Rob Fisher, MFT license # MFT 22886      

"Psychotherapy is the gentle unfolding of the soul"

                                                                      Jon Lonsbury

Reprinted with permission from The California Therapist - July/August, 1998

 

From Insight to Experience -

An Experiential Approach to Couples Therapy

 


By Rob Fisher, M.F.T.

 

Introduction: Think about it... Which would have more impact on you, watching National Geographic on TV or going to Africa and smelling the heat of the rhinoceros as it paws the dust in front of your jeep?  Which would be more rewarding, discussing chocolate cake with a friend or eating it (non-caloric of course!)?  Which is more pleasurable - talking about sex or having it?  If it is true that experience has exponentially more impact than does verbal discussion, then why do we so often conduct psychotherapy as a form of expensive conversation?

 

Psychotherapy is often practiced as an in vitro exploration of a person’s or a couples’ life.  While this is an interesting pursuit, it often lacks depth and aliveness, not to mention brevity. 

 

This is an article about in vivo psychotherapy, about how to bring therapy alive for client and therapist alike.  It is dedicated to the premise that people want not just insight about what is going on in their internal worlds, but the opportunity to experience something different.  It is dedicated to the idea that you can obtain more information about a psychological phenomenon by exploring it as it is happening than by discussing it as a report after the fact. 

 

More specifically, this article is designed to introduce the reader to somatic and experiential interventions in couples psychotherapy.  Many of these interventions can be used regardless of your theoretical orientation.  They provide an opportunity to elegantly access, explore and change systemic and characterological material in a time effective and non-intrusive fashion.  I will present both theory as well as examples of how the concepts may be immediately applied in your clinical practice.

 

Clinical Example: Jack’s complaint about Betsy was that she was too emotionally volatile and prone to verbal and physical violence when angry.  Betsy’s complaint about Jack was that he was unavailable emotionally.  From a somatic point of view, one interesting thing about Jack was the way in which he held his head - high on his shoulders, with his back very straight and the chin tilted up about two inches.  I had some guesses about what was encoded in the posture, but my preference was to have him find out from the inside rather than my interpreting it from the outside.  I would rather be a midwife for his deepening consciousness about himself than an authority who tells him who he is.

 

I said: “How about a little experiment?”  They both said “O.K.”.  I then asked Jack to take a moment to go inside to a mindful, observant state and then to drop his chin about two inches and notice what came up - feelings, thoughts, images, memories, sensations or nothing at all.  After sitting this way for a few moments he said:  “I feel less powerful.”  I next asked him to raise his chin about three inches and for Betsy to notice how it affected her.  She said, “Its amazing, because its such a little thing, but I go into a rage.”  I asked him to lower his chin again to see what that elicited from her.  She said that he felt available to her and that he had a pleading look that made her want to gently take care of him. 

 

This powerful somatic signal had a constant presence and effect in and on their relationship.  Whatever content they might discuss, his posture and her reaction to it was part of the background ambiance in which their conversations took place.  It colored the emotional climate of the relationship and predicted certain patterns of interaction.

 

Raising and lowering of his chin was an access route to significant intrapsychic processes for each of them as well as a circular systemic process in which his withdrawal elicited her rage, which in turn elicited his withdrawal.  Continuing with this process (accessing core material through the body) involved having him explore from the inside his characterological organization which prompted him to hold his chin “above it all”.  This kind of exploration is not talking about his character and defenses; it involves experiencing them from the inside.  His physical organization around his chin also served as a trigger for her and enabled us to explore her object representations relating to an unavailable intimate partner.  Again, we did not talk about her history as much as we had her study from the inside what happened internally when he raised his chin.  A stream of memories, feelings and meaning became available to her in a connected, vital fashion.  Together they were able to develop a visceral sense of the pattern along with its automaticity and circularity, which helped them make some conscious decisions and choices regarding its continuation.

It also provided them with the opportunity to explore new patterns of interaction; to face the fears associated with them as well as to experience their benefits. 

 

 

Benefits of a Somatic Approach: People are holographic. Their internal organization is reflected in their every act, movement, tension, from their tone of voice when they call you on the phone, to the speed by which they transport their body across your office, to the amount of eye contact they maintain with their partner, to the relative positioning of their bodies.  Somatic signals are a powerful commentary on the couples’ internal organization and can provide a quick and accurate diagnosis of a couple's dynamics.

 

 

The most effective way to access the past is through the present.

 

By noticing and working with proprioceptive signals, body tensions, posture, gestures, energy and presence, a skilled practitioner will have immediate opportunities to help a couple recognize and reorganize the dynamics of their relationship.

 

For example, whenever Helen entered the office with her husband, Henry, the first thing she did was to grab a pillow and hold it tightly covering the middle part of her body. This was a prominent and clear signal.  As a therapist I could guess, or interpret what this meant, but that would simply interfere with her own ability to access the meaning of her actions.  I proposed an experiment whereby she could sense the difference in her body with and without the pillow.  She saw how she relied only on herself to provide safety and comfort and shut her husband out from this potentially nourishing interaction, while complaining that he was never available. We then experimented with what it was like to have him gently hold the symbolic pillow for her against her body.  He took over from her the soothing function it provided, and gave her the opportunity to press her limits of accepting care and contact.  She noticed how much she resisted this, and he noticed how much he liked feeling useful to her.  This gave them a new basis to examine an old problem as well as redefinition its causes.

 

People are holographic.

Their internal organization

is reflected in their every act.

 

Working With the Present: One of the keys to working somatically is to pay close attention to, and acknowledge the moment by moment internal experience of the client. The most effective way to access the past is through the present.  By working with the present, characterological organization can be addressed, studied, felt, clarified, as well as new options explored in an immediate and undeniable way.  This approach has the power of immediacy.  As a therapist, you have the opportunity of working with wet clay, as opposed to hearing about clay that has already solidified sometime during the week.  If asked to describe the lines in your hand from memory you would be far less capable than if you are looking at your hand as you speak.  Psychological phenomena and couples dynamics can be most effectively worked with in the present.

 

It is also important to pay particular attention to the process that is occurring in front of you and not become entranced by the content of the conversation.

 

Cynthia and her husband Ron came in to my office.  She began to speak immediately and didn't stop until I interrupted.  She spoke without punctuation - no commas or periods.  One long, desperate run on sentence. The content did not speak nearly as loudly as the presentation. When she took a shallow breath, I inserted: "You feel really fast inside, huh?" She calmed down a notch upon being seen a bit. I took this as a sign that I was on the right track and said, " Let's have Ron say something to you and you notice what happens inside - feelings, sensations, images, memories, anything. Would that be O.K.? " She said, "Yes. Then I instructed him to say, "I hear you and I see you." (Histrionic personality styles are often based on early injuries of not being seen and heard by the significant others in the child's world.) She sat there, quiet for the first time in the session, tears rolling down her cheeks. Finally she said, "That's what I have been waiting to hear from you all these years. "  I had simply contacted her pace, energy level and quality of physical movement.

 

In a desperate attempt to gain his attention, she talked so fast and so much that she alienated him.  The faster she talked, the more disengaged and glazed over he became.  This kind of mutually reinforcing circular pattern is common in couples.  I wanted to interrupt it, as well as address the wound she carried and how it functioned in the relationship.  By noticing and commenting on her pace, I was able to access a significant intrapsychic injury and an interactional pattern based on it.  This helped the couple to develop a new and more satisfying way of relating.

 

Contraindications:  Working somatically tends to uncover deep material more rapidly than many traditional therapies.  It is therefore very important to ask permission prior to potentially invasive procedures and to track carefully the effects of any intervention.

 

It is also inadvisable to work with clients in this fashion who have very rigid personality structures, borderline issues, or strong expectations of therapy involving talk only.  In situations such as these it is best to use somatic signals for diagnostic purposes and only use the mildest form of interventions.

 

Mindfulness: In order to work somatically, to access deeper levels of internal organization, and to avoid the liability of psychological invasion, it is important to enlist the assistance of the client's observing ego in a state that can be called "mindfulness". This is based on the premise that if you are driving down the freeway at 70 miles per hour, it is unlikely that you will notice the smell of the flowers by the roadside.  When one slows down and becomes aware of the minute-by-minute flow of internal experience, one begins to notice the core beliefs, feelings and characterological strategies that determine the kind of life that one experiences.

 

For instance, a couple came in and the wife complained that her husband was unavailable. While she looked at him, her whole body was turned away from him. As she slowly turned to face him, she found herself uneasy about performance and dependency issues. Studying her posture in mindfulness enabled her to stop blaming him and to notice that she was also ambivalent about intimacy and found it easier to blame him rather than to face her internal conflicts about it.

 

Mindfulness is a lot like slow motion. It allows one to notice what was previously unconscious.  Couples can become upset, emotionally volatile and begin to blame each other in a session.  This is usually not very therapeutic unless they have previously been highly disengaged; in which case it represents the beginnings of reengagement.  If, however, mutual blaming and uncontrolled feelings threaten to take over a session, I generally ask the couple to slow down " as I am rather simple minded" and have one partner repeat the central phrase that triggered the emotional reaction. I will direct the other partner to let their spouse know when they are ready to be triggered and then to carefully study and report their reaction, as opposed to acting out in such a way to alleviate their internal pain or conflict.

 

 

 

Mindfulness is a lot like slow motion.

It allows one to notice what was previously unconscious.

 

 

Working in mindfulness with couples tends to undercut blaming and promote self-focus.  Any therapist who has worked with couples knows the tendency of partners to shift the focus onto the character flaws of the other and to save themselves the narcissistic injury of self-examination.  When one notices the present time responses that each partner has to the other and shifts the focus towards understanding their response, there is hope for the interaction disentangling as opposed to escalating in a circular fashion.

 

For example, When Jim and Sally started to talk about their recent dinner out, it soon became obvious that there was a lot of underlying emotion and the session was beginning to get out of control.  She complained that he did not pay attention to her when she talked.  He complained that she was trying to abridge his freedom.  A good case could be made for both their indictments, and had I been a judge, I could have convicted and beheaded them both for their interpersonal crimes against the other. However, the legalistic arguments not withstanding, this was supposed to be therapy. I wanted to study with them her sensitivity to abandonment and his to being controlled.   Two experiments came to mind that could be conducted in mindfulness.  One was to have her try to turn his head towards her and for him to study the images, memories, sensations, emotions and beliefs that surfaced.  The second was for him to turn his attention away from her so that she could equally study the internal effect of this.  By proceeding like this, they were able to stop arguing and make productive use of their therapeutic time.  It is investigations like this that 1) undercut the circular escalation that is the hallmark of painful couples interactions, 2) help develop sympathy for the partner, and 3) reduce the tendency to take one's partners sensitivities personally.

 

Experiments:  Many experiments can be created in therapy to provide the couple with an opportunity 1) to study their issues, and 2) to gently push the envelope of what is already possible to do, act and feel in a relationship.  Providing such opportunities to deeply understand and to actually modify behavioral, cognitive and affective patterns is an important cornerstone of effective therapy.

 

For instance, Phil was upset that Kathy always got angry when he asked for something.  A therapist would have a couple of options to help her explore her reaction to his requests. One way is for her to talk about how she feels and what she thinks when he asks, and to explore her associations around this issue.  This is a fine method and is certainly tried and true in the analytic tradition. Another approach would be to ask her to become mindful, and to direct him to ask her for something.  They then both have the opportunity to study the dynamic underpinnings of this potentially conflictual interaction in a very real, undeniable and responsible way, as opposed to a method which tends to be more mental and which can lack in deep internal connection.  This is the same reason why working with the transference in individual therapy is so powerful.  By studying the interaction in mindfulness, the couple also has the opportunity to develop a "relationship observing ego" which can be applied outside of the sessions. The crucial subtleties of object representations can be best noticed in the present, and tend to be obscured and distorted with the passage of time and implementation of defensive strategies.

 

Needless to say, one would also explore his issues around asking and the communication patterns that took place between them surrounding this issue. 

 

There are different types of experiments. The two most important categories are verbal experiments and experiments involving touch.  Examples of each of these will follow.

 

As a therapist, when you propose an experiment you do not know what the result might be.  This kind of experimental attitude takes the willingness to make mistakes, to not position yourself as the sole authority on the inner world of the client, and to tolerate uncertainty - not an easy task!

 

Proprioceptive Signals: When a client begins to pay attention to the proprioceptive signals that arise internally in a spontaneous fashion, a whole new world of information that was previously unconscious begins to be available to him or her.

 

Kevin and Janie had trouble getting and staying close for very long before an emotional explosion occurred.  I asked Kevin to sit some distance away and I asked Janie to begin to come physically closer to him while he noticed precisely what happened in his body.  When she got within about five feet of him, he started reporting uncomfortable feelings, "squirminess", anxiety, a constriction in his chest, trouble breathing, and the feeling of being trapped. This experience was a window through which to study his earlier emotional intrusion by his mother, which colored his interactions with Janie. Instead of acting out from his uncomfortableness to make it go away, he began to become more conscious of what was driving him.  Janie was also able to depersonalize her experience so that she did not feel so much the target of his withdrawal.

 

Boundaries:  One filter through which to evaluate a couple is the continuum from enmeshed to disengaged.  An enmeshed couple has overly permeable boundaries, while a disengaged couple has boundaries that are overly rigid.  A somatic method for diagnosing this and working it through is to have a couple sit facing each other and use either a string or soft chalk to create a physical representation of their personal boundaries.  This technique relies on the proprioceptive experiences of the clients as discussed above.

 

Alexandra complained in therapy about John's lateness. She organized every aspect of his life.  He responded to this by stealing time for himself and by passive-aggressively being late.  She responded to his attempts at autonomy with escalating rages. I asked them to draw boundary circles and to note how it felt different inside their bodies with and without the circles. John felt instantly relieved when he drew his circle.  Alexandra, however, was faced with an intolerable feeling of aloneness and the memory of her father's abandonment of her and her family when she was twelve.

 

 

Inexperienced psychotherapists tend to oppose their client's defenses rather

than helping them identify, appreciate and reown the wisdom of the defense.

 

Now, instead of John being the villain, the couple was able to appreciate the depth and intensity of her feelings and to creatively and compassionately deal with them, rather than fighting about his lateness and further alienating each other.  Alexandra also began to disassociate John from her father and to give him a little more breathing room, which resulted in less rebelliousness on his part.

 

Working With Defenses: Inexperienced psychotherapists tend to oppose their client's defensive system rather than helping them identify, appreciate and reown the wisdom of the defense.  When this happens, one of the only honorable things the client can do is to resist.  Another approach is to support the defense.  By doing this, the defensive system relaxes, feels sympathized with and the feelings it is designed to protect begin to surface naturally.  It is in this way that the therapist begins to gain the cooperation of the client's unconscious.

 

This approach is different from paradoxical intention in that is not a covert activity on the part of the therapist.  Supporting a defense is always done with the permission of the client for the express purpose of studying the defense, providing therapeutic safety, and allowing information and feelings to surface from a deeper level.

 

In working somatically, one looks for somatic components of the defensive system and offers to have the spouse take them over.

 

For instance, Jake complained that he had to do everything and that Sally was never there for him.  This reflected certain beliefs he had about the availability of emotional nourishment and his ability to take it in. As he spoke I noticed that he held his head rigidly on top of his shoulders in a military fashion.  I asked him if it would be O.K. if Sally helped him hold his head up high.  He said, "Yes".  As she gently took the weight of his head that he had had to hold up by himself since his father taught him to be a "little man"; he first noticed how hard it was for him to let go of this control. Beliefs such as  "No one will ever be here for me" started to become apparent.  He could hear internally his father's injunction to "Be strong and not depend on anyone".  Finally he started to let go and experience the sadness of his early abandonment which had influenced every subsequent relationship.

 

Psychological defenses are always somatically represented.

 

He was defended against dependency. The somatic representation of his defense was literally trying to hold his head up high. 

 

Gesture, Posture, Tensions: From the foregoing it should be obvious that a tremendous amount can be learned about a couple by noticing their postures, gestures and tensions individually and in relation to each other.  Here are some more specific samples of each type of intervention:

 

In the case of a couple afraid of intimacy, one way to work with gestures is to have one partner reach out to touch the heart area of the other while both study the internal effects of this action as well as what the hand seems to be saying. 

 

An example of working with posture follows: Carl would get very upset with Mary. When he did, he fell into a private world of darkness and did not look up at his wife. We noticed that if he made visual contact with her, his image of her as a cruel and dangerous woman immediately diminished.

 

When Jessica and Dan came in to the office and sat down, the most obvious thing about them was the difference in the tension in their ankles.  Dan's were more relaxed that humanly possible, while Jessica maintained a high level of tension, wiggling her foot constantly.  One could speculate form this the type of conflicts they had around time, money and agreements.  By pointing out and discussing these differences with them, they began to relax. I n the next session she commented that she no longer felt compelled to make him make him be like her.  As an alternative intervention, I could have also had each one try to make the other's ankle like their own, or I could have asked him to take over the tension in her ankle.

 

Couple's Sculptures: "A picture is worth a thousand words." A family sculpture is worth at least ten thousand.  Particularly for couples who are highly verbal and cannot stop long enough to notice what they are actually doing, having them produce a sculptures of their relationship dynamics is very useful.

 

The technique works as follows: Have the couple stop whatever they are doing and notice the psychological stance that they are taking with their partner.  Ask them to imagine what a physical sculpture would look like that personifies this dynamic. Each will probably come up with something different.  Then ask one of them to silently direct him or herself and their partner into this precise position in regards to each other - and hold it for a minute noticing how it feels in their bodies, memories and images it calls up, tensions, etc.  After a while, ask for a report from each.  From here, you can explore in a variety of ways.  They can each exaggerate a certain aspect of their sculpture, or diminish it.  They can look for associations about their stance.  The partner can modify a part of their stance and the other person can notice internally how it affects them. Finally, it is usually best to have them recreate the sculpture to fit their ideal prior to continuing with the other person's sculpture.  At this point it is also very important for them to search for any part of themselves that resists it being this ideal way.

 

For example, a turning point came in therapy with Howard and Susan when they did his sculpture.  He placed himself in a corner with her reaching out towards him, as he beckoned with one hand and held her off with the other.  He was able to study each part of his internal conflict about intimacy as he explored the feelings and meaning connected with each hand.  We were able to experiment with what it would be like if only one hand was operative, and in particular, what it was like as he let her in more breaking the trance of the transference and beginning to experience her as his wife rather than his intrusive step-mother.

 

Breaking The Trance of the Transference: We are all familiar with the way in which emotionally laden images from the past form an overlay on present time experience, and how one's partner seems to take on an uncanny resemblance to the emotional characteristics of earlier intimates.  This is the work of transference.  Part of the challenge of couple’s therapy is to break the trance of the past.  What follows is an example of a technique, which although controversial, may be useful in achieving this result.

 

Debby had been molested as a child by her father.  When her husband, John reached out to touch her in a way that could be construed as even a mild sexual advance, she was immediately filled with fear and revulsion.  John, of course, had interlocking issues about his masculinity and rejection, which were easily triggered by Debby's sexual withdrawal. In the middle phase of therapy we tried an experiment designed to break the automatic association between John and Debby's father.  Although intellectually she was able to tell them apart, on an emotional basis, they merged and the image of her father was cast over John making their sexual relationship impossible.  After describing the experiment and asking for both of their permission, I asked Debby to go inside, check into her inner experience and let John know when she was ready by opening her eyes.  He then started reaching out his hand towards her arm (a spot designated as "safe").  He did this in slow motion as she tracked her experience for the point where the fear and revulsion began to appear.  At this juncture, rather than deeply exploring those feelings, (which would be appropriate in an individual session) I asked him to say to her: "Debby, I am John, your husband. I am not your father. I love you, I do not want to hurt you, and you can say 'no' to me whenever you need to'".  She took this in, and her feelings calmed down.  We tried this three times before it was O.K. for him to actually touch her arm without triggering her old response.  They were then able to successfully apply this to their sexual relationship outside of the session.  He had more sympathy for her conflict and pain and personalized her sexual rejection considerably less as a result of this experiment.

 

Summary:  The purpose of this article is to introduce the idea of somatic diagnosis and interventions in couple’s psychotherapy, to provide actual examples of this and to stimulate thinking about new technical possibilities for effective therapy.  It is not intended to provide comprehensive training in these techniques, which, because of their power and potential invasiveness, need to be carefully studied and, when applied, closely tracked for the client's response.

 

 

Rob Fisher, MFT is in private practice in Mill Valley, California where he specializes in couples therapy and consultation as well as individual experientially oriented psychotherapy.  He publishes the Couples Psychotherapy Newsletter and is an adjunct professor at JFK University where he teaches marriage and family therapy and at CIIS where he teaches the theories and techniques of body oriented psychotherapies.  He also teaches at a number of agencies at the postgraduate level and is a Hakomi Trainer.  He has recently published a book entitled Experiential Psychotherapy With Couples – A Guide For the Creative Pragmatist (Zeig/Tucker).

                       Mindfulness in Psychodynamic Psychotherapy

 

Rob Fisher, MFT

 

The single most effective tool in psychodynamic psychotherapy is the use of Mindfulness.  Mindfulness involves turning one's attention inside to notice, from a curious and nonjudgmental point of view, the flow of one’s internal experience.  While a number of contemporary therapies have embraced mindfulness as a means of calming down emotional activation or reducing stress, it can also be used with dramatic results in psychodynamic psychotherapy.

 

Example:  For example, a client, Erin, was talking about how hard it was for her to be emotionally open.  I noticed that her face, shoulders and upper chest were slowly turning red. When I commented on this she was surprise and said, “Yeah, it feels hot there, but I don’t know what that is about!”  I asked her to let the experience of the warmth be there and notice where it took her:  “OK, so let yourself just linger with that feeling of heat.  Feel it in your face and neck and upper chest.  Really take your time so that you can notice the details of your experience, the thoughts, feelings, sensations, tensions, impulses, memories, images that might go along with this. Let me know what comes up.”  She remained silent for a few moments and then said, ”I am ashamed.  I remember a time when I was very open at school and told my friend how much I liked her.  She looked at me with disgust. I never wanted to be open again” She bowed her head in shame. Simply by leading her more deeply into her experience and asking her to pay careful attention, a memory spontaneously occurred. Insight emerged from immersion in her present moment experience.

 

In this example Mindfulness is used by client and therapist alike. By asking Erin to be aware of her experience and to stay with it, letting it unfold, I was asking her to be mindful.  By noticing the details of what was happening with her in the present I was being mindful myself. Mindfulness for the client involves the turning of his or her attention inward without judgment or preference to notice the experience of the moment.  Mindfulness on the part of the therapist involves turning one’s attention outward towards the present moment experience of the client.  It is a state of welcome, curiosity and wonder about the inner world.  It does not involve forcing, thinking, figuring things out, trying to change one’s experience, but just allowing it to be there and noticing how it changes. Without interference, and provided a safe environment, experiences have the same tendency to unfold as does a bud that knows how to become a flower. As therapists and clients we simply need to create a container in which that can happen.  A plant needs sunlight, earth, water and safety from predators (and human beings with big shoes!). A client needs warmth, attention, enthusiasm for their experience, acceptance, a sense of safety and connection with the therapist.  In this context the psyche tends to reveal itself.  It is a matter of inspiration.  How can we as therapists create an atmosphere that inspires a client to explore inwardly? 

 

 

Mindfulness is a primary tool that enables a direct connection between the client and her or his psyche.

 

History: Mindfulness is, of course, borrowed from Buddhism where it is used as a method of meditation to help people to develop an internal place deeper than identification with their momentary experiences.  According to Dharma Teacher Will Kabat-Zinn, MFTI, mindfulness is used in Buddhism to explore what we are beneath our ideas and preconceptions about ourselves, a doorway to discovering who we truly are. Sustained mindfulness can lead increasingly to an internal freedom that is not dependent on any internal or external conditions.  In psychodynamic psychotherapy we are more interested in resolving the experiences themselves.  Both applications are beneficial.

 

In the 1980’s Mindfulness was applied to the realm of psychotherapy by Ron Kurtz who went on to found Hakomi Experiential Psychology which is now taught internationally.  He now refers to his approach as “Mindfulness Assisted Self Study”.

 

In psychotherapy we use it to explore the details of one’s experience “ in vivo” instead of “in vitro”. The essence of many therapies is an attempt to change the client’s experience in relation to their self, the world and others – a rewiring of the neural networks deeper than cognitive insight can achieve.  In psychoanalysis, the heart of therapy is experiential event  - that is the exploration of the transference/countertransference relationship.  It is not just the analysis and interpretation of this relationship that causes change; it is the actual felt experience.  In Gestalt Therapy, one focuses on awareness of the moment.  In Structural Therapy, Minuchin would encourage a couple to have a fight rather than talk about it.  Neural patterns change throughout our lives as a result of new experiences.  While talking about events can help clients unburden themselves and reduce the sense of aloneness around them, we need to generate new experiences for long-term change to occur.  Mindfulness orients the client around the experience of the moment as an entryway to core models of their world.

 

When Jack left the office, stooping to avoid hitting his head on the doorframe, he shook my hand.  A powerfully built man, his handshake offered me a set of limp fingers that stood in sharp contrast to his otherwise imposing physical structure.  By paying attention to this little hologram of his presentation, and in a future session repeating it in mindfulness, his whole relationship to power became crystal clear. As he shook my hand I asked him to carefully study what he did and did not do with his hand and the accompanying thoughts, feelings, images, memories, impulses, etc. He was instantly clear how he had decided never to use his power again after beating up Jonnie Smith in 6th grade.  This decision, evident in his handshake, plagued his relationships ever since. By exploring the moment of the handshake carefully and slowly in mindfulness he was able to become aware of his relationship with power and begin to experiment with new beliefs and behaviors starting with me.

 

Assessment: Mindfulness can also be used for assessment. To assess what is happening in a client’s internal world, one needs details before theories.  From details hypothesis can be generated.  Most of communication between client and therapist is not verbal. When a client comes in with a slow gait and sits down with a sigh, she is communicating to us, not in the language of words, which can be easily disguised, but in the language of experience.  The unconscious speaks in many languages (Ron Kurtz in private conversation).  It is important that we hear it.  By noticing in any moment, not only the content of what is being said, but what the client is doing, how they are doing it and what, at any given moment they are experiencing, we add a dimension to therapy that results in a journey into the depths, not just of the neo-cortex, but into deeper parts of the brain where more fundamental issues are available.

 

 

There is a limit to the effectiveness of conversation in psychotherapy.

 

 

Mindfulness in Psychodynamic Interventions: How then is mindfulness actually used in therapy?  Here is an example with a couple: Jon and Karen had a terrible fight that led them to therapy.  She complained about him, “Whenever I want he says, ‘No’.  I ask him to go to lunch, he says ‘No’. I ask him to go to the movies, he says no.  I ask him to make love, he says no.”  I have had it!”  While I could have reflected back the content of what she had just said, I reflected back her present experience, “That’s really frustrating, huh?”  Smart therapist that I am, I had a pretty good idea of what was going wrong here: she was probably asking in an alienating way.  Following my own lead, I thought I would test my hypothesis.  “So go ahead and ask him for something right now and lets see what happens”.

 

 One can obtain much more information

from the present

 than the past.

 

Contrary to my idea, however she was sweet and inviting in her presentation.  I still knew better, of course.  I was sure that at home she was not on such good behavior.  Then I looked at him.  He said, “See, she is always trying to push me around!”  Clearly he experienced her offer as coercion.  My hypothesis was wrong, but I had at least checked it out experientially instead of relying on my misplaced interpretation.  Appropriately chastened, I asked them to repeat the interaction in mindfulness.  “So, lets try that again, Karen, why don’t you just say one sentence again asking him to go out to a restaurant, and Jon, notice what ever comes up hearing her.  There may be that feeling of being pushed, there may be images or memories, sensations in your body, anything even if its not linear.  Let me know.  Let her know when you are ready and she will say it to you again.”  This time he studied his experience instead of just reacting.  Mindfulness assisted self-study.  He noticed that he was having images of all the people who had pushed him around in his life, from his parents to the Bible to the multinational corporations.  He was fighting all of them.  The good news was that when he refused to make love with her, it was not just her in bed with him, it was all the people whom he felt had controlled his life.  By asking for mindfulness, much material became available that was not readily accessible in ordinary conversation.

 

Protocol:  Here is a brief protocol for using mindfulness psychodynamically.

 

§  The therapist must be aware of what is happening in the present in addition to content.  This includes noticing the immediate actions of the client, her or his style of doing, and his or her moment-to-moment experience.

§  It is also important for the therapist to notice the details of his or her own internal experience moment to moment (countertransference).

  • The client can be asked to study any element of their experience in mindfulness by saying the following.  It is best to select an element that is of interest to the client and in line with the theme of the session:
    • “Lets take a moment to really explore that.  Would that be OK?”(Asking permission)
    • “Let your attention go inside so that you can notice the details of your experience.”  (Orienting inwardly)
    • “Notice the thoughts, feelings, sensations, images, memories, tensions, relaxation, changes in breathing, impulses that occur as you pay attention.” (Providing a menu of possibilities frees clients from the usual limitation of looking for either thoughts or feelings.  Internal experience is quite multidimensional.  Stay away from emphasizing only feelings and thoughts.)
  • “Nothing has to happen”.  (Take the pressure off.  People generally try too hard.  This interferes.)
  • Wait and wonder.  (Your internal state is crucial here.  It is important that you slow down you r internal pace.  This can limbically affect your client who will follow you inside.) 
  • It is also important that you are curious and enthusiastic about their experience.  (While you do not need to put on a miniskirt and wave pom-poms, your interest in what happens can be inspiring to them.  If you try to be neutral, you de-humanize the relationship.  I realize that is a controversial. You can test this out by trying to interact neutrally or with enthusiasm and warmth and note the results. Clients are tracking us like hawks, and are taking in tremendous amounts of information about us whether we try to be neutral or not.)
  • Notice what you can tell about their new present moment experience from the outside and ask for a report as well.
  • Connect with them on this level. By reflecting back, not just content, but their experience, you will deepen the relationship and the therapy exponentially.  Examples of this might be, “You’re sad, huh?” Everything just got still”, “You just tensed up a bit, huh?”  Unless you want to engage the neocortex, keep your sentences short and simple.
  • Ask them to stay with their experience and let it unfold to the next experience. For example, Jane was disconcerted that her excitement about buying a new car seemed clouded.  As she stayed with her experience of excitement mixed with something else emotionally darker, what was unclear started to take form. By staying with the experience of the dark spot, she became clear that her European parents would have looked down on her choice of an American car.  By then staying with the image of her parents’ disapproval, she began naturally to sympathetically feel their hardship as immigrants.  Allowing herself to stay with this feeling led her to a sense of herself as being separate from their values and more connected to herself.

 

 

Conclusion: Through the use of mindfulness in psychodynamic psychotherapy a number of important therapeutic elements become immediately available.  It encourages people to “act in “ instead of “acting out” Rather than take action based on internal events; they can take a step back to study them.  Exponentially more information becomes available in mindfulness than in ordinary conversation.

 

 

Mindfulness Exercise: Try this mindfulness exercise applied to your internal organization as a psychotherapist: Take a moment to first let your attention go inside.  Notice your present moment breathing, the sensations in your body, your thoughts, your feelings, hopes, impulses, memories, images, decisions, beliefs, songs, colors, anything that comes across your consciousness.  Take your time doing this.  Now imagine you are preparing for a client to come to your office.  Notice how you start moving from Jane or John Doe, human being, to Jane or John Doe psychotherapist extraordinaire.  Do you get more open, more formal, straighten your clothes, hide your grief, become more cognitive or emotional, more generous or more rigid? Watch this all as if you were watching an internal home movie in slow motion so that you can pick up even the subtlest of changes you undergo. Notice your own way of becoming a therapist – what you like as well as what you do not like.

 

 

It is empowering for a client explore their own experience as opposed to relying on a therapist to explain what is happening inside.  It helps people become more connected with themselves.  It takes therapy to a new depth that goes beyond the cognitive into the experiential.  The level of therapeutic impact is substantial.  The difference between mindful exploration in therapy and conversation is the difference between wolfing down a Big Mac and fries while driving to your office vs. sitting comfortably in a French restaurant where you are served on small portion of a finely prepared dish. You sit and savor every morsel, noticing how the rosemary mixes with the garlic in the entree, and the particular confluence of raspberry and chocolate in the warm, fragrant desert.  One simply notices more in this state.  One notices the substrata of the psyche. (Analogy courtesy of Kathleen Dunbar, MFT.)

 

How would you like to conduct therapy?

 

 

 

 

 

Rob Fisher is an MFT and training consultant in private practice in Mill Valley where he specializes in training other therapists in working with the present moment.  He is the author of numerous articles and book chapters, and the book Experiential Psychotherapy with Couple – a Guide for the Creative Pragmatists (Zeig/Tucker 2002).  He teaches at JFK University and CIIS.  He is a Hakomi Trainer who teaches trainings in mindfulness based psychodynamic psychotherapy internationally for the Hakomi Institute, and frequently through the Hakomi Institute of California which provides trainings in therapeutic skills in locations throughout California..  He appears at national conferences such as the Psychotherapy Networker Conference, the USABP Conference, and as a master presenter at annual CAMFT Conferences.  He can be contacted at wildtemple@aol.com

Contact Information:

To contact me please call me at
415 389-6340 or e mail me at  wildtemple@aol.com
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