Hakomi Skills for Oriental Medicine Practitioners:
A Mindfulness-Centered Somatic Approach to Working with Qi
by Rupesh Chhagan, Lac, CHP & Lorena Monda, DOM, CHT
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.
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
Hakomipuncture: A Therapy that Combines Acupuncture and Hakomi
by Rupesh Chhagan, LAc, CHP
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
A synapse fires in your body. Electricity leaps through the space between the nerves & lands on the other side. Your body screams, “DANGER! NOT SAFE!!” Immediately, a biochemical waterfall floods your tissues. Adrenal glands pump feverishly atop your kidneys, tensing your lower back. With dilated pupils, your fists and forearms prepare for battle while your leg muscles drop into sprint readiness. This is the picture of Fear.
In the past, people experienced danger at the sight of a predator’s jaws. Nowadays, a letter from the IRS might activate the nervous system into similar high alert. After enough times, this nervous system activation becomes entrenched. In the mind, a core belief is formed: “The world is unsafe.” In the body, hyper-vigilance becomes the norm. Soon, this loop of synaptic firing and muscle tension becomes a lifestyle. Some obvious examples of fear underlying repetitive nervous system stress are war and unprocessed physical or sexual abuse. Yet, habitual patterns of the nervous system happen to all of us. Sometimes it’s a dramatic event that creates a “stuck” nervous system. Sometimes, it’s a subtle accumulation of day to day stress. We all get stuck in ruts.
Take a look at the people around you. Some people slouch while others stand upright. Some radiate peace while anger seethes out of the furrowed brows of others. The body reflects the mind. “As we think, so we become.” Hakomi plus Acupuncture is a very effective combination of therapies to bring the body, mind, and spirit into harmony.
Hakomi is a body-centered therapy, rooted in the understanding that the body is the gateway to the core beliefs of the unconscious mind. Once conscious, these beliefs can be re-evaluated, and where appropriate, powerfully transformed. This helps an individual to build a more satisfying and effective life. Hakomi integrates the mindfulness and non-violence found in Eastern traditions with a unique Western psychological methodology.
Eastern traditions and modern physics understand that everything is energy. Physicists call it photons. Chinese call it Qi. Energy and matter are interrelated phenomenon. Matter is just energy moving at different speeds. Thoughts are Qi. Emotions are Qi. Qi flows through the muscles and organs keeping them alive and supple. As discussed before, core beliefs are simply repetitive thoughts (Qi) an individual gets “stuck” in and becomes reflected in the body (Qi in the form of matter).
Acupuncture is a therapy that adjusts the body’s energy, or Qi. One way of understanding acupuncture is through analogy to an electrical grid. Imagine that the midline of the body and internal organs are power stations. Electricity is generated in the power stations and distributed via power lines (meridians) throughout the city centers (head, neck, torso, abdomen, and pelvis) and into the outlying countryside (arms and legs). In Traditional Chinese Medicine (TCM), this electricity is called Qi. There are 14 major pathways (called meridians) that Qi travels along. Acupuncture points are areas along the path where the flow of energy can be altered for therapeutic effect. They are like light switches that “turn on” the body’s natural healing systems.
I asked Sean to stay with that sensation in the solar plexus. Two acupuncture points were inserted to strengthen the digestive organs, relax the nervous system, and improve confidence and decision-making. The solar plexus responded by loosening and the “fuzzy” headedness also cleared. In this space, another verbal probe was offered, “You can do it your way.” Sean’s whole nervous system relaxed.
From the Chinese holistic perspective, how we think and feel is not just a brain thing. Styles of thinking and emotions are not confined to the head, but originate from the harmonious flow of Qi through the internal organs and their meridians (the associated pathways through the body. When Qi flow is disturbed, psychological and emotional problems manifest. When Qi flow is smooth, virtue, happiness, and wisdom blooms within.
Both Hakomi and acupuncture offer unique insights into the interrelationship between habit patterns of mind and body. Let’s examine the use of Hakomipuncture, the combination of acupuncture and Hakomi, through a case study.
Sean is a male in his mid thirties who comes to the clinic complaining of irritable bowel syndrome and a tendency to depression. His handshake is tense, tendony, and urgent. He is gaunt, fidgety, with quick angular movements. Frustrated and with little hope that this treatment will be of benefit, he lists off his symptoms. Frequent bowels that are loose and burning. Sensitivity to spicy foods, coffee, and alcohol. His every other sentence trails off and begins with “…I don’t know…” He feels a lot of pressure from his family to enter into engineering, a safe economically sound choice in this economy. He often wakes before the alarm with a racing mind, spinning through “to-do” lists he creates for himself. He feels “under the gun” all the time. His pulse and tongue indicate an overactive nervous system and weak digestion.
A brief look into Sean’s family history reveals achievement oriented, overbearing parenting. In response, Sean learned to suppress his natural, unique self-actualizing urges throughout childhood in order to please and gain love from his parents. From the Hakomi perspective, Sean’s life themes center around Freedom and Worth. From the Chinese medicine perspective, Sean is a Wood constitutional type. Wood plays a large role in asserting individuality, overcoming adversity and making life goals. Wood is associated with the Liver and Gallbladder, the regulators of digestion, strategic life planning, and the emotion of anger. Sean’s creative energy was buried under a habit of conformity and pleasing others. Like a high volume of gas in a tightly confined space, Sean’s constricted Liver energy created pressure that interfered with his digestion’s ability to assimilate food and the experiences of life. Instead, food and life experience were swallowed rapidly and excreted with equal haste. The resulting symptoms were hidden resentment, timidity, indecisiveness, and poor dietary choices.
An atmosphere of spaciousness and respect was the missing experience that Sean needed. Sean was encouraged to relax into the table, turn his attention inwards, and become mindful of anything happening in mind and body. Hakomi verbal experiments were offered slowly and repeated three times, “You don’t have to do anything to be loved.” First, the words induced a fluttery heart panic within Sean. He felt as though he had to hold his breath and brace himself. After the second and third time, he felt a mixture of sadness and confusion as well as a knotted up feeling in his solar plexus. Each thing was taken in turn. He found the sadness manifested in a tight chest. I asked Sean to stay with that sensation of the chest. In came a deep realization of years spent racing around “doing” rather than enjoying the process of whatever he was doing. The confusion was looked at next. It manifested as a “fuzzy” headedness, cloudy thinking, and that knot in his solar plexus. I asked Sean to stay with that sensation in the solar plexus. Two acupuncture points were inserted to strengthen the digestive organs, relax the nervous system, and improve confidence and decision-making. The solar plexus responded by loosening and the “fuzzy” headedness also cleared. In this space, another verbal probe was offered, “You can do it your way.” Sean’s whole nervous system relaxed. He took a huge breath and tears streamed from his eyes. It was the missing nourishment he had unknowingly been longing to hear. In the ensuing months, Sean found the treatments a sanctuary where his dormant powers of self-actualization strengthened and he gained greater clarity on what he wanted to study and become. Three important shifts happened:
(1) Digestion: bowel movements reduced to 2-3 times a day; better food assimilation led to more energy and clarity; wiser dietary choices and habits
(2) Mind: he found a more calm, thoughtful, and self-referential quality in his daily life
(3) Spirit: felt “grounded,” inspired, and more engaged with his purpose and relationships with others
The therapeutic approach of combining Hakomi and Acupuncture is transformative. Physical and emotional relief, awareness and insight, and freedom from habit patterns can result from a course of Hakomipuncture therapy. Habitual patterns may involve relationships, sex, work, spiritual practice, addictions, body image, and life purpose. A course of treatment is determined based on severity and duration of symptoms as well as the client’s personal goals for their well-being.
Pins and Needles: Austin Hakomi Practitioner Tames Anxiety Gorilla
by Clayton Maxwell
Trying to explain what happens to me in one hour of Hakomi acupuncture is like trying to explain a dream—the logical, language-forming side of my brain can’t quite grasp the journey it just took, but it knows it was a really important, essential kind of ride. In my few sessions with Rupesh Chhagan of Windhorse Medicine, I was aptly, tenderly guided into an unprecedented awareness of my body, into the murky underworld of my fears and unconscious habits and into the simplest, most relaxed enjoyment of just being. It’s an uncanny, vulnerable sort of adventure—one that I’d only want to take with a capable guide.
I first delved into this mysterious land of Hakomi thanks to a fierce constriction in my chest, like a gorilla squeezing my heart. Its sidekick was a panicky shortness of breath. These mean visitors had invaded such that fundamental things like sleep, ease and laughter were hiding from me like scared strangers. I investigated all options: I visited my general doctor, my allergist, my ENT. Could it be a heart condition? Asthma? A nasal polyp? Nope. Each doctor told me that I was in fine shape. One did suggest, however, that I might have a bit of anxiety.
Anxiety? Ha, unlikely. I do yoga every day, meditate and ostensibly don’t have too much to be anxious about. I am a relaxed, balanced person! Still, that gorilla squeezing my heart was trying to tell me something, and I was eager for it to go back to the jungle it came from. So when a friend touted the therapeutic power of Hakomi, I booked an appointment with a Hakomi therapist and Chinese Medicine practitioner, Rupesh Chhagan.
I didn’t get this at the time, but Rupesh was taking me into “mindfulness.”
Just walking into Soma Vida, the wellness center where Rupesh offices, I feel a shift, like I could sink into the charm and warmth of this funky east Austin bungalow and linger awhile. Rupesh greets me, offers me tea, leads me back to his office and, whoosh, I already feel awash in something clear and calm; I can tell this is no regular visit to the acupuncturist. Rupesh is so deliberate and self-possessed, his presence both kind and very, um, present, that I feel like not only am I entering his office, I am entering a different state of being, and it’s not just the green tea and sweet smell of incense taking me there.
We sit down face to face in chairs. Despite Rupesh’s easy manner, I’m nervous and get out my writer’s notebook, as if writing about the experience will shield me from any risk of too much connection—which is silly, since I’m there to face my gorilla, not take notes. I put the notebook away.
Rupesh’s warmth is paired with a comforting degree of professionalism. Before we get into the nitty gritty of my ailment, we discuss time limits and confidentiality agreements and I sign papers. This is a relief. I’m a little nervous and have no idea what I’m about to do, so it’s good to feel that this journey has clear structure and professional guidelines.
After the formalities, we dig into the reason I’m there—the vice grip on my heart and lungs. With the calm of a horse whisperer, or perhaps a parent coaxing his kid to sleep, he asks me to turn my attention inward and simply notice what I’m feeling. Sitting in that chair in that quiet, sweet-smelling room, aiding by Rupesh’s prompts, I feel an uncanny sensitivity to what’s happening inside my body: I notice my heart rate (fast), the tension in my shoulders, a spaciousness in my belly. I feel a tad tingly. I’d done body scans in yoga and meditation before, but this felt different. I was surprised by how powerful it was to being guided into this internal awareness by someone who is paying close attention to every move I make, every word I say, and seems remarkably interested in it all. It may be the repressed narcissist in me, but I relish being the center of attention whilst dropping into my present moment experience, especially when the attention feels so genuine and natural.
I didn’t get this at the time, but Rupesh was taking me into “mindfulness.” There are many ways to talk about mindfulness, but in the Hakomi lexicon (as explained on www.hakomiinstitute.com), “mindfulness” is a “a state of consciousness characterized by relaxed volition, a gentle and sustained inward focus of attention, heightened sensitivity, and the ability to notice and name the contents of consciousness.” Yep, that’s what we were doing all right—I was paying attention to those subtle micro-twitches of my body and mind and naming them the best I could. It was very cool.
On the table, I keep noticing what’s arising, and Rupesh suggests I direct awareness to that stranglehold in my chest. …..But, it’s one thing to stare it down by yourself at 3 a.m. or while panicking in traffic, it’s another thing entirely to take a look at it while the right person is walking you through. Just closely following Rupesh’s voice while he took my pulse and placed needles helped me not get flattened by fear.
And what made it so particularly cool was going there with someone else’s help–in the spirit of open curiosity and tenderness we took this little trip together. It’s what the Hakomi lot call “loving presence.” If that sounds a tad too groovy for you, well, it’s really not—it’s just warm and connected. I compare it to feelings I’ve had when hiking a mountain on a clear blue day with a friend: the togetherness feels just right, and far preferable to doing it alone.
And then, at the right moment in this improvised dance, Rupesh has me move over to the acupuncture table. There he complements the Hakomi work with some well-placed needles, working with my flow of energy, or “qi” in Chinese Medicine.
On the table, I keep noticing what’s arising, and Rupesh suggests I direct awareness to that stranglehold in my chest. It seems like in order to make some peace with it, I have to look at it, but it’s actually the last place in the world I want to focus my attention. I’m afraid it will smother me. But, it’s one thing to stare it down by yourself at 3 a.m. or while panicking in traffic, it’s another thing entirely to take a look at it while the right person is walking you through. Just closely following Rupesh’s voice while he took my pulse and placed needles helped me not get flattened by fear.
And one particularly lovely day, the gorilla actually totally let go and I found myself on the acupuncture table, free and utterly happy. I could breathe. The anxiety was vaporized by this virtuosic mix of mindfulness with loving presence, and a little bit of needle pricking.
There are too many details here than befit an online article, but suffice it to say, I was awed by how well this elegant therapy worked. Simple but profound, it reached in and transformed the problem far more effectively than traditional talk therapy could have. And I think I only touched the surface of what it has to offer. Happily, at least for now, the gorilla is gone.