Hakomi Mindfulness-Centered Somatic Psychotherapy

by Halko Weiss

  The therapist must be willing to gently refocus the client again and again toward mindfulness, meaning, and subtler experience, and away from refuge in intensity.

  Therapeutic Strategies and Interventions

  The intention of therapeutic interventions with the expressive/clinging client is to help him open to feeling loved—to reach out without expecting rejection—to help him shift from dramatizing to simply speaking the truth about his needs and wants, and to experience being heard and understood at a deep level.

  Expressive/clinging clients have barriers to insight (meaning), response (often reacting or acting without thinking), and completion (finding it difficult to let go). Some probes that help these clients study their core organizing beliefs and habits are: “You are lovable just the way you are,” “I’m here with you,” “I’ll listen to you,” “I’ll pay attention to you.”

  Experiments can be done with having the client mindfully hold back emotional expression to see what else is there, or pausing periodically to have the client practice getting the meaning of things and then contacting his understanding. Other experiments include taking over, reaching out, letting her hold on, or placing a hand on his heart. Sometimes, especially early in the therapy, persons disposed this way talk so much and so fast that it is hard to get in any kind of word or contact in response. Therapists might have to experiment with raising their hand, politely interrupting the system, and entering into the person’s process by saying something along the lines of, “I really want to understand what is happening with you, and to do that, I need us to go a little more slowly.” Or “I know you are saying a lot right now, but I’m not sure you know that I am actually hearing you.”

  When the therapist can really listen to the deep pain and heartbreak of the client, can contact the drama without being seduced or rejecting, and can mindfully explore the creation of a relationship where the client feels listened to and understood without a need for drama, the client disposed to expressive/clinging can experience a genuine opening of the heart. As a result, her creativity and expression can flow into the world from a calm, centered, and informed place. That is the hoped-for integration—not that the client loses her capacity for expressiveness and contact with others, but that it no longer comes from a desperation for inclusion, but from the joy of knowing her fundamental attachments to self and significant others are secure.

  Summary

  The understanding of character dispositions allows for tailor-made interventions that specifically address clients’ particular developmental woundings. When a client’s basic conflicts are intuited, they can guide the therapist’s informed use of other Hakomi uncovering techniques (see Chapters 14–19), especially jumping out of the system (Chapter 22). After uncovering core organizing beliefs and behaviors, corrective (missing) experiences can be offered in mindfulness, so that the new information, when studied and practiced in the therapeutic milieu, might engender more expansive core beliefs and more satisfying life options for our clients (see Chapter 20).

  It is axiomatic in Hakomi that a person is always more than a character type, but rather is disposed toward a particular way of organizing or managing experience. When clients are encouraged to be mindful and study the automaticity of how they are characterologically organized, a constant hope is that they learn more and more about how to rest in a mindful self-state characterized by awareness, curiosity, compassion, and wisdom—beyond the pull of historically influenced ego states—a state of consciousness Schwartz (1995) has called the Self; Eisman (2006) has called the Organic Self; Monda (2000) has called the True Self; Almaas (1986, 1988, 1990) has called the Essential Self; the biblical Paul (Romans 7) has called the Inmost Self; Lossky (1974) has called the Heart Self; and others have called other things in both contemporary psychology and ancient wisdom traditions.

  CHAPTER 24

  Mindfulness and Trauma States

  Manuela Mischke Reeds

  EXPERIENCING TRAUMA IS not only a shock in the life of clients, but also an event that alters how they see themselves. Clients categorize their lives in terms of before and after the trauma experience (Herman, 1992; van der Kolk, 2014). “Before my accident I was able to run and go everywhere. Now I am afraid to leave my house.” Traumatic events can mark distinctive chapters in one’s life or have an ongoing chronic impact on a person’s psychoemotional and physical life (van der Kolk, McFarlane, & Weisaeth, 1996).

  Much has been written and discovered about trauma, especially since the 1990s. Somatic psychotherapy has been greatly enhanced by the works of Bessel van der Kolk (1987, 1994), Peter Levine (with Frederick, 1997), Pat Ogden (Ogden et al., 2006), Babette Rothschild (2000, 2003), and many others in the field who have advanced our understanding that traumatic events are experienced through the body. Treatment modalities need to include a deep understanding and methodology for resolving trauma on a psychophysiological basis (van der Kolk, 2002, 2014).

  We now understand in somatic psychotherapy that work with traumatized clients needs to include working with the sensory experience of the body. Traumatic events cannot be talked away through top-down processing, but need to be carefully renegotiated in the memory and nervous systems of the body through bottom-up processing. The activation levels of the limbic structures of the brain need to be held in an optimum range of neither under- or overactivation, so that the client is able to take in new information on a neocortical level (Ogden et al., 2006). Clients must be able to be alert and focused enough that they can feel, sense, and comprehend what is occurring inside of them, and how they are making sense of their trauma events through a cohesive narrative (Siegel, 2007), so that there is coherent comprehension of what has happened to them.

  Like a good story, the event must be understood on all levels of human experience to make sense. Part of trauma is the senselessness of what has occurred. The more loss or life threat clients have experienced, the more they are faced with the senselessness of it all. Making sense requires an intellectual comprehension along with a physical one, with the hippocampus functioning to weave meaning from implicit memory (Schacter, 1992).

  Many traumatized clients are not able to mobilize these intellectual and physical requirements for addressing the senselessness of their trauma. They cannot operate within what Ogden and colleagues (2006) term the “window of tolerance,” where Porges (2003) says the ventral vagal nerve facilitates our capacity for social engagement, with ourselves (Siegel, 2007) or others. These clients display signs of either hyperarousal (increased sensation, emotional reactivity, hypervigilance, intrusive imagery, and disorganized cognitive processing) or hypoarousal (relative absence of sensation, numbing of emotions, disabled cognitive processing, and reduced physical movement). When these signs are present, it means the person is dissociated to a degree and not really present to the therapy in an effective way (Ogden et al., 2006). Therapists without specific training in working with such indicators of trauma should consider referral or seek the requisite training through the Hakomi Institute, Sensorimotor Psychotherapy Institute, or other qualified training providers.

  In this chapter, the focus is mainly on neurological development and trauma therapy from a Hakomi perspective, and how mindfulness can help mediate the comprehension and integration of traumatic experiences. Trauma therapy is a vast topic and here only a few aspects of our unfolding understanding of how to treat trauma symptoms are highlighted. Please see the references for a more in-depth study of this subject.

  Meeting the Client, Meeting the Brain

  Erikson (1963) helps us understand the trauma to veterans of Vietnam by explaining that key developmental issues such as identity formation happen in late adolescence and early adulthood. However, it also remains true, as object-relations and self-psychologists have researched (Stolorow et al., 1987), that our earliest levels of development leave a foundational footprint that influences how we process later difficulties. Newborn babies are exquisitely sensitive when they arrive in the world. The organ of their sk
in is taking in every touch as a new experience to be processed throughout their whole body and brain (Schwartz & Begley, 2002). Touch and early sensory stimulations are strong excitations for the young nervous system. They are stressful in the sense that the developing brain of the infant has to process and organize these previously unknown experiences (Siegel, 1999).

  The loving orientation of a warm and consistent caregiver provides containment for these arousing experiences. The attuned attention of the caregiver is key as the child learns how to incorporate these strong sensorial activations into an organized pattern of relationship style. For instance, the mother’s soft voice and repetitive, gentle strokes along the baby’s back as he is crying and arching give rise to a rhythmic and intuitive dance, evolving between caregiver and infant through matching voice tone, eye gazing, smiles, and gentle touch. Over time, the child begins to perceive touch and such stimuli as a nonthreat (Cozolino, 2006).

  These experiences are internalized not only as sensory-emotional memory but also as a perception of how the child is being received into the first relationship template. These experiences translate into deep belief structures in the psyche of how one is loved and cared for, and influence one’s capacity for loving another (Kurtz, 1990a).

  When the touch-care continuum is internalized negatively, many years later, life is perceived and felt as a threat—just as the early template of sensorial stimulation was not matched with the experience of love and care. These deep sensate templates become compounded when trauma is present, and provide a confusing and overwhelming landscape for the trauma client (LeDoux, 1996). The capacity of the trauma client for self-reflection, self-soothing, and basic hope in the face of despair (Shaver et al., 2007) is based on how she is resourced in her foundational years when establishing safety in early relationships is crucial. There is a serious difference between chronic developmental trauma and event-centered trauma such as an accident or war experience.

  I am reminded of a Nicaraguan client who was politically tortured, whose capacity for overcoming the most horrific events was admirable. Her reply in one of our sessions to a comment on how well she was doing despite those tragedies was, “They can break my bones, but they can’t take my spirit,” an idea that could evoke endless hours of contemplation. What we know of trauma survivors, especially those who have been tortured, is that a refugee’s unfaltering faith in his or her cause can be a psychological savior in face of such horrifying experiences.

  However, there was another truth about this person. As we referenced her statement in the months to come, I discovered in this client’s history a very loving and warm family, with a mother who was attuned and caring to my client as a young child. Her foundational relational matrix was intact—despite her injured body, the tragedy of having lost every person she had loved including her child, and the trials of living in a foreign country and having few skills in her new country’s language. Still, her internalized mother provided palpable hope in the process of healing her trauma symptoms.

  Learning the internalized skill of self-soothing is a delicate exchange between the mother and the infant (Tronick, 1989). The internal state of the mother regulates much of the baby’s state and vice versa (Schore, 1994). A colicky baby’s cries and fussing can begin to exhaust an already tired parent, setting up an internal chain reaction in the mother (caregiver) and escalating the chain of stimulus until she is overwhelmed. The baby may then experience parental patterns of withdrawal, anger, helplessness, and emotional distancing. Selma Freiberg’s famous term “ghosts in the nursery” reflects the entrenched emotional patterns generated in the subtle, moment-to-moment exchange between caregiver and child (Doidge, 2007).

  Babies who learn that their cues of distress are not responded to as needed develop a high-activation continuum in the brain stem, diencephalon, and limbic regions of the brain whenever stressful moments are experienced (Perry et al., 1995) and become dysregulated when there is no mediation by the caregiver. The dysregulated internal states of the baby can in turn further dysregulate the mother’s internal states, which further dysregulate her infant in a problematic cycle. Infants in this arousal continuum are at great risk for abuse and continuous high stress levels. A prolonged exposure to these high stress levels in the brain can have lasting impact on the developing brain’s memory system and capacity for emotional range (Lewis et al., 2000; Schacter, 1996).

  The intricate exchange that takes place between mother and child on a moment-to-moment basis is largely nonverbal—gestures, facial expressions, and whole body expressions convey the message of the emotional state. The child becomes masterful in reading these cues and responding to them in ways that preserve and enhance the relationship. These exchanges of subtle cues are, I believe, the same in an in-depth psychodynamic approach to psychotherapy (Lewis et al., 2000; Tronick, 1998).

  Psychotherapy as Potentially Overstimulating

  The internal states of clients impact psychotherapists a great deal. If a client is highly dysregulated and not making eye contact with the therapist, this can be met in various ways. How therapists respond to the lack of an empathic relationship depends on their own momentary state and their history, as well as their training (Roy, 2007).

  For instance, Gerald was unable to look me in the eyes at any time. In fact, he constantly diverted his eyes away from me, staring at the carpet, as if lost in a distant dream. Over time, such somatically embedded behaviors of the client, as well as the basic needs of the therapist, can make even the most compassionate therapist uneasy (this is assuming a Western therapist, and I recognize the cultural bias here; see Foster et al., 1996; Johanson, 1992; Lewis et al., 2000; Sue & Sue, 1990). A subtle rejection might begin to form in the therapist who feels she cannot relate to this client or understand him on a deep level. Feelings of resentment or failure might arise. The loving presence of the therapist begins to alter. This, in turn, fuels the worst fears of the trauma client. Instead of experiencing the delight and consistency of the therapist, he once more experiences a caregiving person not seeing or understanding him, and withdrawing (Feinstein, 1990). The internal arousal of stress is exacerbated.

  The intimacy of psychotherapy, and especially somatic psychotherapy such as Hakomi, can easily travel into the terrain of sensory experience (Heckler & Johanson, 2015). This means that although clients might want to discover and transform the core beliefs that are holding them back by impacting their relationships with self and others, the very process of psychotherapy might be adding to their feeling of overwhelm. Activated clients cannot process their core material. The activation level itself prevents clients from bringing the experienced material into the rational and logical part of their brains (the neocortex) for comprehension and processing. The actual experience of the therapy backfires and is experienced as too activating and arousing (Ogden et al., 2006).

  This is a crucial point that is often missed by well-meaning verbal and body-inclusive therapists who feel their unconditional positive regard can automatically create a safe place. The arousal states of clients need to be brought down in specific ways in order for them to witness and comprehend what is occurring. Just beginning to experience a high arousal level can bring up learned defense mechanisms, as well as triggering basic survival mechanisms of protection (Morgan, 2006). This is a delicate balance, as the therapist wants to allow and facilitate the client’s emotional processing, which in a particular moment can escalate into an activation level or trauma vortex that the client cannot manage. It is often important to begin working on the multiple ways a person can resource herself mentally and somatically before beginning to address the trauma directly. Then client and therapist together can track the ability to go back and forth from the resourced position to a piece of trauma small enough to be titrated and digested by the nervous system.

  For more information on how to titrate triggering sensations and how to work without promoting a trauma vortex that can retraumatize a client, we can refer at minimum to the work of Levine
(with Frederick, 1997), Ogden and colleagues (2006), and Rothschild (2000, 2003). All somatic psychotherapy that aims to negotiate the arousal of the nervous system in elegant ways seeks to track and address activations and dissociations beyond the client’s window of tolerance, so clients can actually be present with their experience and find new ways of relating to their triggers.

  Mindfulness and Interruption of Nervous System Patterns

  Mindfulness is a state of being, as well as an inner reflection on moment-to-moment experience (Chapter 10). As discussed throughout this book, the use of mindfulness plays a central role in Hakomi therapy in the discovery of internally held beliefs and experiences. The predicament of clients with trauma is that it is a state of disruption of their life force that renders them unable to handle the arousal levels in their body. The coping mechanisms vary with each person according to his or her capacity for self-regulation and function. Nevertheless, in a general sense, the trauma client has lost the capacity for being with himself in a calm, resourced way. Trauma states can be viewed as uninterrupted states of mindlessness. Lower brain functions are in charge as opposed to the thinking brain.

  Hakomi therapy can provide a beginning place for meeting the trauma survivor’s brain and treating it in a multifaceted way. In Hakomi, we pay attention to present-moment, direct experience, and how the client is relating to it. This direct relationship with time and history has an important function (Pert, 1999). Clients can experience their traumatic past in relationship to multiple parts of themselves (Rowan & Cooper, 1999), as well as to the therapeutic relationship. That the therapist calls the client’s attention to what is occurring for him in the moment offers the client the awareness and self-control to interrupt automatic patterns and experience himself in a new way (Siegel, 2007).

  This might occur in minuscule moments, such as with Sylvia when she glanced up at her therapist with a look worn down by many years of rejection and the chronic emotional pain of trauma. The therapist received her with acceptance and positive regard. She startled. His eyes widened. The Hakomi therapist tracked this and used this moment to gently contact and guide her to noticing that she was surprised not to find the expected hostility. Sylvia’s crying deepened as she nodded. A mixture of recognition, pain past and present, were all mixed in a soup of gratitude and aliveness. She had been seen, received, and led into a new state of aware wakefulness. The past did not matter in that moment. The authentic connection with her own pain and the acceptance by another provided a new experience in which her symptoms took a break. She could let in a ray of hope that life need not be as bleak as she had perceived it to be.