Process Oriented Coma Work according to Arnold Mindell

Process-oriented Coma Work, which also includes working with people in vegetative states,  minimally conscious states, locked-in syndrome or dying processes, is a special field of application of “Process-Oriented Psychology” developed by Arnold Mindell and Colleagues in the seventies of last century. It is also briefly called “Process Work”. It represents a supplementation to the basic and fundamental intensive care treatment of people in a coma.

Mindell (1989) and his wife Amy MIndell (2000) have developed concepts and methods to contact people in a coma, to support them in their awareness of possible experiences, to communicate with them (binary communication1) and to accompany them on their journey. Their long experience with different people from different cultures and in different states of consciousness show, that often feelings of isolation felt by the patient (from results of surveys) and feelings of helplessness often experienced by relatives or caregivers can be reduced significantly.

Process-oriented Coma Work postulated, that people in deep coma or in others severely withdrawn states - even under artificial breathing and sedation - are not entirely without perception or consciousness, but are in very deep altered states of consciousness and that a potential for consciousness is in place as long as the heart is beating.
Furthermore Mindell describes, that people in a coma are not only physically ill, but often feel disoriented and alone and - as experience in working with comatose patients demonstrated repeatedly – are confronted to experiences and issues that are essential for their lives.
Surveys of people, who woke up from a coma showed on the one hand that even these altered states of consciousness, and the experience gained, were of great importance for their lives, but on the other hand that uncompleted processes can persist even after years in the form of mental impairments or somatisation.
For this reason, coma patients need medical care and additionally psychological or even "spiritual" care and support. In such an attendance it’s not a priority assignment to pull comatose patients out of this state or to encourage them to relate to the outside world. Instead the coma worker actively relates on the state of consciousness and the inner experience of the coma patient; supports her in this experience and helps to unfold that process, wherever it leads. In many cases, this work can support people awakening from coma; in other cases it can be to accompany people on their way to death.

Process Work assumes, that every little, supposedly randomly emerging signal of the patient, that could be minimal movements, muscle reactions, breathing noises or changes in skin colour, can be potentially meaningful and an expression of a process seeking for awareness. So even the smallest signals of the patient are perceived by the facilitator as a carrier of information, welcomed and verbally reported back to the patient, as we know, that the hearing is intact even for a coma patient and that his function lapses only with the death.
When the coma patient reacts with positive feedback to the verbally framed signals of the patient, those signals are amplified by the therapist.
The patient is encouraged by the therapists and supported to trust his inner experience in all senses and to follow them. In this way, Process-oriented Coma Work doesn’t only help to establish contact with people in such deep altered states of consciousness, but to communicate with them too, to support them in their "inner journey", and to include them in the treatment and possible upcoming decisions. In addition, it was often shown that the Process-oriented Coma Work can promote recovery. Even in many other very withdrawn states or as non-responsive considered states like vegetative states, minimal consciousness states, locked-in-syndrom, delir, forms of dementia or dying process, the assumptions and methods of the Process-oriented Coma Work are of great benefit.

1 = Binary communication: a form of communication where information is transmitted by a sequence of two signal like 1/0 or yes/no. In process-oriented coma work the facilitators asks questions and the coma patients responds by showing or not showing a signal – like a movement of the little finger – which they have agreed on before.
2= Amplification (of signals): Originally a method of extension of the content of dreams by accumulation and completion of dream images (C. G. Jung). Later Mindell has been extending this method working with experiences like body symptoms or movements to get to their deeper meaning.


Literature recommendation:
Mindell, Amy (1999). Coma - a healing journey. A guide for family, friends and helpers. Portland, Or.: Lao Tse Press
Mindell, Arnold (1989). Coma: Key to Awakening.
Boston, Ma.: Shambala Publications.