratt, 2010).
In addition, when we view the process of Hakomi through the concepts of following and leading, the Western notions of absolute and formal opposition, within which those early “client-led” therapies developed, dissolve into a flux or flow of two distinct but complementary intentions. The Taoist notion of yin and yang is an especially useful view through which to interpret Hakomi, with its practice of “leading within following” and “following even as one leads.” And it is from his grasp of this Eastern perspective that Kurtz developed the Hakomi approach.
However, in spite of the differences, in practice there are numerous points of similarity and plenty of room for cross-fertilization between Hakomi and more conventional humanistic approaches. Certainly, both eschew an overbearing use of the power differential between client and therapist; both are gentle and yielding as opposed to confrontational and challenging of the client. They also share a great respect for the cultivation of empathy, compassion, and experimentation, and mutually refrain from imposing or projecting an absolute system of values or an overarching theory of human development upon their clients.
Furthermore, the concepts of leading and following, when reframed as relative and complementary intentions, are clinically useful. Just as Hakomi therapists keep watch on their own internal state with regard to loving presence, personal agendas, getting hooked by their own countertransference, and other qualities related to personhood, it is well to keep checking on leading and following, for they provide us with valuable feedback about our use of influence and power. We can find ourselves erring on the side of too much following or too much leading. Stopping and realigning with the client’s unfolding organic wisdom can help the therapist repair the breach and regain the traction of the session. Finding time to reflect on one’s own disposition to lead or follow overmuch can serve as creative material for the therapist’s continued personal and professional growth.
CHAPTER 13
Ethics: Right Use of Power
Cedar Barstow
RIGHT USE OF power is the use of personal and professional power to prevent and repair harm and to promote the well-being of all (Barstow, 2005). Body-centered psychotherapies, such as Hakomi, invite an experiential, integrated, and relational approach to the development and practice of ethical awareness and accountability. Right use of power and influence is understood as the heart of ethics (Knowlan & Patterson, 1993). It is my experience that using power skillfully and wisely requires more than good intentions. It requires a lifelong engagement of increasing awareness and sensitivity to our personal and professional impacts.
In the Hakomi method, ethics in the broad scope of the right use of power is embedded in the method itself. The Hakomi sensitivity cycle (Chapter 17) describes the process of increasing sensitivity as a dynamic and spiraling movement. Inspired by the usefulness of this cycle and the positive framework of this Hakomi map, I have identified a power spiral with four aspects of the right use of power. Right use of power is (1) informed, (2) conscious, (3) caring, and (4) skillful. The focus is on developing an increasing level of skill and awareness in each of these dimensions as a positive power model, as outlined more fully in Barstow (2005).
This chapter does not cover the whole range of ethical issues
addressed within these four dimensions, but focuses instead on the topics particularly relevant to psychotherapeutic work using the Hakomi method. The principles, theory, and skills of the Hakomi method encourage and support a deep level of ethical awareness, sensitivity, and wisdom. Hakomi, as a method, includes a refined ability to track subtle clues about a client’s internal experience and to contact them in the present moment. Hakomi therapists also work in a collaborative way, insisting that clients offer their experience and their feedback in an ongoing and present process. The Hakomi method also focuses on establishing safety (see Chapter 14). These practices significantly reduce the possibilities of unacknowledged misunderstandings and harm from power-over directiveness. They also tend to very quickly create a therapeutic atmosphere of special intimacy, vulnerability, and depth. This atmosphere of loving presence calls for an increased sensitivity and watchfulness to not become personally entangled.
Power Differential Ethics
The core of ethical sensitivity comes from acquiring a felt sense of the power differential. The power differential is the inherently greater or enhanced power and influence therapists have compared to their clients (see Table 13.1). The impacts of this enhanced power are many and varied. Written ethical codes designed to prevent harm to clients are based on the effects of the power differential (Hunter & Struve, 1998).
In the Hakomi therapeutic relationship, the power differential has great value. Used wisely and appropriately, it creates a safe, well-boundaried, professional context for growth and healing. More specifically, when used ethically, the power differential offers clients some very important assurances:
1. Confidence in the caregiver’s knowledge, training, and expertise
2. Security and safety
3. Direction and support
4. Role boundary clarification
5. Allocated responsibilities
Table 13.1 Power Differential Role Differences
Caregiver (Power-Up Role) Client (Power-Down Role)
Is in service Is served
Has increased and enhanced power and influence Very often experiences a decreased felt sense of power and influence
Is paid for time and expertise Pays for service
Sets and maintains appropriate boundaries Accepts or challenges boundaries
Own needs and personal process are not focused on Own needs and personal process is known and focused on—self-revelation is important
Less vulnerability Greater vulnerability to rejection, criticism, undue influence, being taken advantage of, disrespect
Depended on for trustworthiness, earns trust Needs to trust
Ultimately responsible for tracking and repairing relationship difficulties Coresponsible for naming and working with difficulties
May be idealized or devalued More susceptible to idealizing or devaluing
May need to assist client in being more empowered May unnecessarily disempower self
Makes assessments and evaluates results Collaborates with or responds to assessments
Because the power differential is role dependent, it is easy to overidentify (that is, get inflated or addicted) with this increased or enhanced power. It is just as easy to misuse this increased power by underidentifying with it (for example, disowning or disregarding one’s power or role-generated impact). Here are several misunderstandings that illustrate the multiplicity of the impact of the power differential for both helping professionals and clients:
1. Using the Hakomi method, we may find ourselves unaware of the amount of transference that the context of loving presence creates.
2. Believing in equality, we may find it difficult to accept that our role creates a power inequality, and that this inequality is actually essential to our effectiveness.
3. Out of fear of manipulative and wounding abuses of power, we may find it difficult to understand that we must own the power that we have, to be able to use it for good.
Underuse of power is also a misuse of power.
4. Motivated by a desire to be of service, we may find it difficult to comprehend that our impact may be different from our intention—that it may be experienced as confusing or harmful.
While training in the Hakomi method, students deepen their sensitivity to the dynamics of the power differential through an experiential exercise in which they sit with a partner and silently role-play being in both the power-up role and the client role. Here are some reflections from therapists when in the power-up role:
I have always equated power with power over, force, and manipulation. I am now seeing power as a skill, as knowledge, as sensitivity and awareness. This is so different.
I now understand that my clients and I are equals as humans, but we have different roles. These roles have significant differences.
The new paradigm of power requires therapists to educate their clients about their use of power.
Ethics of Working in Nonordinary States
A nonordinary state of consciousness is a “mild to deep trance in which awareness is focused in a different way than in ordinary life” (Taylor, 1995, p. 50). Nonordinary states of consciousness can spontaneously arise through many experiences such as ecstasy, shame, trauma, grief, fasting, and peak experiences. Mindfulness, as used in the Hakomi method, is a nonordinary state of consciousness that facilitates profound personal awareness and healing. In teaching and inviting clients to turn their awareness inside to notice whatever their present experience is, we are deliberately encouraging our clients to enter a nonordinary state of consciousness. In a technical sense, mindfulness is not a hypnotic trance state that diverts conscious attention (Wolinsky, 1991). It actually enhances awareness and breaks the trance of everyday habits. Still, when using the Hakomi method, this nonordinary state of mindfulness engenders special concerns about the right use of power. When invited into the state of mindfulness, clients lower their defenses. This puts them in an exposed and vulnerable position, without their normal level of protection. Because of this, the impact of the power differential is heightened and expanded when clients are in such a state.
Qualities and effects of nonordinary states include the following:
1. Time distortion
2. Increased intensity of feeling and sensation
3. Greater need or capacity for faith and trust
4. Increased sensitivity and awareness through all senses
5. Consciousness expansion
6. Relaxation or diffusion of boundaries
7. Increased felt sense of the truth
8. Increased sensitivity to authenticity (Taylor, 1995, p. 54)
When working with clients in mindfulness, it is helpful to make appropriate and effective interventions, assessments, and adjustments like the following:
1. Find out how the nonordinary state of mindfulness is being experienced by the client.
2. Pay especially close attention to setting and maintaining boundaries for privacy, time, confidentiality, touch, and safety and security needs.
3. Learn how to distinguish between a healing process in a nonordinary state and a process in which the client is being retraumatized.
4. Increase sensitivity to subtle safety needs and to body, emotion, energy, and cues.
5. Stay connected to present felt experience.
6. Slow down and be spacious.
Ethics and the Therapeutic Use of Touch
Touch is necessary to both physical health and emotional well-being (Ford, 1993; Montagu, 1978; Peloquin, 1990; Rubenfeld, 2000). Johanson (personal communication) maintains that not to use the power of touch (therapeutically, nonsexually, and appropriately initiated) might be considered unethical since it withholds a powerful therapeutic tool from clients, who then must invest increased time, energy, and money in therapy to the unfair gain of therapists.
Restoring a satisfying and healthy relationship to touch may indeed be considered a worthy goal in therapy. The body is a rich source of wisdom. The use of body information and informed and conscious touch ar
e powerful tools for healing, self-awareness, establishing good boundaries, and cultivating more satisfying connections. Years of cultural, theoretical, and ethical controversy surround the use of touch in the helping professions (Causey, 1993; McNeely, 1987; Smith, Clance, & Imes, 1998; Thomas, 1994). In many states, using touch is illegal or uninsurable—laws often based on traditional psychoanalytic strictures. The United States Association for Body Psychotherapy is an organization focusing on the therapeutic value of including the body and ethical touch in healing work, whose purpose is to increase the attention, validation, and respect afforded to the modalities of body psychotherapy.
Ethical codes for helping professions and state laws related to the use of touch vary greatly. Therapists need to take personal responsibility for researching relevant codes and laws. Controversy arises from the following factors:
1. It is never ethical for psychotherapists to use sexual touch with a client or to engage in or imply sexual intimacy or the future possibility of such. The strong healing power of touch may be undone and contaminated by the betrayal of sexual intimacy in a relationship with a power differential supposedly characterized by trust. The prohibition of even nonsexual touch in helping relationships by some organizations is intended to prevent the egregious harm caused by inappropriate touch.
2. Human beings automatically and uniquely assign meaning to touch. Thus, therapeutic touch is easily misinterpreted by clients as sexual, forceful, serving the caregiver, or controlling. Touch is deeply longed for and a source of deep vulnerability. Use of therapeutic touch is ethically and relationally complex and requires assessment, sensitivity, good tracking, and clarity of intention on the part of caregivers.