What is Mindfulness-Based Psychotherapy?
By Tom Pedulla, LICSW, Author and Psychotherapist in Arlington, MA, specializing in mindfulness-based psychotherapy.
Over the past decade, interest in mindfulness has exploded throughout our society – in medicine, education, business, sports, government, and especially in psychotherapy. In fact, it is now arguably the fastest growing area in all of mental health. This is partly because mindfulness is a skill that can be used by therapists of any theoretical orientation – psychodynamic, cognitive behavioral, interpersonal, whatever – in the treatment of clients with virtually any diagnosis, from depression and anxiety to trauma and addictions.
What is mindfulness?
Jon Kabat-Zinn, who pioneered the introduction of mindfulness into Western medicine in the late 1970s, defines it as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally, to things as they are.” At the Institute for Meditation and Psychotherapy, where therapists are trained in the integration of mindfulness and psychotherapy, we have a similar definition: “Awareness of experience in the present moment with acceptance.” Although grounded in ancient Buddhist teachings, mindfulness is not limited to any particular religion or philosophy. It is a quality that all of us possess and can learn to cultivate and increase through practice. It can also be a powerful healing agent in three arenas common to all forms of psychotherapy: as a resource for the therapist, as a way to deepen the psychotherapeutic relationship, and as a tool for the patient.
Mindfulness as a resource for the therapist.
The therapist’s own mindfulness practice is the cornerstone of all mindfulness-based psychotherapy. By cultivating mindfulness through the formal practice of meditation and the informal practice of mindfulness in daily life, the therapist will naturally bring more mindfulness into the consulting room, even if he or she never mentions it explicitly or teaches mindfulness skills to the client.
Recent research shows that therapists who practice mindfulness meditation experience a decrease in job-related stress and burnout, as well as an increase in self-acceptance, self-compassion, and sense of well-being. In addition, these clinicians report improvements in their relationships with their clients, saying they experience a greater capacity for empathy and an increased ability to be present without being defensive or reactive.
How does this work? By helping therapists attune to their inner experience, mindfulness helps them bring that same level of attunement to their clients. It allows them to recognize and reduce their personal reactions so that they can respond more empathically and effectively to what clients are saying. In other words, it helps them stay connected and improves their ability to listen deeply.
In practice, this usually begins by finding an “anchor,” such as the breath sensations, a place to which one returns one’s attention whenever the mind has wandered. Connecting (and reconnecting) with the anchor is a way of stepping out of the thought stream, which usually takes us into the past or future, and coming back to the aliveness of the present moment. By refreshing and calming the mind, this shift of attention can be a helpful step in clinical relationships, especially when difficult emotions come up.
Mindfulness as a way to deepen the therapeutic relationship.
Warmth. Openness. Compassion. Empathy. Equanimity. Flexibility. Willingness to collaborate. Practicing mindfulness can help therapists and clients alike develop all of these qualities and bring them into the therapeutic relationship.
In mindfulness meditation, we develop three core skills: concentration, or focused attention; mindfulness per se, or open monitoring; and compassionate acceptance.
First, we concentrate the mind by narrowing our focus to one specific aspect of our experience, such as the breath sensations at the tip of the nose. As discussed above, this skill can be very useful during the clinical hour, simply by helping us stay present and connected with what is actually happening.
Then, in open monitoring, we expand our field of attention to include the full range of experience – physical sensations, thoughts, emotions, sounds – as they arise and pass away. By developing this skill, we improve our ability to notice and stay open to whatever comes up, including our most difficult and painful feelings. Even if we’re lost and confused, our therapist can help us come back by asking mindfulness-informed questions, such as: What is happening right now? Can you stay with what is happening? Can you breathe into what is happening or breathe with what is happening right now?
Finally, by developing compassionate acceptance, we can reduce our resistance to painful experience, including the pain of difficult emotions, and increase our willingness to let them be and let them go. We can step back, see thoughts and feelings as just thoughts and feelings, not facts. We can also become less identified with painful thoughts and feelings, and begin to see them more as visitors, not ultimately who we are. Again, the therapist can help, not only by modeling this skill, but also by asking mindfulness-informed questions: How are you relating to this painful experience? Given your history, can you understand why you’re feeling the way you do? Can you be kind to yourself as you go through this difficult time?
Mindfulness as a tool for the client.
Until recently, most mindfulness-oriented therapists were reluctant to teach mindfulness skills to their clients, preferring to leave that task to a meditation teacher or to the client’s own efforts outside of the clinical hour. But today, more and more therapists are deciding that they owe it to their clients (and themselves) to learn these skills and pass them on.
As the field matures, therapists are also learning how to tailor mindfulness practices to fit the needs of particular clients. Instead of a one-size-fits-all remedy, mindfulness-based therapists are beginning to understand how these practices affect different individuals with different problems, how to modify them in different clinical situations, and how to work with the inevitable obstacles that arise.
In mindfulness-based psychotherapy, the goal is not to turn everyone into a dedicated meditation practitioner, but to help clients find more balance, peace, kindness, and fulfillment in their lives.
For more information about mindfulness-based psychotherapy, including some free downloadable meditations, go to www.sittingtogether.com.
Mindfulness-based therapy groups.
In addition to working with a mindfulness-based individual therapist, another way to learn mindfulness skills and how to apply them to psychological problems is by joining a mindfulness-based therapy group. These group programs are generally time-limited (8 to 10 weeks), with weekly meetings that last 2 hours or longer. Some include a daylong retreat. More like meditation classes than psychotherapy groups, they are primarily focused on helping people learn and practice mindfulness skills. They also include homework assignments designed to help participants deepen their experience of mindfulness and establish their own regular mindfulness meditation practice.
Here are some of the more popular group programs, all of which have been empirically supported and are now widely available:
- Mindfulness-Based Stress Reduction. MBSR has been shown to be an effective treatment for a wide range of problems, and is especially helpful for those with psychophysiological conditions. More information at umassmed.edu/cfm.
- Mindfulness-Based Cognitive Therapy. MBCT is similar in structure to MBSR, but is focused on the treatment of depression and other forms of emotional distress. More at mbct.com.
- Mindfulness-Based Relapse Prevention. With MBRP, the goal is helping participants maintain recovery from substance abuse and other addictive behaviors. More at depts.washington.edu/abrc/mbrp.
- Mindful Self-Compassion. The focus of the MSC program is to teach people ways to develop the skill of compassionate acceptance. More at mindfulselfcompassion.org.
To learn more about mindfulness-based psychotherapy, consult any of the books listed below.
- Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy, by Susan Pollak, Thomas Pedulla, and Ronald Siegel.
- Mindfulness and Psychotherapy Second Edition, edited by Christopher Germer, Ronald Siegel, and Paul Fulton.
- Mindful Therapy: A Guide for Therapists and Helping Professionals, by Thomas Bien.
- The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration, by Daniel Siegel.
- The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness, by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn.
- The Mindful Way Through Anxiety: Break Free from Chronic Worry and Redeem Your Life, by Susan Orsillo and Lizbeth Roemer.
- The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions, by Christopher Germer
- The Mindfulness Solution: Everyday Practices for Everyday Problems, by Ronald Siegel.
- The Mindful Path to Addiction Recovery: A Practical Guide to Regaining Control Over Your Life, by Lawrence Peltz.
For information about mindfulness-based training programs for clinicians, visit the Institute for Meditation and Psychotherapy at www.meditationandpsychotherapy.org.
About this Contributor: Tom Pedulla, LICSW, is a psychotherapist in private practice in Arlington, MA, where he works with individuals and also leads Mindfulness-Based Cognitive Therapy groups. A faculty and board member of the Institute for Meditation and Psychotherapy, Tom has been a dedicated practitioner of mindfulness meditation since 1987. He is a co-author of Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy and a contributing author to Mindfulness and Psychotherapy, Second Edition. Tom received his BA in English from Harvard in 1975 and, after a first career in the advertising business, earned his MSW from Simmons Graduate School of Social Work in 2001.