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Hakomi: The Principles

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By Paul Hubbard, MA, AMFT

A new paradigm is happening in the world that emphasizes concepts like connection, inclusiveness, consciousness, body-mind interface, partnership and internal locus of control (Kurtz, 1990).

Truth can exist in multiple, different forms. There is value in being more inclusive and in considering multiple points of view and being open to the possibility that there can be more than one way to be right, in a given situation.

Ron Kurtz, the creator of Hakomi, said that he did not like the word “client,” and instead preferred to say “the people who come to me” (Kurtz, 1990, p. 18). He realized how important it was to shift one’s attitude from a desire “to make something happen” to being totally fine if nothing at all happened in therapy (p. 18). This means letting go of having an agenda. The client has a degree of power to direct their own therapy; therefore, it is important for the therapist to let go of control and any desire to take credit for the work taking place (Kurtz, 1990).

Organicity

Hakomi has several principles, which include organicity. Organicity happens when the therapist works cooperatively with the client’s natural, inherent movement towards wholeness. Organicity “places the locus of healing and control within the client and the client-therapist relationship. The client’s growth and unfolding, his or her answers or resolutions, completions and new directions, are all within” (Kurtz, 1990, p. 25). The therapist is simply present to help assist the client’s process (Hakomi Institute, 2015).

Organicity involves looking for and following natural processes. The therapist doesn’t impose a structure or agenda but rather looks for sources of growth and movement and supports them. This can mean, for example, giving a client time after an interaction to decide what interests and direction they want to pursue. In Hakomi, the therapist supports the client’s defense mechanisms, the ones a client uses to manage significant experiences. There are creative ways to work with the defenses that support growth (Kurtz, 1990).

When the various aspects of the subconscious are able to communicate with the conscious personality, then one can become more self-directed and self-correcting (Kurtz, 1990; Myullerup-Brookhuis, 2008).

Mindfulness

Mindfulness is a principle and a state of consciousness that includes noticing how someone is organizing their experiences. Through mindfulness the therapist assists the client’s own inner wisdom “to create change through awareness rather than through effort” (Kurtz, 1990, p. 27). In therapy, one effect is to just stay with an experience longer and allow things to happen. People organize their perceptions and actions around core beliefs. A primary goal of therapy is to bring organizing material, including core beliefs, into conscious awareness (Kurtz, 1990).

Mindfulness involves being truly present with one’s present-time experience. One cannot be mindful about the past or future. We can only remember the past or anticipate the future. In being mindful, we choose to observe the present without interference. This implies having a receptive attitude which, even if it is only momentary, can provide valuable insights. As we bring our experiences into mindful awareness, we can begin to transcend them and to let them go (Kurtz, 1990; Myullerup-Brookhuis, 2008).

Nonviolence

“Violence in therapy is not just deliberate, physical harm”, violence in therapy can be subtle and not immediately apparent to those of us “raised with the models of authority common to our culture” (Kurtz, 1990, p. 29). For example, when someone assumes they know what is best for another then that is considered violence. This is the opposite of organicity.

Nonviolence involves going with the grain; that is what’s natural and what works. Going against the grain is what generates resistance. Nonviolence in therapy means accepting the client as they are, with their own story, ideas, desires, capacities and pace (Kurtz, 1990).

Ron Kurtz preferred to call defenses or defense mechanisms “managing experience” (p. 29). “In Hakomi, we do not oppose the client’s efforts to manage his or her experience. We support these in an effort to give the client a safe and controlled way to explore the experiences more deeply and completely. Any attempt to oppose such management meets with resistance anyway and the work becomes more effortful and more painful than it need be (Kurtz, 1990, p. 29). After all, one’s management style is their best effort to deal with pain and fear, an old and valuable tool.

By gaining the cooperation of the client’s unconscious and by supporting and following their own process and pace, we hold a space for any experiences that need to happen. By supporting, a client does the work she wants to do and she takes the credit for that work and deservedly so (Kurtz, 1990).


References

Hakomi Institute. (2015). The Hakomi Principles. Retrieved from http://hakomiinstitute.com/about/the-hakomi-method/the-hakomi-principles

Kurtz, R. S. (1990). Body-Centered Psychotherapy: The Hakomi Method. Mendocino, CA: Liferhythm Press.

Myullerup-Brookhuis, I. (2008). The Principles of Hakomi. Hakomi Forum, 19-21, 69-84.

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Boundaries and Types of Touch In Psychotherapy

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(Photo from the Mother Love Bone’s album ‘Apple’)

By Jason Briggs, MA, LMFT

“Art…We are flesh and blood and full of faults. But we are also full of warmth. The world is full of confusion, but there is compassion in its midst. Communication via simple touch can transmit so much of us in just one minute. Like a painting or a piece of music. I want to touch your soul. I only wish I could be sure it was the right thing to do.”
– Jay Woodman, SPAN

In this piece we will explore ways to be boundaried when integrating touch in psychotherapy. Therapeutic touch is defined as any physical contact between a client and her therapist while participating in psychotherapy, which is non-sexual in nature. In this missive, we will address how therapists can use touch to help heal their clients.

Touch is often highly avoided by psychotherapists, partly because it’s rarely discussed in schools and training programs, and because of an over-arching lack of interest and understanding by gatekeepers in the field of psychotherapy, both historically and present. I will discuss how not using touch can be neglectful when a client needs exactly this type of support. Touch is an important and equally healing form of communication, possibly on par with words (i.e., Fridlund, 1994; Young, 2005). Given that touch, so often confused with sexual touch by therapists and clients alike, is so healing, we as therapists must no longer abandon considerations when using touch in psychotherapy and instead explore what using touch can do for our clients to facilitate a greater healing in the therapist-client relationship.

When using touch, one must always consider her rationale for why this adjunct type of support is being used, considering both client and therapist and the boundaries they share and are surrounded by. Touch enacted in therapy by the therapist in traditionally more rigid ways may stem less from an awareness of healthy boundaries and excellent standards of practice and instead from a lack of awareness or interest in the various standards of practice regarding touch and the benefits of the use of touch in psychotherapy. Maybe a therapist considering using touch hasn’t thought of what is barring their interest and ability to use touch as a viable form of communication in psychotherapy. Myths, as unchecked assumptions, are perhaps the most pervasive reason therapists don’t suss out how to use touch in their practice. Here is one such myth:

“There is a myth of the slippery slope that non-sexual touch inevitably leads to sexual touch, which is unfounded, scientifically unsupported and basically is paranoid. It’s pretty crazy actually if we just look at it. The assumption that soothing touch leads to sexual touch is nonsensical. In spite of numerous therapeutic approaches, theories and practices that systematically and effectively use touch in therapy, it has been marginalized, forbidden, called a taboo, often sexualized and at times criminalized by many schools and ethicists, licensing boards as well.” – Ofer Zur

What is the cost of a therapist’s lack of interest and awareness of touch in psychotherapy? Here is one possible outcome: “Indeed, touch deprivation has been consistently linked to aggression, delinquency, social isolation and depression in children and adults (Field, 2003).” Given this knowledge and the standards of practice in the field of psychotherapy, standards rooted in a larger philosophic service-based assumption known as the Hippocratic Oath (to always do no harm), it bears to reason that touch in psychotherapy cannot be ignored as a matter of the wellbeing of the clients we serve.

Boundaries that bar touch are likely to be too rigid and may prevent necessary information from being received by the client, possibly to sooth or calm, and prevent ongoing dissociation, etc. Touch that communicates harmful information to the client by her therapist needs to be withheld by the therapist, as this places her below the standard of care and practice and is illegal.

This harmlessness of using touch and assessing the potency of touch includes the therapist learning the client’s preferences, background, history, ability to stay in the present, power differentials and much more. Consent allows sharing of information, verbal or non-verbal (touch), to be given and received in ways that are experienced as healthy by client and therapist alike. It goes to say that negotiating boundaries around touch must be learned by therapists to raise touch into the realm of healing and that healing must be raised to unequivocal predominance. Boundaries allowing information to be shared in a defenseless way allows bonds to be felt between client and therapist. This sharing is like a cell whose nutrients are present and released, even when toxins exist. Toxins are contained for the time being and released when shame and fear can be let go of by the relational field found in the client-therapist relationship.

There are three types of touch in the literature on touch. The first is those adjunct forms of touch shared by psychotherapists, which complements verbal therapy and can take many forms. The second type of touch is therapeutic touch by body psychotherapists whom use their training in somatic psychotherapies to dictate what type of interventions may be used when considering touch for their client’s needs. The third type of touch is inappropriate or hostile touch and these are sexual, hostile or punishing touches and are illegal and unethical in the field of psychotherapy. With sexual touch the initiator intends to sexually arouse the therapist, client or both. In the first type of touch there are many forms and purposes for using touch with our clients.

Therapists who learn more about their clients and their own relationship to touch and how to use it effectively have advantages over those therapists who don’t have touch at their disposal as an important healing intervention. Raising our voice and awareness regarding touch, as therapists, means embracing the simplicity of touch, its complex applications, and preparations on how to use it in therapy. Doing this means raising touch to its rightful and helpful place in psychotherapy, not only as a valid form of communication but one that embodies a combination of silence, caring and connection, which words simply fail to communicate.


References

O. Zur , Nordmarken, Nola (2015) Touch and Boundaries in Psychotherapy: To Touch Or Not To Touch, Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling, Clinical, Ethical & Legal Considerations, Online Education.

O. Zur (2007). Touch In Therapy and The Standard of Care in Psychotherapy and Counseling: Bringing Clarity to Illusive Relationships. United States Association of Body Psychotherapists Journal (USABPJ), 6/2. 61-93. Copyright USABP www.usabp.org

Mozilla Firefox, Google search, (2018, July 15, 9:10 pm). https://www.goodreads.com/quotes/tag/touch

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Summertime Sadness: Managing Reverse Seasonal Affective Disorder

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By Alicia Cox, MA, AMFT

In the winter months, it is common for people to experience seasonal affective disorder (SAD). The disorder will come and go with the winter season, but can cause a lot of suffering and discomfort during those months. People can also experience SAD in the summer. It is not as common as winter SAD, but can be just as difficult to manage.

Symptoms of SAD include feeling depressed most of the day and almost every day, loss of interest in things you used to enjoy, low energy, sleep disruption, noticeable changes in appetite or weight, feeling agitated, difficulty concentrating, feeling hopeless or worthless, and frequent thoughts of suicide. These symptoms can be brought on because of the limited daylight available during these months. This can affect one’s natural sleep cycle and the chemistry in their brain. People usually stay inside more during these months because of harsher, cold weather, and can feel more isolated.

People can also experience similar symptoms in the summer. Summer SAD includes many of the same symptoms people experience in the winter months, such as sleep disruption, noticeable changes in appetite or weight, and increased anxiety. In some of the areas of the country that experience intense heat in the summer months, such as Sacramento, the onset of summer SAD can lead to staying indoors and keeping blinds closed to keep the heat out. Since it is so hot throughout the day, the ability to exercise outside is also affected, which can cause an increase in SAD symptoms, as well as symptoms related to anxiety, ADHD, and depression.

Here are some ways to manage SAD in the summer:

Talk to your mental health professional about the symptoms you are experiencing to see if it fits the description for a diagnosis of SAD. Your therapist can also help you work on some relaxation techniques that may help calm your mind from increased anxiety resulting from SAD.

You can also try exercising indoors at a gym or in your home with assistance of one of the many free smartphone and computer apps that coach you through workouts. It’s important to get at least 20-30 minutes of activity per day for better physical and mental health.

A person’s sleep cycle is also greatly affected by changes in the seasons. Make sure to stay away from substances, such as caffeine and alcohol, as they can disrupt sleep. Cut off use of these substances at least three hours before you plan to go to bed.

Finally, if you are experiencing symptoms related to changes in appetite and weight gain, practicing mindfulness when eating may be helpful. Mindful eating can help a person slow down and focus in the moment on the experience of eating food. Use your five senses as a guide when using this practice. This exercise will allow you to slow down and connect with your food so you are not eating mindlessly and possibly overeating. Also, try to follow the Dietary Guidelines for Americans when choosing your meals, which can be found at: https://health.gov/dietaryguidelines/


References

Lewis, J. G. (2015 January 14) Reverse Seasonal Affective Disorder: SAD in the Summer. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/brain-babble/201501/reverse-seasonal-affective-disorder-sad-in-the-summer

Mayo Clinic Staff. (25 October 2017). Seasonal affective disorder (SAD). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651

Robinson, L. Segal, J. & Smith, M. (March 2018). The Mental Health Benefits of Exercise, HelpGuide.org. Retrieved from https://www.helpguide.org/articles/healthy-living/the-mental-health-benefits-of-exercise.htm

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Hakomi, Part 2: The Organization of Experience

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By Paul Hubbard, MA, AMFT

In Hakomi psychotherapy, the organization of experience relates to how people organize their life experiences. This includes how they interpret what happens to them and what unconscious core beliefs and unnecessary suffering originate from these experiences. The job of the therapist is to help clients study how they organize their experiences. Transformational psychotherapy deals with the modification of core beliefs (Johanson, 2012; Kurtz, 1990). “Since these beliefs are at the basis of what story we live in the world, they can be termed core narrative beliefs” (Johanson, 2012, p. 52).

Organizing one’s life experiences to create meaning out of life is normal and not necessarily maladaptive. However, if for example, one organizes themselves to be overly self-reliant, due to a lack of support earlier in life, but they do not update the accompanying core beliefs, then they may be unable to receive much support later in life. They could perceive a lack of support even when it was more readily available. They could become so accustomed to not receiving support from others that if it were offered they might immediately block it (Johanson, 2012).

“When you know how you are organizing your experience, you become free to organize it in new ways” (Kurtz, 1990, p.11). In this experience of becoming consciously aware of how we organize our experiences, we begin to transcend the old habits and beliefs we had been stuck in and run by. We now have new, previously unavailable, choices. (Kurtz, 1990).

To effectively study how one organizes their experiences, it is essential to stay out of ordinary conversation. Psychotherapy is not the same as ordinary conversation and it is necessary to make a distinction between them so the therapist and client don’t get caught up in the rituals and rules of polite conversation. For example, in a polite conversation, one doesn’t interrupt the other person or take charge of the discussion. But in order to take the therapy to a deeper level, the therapist needs to be more directive and to assist in narrowing the range of pertinent topics that are discussed in therapy by focusing on present time experiences (Kurtz, 1990).

Studying a client’s present time experience is a good way to assist them in discerning how they organize their experiences. This involves asking a client to get into a state of mindful relaxation and to simply notice what they are feeling emotionally and what physical sensations they are experiencing in their body. Noticing this can become for them an access portal to the core beliefs behind it. This is an experiment in consciousness. There are numerous creative ways to do these experiments and Hakomi therapists will ideally know at least two dozen different ways. One way to do this is to offer a previously unavailable or inaccessible nourishing experience, in the form of a statement (Kurtz, 1990; Martin, 2016).


References

Johanson, G. (2012). Mindfulness, emotions and the organization of experience. Hakomi Forum, 25, 49-70.

Kurtz, R. S. (1990). Body-Centered Psychotherapy: The Hakomi Method. Mendocino, CA: Liferhythm Press.

Martin, D. (2016, October 27). What is Hakomi? Retrieved November 26, 2017, from https://hakomieducationnetwork.org/about-hakomi/what-is-hakomi/

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Three Ways to Improve Your Memory

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By Alicia Cox, MA, AMFT

With all the stressors in life, it is common to sometimes have a difficult time remembering simple day-to-day details. There are many things that can affect memory, including sleep, stress and mood. People of all ages can experience difficulties in this area at various points in their life, but luckily, there are various skills that may help people improve their ability to retain and retrieve information.

Listed below are a few practices that can help improve your memory:

  1. Stop multitasking: This is something I tell my clients to do in order to keep their anxiety under control, but it can also help you stay more focused on a task, which can allow you to have a stronger memory of what you are working on. Being fully present during a task, physically and mentally, will improve your memory and overall mental well-being.
  2. Use memory tricks: There are several memory tricks that help your brain retrieve information readily.
    • Repeating what you hear out loud multiple times helps your brain record the memory, increasing the likelihood that you will remember it.
    • Associating new and old information can be helpful in allowing retrieval of information since it connects new information with something your brain is already familiar with. You can do this by creating a story around what you would like to remember.
    • Keeping a to-do list on your phone seems like a no-brainer, but it is important because humans are better at recognition than recalling information. Your list can either be handwritten or typed on your phone, as long as it is handy.
    • Breaking information up into smaller sections also helps when needing to store large quantities of facts and details. Sometimes looking at a large section of information can be overwhelming, so it is important to organize the information in a way that helps you remember it.
  3. Mindfulness: Practicing mindfulness skills have been shown to improve memory and allow people to focus on tasks without allowing their minds to wander. In one study, a group of students enrolled in a two-week mindfulness course was compared to a control group that did not take the class. The group that participated in the mindfulness class had higher scores in reading comprehension on the GRE and reported being less distracted during the exam than the other group.You can practice mindfulness skills with simple meditations in which you focus on your breath and scan your body to notice any sensations that arise. This is a practice of staying present and also emphasizes focused-attention.

References

“4 tricks to rev up you memory.” (July 2017). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/aging/4-tricks-to-rev-up-your-memory

Mrazek, M. D., Franklin, M. S. Phillips, D. T., Baird, B. & Schooler, J. W. (March 28 2013). Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering. Association for Psychological Sciences. 24(5), 776-781. DOI: 10.1177/0956797612459659

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Touch and Considerations of Touch In Psychotherapy

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By Jason Briggs, MA, LMFT

“In the seventy-three seconds prior to the explosion that killed the seven astronauts aboard the space shuttle Challenger in 1986, one was recorded saying to another, ‘Let me hold your hand.’”
– Born to Serve, The Evolution of the Soul Through Service by Susan Trout, PhD

Therapeutic touch is defined as any physical contact between a client and her therapist, while participating in psychotherapy. Psychotherapists often avoid touch in their practice, mostly because it is rarely discussed in schools and training programs. There are also unchecked assumptions about public attitudes of the role therapeutic touch has in the field of psychotherapy, counseling and other licensed clinical fields, as an important and equal healing form of communication, possibly on par with words. Touch is one of many non-verbal modes of communications (i.e., Fridlund, 1994; Young, 2005).

Many psychotherapy practitioners use therapeutic touch to advance healing in relationship with their clients. These clinicians must be broad-minded, informed by boundaries, skillful about its applications, and understand what happens in its absence. “In line with Harlow, Montagu concludes: ‘When the need for touch remains unsatisfied, abnormal behavior will result” (986, p. 46). However, many attitudes inform this ‘separating out’ of using touch in psychotherapy and so legal and ethical mandates need to be regulated, codified and put in to law. Alongside these boundaries and limits, we can also do much as clinicians to learn about and normalize touch, freeing its healing effects to allow it to be helpful and mutually beneficial for therapist and client alike.

Legally, when thinking of using therapeutic touch in psychotherapy, for many clients and clinicians alike, sexual touch may often be confused with therapeutic touch. Therapeutic touch is a touch on a person’s body that may be on skin or clothes and isn’t sexual. This article’s focus isn’t to pour over the entirety of what informs this confusion and how this cultural sanctioned, unchecked assumption came to be, research points to some of these reasons, why such confusion arises when the use of therapeutic touch is used in psychotherapy. To be clear, therapeutic touch or as Mason categorizes it, affectional sharing, is both legal and ethical to use with clients in the field of psychotherapy. Legally, this must be expressed as non-sexual touch, meaning, no touching of the genitals or sexual touching of any kind. Sexual touching is a form of sexual misconduct. Sexual misconduct covers a broad range of activities, including verbal suggestions, innuendoes or unwanted advances. This kind of sexual behavior by a therapist with a client is considered sexually exploitive, illegal and unethical and isn’t therapeutic touch:

“Part of the problem with differentiating sexual and non-sexual touch in therapy stems from the lack of differentiation between sexual feeling and sexual activity. While about 90% of therapists report being sexually attracted to their clients at some time (Pope & Vasquez, 1998), less than 10% have ever violated their clients sexually. Lazarus and Zur (2002), Smith et al, (1998), like many other writers, emphasize that the problem of such lack of differentiation is rooted in insufficient professional education. Part of the problem with differentiating sexual and non-sexual touch in therapy stems from the lack of differentiation between sexual feeling and sexual activity. They view the problem as starting with graduate schools, which focus on rigid, restrictive ethical education and the teaching of risk management practices rather than providing a focus which will assist students in recognizing and processing their sexual feeling towards clients; something, which most would agree, is a common element in the therapist/client dynamic (Pope, Sonne, & Holroyd, 1993). Such lack of education undoubtedly exacerbates the problem, resulting in untrained therapists who tend to deny difficult or unacceptable feelings in a process, which is likely to increase their vulnerability to violate their clients.”

We have let our clients down as therapists who throw the proverbial baby of therapeutic touch out of the bath tub of their own repressed sexual feelings, and often withhold meaningful help and healing touch.

Considerations of ethical standards of practice and care, when a therapist is considering using touch in psychotherapy, are that informed consent to use touch must be written and can take many forms. Whatever way the written informed consent is being offered when intending to use touch with clients in psychotherapy, whether in the standard informed consent for treatment or a completely separate informed consent statement, should be discussed, reviewed together and fully understood prior to being signed. Once signed, verbal consent should be the ongoing default for whether touch is wanted by a client. Subtle forms of coercion, such as asking about a client’s wish for touch after a client has said “no” to an invitation from her therapist to receive some form of touch, is sexual exploitation. The nature of consent to experience therapeutic touch in psychotherapy is ongoing moment to moment and can change at the client’s whim, meaning without an explanation and without external coercion (overt and covert) and fear of punishment by the therapist. The skilled, judicious and attuned ethical therapist tracks verbal and non-verbal communications to learn how to use therapeutic touch with his client’s complete and unequivocal consent. Uncertainty expressed by a client is still viewed by the therapist as an implied “no” and warrants validation and support.

Sometimes a robustly honored “no” can lead to a client accepting therapeutic touch later, emphatically altering the trajectory of their healing process. Once a colleague told me of a client he had who went from initially saying, “I don’t like touch,” to saying, “I think I’m ready for a hug,” after a year of therapy. This prompted him to ask her the question, “how do you think touch can help you in our psychotherapy sessions?” They reviewed some of the research on the value, importance and help one gains through therapeutic touch and together they established a gradually longer hug, always allowing the client to end at her convenience. Once I observed my colleague and his client sharing one of these longer hugs, and upon one of his other colleagues waiting for their hug to end, said to her client, “I’d like to offer you a hug but not that long.” They all laughed and knew that this was her comfort level as a clinician, and this was to be honored and respected, as well the therapeutic touch shared by her colleague and his client.

What are the benefits of the use of touch in psychotherapy? The benefits aren’t just anecdotal, just as much harm is done with words in relationships, so too does the logic follow that touch can be used to harm or heal. We know that touch is instantly reciprocal; we touch and are touched by the other, in one instant when touch is shared, regardless of the intent. We often forget about the innocence we had in ourselves and our clients had in themselves, when harmed by another’s reckless use of touch. In those moments, we forget about what we gave and focus on what we lost. Let us remember, with love and innocence we touched those who harmed us, and it this that remains.

Thus let us always remember, the therapists’ rationale for the use of touch in psychotherapy is essential, to help ourselves and our clients recover their healing. This rationale, should always include the clinicians knowing the ego strength of the client they serve, their propensities toward transference of dissociating when experiencing touch, being over compliant, being inclined to sexualize touch, while having conspicuously absent feelings (either positive or negative) about experiences around touch (black and white thinking and behaving is one of the guises under which projection may occur), etc. The needs of the client must always be uppermost in our minds as therapists. One way to inoculate ourselves against the possibility of putting our needs above our clients’ is by finding ways to have our own physical touch needs met in our communities. Confronting the question of how to touch in psychotherapy, and meeting the complexity of issues that arise when thinking about how to operationalize it, can seem daunting. With the myriad of professional and personal, legal and ethical issues surrounding using touch in therapy, and with a grasp of the complex issues and powerful sensations and feelings that may arise, there can be an amnesia and silence that buries the healing. Healing is a much better reason to begin to understand how to embody right relations to touch we can accept, while learning to not only give touch to our clients in therapy, but to see them be more embodied, whole, connected and free.


References

Fridlund, A. (1994). Human Facial Expression: An Evolutionary View. San Diego, CA: Academic Press.

Pope, K. S. (1990-b). Therapist-patient sexual contact: Clinical, legal, and ethical implications. In Margenau, E.A. The encyclopedia handbook of private practice. pp. 687-696. New York: Gardner Press, Inc.

Pope, K.S., & Vasquez, M.J.T. (1998). Ethics in therapy and counseling: A practical guide, 2nd edition. San Francisco: Jossey-Bass.

Trout, Susan, S. (1997). Born to Serve, The Evolution of the Soul Through Service. Alexandria, VA: Three Roses Press.

Young, C. (2005). About the ethics of professional touch. Retrieved from http://www.eabp.org/pdf/TheEthicsofTouch.pdf and

Young, C., and Westland, G. (2014). Shadows in the History of Body Psychotherapy: Part I. International Body Psychotherapy Journal: The Art and Science of Somatic Praxis. Retrieved from http://usabp.org/wp-content/uploads/2013/10/IBPJournal-Vol-13-1-Spring-2014.pdf

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Bringing Awareness to Post-traumatic Stress (PTSD)

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By Elaine Townsend, Ed.D.

Approximately one in 11 people will have post-traumatic stress (PTSD) in their lifetime, according to the American Psychiatric Association (APA). Individuals with PTSD can have disturbing thoughts and feelings related to a traumatic event. These individuals can avoid situations or others that remind them of the past trauma. Sometimes just learning that a friend or family member died accidentally or suddenly is a trigger. However, not everyone who is exposed to these events is triggered. Most people recover from the fight or flight response to a traumatic event (APA, 2018).

Individuals who experience PTSD can have varying degrees of symptoms from intrusive thoughts, avoiding anything that might remind them of the event, negative thoughts about who they can trust, as well as arousal and reactive symptoms such as angry outbursts, reckless behavior, and feeling startled (APA, 2018).

Military personal are at a greater risk of PTSD, due to being in war zones. Operations Iraqi Freedom had about 11-20 military personal out of 100 suffer from PTSD. Those that served in the Gulf War had 12 out of 100 suffer from PTSD. The Vietnam War had about 15 out of every 100 veterans diagnosed with PTSD in the 1980s. Out of those, about 30 out of 100 will have had PTSD in their lifetime (The Disposable Heroes Project, 2017).

Symptoms experienced by the soldiers included recurring nightmares, sleeplessness, loss of interest, anger or irritability, being always on guard, trouble concentrating and becoming easily startled. Symptoms may not show for months or years after the event (The Disposable Heroes Project, 2017).

Children and teens experience trauma differently. They may wet the bed, forget how to talk, act out scary events and be unusually clingy. Older children may develop disruptive and disrespectful behaviors. This might include thoughts of revenge or feeling that they should have prevented the incident (NIMH, 2016).

Proven treatment for PTSD includes medication and counseling. Also, it helps to seek support from friends, family or a support group where one can respond in an effective manner despite feeling fear. It has been studied that resilience factors can be genetic or neurobiological in nature. Education and learning about the triggers and symptoms are helpful in Cognitive Behavioral Therapy (CBT). CBT teaches about trauma and how to use relation and anger-control skills. CBT can include exposure therapy, where one faces fear gradually. Also, Cognitive Restructuring helps with looking at trauma without feeling guilt or shame (NIMH, 2016).

Mild activity can reduce stress, along with setting priorities. Some individual’s symptoms improve naturally over time, according to The National Institute of Mental Health (NIMH, 2016).

“The greatest weapon against stress is our ability to choose one thought over another.” – William James


References

20 Inspiring Quotes to Relieve Stress, Anxiety & Tension (2018). Retrieved from https://sayingimages.com/quotes-relieve-stress-anxiety-tension/

Post-Traumatic Stress Disorder (NIMH, 2016). Retrieved from: https://nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

Symptoms of PTSD: Learn How to Catch it Early On. (Walker, B. 2017). Retrieved from https://dhproject.org/symptoms-of-ptsd/?utm_source=5SG<Google&utm_medium-CPC&u…

What Is Posttraumatic Stress Disorder? (APA, 2018). Retrieved from https:www.psychiatry.org/patients-families/ptsd/what-is-ptsd

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Healing with Hakomi, Part 1

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By Paul Hubbard, MA, AMFT

The Hakomi Method is a form of contemporary, body-centered or somatic psychotherapy created by Ron Kurtz in the 1970s. It is influenced by general systems theory, particularly living systems, whereby complex systems share basic organizing principles, and is rooted in spiritual principles of the East, including Buddhism, Taoism, mindfulness and nonviolence Hakomi Institute, 2015; Kurtz, 1985).

Nonviolence in psychotherapy includes a willingness to let go of taking credit for a client’s successes in therapy. This means being fully participatory in a client’s healing process without having an agenda or seeing oneself as a hero, even in more subtle ways (Kurtz, 1990).

Growth requires courage, especially when feelings of failure are part of a client’s pain. So how does the therapist hold a space for the re-emergence of vulnerability and courage in the client? They do it through grace, magic, wisdom, care, and by acknowledging the aspects of the client that are ready to grow and heal (Kurtz, 1990).

It is important to recognize what the client is ready to express, and know what potential exists in each moment. At the most basic level, this means, for example, responding to a client’s body language and being mindful of changes in his tone of voice or his eyes becoming moist, and then saying…’Some sadness, huh?’ Recognizing and naming can help a client become more open to any tears or emotions and/or acknowledge a part of herself that would otherwise go unnoticed and slip back into the unconscious (Kurtz, 1990, p. 7).

“To gently name what is real, here and now, to speak out simply without arguing or proving, that is not force,” wrote Kurtz in his book Body-Centered Psychotherapy: The Hakomi Method. “It is a wise and graceful use of the energies of the moment. It calls forth what is true in the client. And that is magic—the calling forth by naming. It has the authority of truth, truth spoken cleanly, with no other motive than to be present and bear witness.”

If the client has been holding back and hiding the truth from both themselves and others, the client’s prior inability to deal with pain can be transformed by the therapist witnessing the client’s truth from a place of love. Energies that were spent in limiting oneself become free to promote new insights into one’s old and unconscious self-sabotaging behaviors (Kurtz, 1990).

When the therapist asks a client to be mindful of what they are experiencing, he is asking for vulnerability and openness from the client for whatever will emerge. Beyond the vulnerability of mindfulness is the vulnerability of the inner child. This child has been hurt and discouraged many times in the past. When the therapist embodies wisdom and care, the wounded child, in the unconscious of the client, responds positively and can be re-integrated back into the conscious awareness of the client (Kurtz, 1990).


References

Hakomi Institute. (2015). Memoriam to Ron Kurtz. Retrieved from http://hakomiinstitute.com/resources/ron-kurtz

Kurtz, R. S. (1985). Foundations of Hakomi Therapy. Hakomi Forum, 2, 3-7.

Kurtz, R. S. (1990). Body-Centered Psychotherapy: The Hakomi Method. Mendocino, CA: Liferhythm Press.

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Cultivating Gratitude To Improve Well-Being

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(Photo Credit: Natalie Board)

By Alicia Cox, MA, AMFT

Even though many of us believe we are grateful for what we have in our lives, we may not always use gratitude in our everyday life. Gratitude is defined as “the quality of being thankful; readiness to show appreciation for and to return kindness.” We may believe that we feel this way but can forget to stop and reflect on what we are grateful for as part of our daily routine. There are many mental health benefits associated with reflecting on gratitude. Including a gratitude exercise in your daily routine can not only improve your mood but can also influence your general well-being.

There are several ways one can cultivate gratitude. In one study published in the Journal of Happiness Studies, older adults participated in a gratitude intervention to improve their well-being and non-clinical depression. Each adult was asked to write down three good things that they are grateful for in their life, every day for 15 days. As a result of this intervention, the adults showed significant improvement in happiness and well-being by the end of the intervention. This positive improvement continued to the 30 days follow-up. There was also a decrease in stress while participants were actively involved in the research study. This gratitude exercise has not only been shown to be an effective treatment, but it is also inexpensive for participants to join in this exercise. All you would need to participate in this exercise is a journal, either on your computer or in written form, and write down what you are grateful for each day.

In another study published in Applied Psychology: Health and Well-Being, researchers used a gratitude contemplation intervention to improve mental health of individuals. When a person completed a 4-week gratitude contemplation exercise, they reported higher rates of self-esteem and satisfaction with their lives. It was also shown to consistently cultivate gratitude in a person’s everyday life. The positive effects of the treatment intervention were maintained over the course of the study. This study showed that daily participation in a gratitude exercise improved one’s well-being, in addition to various components of one’s mental health.

Another method you can use is to reflect on what you are grateful for at the end of each day. You can do this in bed before falling asleep or in a meditation, any method you find useful to contemplate the positive qualities of your life. I know from personal experience that it can sometimes be difficult to find things that you are grateful for when you have multiple stressful events thrown at you or you are dealing with chronic illness or pain. By making this exercise part of your daily routine, just as you would with brushing your teeth, you can temporarily shift your attention to what is going right in your life and receive all the mental health benefits that come along with it.


References

Gratitude (n.d.) In Google online. Retrieved from https://www.google.com/search?q=define+gratitude&oq=define+gratitu&aqs=chrome.0.69i59j69i57j0l4.3638j1j7&sourceid=chrome&ie=UTF-8

Killen, A. & Macaskill, A. (August 2015). Using a gratitude intervention to enhance well-being in older adults. [Abstract] Journal of Happiness Studies, 16(4), 947-964. https://doi.org/10.1007/s10902-014-9542-3

Rash, J. A., Matsuba, M. K. & Prkachin, K. M. (27 October 2011). Gratitude and well-being: who benefits the most from a gratitude intervention? [Abstract] Applied Psychology: Health and Well-Being. https://doi.org/10.1111/j.1758-0854.2011.01058.x

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The Buddhist Meditation Practice of Tonglen

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photo credit: Kwanbenz)

By Nicolina Santoro, MA, LMFT 

The act of being aware of how and why we suffer broadens our own understanding of the world by visualizing the reality of an empathetic connection we share as we breathe in. The meditative breath practice of Tonglen involves inhaling through the pain the person you are visualizing is experiencing or is perceived to have caused while breathing out a new frequency of love toward the person we are trying to help, accept or forgive.

According to The Tibetan Book of the Dead by Sogyal Rinpoche, Tonglen is effective in negating the restricting and sometimes detrimental influence of our ego by opening our hearts to those around us without losing ourselves in their personal drama. We are compassionate observers and teachers, while the people around us teach us about how their experience of suffering has affected them.

A powerful part of this practice is visualization, which has a number of cognitive benefits. Continually visualizing scenes that evoke positive emotional states reinforces the production of neurotransmitters in the brain associated with positive emotional states, and encourages the pruning of synaptic relationships that are counterproductive to this practice.

Tonglen Breathing Exercise

It is important to be in a quiet place where you can assume a comfortable posture. As this is a breath awareness exercise, it can be helpful to place your hand on your stomach to increase awareness of your diaphragm moving in and out with each breath.

While inhaling, visualize the pain associated with what you are trying to release around a specific person. Any confrontations or experiences that were especially salient to you will be a good fit for this exercise.

While exhaling, visualize having a positive healing experience with this person, where love is flowing from you to the subject of your practice. This practice is a process of thought transmutation that encourages emotional healing around a person or experience.

A good rule of thumb when adopting any meditation practice is to accept that you may find it difficult to focus while you are experiencing the miscellaneous thought traffic that will drift in and out of your meditation time. Also, if you are a novice meditator, keep it brief at first. Try 10-minute increments once daily until you can sit with ease, then increase the time in 5 or 10 minute intervals until you find what amount of time gives you the maximum benefits.


References

Rinpoche, S. (1993). The Tibetan Book of Living and Dying. (p. 195). NY:Harper Collins.

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