How Therapy Works by David
Raughton, MFT ©2007
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, cognitive, and
experiential.
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 a good therapy relationship, 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 deepen and
speed change.
Cognitive Aspect: 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 everyday. Although many of these automatic thoughts are
neutral and have little impact, some thoughts can have very negative affects.
Psychologically and physically we respond to many negative thoughts 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.”
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. Also, developing a more loving
attitude toward one’s self can defuse them. Recognition of the negative
cognitions and their affects, combined with the experiential work described
below, is especially helpful for dealing with acute symptoms, including
depression, anxiety, panic, and excessive anger.
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." He will find changing
his thoughts will change how he feels.
This is not achieved merely through willpower or positive thinking. Instead, by recognizing the relevant
cognitions and challenging the harmful ones, he is no longer passively pummeled
by them.
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 (mindfulness) 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: first 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 experience in therapy, and extended outside. The past is more readily forgiven and left
behind.
An example of a core
experience is a person whose need for emotional closeness was ignored or
rejected as a small child. They may
develop a core belief that it is not safe to allow deep intimacy or depend on
others. Kurtz has referred to this
character strategy as self reliant.
Through contacting their core experience, and finding new nourishment, a
person can develop beliefs with the potential of allowing more satisfaction,
such as “There are trustworthy persons on whom I can depend and be close”, and
respond to life in a way that makes this a reality.
Summary: I have summarize 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) What we
think affects what we feel, and we can become more conscious of our cognitions
and challenge self-defeating ones. And 3) Awareness of our direct experience
(mindfulness) helps us contact core experiences, and discover new more nourishing
possibilities. For me, Hakomi
Psychotherapy integrates these three aspects, and is the primary approach I
use.
David Raughton,
MS, MFT is a Certified Hakomi Therapist with a private practice in