May 2006

Self –Regulation and Structuring of the pROSHI Session

-Rich Glade, MA, LCSW

As a young psychotherapist I had the opportunity to work with Dr. Dave Phillips, a psychiatrist who was Director of Mental Health for the city of Edmonton, Alberta (Canada). Dave was a marvelous teacher and mentor and although he has been gone for quite some time whenever I feel out of my depth I think of him and wish I could tap his wisdom.

When I first began to work with Dave I was not impressed—he seemed to waste so much time. Sometimes he would visit with clients in the waiting room when it was past the time for the session to start and even if a session was pushing past the time for it to end Dave would insist on a period of eight to ten minutes of reflection and consideration before the client(s) were ‘released’ to leave. My youthful eagerness led to a couple of tense discussions with Dave who simply stated that his casual and friendly contacts and his time for completion through reflection and consideration where essential to the
client’s process. It was only when I had several years of experience that I actually began to appreciate how essential to Dave’s effectiveness his ‘wasting’ time actually was.

When I first came across the Sensitivity cycle described by Ron Kurtz I realized in an even more complete way the wisdom of Dave Phillips. The Sensitivity cycle is a way to conceptualize any human process that involves transformation or change. I immediately used the cycle to conceptualize both my work with others and my own personal work. When I acquired my first pROSHI naturally I used the cycle and it has seemed a good fit. In this style of work the pROSHI sessions are not viewed as treatment but rather as a skillful means for supporting the client in developing more self-regulation and self- awareness as well as directly improving their functioning. I have become convinced that the pROSHI can become a powerful tool for any one to support their self-care and that often my role is to teach the client a basic approach to self-care and self-regulation while offering pROSHI work. By using the Sensitivity cycle as my ‘structure’ for pROSHI work I also support the client in learning an approach which, they can then use on their own.

The Sensitivity Cycle Since the cycle is an organic one, technically it has no starting point. I will describe the four phases and then outline how they are used to organize pROSHI work.

In this phase some time is spent letting go and allowing space. Dr. Eugene Gendlin developed a technique which he calls Clearing Space and which allows a person to get settled and clear. The Weber-Fechner Law indicates that the more static in a system the more power a signal must have to be clearly and accurately received. In our busy and often confusing culture taking time to let things settle can be profoundly helpful in coming to see things as they actually are.

Making space and getting quiet allow the preparatory groundwork for the next phase, which is clarity. The client who has difficulty clearing space, relaxing and allowing things to become clear has resistance to insight. Often some of the busy-ness that the client finds in her mind is recognized as having some qualities of what has been called the “avoid—dance”. How the client works with this phase allows the exploration of the client’s motivation and outcomes and her possible ambivalence and resistance with regard to the overtly stated intentions for her pROSHI work. Skillful exploration of ambivalence and resistance as well as the downside of effective work is often essential to both accomplishing that work and that work actually integrating. Sometimes this exploration leads to a cleaner outcome and intention to which the client can give whole-hearted effort. In my experience it can also be helpful to the client to learn how to honor their own resistance and work with it skillfully.

This phase is one within which one finds a clear sense of

-one’s current reality and immediate situation
-one’s values, priorities and intentions
-one’s immediate priorities and interests

In a case where clarity isn’t easily found I routinely use Gendlin’s Six Step Focusing technique to find a beginning clarity. One can also simply be satisfied with a clear intention (I have done quite productive pROSHI sessions with only the intention to become more clear). A pattern of resistance or ambivalence can be worked with by moving back and forth between the phases of relaxation and clarity. If the client continues to resist clarity she may simply be avoiding taking action. This resistance if not made explicit and worked with skillfully can undermine whatever power to effect positive results the pROSHI work might otherwise have.

-Effective (Skillful) Action
This phase is the actual pROSHI session and is divided into two sub phases:

-Getting settled which includes deliberate choices of

-glasses and settings on the glasses and or magstims
-location of magstims if they are used
-appropriate posture and any other arrangements for comfort and
stability -secondary activities such as cd’s

-Actual session

-monitoring the experience with mindfulness and possibly a
device for tracking psychophysiological measures

-adjusting session length, light intensity and polarity as necessary

Unskillful work at this stage is a way to sabotage achieving skillful outcomes which will bring about change. Consistent difficulties or interruptions can be usefully explored and may require a return to relaxation and clarity.

– Appreciation and Integration
This phase involves both reflecting on and savoring the experience and taking the time to let the experience settle. This may begin with simply taking a little time immediately after the session to just be with the experience. Often the habitual pattern is to jump immediately into another activity, which again is a clear indication of ambivalence and resistance and should be made explicit and explored in the manner indicated above.

The actual four-phase cycle can be diagramed like this:

Phase                                                                             Barrier or resistance
Relaxation (orientation)                                             Completion
Clarity                                                                             Insight/recognition
Effective action                                                            Response/engagement
Appreciation and Integration                                   Nourishment/ living life-forward

Structuring the pROSHI Session As part of my intake, I introduce and explain the Sensitivity cycle. I also give instructions to the client in the Six Steps of Focusing and explain that we will use both of these techniques as homework and as a regular part of our work together. I recommend both Gendlin’s small book (Focusing) and his instructional cd. I discuss with the client along with their other intake materials their scores on the short form of the AAQ (Acceptance and Avoidance Questionaire; this often provides a way to raise the issues of resistance and ambivalence and to explore any secondary gains to the problematic issue the client wishes to address. An essential aspect of the preliminary session is to specifically explore (in descriptive terms as much as possible) the client’s current situation, values, priorities and intentions and their specific outcomes for our work and how they will know that we are making acceptable progress. This work provides the basis and background for working with client ambivalence and resistance. At the end of this initial ‘intake’ session we set up a schedule for our work.

The first actual pROSHI session begins with the relaxation phase. This can take anywhere from as little as five minutes to as much as fifteen. In many cases I begin this relaxation phase with full body stretching before Gendlin’s Clearing Space exercise. The client is instructed to use the full body stretch and Clearing Space at least once a day between sessions. It is not uncommon for the pROSHI work to re-focus at this point on learning to relax deeply and fully and the presenting issue is held in abeyance while this work proceeds for a few sessions.

Following the clearing space exercise I do a guided focusing session with the client and when she is clear and ready we proceed with the session. While I do not always insist on it I assign clients the homework of doing regular focusing sessions. I have a recorded CD which takes the client through the six steps of focusing which they can purchase for home use.

Choices about session length, the color of glasses and other session parameters are jointly made in consultation with the client. The option of using a recliner or a straight-backed chair is explored and the client is encouraged to select which one based on the intention they have developed.

Over the past four months I have monitored many pROSHI sessions with the ear ppg sensor and the FreezeFramer software. This allows me a detailed moment to moment track of physiological coherence which I use to know when it might be time to switch from + to – phase and or if the session length might skillfully be shortened or lengthened. (In my experience- a decrease of over 35% in achieved physiological coherence is an indicator that a person’s system is reaching a saturation point and training will begin to have a reverse effect—changing the polarity may restore the increase in coherence—if not I terminate the session.) I also use the J&J C2+ to monitor collateral changes in EEG patterns as well as other peripheral measures and HRV.

After the actual pROSHI work is ended I encourage the client to simply sit and be with their experience—particularly body sensations and other aspects of their internal experience. After five to ten minutes and on cue from the client I share anything that seems relevant from my monitoring and together we plan homework and get a sense of where our next session is likely to begin. The client is also reminded of the importance of home practice of the full body stretch and the clearing space exercise.

By working this way I have been able to fit my pROSHI work closely to the client’s experience and the results have been quite good. Actual portion of our session time using the pROSHI has been highly variable. For example, I have done many magstim and/or Shakti coil sessions where the time was three minutes or less and sometimes relaxation sessions with the glasses have run as long as an hour. I encourage my clients to experiment and explore; and to track their after-session and between-sessions experience closely.

This approach may not be suitable for some clients and equally it may not be a good fit for some who are providing opportunities for pROSHI work. However, while I am a psychotherapist trained in experiential and person centered approaches such as this one, this approach does not require formal training beyond learning Focusing, basic attentiveness and becoming friendly toward all aspects of one’s inner process. For someone working by themselves this approach can provide guidance and support from one’s own resources. My clients have regularly achieved both their original outcomes as well as a clear increase in self-reliance/self-awareness/self-regulation and reduction in avoidance with this approach.

Selected Bibliography:
Self-awareness, Self-regulation and Self-Reliance

Assagioli, Roberto: Psychosynthesis; New York; Penguin; 1971
: The Act of Will; New York; Penguin; 1974

Austin, James H: Zen and the Brain; Cambridge, Mass.; MIT Press; 1998

Cornell, Ann Weiser: The Power of Focusing; Oakland, CA; New Harbinger; 1996
*    : The Radical Acceptance of Everything; Berkeley, Ca.; Calluna; 2005

*Emery, Gary Rapid Relief from Emotional Distress; New York; Rawson; 1986

* Epstein, Mark: Thoughts Without a Thinker; New York; Basic Books; 1995
: Going to Pieces Without Falling Apart;

*Ferrucci, Piero: What We May Be; Los Angeles, CA; Tarcher; 1982

* Fryba, Mirko: The Art of Happiness: Teachings of Buddhist Psychology; Boston, Mass; Shambhala; 1989

Gendlin, Eugene: Experiencing and the Creation of Meaning: A Philosphical and Psychological Approach to the Subjective; Evanston,Ill; Northwestern University Press; 1962/1997
*    : Focusing; New York; Everest House; 1978
: Focusing-Oriented Psychotherapy; New York; Guilford; 1996

Hayes, Steven C. Hayes et. al: Acceptance and Commitment Therapy; New York; Guilford; 1999

*Hinterkopf, Elfie: Integrating Spirituality in Counseling; Alexandria, VA; ACA;1998

Kurz, Ron: Body Centered Psychotherapy/The Hakomi Method; Mendocino, CA; LifeRhythm; 1990
: The HAKOMI Manual—2005 not available for purchase

Maher, Alvin R: The Complete Guide to Experiential Psychotherapy; New York; Wiley; 1996

Moustakas, Clark: Being In, Being For, Being With; Northvale, N.J; Aronson; 1995

* Podvoll, Edward M: Recovering Sanity; Boston, Mass; Shambhala; 2003

Rossi, Ernest Lawrence: The 20 Minute Break: Using the New Science of Ultradian
Rhythms; Los Angeles, CA; Tarcher; 1991

*Tarthang Tulku: Tibetan Relaxation; Berkeley, CA; Dharma Press; 2003

* Wise, Anna: Awakening the Mind; New York; Tarcher; 2002

*Gendlin, Eugene; Focusing; An Audio Renaissance Audiobook; 2002

*Cornell, Ann Weiser: Learning Focusing;; 2005

*I am including a link to some Resources I use for the practices I have described above.