8.) KP: Can you share another example of how you would work with a client that presents with both psychological and physical concerns, like chronic pain or an injury?
Janice: In general, I go very slowly. As part of my private practice, I see some clients at a medical clinic called Chapel Hill Doctors Integrative Health Center. Many of those clients are dealing with both physical stress and medical histories. Part of the work involves teaching them mindfulness and body awareness practices — sitting in meditation, pausing, taking a moment to breath, grounding. I might ask questions like “Are you in front of yourself, or behind yourself?” “Are you in your brain, your torso, or is you awareness in your feet?” These practices can help them be more aware of their entire body and being.
But, also I really work with the cognitive material. People need to be heard and listened to about the types of pain and suffering that they’re experiencing. Part of it is working with the body, but also a big piece of people’s need for healing is to be heard. So, just to be listened to is huge. And, that is more traditional psychotherapy.
One other thing I play with a lot is helping people distinguish between the “story” and what is actually happening this very moment. Helping people notice their inner dialogue. For example, if pain in the knee is the presenting problem, that narrative may be “I’m going to have pain for the rest of my life.” Instead of going so far into the future, I try to help the client notice there’s pain in the knee right now. That can provide a lot of help for people, to help distinguish what their context is. Noticing pain now vs. believing it will last forever tend to lead to two different emotional states. So, I try to help clients develop the part that can look and see when they’re involved in a story and how to get some perspective from it and see it more as just “mind” or “thought obsession.” It’s about witnessing their process, which is part of the mindfulness tradition.
KP: from my experience, when people can create that space between the narrative and the now, there is some ease, some comfort that often seems to naturally arise out of that.
Janice: Yes, that’s true. I’m also watching what they do, where they go into their bodies when they go into the stories, and where they go when they’re more in the now. And, trying to help them become more aware of that, so that when they’re doing a lot of what I and others in the Buddhist community call “selfing” (e.g., creating the story), then they can see it as a process to notice on a body level, as well as on a mind level.
KP: So, the awareness can help them develop some skill – where they can notice that they’re not in the now, and then engage in a certain type of movement, or breathing, to bring me more into the present. Is that what you’re saying?
Janice: Yes, and usually what’s helpful for so many people is finding the breath. Having them simply inhale through the nose and exhale through the mouth for a period of time can bring them more into the now. Or, sometimes, it’s about finding a sound, or finding a visual image of a peaceful place, one that they can come revisit when they feel distressed. There are many ways to reconnect with the now. This helps them notice when they’re in their being vs. doing mind.