by Halko Weiss
Jaffy Phillips (2003) succinctly describes the values of the use of touch, and the ways in which touch can support healing and the deepening of self-awareness: “When you touch someone, everything changes.” Touch is a physical and relational experience that is generally imbued with layers of historical, cultural, and psychological meaning. The meanings evoked by touch are often unconscious or nonverbal, and they often manifest somatically or relationally before the client is able to articulate anything about them. Boundary issues, transference, and countertransference are common examples of this kind of response. If unaddressed, the unintended consequences of touch can wreak havoc in the therapeutic relationship and ultimately damage the client.
The Hakomi method has been a bodymind psychotherapy since its inception. Several techniques consciously and deliberately use touch to assist and support therapeutic change. Taking over and supporting spontaneous emotional management are two specific techniques where touch may be employed. Touch may be used in other creative little experiments in mindfulness (see Chapter 16). This exploratory, mindful context for touch builds in safety, as it invites the client to notice and report the impact of touch in the moment. Still, the therapist’s sensitivity to impact and awareness of the possible risks is especially important when using touch in clinical practice.
Hakomi’s ethical guidelines in the use of touch are as follows:
1. Client knows how and why touch will be used in the therapy.
2. Client understands limits and boundaries of touch (for example, nonsexual).
3. Client agrees to this and gives permission.
4. Clients know that they can stop or discontinue the use of touch at any time, and that they are always in control of when, where, how, and for how long they are touched.
5. Therapist continually tracks for indicators of how the client is experiencing the touch—whether it is as intended—and checks in with the client on the impact of the touch.
Additional factors to consider:
1. Touch should always and only be used deliberately, carefully, and consciously.
2. The use of touch should be accompanied by assessment and a clear clinical rationale that is in the service of the client’s process.
3. Time should be taken to become clear about one’s intentions and feelings toward the client. Lack of clarity about intentions is often a sign that shadow material or countertransference is present.
4. Become familiar with one’s own touch issues and potential countertransferences.
5. Be mindful: stop touching when the intention is complete.
Avoid touch when:
1. The therapist does not want to touch.
2. The client does not want to be touched.
3. The client is likely to misinterpret the touch.
The Ethical Importance of Resolving Difficulties
Ethics and power are all about how we treat others through our attitudes and our behavior. Relationships are what make ethics necessary. Being sensitive to our impact and staying connected even in conflict is at the core of ethical relationships. Relationships are most effective and grievances are avoided when we are able to resolve problems and repair connections.
We must assume that there will be relationship issues and that our clients will experience feeling hurt. No matter how good our intentions: we make mistakes; we have a complex impact on others; we misunderstand power dynamics; we are naive; we project and are projected on; and harm is caused. We may automatically and habitually link present conflict with past trauma. When conflict triggers old trauma, we may disengage from relationships, dissociate, lose touch with our resources, feel hopeless with shame, or blame others.
When acknowledged and attended to, most mistakes can be corrected and most harm can be repaired. A number of studies have shown that what people need when they have been harmed in a helping relationship is surprisingly simple, as summarized below (Stolorow et al., 1987). Unacknowledged hurt feelings can escalate toward an ethical grievance at an alarming rate. Rather than getting defensive, feeling ashamed, or referring to clients as resistant, we can attend directly to the difficulty.
What Clients Need When They Have Been Harmed in a Helping Relationship
1. Acknowledgment
They want their experience acknowledged, understood, validated, and empathized with.
2. Understanding
They want to know what happened, or what our intention was.
3. Regret
They want an apology, or an authentic expression of our sorrow or regret.
4. Learning
They want reassurance that we’ve learned or understood something about ourselves or how to better care for them.
5. Repair
They want to reconnect and participate in repair of the relationship or in gaining clarity and letting go.
The more immediate the attention to the problem, the more clear and complete the resolution. Skills of tracking and contact—so central to the Hakomi method—are of great help to therapists in noticing and attending to safety and relationship issues in present time. By approaching ethics and power reparationally, we can put our attention toward skillful resolution, relationship repair, and self-correction.
Case Example
The phone message said, “I want to come in for a completion session because I need to use my financial resources for something else.” Steven, a body psychotherapist, wondered what else might be going on for this client, who had not yet met the goals she had set for herself. When Carrie came for her completion session, she focused on how great therapy had been and how thankful she was, and how unfortunately she just couldn’t afford to come anymore. Steven sensed some tension and asked Carrie, “Is there anything at all that you are disappointed about?” Carrie answered, “No, you have been such a good listener and so patient and insightful.” Steven checked again. “Thank you. As I think about the work we’ve done together, I wonder if you feel discouraged that the problem you came in to work on hasn’t resolved even though you’ve gotten clearer about it.”
Carrie was silent for a time and then, apparently feeling safe and encouraged, took what was a big risk for her. She spoke thoughtfully. “Yes, actually, I am disappointed. I’ve done a lot of therapy and once again it seems like it hasn’t worked. If it was working, I’d feel like my money was being well used.” Steven contacted her feelings and her courage and thanked her for being so honest. Carrie went on, “And something else—I have felt a little uncomfortable with how close to me you move your chair, and sometimes, like when we did the experiment when we were pushing hands so I could find out about anger, touching was too much. But I thought, you’re the therapist and I really want to change and so I never said anything.”
Steven took a breath and responded, “Thank you for telling me. Again, that must have taken courage. I am so sorry that I wasn’t tracking the cues you have given me about your discomfort. Could we spend a few minutes with this? I’ll start moving my chair back and you tell me when the distance feels just right.” After finding and experiencing the right distance, which turned out to be about 6 feet away, Steven suggested an experiment in mindfulness in which he would move slowly closer. She would hold up her hand when she began to feel uncomfortable and they could both notice what happened. Steven described tracking a slight tensing in her cheeks, but otherwise, everything about Carrie’s demeanor and posture seemed visibly unchanged to him when she was uncomfortable.
Carrie had an insight: “I feel it all inside me and I put a lot of effort into making sure that you won’t notice anything that might not be agreeable.” Steven responded, “So it seems that you have been working hard for me not to be able to notice. And you succeeded, but it cost you a lot of suffering. I’m imagining you might be a bit angry that I didn’t notice.” She said, “Well, yes. You’re the therapist. You’re supposed to notice. I don’t want to have to tell you. Then I feel like I’m doing your job!”
From this interaction, Steven was able to self-correct by bein
g more attuned to Carrie’s discomfort cues and her fears of not being liked. Carrie had had a successful experience of revealing discomfort and not being rejected. She took a several-month break and then returned to work successfully, this time, with being more personally engaged and self-disclosing in her relationships. Had Steven not found a way to help Carrie talk about these concerns, her sense of betrayal and distrust could have escalated into a grievance and kept her away from seeking successful therapy in the future.
Ethical Proactivity
Responses to issues of power and ethics can be unconscious and history based, and littered with automatic behavior and outdated beliefs. By actively exploring our ethical edges, taking care of ourselves, and asking for and using feedback constructively, we become more sensitive. We can increase our skills, change ineffective habits, and use lessons from our history to grow. Focusing on proactive right use of power takes ethics to a deeply refined level.
Case Example
He was a well-loved music teacher. He loved his students. After several months of therapy, he told his therapist that he was ready to talk about something he hadn’t had the trust to bring up before and even then wasn’t sure how it would be received. He had felt for a while that something about the way he loved his students, especially the boys, wasn’t right. He had noticed that when he gave one of the boys a hug, he was grasping on, wanting to father him, wanting to give him more than a teacher should. He had then had a dream that he was holding one of his students and then in the dream the student was holding him. The therapist appreciated his courage and helped him explore what was going on. His father had died when he was six and he had experienced an aching longing for father love and attention that he felt as an adult as a deep, vacant place in his chest. In paying attention to this place in his chest, it became clear that this was the emptiness he was trying to fill when he was hugging his students. Understanding this strong need from his childhood helped him find other ways to connect and be nourished—filling himself with his music, reaching out more to friends, being more playful. His love for his students then shifted dramatically to more appropriate expression. His courage in bringing this issue to therapy resulted in proactive behavior that prevented harm to his students.
Conclusion
The Hakomi method is highly tuned to the establishment and maintenance of ethical decision making and ethical therapeutic relationships. Therapeutic relationships are intended to be empowering. The power differential role can be used to support self-discovery, rely on internal wisdom, become more lovingly present, reduce unnecessary suffering, and create new possibilities. This use of personal and professional power promotes empowerment and well-being.
Right use of power is the heart of ethics. Empathy and compassion can inform often complex and challenging situations, so that both caregivers and clients will be empowered to self-correct and grow into increased sensitivity. The development of compassion, “as being an ability to imagine—to see—the connection between everyone and everything, everywhere” (Barasch, 2005, p. 304), is the salve for wounds and separation, and the inspiration and motivation for those who are in positions of power and trust. In becoming increasingly ethically sensitive and aware, we can and must link our power with heart.
Section IV
Technique and Intervention
CHAPTER 14
The Skills of Tracking and Contact
Donna Martin
HAKOMI HAS BEEN described by Ron Kurtz as a method of assisted self-study. Two of the most important skills for the therapist that support this approach are called tracking and contact. Tracking is an active form of witnessing, which involves paying attention to the outward signs of the client’s internal, present-moment experience and the way her experience seems to be organized by core beliefs and habits. Contact is the skill of verbally responding to the client, to demonstrate presence and understanding as well as to help bring something into the client’s consciousness for the purpose of self-study.
These are the most fundamental skills in the method, and the rest of the process unfolds from how well these are practiced. Contact and tracking are a big part of creating the kind of limbic resonance on which the therapeutic relationship and process of therapy are based. In A General Theory of Love, limbic resonance is defined as “a symphony of mutual exchange and internal adaptation whereby two mammals become attuned to each other’s inner states” (Lewis et al., 2000, p. 61). The authors go on to say that the first part of emotional healing is being limbically known—“having someone with a keen ear catch your melodic essence” (p. 168). In the Hakomi method, we consider the concept of limbic resonance to be similar to what is being described as “attunement” or “mindsight” (Siegel, 2006). The skills of contact and tracking can be honed further and further, and will eventually become the skill base for an attuned therapeutic relationship—a crucial aspect of therapy in the context of attachment theory (Cozolino, 2006; D. Siegel, 2010; Wallin, 2007) as well as in common factors research, where the therapeutic alliance is understood as a core indicator for therapeutic success (Ardito & Rabellino, 2011; Hubble, Duncan, & Miller, 1999; Wampold, 2001).
Tracking
One of the distinguishing characteristics of the Hakomi method is the use of little experiments done in mindfulness for the purpose of self-study (see Chapter 16). Helping clients to “lower the noise”—to quietly slow things down in order to notice and study what is happening in their bodies, their thoughts, and their feelings—is a fundamental aspect of this approach.
Tracking is the key to setting up experiments through the observation, by the therapist, of much more than the verbal story being told. The therapist is taking in information all the time from such things as tone of voice, pacing, gestures, posture, facial expressions, and the many ways that clients communicate their internal world and the models they hold of their reality.
Daniel Goleman (1996), in his book Emotional Intelligence, estimates that more than 90% of someone’s emotional experience is expressed nonverbally. Research has shown that “we can learn a lot more about what people think by observing their body language and facial expressions . . . than by asking them directly” (Gladwell, 2005 p. 155). Yet most of us have not learned to pay much attention to more than the verbal content of someone’s story—to listen to the narrative beliefs behind the story being told, to the storyteller behind the stories.
Tracking is about taking in information about the client on as many levels as possible. The key to this, more than anything else, is the state of mind of the therapist. So to talk about tracking, as therapists, we must first look at our own states of mind.
There is an old Chinese tale of a man who came out of his home to chop wood only to discover that his axe was missing. He looked around and noticed his neighbor’s boy playing in the yard next door. As he looked, he noticed that the boy looked like a thief, sounded like a thief, moved like a thief. Suddenly the neighbor from next door came back with the axe, which he had borrowed. Now the boy, when the old man turned to see him again, looked like a child, sounded like a child, moved like a child.
It is easy to demonstrate to yourself that your perception is altered by your state of mind. Sit in a public place, for example, and take a moment to imagine this fantasy: All the adults you see are only five years old. This is a kindergarten setting. Now look around. Can you see the child in everyone? Imagine another fantasy: Everyone around you has saved someone’s life. Look around again. Can you see bravery, kindness, dignity, humanity? Ordinariness and greatness all rolled up in one being?
We cannot begin to observe or track another without attending first to our own states of mind and habits of perception. Kurtz developed a practice for shifting the attitude of the therapist in a way that cultivates a state of mind most conducive to working with others in a healing way. He called it the practice of loving presence (see Chapter 9). It involves being very good, as a first step, at mindfully noticing our automatic tendencies and habits of perception and attention. We w
ant to become more conscious of what Malcolm Gladwell (2005) calls our “blink” perceptions, or Kahnemann (2011) calls “system one,” namely the way our adaptive unconscious (Wilson, 2002) reacts to people and situations.
The next step in this practice is to create a kind of spaciousness—to clear away the habitual projections and attitudes that obscure clear perception. In that new state of spacious mind, we learn to look more receptively, more intuitively, and more appreciatively (Johanson, 2008).
We then create an intention to see something in the other that inspires us. We invite and search for those qualities in the other that nourish us—qualities like courage, vulnerability, sensitivity, gentleness, determination, and intelligence. The natural result of finding this—something that inspires and nourishes us—is twofold. First, we relax. We are touched and reminded of the client’s strengths and innate beauty. Our heart opens to see this person in her wholeness.
Amazingly, the person begins to realize, unconsciously at first, that she can reveal herself safely. She feels invited, accepted, and appreciated, and begins to express even more of herself. This is noticed by the therapist, who then feels even more inspired and nourished. A reinforcement cycle is underway that deepens the connection, and this creates the context for assisted self-study and discovery to occur naturally and spontaneously in ways that will serve the client and begin the healing process.
Tracking for Signs of Present Experience
In any case, tracking is best done from this calm, receptive, appreciative state, noticing any signs of the client’s present-moment experience. We watch for nonverbal signs such as the client’s breathing, body movements, skin tone, angle of the head, quivering, twitching, tension patterns, facial expressions, tears, sighing, tone of voice—anything at all that gives us a sense of what is happening internally for the client. We pay special attention to tracking the level of nervous system arousal in the client—how activated he is. When the person has been traumatized, we want to look for signs that he is outside the window of tolerance, either too highly aroused to be able to use mindfulness, or too numb and dissociated. We need to be able to recognize signs of hyper- or hypoarousal, dissociation, or trance. We need to notice when the person is in flight-or-fight mode, and to help him calm down. We want to be able to see, sense, and recognize even fleeting signs of the client’s internal state as it changes from moment to moment. Since collaboration is so important in therapy (Duncan, 2010), we also enlist the client, when appropriate, to become sensitive to tracking himself, and naming his present felt experience while staying with it, as opposed to coming out of it to report to us about it from a distance.