The heart of Core Process Psychotherapy
By Susan Groves
Core Process Psychotherapy (CPP) is a modality that is being progressively introduced in South Africa as therapists return to the country after completing their training in the UK. I am one such returned practitioner, with a practice in Cape Town, where a couple of my colleagues have recently joined me.
What drew me to the training?
Prior to my interest in CPP, I was working largely with the poor in the Karoo and Eastern Cape [in South Africa] first as a social worker, doing development work, and later as a theologian and Anglican priest. My Christian roots and training led to my exploring various forms of silent meditation, which inevitably began to include Buddhist practice. Through my exploration of the Buddhist tradition I was fortunate to meet Thanissara, a former nun, who, with her partner Kittisaro was, at that time, establishing a hermitageDharmagiriin the Underberg. Thanissara had had contact with the Karuna Institute having recognized that there are elements in ones life that cannot be shifted through meditation and that the psychotherapeutic journey can be an invaluable path of enquiry.
I had never been drawn to the study of psychotherapy before, but soon after beginning the foundation course, it was as if I caught a whiff and I applied to register for the professional training and later that year moved to England for what turned out to be a 7 year training period. For me it was definitely the broader spiritual holding that drew me to the work.
The Karuna Institute:
The Karuna Institute is situated on Dartmoor in the south of England. The setting is wild and remotean excellent place for such a training. Karuna is a Sanskrit word meaning compassion. The Institute was begun in 1980 by Maura Sills and her husband Franklyn Sills. They developed the Core Process model drawing on the Buddhist tradition and Western psychological theory. The Institute offers an MA in CPP, which is validated by Middlesex University.
Why Core Process? What do these words mean? The word core refers to what in Buddhism is often spoken of as brilliant sanitythat essence of the person that is always present, even in the midst of extreme difficulty. In Christianity, a similar concept is the understanding that each of us is made in the image of God. Clinically, the implications of this are profound. Whatever the state in which the client finds him or herself, there is a deep confidence in the inherent goodness and health of the person. It can be difficult to really know this quality in oneself. The Core Process training is such that ones confidence in this core each persons brilliant sanityis unshakeable.
The word process refers to the way in which we meet the world. In Buddhism the sense of self is seen to be a construct that can be explored and that can become more fluid. Process is the way we have become accustomed to meet the world, and we usually identify this with who we are. The opportunity in CPP is to begin to slowly soften this sense of self, to be able to slow down its processes enough to notice how it constellates itself. This is a fine art.
The first of the four noble truths or, perhaps more helpfully, ennobling truthsin Buddhism is often stated as there is suffering. Alternative translations of the Sanskrit word dukkha are unsatisfactoriness or essential ambiguity. As a friend said to me recently: why is life so unreliable? She was referring to the fact that one may feel one is entering a good space, only to wake the next day feeling pretty desolate.
In Core Process, in the therapeutic hour, there is an invitation to be with what isthis may include thoughts, imagery, sensations in the body, a movement that needs to happen. Core Process has been described as an exploration of how we are in our present experience, and how this expresses the past conditioning and conditions of our lives. One works, typically, from a place of emptiness and not knowing, asking the question: what is this? So, should a client speak of feeling disgruntled, even angry, one would not assume one really knew what this meant. One would enquire into these descriptions, also perhaps inviting the client to become aware of any accompanying bodily sensations.
Having worked extensively in rural South Africa prior to completing the psychotherapy training, I had seen the raw and ugly face of deprivation. This was a suffering that I knew, as least in some measure. Thereafter, living in the privileged community in Hogsback (South Africa) and, thereafter, in Devon in England, was an important counterpoint for own cultural background For me, a profound finding from this journey is the commonality of suffering. It may have very different faces, but is something that is part of the human experience.
The Brahmaviharas/ Divine Abidings
CPP is often referred to as a psychospiritual modality. I have said that it draws deeply on the Buddhist tradition. What places CPP within the psycho-spiritual is the understanding that the therapeutic encounter happens within a wider healing and holding field. So the two people in the room are not considered to be discrete individuals. Rather they are seen to be there with the ancestors of each, and all this within a wider field of support. The Vedic teachings in the Buddhas time spoke of the 4 Brahmaviharas or divine abidings (my own translation is a good place to hang out). These are metta, or loving kindness; karuna, meaning compassion; uppekkha, or equanimity; and mudita, meaning sympathetic joy. The trainee therapist is trained to hold these qualitieswhich are also intrinsically part of each of usand to rest in them in the therapeutic meeting. There is a profound sense that one is not on ones own in the work, and this allows for a greater sense of ease than would otherwise be the case. This sense of being supported in the work by a wider field of kindness and wisdom is vital for me.
Embodied Presence in Relationship
Core Process Psychotherapists, in their training, cultivate the quality of presence. Therapists are encouraged to rest in their being nature and to receive the client from this place. A particular emphasis that CPP holds, which is not always included in other psychotherapeutic modalities, is that of including the somatic in the therapeutic encounter. So the body of the therapist and that of the client are held in awareness equally with other forms of arising. Beginning to pay attention to the body may take several years for many of us. We have become accustomed to place more value on cognition and feelings. It is very enriching to include this aspect in the work as it reminds us that we are dwelling in mystery. In this attention to the vague/less formed, we are in a more delicate enquiring space, with less control. So the therapist will be aware of her/his body as a tool, receiving clues as to what might be happening within the space. At times, the therapists somatic experience may be shared with the client, but this is not necessarily typical. (An example might be: As you said that, I became aware of a pain around my heart area, and Im wondering, how is your heart doing now?) The therapists body will sensitize her/him to what may be occurring beneath the level of words. There will, as appropriate, be a gentle invitation to the client to be aware of body sensations that arise. There is not an attempt then to interpret these, but they are merely held in awareness. Sometimes it is the lack of body awareness that may be enquired into, such as in the following example:
Client: Im in an ice block
Therapist: Is all of you in the ice block?
Client: No, not my head and feet?
Therapist: Can any part of you move?
Client: Yes, my eyes.
This may be all the dialogue relating to the body at this point, but one would probably return to this sense of frozen-ness later in the session, by which time it may well have changed. Another short example shared with me by a colleague is the following:
Therapist: Where are you now?
Client: Im on the ceiling.
Therapist: May I join you there?
So body sensationor lack thereof can be a useful area of enquiry, along side other areas of access.
A 2-person awareness practice
Maura Sills, a pioneer of CPP, continues to view CPP as an experiment25 years oninto whether a one-person awareness/ mindfulness practice can become a two-person practice. Hence the emphasis on present moment awareness as the portal, if you like, for whatever the client might bring. Questions that are often asked may be: Whats happening now and how is that for you? These are two very useful questions. In fact early in the training, in practicing in pairs as therapist and client, the therapist was only permitted to use these two questions. This was initially for a short period of about 10 minutes and later for the whole therapeutic hour. Its a very useful exercise. In this way one is enquiring into the persons immediate experience and then enquiring into their relationship to this experience. For the client, this can very much include what is happening in the body. For the therapist, the encouragement in this practice is to bring a freshness and flexibility to each moment, with the awareness that this moment is different from the one that preceded it. It keeps the work very fluid and alive.
I will now concentrate on one of the Brahmaviharas in more depth. Sympathetic joy has been described as the quivering of joy in resonance with the otheras if the string on one musical instrument vibrates and those on the accompanying instrument vibrate in sympathy. CP therapists dont miss a chance to resonate with the joy of their clients!
It can be with difficulty that we orient to joy. There is perhaps help we can draw from the religious traditions here with their emphasis on rejoicing and thanksgiving. Findings from neuro-science confirm that we more easily orient towards difficulty and pain. Neuroscientists explain this by reminding us of our animal nature that is attuned to threat and survival. So one encourages clients not to skip over their more joyous experiences.
The following is a story I related to a therapist I saw briefly many years ago which may illustrate the CP approach regarding joy. As an 8-year-old child, I told my mother I had a sore foot and could not go to school. I was afraid, having been warned by an adult on the train the day before that she would be reporting me to the school for boisterous behavior. My moma nursebandaged my foot (though I dont think she really believed me), packed a picnic, and we went to sit on a blanket under the pride of India tree on the lawn.
On hearing this story, Sheila, my therapist, said earnestly: So you couldnt tell your mother the truth. I felt somewhat humiliated on hearing that, but I do remember thinking she was clever. A CP approach might, by contrast, go something like this: Oh wow, you had a picnic with your mom! Was the tree in flower? Do you remember the quality of the shade? And so on. One would savor the experience. For me, it may be my only memory of time alone with my mother (we were a family of four). So, yes, enquiring into joy is part of the exploration.
Where do you take refuge?
In CPP there is, in accordance with the emphasis on joy, almost an insistence on self-care. This is often expressed in terms of resourcing oneselfwhich is, I suppose, returning to source. One is encouraged to discover ones own ways of replenishing oneself. The result of this is that, in doing the work, one is refreshed and able to be as fully present as possible to oneself and to the other. A recent book on neuro-science, in a similar vein, speaks of taking refuge. The client is invited to notice their places of refuge. For some, it may be drinking a cup of coffee or looking at a photograph of a grandmother. I remember hearing of a client who could access the body sense of galloping on a horse, and this would sustain her in difficult times. I remember one of my clients referring to a memory of twisting pastry to make jam tarts with her granthis image could soothe her. This really is an ongoing exploration for each of us: Where do we go for refuge? For myself at present I am nourished by a man coming over regularly to teach me a little about organic gardeningwe work together for a few hours in the garden. Similarly, a young Xhosa-speaking woman who is teaching me more Xhosa is something that gives me much energy and joy.
I worked as part of a public mental health team in England, and I enjoyed the fact that we were therapists from different therapeutic backgrounds. It did seem to me that the emphasis of CPP on self-care not as an add-on but as an intrinsic part of the trainingmade a real difference as to how we held the work. It seemed clear to me that as CP therapists, we were less tired and less overwhelmed by the work than our colleaguesand perhaps less determined that our clients would get better. It seemed to me that looking after ourselves in our lives did enable the CP therapists to do the work with joy and refreshment, rather than strain and exhaustion.
Where does Core Process fit in with other therapeutic modalities?
In England, where the Karuna Institute is based, Core Process training has long been linked to the Psychotherapy Council (UKCP). CP falls under humanistic therapies in the categorization of the United Kingdom Council for Psychotherapy. There is an emphasis on the pre- and peri-natal in the training, so in a sense it has this is in common with a more psychodynamic approach, with its emphasis on the importance of early childhood development.
The Pre and Peri-Natal Field
CPP attends closely to the field of pre- and peri-natal experienceterritory that is increasingly receiving attention. There is growing evidence of the sentience of the unborn child from the earliest time of conception. The time in the womb, the birth process itself and the early period of infancy are extremely formative, as many forms of psychotherapy will attest. In CPP there is an openness to including information from this early time. This may take the form of movement or physical contact. An example may be the following.
The client may experience a sense of pressure on the top of the head. The therapist might enquire into where exactly this pressure is felt. The therapist may then notice that there is a slight movement forward in the client. S/he might then ask: Is there a movement that wants to happen? The client may respond that there is a sense of being pulled forward and down. This movement may then be very gently invited, with support as necessaryfrom cushions, the therapists hands or body.
Clearly this territory is all at the level of the pre-verbal. Hence the importance placed on what Ive recently seen referred to as the psycho-physiological attunement of the therapist to the client.
Relationship is an area of difficulty for many. In the beginning is relation, says Buber. For many of us in the West this is where the work is. Working on the self will also enable us to be in community with each other better, something we sorely need.
Perhaps cognition has been privileged for too long. The answers dont lie in the intellect alone. We need to be open to what is beneath cognition. This isnt to belittle the intellect, but rather to correct an imbalance that has held sway for too long.
This involves a slowing down, and a willingness to dwell in a subtle field. It involves interest, attention and a staying with what arises. The client may not be obviously attending to being in the present moment, but that is where the therapist is called to be.
Psychotherapy for the ordinary person. I think Ill make that my mantra. I think it was Bion who said that therapy was too good to be wasted on the ill. The value of depth inquiry for those of us who are supposedly normal is immense.
I feel its not too large a claim to make that Core Process is at the forefront of a paradigm shift in the therapeutic process. A colleague summarized the basics of the approach as follows:
- being grounded in embodied awareness
- daring to stay present and open to being affected by clients
- how to stay present and not to split off into cerebral analysis There is a simplicity in the above and a profundity.
About the author Susan Groves is a registered social worker with a private practice in Plumstead, Cape Town. She can be contacted on +27 (0)21- 7616073 or by email at susancgroves@ gmail.com.
For further information:
Franklyn Sills. Being and Becoming: Psychodynamics, Buddhism, and the Origins of Selfhood.
This article was first published in New Therapist, May/June 2011 and is reprinted with permission www.newtherapist.com.
 Typically in Buddhist practice one sits on a chair or cushion for a period of time and is encouraged, within a field of kindness and compassion, to notice what happens within oneself and in the wider field. Mauras experiment was to do this practice in relationship with another, holding awareness of what then happened in the space.
 Buddhas Brain: the practical neuroscience of happiness, love and wisdom. Rick Hanson with Richard Mendius 2009. Oakland:New Harbinger Publications
 Margaret Wilkinson in Changing Minds in Therapy. Emotion, attachment, trauma and neurobiology warns against cognitive imperialism (p 186). 2010 New York:W.W.Norton & Company.