Hakomi and The Heart & Soul of Change
This short paper was inspired by my reading of the recent publication of the American Psychological Association, The Heart and Soul of Change (edited by Hubble, Duncan and Miller). The first part of the paper summarizes some of the research cited in the book and observations made by the authors. In the second part of the paper I have attempted to relate this stimulating material to the principles and practice of Hakomi. I hope the paper sets up some dialogue around the crucial question of What works in therapy?
It is sobering to reflect on Hans Eysenckss research demonstrating that two thirds of all clients, bearing a diagnosis of neurosis, substantially improved within 2 years, whether or they had therapy.It is the search for what works that has contributed to the explosion of therapy models. Dating from the 1960s, the number of psycho-therapy approaches and theories has grown approximately 600% and it is estimated that there are now more than 200 therapy models. Techniques, associated with the various models exceed 400. But, most research shows no difference in effectiveness among the various treatments for psychological distress. This has been called the dodo bird verdict borrowed from Alice in wonderland: Everyone has won and all must have prizes. As more evidence accumulates, it seems that the dodo bird verdict is not to be overthrown.
What this means is that there is little evidence to recommend the use of one type of therapy over another in the treatment of specific problems. Consequently, attention has turned now, to common elements of therapy rather than the theoretical tenets on which they were based. The authors have identified four common factors: client/extra-therapeutic factors; relationship factors; placebo, hope and expectancy; and model/technique factors. The first, Client/Extra-therapeutic factors, account for 40% of outcome variance. The authors argue that the most parsimonious explanation for the dodo bird verdict is that it is the client, not the therapist or technique that makes therapy work. It is the engine that makes the therapy work. The clients own generative; self-healing capacities allow them to take what therapies have to offer and use them to self-heal (p.14). Clients then are the magicians with the special healing powers. Therapists set the stage and serve as assistants who provide the conditions under which this magic can operate. They do not provide the magic, although they may provide means for mobilizing, channeling, and focussing clients magic (p.95). One way of viewing this is that all change is self-change and that the therapy is simply professionally coached self-change.
Relationship factors are next accounting for 30% of the successful outcome variance. However, as yet, it is unclear how the therapeutic relationship may be healing. The authors of this chapter (Tallman & Bohart) offer four possibilities. First, the relationship may be healing because it provides a corrective emotional experience, a relationship which mends the damage done by toxic relationship in the clients past. (Could this be Hakomis Missing Experience?). Second, reinforcement of appropriate behaviours could be healing and third, the relationship provides new learning opportunities. Lastly, the therapists empathy, acceptance etc. may mobilize client experiencing or self-structuralisation, which in turn heals. In short, the relationship is a resource that facilitates, supports, or focuses clients self-healing efforts. Interestingly, it is the clients assessment of the alliance that matters more than the therapists expertise in providing ideal relationship conditions. In a sense the client creates their own therapist.
Relationship factors represent a wide range of relationship-mediated variables including caring, empathy, warmth, acceptance, mutual affirmation, and encouragement of risk taking and mastery.
The third of the common factors is Placebo, hope and expectancy, accounting for 15% of successful outcome. Expectancy relates to the client and therapist believing in the restorative power of the treatments procedures or rituals. Optimistic attitude, positive expectancy and belief in ones own power to promote recovery are aspects of an old-fashioned concept the concept of hope. Research is demonstrating that hope is positively associated with success on a number of coping, work and achievement tasks. Conversely, the loss of hope hopelessness has been associated with health complications and poor treatment outcomes.
Models and Techniques are the last of the 4 factors and like expectancy, account for 15% of improvement in therapy. In this book models/techniques include a rationale, offer and explanation for the clients difficulties, and establish strategies or procedures to follow for resolving them.
Hakomi and the Four Common Factors
Starting with the last common factor, it is interesting to look at the change in Rons work over the years and the parallels with relative importance of the common factors. In a recent seminar, he replied to the question How has your work changed?; by saying that his first focus had been techniques. Once these become easy he turned hisattention to the bigger picture or the Method. The next discovery was the importance of the therapeutic relationship. Finally, he looked at the therapists attitude and developed the Loving Presence Trainings. The research is showing that techniques/models are the least important (15%) compared to relationship factors (30%) but what about the client/extra-therapeutic factors accounting for 40% of the improvement in therapy?
The principle of Organicity is equivalent to the most potent common factor; the clients capacity for self-healing. In Hakomi we could see the therapist as a mid-wife to the patients self-healing or even re-birth replacing the metaphor of the therapist as hero performing magic to heal the client. When we trust this principle we can let what wants to happen happen all by itself just facilitating the process. Transformation is waiting to happen and our job is to guide the clients process toward it.
The view that all change is self-change aligns with the change we aim to facilitate in Hakomi; we change peoples models of themselves and their world by changing their core beliefs. We change the way they habitually (and unconsciously) organize themselves to perceive and operate within their worlds (see Kurtz, The Experiential Method: Revised version). Central to Hakomi is the use of Mindfulness or undefended consciousness to discover the ways we do habitually organize ourselves. Moment my moment we notice what is happening to us and inside of us, not attempting to control what happens next. Mindfulness is a deliberate vulnerability (Kurtz), a way of silencing the noise which interferes with our capacity to study ourselves. The principle of Non-Violence guides the therapist in supporting the clients discoveries and change by gaining the co-operation of the unconscious mind. Careful tracking of client responses allows the therapist to support defenses and change course when the unconscious is unwilling. Remembering the principle of Unity, the therapist joins the client in their journey creating an intimate dance in the relationship which develops. Contrasting with the more traditional or Medical Model of patient/client as the one with pathology and the doctor/therapist as the one who diagnoses and cures, unity affirms that client and therapist are in the experience together. Closely allied to this is the principle of Mind-Body Wholism, affirming the lack of separation of mind and body, again contrasting with the dualistic notion of mind and body as a foundation of modern medicine. Last but not least, Hakomi is an experiential method inviting the client to experience rather than talking about experience. Because experience is a true reflection of belief we can find core material quite quickly. What may take a long time with talking therapy can be discovered in a short time, even one session. Perhaps we could say the experiential method is a direct route to the Heart and Soul of Change. The Hakomi Method has been called the Royal Road to the unconscious (Grace Unfolding).
Part of supporting clients self-change is to enhance and develop the clients resources, both internal and external. The art of building the clients resources is a major focus in the HIS Resolving Trauma work. When resources can be experienced as a felt sense the client, potentially, has access to them all the time.
It could be said that the relationship is the Heart of Hakomi and learning to be a loving presence is not learnt by reading a textbook. Therapists in training can only learn the art of loving presence through a commitment to working with themselves. It is who we are much more than what we do that creates a healing relationship or, perhaps, who we are guides what we do in a healing relationship.
Does there have to be a problem? The research findings are related to clients presenting with a problem but, the name Hakomi, means How do you stand in relation to these many realms? The focus in Hakomi is exploring Who you are. Clients making a commitment to working in this way need to put self-study before solutions. Paradoxically, the solutions may emerge when the pressure is off solving the problem.
There needs to be a basic commitment to self-study not to solving / resolving a specific problem.
The Heart and Soul of Change: What Works in therapy, Editors Mark A. Hubble, Barry L. Duncan and Scott D. Miller, American Psychological Association, Washington, 1999.