by Halko Weiss
Cautions
At the same time, Lilienfeld (2007) and Cummings and Donohue (2008) have noted the problems of simply following charismatic leaders in the field who circumvent honest dialogue with the research tradition. As Neukrug (2007, p. 384) argues, though it is necessarily true that “all research is biased . . . that does not mean that research is not important.” And all research that results in actual data is good, even though the theory that drove the experiment might not hold up (Johanson, 1988). The postmodern quest to know everything contextually in relation to everything else remains and requires that we honor all the pieces of the puzzle available to us (Wilber, 1995).
Levels of Experiencing and More
One of the common factors of therapeutic effectiveness delineated by Castonguay, Goldfried, Wiser, Raue, and Hayes (1996) relates to levels of experiencing. Of the seven levels the study explores, Hakomi therapy operates routinely and preferably at the highest levels of gaining “awareness of previously implicit feelings and meanings . . . [and] an ongoing process of in-depth self-understanding” (p. 499). It has been gratifying that many stock-in-trade elements of Hakomi from its post-1960s beginnings have found mainline psychological support through ongoing research. For instance, Hayes notes that the cognitive-behavioral therapy tradition
has maintained its core commitments to science, theory, and good practice. In the last 10 years, a set of new behavior therapies has emerged that emphasizes issues that were traditionally less emphasized or even off limits for behavioral and cognitive therapists, including mindfulness, acceptance, the therapeutic relationship, values, spirituality, meditation, focusing on the present moment, emotional deepening, and similar topics. (2004, p. xiii)
Compassion and the Positive
Another gratifying development in psychodynamic work through the influence of attachment, developmental, and psychotherapy efficacy studies is research supporting the use of compassion and positive affects in therapy (Baumeister & Leary, 1995; Beebe & Lachmann, 2002; Bridges, 2006; Davidson & Harrington, 2002; Decety & Jackson, 2004; Fehr et al., 2009; Fosha, 2000, 2004, 2009b; Fredrickson, 2001; Fredrickson & Losada, 2005; Germer, 2009; Gilbert, 2005, 2010; Greenberg & Paivio, 1997; Greenberg, Riche, & Elliott, 1993; Ji-Woong et al., 2009; Johnson, 2009; Keltner & Haidt, 1999; Laithwaite et al., 2009; Lamagna & Gleiser, 2007; Lewis et al., 2000; Panksepp, 2001; Paivio & Laurent, 2001; Prenn, 2009; Schore, 2001; Shiota, Keltner, Campos, & Hertenstein, 2004; Trevarthen, 2001; Tronick, 1998; Tugade & Frederickson, 2004). This is something Kurtz (1990a) affirmed from the beginning, though he knew it was not the mainline model of “professional demeanor” (Kurtz, 2008, p. 15) at the time. In training sessions he was often heard to say, “Find something in the client to love.”
An Impulse Toward Growth
Something occurs in therapy that seems beyond the control of therapist or client. Growth happens in the face of ignorance, stumbling, and fumbling by therapist and client alike. Growth doesn’t happen despite the most highly trained clinician employing the most state-of-the art techniques. Peck (1978) was so impressed that growth happens at all—in the face of so many obstacles working against it—that he posited some spiritual force called grace to account for it in his best seller The Road Less Traveled. In Hakomi, Kurtz (1990a) often referred to the concept of “negentropy” as expounded by Bateson (1979), Prigogine and Stengers (1984), and Wilber (1995): the notion that there is a force in life that moves to build wholes out of parts, as well as the more well-known second law of thermodynamics that posits the opposite. By any name (“transformance” for Fosha, 2000; “the life-forward direction” for Gendlin, 1996), there is an organic impulse, which can be experienced phenomenologically, to heal through moving toward increased complexity and wholeness. Hakomi therapists always count on this organic impulse, and it has received increasing research support in recent years (Eigen, 1996; Emde, 1988; Fosha, 2006, 2008, 2009a, 2009b; Ghent, 1999, 2002).
Larger Self-States
There are also core aspects of mindfulness or consciousness—including passive awareness and active compassion—that Hakomi therapists assume are essentially present in all clients. These potentials are there, regardless of the person’s object relations history as it shows up on the ego level of past conditioning. Others refer to these essential qualities as comprising the self, core self, heart self, ontological self, and so on. The concept of a larger self, new to Western psychology (Schmidt, 1994), has likewise received research support since Hakomi’s beginnings (Almaas, 1988; Fosha, 2005; Kershaw & Wade, 2011; Mones & Schwartz, 2007; Panksepp & Northoff, 2008; Russell & Fosha, 2008; Schwartz, 1995). Eisman (2006) has led the way in Hakomi by developing an entire healing approach called the re-creation of the self that centers on resourcing clients as fast as possible in the nonegocentric transhistorical aspects of this larger self-state.
Resourcing
The emphasis on resourcing through larger self-states is congruent with the more general emphasis on resourcing in Hakomi by helping clients be in touch with their strengths, bodily energies, hopes, positive images and memories, and so forth. Much research supports this emphasis (Gassman & Grawe, 2006). For trauma therapists who work with lower-brain activation, multiple forms of resourcing are absolutely necessary (Ogden et al., 2006). Hakomi in general always begins with fostering qualities of safety, curiosity, and present-moment experiencing, which is a way of resourcing clients to be able to successfully explore inner material (Fogel, 2009). Humor—that Kurtz was so brilliant with—is a hypnotic affirmation of faith communicating to clients that they have what it takes to deal with whatever is afflicting them. Working through barriers to transformation and the introjection of positive “missing experiences” in Hakomi is a way of both unburdening hurtful experiences and expanding a client’s toleration of positive experiences (Robbins, 2008). Encouraging clients to move toward the future with hope by integrating more positive experiences in their lives, while dealing mindfully with whatever barriers arise, stimulates the immune system and a more grateful, energized way of meeting life (Johanson, 2010b; LeShan, 1984).
Appropriate Trainees
Although Hakomi therapy training is offered primarily as continuing education for licensed mental health professionals, the central importance of relationship, self-qualities, compassion, and awareness to psychotherapy has led institute faculty to also accept others in training who are assessed as able to benefit from the teaching. An array of bodyworkers, naturopaths, lawyers, teachers, artists, nurses, medical doctors, and others have taken Hakomi training, either to learn Hakomi methods they can incorporate into their work or as a way of tasting the field of psychotherapy before committing to various graduate programs. Is it ethical to train people in therapeutic techniques who are not licensed? What does the research have to say about this?
As it turns out, our commonly held assumptions about what makes better psychotherapists, enshrined in our requirements for licensure and membership in clinical associations, are not faring well in research. Surely, getting advanced degrees and licensure enhances our effectiveness. No, not really. Nyman, Nafzier, and Smith (2010) established that there was no discernible difference in outcome if the therapy was done by a licensed doctoral-level psychologist, a predoctoral intern, or a practicum student. How about professional training, discipline, and experience? It certainly sounds logical, but no, it doesn’t hold up (Beutler et al., 2004). Using the right method or the latest evidence-based treatment should help. While we continually keep trying to find the key, any single one has yet to be found, though many seem to work in their own way (Duncan et al., 2010). Plus, no studies support increased effectiveness through continuing education, which is disappointing and hard to believe. What about therapists working on themselves as their own best instrument in therapy? Wonderful subjective benefits are reported here, but they do not show up in terms of affecting effectiveness (Geller, Norcross, & Orlinksky, 2005).
The upshot of this research does not support the necessity of state licen
sure boards so much as registries of psychotherapists that list one’s training and ethical allegiances, and then respects clients’ ability to search and find practitioners who provide the help they are seeking. (Hakomi faculty members, due to our tender pride and hubris, might point out that the above research did not study Hakomi training and supervision.)
Collaboration
One bright spot in efficacy outcome studies is that soliciting and responding appropriately to client feedback does improve the outcome for the client and the development of the therapist (Anker, Owen, Duncan, & Sparks, 2010; Duncan, 2010; Duncan, Solovey, & Rusk, 1992). This research finding is fully congruent with training in the Hakomi method. Hakomi’s organicity principle states that when all the parts are connected within the whole, the system is self-organizing and self-correcting. This translates into the Hakomi therapist tracking and contacting a client’s felt present experience in such a way that the therapist helps the person safely mine the wisdom of his or her own experience in a continuously collaborative way. This fine-tuned collaboration in turn provides a profound safeguard against either licensed or nonlicensed trainees unwittingly committing forms of violence on the client or inducing appropriate resistance. Other aspects of Hakomi training could be explicated that fit in with research findings on how psychotherapists develop and grow (Orlinsky & Roennestad, 2005).
More Encouraging Developments
In contrast to the state of psychology in the 1960s, there is now serious and sustained research dedicated to cross-cultural and social issues (Augsburger, 1986; Foster et al., 1996; Helms & Cook, 1999; Keita & Hurrell, 1994; Marsella, 1998, 2009; Marsella, Bornemann, Ekblad, & Orley, 1994; Marsella, Johnson, Watson, & Gryczyski, 2008; McGoldrick et al., 1996; Nader, Dubrow, & Stamm, 1999; Pinderhughes, 1989; Ponterotto, Casas, Suzuki, & Alexander, 2010; Sue & Sue, 2010; Vasquez, 2012; Wessells, 1999).
Likewise, though Hakomi has never been presented as a spiritual path or endorsed the path of any other spiritual tradition, it has always been open to the spiritual dimension of clients as an important aspect of their being. This significant facet of many clients’ lives (Eisner, 2009; Johanson, 1999b; Mayo, 2009; Monda, 2000; Sperry, 2010; Torrance, 1994), routinely ignored or pathologized in the 20th century (LeShan, 1990), is now being researched in such journals as the American Psychological Association’s Division 36 Psychology of Religion and Spirituality and the Journal of Spirituality in Mental Health from Routledge Press, textbooks such as Miller (2003), numerous APA titles, and myriad contributions of others.
Hakomi-Sponsored Research
Hakomi leaders have encouraged and pursued research wherever possible within Hakomi’s context as a training institute. Through the leadership of the Hakomi Institute of Europe, the first major empirical research was done demonstrating the efficacy of body psychotherapy methods in outpatient settings. This multiyear, multicenter investigation was done in Germany and Switzerland, and involved both clinical practitioners and university professors (Koemeda-Lutz et al., 2006). In the United States, Kaplan and Schwartz (2005) provided a methodologically rigorous study of the results of working with two clients within a 12-session protocol.
Further research into body-inclusive psychotherapy was given a major impetus when Halko Weiss, director of the Hakomi Institute of Europe, joined with his colleague Gustl Marlock to edit the Handbuch der Körperpsychotherapie, a thousand-page handbook on body psychotherapy published by Schattauer, a highly respected medical publisher in Germany. This well-referenced and positively reviewed work has contributions from 82 international experts. The English translation (Marlock & Weiss, with Young & Soth, 2015) will likewise further the field in many countries and give impetus to the growing literature addressing somatic issues (Aron & Anderson, 1998; Boadella, 1997; Field, 1989; Griffith & Griffith, 1994; Halling & Goldfarb, 1991; Heller, 2012; Kepner, 1993; Leder, 1984, 1990; Matthew, 1998; Ogden et al., 2006; Romanyshyn, 1992; Shaw, 2003, 2004; Stam, 1998; van der Kolk, 1994).
Hakomi faculty have taken leadership positions in the European Association for Body Psychotherapy and the United States Association for Body Psychotherapy, supporting both professional conferences and journals. The Hakomi Institute itself has sponsored numerous professional conferences that have highlighted keynote speakers outside Hakomi, such as Stephen Wolinsky, Peter Levine, Richard C. Schwartz, Thomas Lewis, Stephen Porges, Bessel van der Kolk, Diana Fosha, Susan Aposhyan, Babette Rothschild, Christine Caldwell, and more.
Through 2014, the institute has published 27 editions of its annual journal, Hakomi Forum. In the first 10 years of the Forum, many contributions concentrated on clinical reports on the use of the method with couples, psychodrama, biofeedback, emotionally disturbed adolescents, values, cancer patients, eating disorders, seniors, the Q-sort technique, storytelling, yoga, curiosity research, neurological correlates, groups, organizations, supervision, adolescents, families, ontological development, transference and countertransference in the here-and-now therapies, touch, pre- and perinatal trauma, laughter, despair, psychotic jail inmates, emotion, grace, boundaries, ethics, multiplicity, self-theory, and more.
As the Hakomi method matured and grew, the editorial board expanded significantly beyond the founding trainers of the institute, and more articles referencing mainline psychology appeared, though the editorial policy continued to accept more experiential, poetic, and clinically informed articles along with scholarly and scientific contributions. A number of colleagues and collaborators outside of Hakomi have contributed to the ongoing dialogue of the Forum over the years, including Eligio S. Gallegos, Chogyam Trungpa, Jerome Liss, William S. Schmidt, David Feinstein, Suzanne M. Peloquin, Albert Pesso, Stephen Pattison, Eugene Gendlin, Jack Engler, Richard Schwartz, Stephen Wolinsky, Belinda Siew Luan Khong, Aline LaPierre, David N. Elkins, Martha Herbert, Siroj Sorajjakool, Miriam Greenspan, Carole M. McNamee, Louise Sundararajan, Diana Fosha, and others.
The majority of clinical research by Hakomi therapists has been dedicated to what Gendlin (1986, p. 133) has termed “playing in the laboratory.” This is part of the trend in psychotherapy research toward identifying and evaluating small subprocesses of therapeutic interactions, as opposed to evaluating entire therapies in relation to each other (Johanson, 1986). Playing in the lab involves creatively and curiously exploring a subprocess with the rapid feedback in a clinical encounter that can confirm or disconfirm a hunch or open up new trailheads. It eventually leads to promising hypotheses that are worthy of the more extensive time, money, and energy that go into formal research.
The main laboratory settings for Hakomi are private practice, public and private health services clinics, and comprehensive psychotherapy training. Here Gendlin’s (1986) suggestion that there be a central data bank of successful cases that can be examined further is carried out. Ron Kurtz left over 400 videotapes demonstrating his work. The Hakomi Institute asks those who have successfully shown enough competency in the method to become certified Hakomi therapists or practitioners to place copies of their certification tapes in a central office archive. These case examples are available for the psychotherapy process Q-sort technique (PQS; Jones, 2000), and other research uses outlined by Goldfried and Wolfe (1996), Jones and Pulos (1993), Kazdin (2007), Nathan and Gorman (2002), and others. There are a number of research studies the Hakomi Institute would like to engage in when possible.
However, on behalf of the many right-brained practitioners drawn to the experiential power of the Hakomi method, it must be said there is much sympathy for the summary of Shedler (2010, p. 107) who asserts:
Many of the psychotherapy outcome studies . . . are clearly not written for practitioners . . . [but] for other psychotherapy researchers. . . . I am unsure how the average knowledgeable clinical practitioner could navigate the thicket of specialized statistical methods, clinically unrepresentative samples, investigator allegiance effects, inconsistent methods of reporting results, and inconsistent findings across multiple outcome variables of uncertain clinical relevance.
. . . Psychotherapy research needs to be more consumer relevant (Westen, Novotny & Thompson-Brenner, 2005).
Today, as suggested above, psychology and psychotherapy comprise an exciting and promising field that has grown considerably since Hakomi’s beginnings in the post-1960s era. Part of the excitement is the responsibly eclectic expansion of concern to include contributions from developmental studies, interpersonal neurobiology, trauma, and the body (Levine with Frederick, 1997; Ogden et al., 2006; Rothschild, 2000; van der Kolk, 1994, 2003), multicultural values, social structures, and more. All this is being done with a view to better integrate theory and clinical practice while applying the techniques to coaching, teaching, human relationships, groups, corporate situations, and more. Hakomi, as a mindfulness-centered somatic psychotherapy, has a specific and unique contribution to make to the training of healers in today’s world. At the same time, the large umbrella of its theoretical principles offers a home base from which research contributions from these many realms of healing can be integrated. A hallmark and value of Hakomi remains the close congruence between theory, method, and technique, always tested and refined through experience in the field.