by Halko Weiss
3. Experiencing and exploring one’s own power, resources, and response options.
Case example: When confronted with conflict-laden situations, a young man routinely began to stutter, panic, and dissociate. This client had been physically abused by his father until the age of 18, but now had a powerful physical presence of his own. Given that the client began to dissociate (in connection with a racing heart, shortness of breath, and feeling numb) as soon as he came in contact with difficult memories, an uncovering approach was not feasible. He could not observe his inner world without getting sucked into a painful psychological swamp. He could, however, access his experience in the present moment. As a result, he was capable of realizing how powerless he felt in conflicted situations. In these situations, he experienced himself as a 10-year-old child in relation to his father. We tested his actual current strength through the experiment of him pushing his hands against mine. He began to recognize his own strength and found himself enjoying the moment when my own strength faltered in relation to his power. He was then able to take this experience into conflict-laden scenarios, reminding himself of his own strength through the process of briefly pushing his hands against one another or tensing up his arm muscles. Using these techniques, he was able to prevent himself from slipping into the trauma-driven repetition of his old coping mechanisms. As a result, he learned to improve his breathing and reduce his stuttering.
4. Perceiving and testing reality (such as the meanings of the therapist’s reactions).
Case example: Client: “Did you laugh because you’re amusing yourself at my expense?” Therapist: “No, I’m just excited about what a good experience you had this weekend at home.”
Improving Self-Regulation Through Increasing Self-Awareness
Differentiating the Inner Observer From the Inner Critic
When the ability for self-observation is present to some degree, it can be used in the service of becoming aware of automatic inner and outer reactions as is normal in Hakomi, and perhaps even in the service of changing or regulating them (Schore, 1994). When introducing this method to improve self-regulation, it is important to underscore the difference between the inner observer and inner critic and give the client tools to help avoid confusing the two. Employing the self-state of the client (Eisman, 2006; Schwartz, 1995) in relation to the multiplicity of internal, historically conditioned parts can be helpful in some cases.
During a long-term course of psychotherapeutic treatment, a female client in a deep depression became aware of the reason she would repeatedly describe difficult childhood experiences despite the fact that she felt worse afterward. Retraversing the memories of these experiences would always stir her up and lead her to question herself. This repetition, she realized, was focused on the dynamic of being understood—a quality that had not been present in her early life and had been sorely missed. While commenting on her need for understanding, however, she would simultaneously make skeptical comments that served to block its integration. As she became aware of this, she began to get mad at and reprimand herself, which led her to feel even worse. In the end, she would sink into her familiar state of depression. Over time, she became more and more aware of her need for understanding and better able to trust her insights or note when they did not seem to fit. At this point, although further developmental healing work remained to be done, the realization that she was seeking and needing understanding helped her be more understanding of and compassionate with herself. She learned to modify her behavior so as not to be insensitive to those around her. Instead of repeatedly taxing her friends’ compassion through repetition of the same stories, she found a way to both ask for and receive what she really needed: compassion and understanding.
Experiencing and Valuing the Protective Mechanisms
Discussing a client’s defense mechanisms is a particularly tricky thing to do. This process of bringing the system into consciousness should be approached and discussed from the perspective that these defenses are valuable and have served a necessary and important purpose, namely, ensuring the client’s protection. Failure to do so can put the internal structures that these defense mechanisms have been protecting at risk and destabilize the client. Normally in Hakomi, defense mechanisms are not named and interpreted as in some psychodynamic approaches. They are usually contacted as the process unfolds in a way that invites curiosity and the empowerment of self-discovery: “Oh, anger comes up when someone questions you[?] Are you curious about that? Maybe we can hang out with the anger longer, and see if it can say more about itself.” If intrapsychic work is possible, that is, if sufficient structure is present, the client may eventually be able to recognize that these behaviors may no longer always be necessary and can be seen instead as optional approaches along with others that together provide more flexibility and freedom.
Mindfulness
Currently, multiple psychotherapeutic approaches are being introduced and discussed under the name “mindfulness-based therapy.” These therapies are discussed in relation to their application for the purposes of stabilizing those with difficult clinical disorders (Grossmann, Niemann, Schmidt, & Walach, 2004; Sonnenmoser, 2005). For each of these approaches, the client must be capable and interested in at least occasional self-reflection, in building up the “reflexive mind” (Aron, 1998b). Mindfulness and the development of an inner observer are important self-regulation techniques in the trauma therapies of Reddemann (2001) and Rothschild (2000, 2003), as well as in Jon Kabat-Zinn’s mindfulness-based stress reduction (1990) and in Marsha Linehan’s dialectical behavioral therapy (Hayes et al., 2004). With each of these therapies, the goal is for clients to develop the ability to step back and observe themselves from a nonjudgmental stance, such that they are neither overwhelmed nor dissociated, so that they can become more aware of their patterns of action and reaction. In these therapies, mindfulness is one technique employed within the context of other clinical interventions or methods. In contrast, the Hakomi method is the integrated employment of a state of mindfulness throughout its therapeutic approach. This includes assisted meditation (Kurtz, 1990b), staying with and observing one’s own experience, and supporting mindful self-study (Johanson & Kurtz, 1993) when a client is structurally capable.
Some experienced therapists have explored using mindfulness with psychotic patients in inpatient settings as a way of helping them introduce a distance between them and voices they hear that can take over the seat of consciousness: “Can you say ‘hi’ to that jealous voice?” (Coleman & Smith, 2006; Romme & Escher, 2000; Whitehead, 1992). A listing of other resources for working with voices, plus an alternative view of working with psychosis in general that is compatible with Hakomi, can be found in Williams (2012).
The Security-Providing Helper-Ego Function of the Therapist
Because of the number and level of unsettling physical symptoms they are dealing with, structurally deficient clients with anxiety are often not able to engage in mindful observation of their bodies. In these cases, the therapist can provide psychoeducational information about what different physical reactions normally mean.
In the closing session of a long-term course of psychotherapeutic treatment, a female client who experienced panic attacks and a number of phobias told me the following: “What was most helpful in the beginning was when you explained that all strong, emotional reactions result in increased heart rate—both in joy and in fear. Learning that this was normal was such a relief.”
In this case, the therapist is not helping the client explore her own self-organization, but is acting as an expert whose information can normalize experiences and help clients better orient themselves and assess their own experience. When this results in a calming response, the therapist can contact it in order to call the client’s awareness to it: “It’s a relief to know that, isn’t it?”
Only a Secure Therapist Can Provide Security
In accompanying clients with structural limitations through their therapeutic journeys—journeys that are chall
enging for both therapist and client alike—it is the therapist’s own internal sense of safety and security that enables a positive therapeutic outcome. The ability of the therapist to successfully provide a holding environment, to be able to create a therapeutic container that can enable clients to share difficult memories and strong emotions while remaining present and not overwhelmed, is largely dependent on how well a therapist knows and is in touch with his own boundaries. In situations in which a therapist is feeling overly challenged, unsure, or threatened by the client’s or his own experience in the moment, maintaining the therapeutic framework becomes impossible—and yet, this dyadic regulation (Schore, 2003; Siegel, 2003) is exactly what these clients need most in these moments.
In order to feel safe working with a physically imposing client’s repressed anger and power, I ensured that our sessions took place while other therapists were present in the practice’s office. Knowing that I could call out for help if I needed to enabled me to stay calm and remain present in our work.
Because therapists working with structurally deficient clients are required to take on responsibility for a great deal of the psychological leadership and regulatory functioning, ongoing supervision is particularly important. It is with supervision, for example, that clarity can be gained around whether feelings of insufficiency are based in countertransference or if they indicate the therapist is up against personal limits or the limits of competence. These types of feelings are important to pay attention to, as is the process of distinguishing the particular meanings they might carry.
Conclusion
The use of the Hakomi method must be approached carefully with clients with structural limitations and those who are more clinically disturbed. Clinical knowledge about disorders and treatment methods is as important as being in touch with oneself, the client, and the process as it unfolds. A diagnostic process that continues throughout the course of therapy in conjunction with supervision will serve the therapist well in this type of work—helping to ensure that the therapist will not come to feel overwhelmed or burned out but will be able to guide even long therapeutic processes with joy and genuine curiosity.
APPENDIX 1
Glossary of Hakomi Therapy Terms
Cedar Barstow and Greg Johanson
THIS GLOSSARY IS provided as a convenience to readers who might not be familiar with all the terms used in the chapters, especially those used earlier in the text that are not more carefully defined until later.
accessing: The process of transitioning from ordinary consciousness through turning a person’s awareness inward toward felt present experience in a mindful or witnessing state of consciousness.
barriers: Beliefs that block the normal organic process of attaining sensitivity and satisfaction. Insight barriers block clarity about what is needed. Response barriers block effective action to obtain what is needed. Nourishment barriers block the experience of satisfaction when something is obtained. Completion barriers block the relaxation that functions to savor the need satisfied, release tensions, and give further clarity about what other need the organism is now ready to reorient toward. More generally, barriers are those parts of us that come into play after some sort of wounding that attempts to protect us from the hurt ever happening again.
bottom-up processing: A concept from sensorimotor psychotherapy that contrasts the mindful processing of sensations, tensions, and such generated by lower brain functions as a result of traumatic activation (bottom) with that of the more common mindful processing of thoughts, emotions, and memories available to the cerebral cortex (top-down processing). Premature top-down processing can evoke a harmful trauma vortex, if bottom-up processing of sensations as sensations has not empowered the body to titrate and metabolize such material without being overwhelmed by their normally instantaneous eruptions.
CAS (complex adaptive systems): One of the commonly used terms for the science of living organic systems that informs the Hakomi method’s principles and view of human psychology, functioning, and transformation.
character: In a positive sense, a person’s stable way of making meaning of life through organizing multiple dispositions from metabolic, psychosocial, and structural factors so that the person displays consistent, predicable behavior. In a therapeutic sense, a way of experiencing and expressing oneself in a rigid way, unaware of or unable to make use of a wider range of realistically available choices.
character process: Any one of a number of characterological ways of being in the world that have been delineated in Hakomi and general psychological literature as having identifiable, predictable components (see character above). Referred to in Hakomi literature by both descriptive and classic terms: sensitive/analytic = schizoid; dependent/endearing = oral; self-reliant = compensated oral; tough/generous = psychopath I; charming/seductive = psychopath II; burdened/enduring = masochist; industrious/overfocused = phallic; expressive/clinging = hysteric.
character strategy: The patterns, habits, approaches to the world a person has developed to achieve pleasure and satisfaction while avoiding perceived painful situations, given the nature of the person’s particular core organizing beliefs about the world.
child: A state of consciousness in which one is aware of one’s current adult status and at the same time is experiencing the memories, feelings, thought modes, and speech patterns of childhood.
contact: An initial and ongoing technique in which the therapist names the immediate, often emotionally meaningful, experience of the client in a simple way the client can easily confirm or modify. Therapist: “A little sad, huh?” Client: “Uh, it has more of a quality of grief.” Level 1 contact is used when the therapist is attempting to build an interpersonal bridge of understanding. Level 2 contact is used as an accessing technique to invite the client to pay mindful attention to his or her intrapsychic experience.
core beliefs: The usually implicit level of consciousness, normally influenced by developmental beliefs and decisions, that organizes and mobilizes experience and response before experience and response happen; the program that is running the computer; the level of creative imagination or filtering that makes reality available to consciousness.
core material: Composed of beliefs, nervous system patterning, sensations, memories, images, emotions, and attitudes about self and the world—and related to (often early) formative experiences—core material shapes our patterns of behavior, our bodily structure, and our experiences. Core material is primarily unconscious until brought to awareness.
deepening: The process of helping a person stay with present experience in a mindful or witnessing state of consciousness long enough for it to lead to information about core organizing beliefs; how reality is being structured or limited.
dispositions: A term from the philosopher of science Karl Popper for describing the unconscious as the result of multiple genetic, metabolic, interpersonal, cultural, and social forces that dispose one’s organization of experience in various directions, but do not absolutely determine the result. All persons have at least the ability to be co-creators of how they are organized.
hierarchy of experience: A common shift or progression in the course of the deepening process is from thoughts and ideas, to sensations and tensions, to feelings and emotions, to memories and images, to meanings and beliefs.
holon: A shorthand term from Arthur Koestler in the philosophy of science that describes the most basic building block of life. To be a holon means to be a whole that is made up of parts, which in turn is a part of a greater whole, resulting in an interdependent, participatory universe, one of the implications of Hakomi’s unity principle.
intersubjectivity: The assumption that all people, clients and therapists alike, organize their experience in unique ways. The implication for therapy is that no one can claim to experience life cleanly or correctly, so that the process must embrace the humility of curiously collaborating and comparing intuitions of what is happening and what is possible.
jumping out of the
system (JOOTS) Going from being in some automatic form of habitual behavior between client and therapist, to noticing the pattern, to the freedom to step outside the normal reactions through nonjudgmentally naming them in a way that brings them under observation.
magical stranger: The therapist as a compassionate adult who appears as if by magic when the client is experiencing a traumatic childhood memory, to support the child through the painful and confusing event.
method: Hakomi therapy as a specific form of psychotherapy that distinctively (in a classic form that always allows for the spontaneous) progresses through a mindful sequence of accessing, deepening, processing, transformation, and integration, with accompanying notions about character, therapeutic approaches, techniques, and so on.
mind-body holism: One of the principles that maintains that mind and body are inseparable in interacting and influencing each other. Core narrative beliefs that can come into mental awareness influence posture, body structure, gesture, facial expression, emotions, and so on through the voluntary musculature, hormone system, and such. Feedback from chronic bodily mobilizations confirms and reinforces belief systems. Hakomi therapy constantly explores the mind-body interface.
mindfulness: A witnessing state of consciousness characterized by awareness turned inward toward live present experience with an exploratory, open focus that allows one to observe the reality of inner processes without being automatically mobilized by them. Also, a principle of the work that maintains the value of being able to step out of the habits and routines that normally control consciousness and behavior to observe the reality and organization of experience without being fused or blended with it, so that choices and change become possibilities.