Superordinate Skills: Inner Tracking
If, in ordinary life, mindfulness, or attention, is directed to any object, it is rarely sustained long enough for the purpose of factual observation. Generally, it is followed immediately by emotional reaction, discriminative thought, reflection, and purposeful action. –Nyanoponika, The power of Mindfulness.
A 1 Concept formation
Inner Tracking is using subtle individually based feedback to enquire as to what micro-interventions are actually useful to a client rather than what we hope or expect is useful.
Inner Tracking (IT) is not using tests that indicate something is working or research evidence of what is alleged to work.
IT is not about modular (e.g. CBT thinking or Gestalt or EMDR) thinking.
IT means assuming always that the client, in a state or "mindfulness" or a light trance at best, is acutely aware of what is happening to their inner world and what seems likely to be useful, is useful or where the next direction to head in is likely to be.
IT makes the use of SUDS trivial though still useful of course.
IT is like having the client tell you, you are being successful "even as we speak"!
IT is not waiting to the session ends or next week to find out 'how it went'!
A 2 Compared with 'Outer Tracking'
I used to use things like the 16PF or BDI to tell me what a client may have as a problem or how much anxiety or depression etc they had. Later I began to realize that these things were via clinical judgment, obvious. I began to see these instruments as gross, blunt and unnecessary unless I was writing a report.
I call such things outer tracking devices. They are useful instruments to tell us something is happening or to give us a diagnosis or an indication or therapeutic progress.
Another outer tracking process is the whole diagnostic process. After a while, as a devoted therapist/clinician I couldn't care less what diagnosis a person had once we were past the preliminaries. Once someone has been determined anxious, panicked or depressed or PTSD'd I say "so what" unless I can help them. Hence IT is for the ultimate pragmatist. Don't tell me endless amounts about whether it is anxiety or depression or personality disorder unless you can tell me what to do, right now, with this particular individual.
Recently Professor Van der Kolk at the International PTSD conference, in a closing speech said: "The more I have come to know about research and therapy the more I have come to believe that researchers can be more humble and clinicians more proud." Hear, hear! Therefore, I recommend IT to you as an excellent device for clinicians whom rightfully can think of themselves as the leading edge of empiricism and not researchers.
B 1 Process of Inner Tracking
The basic process of inner tracking is quite simple. You simply ask questions about how your techniques are progressing.
B 2 Relationship
Explain to client that you are an expert in techniques but you do not know which particular technique will work or when. For example, we may think that a cathartic reaction may be sufficient for "X" to occur but is it? Many models have in-built assumptions at various points along the way but what is really working and when?
Therefore, you explain that you wish to form a team working process, to find out what is working. They know what is working at almost any point in the process but we don't normally ask, until too late in the session when the information has become virtually if not actually unconscious.
You explain that they are to adopt a watchful (or mindful) attitude to what is happening in their bodies (compared with Hakomi procedures). After micro-intervention "Y" is tried you simply ask how it affected the targeted: fear, panic, pain etc. "Like a scientist you do not presume that it helped: you ask, "What in that procedure was helpful at all, if anything." Or when I got you to think of the alternative thought what effect did that have on your feelings, body or mind? How did it compare with how you felt before?
Hence the relationship is formed as you as the expert on procedures but ignorant of where and when it will affect this client if at all and they are the experts on knowing what is helping, if and when.
B 3 A worked example
- Client with panic style anxiety. From behavioural analysis and history taking, the origins appear to be caused either during a hospital admission 4 years ago or from childhood.
- My procedure is to locate the feeling in the body via shape of anxiety in the body site, colour that would be associated with it and various key feeling or sensation words. This procedure effectively 'locks the feeling in'.
- During a focused breathing regression (focused onto the above 'lock-on'), she regresses to a point in childhood about six yo. Yes, Daddy was yelling and hitting Mummy. (IT "Was this feeling like the one you had when we started, the yellow, block like feeling, burning sensation in the chest? Yes it was. IT "Was it the same feeling? Yes it's exactly the same as I get when my boss yells at me")
- At this stage I would do some inner child work focusing on getting a shift in the pain experienced by the child. IT questioning would reveal via the dialogue whether this pain actually shifts or not.
- If the pain remains, ask what is happening, what resistance etc and correct this. Ask again is the feeling gone. When it has, via whatever clever idea you have you have effectively erased the anxiety experienced via the adult. This can be confirmed later by the adult on return from the regression.
C 1 Commentary
It is not important as to whether you are into focused breathing or not the same procedure can be used with exposure work in PTSD. The techniques are not the issue here that is your problem, you are the expert in techniques it is whether you are picking up crucial feedback and building on success at each point in the chain.
I once had a client who had a phobic reaction to driving around an intersection corner. His SUDS scale was up around 7-8 (high) and no matter how relaxed I got him he still froze when he went past this corner, which was near the hold-up that caused his PTSD. I solved the problem by getting him, in imaginal mode to see himself driving past the corner in a bath-tub!
I then asked if it had any effect and he said the score was only 2-3 because he found the actual experience strange/confusing and a bit funny. His anxiety was replaced by this new sensation but he was for the first time able to imagine himself going past the exact same corner. Not long after he succeeded in-vivo. He now drives past this area all the time.
Was this sophisticated exposure procedure? I don't think so, it was a trick, 'a little experiment', (after Hakomi), conducted by two scientists he and me!
C 2 Contraindications/Reservations/Recommendations
- If the person has no insight, or poor ability to process or face their issues they may struggle with IT, however it is still worth trying in most cases.
- It is still presumed that therapists will have proficiency in the techniques they are using. You have to know about the correct use of your procedure, your client is not responsible for this department, only for confirming or disconfirming success.
- Do not interfere with crucial therapeutic moments with questioning. Clients need inner time to process, digest and react to your micro-interventions.
- Avoid challenging questions like "Why didn't that work?" Instead, try "What happened? What did you observe in your body?" Adopt the objective stance of the observer who tries one thing and stands back to observe its effect.
- You may however ask after a promising response: "So is this the area we need to work on? If we could shift this feeling, would that be what you are looking for? Do you think that if you could cry it would help?"
- If you are eliciting reactions that consistently indicate you are not progressing this is very useful information and your client has an opportunity (and a willingness I've found) to help you reformulate. Once I found out by fine-tuned questioning that a client was not able to detect any difference in a regressed child state compared with her normal adult state. This meant there was no functioning separate "adult" to assist and explained to me at once this was the wrong model, and why it wasn't working and where I could take pressure off of the client.
- IT is about timing. Don't wait until the session is over before you enquire. I cannot state more emphatically that such questioning has nothing to do with IT. IT is about subtle, timed questions with a client who is educated and 'mindful'
- I recommend IT for trainees and for anyone who wants to know answers to the questions "What am I doing that works" and "What am I doing personally that makes a difference?" Inner tracking is great for building therapist confidence.