Sunday, September 02, 2012

Gregor Žvelc - Facilitating Natural Healing Process within Attuned Therapeutic Relationship

This is an excellent article from the recent issue of The International Journal of Integrative Psychotherapy, by Gregor Zvelc, Director of Institute for Integrative Psychotherapy and Counseling, and founding member of International Integrative Psychotherapy Association (IIPA).

Zvelc outlines his mindful processing method in psychotherapy, an approach that allows clients to experience their inner states in a moment to moment subjective attunement with the therapist. He contextualizes his model within the other mindfulness-based therapeutic models.

Zvelc, G. (2012). Mindful Processing in Psychotherapy – Facilitating Natural Healing Process within Attuned Therapeutic Relationship. The International Journal of Integrative Psychotherapy, Vol. 3, No. 1, p. 42-58. 

Gregor Žvelc

Mindfulness is non-judgmental, accepting awareness of what is going on in the present moment. The author proposes that mindfulness promotes natural healing of the organism, where the change comes spontaneously by acceptance and awareness of internal experience. Such process the author describes as ‘mindful processing’, because with mindful awareness disturbing experiences can be processed and integrated. The author’s interest in how mindfulness can be systematically applied in psychotherapy led to the development of the ‘mindful processing’ method, which invites the client to become aware of the moment-to-moment subjective experience. The method is used within attuned therapeutic relationship and the theoretical framework of Integrative Psychotherapy. Mindful Processing is not goal-oriented and doesn’t strive to achieve a positive outcome. Such an outcome is a natural by-product of accepting awareness of both pleasant and unpleasant inner experience (body sensations, affects and/or thoughts). The method is illustrated with a transcript of a session with commentary.

It is remarkable how little we know about experience that is happening right now… This relative ignorance is especially strange in light of the following: First we are subjectively alive and conscious only now. Now is when we directly live our lives. Everything else is once or twice removed. The only time of raw subjective reality, of phenomenal experience, is the present moment.
(Daniel Stern, 2004, p. 3)

Mindfulness has become a very important concept in psychology and psychotherapy in recent years (Siegel, 2007). Mindfulness is non-judgmental, accepting awareness of what is going on in the present moment. Kabat-Zinn (1994) defines it as “paying attention in a particular way: on purpose, in the present moment and non-judgmentally” (p.4). Mindfulness-based interventions are becoming increasingly used in mental health settings. There has been an increasing amount of research about mindfulness over the last 10 years in clinical and health psychology. Siegel (2007) reports that mindfulness training helps to reduce subjective states of suffering, improve immune functioning, accelerate rates of healing, nurture interpersonal relationships and an overall sense of well being. Mindfulness has been shown to change brain function in positive ways, increasing activity in areas of the brain associated with positive affect (Davidson et al., 2003). Mindfulness training is also associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking (Hölzel et al., 2011). Mindfulness approaches have been shown to decrease stress and improve quality of life (e.g. Nyklíček & Kuijpers, 2008; Shapiro, Astin, Bishop, & Cordova, 2005). Mindfulness interventions are used with success with different mental health issues including depression (e.g. Ma & Teasdale, 2004; Kenny & Williams, 2007), anxiety disorders (e.g. Miller, Fletcher, & Kabat-Zinn, 1995), borderline personality disorder (e.g. Bohus et al., 2000), binge eating disorder (Telch, Agras, & Linehan, 2001), and even psychosis (Bach & Hayes, 2002; Gaudiano & Herbert, 2006). Mindfulness based cognitive therapy prevents relapse in cases of chronic depression (Teasdale et al., 2000; Ma & Teasdale, 2004; Williams, Duggan, Crane, & Fennell, 2006).

Martin (1997) proposed that mindfulness is a common factor which underlies different psychotherapy approaches. There are several specific approaches that explicitly emphasize the cultivation of mindfulness.

The most known of these approaches are:

• Mindfulness Based Stress Reduction (MBSR; Kabat-Zinn, 1990)
• Mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002; Crane, 2009)
• Acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999),
• Dialectical behavioral therapy (DBT; Linehan, 1993),
• Sensorimotor psychotherapy (Ogden & Minton, 2000; Ogden, Minton, & Pain, 2006).
Germer (2005) proposed three different ways of integrating mindfulness into psychotherapy. The therapist may:

1) personally practice mindfulness, thus bringing the quality of mindful presence into the therapy room with the client;
2) use a theoretical frame of reference informed by research and mindfulness practice;
3) explicitly teach the client how to practice mindfulness.
Germer (2005) collectively refers to this range of approaches as mindfulness-oriented psychotherapy.

Mindfulness and Integrative psychotherapy

Integrative Psychotherapy developed by Erskine and colleagues (Erskine, Moursund, & Trautmann, 1999) integrates theories and methods from psychoanalytic, humanistic and behavioral traditions of psychotherapy into a new theoretical framework. While the word ‘mindfulness’ is not explicitly mentioned in their writings, I think that mindfulness practice and research are very compatible with the framework of Integrative Psychotherapy (Žvelc, 2009). Theories and methods of Integrative Psychotherapy are based upon the philosophy of accepting awareness within attuned therapeutic relationship. Main methods of Integrative Psychotherapy are Inquiry, Attunement and Involvement, which invite the client in contact with self and others and promote integration of dissociated states of self. These methods invite the client into state of awareness and acceptance of his/her internal experience, which is the main mechanism of mindfulness.

Inquiry involves respectful exploration of the client's phenomenological experience. The therapist asks the client to reveal to him his subjective perspective; in doing so, the client becomes increasingly aware of his relational needs, feelings, behaviour and thoughts (Erskine et al., 1999). The therapist invites the client to search for answers, to think in new ways and to explore new avenues of awareness. For an effective inquiry, there is no expectation that the client will come to some predetermined goal or insight (Erskine et al., 1999). Inquiry promotes awareness and increases internal and external contact. With respectful Inquiry we are actually inviting the client to be aware of his/her experience.

Mindfulness can be defined as nonjudgmental, accepting awareness of one’s own experience in the current moment (Černetič, 2011). Such awareness can include internal experience (thoughts, feelings, and physical sensations) and/or external stimuli (e.g. sounds, colors, odors) that an individual becomes aware of in an allowing manner, without trying to avoid or suppress them (Žvelc, Černetič, & Košak, 2011). With respectful inquiry the client may become increasingly aware of aspects of his experience which he/she often tries to avoid. Therapeutic Inquiry alone is often not enough, it should be coupled with involved therapist’s response which invites the client to accept his/her experience. For healthy contact that promotes integration, full awareness is not enough; it should be coupled with acceptance of our experience (Žvelc, et al., 2011).

Involvement means that the therapist is willing to be affected by what happens in the relationship with the client (Erskine et al., 1999). Therapeutic involvement includes acknowledgment, validation, normalization, and presence. With acknowledgment, the therapist demonstrates that he is aware of what the client is feeling and experiencing. Validation is the acknowledgment of the significance of the client’s experience. Normalization depathologises the clients’ definition of their internal experiences or their coping mechanisms. In this manner, the therapist communicates to the client that his experience is a normal, and not pathological or defensive reaction. The next aspect of the Involvement is presence, which is described by Erskine & Trautmann (1996) in the following way:
‘Presence is enhanced when the therapist decenters from his or her own needs, feelings, fantasies, or hopes and centers instead on the client’s process. Presence also includes the converse of decentering, that is, being fully contactful with his or her own internal process and reactions. The therapist’s history, relational needs, sensitivities, theories, professional experience, own psychotherapy, and reading interests all shape unique reactions to the client. Presence involves both bringing the richness of the therapist’s experiences to the therapeutic relationship as well as decentering from the self of the therapist and centering on the client’s process.’ (p. 325).
I think that with these words authors express the essence of mindfulness of the therapist within therapeutic relationship.

The third method of Integrative Psychotherapy is attunement. Erskine and Trautmann (1993/1997) describe attunement as a two-part process: 'the sense of being fully aware of the other person's sensations, needs, or feelings and the communication of that awareness to the other person.' (p. 90). Attunement goes beyond empathy – it provides a reciprocal affect and/or resonating response. Therapist can be attuned to a wide variety of client behaviours and experiences, but especially to his rhythm, nature of affect, cognition, developmental level of psychological functioning and relational needs.

Inquiry, attunement and involvement provide the therapeutic framework within which the client is invited to become mindful of his/her experience. These methods provide the basic framework for processing of dissociated and unresolved experiences.

Read the whole article.
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