How Therapy Works
By David Raughton

David Raughton, MFT, is a Certified Hakomi Therapist with a private practice in Berkeley. Hakomi Therapy is a method of psychotherapy which emphasizes the therapeutic relationship, the use of mindfulness, and changing negative core beliefs.

There are many theories and techniques of psychotherapy. How therapy works often seems more mysterious or complicated than necessary. In my practice there are three primary aspects which make a difference. These aspects are: relational, experiential, and cognitive. It is not difficult to understand how each of these aspects influence a client. Although the process need not be complicated, the impact on changing lives can be profound. In this paper I will summarize my understanding of how these three aspects make a difference for clients.

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. The importance of relationship to psychological regulation is well explained in the book A General Theory of Love by Thomas Lewis, MD, et al. Although people may seek therapy for many reasons, difficulty in relationships is a primary one.

The experience of a stable relationship, including with a caring therapist, can help the client feel more secure 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.

Feelings in response to being in relationship also arise. At times, it is helpful to share my own feelings, especially in response to the client, to promote an authentic relationship. Although a good relationship with the therapist is essential to effective therapy, the next two aspects deepen and speed change.

Experiential Aspect: Intellectual insight by itself is of limited value in helping people change. Many of us have had the experience of "spinning our wheels" in an attempt to understand a personal problem. Or through reading a book or attending a workshop we had a major "insight" only to find it had no significant impact on our lives.

However, insight derived from a deeper connection and experience of ourselves does lead to the unraveling of old patterns. Often in childhood we develop strategies or assume roles, which helped us survive, but now limit our relationships and self-expression.

Or, we have experienced traumas which have disrupted our coping. Many of these strategies or disruptions 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 in which I have been trained.

For example, a client may be highly agitated by minor altercations. By "studying" the agitation with the client's own awareness, including the sensations, emotions, and images, unconscious core experiences may emerge. The client may have been violated in many ways growing up, and react as if there is a major threat now when there is none. With mindfulness the client is able to differentiate between the initial threatening situation and current circumstances. They can then find more satisfying ways of relating and expressing themselves. Often strong emotions are released as one deeply connects with core experiences. After such connecting, meaningful insights are made by the client. It is essential that the client feels safe in the therapy, and has developed sufficient mindfulness and inner resources for such work to be healing and not overwhelming.

Another example is a client who finds himself drawn to neglectful or abusive partners. By experientially "studying" the sensation of a hole in their gut or heart, previously unconscious wounds may emerge. Vivid memories and feelings may arise. With mindfulness and the safety of the therapy relationship the client can begin to recognize they are worthy of love despite the neglect of caregivers. The loving presence of the therapist and the client's own cultivating of loving presence toward themselves are essential to helping the client heal.

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 cognitions can have very deleterious effects.
Psychologically and physically we respond to many negative cognitions as if they were actual stressful circumstances. As Mark Twain put it, "I've ...seen a lot of hard times ... most of which never happened." Evaluating the evidence, rationality, or efficacy of negative cognitions can help us dislodge them. This is especially helpful for dealing with acute symptoms, including depression, anxiety, panic, and excessive anger. This type of work is known as cognitive therapy, and is described in many books. Among the most popular is The Feeling Good Handbook by David Burns, MD.

An example of working with the cognitive aspect is helping a depressed client disengage from negative self talk. She may be accepting her self-deprecating cognitions as "truth." She will find changing her thoughts will change how she feels.

This is not achieved merely through willpower or positive thinking. Instead, by recognizing the relevant cognitions and challenging the harmful ones, she is no longer passively pummeled by them. This work is enhanced if deeper negative core beliefs have been exposed by experiential work.

Summary: In this article 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 grow. 2) Awareness of our direct experience (mindfulness) helps us contact core experiences, and discover new more nourishing possibilities. And 3) What we think affects what we feel, and we can become more conscious of our cognitions and challenge self-defeating ones.

Depending on the client, one aspect or the other may be most important, but all three can make a difference. As I said in the beginning, I believe therapy need not be overly mysterious or complicated, but it is indeed profound. I feel blessed to be able to participate in each client's healing journey.