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How to incorporate mindfulness into psychotherapy

Sitting Together: Mindfulness-based psychotherapyMind­ful­ness is good for you. In thou­sands of stud­ies, moment-to-moment, non-judg­men­tal atten­tion has been shown to improve well-being, strength­en rela­tion­ships, increase focus and atten­tion, and even boost our immune sys­tems.

So it’s no sur­prise that ther­a­pists have tak­en an inter­est in using mind­ful­ness with their patients. The poten­tial for ben­e­fit is clear­ly great. But how can ther­a­pists actu­al­ly incor­po­rate mind­ful­ness into their prac­tice? And, is it always help­ful to patients?

To get answers to these ques­tions, look no fur­ther than Sit­ting Togeth­er: Essen­tial Skills for Mind­ful­ness-Based Psy­chother­a­py (Feb­ru­ary 2014; 240 pages). The authors—Harvard-based psy­chol­o­gists Susan Pol­lak and Ronald Siegel, and clin­i­cal social work­er Thomas Pedulla—provide a wealth of research demon­strat­ing the ben­e­fits of mind­ful­ness for both ther­a­pists and patients, along with detailed guid­ance on when and how mind­ful­ness prac­tices might be use­ful in spe­cif­ic ther­a­peu­tic sit­u­a­tions.

There seems to be lit­tle con­tro­ver­sy over ther­a­pists prac­tic­ing mind­ful­ness them­selves, and the authors high­ly rec­om­mend doing so. In sev­er­al stud­ies, researchers found that ther­a­pists who prac­tice mind­ful­ness expe­ri­ence less burnout, more self-com­pas­sion, and a bet­ter con­nec­tion with their patients, lead­ing to more well-being for ther­a­pists. Addi­tion­al­ly, some research shows that ther­a­pists who prac­tice mind­ful­ness are more high­ly rat­ed by their patients.

Ther­a­pists can eas­i­ly incor­po­rate mind­ful­ness into their days as clin­i­cians, the authors write. They sug­gest tak­ing a mind­ful eat­ing break or using an unex­pect­ed “no-show” hour to eschew paper­work in favor of mind­ful med­i­ta­tion, which can help ther­a­pists decrease resent­ment and devel­op more self-com­pas­sion. Sim­ple mind­ful­ness prac­tices like these can help ther­a­pists tap into their own joy and increase their tol­er­ance for expe­ri­enc­ing dif­fi­cult emo­tions, ben­e­fit­ting them­selves and their patients.

But ther­a­pists need to take more care when sug­gest­ing mind­ful­ness prac­tices for their patients, accord­ing to the authors. Mind­ful­ness involves prac­tic­ing three basic skill sets, each with dif­fer­ent effects:

  • Con­cen­tra­tion, or focus­ing atten­tion on a fixed object of aware­ness, which can help you under­stand the way your minds work;
  • Open mon­i­tor­ing, or pay­ing atten­tion to what­ev­er is pass­ing through your con­scious­ness, which can help you remain curi­ous and open to what­ev­er emerges in life; and
  • Accep­tance, which involves a devel­op­ing a com­pas­sion­ate stance towards your expe­ri­ence and your­self. Though each skill is impor­tant to mind­ful­ness, any one can poten­tial­ly help or hin­der a patient’s heal­ing.

For exam­ple, patients who are very anx­ious and jit­tery may not be able to sit still and focus on their breath with­out increas­ing their anx­i­ety; they might instead ben­e­fit more from walk­ing med­i­ta­tion or focused atten­tion on some­thing out­side them­selves, such as sounds in their envi­ron­ment. A woman stuck in an abu­sive mar­riage may not ben­e­fit most from lov­ing-kind­ness med­i­ta­tions, instead need­ing to con­nect with her anger through just talk­ing about her sit­u­a­tion and con­sid­er­ing her options. Mind­ful­ness prac­tices don’t always aug­ment ther­a­py, but they can cer­tain­ly help in many sit­u­a­tions.

The authors guide ther­a­pists through the cir­cum­stances to con­sid­er before pre­scrib­ing mind­ful­ness prac­tices for patients. For exam­ple, ther­a­pists should be expe­ri­enced prac­ti­tion­ers them­selves and take into con­sid­er­a­tion the readi­ness of their patients to han­dle mind­ful­ness expe­ri­ences. They must under­stand how dif­fer­ent mind­ful­ness prac­tices impact people—i.e. know­ing whether the prac­tice offers a sense of peace and safe­ty, which some accep­tance prac­tices do, or whether it inten­si­fies aware­ness of thoughts and emo­tions, which con­cen­tra­tion or open aware­ness prac­tices might do.

These and oth­er issues, such as the strength of the ther­a­peu­tic rela­tion­ship, should be con­sid­ered before imple­ment­ing mind­ful­ness with patients, they warn.

Patients may not be open to the idea of mind­ful­ness because of reli­gious or oth­er rea­sons. In this case, the authors sug­gest that ther­a­pists intro­duce mind­ful­ness as a sci­en­tif­i­cal­ly-proven stress reliev­er, rather than a sec­u­lar ver­sion of a Bud­dhist prac­tice. Ther­a­pists can also pro­vide grad­u­at­ed expe­ri­ences for patients, using time in the ther­a­py ses­sion to make sure patients feel com­fort­able with the prac­tices and that con­cerns are addressed.

The authors have both a firm grasp on mind­ful­ness and impor­tant insight into the ther­a­peu­tic process. Their book is full of clin­i­cal exam­ples as well as detailed direc­tions on how to use mind­ful­ness in dif­fer­ent ther­a­peu­tic sit­u­a­tions with dif­fer­ent kinds of patients. If you are a ther­a­pist inter­est­ed in incor­po­rat­ing mind­ful­ness into your own life or into the work you do with patients, I high­ly rec­om­mend this thor­ough, thought­ful book.

jill_suttie.thumbnail– Jill Sut­tie, Psy.D., is Greater Good‘s book review edi­tor and a fre­quent con­trib­u­tor to the mag­a­zine. Greater Good is an online mag­a­zine based at UC-Berke­ley that high­lights ground break­ing sci­en­tific research into the roots of com­pas­sion and altru­ism.

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