How Therapy Works by David Raughton, MFT revised ©2013 

How therapy works often seems more mysterious or complicated than necessary.  In my practice there are three primary aspects of therapy which make a difference for clients.  These aspects are: relational, experiential and cognitive.

Relational Aspect: Humans are relational animals.  Studies have shown more isolated individuals tend to suffer physical and emotional symptoms. And conversely, satisfying relationships are fundamental to a happy life. Although people may seek therapy for many reasons, difficulty in relationships is a primary one.

A caring and supportive relationship, including with a therapist, can help a person mobilize their resources and cope.   Also, how the client relates to the therapist reflects how they relate to others.  In therapy the client can explore ways they hold back, make assumptions, or avoid contact with themselves or others.  Although a good relationship with the therapist is essential to effective therapy, the next two aspects can 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 our self does lead to the unraveling of old patterns.  Often in the course of our lives we develop strategies or assume roles, which helped us survive, but now limit our relationships and self-expression. 

Many of these strategies operate largely automatically or unconsciously.  I use the experiential method of present focused awareness to help the client "study" their present experience in a way which allows the unconscious to unfold.  The Hakomi Method, developed by Ron Kurtz, is the particular form of mindfulness based psychotherapy I use. 

Hakomi psychotherapy is based on five principles.  These principles are: Organicity, Mindfulness, Nonviolence, Mind-Body Holism, and Unity.  Working from these principles Kurtz observed a typical cycle within a therapy session. The cycle includes emotionally contacting and connecting with the client, then directing the client into mindfulness, and finally evoking and deepening into core material with gentle experiments. 

Skillfully conducted, this allows the emergence of core experiences.  Core experience includes memories, body sensations, emotions, and beliefs associated with early wounds.  Often vivid memories arise and strong emotions are released as one deeply connects with core experiences.  New possibilities of satisfaction and expression are discovered.  Then the past is more readily forgiven and left behind.

An example of a core experience can be seen in a person whose need for emotional closeness was ignored or rejected as a small child.  This person may develop a core belief that it is not safe to allow deep intimacy or closeness with others.  Kurtz has referred to this character strategy as self reliant.  Through accessing core experience and finding new nourishment, a person can develop beliefs with the potential of allowing more satisfaction, such as “There are trustworthy persons with whom I can be close.” Then the person is better able to respond to life in a way that makes this a reality.

Cognitive Aspect: Cognitive techniques in the various forms described below are especially helpful for dealing with acute symptoms, including depression, anxiety, panic, and excessive anger. 

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 every day.  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.” 

There are many ways of working with cognitions. Evaluating the evidence, rationality, or efficacy of negative cognitions can help us dislodge them, as described by Aaron Beck and other developers of Cognitive Behavioral Therapy.  Or, simply a more mindful relation to our passing thoughts can help us take them less seriously, or be less fused with them, as described by more recent developments in cognitive based therapy, such as Acceptance Commitment Therapy or Dialectical Behavior Therapy. Also, developing a more loving attitude and relationship with one’s self can defuse negative cognitions.

An example of working with the cognitive aspect is helping a depressed client disengage from negative self talk. He may be accepting his self-deprecating cognitions as "truth."  By watching these cognitions from a mindful state, he can begin to disempower them.

He may also find that by actively changing his thoughts he will change how he feels.  This is not achieved merely through willpower or positive thinking.  Instead, by recognizing and challenging the harmful cognitions he is no longer passively pummeled by them.

Conclusion: I have summarized the three major aspects that for me account for effective therapy.  1) Being in relationship, including with a therapist helps one to feel more secure and to cope.    2) Deepening awareness of our direct experience helps us contact core wounds and beliefs, and discover new more nourishing possibilities.  3) What we think affects what we feel, and we can become more conscious of our cognitions and challenge or defuse self-defeating ones, especially when dealing with many acute symptoms.

Together these aspects combine to develop a more kind, conscious, and loving relationship with one’s self. One is then in a much better position to seek satisfaction and cope with whatever challenges may arise.

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