Hakomi Mindfulness-Centered Somatic Psychotherapy

by Halko Weiss

  As we look back on all these developments, we can sense how the spirit of the times has formed the very core and feel of the Hakomi method: specifically, its emphasis and trust in the individual’s hidden wisdom and freedom, the refusal of practitioners to take a superior position as the all-knowing therapist, the willingness to support each client’s highly personal and unique path, the valuing of live felt experience in the body, the appreciation of complexity, the bias toward investigation and curiosity over set goals and treatment plans, and the emphasis on loving presence as foundational for deep healing, all of which reflect the emergent fusion of scientific and spiritual perspectives.

  When we look back historically to the 1960s, 1970s, and 1980s, the fruit was all there, waiting to be plucked, processed, and integrated in a unique way by a uniquely gifted person and teacher who has left an ongoing, still unfolding, healing legacy (Johanson, 2011a, 2011b, 2011d).

  Hakomi in the Context of Research and Science

  Greg Johanson

  A unique background foundation in sciences of complex nonlinear systems has served the Hakomi Institute well in its primary functioning as a training institute as opposed to a research institute. Hakomi of Europe, headquartered in Germany, led the way in getting Hakomi approved as a scientifically validated modality within the European Association of Psychology in the European Union (Schulmeister, 2005). As such, the Hakomi Institute is an approved psychotherapy training provider in the European Union. Credits in doctoral programs for studying Hakomi have been obtained through a number of educational institutions worldwide. Likewise, the Hakomi curriculum was approved as an official national training program for psychotherapists in New Zealand through the Eastern Institute of Technology in Napier. Subsequently, chapters on Hakomi therapy have been included in standard textbooks on theories of counseling and psychotherapy (Roy, 2007), as well as being investigated in various theses and dissertations (Benz, 1981; Kaplan, 2005; Myllerup, 2000; Rosen, 1983; Schanzer, 1990; Smith, 1996), other books (Johanson & Taylor, 1988), and articles.

  Critical Consumers of Research

  Research in general, of course, is a broad topic with numerous aspects. Hakomi, as a training institute consumer of research, has striven to have an engaged, constructive, yet critical relationship with psychotherapy research in particular that remains in tension with its clinical experience.

  To begin, Hakomi practitioners have not been willing to wait for positivistic scientific approval of what seemed clearly therapeutically helpful, though we do track a wide range of scientific studies for confirmation or disconfirmation as they arise. For instance, Kurtz realized in the early 1970s the potency of mindfulness in helping clients become aware of and transform the way they organized their experience, something central to depth psychotherapies (Shedler, 2010; Stolorow et al., 1987). The effectiveness of this discovery has been explored and deepened through Hakomi ever since. Most other therapists who were interested in the mindfulness-therapy interface would not allow themselves to speak of it in professional settings until the early 1990s (R. Siegel, 2010). Kabat-Zinn began publishing about the use of mindfulness for working with pain in the mid-1980s (Kabat-Zinn, Lipworth, & Burney, 1985). Linehan (1993) published on the use of mindfulness in treating borderline personality disorders in the early 1990s. Today, there is an ever-growing wealth of studies related to mindfulness and psychotherapy (Johanson, 2006, 2009a). In particular, there is now much exciting knowledge from interpersonal neurobiology about the underlying mechanism of mindfulness (Hanson with Mendius, 2009; D. Siegel, 2007, 2010; Simpkins & Simpkins, 2010).

  The example of mindfulness illustrates that experimental psychotherapy research does not generally produce new knowledge so much as evaluate hypotheses generated in clinical practice (Gendlin, 1986; Goldfried, 2009). It is also an example of how Hakomi has maintained “the standard of a respectable minority . . . out of concern that the standard of common practice was insensitive to emerging but not yet popular treatments,” a standard that “recognized that the healthcare fields do not always have a consensual view of what is effective” (Beutler, 2009, p. 308).

  The Personhood of the Therapist

  This stance of a respectable minority has also played out in Hakomi’s caution about the supposed gold standard of randomized clinical trials (RCTs) that separate “the person of the therapist from the acts of psychotherapy” (Beutler, 2009, p. 311). Hakomi training always balances concentration on the being or personhood of the therapist with the doing aspects of method and technique, as it has always been obvious that it is the characterological limitations of therapists that restrict their effectiveness in utilizing the process itself. This position is congruent with much research that has built on the investigation of common factors and has underlined the importance of the therapeutic relationship (Ablon & Jones, 2002; Beutler et al., 2003, 2004; Castonguay & Beutler, 2006; Duncan & Miller, 2000; Horvath & Bedi, 2002; Mahoney, 1991; Norcross, 2002, 2005; Orlinsky, Ronnestad, & Willutzki, 2004; Safran & Muran, 2000; Sexton & Whiston, 1991; Shedler, 2010; Tombs, 2001; Vocisano et al., 2004; Wampold, 2001; Whiston & Coker, 2000).

  Factors That Comprise Psychotherapy

  Along this line, Hakomi practitioners agree with those who argue that we need to “revise our definition of ‘research-informed psychotherapy practice’ so that it addresses those factors that actually comprise psychotherapy” (Beutler, 2009, p. 302). The Hakomi unity principle agrees that variables must not be ruled out related to “therapist and patient personalities, interpersonal values, therapist and patient gender, socials skills, and attachment levels and the like [which] are not always capable of being randomly assigned” in RCT trials (p. 310). The same applies to cross-cultural issues (Johanson, 1992). And, as Gendlin (1986) has pointed out, it is better not to isolate chemical versus psychological versus social factors, but control for all three and test them together. “They are already always together. . . . Everyone thinks, feels, dreams and imagines; has a body; has a family; acts in situations; and interacts with others” (Gendlin, 1986, p. 135). Likewise, “the practice of therapy often involves more complex clinical cases” with numerous comorbid conditions, which are little dealt with in academic research (Goldfried, 2009, p. 26). Though the DSM is purposefully atheoretical, Hakomi continues to see, with others (Blatt & Zuroff, 2005), the connections in character issues related to Axis II that affect many Axis I conditions and, thus, the value of teaching characterology, though in a nonpathologizing way.

  Beyond Acute Symptom Alleviation

  As a psychodynamic depth psychotherapy, it is significant to Hakomi that “researchers . . . have yet to conduct compelling outcome studies that assess changes in inner capacities and resources,” because

  the goals of psychodynamic therapy include, but extend beyond, alleviation of acute symptoms. Psychological health is not merely the absence of symptoms; it is the positive presence of inner capacities and resources that allow people to live life with a greater sense of freedom and possibility. Symptom-oriented outcome measures commonly used in outcome studies . . . do not attempt to assess such inner capacities. (Shedler, 2010, p. 105)

  The development of such tools as the Shedler-Westen Assessment Procedure (Shedler & Westen, 2007) that assess “inner capacities and resources that psychotherapy may develop” (Shedler, 2010, p. 105) in support of healthy functioning is important to Hakomi since a main goal of the method is to mobilize a client’s capacity to employ mindful or compassionate awareness (Eisman, 2006) with aspects of the self that might be evoked throughout a lifetime, beyond formal therapy. This kind of research could help confirm that it is intrapsychic changes in the organization of a client’s experience, something central to Hakomi (Johanson, 2006), that “account for long-term treatment benefits” (Shedler, 2010, p. 103). A change mediated through the neuroplasticity of the brain alters the flow of energy and information and “activates neuronal firing that is integrative and produces the conditions to promote the growth of integrative fibers in the nervous
system” (Siegel, 2009, p. 166), the physiological mechanism for effective psychotherapy.

  Clinician-Researcher Interface

  Many people in the field are aware of the “long standing strain in the alliance between clinicians and researchers” (Goldfried, 2009, p. 25). For one thing, evidence-based treatments don’t work as well in actual practice settings as they do in the lab, partly because perfectly and narrowly diagnosed clients do not walk through the treatment door, and it does matter who uses a treatment protocol in what way. Others note “the chasm that exists between science and practice . . . [along with] how weak the evidence is for certain widely held beliefs about the nature of empirically supported treatments” (Beutler, 2009, p. 301; cf. Goldfried, 2009). For instance, it is not true that “psychotherapy would be more effective if everyone practiced an ‘empirically supported treatment’ . . . [or that] cognitive and cognitive-behavioral therapies are more effective than relational and insight-oriented forms of psychotherapy” (Beutler, 2009, p. 303; cf. Duncan & Miller, 2006; Elkin et al., 1989; Kazdin, 2008; Schulte, Kunzel, Pepping, & Schulte-Bahrenbert, 1992; Shedler, 2010; Wampold, 2001; Wampold et al., 1997).

  Likewise, it is now clear that “most manual-driven therapies are equivalently effective and not substantially different from most rationally derived therapies” (Beutler, 2009, p. 310). The effects of cognitive-behavioral interventions tend to fade and require relapse prevention strategies (de Maat, Dekker, Schoevers, & de Jonghe, 2006; Gloaguen, Cottraux, Cucherat, & Blackburn,1998; Westen, Novotny, & Thompson-Brenner, 2004).

  Though it is not yet common knowledge in all academic or therapeutic quarters, empirical evidence plainly supports the efficacy of psychodynamic therapy, a characteristic of Hakomi (Ablon & Jones, 1998; Bateman & Fonagy, 2008; Blatt & Auerbach, 2003; Bucci, 2001; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Fonagy et al., 2002; Jones & Pulos, 1993; Leichsenring, 2005; Leichsenring & Leibing, 2003; Leichsenrinn & Rabung, 2008; Leichsenring, Rabung, & Leibing, 2004; Milrod et al., 2007; Shedler, 2010; Szecsoedy, 2008; Westen, 1998).

  Norcross, Beutler, and Levant (2005) note other unexamined assumptions and limitations of research. There is certainly a social construction aspect to validity studies (Kvale, 1995). Linford and Arden (2009) have called into question what they term the Pax Medica of the current three-part standard of therapeutic practice comprising strict DSM categories, evidence-based treatments (Blatt & Zuroff, 2005; Duncan & Miller, 2006; Elkin et al., 1989; Kazdin, 2008), and the use of antidepressants (Greenberg, 2010; Kirsch, 2010; Meyer et al., 2001; Turner, Matthews, Linardatos, Tell, & Rosenthal, 2008; Wakefield & Horwitz, 2007).

  A Complimentary Model

  Based on Hakomi principles (Chapter 5; Johanson, 2009b; Kurtz, 1990a), practitioners recognize the interrelatedness of all things and generally think that psychological science would do well to conceptualize research subjects with a metaphor something like the rhizome suggested by Deleuze and Guattari: “A rhizome has no beginning or end; it is always in the middle between things, interbeing” (1987, p. 25). It embodies an “acentered multiplicity” (p. 17) that is multiply derived or overdetermined, which displays nonlinear emergent properties. Thus, there can be “no dictatorial conception of the unconscious” (p. 17). While hardly anyone will disagree that a human being is a nonlinear system with the possibility of emergent properties that defy easy determinisms, almost all psychotherapy research defaults to a linear setting (Johanson, 2009b, 2009c; Marks-Tarlow, 2011; Thelen & Smith, 2002), and thus builds in constraints and limitations that tend to throw away unexpected results.

  The rhizome metaphor would lend itself to adopting Kurtz’s preference to work with Popper and Eccles’s (1981) conception of unconscious behavioral determinants as “dispositions.” We are not absolutely determined, but rather disposed by many factors such as genes, biochemistry, interpersonal relationships, and cultural and social forces in various directions. Since everything is interconnected, each variable will produce a disposition in relation to the others so no one item can remain independent. This approach fosters a healthy degree of humility in psychological research that allows for a pluralistic conception of psychology and a number of types of investigation, something contemporary theorists are calling for (Held, Kirschner, Richardson, Slife, & Teo, 2010; Teo, 2009).

  A Model Embracing Awareness and Complexity

  Certainly, according to Hakomi and postmodern principles, there is no question that all psychological research and methodologies reflect underlying philosophies and values (Bishop, 2007; Johanson, 1979–1980; Polkinghorne, 1983; Spackman & Williams, 2001), of which one should be as conscious and explicit as possible (Romanyshyn, 2007, 2010). For instance, the pre– World War II period valued the importance of the Freudian differentiated autonomous self as opposed to the self-in-relation concept of postwar feminist therapists (Gilligan, 1982; Jordan et al., 1991). Likewise, Sundararajan, Misra, and Marsella contrast the Western grand atomic self, which considers mental diseases as entities and culture only as an add-on to the self, with multicultural views of a relational or contextual self that affirm that “all mental disorders are culture-bound disorders since no disorder can escape cultural encoding, shaping, and presentation” (2013, p. 75).

  Translated into research methodology, the [Western] particle/atomic perspective favors a descriptive model that generates numerous objective lists in psychology—behaviors, personality traits, social cognitions, and so on. By contrast the [multicultural] wave perspective favors the holistic, explanatory models that capitalize on hermeneutics—interpretations and narratives of emergent phenomena such as meaning and subjective experiences. (p. 74)

  An Integral Model

  Hakomi’s unity principle fits most closely with Wilber’s (1995, 2000, 2006) AQAL (all quadrants, all levels) integral model of human functioning (see figure 5.1). Here the quadrants are derived from acknowledging the individual and communal aspects of being human, combined with both the objective-outer-monological and the subjective-inner-dialogical aspects. The resultant quadrants represent the inner aspects of individual consciousness and cultural values as well as the outer aspects of individual behavior, biochemistry, and social structures in a nonreductionistic mutual interplay where each quadrant has a science, methodology, and validity appropriate to its field. A danger for research from this integral perspective is overemphasizing variables from one quadrant while ignoring those from the others, which constricts the contextual field and relevance of the research.

  This integral, holonic (Koestler, 1967) conception of humanity certainly makes room for the use of qualitative research stemming from phenomenological, existential, hermeneutic perspectives (DeAngelis, 2010; Giorgi, 1970; Giorgi & Giorgi, 2003; Halling & Nill, 1995; Michell, 2003; Moustakas, 1990; Packer & Addison, 1989; Wertz, 2005; Wiggins, 2009). It honors and requires quantitative studies as well. It celebrates developments in neurobiology that demonstrate that mind (inner aspect) and brain (outer aspect) inform each other (Kandel, 2007; Porges, 2011; Schacter, 1992, 1996; Siegel, 1999, 2006, 2007).

  Thus, Hakomi affirms the use of mixed-methods research that combines to offer the broadest view of a subject (Creswell & Plano Clark, 2007). Wiggins (2011) writes that there is a dilemma in the use of mixed methods in that every use of the mix tends to come from an underlying positivist or interpretivist worldview that evaluates or subsumes the methods in accord with its privileged viewpoint. Mruk (2010) offers a research approach to an integrated description that carefully conserves overall holistic humanistic concerns and principles, but incorporates traditional positivistic values related to validity, prediction, measurement, control, and real-world utility. The APA Presidential Task Force on Evidence-Based Practice (2006), on the other hand, wanted to endorse “the evidentiary value of a diversity of research methods” (Wiggins, 2011, p. 55). However, in an unacknowledged way, “as Wendt and Slife (2007) observed, the task force proposal places qualitative methods on the bottom of a hierarchy of research methods, ranked according to thei
r rigor and value within a positivistic worldview” (Wiggins, 2011, p. 55).

  For Hakomi, the research paradigm wars (Gage, 1989 ) and dilemmas (Wiggins, 2011) are transcended by the adoption of Wilber’s AQAL model that not only honors but invites the “otherness” of methods appropriate to each quadrant. A framework that accounts for, welcomes, and utilizes the most research from the most places is more inclusive than a lesser one, and it is not an arbitrary power move to say this, any more than it is to assert that a molecule has a more inclusive embrace than an atom, or that this paragraph has more significance than a single letter, though atoms and letters are more foundational as building blocks (Ingersoll & Zeitler, 2010; Wilber, 1995). Those espousing the AQAL framework would, however, criticize approaches with a limited viewpoint and methodology such as Baker, Mall, and Shoham (2010), who attempt to be imperialistic or reductionistic in making their partial perspective more than what it is.

  Encouraging Developments

  With all the above cautions noted, the overall thrust of psychotherapy research in the last 30 years, in conjunction with that of cognate disciplines such as interpersonal neurobiology, trauma, and developmental studies, has been quite substantial and encouraging. It is an exciting time in psychology and psychotherapy. Research now confirms that psychotherapy is actually effective (Seligman, 1995), and the Dodo bird conclusion from comparing therapies that “all have won and must have prizes” has likewise induced some helpful humility in the field, motivating schools to learn from each other, including the delineation of common factors (Bateman & Fonagy, 2008; Beutler et al., 2003; Bohart, 2000; Bucci, 2001; Castonguay, 1993; Frank, 1986; Lambert & Ogles, 2004; Lipsey & Wilson, 1993; Luborsky, Singer, & Luborsky, 1975; Mahoney, 1991; Orlinsky et al., 2004; Sexton & Whiston, 1991; Smith & Glass, 1977; Smith, Glass, & Miller, 1980; Stevens, Hynan, & Allen, 2000; Stiles, Shapiro, & Elliot, 1986; VandenBos & Pino, 1980; Wampold, Minami, Baskin, & Callen-Tirney, 2002; Wampold et al., 1997).