Check out the previous section, Part 2, Mindfulness: Dealing with distress.
The Mindful Therapist
“The way we bring ourselves fully into connection with those for whom we care is one of the most crucial factors supporting how people heal – how they respond to our therapeutic efforts. Whatever the individual approach or clinical technique employed, the therapeutic relationship is one of the most powerful determinants of positive outcome in a range of studies of psychotherapy (see Norcross, Butler and Levant, 2005). Why is our presence – not just the interventions we offer, or the theoretical stance we take – the most robust predictor of how our patients respond? What is ‘presence’ and how can we cultivate this in ourselves?” (Siegal 2010).
Recent research indicates that therapists and counsellors who practice mindfulness may be more effective in working with their clients. Some research would suggest:
- Doctors who are more empathic have patients who heal faster and have more robust immune systems (Rakel et al, 2009).
- Mindfulness practice prevents burnout in primary care physicians and promotes positive attitudes towards patients (Krasner et al, 2009).
Siegal (2005) suggests that there are a number of key elements to the mindful helper:
Presence: the way we are grounded in ourselves, open to others, and participate fully in the life of the mind.
Attunement: As we both transmit and receive signals, we have the opportunity to tune into those incoming streams and attend fully to what is being said and expressed, rather than being swayed by our own perceptual biases.
Resonance: the physiological result of presence and attunement is the experience of two being “feeling felt” by each other. Resonance is also what our human nervous system requires for a sense of connection to others in early life (viz. attachment theory).
Trust: When resonance occurs then there is a doorway to feeling safe.
Truth: As we open ourselves to others and to ourselves, the nature of our internal work consisting of memory, perception and desire emerges into awareness.
Briere (2011) also highlights the importance of the here-and-now nature of the client-worker relationship, with its useful capacity to both ground the client in the present, and to also act as a corrective to damaged attachment.
“By offering unconditional caring, acceptance, mindful awareness and attunement, the compassionate clinician becomes the antithesis of, if not the antidote to, the client’s initial traumatisation, providing input for changes in the survivor’s perception and response system. The therapeutic relationship itself becomes a non-verbal cognitive therapy instrument, heightening awareness of the disparity between then and now”
Other terms for this finely attuned attachment between worker and client are “dialogical mindfulness”, “inter-being” or “relational mindfulness (Lysack, 2008), the moment by moment awareness of two people in a relationship. A worker can bring this into awareness for a client, while at the same time recognising for themselves the thoughts, feelings and body sensations that are occurring in each moment of the interaction. Making these elements explicit through language can be therapeutically powerful.
“As you talk about what has happened and I can see the tears in your eyes and as I am noticing the pain in your voice, I am aware that this is a very important moment between us, a really significant part of our human-to-human contact and relationship. What is it like for you right now, what is happening as you and I share your pain and distress?”
“Once the realisation is accepted that even between the closest human beings infinite distances continue to exist, a wonderful living side by side can grow up, if they succeed in loving the distance between them which makes it possible for each to see the other whole against the sky.”
Rainer Maria Rilke, Letters.
Most mindfulness literature assumes that workers who teach mindfulness to clients have their own mindfulness or meditation practice. Compassion and Self-Compassion meditations (metta/karuna meditation), also often called “Lovingkindness Meditations”, can be useful tools for counsellors and therapists to enhance awareness of their own thoughts, feelings and bodily sensations and to practice holding themselves in a space of gentle, curious, non-judgmental awareness and acceptance (See Appendices B & C, Compassionate mindfulness exercise for carers and Gratitude meditation).
“A therapist has to practice being fully present and has to cultivate the energy of compassion in order to be helpful.
Your career is the career of enlightenment, of love.”
‐ Thich Nhat Hanh.
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Appendix A: Mindlessness Inventory
Appendix B: Compassionate mindfulness exercise for carers
Appendix C: Gratitude meditation
Appendix D: Nightmare protocol
Appendix E: Flashback protocol
Appendix F: Sleep hygiene
Appendix G: SUDS – Subjective Units of Distress Scale
Abramowitz, J.S., Deacon, B.J., & Whiteside, S.P., 2010. Exposure Therapy for Anxiety: Principles & Practice. New York, Guilford Press.
Baer, R., ed., 2006. Mindfulness Based Treatment Approaches: Clinician’s Guide To Evidence Base & Applications.
Briere, J., 2013. Principles of Trauma Therapy. Sage, New York.
Geller, S.M. & Greenberg, L.S., 2012. Therapeutic Presence – A Mindful Approach to Effective Therapy. American Psychological Association, London.
Germer, C.K., Siegel, R.D., & Fulton, P.R., eds., 2005. Mindfulness & Psychotherapy. Guilford, London.
Lysack, M., “Relational Mindfulness & Dialogic Space in Family Therapy.” in Hick, S., & Bien, T., eds., 2008. Mindfulness & The Therapeutic Relationship. Guilford, London.
Mace, C., 2008. Mindfulness & Mental Health. Routledge, New York.
Segal, Z., Wiliams, M., & Teasdale, J., 2002. Mindfulness-Based Cognitive Therapy for Depression. Guilford, New York.
Shapiro, S., & Carlson, L., 2009. The Art & Science of Mindfulness. American Psychological Association, New York.
Williams, M., & Kabat-Zinn, J., 2013. Mindfulness: Diverse Perspective on its Meaning Origin and Applications. Routledge, London.
Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J., 2007. The Mindful Way Through Depression. Guilford, New York.