Mindfulness as a therapeutic tool

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Article from Éisteach, published by the Irish Association for Counselling and Psychotherapy on the use of mindfulness in counselling and psychotherapy with examples.

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Mindfulness as a therapeutic tool

  1. 1. Mindfulness as a therapeutic tool Éisteach, September, 2008 Padraig O’Morain MIACP IntroductionFive years ago, Margaret’s brothers convinced their mother to cut her out of a promisedinheritance, a share in the farm on which they had all grown up. Her mother died thefollowing year and the farm went to her brothers who sold it with a planning permissionfor a housing development. Her brothers are now rich while Margaret continues to workhard for a modest income.The injustice of what was done to her took away Margaret’s peace of mind. For nearlythree years following her mother’s death, she thought of little else. She lost sleep, shewas distracted and her husband and children grew sick of listening to her talking about“the farm.”Then she learned the practice of mindfulness. As she practiced, her obsessive thinkingabout the farm and her brothers began to fall away. She began to notice what wasgoing on around her, to pay attention to what she was doing and to keep more andmore of her awareness in the present moment.Margaret gradually got back her peace of mind, accepted that she had been out-manoeuvred and conned by her brothers and that she could do nothing about it, and gotinvolved again with the life of her own husband and children. Definition and explanationWhat is mindfulness? In a handout I give to clients and other interested parties, I explainthe process of mindfulness as follows:“Mindfulness involves taking your attention away from the past and future and awayfrom your imagination - and instead becoming aware of what is going on right now. Youcan do this as you go about your daily life. Notice where you are, what you are doing,what you are seeing and hearing, notice that you are breathing, standing, walking orsitting or lying down.“Your mind will keep drifting out of the present so you need to keep bringing it back. Itis bringing your mind back to the present that makes up the practice ofmindfulness. Never criticise your mind for drifting away: just bring it back kindly andgently.”Note that mindfulness involves maintaining awareness about what is going on, whateverthat might be. So it doesn’t matter that somebody is drilling on the street outside (notfrom a mindfulness point of view at any rate!) that somebody in the apartment aboveyou is playing the bongo drums or that you can hear your tummy rumbling.
  2. 2. If you are practicing mindfulness you simply take it all into awareness without gettinginto a mental drama about it. So you note that these things are going on and you mayeven be annoyed by them but you don’t make speeches to yourself about how they’realways digging up the roads for no reason at all, how people should go out and get a jobinstead of playing bongo drums in an apartment block or how embarrassed you feelwhen your tummy starts rumbling during your meditation class.You simply note the bongo drum, the drill, the tummy sounds, your annoyance and youleave it at that and get on with whatever you’re doing. Example: Awareness exerciseTo get into this state of mind it can help to do an awareness exercise now and then.Here is one I go through with my clients:“From time to time, notice your breathing.Notice your posture.Notice the length of your spine.Notice the points of contact between your body and the chair, floor, ground.Notice your clothes touching your body.Notice the sounds around you.Notice the nearest sound you can hear.Notice the furthest away sound you can hear.Now notice your breathing again.”This simple exercise can take thirty minutes or thirty seconds as you wish. I find thatclients tend to use it as a sort of brief checklist if they find themselves distracted as theygo through their day. Background to mindfulness practiceClients who give a little time to this exercise can find it very relaxing but there’s more tomindfulness than that. Mindfulness has been used for thousands of years in theBuddhist tradition to sharpen people’s awareness of their patterns of behaviour so thatthey can step outside these patterns. Mindfulness provides an antidote to brooding(which can lead to, or maintain, depression) and helps people to avoid endlesslyrepeating distressing or unhelpful thoughts, images and mental scenes. This, in turn,helps avoid repeating unhelpful behaviours.According to Buddhist psychology, we build up patterns of reactions to events. First, weperceive an event which could be something external or which could be a memory orthought. We then have a reaction which is made up of physical, mental and emotionalassociations with the event. We are swept away by the reaction, sometimes as if in atrance. This process distorts our future perceptions with the result that we are no longerfully aware of the reality around us. (Brazier, 2003).
  3. 3. Let us say it’s Saturday morning and I’m angry at that drilling going on down the street.The doorbell rings and there stands the young lady I fell madly in love with last monthand who has so lost her common sense as to fall (temporarily) in love with me.Suddenly my mind and emotions are overwhelmed by all the pleasurable things Iassociate with her and by the infantile emotions she summons up. The drilling no longerexists. I may be wide awake but I am also in a trance.Even when we are not infatuated, we spend much of our day in one trance or another,daydreaming, fantasising, remembering, resenting and so on. Buddhism seesmindfulness as a way to step out of that process and to get in touch with reality. I leaveit to the philosophers to debate the merits of the Buddhist assumption that being intouch with reality is always better than being out of touch with it.I hope, though, that this explanation will show readers why it is that Margaret was ableto derive such a benefit from mindfulness. The practice of mindfulness helped her tostep out of a series of reactions that was ruining her life far more effectively than herbrothers’ sharp practice had done. Practice and research: Pain and DepressionIn recent times the work of Dr Jon Kabat-Zinn at the University of MassachusettsMedical Centre has given a huge boost to the use of mindfulness in mainstream healthsettings. His clinic teaches mindfulness and yoga to people suffering chronic pain andstress. His work has enabled patients suffering permanent pain to re-gain control overtheir lives though the pain, of course, persists. In addition to helping patients live moresatisfactorily with chronic pain, his clinic has achieved significant and sustainedreductions in levels of anxiety, in reducing the severity and frequency of panic attacksand in improving the management of psoriasis. Kabat-Zinn has written up his work in anaccessible way in his book “Full Catastrophe Living” (1990). Similar work is done inIreland through Blue Sky, which works out of the Dublin Buddhist Centre and one ofwhose principals is a GP, Dr Kate Healy (see Sources & References below).The uses of mindfulness in western psychology have been studied for some years nowat the Centre for Mindfulness Research and Practice at the University of Wales, Bangor.Some Irish counsellors and psychiatric nurses have undertaken courses at the centre.Researchers in Wales and elsewhere have found mindfulness to be helpful in reducingthe risk of relapse in persons who have had a number of episodes of depression (Segal,Williams and Teasdale, 2002). They suggest that persons with relapsing depressionhave created a link in their minds between low mood, fatigue and negative thoughts.When one of these occurs, as happens to all of us from time to time, the person whohas made this link assumes that the depression is back, they suggest. The person thentriggers the other components of depression. So a person who wakes up in a low moodmay immediately indulge in negative thinking about the supposed return of thedepression, stay in bed and, as a result, feel fatigued on finally getting up. Before long,the depression really has returned. But the person who practices mindfulness, theysuggest, can spot what is going on and interrupt the sequence by getting the right
  4. 4. amount of sleep and striving to steer their thinking away from the negative. Some other applications in counsellingAnxiety. In my own work, I have found mindfulness to be helpful to people withexcessive anxiety and panic attacks and, to a lesser extent, to people with depression.In relation to panic attacks, it can help the client to maintain awareness of what is goingon during the panic attack instead of “awfulising” to himself or herself about it. The aimis to make the panic attack a less frightening event than before so that the client beginsto live without avoidance of places and situations which might trigger attacks.Parenting. I have also found mindfulness to be of immense benefit to a parent who wasbeing ‘driven demented’, as he put it, by his three children until he developed presenceof mind in the face of their antics. He did so through using mindfulness which gave himthe ‘mental space’ to avoid having his emotional buttons pressed by three very skilfulyoung button-pressers!Anger. A person who had learned the destructive habit of being angry at the smallestdeparture from what he wanted changed his behaviour when he became aware of whatwas going on in his mind before he flew off the handle. Again, mindfulness gave himthat ‘mental space’ and the opportunity to think twice.Work problems. A businesswoman developed resilience in dealing with some nastycolleagues by learning to spot them pressing her emotional buttons. Others were able tobe more assertive in the face of workplace bullying by practicing mindfulness.Mindfulness opens users’ eyes to the fact that they have choices about how they reactto their tormentors.Counselling. As a counsellor you probably already practice mindfulness in thecounselling room by maintaining awareness both of your client and of your ownreactions to your client. Any counsellor who deliberately uses attending skills is usingmindfulness even if he or she does not call it that. A note of cautionThe following are a few notes of caution for therapists introducing mindfulness to theirwork with clients.Mindfulness is not the answer to everything. It is too easy to over-sell the benefits ofmindfulness, especially at a time when its use is becoming more popular. I have seenmindfulness bring about major benefits in the lives of some clients – and make nodifference at all to others. In many of the cases mentioned above, mindfulness revealedto the client what he or she needed to work on – in doing so, mindfulness practiceperformed a valuable service but it was not the beginning and end of a solution.Different people need different kinds of mindfulness. People who live in their heads,
  5. 5. endlessly analysing their own thoughts need to be steered towards mindfulness of theexternal world, of sights, sounds and other people. On the other hand, if you are doingCBT with a client, mindfulness of thoughts or of emotions may be helpful – this is similarto the practice of ‘spotting’ as used by members of Recovery Inc.Mindfulness is not an anaesthetic. Mindfulness is sometimes promoted as a means ofrelaxation and stress reduction. But while mindfulness reduces stress, its main value isin revealing what needs to be done and sometimes what needs to be done is painful.For instance, the person who uses mindfulness during panic attacks – an approach Iadvocate – can expect to feel emotional distress during the attack.Mindfulness may be unhelpful to some psychiatric patients. When the Buddhist teacherand writer Jack Kornfield worked at a state mental hospital in the US, he tried to teachmeditation to some of the patients. “It quickly became obvious that meditation was notwhat they needed. These people had little ability to bring a balanced attention to theirlives, and most of them were already lost in their minds. If any meditation was useful tothem, it would have to be one that was earthy and grounded: yoga, gardening, tai chi,active practices that could connect them to their bodies.” (Kornfield, 2002).Caution clients about the temporary euphoric effect. Sometimes persons beginning topractice mindfulness experience a beautiful sense of calm and clarity. It does no harmbut it doesn’t last. If a client reports that he or she is having this experience it is worthtelling them gently that the effect will fade and that there is nothing to be gained fromtrying to get it back.When introducing mindfulness, get the timing right. As with everything else incounselling, there is little point in introducing mindfulness until the client feels heard andunderstood. Sometimes it is helpful to introduce mindfulness towards the end of the firstsession as a technique which might help. At other times it may only become appropriateto introduce mindfulness at a second or subsequent session. And at times it may not beappropriate at all. This is a matter of judgement and of that sense of what it is right to doand when it is right to do it that counsellors gradually develop.Mindfulness of the body may be too difficult following physical attack or torture. I amindebted to a participant in one of my workshops for the information that persons whohave been tortured can find mindfulness of the body or of breathing quite difficult andfrightening. In such cases, mindfulness of one’s surroundings, of sounds, of colours andof other aspects of external reaction may be helpful. Further exercisesEarlier I described an exercise from a handout on mindfulness which I give to myclients. There are two other exercises on the handout and you might like to try them outyourself:The first is to establish what I call “mindfulness cues”. This involves using habitual
  6. 6. behaviours to remind you to practice mindfulness. Choose one or two and then decidethat when performing them you will maintain awareness of what you are doing, ratherthan daydreaming or getting caught up in fears or anxieties. Examples of mindfulnesscues include: Using the telephone, going up or down stairs or steps, arranging yourdesk or other workspace, tidying, washing up or taking a shower.The second is mindfulness of breathing and you can do this for five minutes or forty fiveminutes as you like. Begin by sitting still. Notice that you are breathing in and out.Notice the in-breath and the out- breath. When thoughts come into your mind just letthem float on by. Do not get involved with them. Simply go back to noticing yourbreathing in and out. If you like you can count your breaths, counting from 1 to 10 andthen back to 1 again. And finally…If you want to use mindfulness with your clients, begin by using it yourself. Only thencan you answer the questions your clients will have.
  7. 7. Sources & References: WebsitesThe Institute for Meditation and Psychotherapyhttp://www.meditationandpsychotherapy.org/index.htmlCentre for Mindfulness Research and Practice, University of Wales, Bangorhttp://www.bangor.ac.uk/mindfulness/Center for Mindfulness in Medicine, Health Care, and Society (CFM)http://www.umassmed.edu/cfm/This is the website of the ground-breaking mindfulness centre run by Dr Jon Kabat-Zinnat the University of Massachusetts Medical Centre.Dublin Buddhist Centrehttp://www.dublinbuddhistcentre.org/index.htmlThe centre runs meditation courses at various times through the year.Wildmindhttp://www.wildmind.org/Offers a reasonably-priced mindfulness of breathing course and free resources. BooksA Path with a Heart, by Jack Kornfield, Rider, London, 2002. Covers a broader rangethan mindfulness and not an easy read in my view though it contains many interestingmeditation exercises.Buddhist Psychology, by Caroline Brazier, Robinson, London, 2003. A generalintroduction to Buddhist psychology by a psychotherapist.Mindfulness and Psychotherapy, edited by Christopher K. Germer, Ronald D. Siegeland Paul R. Fulton. The Guildford Press, New York and London, 2005. Expensive(about €40 but worth it if you’re interested in the topic).Full Catastrophe Living, by Dr Jon Kabat-Zinn, Bantam, New York, 1990.A detailed introduction to Kabat-Zinn’s pioneering work at the University ofMassachusetts Medical Centre.Mindfulness–based Cognitive Therapy for Depression, Segal, Z.V., Williams, J.M.G. &Teasdale, J.D, Guilford Press, 2002. The main focus of this important book is onpreventing relapse into depression.Calming Your Anxious Mind, Jeffrey Brantley MD. New Harbinger Publications, 2003.
  8. 8. Applying mindfulness to anxiety, fear and panic.Reference to this article:O’Morain, Padraig, Mindfulness as a therapeutic tool. Éisteach, September, 2008.Dublin: Irish Association for Counselling and Psychotherapy.

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