Hakomi Mindfulness-Centered Somatic Psychotherapy

by Halko Weiss

  Adding the active elements of compassion to the passive element of the bare attention of awareness can help heal the fragmented ego appreciated in the West. Staying with the practice of simply watching experience arise and move by can help progress toward the unity consciousness esteemed in Eastern psychology. There can be a bridge here, with no need for a false forced choice. Thich Nhat Hahn, the eminent teacher of mindfulness and peace, could come upon a Japanese soldier in the jungle and teach him the value of a witnessing form of meditation. He could also have the active compassion to let the soldier know that the war is over.

  Husband, Ben

  T: Hey, good to see you. [Promoting positive affect and transference, nourishment, secure attachment, and what Fosha refers to as not just seeking a new ending but also seeking a new beginning.]

  C: Uh huh. And what is so good about it? [Trusts therapist enough to challenge—a return greeting in ordinary consciousness.]

  T: [Smiling and making eye contact.] Oh, you know. No good reason really. Well, maybe your engaging smile, your dedication to your family, your persistence, your loyalty. Not your good looks, for sure. Well, actually, you are skinnier than me. I wouldn’t even be able to deploy. [An attempt at integrating humor into the process. If people are at least cocreators of the meaning of their lives, then the creativity they use to organize their experience in one way is still available to help reorganize it in a new way. Humor affirms this capacity, which would not be appropriate with someone who was an absolute “victim” or “sick.” Also an example of the use of self-disclosure (Prenn, 2009).]

  C: [Laughs.] Hey, you can be skinny too. Want to join me each morning for a 10-mile run? [Appropriate rejoinder reflecting decent therapeutic alliance, a lot of mutuality, though still asymmetrical. It is important that clients know the therapist appreciates them in their strengths as well as their vulnerabilities.]

  T: Pass. Although I am working out a lot. I can now do three laps around the car without needing an oxygen tank! So what is going on that it is not so good to see you today? [Transition from initial nourishing small talk and contact to issues at hand. Important that positive exchanges never gloss over the truth of present experience.]

  C: Still having a hard time just relaxing with Ed. End up ordering him round, like I’m trying to whip him into shape or something. Geez! The kid is barely four, and it feels like I’m an E9 [sergeant major]. But the most distressing thing is that I was walking around the village when Trish and Ed were in church; fairly relaxed, taking in the green, starting to feel that maybe I was in a relaxing place when a car backfired and I hit the deck! Jumped back up really quick, but really embarrassing and I haven’t been back in town since. [PTSD symptoms: exaggerated startle response, sense of reliving trauma experience, significant social stress, avoiding activities and places.]

  T: Wow! Lower brain just took over. Yeah, very disturbing. [Contacting present experience in a way that validates the event. This is the 10th session, and the therapist has been sharing some physiological information with Ben that helps him feel that his reactions are in the ordinary realm in terms of what he has been through, and that it is known, recognizable, and workable.]

  C: Seriously. How can I function in the world and think about getting an ordinary job? [More symptoms of detachment, estrangement from the world, and poor sense of future possibilities.]

  T: So, just remembering the backfire is activating. Let’s stand up together and do some resourcing. Stand in that [baseball] short-stop stance, feel the ground under your feet. . . . Feel the flexibility in your knees. . . . Rock right and left a little bit. Notice the transition between the two. . . . Notice your strength and readiness to do what needs to be done. . . . Put your hand on your lower stomach and breathe into it on the in breath, and make your hand move out. . . . Can you feel your hand there? What tells you it is there? . . . Just notice whatever other signals you are getting from your body. [Because the activation levels are taking the client in a hyperaroused state beyond his window of tolerance, the therapist abandons verbal, top-down processing that could risk setting off a trauma vortex. The client allows him to become very directive, concentrating on the body instead of emotions, since they have done resourcing together before. The therapist does encourage mindfulness of body signals. The instruction to “just notice whatever other signals” is a more general invitation to mindfulness. The therapist is exploring how resourced the client is in relation to being present to experience from the theoretically more safe distancing place of mindfulness.]

  C: I feel like I’m on lookout. [The physically ready stance is resourcing but evokes the memory of serving as a lookout.]

  T: Yeah, looks like your head is rotating a bit, bobbing and weaving slightly, like you are really vigilant. [Therapist contacts the experience but is a bit worried about not wanting to throw the client back into a traumatizing memory that would overwhelm him.]

  C: I can sense my eyes are tightened and squinting. It feels like when I was big into R&S [reconnaissance and surveillance]. I was always good at the Avoid Ambush drills and did a lot of gap work [lining out safe passages through minefields]. [Client is on the dynamic edge of being able to mindfully witness his sensations and tensions, and being in danger of getting flooded and fused with traumatic memories. Kurtz often noted that learning happens on the edge between order and chaos, and the therapist attempts to track the balance here.]

  T: Let’s just bring your awareness and curiosity to the eyes alone, to the tightening—not what it means, but just study it in terms of muscular tension alone and notice what happens. . . . Report on your experience without coming out of it, and tell me about it. [Therapist feels things are too volatile and chooses to employ what Ogden calls “directed mindfulness,” directing mindfulness to lower brain-generated sensations decoupled from emotion, stories, and so on. Reporting without “coming out of it” to tell the therapist about it is a helpful directive for keeping the client’s mindful focus on the unfolding of internal experience, which is interrupted when he feels he has to come back to the normally expected realm of interpersonal discourse to report.]

  C: As I pay attention to the tightness, it seems to loosen up. . . . Now I’m noticing some kind of fear in my gut. [The process unfolds in this mindful state, with one thing becoming connected to another that fleshes out this procedural tendency.]

  T: So, let’s pay attention to the fear in the gut simply on a sensation level and follow it wherever it goes. [Continued use of directed mindfulness of sensorimotor processing. The “we” language of “let’s pay attention” supports both secure attachment and the dynamic of there always being an interpersonal process parallel to the intrapsychic exploration mindfulness often encourages.]

  C: The fear sensation seems to travel up into the throat . . . where it clamps . . . down . . . or clumps up . . . kind of like a ball. [Good witnessing that serves to self-regulate instant, out-of-control fear and maintain a curious, open stance toward it.]

  T: I’m just guessing, but it seems like the sensation wants to move, and there is some other part of you that wants to block it for some good reason we don’t know right now. How about we experiment with you holding this pillow to your face and mouth and allow it to be the part that is clumping up the movement of the sensation? Don’t force anything, but just hold it there and notice what arises spontaneously. [This is an example of a taking-over technique from Kurtz, who finds that when a defense is supported in the state in which it naturally arises, it paradoxically allows the process to go forward. The word “experiment” underscores an experimental attitude that underlies mindful work, which lends itself to more curiosity and allowing, as opposed to forcing or engineering. It fosters the attitude that whatever is evoked in the process is fine and natural and becomes ongoing grist for further processing. Likewise, the phrase “I’m just guessing” makes it crystal clear the client needs to go with the truth of his experience and feel free to ignore the therapist’s guess if it is not accurate.]

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p; C: Uh, okay. [Holds pillow close to mouth.] . . . Oh! [Shows signs of increasing agitation. . . . Holds pillow forcefully toward mouth so the sound is quite muffled while screaming into it repeatedly in rhythm with rocking motions of head down and up.] [Spontaneous occurrences such as this that are not the result of directives are usually trustworthy. The pillow muffling the sound has apparently worked in taking over the function of some part of Ben that didn’t want people hearing him yelling.]

  T: Okay, keep screaming as long as it feels good, feels right. [We are working not with a hydraulic-expressive model here but with an information-processing one, so the therapist is not encouraging simple catharsis or emptying. But tracking pleasure in terms of what feels good, right, or satisfying is often a good indicator of completing some action tendency that has been thwarted.]

  C: [Finishes screaming in a semiexhausted but seemingly good state.] Oh man! I got it . . . whew . . . both parts [more heavy breathing, catching breath]. . . . The scream is “Get out! Get out!” I’m so tense being responsible for my men, worrying about their welfare, worrying I’m going to have to call some wife and give her the most shocking f-ing news of her life, and this is no place to be. They need to get out of there, get out of danger. The pillow is duty, mission. [Core Army values—never abandon the mission. The wonderful result of encouraging a mindful, curious process is that clients end up interpreting for themselves, which often allows the therapist to follow more than lead.]

  T: Whoa. Yeah. You nailed it. How horrendous being responsible for life and death. No wonder you want to get them out of there. [Basic human confirmation.]

  C: God yes! I think this is why I hesitate to go to church. I don’t like this God business. [A spontaneous connection arises.]

  T: Okay, so we need to check in more about doing God duty. Right now, check in on how your body is doing. Notice if there any other sensations or movement tendencies that are talking to you. [Therapist invites a search for other aspects of the mind-body that might be involved in this procedural tendency to be in hypervigilant duty mode.]

  C: There is energy in my legs for sure. [Good witnessing of what is there without slipping into overactivation.]

  T: Sense into the energy and notice if it wants to mobilize you into any kind of movement. If so, slowly follow just the beginnings of the movement. [Here the therapist has a hunch and is entraining awareness toward movement, when energy can actually lead to other things as well.]

  C: [Slowly, mindfully checks in with energy.] . . . Yeah, it wants to move the legs. . . . IT WANTS TO RUN!

  T: Yeah! So in your imagination now, and also allowing your legs to move up and down as much as you want, yell to the squad to get out and run! No mission here! Nobody left behind! No reason to be here! Run! Run! Run! [We know from trauma work and recent research in neurobiology that the imagination can stimulate the same neural networks as in real life and can be used to complete action tendencies frozen in time. The instruction here takes into consideration the countermessage of the clumped-up throat that prevented the natural expression of screaming and running in the war zone.]

  C: [Takes a few minutes to really get into the running away scene where he shepherds his men like a sheepdog, with his actual legs going up down rapidly while running in place and imagining. Finally collapses on floor in a good way and leans back against the sofa.] Oh, man! Oh, geez. I finally feel relaxed, like I don’t have a foot on the gas and brake at the same time. [Natural result of an action tendency taking its course, and an implicit procedural tendency coming into cortical consciousness.]

  T: Great. Very nice. So just sit back for awhile and savor what it is like to be in this state of relaxation. Notice in a curious, spacious way what is different in your sensations, tensions, feelings, attitudes, whatever. [Important to savor and integrate the new experience. A large part of mindful processing is simply slowing things down.]

  C: [Follows instruction in a slow, mindful way.] . . . I really like looking around with my eyes in a soft way that takes in more information actually than when they are tense and seriously focused.

  T: So, from this relaxed state, I would like you to experiment with inviting the on-duty sergeant you that is mobilized to be on mission and worried about his men to come into view. Let me know when you have some kind of visual image or bodily sense that he has come into view. [This is an example of the distancing-while-still-being-present aspect of mindfulness. Saying “visual image or bodily sense” makes room for those who don’t get visual images easily.]

  C: Okay. He is front and center.

  T: Good. So, check if you are in that place of compassionate awareness that can express to him some gratitude and thanksgiving that he can go on this impossible God duty where he takes on a mission while carrying all this concern for his men and just wants to get them out of there. And if you are in that space with him, notice if he can take in the appreciation.

  This type of mindful therapy is never about exorcising or fighting against parts of one’s internal ecology. Honoring or respecting the benevolent intent behind each part, as Richard Schwartz suggests, helps make each part a harmonious and coherent element of one’s narrative.

  The compassion of the client’s larger self-state that can express appreciation to the God-duty warrior is not necessarily voting for such a position in our war-torn world. The qualifier “if you are in that space” makes room for parts of the client’s inner family, team, squad, committee, or tribe to be present that might have objections to thanking the God-duty part, which would then need to be dealt with first.

  Here the therapist suggests an interchange. Another option would be to ask the client to sense into what the God-duty part of him needs from him right now in terms of a response, and then offer it.

  C: Yes, he is getting it. He appreciates the acknowledgment. [When any member of a team is acknowledged and respected for his or her concerns or perspective, the member tends to relax, trust the leader, and be willing to go along with the team’s decision, even if it is not exactly what that member was advocating.]

  T: Good. He is an important guy to call on when needed that not everyone has. What I would like us to do next is have you stand up again and slowly, mindfully go back and forth between three positions, really studying the minute differences that go into each position, until you can consciously move between them at will with your mind-body-spirit, which is different than when they just happen to you without your intention. The first is the “war zone God-duty on-mission worried about his squad” guy. There are appropriate times this guy needs to take over things. The second is you at home with your family, safe, behind closed doors, relaxed like you are now, in that place where you can enjoy them and allow them to enjoy you. The third is when you are out with your family in the village, where a little more assessment of danger is called for since you are no longer inside the safety of your home, but normally it is far, far from anything like a war zone. Okay?

  Learning to take on these various positions voluntarily in terms of sensations, tensions, thoughts, feelings, attitudes, and so on does not take away the power of lower-brain activation to click in when stimulated by internal or external stimuli.

  It does have an empowering effect on vets to do this differentiation practice that consciously reinforces and acknowledges realities such as, “Here I am in the city where cars backfire, vases fall off the ledge and crash, kids light firecrackers, and, yes, sometimes people use guns.”

  And it is helpful to give both permission and practice to take on the appropriate modes of mobilization for different situations. Being able to take these positions consciously helps enhance awareness and a sense of choice and empowerment, as well as an understanding that it is normal that cars backfiring can evoke startle responses. Going into the city streets with permission to have a measure of vigilance can mitigate the shock of a loud sound.

  The session continued with a good amount of time spent integrating this ability to assess and mobilize appropriately and consciously.
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  Son, Ed (Group Session)

  In Hakomi we emphasize that it is important to help clients become mindful in order to get distance on their experience, as opposed to being at the mercy of it. With clients such as Ben who are war veterans this can be problematic, since the bodies of vets can be so stressed from being hypervigilant, holding back impulses, uncompleted action tendencies (Ogden et al., 2006), and such. There is simply too much tension in the system to find that quiet place of consciousness that can be compassionately aware of how one is organized. This was Reich’s (1949) main point, that tension or body armor masks sensitivity, and sometimes one does not want to be sensitive to certain signals that are causing distress.

  Taking Over and Creative Struggling

  Kurtz’s taking-over technique called creative struggling (see Chapter 17) can be helpful here with lowering the noise level in the system. With veterans it often means helping them hold back tensions in such a way that they can safely explore them and release them. It is difficult to be both the one who tenses and the one who searches for the meaning of the tension at the same time.

  Veterans are often terrified of the thought of becoming uncontained and hurting others, so creative struggling is best done in a group setting where enough physical power is available to provide a safe enough container that allows clients to explore their impulses and fully engage their musculature.

  Since holding tensions is normally unconscious, the awareness of the client is focused on the body, and not on verbal meanings, which may or may not come later. What is creative in this process is that one is asked to struggle in a way that feels good, which serves to enjoin mindfulness of large motor muscle groups. The therapist’s instructions are constantly directed toward what feels nourishing, right, and positive as opposed to any form of a struggle of wills, of force against force.