Rupesh Chhagan LAc   
                                      
In my blog, I will cover all the topics that get me jazzed about life, from nutrition to poetry, from meditation to rock climbing. I hope it will be a source of information, entertainment, and inspiration.

Blog Category: Hakomipuncture

June 7, 2014

» Hakomi Skills for OM Practitioners
posted under Acupuncture, Hakomipuncture


HAKOMI SKILLS FOR ORIENTAL MEDICINE PRACTITIONERS
by Rupesh Chhagan, CHP, LAc & Lorena Monda, DOM

As practitioners of Oriental Medicine, we dedicate ourselves to being sensitive to the unseen realms. We try to see beneath the array of symptoms our patients speak of and get to the heart of the matter: what’s happening with the qi. We know that symptoms arise within a human life—a rich tapestry of qi, bodily experiences, emotions, thoughts, memories, meanings, and belief systems, all affecting a person’s day-to-day choices in addition to their health. So we sit across from a fellow human being and listen with all our senses, knowing whatever we write down on the chief complaint line of their intake form is a woefully inadequate description.

Behind the shoulder pain the athlete complains of, you may sense a lack of self-worth driving the restlessness that makes it hard for him to take the necessary time to heal. Behind the chronic fatigue diagnosis, there’s a worried woman who takes care of everybody in her life, but is unable to recognize her own needs. Whatever the case, there’s a lot more going on than is talked about. And there are times when the treatment stagnates until these deeper life currents are met. As physicians trained in balancing qi, how do we weave the physical suffering our patients speak of with the mental-emotional-spiritual-social world of our patients? How do we organize the complex experience of humanness into a coherent map of qi and its transformation? And how do we understand the influence of our own personhood in the treatment process in order to create a relational space that facilitates healing?

The Hakomi Method combined with Oriental Medicine is a powerful healing system that addresses these questions. Hakomi is a body-centered therapeutic method, rooted in the understanding that the body is the gateway to the core beliefs of the unconscious mind—beliefs that organize our experience on all levels. Core beliefs are like the basic operating system of a human being, driving our behavior, and shaping our bodies and our qi. These beliefs encompass our basic psychospiritual needs like safety, belonging, dependence, power, authenticity, intimacy, worth, and acceptance. The Hakomi Method brings consciousness to core beliefs. Once conscious, these beliefs can be re-evaluated, and where appropriate, powerfully transformed. This helps an individual to make more effective choice to build a more satisfying and healthy life.

Different than talking about issues and problems, which may focus on cognitive understanding, Hakomi works in the present moment with mindfulness and direct, felt experience. The goal is to help patients become aware in mind and body of how they construct their experience. A successful outcome of Hakomi work in an OM treatment context might look like this: a patient walks away with a conscious understanding of why they habitually do what they do and how this relates to their symptom pattern, and more importantly, with an ability to interrupt the unhealthy habit, to notice other options, and to choose the option that leads to greater health and happiness. Think about this: Is there anything that, despite your good common sense, you do or don’t do that you KNOW would be good for your health and happiness? Things like: eating less sugar, exercising more, eating less, sleeping more, watching less TV, meditating more, spending more time with loved ones, and so on. Pause and consider that for yourself. In Oriental Medicine terms, these behavioral adaptations may be the result of patterns of disharmony—deficiency, stagnation, or imbalance. Hakomi is a method of working with present time experience that can help you “get,” directly and specifically in the moment, how these patterns work in qi, body, and mind—to literally deconstruct patterns of disharmony into their component parts and then to construct more healthy and satisfying internal and external patterns.

Loving Presence & the Healing  Relationship
The foundation of Hakomi work is the healing relationship. Studies from the psychological world have shown that a primary influence in successful treatment is the relationship between practitioner and patient. Specific technique is often less relevant than the patient-physician rapport. Since our system of medicine encompasses the mental and emotional realms, it’s important for us to take this into consideration in our treatments. How do we understand the importance of the relationship in healing?

Humans are mammals—wired to connect, built, in fact, to love. Amongst the species, we take the longest to become autonomous. In order to survive, our early needs must be seen by another and responded to. One of our basic needs is connection with another on an emotional level. At the turn of the 20th century, experiments were conducted on two sets of infants in an orphanage. Each was provided with basic life needs like food, water, and adequate shelter. One set of orphans received holding, cooing, and warm affection from the nurses. The other did not. Most of the children from the latter group died or lived a life riddled with health problems. This basic mammalian need continues throughout our lives. Our limbic system is like a Wi-Fi signal, constantly broadcasting out and receiving signals from our fellow human beings. Our biochemistry and our moods are regulated by one another. Mammals in isolation suffer lowered and erratic dopamine and seratonin levels. In essence, we need human connection and emotional resonance in order to be happy. So what does mean in the clinic? Imagine yourself as a patient. Between two doctors of equal knowledge and skill, would you choose the doctor who is warm and understanding or the one who is brusque and distant? Probably an easy choice for most. On an intuitive level, we know bedside manner is important. But we learn few specifics about how to employ the power of our presence in the healing milieu.

There is a field of energy created in connection between patient and physician. What is the quality of that field that facilitates healing? Consider for a moment, in your own life: What are the qualities of the person you want to listen to the stubborn physical ailment that has plagued you the longest, that seems hopelessly incurable—one that frustrates or discourages you. Imagine how this person looks and feels, how they sit, and how they look at you.Take a moment and reflect.

In the classes we teach in acupuncture schools, we do this exercise as a meditation. What comes forward are words like compassionate, wise, patient, present, light-hearted, observant, curious, and attuned. These adjectivess get at the core of the healing relationship and create what in Hakomi we call loving presence.  Hakomi work starts here. The ideal energy to meet someone with for healing is loving presence. It’s the foundation that our method and techniques operate upon.

Seeing Deeply: Tracking
The unconscious mind asks three questions in relationship:

(1) Are you there?

(2) Do you see me?

(3) Do you choose me?

Being present with your patient answers the first question. Not lost in your own thoughts or thinking about what you are going to say next, but truly there. In psychological terms, it’s called attunement, which means to come into harmony with. Reliable and accurate attunement answers the second question for the patient. Being attuned to our patients allows this: an ability to sense the qi in the moment, to see what is really happening, to recognize what’s working and where there’s some adjusting of the qi needed. When we say “sense” qi, we don’t mean some super-psychic aura perception. We are talking about everyday sensory perception. Hearing the fluctuations and quality of tone and speed in speech. Cognitive perception like noticing themes and emotions underlying the story being told. Watching various gestures and postures that relay the movement of qi, and tell the inner story behind the patient’s symptom presentation. This is not news to the doctor of Oriental Medicine. The diagnosis shines through watching the unique way our patients walk from their chair to the treatment table or how they tie their shoes. Unfortunately today, the biomedical model reigns supreme. It’s emphasis on technology can often deemphasize the wisdom of these subjective impressions. In Hakomi work, this deep observational skill, which we call tracking, is refined to a sophisticated degree. We notice small, often unconscious (to the patient) shifts in body, mind, and emotion that are indicators of underlying patterns, and then bring them into the patients awareness (contact them) so they can be studied, worked with, and if necessary shifted toward more functional and healthy balance.

Contact
Being present and seeing deeply leads naturally to the third basic hakomi skill—contact—noticing and empathizing with what the patient is feeling, hearing what he is saying, and then relaying in various ways that you get him and are on the same page. The skill of contact sets up a collaborative relationship between practitioner and patient, empowering the patient to be a primary part of her own healing process. While many practitioners say that this is a goal of working with their patients, few have in-the-moment skills that make this collaboration happen. Contact is the moment-to-moment verbal acknowledgment, in short, simple statements, of the patients present experience—including the things arising that the practitioner is tracking, which the patient might not be fully conscious of (gestures, posture, emotions, attitudes, themes, and so forth). Like reflective listening, but more encompassing, contact allows us to go beyond the patient’s story and deeply acknowledge the storyteller—the person to whom the experience of having pain, or digestive issues, or menstrual irregularity is happening.

Meeting your patient’s words, feelings, and actions with contact answers the third question. The patient knows that you are there for him, that her process is important, that you are working together with the same agenda.

Mindfulness: Directing Awareness 

A fourth Hakomi skill–working in mindfulness–is the hallmark of the Hakomi Method.  Mindfulness is a present-centered, receptive state of mind where one observes what is.  Mindfulness is a gateway to discovering and resolving the complexity inherent in chronic disease patterns.  For example, we can start with a pain the patient feels in her stomach area. As OM practitioners, we already know how to ask our patients to describe the pain–its location, quality, and intensity. From here, we can have the patient stay with the direct experience of her bodily sensations in the moment to see if any other channels of information are available: thoughts, emotions, images, memories. By staying with the present-moment experience that is arising around the symptom, we can translate present experience back into qualities and movements of qi, in order to find out exactly what the qi is doing. We can also discover what wants to happen, thereby gaining accessing to the healing impulse that is trying to manifest within the patient’s condition. In addition, we gain information about the function of the current symptoms (something that we forget when we adopt an antagonistic stance toward symptoms)—what is being held by the current pattern.  And most importantly, instead of talking to our patients about these things, the patient is discovering this for them self in present time. Working directly with qi in mindfulness is a powerful means to constructing effective and efficient treatment plans—treatments that are accessible to the patient and allow follow through outside of the clinic.

Hakomi in the Treatment Room
Imagine a first time acupuncture patient who complains of lower back pain. A balding, young man in his early 40‘s, he works 60 hours a week in a high-pressure job. Kidney pulses are weak. Tongue is peeled and red. Clearly, there’s a Water imbalance. His movements are quick; his eyes are wide. As practitioners aware of the healing relationship, we have the opportunity to model the energy of balanced Water. We know that the Water Phase gives us the capacity to draw our energy deeply inside, find quiet and rest in this bustling world, and replenish our core resources. Water gives us the ability to meet the unknown without a reaction to the natural arising of fear. It will not help the long-term treatment for the practitioner to be racing around the room, or overwhelming the patient with more things to do in his busy life. The missing energy for this patient is deep rest and deep quiet. As practitioners, we can cultivate a space through our personhood that is restful and quiet right there in the treatment room.

From an energetic perspective, this is Loving Presence. Rooted firmly in the present moment, receiving the patient’s personhood, noticing what energy is needed, and, out of kindness, adjusting to invoke the missing energy. This shift starts the healing.

From this quiet space of meeting the patient, the practitioner can then ask him to slow down, and feel inside what happens as he does. Then he can give mindful attention to his back pain, to his relationship to it, and to the myriad of things-—qi, feelings, thoughts, memories, images, attitudes, and beliefs that are at play in the patient’s present condition. The practitioner continues to direct the patient’s awareness throughout the treatment, mindfully tracking and contacting shifts as they occur, as a clear picture of the pattern and its resolution becomes accessible to both practitioner and patient.

 

Rupesh Chhagan, LAc is a Certified Hakomi Practitioner who practices and teaches OM in Austin, Texas.  He has been weaving Hakomi and Qi together wince 2006.

Lorena Monda , DOM is a certified Trainer for the Hakomi Institute, who teaches in the US and Japan. She encountered the power of Hakomi work in the late 1980s and has combined it with her work as a OM practitioner ever since. Both Rupesh and Lorena teach Hakomi-based, Clinical Communication classes to OM students at the AOMA Graduate School of Integrative Medicine in Austin, Texas.

Rupesh and Lorena are developing a training called Hakomi Skills for Oriental Medicine Practitioners, beginning with an Introductory Workshop at Golden Flower Chinese Herbs this September 2014.




July 22, 2010

» Hakomipuncture: A Therapy that Combines Acupuncture and Hakomi
posted under Hakomipuncture


The thought manifests as the word;

The word manifests as the deed;

The deed develops into habit;

And the habit into character.

So, watch the thought and its ways with care

And let it spring from love

Born out of concern for all Beings.

As the shadow follows the body,

As we think, so we become.

–The Buddha, from the Dhammapada

Continue reading »