Three Ways to Bring Mindfulness Into Therapy

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Many ther­a­pists have come to regard cul­ti­vat­ing moment-to-moment aware­ness as a cura­tive mech­a­nism that tran­scends diag­no­sis, address­es under­ly­ing caus­es of suf­fer­ing, and serves as an active ingre­di­ent in most effec­tive psy­chother­a­pies. The clin­i­cal val­ue of mind­ful­ness inter­ven­tions has been demon­strat­ed for many psy­cho­log­i­cal dif­fi­cul­ties, includ­ing depres­sion, anx­i­ety, chron­ic pain, sub­stance abuse, insom­nia, and obses­sive-com­pul­sive disorder.

And it doesn’t mat­ter which ther­a­peu­tic approach we take, be it psy­cho­dy­nam­ic, cog­ni­tive-behav­ioral, human­is­tic, or any oth­er. Mind­ful­ness prac­tices can be tai­lored to fit the par­tic­u­lar needs of our patients. Though his­tor­i­cal­ly mind­ful­ness prac­tices have been pre­sent­ed as one-size-fits-all reme­dies, as the field matures we’re begin­ning to under­stand how these prac­tices affect dif­fer­ent indi­vid­u­als with dif­fer­ent prob­lems, how to mod­i­fy them in dif­fer­ent clin­i­cal sit­u­a­tions, and how to work with the inevitable obsta­cles that arise.

Mind­ful­ness can also enhance emo­tion­al well-being of clin­i­cians, help­ing us devel­op ben­e­fi­cial ther­a­peu­tic qual­i­ties such as accep­tance, atten­tion, com­pas­sion, equa­nim­i­ty, and pres­ence that enrich and enliv­en our work and help us avoid burnout. Once we have devel­oped these qual­i­ties in our­selves, we can safe­ly and thought­ful­ly intro­duce our patients to prac­tices that lead to a wide vari­ety of clin­i­cal benefits.

Here are a few ways that mind­ful­ness can ben­e­fit a ther­a­py sit­u­a­tion, drawn from our new book, Sit­ting Togeth­er: Essen­tial Skills for Mind­ful­ness-Based Psychotherapy.

1. Mindfulness can be a refuge for the therapist

In the prac­tice of mind­ful­ness, we bring atten­tion to our expe­ri­ence in the present moment. We let go of our regrets and rumi­na­tion about the past, or our wor­ries about the future, and return our atten­tion to what is hap­pen­ing right now. We start by focus­ing on the sounds in the room, the sen­sa­tions of the breath, or the feel­ing of sit­ting in a chair with our feet touch­ing the floor. As we devel­op this skill of being open to and accept­ing of what­ev­er is emerg­ing, we become more present in our expe­ri­ence and that of oth­ers. As we become less dis­tract­ed and pre­oc­cu­pied with our own con­cerns, we can lis­ten more fully.

Recent research shows that ther­a­pists who prac­tice mind­ful­ness med­i­ta­tion enjoy a vari­ety of ben­e­fits with no appar­ent neg­a­tive effects. These include a decrease in per­ceived job stress and burnout, as well as an increase in self-accep­tance, self-com­pas­sion, and sense of well-being. In addi­tion, clin­i­cians have report­ed improve­ments in their rela­tion­ships with their patients, say­ing they had a greater capac­i­ty for empa­thy, and expe­ri­enced an increased abil­i­ty to be present with­out being defen­sive or reactive.

You might be think­ing that you are too busy to bring for­mal mind­ful­ness prac­tice into your clin­i­cal day. But even in the busiest clin­i­cal set­tings on the cra­zi­est days, there’s always a chance to prac­tice infor­mal­ly. One of our favorite prac­tices can be done before greet­ing your next patient. It is called “Two Feet, One Breath.” In this prac­tice, you take a moment to pause, feel both feet on the floor, and then feel your inhala­tion and your exha­la­tion. A sim­ple inter­ven­tion such as this only takes a moment and can help you cen­ter, come into the present moment, and con­nect with your patient.

As you devel­op your prac­tice, you’ll become more famil­iar with what we call “anchors,” places to which you return your atten­tion when the mind has wan­dered. It’s like com­ing home after you’ve been away. The anchor offers a sense of safe­ty and com­fort. It can also be invalu­able dur­ing a dif­fi­cult clin­i­cal situation.

Let’s say you’re sit­ting with a patient who’s angry with you, or who con­fess­es he’s been plan­ning sui­cide. You find your­self feel­ing anx­ious, afraid, or con­fused. You notice that you begin to clench your jaw and tight­en your fists. Your shoul­ders rise toward your ears. You won­der what to do. Before for­mu­lat­ing a response, you could try paus­ing for a moment to return to your breath, the sen­sa­tions of sit­ting, or the sounds in the room. Or, you can silent­ly say to your­self, May we both be well. May we both be free from suf­fer­ing. May we both live in wis­dom and compassion.

Con­nect­ing with your breath or your com­pas­sion­ate inten­tion gives you a chance to pause, to come back into the present moment, to dis­pel the clouds of fear and con­fu­sion, and to let your innate wis­dom inform what you do next.

2. Mindfulness can deepen the therapeutic relationship

Cur­rent stud­ies sug­gest that in suc­cess­ful treat­ment alliances, ther­a­pists are per­ceived as warm, under­stand­ing, and accept­ing, approach­ing their patients with an open, col­lab­o­ra­tive atti­tude. Mind­ful­ness can help us devel­op these qualities.

The foun­da­tion­al skill in mind­ful­ness med­i­ta­tion of con­cen­tra­tion or focused atten­tion can be very use­ful in the ther­a­py hour, where so many fac­tors can cause the mind to wander—for exam­ple, when the con­tent of the ses­sion threat­ens us, or an out­side wor­ry dis­tracts us, or the patient becomes dis­en­gaged, mak­ing his or her words less com­pelling, or we just get tired. With­out mind­ful­ness train­ing, we may try to main­tain atten­tion by turn­ing up the inten­si­ty or vol­ume in order to keep things “inter­est­ing.” Through mind­ful­ness prac­tice, we instead learn how to turn up our atten­tion, to prac­tice pres­ence inde­pen­dent of con­tent, to bring our whole­heart­ed atten­tion to what­ev­er is happening.

Of the many fac­tors that inter­fere with atten­tion dur­ing ther­a­py, one of the most chal­leng­ing is the arousal of pow­er­ful and painful feel­ings. Most patients dis­cuss dif­fi­cult expe­ri­ences of ill­ness, loss, fail­ure, and dis­ap­point­ment. Unless we’re very good at denial, we real­ize that these mis­for­tunes could eas­i­ly befall us or our loved ones. Or, we may find our­selves over­whelmed by the pain and sad­ness we expe­ri­ence sim­ply because we empathize with our patients.

Mind­ful­ness prac­tices can be pow­er­ful tools to increase our tol­er­ance for painful emo­tions, enhanc­ing our abil­i­ty to remain atten­tive while sit­ting with suf­fer­ing. This is impor­tant for a strong alliance, because our patients usu­al­ly express only those feel­ings they believe we can tol­er­ate hear­ing. On the oth­er hand, if we’re able to be with a fuller range of expe­ri­ence, this will help our patients do the same.

Many peo­ple are sur­prised by what hap­pens when they bring atten­tion to phys­i­cal dis­com­forts in this way. Often they notice that pain sen­sa­tions are not sol­id, but pulse and change from moment to moment, and some­times pass with­out any spe­cial action on our part.

By prac­tic­ing being with dis­com­fort dur­ing this con­cen­tra­tion prac­tice, we can grad­u­al­ly become bet­ter able to tol­er­ate pain of all sorts, includ­ing the pain of dif­fi­cult emo­tions. We can step back, see­ing our thoughts and feel­ings as just thoughts and feel­ings, not as facts. Instead of get­ting lost in our per­spec­tive, we can redi­rect our atten­tion to the patient and what is unfold­ing in the present moment.

3. Mindfulness can be a tool for our patients

How can we make mind­ful­ness acces­si­ble to the widest pos­si­ble range of patients? What are some of the chal­lenges that arise and how do we respond to them skillfully?

To help skep­ti­cal folks engage with a par­tic­u­lar prac­tice, try pre­sent­ing it as an exper­i­ment, sug­gest­ing that oth­ers in sim­i­lar cir­cum­stances have found it to be use­ful. Depend­ing on the sit­u­a­tion, it can be use­ful to share infor­ma­tion from research stud­ies and pos­si­bly your per­son­al expe­ri­ence with the prac­tice. We sug­gest keep­ing it short, no longer than three to five min­utes, and then ask for a sta­tus report by ask­ing, “What are you noticing?”

Feed­back is use­ful in help­ing adapt or mod­i­fy the prac­tices for your patients. For exam­ple, when they say, “This isn’t working—I can’t get my thoughts to stop,” you’ll want to edu­cate them that mind­ful­ness isn’t about stop­ping thoughts, but com­ing into a kinder and more accept­ing rela­tion­ship with them. If, how­ev­er, some­one reports, “This was real­ly creepy. I had this image of my father stand­ing over bed when I was a lit­tle girl,” you may want to mod­i­fy the prac­tice or set it aside for the time being and try a dif­fer­ent approach.

Espe­cial­ly for those who have a his­to­ry of trau­ma, we sug­gest start­ing with a med­i­ta­tion like the one above that focus­es on sound and being present, rather than fol­low­ing the breath, which can be a trig­ger for trau­ma survivors.

Our goal in intro­duc­ing mind­ful­ness prac­tices to patients is not to turn them all into ded­i­cat­ed med­i­ta­tion prac­ti­tion­ers, but to help them find bal­ance, kind­ness, and ful­fill­ment in their lives. When research shows that even a taste of mind­ful­ness can help, we owe it to our patients (and our­selves) to learn the prac­tices and pass them on.

– This essay is adapt­ed from Sit­ting Togeth­er: Essen­tial Skills for Mind­ful­ness-Based Psy­chother­a­py, and pub­lished cour­tesy of Greater Good, an online mag­a­zine based at UC-Berke­ley that high­lights ground break­ing sci­en­tific research into the roots of com­pas­sion and altruism.

Learn more:

• Mind­ful­ness and Med­i­ta­tion in Schools