Teaching Mindfulness in Therapy – More for you to consider-
New Harbinger Publications has just issued a blog post on problems encountered when teaching mindfulness to clients in therapy. After over 30 years of using mindfulness and meditation in psychotherapy, I have a few words of advice to add. Following these advisories may help to ensure successful implementation of mindfulness interventions and skills with your therapy clients.
- From an ethical and effectiveness perspective, you should NOT be teaching mindfulness and meditation to your clients unless you have your own regular mindfulness and meditation (or yoga) practice.
- Personal practice helps to ensure effectiveness, and it helps to prepare you for thing that could come up with your novice client-practitioners (“dark nights of the soul” regarding some possible documented negative effects). There is no substitute for personal experience in practice.
- Remember, these are embodied practices and skills. They have specific cognitive components (intention, attention, concentration, self-talk to count breaths and allow thoughts to pass, etc.). However, these are embodied practices and skills – “felt sense” in the body while practicing.
- Be certain mindfulness, meditation, mindful movement (yoga only if you are a yoga instructor) are in the client’s treatment plan. Or use a therapy approach that includes these practices, but be sure that therapy in in the treatment plan. Always measure desired outcomes from all clinical interventions.
- Use tasks analysis to teach these skills. Begin with simple steps and short time periods. Always allow the client complete control regarding participation, and always seek feedback on the experience. As the client becomes more attuned to these embodied processes, agree mutually on extending time in practice (in session) and the depth of the skills.
- It may be wise to begin with simple awareness activities and basic breathing techniques. Some clients with untreated trauma and/or polyvagal abnormalities may have great difficulty associating breathwork with relaxation and body/emotion regulation. If this occurs, work with the client so they can practice breathing skills that do not cause emotional dysregulation or anxiety. Include psychoeducation.
- Never introduce a practice to a client if you have not, yourself, mastered the skill. In my own meditation teaching practices (outside of therapy) , I always practice a new meditation skills for months before bringing that skill to my secular meditation sangha.
- Be sure you make it clear what “hat” you are wearing when you combine general therapy with mindfulness/meditation training. There are various mindfulness-based therapy approaches (MBSR, DBT, ACT, MBCT, etc.); however, if you are not using any of these and prefer to introduce a skill/practice as adjunctive therapy clarify the role you are playing in the moment (therapist, trainer, teacher).
- Remain mindfully aware that you need to model acceptance and kindness in your therapy work, especially when mindfulness and meditation are included.
- While leading mindfulness and meditative interventions as skills, practice being the human being simply being in the practice. Reduce the hierarchy if possible, and yet maintain a responsible role as an evidence-based clinician. You are partly responsible for all outcomes, good and bad.
- If teaching such skills in group format, be clear what the differences are in group process and group practice. These experiences are different. When things go smoothly, these subtle realities blend nicely. When this are not going smoothly, you need to recognize what you are doing as the leader – is it a group process issue, or is it a group practice issue? They require different corrective experiences.
- You have clear responsibilities for safety in your therapy, and this safety extends into teaching mindfulness and meditation skills. However, you do not have to comment, expand, pontificate about what clients share regarding their practice with you. I find this problem difficult to avoid in my own meditation training sessions. One is always tempted to add something that you hope may improve the person’s practice. Best to add only when necessary and keep it brief.
- If you use a script to guide mindfulness and meditation training as part of your therapy work, be careful to use it gently. This is not a mainly cognitive/verbal process. It is an experiential/bodily process. Learn the practices well so you do not need to read the “how to” steps in your therapy. However, if you are using a more complex meditation practice, it is be a good idea to guide your own teaching role via a script.
For more information refer to Quintiliani, A. R. (2014). Mindful Happiness…Shelburne, VT: Voice of Vermont Publications. See also Teaching Mindfulness? Avoid These Common Traps for Therapists. Professional Blog, New Harbinger Publications.
By Anthony R. Quintiliani, PhD., LADC
Author of Mindful Happiness
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