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How change happens in therapy: Using mindfulness in psychotherapy

Helping clients practice mindfulness has long been a part of many traditional, talk-based psychotherapies, even though it has not necessarily been conceptualized as "mindfulness" within the theories underlying these therapies.  For instance, many therapists help clients grow from being self-conscious to being self aware, without necessarily thinking of this as mindfulness training. 

Another example is how therapists help clients develop the "observing self": In addition to noticing your mood, you become aware that there also is an "observing self" that notices how you feel, but doesn't drown in this feeling.

1. The practitioner's mindfulness

Having a personal experience of mindfulness has profoundly influenced the way many therapists and coaches experience what they do, and changed the way we do our work. 

By this, I do not mean that we "prescribe" meditation to our clients.  In fact, many of us do not specifically refer to either "mindfulness" or "meditation" during the work we do with our clients.  But the profound change is that it influences how we are, and what we do, during our sessions. The practice of mindfulness helps us look for a different quality of listening - - a deeper way of paying attention to what clients say and mean. 

2. Transmitting an experience

The experience of mindfulness doesn’t just come from the practice of traditional meditation techniques. Standard sitting meditation is not the only way to mindfulness. Many Buddhist traditions include such practices as “walking meditation”. Some traditions go further, considering that any activity can be an opportunity to practice a mindful attitude (e.g. the injunction to “chop wood, carry water” as a way to spiritual development).

Other gateways include "Focusing", which was developed by Eugene Gendlin as he analyzed the process of therapy to understand what happened in successful therapies.

A mindful therapist/coach gives clients the experience of being listened to, and heard, in a profound way. This is an experience that is not often part of everyday life. If all you did was blabber the way you would blabber to a friend, it wouldn't be much more use than that.

In other words, a session is not just about something, it is a very real experience in and of itself. Over time, this process trains clients to improve their ability to "be here now".

3. Self-regulation

As the findings of neuroscience make more inroads into the psychotherapy world, there is a growing interest in "bottom up" processes as opposed to "top down" processes.  In a nutshell, "top-down" approaches focus on how our "higher" functions, such as the intellect or the will, influence what we do.  "Bottom up" approaches focus on how what happens at a sensorimotor level affects what we do and who we are.  Far from seeing the brain as just the organ of cognition, we tend to see it more as the place that receives input both from the outside world and from inside ourselves, and that regulates our functioning “from the bottom up”. 

So there is a growing interest in how mindfulness can help us enhance the natural processes of self-regulation.  This is not done in a mechanical way – i.e. saying "meditate 15 minutes a day" the way you would say "take two aspirins".  Regulating a complex mechanism is a complex thing, as everybody knows from the experience of how difficult it is to relax by just thinking "I should relax".

Several contemporary therapies have developed ways to help people achieve more self-regulation in dealing with difficult or overwhelming circumstances.  The process of doing that involves moment-by-moment attention to fleeting experiences, including body senses.  This is facilitated by of the ability of the therapist to be attuned to the client, and to have the ability to be mindful during this process. 

This creates a learning experience where the client experiences mindfulness and develops skills to increase the ability to be mindful.  While this has a lot of similarity with the skills fostered by meditation, it is not meditation per se - - and it goes further than most people can hope to achieve individually through meditation.

4. A creative learning process

I see my work as a creative process that is based on the very specific circumstances of a very specific client, and the nature of the interaction between this very specific client and me.

Each and every session gives me an opportunity to shape the experience of what happens in sessions in order to help you "get it". 

I am not teaching a whole class to try to impart them some general knowledge of what mindfulness might be. In a session with you, I am focusing on helping you deal with your challenges more effectively. Mindfulness is part of this creative process because being mindful helps you get more out of this experience.

Over time, clients come to internalize this mixture of mindfulness, receptivity and creativity. Neural pathways adapt so that the client knows how to get back to that state of mindfulness / receptivity / creativity without thinking about it, without having to remember a procedure (much the way “procedural memory” helps us remember how to use a bike).

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