Training Compassionate Presence

“Healing is best accomplished when art and science are conjoined, when body and spirit are probed together. Only when doctors can brood for the fate of a fellow human afflicted with fear and pain do they engage the unique individuality of a particular human being…a doctor thereby gains courage to deal with the pervasive uncertainties for which technical skill alone is inadequate. Patient and doctor then enter into a partnership as equals.

 I return to my central thesis. Our health care system is breaking down because the medical profession has been shifting its focus away from healing, which begins with listening to the patient. The reasons for this shift include a romance with mindless technology.”        Bernard Lown, MD, The Lost Art of Healing: Practicing Compassion in Medicine (1999)

I wanted to study with the healer and she instructed me to sit and observe, nothing more. She did not explain what she was doing, and provided no further instructions. Just observe. I did not understand. Yet, I continued to observe because she knew something, she did something that seemed to be associated with improvement and healing of many patients. A few showed remarkable improvement – at times it seemed miraculous. I felt drawn to understand. It was an unique opportunity and I was prepared to follow her guidance.

Dora Kawakami Muramatsu

Three remarkable healers: Dora Kunz, Mitsumasa Kawakami and Norihiro Muramatsu.

The healer was remarkable. When she put her hands on the patient, I could see the patient’s defenses melt. At that moment, the patient seemed to feel safe, cared for, and totally nurtured. The patient felt accepted for just who she was and all the shame about the disease and past actions appeared to melt away. The healer continued to move her hands here and there and, every so often, she spoke to the client. Tears and slight sobbing erupted from the client. Then, the client became very peaceful and quiet. Eventually, the session was finished and the client expressed gratitude to the healer and reported that her lower back pain and the constriction around her heart had been released, as if a weight had been taken from her body.

How was this possible? I had so many questions to ask the healer: “What were you doing?  What did you feel in your hands? What did you think? What did you say so softly to the client?” Yet she did not help me understand how I could do this. The only instruction the healer kept giving me was to observe. Yes, she did teach me to be aware of the energy fields around the person and taught me how I could practice therapeutic touch (Kreiger, 1979; Kunz & Peper, 1995; Kunz & Krieger, 2004; Denison,2004; van Gelder & Chesley, F, 2015). But she was doing much more.

Sitting at the foot of the healer, observing for months, I often felt frustrated as she continued to insist that I just observe. How could I ever learn from this healer if she did not explain what I should do! Does the learning occur by activating my mirror neurons? Similar instructions are common in spiritual healing and martial arts traditions – the guru or mentor usually tells an apprentice to observe and be there. But how can one gain healing skills or spiritual healing abilities if you are only allowed to observe the process? Shouldn’t the healer be demonstrating actual practices and teaching skills?

After many sessions, I finally realized that the healer’s instruction to observe the healing was an indirect instruction. I began to learn how to be present without judging, to be present with compassion, to be present with total awareness in all senses, and to be present without frustration. The many hours at the foot of this master were not just wasted time. It eventually became clear that those hours of observation were important training and screening strategies used to insure that only those students who were motivated enough to master the discipline of non-judgmental observation, the discipline to be present and open to any experience, would continue to participate in the training process. It was training in compassionate mindfulness. Once apprentices achieved this state, they were ready to begin the work with clients and master the technical aspects of the specific healing art or spiritual practice.

A major component of the healing skill that relies on subtle energies is the ability to be totally present with the client without judgment (Peper, Gibney & Wilson, 2005; Peper, 2015). To be peaceful, caring, and present seems to create an energetic ambiance that sets stage, creates the space, for more subtle aspects of the healing interaction. This energetic ambiance is similar to feeling the love of a grandparent: feeling total acceptance from someone who just knows you are a remarkable human being. In the presence of a healer with such a compassionate presence, you feel safe, accepted, and engaged in a timeless state of mind, a state that promotes healing and regeneration as it dissolves long held defensiveness and fear-based habits of holding others at bay. This state of mind provides an opportunity for worries and unsettled emotions to dissipate. Feeling safe, accepted, and experiencing compassionate love supports the biological processes that nurture regeneration and growth.

How different this is from the more common experience with medical practitioners who sometimes have too little time to listen and to be with a patient. We might experience a medical provider as someone who may see us only as an illness (the cancer patient, the asthma patient) instead of recognizing us as a human being who happens to have an illness(a person with cancer or asthma). At times we can feel as though we are seen only as a series of numbers in a medical chart – yet we know we are more than that. People long to be seen. Often the medical provider interrupts with within the first 90 seconds with questions instead of listening. It becomes clear that the computerized medical record is more important than the human being seated there. Sometimes the patients can feel more fragmented and less safe, when they are not heard, not understood. In this rushed state, based upon “scientific data,” the health care provider may give a diagnosis without being aware of the emotional impact of the diagnosis.

As one 23 year old woman reported after being diagnosed with vulvodynia,”I cried immediately upon leaving the physician’s office. Even though he is an expert on the subject, I felt like I had no psychological support. I was on Gabapentin, and it made me very depressed. I thought to myself: Is my life, as I know it, over?” (Peper, Martinez Aranda, P., & Moss, 2015 Martinez Aranda, P. & Peper, E., 2015)

What was missing for this young woman was compassion and caring. Sometimes, the healthcare provider is unaware of the effect of their rushed behavior and lack of presence. They can issue a diagnosis based on the scientific data without recognizing the emotional impact on the person receiving it.

Sitting at the foot of the master healer is not wasted time when the apprentice learns how to genuinely attend to another with non-judgmental, compassionate presence. However, this requires substantial personal work. Possibly all allied healthcare providers should be required, or at least invited, to learn how to attain the state of mind that can enhance healing. Perhaps the practice of medicine could change if, as Bernard Lown wrote, the focus were once again on healing, “…which begins with listening to the patient.”


Denison, B. (2004). Touch the pain away: New research on therapeutic touch and persons with fibromyalgia syndrome. Holistic nursing practice, 18(3), 142-150.

Krieger, D. (1979). The therapeutic touch: How to use your hands to help or to heal. Vol. 15. Englewood Cliffs, NJ: Prentice-Hall.

Kunz, D. & Krieger, K.  (2004). The spiritual dimension of therapeutic touch. Rochester, VT: Inner Traditions/Bear & Co.

Kunz, D., & Peper, E. (1995). Fields and their clinical implications. in  Kunz, D.,(ed). Spiritual Aspects of the Healing Arts. Wheaton, ILL: Theosophical Pub House, 213-222.

Lown, B. (1999). The lost art of healing: Practicing compassion in medicine. New York, NY: Ballantine Books.

Martinez Aranda, P. & Peper, E.  (2015). The healing of vulvodynia from the client’s perspective. 

Peper, E. (2015). Towards the end of suffering: The contributions of integrating mind, body and spirit by Mr. Kawakami. In: Kawakami, M., Peper, E., & Kakigi, R. (2015). Cerebral investigation of a Yoga Master during Meditation-Findings from Collaborative Research. Fukuoka, Japan: Showado Publisher, 7-13.

Peper, E., Gibney, K. H. & Wilson, V. E. (2005). Enhancing Therapeutic Success–Some Observations from Mr. Kawakami: Yogi, Teacher, Mentor and Healer. Somatics. XIV (4), 18-21

Peper, E., Martinez Aranda, P., & Moss, E. (2015). Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report. Biofeedback, 43(2), 103-109.

Van Gelder, K & Chesley, F. (2015). A Most Unusual Life. Wheaton Ill: Theosophical Publishing House.



  1. I thank Peter Parks for his superb editorial support and encouraging me to publish it.
  2. This blog was adapted the following two published articles, Peper, E. (2015). Compassionate Presence: Covert Training Invites Subtle Energies Insights. Subtle Energies Magazine, 26(2), 22-25; Peper, E. Sitting at the foot of the master-Covert training in compassionate presence. Somatics, 18(3), 46-47.







Less Medicine, More Health?

Should I get a body scan?

How aggressively should I lower my blood sugar level as I have type 2 diabetes?

I have no symptoms, should I get a routine mammogram?

I feel great, should I follow my doctor’s advice and have my annual physical?

These and hundreds of other questions often imply that the more medical care the better and healthier you will be. We assume that more care, more testing, the newer the drug, the more screening, etc. will prevent illness and promote health. In numerous cases this is not true! Although medical care can be superb for the treatment of acutely ill and injured, excessive use sometimes leads to harm.

In a superb book, Less Medicine, More Health, by Dr. H. Gilbert Welch, professor at Dartmouth Medical School and recognized expert on the effects of medical testing, the following seven basic assumptions underlying too much medical care are described in a readable and personable style.

  1. All risks can be lowered
  2. It’s always better to fix the problem
  3. Sooner is always better
  4. It never hurts to get more information
  5. Action is always better than inaction
  6. Newer is always better
  7. It’s all about avoiding death

Welch’s book explains the assumptions and the limitations of the assumption. Before assuming that the recommended medical procedures will improve your health—in some cases it will make you sicker—read his book, Less Medicine More Health.


Welch, H.G. (2015). Less Medicine, More Health. Boston: Beacon Press. ISBM 978-0-8070-7164-9

Resolving pelvic floor pain-A case report

It’s been a little over a year since I began practicing biofeedback and visualization strategies to overcome vulvodynia. Today, I feel whole, healed, and hopeful. I learned that through controlled and conscious breathing, I could unleash the potential to heal myself from chronic pain. Overcoming pain did not happen overnight; but rather, it was a process where I had to create and maintain healthy lifestyle habits and meditation. Not only am I thankful for having learned strategies to overcome chronic pain, but for acquiring skills that will improve my health for the rest of my life. –-24 year old woman who successfully resolved vulvodynia

Pelvic floor pain can be debilitating, and it is surprisingly common, affecting 10 to 25% of American women. Pelvic floor pain has numerous causes and names. It can be labeled as vulvar vestibulitis, an inflammation of vulvar tissue, interstitial cystitis (chronic pain or tenderness in the bladder), or even lingering or episodic hip, back, or abdominal pain. Chronic pain concentrated at the entrance to the vagina (vulva), is known as vulvodynia. It is commonly under-diagnosed, often inadequately treated, and can go on for months and years (Reed et al., 2007; Mayo Clinic, 2014). The discomfort can be so severe that sitting is uncomfortable and intercourse is impossible because of the extreme pain. The pain can be overwhelming and destructive of the patient’s life. As the participant reported,

I visited a vulvar specialist and he gave me drugs, which did not ease the discomfort. He mentioned surgical removal of the affected tissue as the most effective cure (vestibulectomy). I cried immediately upon leaving the physician’s office. Even though he is an expert on the subject, I felt like I had no psychological support. I was on Gabapentin to reduce pain, and it made me very depressed. I thought to myself: Is my life, as I know it, over?

Physically, I was in pain every single day. Sometimes it was a raging burning sensation, while other times it was more of an uncomfortable sensation. I could not wear my skinny jeans anymore or ride a bike. I became very depressed. I cried most days because I felt old and hopeless instead of feeling like a vibrant 23-year-old woman. The physical pain, combined with my negative feelings, affected my relationship with my boyfriend. We were unable to have sex at all, and because of my depressed status, we could not engage in any kind of fun. (For more details, read the published case report,Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report).

The four-session holistic biofeedback interventions to successfully resolved vulvodynia included teaching diaphragmatic breathing to transform shallow thoracic breathing into slower diaphragmatic breathing, transforming feelings of powerlessness and hopelessness to empowerment and transforming her beliefs that she could reduce her symptoms and optimize her health. The interventions also incorporated self-healing imagery and posture-changing exercises. The posture changes consisted of developing awareness of the onset of moving into a collapsed posture and use this awareness to shift to an erect/empowered postures (Carney, Cuddy, & Yap, 2010; Peper, 2014; Peper, Booiman, Lin, & Harvey, in press). Finally, this case report build upon the seminal of electromyographic feedback protocol developed by Dr. Howard Glazer (Glazer & Hacad, 2015) and the integrated relaxation protocol developed Dr. David Wise (Wise & Anderson, 2007).

Through initial biofeedback monitoring of the lower abdominal muscle activity, chest, and abdomen breathing patterns, the participant observed that when she felt discomfort or was fearful, her lower abdomen muscles tended to tighten. After learning how to sense this tightness, she was able to remind herself to breathe lower and slower, relax the abdominal wall during inhalation and sit or stand in an erect power posture.

The self-mastery approach for healing is based upon a functional as compared to a structural perspective. The structural perspective implies that the problem can only be fixed by changing the physical structure such as with surgery or medications. The functional perspective assumes that if you can learn to change your dysfunctional psychophysiological patterns the disorder may disappear.

The functional approach assumed that an irritation of the vestibular area might have caused the participant to tighten her lower abdomen and pelvic floor muscles reflexively in a covert defense reaction. In addition, ongoing worry and catastrophic thinking (“I must have surgery, it will never go away, I can never have sex again, my boyfriend will leave me”) also triggered the defense reaction—further tightening of her lower abdomen and pelvic area, shallow breathing, and concurrent increases in sympathetic nervous activation—which together activated the trigger points that lead to increased chronic pain (Banks et al, 1998).

When the participant experienced a sensation or thought/worried about the pain, her body responded in a defense reaction by breathing in her chest and tightening the lower abdominal area as monitored with biofeedback. Anticipation of being monitored increased her shoulder tension, recalling the stressful memory increased lower abdominal muscle tension (pulling in the abdomen for protection), and the breathing became shallow and rapid as shown in Figure 1.

Fig 3 biofeedback relax memory relax

Figure 1. Physiological recording of pre-stressor relaxation, the recall of a fearful driving experience, and a post-stressor relaxation. The scalene to trapezius SEMG increased in anticipation while she recalled the experience, and then initially did not relax (from Peper, Martinez Aranda, & Moss, 2015).

This defense pattern became a conditioned response—initiating intercourse or being touched in the affected area caused the participant to tense and freeze up. She was unaware of these automatic protective patterns, which only worsened her chronic pain.

During the four sessions of training, the participant learned to reverse and interrupt the habitual defense reaction. For example, as she became aware of her breathing patterns she reported,

It was amazing to see on the computer screen the difference between my regular breathing pattern and my diaphragmatic breathing pattern. I could not believe I had been breathing that horribly my whole life, or at least, for who knows how long. My first instinct was to feel sorry for myself. Then, rather than practicing negative patterns and thoughts, I felt happy because I was learning how to breathe properly. My pain decreased from an 8 to alternating between a 0 and 3.

The mastery of slower and lower abdominal breathing within a holistic perspective resulted in the successful resolution of her vulvodynia. An essential component of the training included allowing the participant to feel safe, and creating hope by enabling her to experience a decrease in discomfort while doing a specific practice, and assisting her to master skills to promote self-healing. Instead of feeling powerless and believing that the only resolution was the removal of the affected area (vestibulectomy). The integrated biofeedback protocol offered skill mastery training, to promote self-healing through diaphragmatic breathing, somatic postural changes, reframing internal language, and healing imagery as part of a common sense holistic health approach.

For more details about the case report, download the published study,  Peper, E., Martinez Aranda, P., & Moss, E. (2015). Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report. Biofeedback. 43(2), 103-109.

The participant also wrote up her subjective experience of the integrated biofeedback process in the paper, Martinez Aranda & Peper (2015). Healing of vulvodynia from the client perspective.  In this paper she articulated her understanding and experiences in resolving vulvodynia which sheds light on the internal processes that are so often skipped over in published reports.


Banks, S. L., Jacobs, D. W., Gevirtz, R., & Hubbard, D. R. (1998). Effects of autogenic relaxation training on electromyographic activity in active myofascial trigger points. Journal of Musculoskeletal Pain, 6(4), 23-32.

Carney, D. R., Cuddy, A. J., & Yap, A. J. (2010). Power posing brief nonverbal displays affect neuroendocrine levels and risk tolerance. Psychological Science, 21(10), 1363-1368. Available from:

Glazer, H. & Hacad, C.R. (2015). The Glazer Protocol: Evidence-Based Medicine Pelvic Floor Muscle (PFM) Surface Electromyography (SEMG). Biofeedback, 40(2), 75-79.

Martinez Aranda, P. & Peper, E. (2015). Healing of vulvodynia from the client perspective. Available from:

Mayo Clinic (2014). Diseases and conditions: Vulvodynia. Available at

Peper, E. (2014). Increasing strength and mood by changing posture and sitting habits. Western Edition, pp.10, 12. Available from:

Peper, E., Booiman, A., Lin, I, M.,& Harvey, R. (in press). Increase strength and mood with posture. Biofeedback.

Peper, E., Martinez Aranda, P., & Moss, E. (2015). Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report. Biofeedback. 43(2), 103-109. Available from:

Reed, B. D., Haefner, H. K., Sen, A., & Gorenflo, D. W. (2008). Vulvodynia incidence and remission rates among adult women: a 2-year follow-up study. Obstetrics & Gynecology, 112(2, Part 1), 231-237.

Wise, D., & Anderson, R. U. (2006). A headache in the pelvis: A new understanding and treatment for prostatitis and chronic pelvic pain syndromes. Occidental, CA: National Center for Pelvic Pain Research.

Doctor Mike Evans: What’s the Best Diet? Healthy Eating 101

A healthy diet is much more than just focusing on a single food. People focus so often on adding one type of food or eliminating another such as, “Don’t eat ice cream!”, “Eat chia seeds.” “No red meat.” In almost all cases, it is not just one thing, instead a healthy diet is embedded in awareness and healthy life style choices. Watch the superb common sense white board video presentation by Doctor Mike Evans, What’s the Best Diet? Healthy Eating 101. In this short presentation, he summarizes the best practices known. Implement his approach and your health will significantly improve.

Gut understanding-From salivating to pooping and all that is in between

Eighty percent of all your cells in your body are bacteria and not human cells. Or is it that human beings are this mixture of beneficial bacteria and human cells? The majority of the bacteria live in our large intestines and contribute to our health and well-being. One of the hottest area in medicine and biology is the study of the human microbiome–understanding the role of the bacteria that co-habitate with us. The dynamic mixture of healthy and harmful bacteria can create illness or health and change our moods.

Ever wondered how food is digested, what foods do for you, what is a stomach ache, diarrhea or how defecation occurs? To understand our digestive tract from the mouth to the anus, from the first morsel of food entering our mouth to pooping is explained in superb readable book, Gut-The Inside Story of Our Body’s Most Underrated Oran, written by the German writer and scientist. Giulia Enders. It is a must read for anyone concerned about impact of cesarean birth, food allergies, eczema, ulcers, effect of antibiotics, constipation, farting, bloating, etc.For a fun summary, see Steve Palkin’s interview with Giulia Enders on YouTube.


Understanding marketing to doctors, food waste and sugar consumption through humor

The Last Week Tonight Show with John Oliver is a superb presentation of the problems and solutions about our health and food systems. Using humor, John William Oliver hosts the weekly HBO program on Sundays at 11pm and provides superb documentation of the corruption and marketing strategies that often negatively affect our health, diet and budget.
For evidence based–yet humorous–reporting watch the following episodes;
Marketing to Doctors (HBO). Pharmaceutical companies spend billions of dollars marketing drugs to doctors (published on Feb 8, 2015).

Food Waste (HBO). Producers, sellers, and consumers waste tons of food. John Oliver discusses the shocking amount of food we don’t eat (published on Jul 19, 2015).

Sugar (HBO). Sugar. It’s in everything!
Is it good for us? Well, the sugar industry thinks so (published on Oct 26, 2014).

For additional information, see the following blogs:

What the food companies forgot to tell you: For the sake of profits we promote metabolic syndrome, obesity and diabetes

Be aware of evolutionary/environmental traps

Over diagnosed: Should I have more tests?

Drug to smart phone addiction-A need for a new perspective

The federal and state governments have spent more than $1 trillion during the last 40 years on the  war on drugs. A war that has been so unsuccessful that more than half a million people are in prison for drug law violations–a tenfold increase since 1980. Once released from prison with the stigma of a criminal record, the people face a very difficult future.

Clearly, the present drug policies are not working.  There is a need to rethink the basis and treatment of addiction. Watch British journalist Johann Hari’s 2015 Ted talk in which he offers surprising and hopeful ways of thinking about an age-old problem.


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