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Mindfulness Matters

Mindfulness Matters

Living in the Present Moment of Clinical Work

posted by Dr. Arnie Kozak


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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.

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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.

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 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.

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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.

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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.

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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.

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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/

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Happy Nirvana Day

posted by Dr. Arnie Kozak

Yesterday was Valentine’s Day; today is Nirvana Day or Parinirvana Day. It is the day that celebrates the Buddha’s death or his release into the final state of nirvana. A few years ago, in a post about Nirvana Day, I commented on the assumption regarding rebirth that this description requires. Today, I’ll focus on the concept of nirvana itself.

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Nirvana is hard to describe. In fact, it’s impossible to explain it adequately with language. It is a phenomenon that defies concepts, which of course require language. The Buddha did his best to capture it with a metaphor. Nirvana means to blow out as you would blow out or extinguish a candle flame.

It’s not life that blows out or ceases but the conceptual and language based processes that give rise to dukkha–the experience of suffering, stress, dissatisfaction, anguish, and so forth. The ultimate language-based concept is that of self. When we stop engaging in mind activity that affirms and pursues the desires of this self, we are closer to nirvana, whatever that phenomenon might be.

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The history of Buddhism and popular culture have given a mystical, transcendental feel to nirvana. It is an abode of bliss. It is special and requires special circumstances to achieve. That specialness, itself, becomes an impediment to the experience of nirvana.

We can cut through this mystification of nirvana and go back to the original metaphor–the cessation of a fire. The fuel for the fire is the activity of our minds as they pursue desire. Every moment that we cling to something that we want or push away something that we don’t is wood for that fire. Every moment we seek comfort, predictability, and reassurance as if our well-being depended on it, more is added to the pile.

If we stop doing these things and, instead, accept what is happening now with equanimity, then there is nothing more being added to the fire and it will go out. Not like a candle flame, but like a bonfire it will diminish and eventually go out. To experience nirvana is to awaken to the reality of the moment.

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Of course, it is very difficult, almost impossible to not add anything at all to the fire. Our minds are very active and have a lifetime of habit and conditioning behind them. So, we can look for mini-cessations and little hits of nirvana. We can aspire to keeping the fire more like a smoldering camp fire rather than a raging bonfire. This is a choice that we have in every moment.

Equanimity is another term that could benefit from some explanation. Equanimity is the prerequisite for nirvana. It does not seek to eliminate the discomforts, uncertainties, and disappointments in life nor does it passively acquiesce to them. Rather, equanimity is a way of experiencing what is happening with clarity, openness, and an absence of a compelling sense of self. It’s not that we are necessarily self-less, instead, we are just not making the value of ourselves in that moment contingent upon any of the prevailing conditions.

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Equanimity allows us to be right there in the middle of things, dealing with them as necessary without adding layers of perturbation. In other words, when we can be equanimous, we don’t add any wood to the fire. We can cool our minds with mindfulness in the moment. We don’t compound dukkha.

We will be exploring equanimity and even little hits of nirvana in my upcoming workshop at the Kripalu Center for Yoga and Health called Mindfulness A–Z: Liberating Regret, Stuckness, and Perfectionism. I hope you can join me there .

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Finding Our Place in the World

posted by Dr. Arnie Kozak

The TreeThere is no such thing as “nature” if we are part of all things. To seek nature sets us apart from the natural world. In the Tao, there is no separation.

Any separation we feel is conventional and not based upon a deep analysis of the how the material world is put together. Everything is bound by forces, always in exchange. The fact that these forces and exchanges are invisible is irrelevant.

Rilke had a suggestion in his Book of Hours, in the beautiful translation by Anita Barrows and Joanna Macy (2005, Riverhead Books). when he said:

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If we surrendered
to earth’s intelligence
we could rise up rooted, like trees

Instead we entangle ourselves
in knots of our own making
and struggle, lonely and confused

We are part of the earth’s intelligence whether we realize it or not.

This Rilke quote reminds me of my own encounter with a tree after a meditation retreat at the Insight Meditation Society (IMS). I knew it was alive. Not just a living thing in the way that plants are alive but part of the living fabric of all things.

It had a presence, a dimensionality that I had not been able to see prior to a week of continuous silent meditation.

To see the tree, I had to set aside my knots–the entanglements of my personal stories, narratives, and desires. The meditation retreat helped me to do that. When I could see the tree with a vastly diminished sense of separation, I felt more connected. I wasn’t lonely because my place amongst all things seemed just as evident as the tree. I didn’t have to prove anything to myself with excessive thinking. I just needed to co-exist with the tree. Each of us breathing in our way.

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I was no longer confused about my place in the world either.

The retreat took place in December and I was back in the area in late February teaching at the Barre Center for Buddhist Studies that is next door to IMS and shares the trail system where my tree lives. I hiked through the snows to visit with the tree (pictured above). While it is an impressive looking tree, that is all that I saw–a tree. That dimensionality was gone now that I had re-entered the workaday life and spent more time in the default mode network of my brain than I did on retreat. I had lost my connection to the earth’s intelligence.

I could feel a glimmer of connection to that unified way of perceiving and I know that I could reestablish that connection with enough intensive practice. The tree hadn’t changed, obviously. After my first meeting with the tree, I wrote these lines:

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Trees are born, grow old, and die.
Sometimes they get sick.
Sometimes a mean wind knocks them over.
Can trees know?
Can they know they are connected to everything else?
To the earth and to each other?

They abide without a sense of me
distinct from the others.
They swing with the breeze
Patiently breathing in the sky

Like the trees, we are born, grow old, and die.
Sometimes we get sick.
Sometimes a mean circumstance knocks us over.
We are conscious, a talent we often waste

Yet, we are also fabricated.
Not of wood and chlorophyll
but of story, memory, and anticipation.
We complexify ourselves by drawing distinctions
that the trees do not require.
We don’t see the roots that connect us
so we feel free to claim the ground as mine.

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We chase illusions, mistaking
appearances for the real
We forget that a single moment
in this breathing body can realize
that we are nothing more than mobile trees
When we go into silence
this presence shows itself
and we can come to know what the trees know:

Love.

It seems like we are always engaged in the process of finding our way back to this love born of connectedness. Forgetting is an obstacle. Arrogance is an impediment. Fear is a tether that keeps us in story when the trees are breathing all around us. Mindfulness is the way back to this connected presence of love; the way out of loneliness and confusion.

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Visit With an Old Friend: Three Steps to Awakening By Larry Rosenberg

posted by Dr. Arnie Kozak

threestepsawakeningLarry Rosenberg’s latest book came out in 2013 and I am just getting to it. I’ve been holding offer, like saving something precious that you know will likely not be replaceable. Larry is now in his 80s, and while he certainly may publish another book, this may be his last. It’s been a delicious pleasure to visit with my first mindfulness teacher.

Larry comes from a skeptical, educated, and intelligent perspective. He is a no nonsense guy from Brooklyn who cuts through hype to get to the heart of the teachings.

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Three Steps to Awakening: A Practice for Bringing Mindfulness to Life is largely based on Larry’s talks at the Cambridge Insight Meditation Center, some of which I’ve likely attended over the years. The book has his warm, direct, conversational tone that I so appreciate in his teachings. Larry is very funny and his humor is upaya–skillful means–that makes the Buddha’s teachings more available to people. I laughed out loud when I read this passage:

Interested in religion? What kind? Buddhism? What flavor? Vipassana? Oh, you’ve tried that? A little too dry, perhaps to much talk about suffering and impermanence? You might prefer Dzogchen, the innate perfection of the mind. Besides, most vipassana teachers are not even monks; they just wear sweatpants …

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As the title suggests, Larry’s approach is practical–meaning practice based. He presents methodology grounded in the Buddha’s original teachings that are just as relevant today as they were 2500 years ago (mostly because we still have bodies that breathe).

In this book, he condenses the 16-part Buddha’s teaching of the anapanna sati to 2-parts. It’s not meant as an economical short-cut for busy yogis. Rather, it is a distillation of the practice in a way that makes it more available and less likely to distract (after all, think of all the perfectionism you might bring to bear on a method with 16 steps!).

Let’s look briefly at the first part. The Buddha said, “Being sensitive to the whole body, the yogi breathes in. Being sensitive to the whole body, the yogi breathes out.” When you focus on your breathing, you don’t lock it down tight on any one or more features of the breathing apparatus. Instead, you place the breath in the context of the wider, where it actually resides.

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Investigate this the next time you do some breathing meditation. The breath is obvious at the nose, the mouth, throat, chest, and abdomen. But where exactly do the sensations linked to these anatomical parts end and the rest of the body begin. As you pay attention, you may notice a feeling of spread, as if the breath expands into your entire head, neck, and torso.

If you pay very careful attention for prolonged periods of time, you may also notice that the whole body participates in the process of breathing as the blood flows carrying oxygen. We are breathing bodies. The Buddha knew this and he took this awareness all the way to awakening.

We can do the same.

Three Steps to Awakening is a valuable read that can deepen and further your practice as it has done for my practice. It also contains questions and answers from students and I find this is the best way to teach and learn the dharma–the lessons of the Buddha and the truths these lessons point towards.

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