Dec

6

2014

The Present Moment Part 4: Challenges in Mindfulness

Our thanks go out to Margaret Landale for producing this series on mindfulness and psychotherapy.

In this set of articles we will explore embodied attunement and empathy as key qualities for working mindfully in the present moment.

All content is adapted from a talk given by Margaret Landale at the BACP Universities & Colleges Conference 2014, with her permission. Thank you Margaret! If you’d like to hear more from Margaret, please see this interview and attend our workshops on Mindfulness in Psychotherapy. Also visit Margaret’s website.

Mindfulness and psychotherapy – final points

Challenges for ‘being present’

Previously, we focused on how mindfulness and psychotherapy fit together naturally. But let’s now look at the challenges of working mindfully in the present moment.

Mindfulness challenges

For both therapists and clients, engaging with our embodied and felt experience may sometimes feel difficult, threatening or overwhelming. Consider, for example, early trauma issues when clients have learned early to dissociate from their direct experience. Or what about shame issues, or deeply rooted tendencies for self-criticism or self-loathing? If self-regulation and social engagement systems are undermined then self-reflective processes can feel highly threatening. So, rather than assuming that we can easily engage our client’s attention to focus on their direct embodied and felt experience, we often have to start this process by practicing more mindful ways of paying attention ourselves.

An example of mindfulness in therapy

I will now draw on my own clinical experience to illustrate how the therapist’s mindfulness can be a powerful resource.

This composite vignette aims to illustrate how mindfulness can help the therapist maintain embodied presence and empathically attune to the client’s experience and expression. By accepting the client’s behavior fully it becomes possible to recognise some deeper coping strategies and patterns of self-organisation, thus helping the client to begin to reflect on this in later sessions.

After announcing to G that my fees will increase by £2 we sit in silence. I notice her face has gone pale and withdrawn. Her jaw moves slightly as if gritting her teeth, her shoulders are hunched and her right hand keeps pulling the sleeve of her jumper. She looks out of the window. The silence seems to grow heavy as the minutes creep by.

I notice that my breathing feels restricted as if a weight is pressing down on my chest. I also feel slightly sick at the pit of my stomach. I am beginning to feel cold. I feel I have made a mistake, I should have taken care of her, not demanded more money. What difference does £2 really make to my income? I catch these thoughts and in an attempt to bring myself back into the room and make contact with her I say: “We have been sitting here in silence since I told you about the fee increase.”

Silence. G’s face seems to be closing off even more, she does not look at me, and the silence seems to grow heavier still. My head fills up with fragmented thoughts. I notice that I have started to think about what I am going to cook for supper and when to buy the missing ingredients for it. Bringing myself back into my body I notice tension in my shoulders and experience restlessness in my legs. I also become aware that the coldness is in my stomach, something icy…as I breathe into it I notice something else lurking there. Irritation? I feel restless, the silence feels increasingly difficult for me and I say: “I imagine your silence is telling me that you are angry with me for increasing my fees”. As soon as I have spoken these words, it feels all wrong. Rather than enduring the only way she knows how to relate to me right now, I am trying to push things on, force her to speak to me because I find the silence and the feelings it evokes in me unbearable.

I decide to give in to the silence, to accept it as a powerful form of communication, this is it! Letting go of my expectations of what should happen, accepting what is so right now, I settle into my seat. I become aware of my breathing. Slowly I can feel my mind calming. I can hold G in my awareness, a sense of being with her, stepping right into the silence with her, joining her in this heavy, cold silent territory.

As I watch her ashen face, take in how tense she looks, hardly breathing and how held in, thoughts come up for me about her experiences as a child and how she had to manage her mentally ill mother, her only attachment figure. I remember what I know about the serious neglect she endured and I feel a deep sadness as I engage with G’s silence in this context.

I say: “I am thinking of you as a small girl and how it was impossible to complain or make a fuss or be angry when things were taken from you, or when you were left without.” She shoots me a quick glance and as she averts her eyes again, I can see tears welling up in her. As the tears are beginning to run down her cheeks, the silence between us seems to become softer, warmer.

During the rest of the session and further sessions we were able to help G explore her reaction to my fee increase. We identified her silence as a protective shield, something to hide behind, an effective tool for withdrawing from situations which trigger overwhelming and uncomfortable feelings.

She told me that she had felt a great and icy rage towards me and at the same time felt bad for being so unreasonable. As we unpacked this she began to notice the deep mistrust and despondency, which lay beneath. These were all previously unrecognised facets of her experience. Together we were now able to help her be more attentive to, and accepting of, these dilemmas.

The importance of mindfulness

What I hope this vignette illustrates is how supportive mindfulness can be for the therapist as a way of managing an unfolding process that happens, sometimes with very few words, within the therapeutic relationship. The therapist’s capacity to be mindful is especially important in relation to working with clients who bring early developmental or complex trauma issues to their therapy.

In Allan Schore’s words:

Affect, both its regulation and dysregulation, play a central role in the infant-caregiver and patient-therapist relationship. Affect dysregulation is associated with stresses within the therapeutic alliance, and therefore it is important to understand the etiology and operations of early-developing yet enduring defense mechanisms that are mobilized by relational stress. (13)

Early trauma implies that the client’s early self-regulatory systems were undermined and this is carried mainly in the body. In this context the non-verbal aspects of communication between therapist and client become critical. Schore’s thinking underlines this point and mindfulness provides us with both an understanding and access point for the core work we need to be doing with our clients.

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