There are a number of name brand mindfulness-based interventions for use in clinical work, starting with Mindfulness-Based Stress Reduction (MBSR) in 1979. Since then, we’ve seen the emergence of Mindfulness Based Cognitive Therapy (MBCT), Mindfulness Based Relapse Prevention (MBRP), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and a growing list of others. Basic mindfulness skills are integral to each of these interventions.
Clinical encounters are, by their very nature, matters of presence. When we can fully embody the moment that presence can promote healing, connection, and insight. Mindfulness can facilitate this presence and has a three-fold purpose: 1) enable clinical presence and other features of emotional intelligence such as compassion, emotional regulation, and acceptance; 2) mitigate stress and burnout; and 3) augment your your clinical repertoire of tools to offer clients and patients.
Based on my mindfulness-based psychotherapy work with patients and in my teaching clinicians, I have developed seven principles to guide the application of mindfulness in the clinical setting that touch on the three-fold purpose enumerated above. These are: Be Present; Be Still, Open Your Heart, Transmute Affect, Negotiate the Now, Teach What You can Own, Give What Can be Taken, and Make Yourself Vulnerable.
Be Present, Be Still: Our first task as clinicians is to show up for the person sitting in front of us. To do this, we must be present and able to sit still in both body and mind. This skill of inner and outer quiet is one that is facilitated by our own meditation practice—a key feature of mindfulness-based interventions.
Open Your Heart: When we are able to be still and let go of self-preoccupation, it is easier to open our hearts with empathy, compassion, and even love. Indeed, being fully present is a rare act that conveys the depth of care that a psychotherapeutic relationship should embody.
Transmute Affect: Clinical work involves energy exchanges whether we are aware of them or not. The process is saturated with feelings and often very strong emotions. Grounded in mindfulness, we can open ourselves without losing boundaries and taking on burdensome affect. I have a saying that when we are present to the moment, we don’t receive unwanted presents of distressed patient emotions. Sustaining mindfulness in real-time as we work with people, helps us to be connected but not afflicted by the intensity of clinical work thereby reducing stress and the risk for burnout. Of course, this skill applies in any interpersonal situation, not just clinical ones.
The first three of these principles are privately held and are relevant whether you bring mindfulness explicitly into your clinical work. The next four are relevant when you introduce mindfulness concepts and practices into your clinical work.
Negotiate the Now: Is the process of bringing present-moment phenomenon into the fold of mindfulness. For instance, if the person you are working with is experiencing an intense emotion stemming from a distressing story, you redirect their attention from the narrative driving the feeling and behavior to the experience in the body. This helps people to become mindful of their emotional reactivity and is the gateway to being less reactive. It is also helpful in de-escalating situations in session.
Teach What You can Own: When Jon Kabat-Zinn started training instructors for MBSR, he decided not to make it a protocol driven approach. Instead, teachers would draw from their own practice experience to make the process their own. Teaching mindfulness cannot be an intellectual affair. The prerequisite, then as it is now, was a personal meditation practice. Kabat-Zinn recommended a daily practice and at least two long silent sitting retreats. The more you embody the practice, the more you can provide to others.
Give What Can be Taken: People span a range of openness to mindfulness practices. As the popularity of mindfulness grows, perhaps even to revolutionary proportions, more people are familiar with mindfulness. Some people, though, may have concerns about conflicts with their religion because mindfulness stems from and is associated with Buddhism. Others will be quite open to deeper wisdom traditions that inform mindfulness meditation. Mindfulness-based psychotherapy starts from a secular, psychological approach to mindfulness and can be scaled up into explicitly Buddhist psychology depending on the needs of each individual participant.
Make Yourself Vulnerable: This is, perhaps, the most counterintuitive of the seven principles. Patients and clients may readily idealize our mindfulness capacities and create a sense of separation. It is important for us to let people know that we have not perfected our practice and that we struggle to be mindful daily, just as they do.
These seven principles, the mindfulness practices they include, and the Buddhist wisdom traditions that inform them provide a radical approach towards the alleviation of suffering, both for ourselves and the people we treat. We can offer more than just helping patients and clients to have better tuned narrative selves, we can open them to a world of experience beyond this storied self that can change their relationship to the vicissitudes of life from one of resistance and anguish to one of acceptance and peace.
Arnie Kozak is a clinical assistant professor in psychiatry at the University of Vermont College of Medicine. He will be leading a retreat, “Living in the Present Moment of Clinical Work: Mindfulness Skills for Mental Health Professionals,” March 13-15, 2015 at Copper Beech Institute, Connecticut’s premier retreat center for mindfulness and contemplative practice. For more details, visit: http://copperbeechinstitute.org/clinical-work/