When you hear the term mindfulness in a psychotherapy context what thoughts do you come up with? Do you wonder how mindfulness practices can be used in a private practice setting? Do you think that mindfulness doesn’t fit with your approach or modality?
Lisa Dale Miller’s July 24th, 2009, presentation provided an introduction to Mindfulness-Based Psychotherapy (MBP) and its uses in private practice through discussion and interactive case examples.
She began by saying that mindfulness tools can be used no matter what modality or techniques of psychotherapy we use and that they can be the most powerful homework we can give to our clients. Mindfulness is paying attention to the present moment with a compassionate, open curiosity. Mindfulness practices provide a set of skills that help clients recognize what is actually arising within and without, and realize they always have a choice in how they respond.
Miller read the poem The Real Work by Wendell Berry. She referred to the state of mind in Berry’s poem as “don’t know mind” and acknowledged that for many clients “don’t know mind” brings up powerful feelings of fear. This fear often arises when the client thinks she knows what will happen and it is usually the worst-case scenario. Miller further pointed out that when clients voice fears of uncertainty, more often than not, they are fixated on an automatic, habitual form of catastrophic knowing and unwilling to directly experience not-knowing. Mindfulness is a set of skills to get the client focused on fear and boredom. It opens the door to what is really going on, not just what a client tells herself and provides a means to examine this from a calm and peaceful state.
Mindfulness has been linked with analytic psychology for almost 40 years, introduced by Jack Engler, Ph.D., and others. Jack Kornfield, Ph.D., Joseph Goldstein, Ph.D., and Sharon Salzburg studied Buddhist meditation in India, Burma, and Thailand and returned to the U.S. in the early 1970s to teach insight (Vipassana) meditation. Kornfield and Goldstein became psychologists and have spent many years training psychotherapeutic professionals in applying mindfulness to psychotherapy. Another pioneer, Jon Kabat-Zinn, M.D., founded the Stress Reduction Clinic at the University of Massachusetts Medical School in 1979, and created the Mindfulness Based Stress Reduction (MBSR) program.
In the last ten years, MBP has come into its own. MBP combines psychodynamic and cognitive behavioral interventions, with mindfulness and heartfulness meditation practices, to awaken insight and promote active change in clients.
The two pillars of MBP are mindfulness and heartfulness. Mindfulness meditation brings about calm, clarity, and insight, while heartfulness meditation cultivates emotional healing. Mindfulness meditation develops attentional concentration and insight. Concentration practices cultivate mental calm, stability, and vividness, primarily through mindfulness of breath meditation. Insight is cultivated through direct knowing of internal and external phenomena as they arise and pass away, not being lost in conclusions or judgments about them. It is paying attention to pleasant experiences, painful experiences, and neutral experiences, with curiosity and openness. This helps bring about wisdom and equanimity. Insight meditation provides recognition of the impermanence of all phenomena and direct experience of habitual mental reactivity to aversion and craving. The experiential focus it provides serves as an antidote to negative internal narratives, hatred, instability, and ignorance.
The heartfulness aspect of MBP includes tools for emotional healing through the development of compassion and loving-kindness for oneself and others. Miller related that it is her experience that most people who come for therapy suffer with some form of self-loathing. She theorized that self-hatred, self-judgment, self-blame, and self-doubt are at the root of much of the suffering people experience. Through the practice of loving-kindness and compassion, we can help our clients cultivate safety, well-being, health, and ease, while providing an antidote to self-generated ill-will, self-hatred, and self-judgment.
After her overview, Miller took case examples and questions from the audience. In brief they are below.
Question: Can MBP be used with children? I see an 11-year-old girl who is fearful, what mindfulness practices could I use?
Answer: Yes, mindfulness can be used with children. Until the age of 12, only walking meditation is advised. You can teach a child to walk slowly and pay attention to her breath. For the 11-year-old, I would consider both guided imagery to help her find safety in her own body and loving-kindness meditation in the form of a game or song.
Question: What about with a 9-year-old boy who is afraid of death?
Answer: Don’t negate it. Bring up the question of what death may be like, have an open, frank, clear discussion of what he thinks death is, where he thinks we go when we die, etc. Be creative. This may help you understand his fear. Then introduce some anxiety-reducing techniques.
Question: How would you work with a mother who adopted three kids with extensive trauma and failed adoptions, who then become her caretakers? There is marital tension and she seems to be developing an anxiety disorder. Her husband is disappointed in her household duties and now she can’t talk to him.
Answer: This is a family system problem — the couple needs to be strengthened, get on the same page and support each other. Mindfulness would add tools for sanity. You can’t get rid of their pain, but you can give them tools to lessen their suffering. It sounds like mom has a low opinion of herself and feels deeply incapable. Her husband may be triggering her deep wound of self-loathing and self-blaming. When we work with a couple, we can give them the skills of compassionate recognition of the other’s suffering. Model and teach through mindfulness how to think before responding and how to respond from an open inquiring place rather than assumptions. Combine the tools for heartfulness with tools for self-awareness.
Miller ended the talk by sharing her intention to offer a MBP consultation group for clinicians. For more information we were directed to her website: http://www.lisadalemiller.com/mbpsych.htm.
Author: Robin Mullery
Presented by: Lisa Dale Miller, MFT
