Mindfulness and Psychotherapy: What is the Buzz All About?
By Dr. Ana Bodnar. Registered Psychologist
Published in the Ontario Society of Psychotherapists Newsletter, January 2007
What is the buzz? What is this mindfulness all about? And why has it become trendy in psychology of late? It has been often said that there is nothing new under the sun, but what is new is when worlds meet, collide and then come into fusion. That is what I find so exciting about this recent work in mindfulness and psychotherapy. Both are attitudes and practices that are aimed at diminishing the pain and suffering of human beings, and both support healing and well-being. Mindfulness can bring a greater sense of mental calm, can support the idea of developing a “witness” to our own experience, can diminish reactivity and negative mental patterns, and can support the development of a general sense of well-being, kindness and compassion. Mindfulness, and meditation in general, are techniques that individuals can learn for themselves that are stabilizing and empowering. Mark Epstein (1998), one of the leading authors and teachers in the field of Buddhism and psychology, sees mindfulness as providing a “holding environment” for people to be able to contain their own experience and come into conscious relationships with it. He brings together the worlds of psychoanalysis and Buddhist psychology in his practice and his writing. He is one of a current breed of North American psychologists and Buddhists who are successfully integrating these worlds.
Probably the most famous mindfulness based approach is Mindfulness Based Stress Reduction (MBSR), developed by Jon Kabat Zinn (1990) at Boston Medical School. It is a structured program that has been used with thousands of people experiencing anxiety, chronic pain and various forms of physical illness. The program includes mindfulness meditation, yoga practice, communications exercises, and intense home practice. Research about the positive effects of MBSR is plentiful and convincing.
Mindfulness Based Cognitive Therapy, developed by Segal et al. (2002), is successful in diminishing the rate of relapse in depression. Dialectical Behaviour Therapy, developed by Marcia Linehan (1993), teaches individuals how to use mindfulness to contain difficult emotional states and not act in a self-destructive manner even when they experience extreme, even suicidal ideas. My clients have participated in each of these types of programs with great success. In my own practice, I incorporate many mindfulness based approaches and exercises.
What does mindfulness mean?
Mindfulness, in its essence, is “to pay attention fully without judgment.” This sounds simple in theory, but in any workshop that I have led, or with individual clients, when I ask people to practice mindfulness on their breath, they quickly realize just how difficult this is. The nature of our mind is to be busy, active, full of commentary, judgment, interpretation. In meditation circles, this is called “monkey mind,” since like a monkey, our mind likes to jump everywhere. While we are trying to focus, it has run off to plan our trip to the supermarket, remember phone calls we have to make or hurtful comments. Five minutes can pass before we realize that we are not focused on our breath!
Mindfulness is drawn from the Eightfold Path in Buddhist Psychology. Buddhist Psychology as a whole offers us ways of living in peace and harmony with ourselves and our worlds, ways to develop a greater sense of compassion for ourselves and others. The Buddha developed the Four Noble Truths, and the Eightfold Path, as a way to bring people to peace.
Number Seven of the Eightfold Path is “Right Mindfulness,” which is seen as the controlled and perfected faculty of cognition. It is the mental ability to see things as they are, with clear consciousness. Usually, the cognitive process begins with an impression induced by a perception, or by a thought, but we do not stop there. We conceptualize sense impressions and thoughts almost immediately. We interpret them in relation to other thoughts and experiences, which go beyond the facticity of the original impression. The mind posits, joins and weaves these constructs into complex interpretive schemes. All this happens only half consciously, and as a result, we often see things obscured. Right mindfulness is anchored in clear perception and it penetrates impressions without getting carried away. Right mindfulness enables us to be aware of the process of conceptualization in a way that we actively observe and control the way our thoughts go. Buddha accounted for this as the four foundations of mindfulness: 1. contemplation of the body, 2. contemplation of feeling (repulsive, attractive, or neutral), 3. contemplation of the state of mind, and 4. contemplation of the phenomena.
Using Mindfulness in therapy and in our lives
One of the greatest gifts of mindfulness practices is that they are in fact “practical.” We can see how very useful this can be in our work. Suffering is so often based on restlessness and agitation, faulty cognition, distorted interpretation, automatic thinking, and projection. As clinicians, we deal with our own counter transference. Mindfulness meditation can offer ways to watch one’s thoughts without being identified with them, or swept away by them. Mindfulness practice can give us that space, that moment where we can choose to go down a different mental pathway, aware from reactivity and towards clarity of response.
Metta (loving kindness) practices can teach us how to be kinder and more compassionate with ourselves and others. Loving kindness can be done as a formal meditation practice within therapy sessions, and also cultivated in all moments of our own and our clients’ lives. When doing it as a formal practice, we move into a meditation position, relax into our breath, and hold the intention for all aspects of ourselves and say “May I be peaceful. May I be happy. May I be safe and protected.” This practice is repeated, and includes: becoming aware of your mind, the range of emotions that it can experience, and connecting with any suffering, pain, confusion, stillness, serenity and spaciousness that you experience. As you do so, gently repeat these same phrases. After a few moments, this intention of kindness and well-being is extended outward to a benefactor, to a friend, to someone we are neutral towards, and later in the practice, to someone who has hurt us, saying “May you be peaceful. May you be happy. May you be safe and protected.” As simple as this sounds, it has profound effects, in setting the aim and repeating the desire for happiness. These practices are so beneficial in our day to day lives, bringing us to greater presence in our own lives, and a deeper sense of gratitude and kindness.
I incorporate mindfulness based practices in my counselling work in a variety of ways, based on client need, usually integrating it with psychodynamic or cognitive approaches. With many clients, I begin the session with a short meditation as a centering practice, and will often teach mindfulness practices to use at home on a regular basis. I also teach Metta practice, and integrate it with psychotherapy interventions aimed at diminishing self-criticism and promoting self-acceptance. To work in this way as therapists, we need to find the “teacher” within us, even to the extent of assigning homework practice.
And I encourage clients to practice mindfulness in their lives as they walk, eat, speak with others, and go about their daily work. Clients report good results with these practices and become engaged with this attitude of living.
Applications for Mindfulness
Many of the difficulties experienced by Western people are what we call “disorders of the self” – low self-esteem, disturbances in our connections with others, intense self-criticism and self-rejection. Anxiety states are often related to a deep sense of “not being good enough,” not having faith in one’s own abilities, and anticipating difficulty coping with future events. If we can help our clients learn to live more in the sensory experience of the present moment, to see the experience of anxiety as phenomena not as a fact, and to feel safe with this, then we can go a long way to helping them overcome these anxieties of the self.
Mindfulness and loving kindness can also be very helpful with feelings of depression. Depression has many causes, organic and psychodynamic, often a combination of both. One of the patterns that I often see in my own clinical practice is people with ongoing self-criticism, self-hatred and self-rejection. More than one person has been shocked, surprised, amazed by the idea that they could treat themselves with kindness and compassion, saying “You mean I can do this, I can change this horrible way I treat myself, I can learn self compassion?” It is not something that had occurred to them, and appears as if by magic. Learning self-love appears simple but not so easy to do. There are long-standing habits of being that need to be changed, but the good news, as we know in psychotherapy, is that change is possible. The more we practice the positive ways of being, the more they become reality in our lives.
There is also a brain connection. Extensive research into meditation and brain function has shown that, even as adults, our brains can set down new neural pathways. So as we deepen our meditation practice, we can actually change the structure of our brain in positive ways.
Change is the nature of life; we just need to get out of its way. Interesting research being done in self-compassion is finding that individuals with greater self-compassion are more likely to be resilient overall and have better interpersonal relationships. Self-compassion is currently being explored as a more valuable tool of analysis than self-esteem.
I hope these thoughts about how you can bring mindfulness and loving kindness to your own practice and to your clients are useful. I am collecting stories of how therapists are using mindfulness in their clinical practice and would love to hear from you at firstname.lastname@example.org.
References and Recommended Reading
Chodron, Pema. Comfortable with Uncertainty. Shambala Press, 2003.
Epstein, Marc. Going to Pieces without Falling Apart. Random House, 1998. (Check his three other books as well.)
Kabat Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. Bantam, 1990.
Linehan, Marsha. Cognitive -Behavioural Treatment of Borderline Personality Disorder. The Gilford Press, 1993.
Segal, Z.V., Williams, J.M.G. and Teasdale, J.D. Mindfulness-Based Cognitive Therapy for Depression: A new approach to preventing relapse. New York: Guilford Press, 2002.
Saltzberg, Sharon. Loving Kindness: The Revolutionary Art of Happiness. Shambhala, 1995.