Mindfulness, meaning and self-compassion in body psychotherapy
Halko Weiss and Maci Daye
The use of reflection has long been a cornerstone of psychoanalytic and psychodynamic therapies, and for good reason (Shedler, 2010). Reflection provides a meta-level view of the client’s psychic life and has the power to uncover vital information on the unconscious roots of emotional suffering (Aron, 1998; Falkenström, 2012; Holmes, 2009). Without meaning, human beings are unable to orient to life and mental health is compromised (Siegel, 1999). While the existential importance of meaning-making has been well established (Bateson, 1979; Frankl, 1997; White, 2007), newer research indicates that self-compassion also plays a vital role in well-being (Neff and Dahm, in press), and is related to the way we understand and look at ourselves (Germer and Siegel, 2012). In this chapter, we argue that meaning derived through “bottom-up” processes (Gregory, 1997, p. 191), aided by mindfulness, is more reliable than reflection, and that it also fosters self-compassion.
In psychotherapy, reflection generally consists of “top-down” processes, such as interpreting, making mental connections, explaining, and creating a coherent story in words. Unfortunately, these processes are subject to social desirability and other cognitive biases that prevent clients from looking at themselves honestly and with kindness. Through case studies, we will show how the experiential use of mindfulness in body-psychotherapy can eliminate these biases. Furthermore, when clients observe normally implicit processes in an open and accepting way, meanings emerge spontaneously, as does self-compassion.
Body-psychotherapists have long taken the bottom-up route (Johnson, 2015), which starts with accessing and studying somatic experiences without attaching meanings for long periods of time. Here, we are drawing on the teachings of Hakomi Mindful Somatic Psychotherapy (Weiss, Johanson, and Monda, 2015). In the years since its inception in 1980, Hakomi has incorporated the findings of affective science and interpersonal neurobiology and refined its methodology accordingly.
Reflecting on experience to construct a coherent story relies on “top-down” processes and pre-existing mental models (Bateson, 1979; Bishop et al., 2004; Ogden, Minton, and Pain, 2006; Siegel, 2017). These processes are highly automatic and subject to the following errors and distortions (Harrer and Weiss, 2015):
According to Olendzki (2005, p. 264) “Ours is a universe of macro construction, in which the continually arising data of the senses and of miscellaneous internal processing are channeled into structures and organized into schemas that support an entirely synthetic sphere of meaning – a virtual reality.” What’s more, the conversion of experience into meaning is the result of reoccurring neural activations (Begley, 2007). For this reason, we are apt to see, hear and think the same things over and over, even when our conclusions are faulty (Lewis, Fari, and Lannon, 2001; Wilson, 2004).
In regard to self-compassion, the mind’s penchant for critical thinking, as well as comparing and judging, makes it difficult for many people to accept their egodystonic behaviours, traits, impulses, feelings and internal parts of the self (Rogers, 1961; Schwartz, 1995). For this reason, self-reflection may be anathema to self-compassion; which requires, instead, an all-partisan attitude towards the subpersonalities that comprise a person’s inner world, along with care for the way those parts have suffered (Neff, 2011).
Mindfulness has entered the psychotherapeutic stage comparatively recently but has been warmly embraced by practitioners of many modalities (Bishop et al., 2004; Daye, 2015; Johanson, 2006). It is frequently taught within a structured group setting as an adjunct to cognitive behavioural therapy to enhance affect tolerance (as in Dialectical Behavioural Therapy), manage chronic pain (in Mindfulness-Based Stress Reduction), or prevent relapse into depression (Mindfulness-Based Cognitive Therapy). Recent modalities, such as Acceptance and Commitment Therapy (ACT), use mindfulness to promote psychological flexibility, which enables clients to observe unpleasant states of mind without being held back or driven by them (Falkenström, 2012; Hayes, Follette, and Linehan, 2004). As we will demonstrate, mindfulness can also support meaning-making in psychodynamic therapy.
The classical literature describes mindfulness as pure observation (Gunaratna, 1970; Nyanaponika, 1976). More recently, mindfulness has been defined as the regulation of attention to the present moment, combined with an accepting, open and curious attitude (Bishop et al., 2004). With practice, mindfulness develops the capacity to study what is going on intrapsychically, without preferences or judgements, and without the constraining forces of explicit mental processes.
The “Observing Self” (Deikman, 1982, p. 91ff) is less influenced by automatic interpretations, habitual ways of processing information, or character-driven forces than the reflecting self. It is likewise untainted by confabulation, social desirability or false memory syndrome. The Observing Self is limited by infantile amnesia; however, it can detect remnants of early emotional learning by noting reactions and impulses in the present. For example, a person may notice that they have a contracted belly, sweaty palms and the impulse to cross the street whenever a large dog is approaching, without remembering that they were knocked down by a neighbour’s boisterous Labrador retriever as a toddler.
Studies indicate that mindfulness promotes a thickening of the pre-frontal medial cortex and other neuroplastic changes in the brain (Begley, 2007; Lazar et al., 2005; Siegel, 2007). With changed equipment, the observing mind can explore presenting issues from an even higher state of consciousness than self-reflection as it hovers above while a person moves between various self-states (Siegel, 1999). This capacity is sometimes described as a saluto-genetic split of consciousness that allows a person to witness an emotional state without being pulled into it. Buddhist texts call this “dis-identification” (Anderssen-Reuster, Meibert, and Meck, 2013; Hoelzel et al., 2011). Teasdale et al. (2002), call it “metacognitive awareness” (p. 275).
Mindfulness therefore affords a second meta-level above the meta-cognitive level of self-reflection. So, from one meta-level to another meta-level (the first), that can reflect on its object of study (Bishop et al., 2004; Flavell, 1979; Kegan, 1982). This allows clients to observe their habits of self-organisation in real time. This second meta-level is also a boon to self-compassion. By cultivating a warm, curious, and accepting attitude towards present moment experience, the Observing Self develops an all-partisan relationship with the often-conflicted internal parts of the self. The internal observer can also dis-identify from the critical thoughts, ruminations and self-judgements that may lead to low self-esteem and depression (Pyszcynski and Greenberg, 1987; Raes, 2010).
Implicit memory refers to everything a person has learned without conscious processing or encoding (Cozolino, 2006; Wilson, 2004). In other words, learning that never became conscious because it occurred during infancy or was encoded emotionally and somatically later in life. There are many forms of implicit learning: procedural memory involves the development of motor skills such as standing upright. Once mastered, a person does not have to think about which muscles to use to balance on two legs because the body knows how to do this. Another form of implicit learning is relational. Just as children learn the grammar of language by hearing others speak, children learn a grammar for lifelong relating based on early experiences with attachment figures. These experiences sculpt the brain, imprinting the known but not remembered rules of relating in the neural hardware by 12–18 months of age (Cozolino, 2006; Graham, 2008; Schore, Dagniela, and Sieff, 2015).
Interestingly, self-compassion is believed to also grow out of the caregiving system and is correlated with higher levels of oxytocin, a hormone that engenders feelings of connection, safety, comfort, and trust (Carter and Porges, 2013; Neff and Dahm, in press). A critical caregiving system, on the other hand, is believed to trigger the threat response, generating feelings of depression, anxiety, and elevated levels of cortisol (Goetz, Keltner, and Simon-Thomas, 2010). Neff and McGeehee (2010) suggest that children reared in critical, insecurely attached family systems adapt to their environment by becoming self-critical of themselves.
The power of implicit learning applies to all complex adaptive systems, from a national economy to a single human, as they adapt to their environment automatically and without conscious processing. This was demonstrated by early experiments with amoebas (Alsup, 1939). Like humans, amoebas will contract if they are exposed to a single electric shock but will expand again after a refractory period. However, they will remain in a contracted state much longer if the shocks are repeated. This indicates that even amoebas learn to “anticipate the future” (Holland, 1995, pp. 31–34) although they do not have a nervous system or a brain.
From the point of view of Body Psychotherapy, the human body also adapts to its environment automatically. It implicitly learns what kind of world is out there, and organises its physiology accordingly (Bentzen, 2015; Grand, 2015). This level of embodiment is of great interest to body psychotherapists, who observe and explore these physical adaptations to identify the early life lessons implicitly encoded in the body (Kurtz, 1990; Lowen, 1958; Reich, 1933/1972). Here we define embodiment as the: 1) physical expression of a person’s prior learning and resulting beliefs about life (whether conscious or not); 2) process of gaining a conscious, bodily felt sense of this implicit learning; and 3) on-going experience of having an integrated body-mind.
It is virtually impossible to access implicit memory data through reflection. However, mindful self-study of the body stimulates the neural circuits associated with emotional learning, rapidly and directly (Fogel, 2009; Kurtz, 1990; Marlock and Weiss, 2015; Varela, Thompson, and Rosch, 1991; Weiss, 2009). The non-judgmental and highly sensitive Observing Self can then decipher the learned but not remembered information revealed in a person’s posture, gestures, facial expressions, and internal sensations (Kurtz and Prestera, 1977). In so doing, meanings surface spontaneously, without thinking, analyzing or reflecting.
Linda’s head is leaning forward as she is speaking about how hard her life is and that she has no one to lean on. The therapist suggests doing an experiment in mindfulness. She offers to support her client right now, by cradling Linda’s head. Linda consents to the experiment and becomes mindful as she studies the changing experiences in her body. When the support is provided, she is surprised to notice that instead of relaxing into it, her muscles tense automatically. She detects a “steely” quality in her core, from the stomach to her throat.
Encouraged by the psychotherapist to simply stay with the tensing and see what develops, Linda reports that she senses something “grey” about her emotional state. She becomes aware of feelings of isolation that deepen as she lingers with her present experience. Tears well up in Linda’s eyes, as it seems to her now that she needed to provide support to herself, even as a child, and that depending on others would have somehow been dangerous.
Although Linda had no explicit memories attached to this experience, by studying her physical and emotional reactions in mindfulness, she came to understand something essential about how she organises around support. Prior to the experiment, Linda had no idea that a part of her would automatically defend against support because, consciously, this is what she longs for. Now she understands that one reason her life is so hard is that an internal part is protecting her from depending on others. In subsequent sessions, Linda explored this unconscious barrier and allowed herself to gradually receive support from others.
Contact with direct experience opens the door to new experiences (Gendlin, 1996; Perls, Hefferline, and Goodman, 1951; Stern, 1985). The Observing Self (as cultivated in mindfulness practice) can see what is true by studying the automatic process of self-organisation (Markose, 2003) that is evoked when a trigger (such as support for the head) is introduced in the session. Kurtz (1990) called this way of evoking experience accessing. It is aided by the neutral Observing Self, which can study habits of self-organisation without evaluating them as good or bad.
Pure observation is thus akin to the empirical approach used by natural scientists. For example, the botanist notices the shape, size and colour of the flower, without preferences for how the flower should be. By studying the flower in this open, non-judging way, the scientist becomes a more precise and differentiated observer. Clients can, likewise, train themselves to become astute and non-judgemental observers of their present experience, noticing details in their body-mind that hold meanings that were previously outside of awareness.
Mindful somatic psychotherapy diverges greatly from ordinary conversation, at least for significant parts of a session. To access formative experiences encoded in implicit memory requires an experiential approach (Ecker, Ticic, and Hulley, 2012; Greenberg et al., 1998) that privileges the body (Damasio, 1999). A mindful somatic approach involves gathering raw data from subcortical levels, including sensory inputs, before the higher levels of the brain intercept them. Otherwise, the data will be interpreted in accord with pre-existing templates and mental models which, as indicated earlier, are subject to various errors and distortions.
Neuropsychologists call this “bottom-up” processing (Siegel, 2017, p. 127). Psychotherapists can support bottom-up processing by encouraging their clients to sense, listen, look and feel into themselves before coming up with a story or explanation (Ogden et al., 2006; van der Kolk, 2015). Clinicians can also slow themselves down and allow meanings to unfold from within the client, rather than offering interpretations or reflections on their client’s behaviour.
A somatic approach can evoke the core organisers of experience through direct observation rather than by exploring them intellectually (Sparks, 2015). For example, a therapist working with a client who has difficulties with intimacy might design an experiment to study how the client’s contracted chest and shoulders contribute to a life stance of withdrawal. The therapist could, for instance, suggest that the client slowly and mindfully experiment with opening and closing their posture while monitoring their feelings and sensations. In effect, the therapist is avoiding reflecting upon memories around intimacy, and choosing to explore how the body is managing the issue automatically.
Brian came to therapy to address his “explosive intensity,” which would overtake him, especially at work. More than once his supervisor told Brian that he needed to get a hold of himself or he would not last long in his position. Brian didn’t understand why he would “lose it” so easily, but he very much wanted to keep his job.
After being oriented to mindful self-study, Brian was ready to explore the internal processes related to his anger. Brian reported that he became angry whenever his proposals were resisted by his colleagues. The therapist asked Brian to identify a statement that might trigger his anger, a statement that would capture the essential feel of the resistance from his colleagues. The statement he chose was, “No, we’re not going to do that.”
The therapist guided Brian into a mindful state and said: “What happens inside when you hear someone say the words, ‘No, we’re not going to do that?’”. After a short pause, Brian noticed tension throughout his body, particularly in his arms. He had an impulse to jump up and “do something.” The therapist encouraged Brian to stay with the tension and study this impulse. After a minute or so in silent self-study, Brian noticed something in his stomach. It feels “tight, dark, and very intense,” he reported. Once more, the therapist invited Brian to simply observe his experience with curiosity. After about 30 seconds or so, the therapist asked, “Is there an emotion that goes with the sensation in your stomach?”. Brian felt into himself and then said, “It is fear . . . a huge fear.”
The therapist assumes that the body has learned something from its environment and is “anticipating the future” (Holland, 1995). Rather than making interpretations she invites Brian to study his fear. Step-by-step Brian goes more deeply into it, activating the neural circuitry connected to his early learning.
An image of Brian’s father begins to appear. Brian experiences himself as very small, “almost like a 7-year old.” His therapist encourages Brian to stay with the image and the feeling of being a child. It becomes clear to the boy that he is both awed by and fearful of his father. Brian also senses how inferior he feels around his father, particularly when he becomes impatient with Brian. After exploring this for a while, the therapist asks: “What does this boy seem to be learning from this? What kinds of ideas is he getting about himself when his father gets so short with him?”. Brian hesitates, struggling to hold back tears, and then says, “I’m not worth anything at all.” He reports that the pressure in his stomach is pulling him downward, “like I might collapse into a deep, dark pit of pain.”
As Brian says this, the therapist detects a change in Brian’s face: his jaw is tightening and hardening a bit. She names her observation.
Brian reports that he is starting to get angry and that he once again feels the tension in his arms and the impulse to do something. The therapist asks if Brian still feels the deep, dark pit of pain in his belly. Brian investigates this and with a slight smile says, “No, I don’t. The anger is helping me feel bigger and stronger. It’s like it’s making sure I don’t collapse.”
Brian and his therapist were now able to see what lay behind Brian’s fury: his angry outbursts rested on feelings of worthlessness and the fear of collapsing into utter despair. Coming up with good ideas was one way the adult Brian had been unconsciously trying to compensate for the implicitly encoded belief that “I don’t matter.” When his colleagues resisted his ideas, Brian touched back into this worthless state, from which sprung an angry part that helped him feel stronger. Over the next few months, Brian developed a compassionate relationship with the young boy inside as well as the angry protector part of him. He also integrated numerous experiences from subsequent therapy sessions that contradicted and eventually modified this belief. As Brian healed the pain of feeling unworthy, his angry outbursts diminished significantly.
In body-centred psychotherapy, meaning arises by sensing into an activation in the present moment. It is a direct encounter with arising embodied phenomena, unfiltered by mental concepts. Mindful somatic psychotherapy therefore involves: 1) guiding the client into a mindful state; 2) directing attention to what is arising or using experiments to access implicit learning; and 3) supporting meaning-making through observation and direct experience, rather than through reflection.
When clients like Brian see that their adaptive strategies were born of necessity, rather than weakness or some character flaw, feelings of self-compassion often replace feelings of worthlessness and shame. Therapists can also point out that the ways a client learned to protect themself from re-injury were adaptive and resourceful. Self-understanding, accompanied by feelings of self-care, is the next step, which also fosters a reintegration of “exiled” parts (Schwartz, 1995, p. 47) and communication between inner child parts and the compassionate self.
Bella, a retired school teacher from Austria, decided to sample body-centred psychotherapy at the recommendation of her physician. Bella reported that despite years of physical therapy, she still had excruciating pain in her neck and shoulders. Bella judged herself for being too “weak,” and wondered if she was using her pain as an “excuse” to avoid the stress of daily life.
In her second session, Bella mindfully directed attention to the pain in this area. She noticed a squeezing and pinching at the place where her shoulders met her neck. She also reported some fear in her belly and a sense of confusion. Her therapist encouraged Bella to feel into this activation and notice any images or memories connected to this state.
In so doing, Bella slowly entered a regressed child state. The therapist checked to make sure Bella’s Observing Self was still present before proceeding. Bella nodded. Returning to the experience of the child, Bella reported that she sees herself standing at the edge of a cornfield. She is anxiously staring at the distant horizon. Only then does a memory surface: the young Bella is waiting for her father to return from the war. A part of Bella is now activated in a way she had long forgotten. She feels very tense and her shoulders ache very badly. Her young part tells the therapist that she does not know whether her father is coming back or not.
The therapist then asks the child if it would be okay to leave her for a minute to talk to the grown-up Bella. The girl agrees, so the therapist turns to the mindful adult, and asks: “Did your father ever come back?”. The adult answers: “No, he did not.” The therapist thanks the mindful adult and returns to the “child” who is still waiting at the edge of the cornfield. The therapist says: “I have very bad news for you, little girl . . . your father has died in the war. He is not coming back.” Bella breaks down and weeps for a long time while her therapist holds her.
A mindful state allowed Bella to access deep layers of her unconscious and receive a vital experience (in this case the truth) that was missing throughout her life – at least by the levels of her neural circuitry that were holding her distress. Mindfulness can access early learning and regressive states fairly easily, while the compassionate and somewhat detached observer safeguards against ‘malign regression’ (Geissler, 2015, p. 572). This enables clients to stay curious and calm on a second meta-level while they actively engage in understanding themselves. In this safe and exploratory context, the organisers of experience can be accessed and eventually transformed.
Bella reported that she now understands that her body aches were linking her to an experience long in need of healing. She appreciates the effort her inner child has made to connect with her. As mentioned above, when clients understand themselves, they often feel compassion for the ways they have suffered and the heroic ways they have tried to manage this suffering. They can also take the next steps towards greater levels of freedom. At last, little Bella was able to grieve her father’s death in an integrated way. Working with the body in mindfulness thus offers an emancipatory path from the pain of the original wound and the self-judgement that often comes with it.
This process can also be understood as the mindful activation of a prior problematic state, or part, that is “frozen in time” (Schwartz, 1995, p. 105), followed by the therapist’s introduction of a corrective experience (Pesso, 1973). This facilitates the neurological process of memory reconsolidation, which occurs after an old memory is activated and paired with a corrective experience in the present (Duvarci and Nader, 2004; Ecker et al., 2012; Hanson, 2013; Nadel, 1994).
The change that clients seek through therapy, which may be to heal pain, find self-acceptance, and experience themselves and others differently, is born of experience rather than reflection. This is because the core organisers that convert experience into meaning and feeling reside at the biological substrate of the unconscious, or sub-cortical, brain. These structures are highly stable. They can only be modified by integrating corrective experiences that mismatch prior emotional learning, and only when the relevant levels of this substrate are activated (Ecker, 2012, Grawe, 2004).
Experiential, body-based psychotherapies can safely promote activation by employing mindfulness. Once meanings arise into consciousness, such as, “My needs don’t matter” or “I’ll be hurt if I open up,” therapists can offer experiences to the contrary during the session. When these experiences are integrated, existing elements of self-organisation are deautomatized (Deikman, 1982, 2014). This increased freedom from habitual adaptive strategies allows clients to experience life in a fuller way.
Talk therapy, with its emphasis on elaborative cognitive processes, including self-reflection, risks generating meanings that rely on highly automatic and biographically-biased mental activity. Mindful self-observation of somatic processes, on the other hand, opens a comparatively easy and direct path to implicit memory. The latter uses bottom-up processing to access implicitly encoded limiting beliefs to transform them. By suspending meaning-making, the bottom-up approach makes space for novelty, which may involve unearthing significant memories, or bringing into consciousness the impact of early (pre-conscious) experiences on one’s structures of self-organisation. When combined with mindfulness, a bottom-up approach also deepens self-compassion for the creative and resourceful adaptations the younger self made to survive within its early environment.
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