How Therapy Works by
David Raughton, MFT revised ©2013
How
therapy works often seems more mysterious or complicated than necessary. In my practice there are three primary
aspects of therapy which make a difference for clients. These aspects are: relational, experiential
and cognitive.
Relational Aspect: Humans are relational animals. Studies have shown more isolated individuals tend
to suffer physical and emotional symptoms. And conversely, satisfying
relationships are fundamental to a happy life. Although people may seek therapy
for many reasons, difficulty in relationships is a primary one.
A
caring and supportive relationship, including with a therapist, can help a
person mobilize their resources and cope.
Also, how the client relates to the therapist reflects how they relate
to others. In therapy the client can
explore ways they hold back, make assumptions, or avoid contact with themselves
or others. Although a good relationship
with the therapist is essential to effective therapy, the next two aspects can
deepen and speed change.
Experiential Aspect: Intellectual insight
by itself is of limited value in helping people change. Many of us have had the experience of
"spinning our wheels" in an attempt to understand a personal
problem. Or through reading a book or
attending a workshop we had a major "insight" only to find it had no
significant impact on our lives.
However,
insight derived from a deeper connection and experience of our self does lead
to the unraveling of old patterns. Often
in the course of our lives we develop strategies or assume roles, which helped
us survive, but now limit our relationships and self-expression.
Many
of these strategies operate largely automatically or unconsciously. I use the experiential method of present
focused awareness to help the client "study" their present experience
in a way which allows the unconscious to unfold. The Hakomi Method, developed by Ron Kurtz, is
the particular form of mindfulness based psychotherapy I use.
Hakomi
psychotherapy is based on five principles.
These principles are: Organicity, Mindfulness, Nonviolence, Mind-Body
Holism, and Unity. Working from these
principles Kurtz observed a typical cycle within a therapy session. The cycle
includes emotionally contacting and connecting with the client, then directing
the client into mindfulness, and finally evoking and deepening into core
material with gentle experiments.
Skillfully
conducted, this allows the emergence of core experiences. Core experience includes memories, body
sensations, emotions, and beliefs associated with early wounds. Often vivid memories arise and strong
emotions are released as one deeply connects with core experiences. New possibilities of satisfaction and
expression are discovered. Then the past
is more readily forgiven and left behind.
An
example of a core experience can be seen in a person whose need for emotional
closeness was ignored or rejected as a small child. This person may develop a core belief that it
is not safe to allow deep intimacy or closeness with others. Kurtz has referred to this character strategy
as self reliant. Through accessing core
experience and finding new nourishment, a person can develop beliefs with the
potential of allowing more satisfaction, such as “There are trustworthy persons
with whom I can be close.” Then the person is better able to respond to life in
a way that makes this a reality.
Cognitive Aspect: Cognitive techniques
in the various forms described below are especially helpful for dealing with
acute symptoms, including depression, anxiety, panic, and excessive anger.
Working
with our cognitions is different from intellectual insight. Cognitions are the thoughts or images which
pass through our mind. Thousands of
cognitions arise spontaneously every day.
Psychologically and physically we respond to many negative cognitions as
if they were actual stressful circumstances.
As Mark Twain put it, “I've …seen a lot of hard times … most of which
never happened.”
There
are many ways of working with cognitions. Evaluating the evidence, rationality,
or efficacy of negative cognitions can help us dislodge them, as described by
Aaron Beck and other developers of Cognitive Behavioral Therapy. Or, simply a more mindful relation to our
passing thoughts can help us take them less seriously, or be less fused with
them, as described by more recent developments in cognitive based therapy, such
as Acceptance Commitment Therapy or Dialectical Behavior Therapy. Also,
developing a more loving attitude and relationship with one’s self can defuse
negative cognitions.
An
example of working with the cognitive aspect is helping a depressed client
disengage from negative self talk. He may be accepting his self-deprecating
cognitions as "truth." By
watching these cognitions from a mindful state, he can begin to disempower
them.
He
may also find that by actively changing his thoughts he will change how he
feels. This is not achieved merely
through willpower or positive thinking.
Instead, by recognizing and challenging the harmful cognitions he is no
longer passively pummeled by them.
Conclusion:
I have summarized the three major aspects that for me account for effective
therapy. 1) Being in relationship,
including with a therapist helps one to feel more secure and to cope. 2) Deepening awareness of our direct
experience helps us contact core wounds and beliefs, and discover new more
nourishing possibilities. 3) What we
think affects what we feel, and we can become more conscious of our cognitions
and challenge or defuse self-defeating ones, especially when dealing with many
acute symptoms.
Together
these aspects combine to develop a more kind, conscious, and loving
relationship with one’s self. One is then in a much better position to seek
satisfaction and cope with whatever challenges may arise.
David
Raughton, MFT is a Certified Hakomi Therapist with a private practice in
Berkeley. The Hakomi Method is a form of
psychotherapy which emphasizes the therapeutic relationship, the use of
mindfulness, and changing negative core beliefs.