by Halko Weiss
In the therapeutic moment when Jade and I had a genuine exchange of love and care, when she actually experienced being received, she became at once painfully aware of the lack of this kind of intimacy with her mother, and at the same time of the experience of having it. She was able to wake up to the intimacy in the present moment. She could experience in her body what that felt like.
The therapeutic experience between Jade and me as the loving therapist figure provided a missing experience from without that then enabled her to welcome her baby self into the world with love, admiration, and care. She was empowered to provide comfort and a cradle for herself from within, as she was not able to do before. The presence of these missing experiences was a landmark on the road toward understanding, completion, and working through.
Jade’s intuitive realization of the left cradle provided her with a perfect missing experience of what should have happened in her original mothering. Alan Schore (2005) has studied this phenomenon, finding that during left-side cradling, the right-to-right hemisphere connection is significant. The left cradle encourages emotional bonding between mother and infant (Manning et al., 1997). The right hemispheres connect and enhance the attachment transaction: “The social experience-dependent maturation of the right brain in human infancy is equated with the early development of self” (Schore, 2005, p. 205). And, as Siegel (2007) has noted, when Jade can become a friend to herself and mindfully bring the essential compassion of the witness state to bear on her internal parts, the same primary attachment neural networks are stimulated.
Laughter
Laughter is common in Hakomi therapy. We initially organize our experience in life when we have few and limited experiences to go on. However, the same capacity to make or remake meaning remains with us throughout our lives. While it would not be appropriate to laugh in the presence of one who was truly a victim or at the complete mercy of his circumstances, laughter is an affirmation that life is a creative, nonlinear act, and that we all retain the capacities to be at least cocreative in the meaning process. Laughter likewise affirms that both therapist and client have a compassionate witness to bring to bear on the process of working through (Pattison, 1990), making collaboration appropriate. In fact, the long-range goal of Hakomi therapy is to empower clients to make intentional continued use of the compassionate witness state so that it becomes a lifelong resource for them beyond the parameters of therapy (Eisman, 2006).
Nourishment
Typically, clients like Jade need to have multiple experiences like what happened for deeply ingrained beliefs to change and new neural networks to be reinforced (Cozolino, 2002). The paradox of experiencing the pain of loss, coupled with the joy of receiving what has been missing, has a bittersweet quality to it. Helping clients realize this threshold experientially by having them recognize it and find the newness in it while still acknowledging the pain is a delicate balance. The therapist’s fine attunement to the moment is needed. It is essential not to rush into wanting to make clients feel better, or give them explanations, or rationalize the situation. This would be a disservice in this vulnerable moment of recognition and deeply felt experience. Working through is never rushing through. Therapy happens nonviolently at the barriers (Chapter 17). When clients can relate as a larger self to their inner child through a core, mindful place of awareness and compassion in between sessions, the healing accelerates and dependence on the presence of the therapist lessens (Almaas, 1990; Eisman, 2006; Fosha, 2005).
Waiting, holding clients in the therapeutic emotional exchange, and allowing them to recognize the self-authenticating goodness of the moment is crucial when in session. Offering nourishment in the form of physical contact can be an important agent of the missing experience (Kurtz, 2004). This needs to be done with sensitivity to the potential emotional activation that physical contact can have for the client. The issue of touch in the therapeutic exchange can be highly beneficial, but it also can be a confusing terrain for both therapist and client, if the deeper core issues are about boundary violations or relational trauma of any kind. This issue requires deeper exploration than can be done here (see Chapter 13; Causey, 1993; Hunter & Struve, 1998; McNeely, 1987; Peloquin, 1990; Smith et al., 1998; Thomas, 1994; Zur, 2007).
In Jade’s case, however, the nourishment of touch and emotional closeness provided part of the missing experience. “This did not happen then, but it is happening now” became the new experience. Jade’s mindful discovery that she could be loved had much greater impact than if I had simply told her so in ordinary consciousness. Here, she discovered it for herself and made it her own experience, not simply an intellectual insight. How much clients can actually be present to such intimacy is a good indicator of whether particular experiments with nourishment are the right ones. The issue with nourishment or gratification in Hakomi therapy is how clients are unable to take it in—and which barriers need to be negotiated to safely allow in missing experiences previously organized out (Chapter 17). Freud indicated that working through our compulsion to repeat old patterns (Johanson, 1999a) yields to an ability to experience new situations as new. Working through old beliefs results in being able to differentiate past from present.
Affect Synchrony, Loving Presence, and Somatic Resonance
The therapist’s loving presence (Chapter 9) is essential when clients are working through these moments of painful memories. Loving presence provides the container in which clients can safely and deeply experience whatever they need to go through (Lewis et al., 2000). It allows for a synchrony between therapist and client, deepening the therapist’s attunement so he can track and contact the client accurately, like a parent intimately aware of and sensitive to a child (Stolorow et al., 1987). The German word Einfühlung describes the phenomenon of being able to resonate with another and feel what he is feeling. It literally means “feeling into someone” and explains the sensorial aspect of being with another. Sensory empathy (Zanocco, 2006) describes this phenomenon between therapist and client (Fosha, 2000). The studies of mirror neurons highlight a possible explanation for such empathic occurrences (Rizzolatti & Craighero, 2004). The minute physical exchanges of positive facial expressions, (Ekman & Rosenberg, 2005), as well as positive whole-body responses, provide a new way of being received (LeDoux, 1996).
When such processes encourage Jade to deepen, mindfully regressing (Chapter 18) into the formative experiences that gave rise to the core beliefs, she is in a dual state of consciousness, both sensing herself as the younger child and knowing she is an adult in a therapy session. The interpersonal therapist-client synchrony and affect regulation (Schore, 2005) calms the child part (Chapter 18), which in turn facilitates the empowerment of the client’s adult or essential self-state to intrapsychically witness and respond compassionately to its inner child (Marlock & Weiss, 2001). An experience of working through in Jade’s case came from this inner witness state embodying compassion while the same state was present in the therapist (Allen & Knight, 2005). Thus, working through often reflects a parallel intrapsychic and interpersonal process, affirming from within and confirming from without (Brown & Ryan, 2004).
Jade found access to her core through her initial grief over the loss of her mother’s love. This opened her to the transformational experience of taking love in rather than defending against it.
Working Into the Core and Through
When clients are working through the core experience, a paradox arises: They are averse to going into the intensity of the experience; since there is a strong association of pain and sadness, avoidance of feelings is high. There are good reasons for clients to have such avoidance or resistance. Hakomi therapists assume that these defenses are highly astute ways of managing the client’s experience (see Chapter 17; Kurtz, 1990b). Such a view depathologizes clients’ defense systems, celebrates the wisdom of the often young self that devised ways to survive, and affirms an active participation on their part that creatively designed ways to protect and remain safe (Hayes, Strosahl, & Wilson,
1999).
During the working-though stage, clients face a crossroads: whether to go further into the experience or to listen to the parts of their unconscious that are trying to manage the experience. In this situation, the Hakomi method of yielding to the resistance and listening for what the unconscious is revealing through these parts is a powerful tool (Chapter 17).
Asking clients to deepen their experience is an act of faith on the part of the therapist that an organically wise unfolding is taking place. Since clarity does not come to clients all at once, instead of rejecting moments of lack of clarity as failures, they can be recognized as stepping-stones along the way to lucidity. When we proceed with an experimental attitude (Chapter 11), every result becomes new information. Hakomi therapists welcome the intelligence of clients’ feelings in the moment in a gentle and noninvasive way that is able to tolerate mystery (Johanson & Kurtz, 1991).
The crucial moment in Jade’s story took place when she deepened into her grief and had a sensory experience of it (Craig, 2003), tuning into what Damasio (1999) terms somatic markers. She experienced the loss of her mother’s love as a felt sense (Gendlin, 1996) in the moment, as if it were occurring right now. New clarity came when she was able to stay with this experience while being fully conscious that it was happening in a new context—that of a safe and caring therapeutic relationship.
At this point, clients have a choice whether to continue to identify further with the old belief set or to disidentify (Chapter 20) with the painful experience and move toward new options. The therapist needs to help clients with this process of disidentification, since they can easily construe feeling the old pain as confirming their reality one more time (Martin, 1997; Teasdale et al., 1995). Mindfulness that results in the client having the psychic distance to differentiate between having reactions as opposed to being those reactions (Kegan, 1982) is not ordinarily taught in Western culture, and must be tracked and encouraged by the therapist (Chapter 10).
Working through, in terms of the client being able to “independently face and master the conflicts in ordinary life” (English & English, 1958, p. 591), is a process affected by many variables. When clients are able to regard their new experience as real and helpful, they see that they can impact the experience they are having in the moment. This awareness lifts their previous sense of powerlessness toward the past, replacing it with a sense of understanding and compassion for what occurred in the past. Once perception shifts, the internalized past makes sense, and clients are able to see themselves and their important relationships in a new way. The narrative of their life takes on a new order, and this coherence is one of the best predictors of future healthy attachment relationships (Siegel, 2003). When deep-seated belief systems shift, they lead to the emergence of a new, more updated story, one that includes more detail and complexity. This opens up the horizon of the future, offering clarity about what one now wants to bring into one’s life that is nourishing and energizing, increasing hope, and bringing to light new and viable choices (Johanson, 2010b; LeShan, 1994).
CHAPTER 20
Transformation
Halko Weiss
MANY FACTORS CONTRIBUTE to change and learning in psychotherapy (Goldfried, 1980). The factors cited in the psychodynamic literature are the therapeutic relationship, “actualization” of the problem (Grawe, 2001)—where it comes alive as an in-the-moment experience—personal conviction and experience of the therapist, expectancy of the client (placebo effects), respectful collaboration between client and therapist (Duncan, 2010), and so forth. Generally, little credit is given to method or technique, with many metastudies showing that the personality of the therapist is more important than his or her therapeutic modality (Grawe, 2001; Hubble et al., 1999; Wampold, 2001).
Consequently, there are good reasons why Hakomi therapists put a lot of emphasis on the therapeutic relationship (Chapters 9 and 14), although it is hard to find conclusive research on what exactly that relationship should look like. Attachment theory researchers suggest a number of qualities, such as presence, safety, and so forth (Cozolino, 2006; D. Siegel, 2010; Wallin, 2007), and, in recent years, a number of psychoanalysts have discovered that the characteristics of mindfulness can also powerfully shape the therapist’s attitude in a positive way (Germer, 2005; Hick & Bien, 2008). According to these theorists, the state of being of the therapist is a strong component of how the relationship unfolds—a powerful support for Ron Kurtz’s emphasis on loving presence.
The Hakomi tradition has approached the question of transformation heuristically, taking the path of applicable argument and convincing explanation. The models we use contain well-grounded elaborations of previously established schools of thought regarding change. Among these are acceptance (Kohut, 1984; Rogers, 1951; Segal et al., 2002), creating meanings (Freud, 1999b), sharing with another person (Catholic confession, for instance), switching logical levels (Watzlawick et al., 1974), and external regulation of internal processes, such as attention (Schore, 1994).
In particular, though, and on the level of practical intervention, Hakomi employs three strong and consistent strategies to bring about lasting change for our clients: (1) disidentification, (2) integration, and (3) experiential learning. These are discussed below in detail.
Disidentification
With the use of mindfulness, Hakomi therapists introduce a tool dedicated to establishing an internal observer. They pay constant attention to tracking who is involved in the therapeutic process as the “I” of the client: Is she yelling, “I am furious,” or is she reporting, “I notice this surge of fury coming up. . . . It needs to yell”? In the latter, the observer is present and can report on her state, while in the former, the client is identified with a limiting state of being (in this instance, fury) and is “hijacked” (Goleman, 1996, 2004) by powerful emotional experience. As Schwartz (1995) would note, the furious part is blended or fused with her state of consciousness.
Hakomi therapy supports the emergence of states that are difficult for the client, but also prepares for and supports an observer to be present, especially throughout those more regressive moments (Chapter 18).
Through the concept and practice of an internal observer, Hakomi connects to ancient traditions of spirituality, those of Buddhism in particular (Johanson, 2006; Nyanaponika, 1976). Modern science shows that we can train and develop the ability to observe internal processes (Davidson & Begley, 2012; Hayes et al., 2004) through mindfulness practice. Among other benefits (Davidson et al., 2003; Kabat-Zinn, 1990; Langer, 1989), a regular mindfulness practice supports a capacity to distance persons from their own experiences without dissociating from them. In other words, the internal observer unties a person from the strong pull of identification with the different states he habitually moves through (Schwartz, 1995; Watkins & Watkins, 1997; Wolinsky, 1991).
With the cultivation of an internal witness, self-identification slowly moves into the observing position, with its traditional characteristics: calm, slow, compassionate, and interested in internal parts, with a feeling of well-being. With practice, this core state starts appearing more often. Suffering states seem more remote, and compassionate involvement with internal processes becomes possible (Eisman, 2006; Schwartz, 1995). Persons begin to move in a progressive direction where they are less likely to be overwhelmed by negative emotions. They collect the personal power to develop and find centered and integrated states of being.
This process seems to involve training effects (Hayes et al., 2004; Johanson, 2015) that create changes in the neural architecture (Brefczynski-Lewis, Lutz, Schaefer, Levinson, & Davidson, 2007; Hanson with Mendius, 2009). It has similarities with older concepts in psychotherapy like the “reflexive ego” in psychoanalysis, or with the externalization techniques of the here-and-now therapies that bring about a more outside position of observation as well.
Today, a strong movement has developed supporting the use of mindfulness in both the psychodynamic (Germer et al., 2005; Safran, 2003) and the cognitive-beh
avioral traditions (Hayes et al., 2004; Linehan, 1993). Humanistic psychology has used closely related approaches for several decades (Gendlin, 1996; Perls, 1973; Pesso, 1973). This general approach actually takes center stage in the so-called third wave in cognitive-behavioral therapy, where processes similar to the ones described in this book are sometimes called “decentering” (Segal et al., 2004) or “reperceiving” (Shapiro, Carlson, Astin, & Freedman, 2006).
Typically, clients who work in a mindfulness-centered way for a while report experiences similar to those of Bob, a 42-year-old engineer who started therapy in a fairly depressed state he called a “midlife crisis”: “With reasons I still don’t fully understand, I can see the gray fog come up. I know it has the power to pull me in, but that rarely happens now. I sit down, focus on my state, and usually connect to ‘ne’er do well Bob’ [a name he gave to a childlike part in himself]. I soften, warm up, and light comes in. I become aware of that hole in my chest, but I just see it clearly. It is pain and hurt. I understand it so well, but it does not have the power to dominate me.”
Integration: Accommodating the New
Psychotherapy has a long history of looking at personal healing as a process of integration. In 1921, Freud pointed out that “the progressing development of the child towards a mature adult generally brings about an ever-expanding integration of the personality, a condensation of the individual drives and purposes that have grown in it independently” (1999a, p. 85, translation by author). Assagioli (in Ferruci, 1982), Jung, and other psychodynamic theorists have kept that understanding alive. Humanistic psychology (Perls, 1973) and systems psychotherapy (Berne, 1972; Schwartz, 1995; Stone & Stone, 1989; and others) are among the great variety of approaches that emphasize the importance of integrating dissociated, alienated, or polarized parts of the psyche.