Aug

16

2022

Working with Mindfulness in Therapy

Mindfulness is all the rage these days. It has been adopted in schools, workplaces and by individuals, often in search of the promise of an all-elusive peace of mind.

In advance of our one day online CPD event: Anxiety: Attachment, Neuroscience and The Body on 8th October 2022, and drawing on the work of Margaret Landale and others, we explore how mindfulness has a role to play in therapy and helping clients to manage their anxiety.

As therapists, we can work mindfully in the present moment with our clients, including through the practice of empathy and embodied attunement. This approach can be helpful in addressing a wide range of presenting issues including anxiety, depression and complex trauma.

This article draws heavily on the work of Margaret Landale and our 2014 set of articles exploring working with The Present Moment in Therapy, adapted from a talk given by Margaret at the BACP Universities & Colleges Conference 2014, with her permission.

Empathy

Independent of modality, empathy is widely acknowledged to be key in effective psychotherapy and counselling.

Carl Rogers identified empathy as one of the core conditions for an effective therapeutic relationship. He defined empathy as the therapist’s ability:

…to sense the (patient’s) private world as if it were your own, but without losing the ‘as if’ quality. (1)

In this video Brene Brown describes how in turn empathy creates connection (in contrast to sympathy which drives disconnection):

Brene Brown cites Theresa Wiseman’s 4 qualities of empathy that include:

  1. Perspective taking
  2. Staying out of judgement
  3. Recognising emotion in others
  4. Being able to communicate that back

She notes that advice or a direct response rarely makes things better. What makes things better is connection, the experience of feeling with another.

Embodied Attunement – felt sense in the body

Building on this, Buber noted the importance of a body response, the sensed and felt embodied attunement to our client’s world, writing:

The therapist must feel the other side, the patient’s side of the relationship, as a bodily touch to know how the patient feels. (2)

Similarly, Daniel Siegel talks about the importance of ‘being felt’ by the other. (3).

This is far less about diagnosis or cognitive understanding. Instead, the focus is on building a safe and supportive therapeutic relationship, which in and of itself has healing qualities.

As a therapist, this is not always easy, especially when sitting with a client with complex trauma, in their distress and dis-regulated emotions.

Enter compassion.

Compassion: a special form of empathy

Germer and Siegel describe compassion as a ‘special form of empathy’ when they write:

We can be empathic with just about any human emotion – joy, grief, excitement, boredom. Compassion, however, is a special form of empathy insofar as it is empathy with suffering (along with a wish to alleviate it). Suffering is a prerequisite for compassion. (4)

Capacity for self-regulation

Margaret Landale invites us to think of compassion as empathy with the necessary skills to appropriately support our clients in their self-awareness, self-organisation and self-expression.

In order not to be overwhelmed by the other, this requires the therapist to possess a good capacity for their own self-regulation.

This affect regulation requires the therapist to track and process complex emotions in themselves first, grounded in an embodied awareness, in the present moment. A process that can be supported through regular on-going mindfulness practice.

Mindfulness defined

Shapiro and Carlson (2006) define Mindfulness as:

“The awareness that arises out of intentionally paying attention in an open, kind and discerning way. (5)”

The role of mindfulness

Mindfulness skills are becoming recognised as an important resource for psychotherapists and counsellors. These skills can help the counsellor to be present and pay attention to both their own, and their client’s, experiences and interactions. In growing our own capacity to tolerate and engage with emotions of all types, including those that are deeply uncomfortable, this way of being can be modelled to our clients within the therapeutic relationship itself.

In turn this way of being can be modelled to the client within the therapeutic relationship “encouraging a present-centered and accepting attitude”(6).

Mindfulness as a process

Shapiro and Carlson (2006) describe Mindfulness not as a state, but as a process (which they call the IAA Model) that includes:

  • Intention
  • Attention
  • Attitude

This video from Shauna Shapiro provides a human and accessible overview of the IAA Model of Mindfulness:

Intention is about SETTING A DIRECTION, remembering what is most important, and more poetically: setting the compass of our heart. This could be towards deepening our understanding of the workings of the mind and expanding the field of our awareness.

Attention describes PRESENT MOMENT AWARENESS. We learn how to attend to the present moment, ideally with the mind and body in one place. What is happening here and now, in this moment? In therapy this includes attention to verbal and non-verbal communication, using our senses as well as our thoughts.

Attitude explores HOW WE PAY ATTENTION. The invitation is to cultivate an attitude of curiosity, openness, non-striving, non-judgment and acceptance.

Everything that a client brings to the room is deemed to be okay. But first, the therapist needs to find this in themselves, allowing themselves to be absolutely okay with however they are feeling and staying with it. This may involve being curious about what a current sadness feels like in the body, without pushing it away or judging it, creating space to reparent ourselves.

This process is not easy, and cultivating these skills is a lifetime practice, through a regular meditation or other daily mindfulness practices.

Mindfulness in Therapy

Many therapists of course are already familiar with working in the present moment. This includes through ‘here and now’ relational approaches and working with transference and countertransference. Seeth back in 1982, wrote:

All therapists, regardless of their theoretical orientation must draw essentially on the same raw sensory data. As a therapist, I have what I can see, hear, or otherwise sense outside me (the client’s words, postures, gestures, tones of voice, patterns of breathing, etc.), and what goes on inside me (my own proprioceptive sensations, feelings, thoughts and associations, hunches and intuitions etc.). (7)

One of the challenges for integrating this ‘raw data’ mindfully is the traditional and cultural bias towards thinking and talking as a way to resolve problems. As client challenges are often rooted in deeply held emotional dilemmas or complex trauma, the thinking root has its limitations. (8)

As Shapiro and Carlson point out:

Mindfulness teaches us to let go of this habitual intellectual problem-solving mode (at least temporarily) and bring our awareness to the difficult emotions underlying our experience and to the felt sense of these emotions in the body. Through this process we are able to stop and attend, centering ourselves in the body instead of automatically reacting. (9)

In this way, Mindfulness can be a powerful resource in therapy, assisting with empathic attunement and non-judgemental recognition of client coping strategies and patterns of self-organisation.

Mindfulness challenges

Mindfulness is easy to write and talk about, but more difficult to put into practice.

In reality, being present to embodied felt experience can feel challenging, threatening and indeed overwhelming. This is especially true in the case of clients who learned to dissociate from their direct experience as young children in order to protect themselves; as well as clients experiencing deep shame, or a harsh inner critic. In these cases, the self-reflective focus in the here and now can be experienced as being highly threatening.

Early trauma implies that the client’s early self-regulatory systems were undermined, and this is carried mainly in the body. In this context, the non-verbal aspects of communication between therapist and client become critical. In such cases, the work may begin with the therapist focusing on their own direct embodied, felt experience without also directing the client to do so. Overtime this focus may expand wider.

Conclusion

Mindfulness is not for the fainthearted. It can be hugely valuable as a resource, but also challenging. It takes time and commitment to develop, and a courageous willingness from counsellors and therapists to explore and enter places within themselves and their clients that are wordless, unsettling, and sometimes indescribable.

At the same time mindfulness and compassion can help us develop a safe and containing intra and inter-personal relationship, which facilitates the integration of dissociated parts and the processing of traumatic memories. (10)

In this respect mindfulness deserves all the attention it is getting. The core skills of mindfulness, when applied with experience, offer us an approach to working deeply with clients on their core issues, which they have come to therapy to surface, understand and explore:

As we practice and watch, we begin to see that the mind can accommodate everything and that there is no need to struggle against ourselves. Thoughts come, feelings come, sensations in the body come – we simply watch, without judgment, without clinging or fear, but rather with a feeling of accommodating warmth and friendship with ourselves. (11)

Upcoming Workshop

Interested in exploring further how to work with clients experiencing anxiety? Join us for our one day online CPD event: Anxiety: Attachment, Neuroscience and The Body on 8th October 2022.

In this one-day seminar our three speakers: Victoria SettleSmita Rajput Kamble and Suzanne Worrica, will explore the experience of anxiety, and how we can effectively work with clients experiencing these symptoms in therapy.

We will explore the neuroscience of anxiety, the function of anxiety in everyday life and the experience of collective anxiety experienced in response to world events. The day will offer ideas about why some people become overwhelmed with anxiety and panic, including early causes around attachment rupture, and also offer some ways to work with anxiety and panic, including somatic/body-based approaches.

References
  1. Rogers, C. (1957). The Necessary and Sufficient Conditions of Therapeutic Personality Change. Journal of Consulting Psychology, Vol. 21
  2. Buber, M., (1967).  A Believing Humanism.New York: Simon & Schuster.
  3. Siegel, D., (2010 a). The Mindful Therapist. New York: Norton.
  4. Germer, C., Siegel, R., (2012). Wisdom and Compassion in Psychotherapy. New York: Guilford Press.
  5. Shapiro, S., Carlson, L., Astin, J., and Freedman, B., (2006). Mechanisms of Mindfulness. Journal of Clinical Psychology, Vol. 62(3), 373-386. ‘Wiley InterScience’ Published 2006 [Available from: DOI 10.1002/jclp.20237].
  6. Cigolla, F. and Brown, D. (2011). A way of being: Bringing mindfulness into individual therapy, Psychotherapy Research, 21:6, 709-721, DOI: 10.1080/10503307.2011.613076
  7. Seeth, K., (1982). On psychotherapeutic attention. The Journal for Transpersonal Psychology. 1982. Vol. 14. No.2., p. 142.
  8. Ogden, P. et.al., (2006).Trauma and the Body.New York: Norton.
  9. Shapiro, S. and Carlson L., (2010). The art and science of mindfulness.Washington DC: American Psychological Association.
  10. Germer, C., (2005). Mindfulness What Is It? Does It Matter? In: Germer, C.,Siegel, R., Fulton, P., eds. Mindfulness and Psychotherapy. New York: Guilford Press. pp. 3- 27.
  11. Goldstein, J., and Kornfield, J. (2001). Seeking the heart of wisdom.Boston: Shambala.

 

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