This is a paper on mindfulness I submitted for publication to a newsletter for therapists.
Using Mindfulness in treatment: A 2-point approach
Using mindfulness has been part of the discourse on effective approaches to mental health treatment. People in Western culture have turned to mindfulness to enhance their lives. Increasingly, we are seeing evidence come forth showing mindfulness practice can help treat many of the symptoms people struggle with.
As mindfulness gains acceptance in our culture, I would like to propose an approach to using mindfulness in psychotherapy that can have a real and meaningful impact on client’s lives. I call this a 2-point approach to mindfulness in treatment.
Point 1 is the introduction, psychoeducation and invitation for the client, made by the therapist, to use mindfulness to treat one or more of the symptoms the client is struggling with. Point 2 is much broader in scope. Point 2 covers any resistance or challenges that arise for the client and this can come in many forms. Sometimes a person may try to practice mindfulness and struggle with making progress and other times they may struggle to do it at all. How this is handled in the treatment is important and critical to a good outcome.
Mindfulness is a certain type of meditation that can be done in many ways. The main ingredient is the person trains their mind to focus on one thing and when the mind drifts off from this one thing, the person gently and decisively returns their attention to the object of attention.
Mindfulness can help people use their thoughts in more direct and effective ways, thus decreasing symptoms of depression. Mindfulness also was shown to improve people’s ability to self-regulate by increasing ability be aware of one’s body. Simply stating “research has shown mindfulness can help with the anxiety symptoms you are experiencing” has helped me to avoid struggles with patients who may be skeptical about why a clinician is suggesting a practice that has religious affiliation.
Many times, clients will become encouraged by the idea that mindfulness can help their chronic anxiety but return to follow up sessions with concerns that it is not working or they are feeling they doing it wrong. This is where point number 2 of the 2-point approach comes in. If the data is that mindfulness works but the client in the room is not benefitting from it then they are either not doing it enough or not doing it at all. Doing mindfulness wrong is rarely an issue since the point of the exercise is to try to do it and that is the doing of it. If they are trying, they are doing it. There are some folks for who mindfulness is not a workable solution. We as clinicians need to use our clinical judgement in this case to make sure we are not suggesting this approach to people who it is not suitable for. That is a longer discussion not appropriate for this article.
In many ways point number 2 is the more important point. It gets to the central theme in a person’s life. If you have a solution in front of you, what is stopping you from practicing it? How can we use this therapeutic hour to help you understand how to make taking care of you your number one priority? How can we use our time together to understand what thoughts and ideas get between you and making the time to take care of yourself? The answers to these questions are not always easy but the process in finding out the answers can prove to be very instructive to the client as they work towards managing their emotional symptoms and finding ways to live a more satisfying and effective life.
The following is an illustration of how this may unfold in treatment. Joey is a 29 year old engineer who comes to treatment because of late night awakening, chronic feelings of overwhelm and a sense that despite excelling in his career and a strong group of friends who care about him he is struggling to get by day to day in his life. He wakes up in the middle of the night in a panic sometimes and does not know why.
I asked Joey if he ever tried mindfulness meditation and he said he knows it is popular but has not used it himself. He seemed doubtful it could be of help to him. I offered to send him a link to a youtube video that described a mindfulness technique in a secular and accessible manner. He accepted the offer. At our next visit, I inquired if watched the video and if he had any questions. He said he saw the video and tried mindfulness for 5 minutes twice in the last week and would be working to use it more in his life and he can see how it may help.
Over the course of the next 4 sessions, Joey would talk about how difficult it was to tolerate his feelings of anxiety, that he felt like his life was not progressing in line with his peers and he continued to struggle with late night awakening. When I noticed that Joey was feeling anxious because he felt helpless or his agitation increased as he was talking about feeling anxious, I would calmly and in a matter of fact way state mindfulness practiced daily for 20 minutes 2x per day can help with these very symptoms. Joey would state he understands and continue to focus on his experience of his anxiety and struggle to have perspective on his feelings. Over these next 4 sessions, Joey would become increasingly frustrated with himself for not making progress. As he started to realize that it was his responsibility to find a way to tolerate his feelings, he become more willing to try mindfulness. Finally, after the 4th session since I introduced the idea to him he decided to commit to doing it daily. Over the course of the next 3 months, Joey came to realize that he felt better overall, and more able to tolerate his feelings, notice when he was getting anxious sooner and sooth himself before he became too worked up. His late night awakening subsided and he commented in one session “ I feel off when I don’t practice mindfulness, it doesn’t solve everything but it helps enough that I have realized this needs to be a part of my daily life.”
 Greenberg J, Shapiro BG, Mischoulon D, et al. Mindfulness-based cognitive therapy for depressed individuals improves suppression of irrelevant mental-sets. European Archives of Psychiatry and Clinical Neuroscience [Internet]. 2016 :1-6.
2 De Jong M, Lazar S, Hug K, Mehling WE, Hölzel BK, Sack AT, Peeters F, Ashih H, Mischoulon D, Gard T. Effects of mindfulness-based cognitive therapy on body awareness in patients with chronic pain and comorbid depression. Frontiers in Psychology. 2016;7 :967.
How to find a therapist:
I have been told repeatedly that people have a hard time finding a therapist. I have also seen several people in my practice who had therapy in the past and were not pleased with their experience. I decided to provide a process people can utilize to find a therapist or gauge their current therapy. I try to educate people who come to me for treatment to use this same process to evaluate their own treatment with me. This can be used by people at any point in their therapy but I will start with the initial phone calls. I would caution you that if you are using this in your current treatment with your therapist that you bring your findings to them and discuss it. Once you read through this you will understand why I suggest this.
Assuming you are using insurance, first thing you want to do is get a list of clinicians in your area, that you can reasonably travel to, that accept your insurance and are taking new clients. You can also use a variety of internet based directories such as “psychology today”.
Make a short list of therapists, about 5 or so and call them. Use any criteria you want to make this initial list. Men, women, cool name, fun picture, nice smile, whatever works for you. Call them and leave your name, say you are looking for a therapist and would like to talk with them about setting up an appointment.
Wait for a phone call back. This is where the “meat” of the process begins. Notice your reactions. You can write them down if you want or just notice them.
Joe Smith calls back within 2 hours and is attentive to your request, prompt in returning your call and professional and courteous. “I like him, he seems mature and responsible, I feel safe” may be something that runs through your head.
Sally Sue calls back 2 days later. There is a baby crying in the background, she seems distracted and she says “Oh hi I’m so sorry what was your name again, I didn’t call you back already, did I?” You may feel unimportant, neglected, irritated. Note that. Maybe you feel calm, safe, she is casual, spontaneous, you like her style. Whatever your reaction, note it.
Based on your experience on the phone, schedule meetings with 2-3 clinicians. Go to your appointment and tell them why you are there, what is going on, what you are struggling with, what you need help with. Ask them anything you want to know. See how they respond. This is crucial information. An open, candid, measured, heartfelt response to a question may be an indicator how you will be treated in the future. A defended, curt, deflected response may also be an indicator of how this clinician will respond to you. Listen and notice your reaction to the therapist. Pay as much or more attention to your reaction as you do to what the therapist is saying. This is very important information. If it is clear to you that you like one of the clinicians, make a follow up appointment and commit to working with them for a period of time. If it is not clear, read on.
Whatever happens for you in the session with the clinician, say there are 2 therapists you are now considering, note it. However, this time, tell the therapist exactly what you experienced. Do not try to edit it in your mind, do not worry about hurting their feelings, do not worry about how it will sound or how it will land in the room. Just say it. Again – listen to your reaction.
Maybe you say: Therapist Joe, when I said I wanted help with feeling like my life is not going anywhere, you said “Oh ok, I understand” but you did not ask me what it means that I feel this way or what’s wrong in my life.
Maybe they reply: I am sorry you feel that way, I am interested in what you have to say.
Listen to yourself as they reply. Does it sound sincere, do you feel heard, do you feel supported?
Maybe they reply: Ok, well can you tell me more about what leaves you feeling stuck?
There is no right answer from the clinician. What is most important is how their words land, how you feel as you listen to them. Notice what is coming up.
Use the information you collect from your reactions to decide which therapist to choose. Feel free to ask any questions you wish. Notice how they respond and notice how you feel. Choose the therapist that leaves you feeling hopeful and optimistic about yourself.
Mindfulness is used in many contexts as a means to being more present in your life. It has become quite common and the evidence for mindfulness is steadily increasing.
In the context of treatment for mental health issues, mindfulness is particularly helpful for symptoms of anxiety, depression and physical pain.[ref]http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1809754[/ref]
It can be confusing, all the different types of therapy, therapist qualifications, life coaches etc, there is an endless list of options for people you can call for help when life is difficult to manage.
Psychotherapy is a particular kind of process that is different from counseling or coaching. Most people who come to see me know what the problem is. They feel anxious. Their child is acting out in school. They were diagnosed with an illness and find their limitations difficult to accept.
These problems are however, symptoms. Just like sniffling is a symptom of a cold, anxiety is a symptom. A cold is more than sniffling. It is part of a syndrome. Same with anxiety. Anxiety is a prominent symptom, one that causes the most discomfort but there is usually more to the story.
Psychotherapy can help you get to the root of the problem. You can learn why you are anxious, why your child is misbehaving and most importantly, what needs to be done to change course so the pain can start to feel more manageable.