Mindfulness: Transforming the Therapist and the Therapy

Published in the Greater Washington Society for Clinical Social Work Newsletter

As I sit in my office with a woman in her mid-thirties, I sense a tide of anxiety rising in her and resonating in my own body. I notice a fluttering in my torso and belly and a slight contraction in my chest. Immediately I put both feet on the floor and focus on sensing the floor’s solidness beneath me. I also bring awareness to where my body meets the chair: legs, buttocks, shoulders and arms. I focus on the sensations of support my body experiences both from the chair and the floor. I sense the rhythm of my breath as it moves through my body.

Using the tools of Mindfulness I have become aware of my reactions to my client’s state and then am able to ground myself in my body in the present moment. By doing so I am building more internal capacity by deepening and expanding my own container. I trust that my client will benefit from this through the inter-subjective field of our relationship.

Mindfulness is a powerful tool for self-regulation. By bringing awareness to any subjective experience we change our relationship to it. But the benefits of mindfulness go far beyond self-regulation. Mindfulness can expand and transform the self of the therapist. In that way through our own practice of Mindfulness we can indirectly deepen and improve our work with clients even if we never teach them mindfulness skills.

As one therapist in a class I recently taught on Mindfulness for Therapists put it, “I was able to sit with very powerful material more calmly and not immediately rush in to do something or fix it.” A few weeks later she said that she noticed that her work with one particular client was much deeper and she attributed it to her own increased capacity to tolerate the intense affects this client brought into the room.

Mindfulness is an open, non-judgmental awareness of the present moment. It is a practice of allowing and accepting whatever is there, regardless of whether it is pleasant or painful. The aim of mindfulness is to accept our experience without judging, analyzing or evaluating it. Mindfulness is a place of awareness from which to observe, notice and experience what is happening inside you- the body sensations, thoughts, and feelings that arise and change moment to moment- without focusing on the content. This capacity for awareness helps strengthen the observing ego and creates an anchor in the present that grounds a larger sense of self- a calm center from which one can observe one’s own subjective experience.

Mindfulness skills are deceptively simple in concept but they take practice to develop. It is similar to learning an instrument or a new language. I started a daily practice of meditation about 15 years ago and began attending retreats once or twice a year to deepen my skills. It has had a profound personal effect on me. Over the years I have gradually integrated mindfulness into my therapy with clients-bringing a deeper sense of connectedness, self-knowledge and presence into my work.

On this particular day, I ask my client what she notices in her body. She senses herself perched on her chair, leaning forward as if she might spring up and flee at any moment. She notices that she is hardly able to breathe and experiences the contraction in her chest and throat. I wonder with her if she can sense the place where her feet touch the floor- and she can’t, but she can feel her buttocks in the chair. As she does this she becomes aware that there is slightly more space in her chest.

I think of mindfulness as a safe space or container where we can learn to hold our internal experience without judgment or reactivity. I also think of it as an experimental space where we can learn to respond rather than react. We can try on and practice new responses and develop new capacities. Most importantly we can explore the being mode as compared to the doing mode.

Winnicott described the holding environment that the good-enough mother creates for the child as a space in which the child can discover herself. The mother creates that space by being present, but not intrusive. In that space the child can relax, explore and develop what Winnicott called “the capacity to be.” (Playing and Reality)

This space of the parental holding environment is an essentially experimental space out of which the experience of self emerges. It is space of possibility, of change, of not knowing. It is the space from which play, creativity and art emerge.

As therapists we attempt to create such a holding environment with our clients. Mindfulness can deepen and extend that space. Mark Epstein likens mindfulness to this safe parental holding environment within which a child makes discoveries about herself that affirm her sense of existence “The infant who can be, as opposed to one who can only do, has the capacity to feel real” (Going to Pieces Without Falling Apart p40)

The benefits of Mindfulness both for the therapist and client are numerous. Mindfulness helps to increase the ability to sit with and hold affectively charged material, to develop greater self and bodily awareness, to expand the ability to self-soothe and self-regulate and to tolerate anxiety and change. It also helps to quiet self-criticism and judgment, build self-acceptance and clarify internal conflicts.

These are all capacities that support the work of psychotherapy and indeed are often goals of psychotherapeutic work. In recent years mindfulness has become a key component of entire models of therapy including Somatic Experiencing, Mindfulness Based Cognitive Therapy for Depression, and Dialectical Behavior Therapy. But Mindfulness skills can be integrated into any model of psychotherapy.