Mindfulness and psychotherapy both develop “skills” that dovetail very closely. These include skills of open-mindedness and curiosity, non-judgmental awareness and exploration, which in turn lead to compassion, self-acceptance, and comfort in the present moment.
In psychotherapy these are skills that are developed in the context of a deepening connection between therapist and patient leading to increasing sharing and freedom of expression. By gradually increasing tolerance and allowing exploration, not just of the “problem” state but of the mind itself, mindfulness and psychotherapy both help the mind to relax, and in its relaxation, the mind heals.
Another important skill is staying present. Many mental states live in the past or in the future. Regret looks behind while worry looks ahead. What we want and don’t have yet, or what we should have done differently. While planning and reviewing are important cognitive skills — part of what neuropsychologists call executive functioning — in present society they are skills that are in overdrive, like an engine revving without going anywhere. Not only that, people’s specific histories and makeup put a stamp on the ways in which their minds have difficulty staying present. Some individuals are stuck in the past in the form of regret and the need for a “do-over.” Others are firmly focused on the future in terms of achievement, ambition, or performance. Happiness is conceptualized as contingent on their future ability to accomplish their goals. Goals are important and even necessary for optimum functioning, but to the extent that it leaves some people un-centered and unable to live comfortably in the present, it is a form of imbalance. In its most extreme form, people suffering obsessive compulsive symptoms feel locked or trapped in their dread of undesirable future outcomes.
The importance of cultivating present moment awareness in the context of worry and bias
Mindful psychotherapy calls repeatedly on the patient to notice what is occurring in the here and now as a way of setting the “compass” of the mind to the true north of reality.
While understanding what has happened in the past and what is hoped for or expected for the future, psychotherapy helps individuals get grounded in what is real and relevant in the present. For example, an athlete may unnecessarily hamper their present performance by allowing her thoughts and emotions to ruminate on a poor performance in last week’s game. Last week, the athlete may have slept poorly. She might have seen a text message right before the game that threw off her focus. The temperature in the stadium might have been off. She may be preoccupied by an ambiguous comment from her coach. She may allow herself to succumb to her “hunch” that her coach does not support her
Mindful therapy accepts and acknowledges the complex state of feelings and thoughts that are happening, and helps the patient to relax into them. Subjective reality is honored and investigated. This helps the patient to loosen the power of fear and worry, which in turn helps people recognize the truth of present moment reality. At this moment, during this game the conditions are not the same as last week’s game. What you do now does not have to be determined by what happened before. The coach may or may not support you, but for now what is real is that this is what you fear, not what you know. Cultivating mindfulness over time helps people expand their capacity to engage with vitality with the present, versus sacrificing the present by being mentally and emotionally absorbed in the past or future.
The role of relationship in mindful psychotherapy
As valuable as awareness and insight is, they are not sufficient for change or healing. Therapy is not successful in an emotionally sterile environment, but must be accompanied by a change in attitude or heart, by the cultivation of compassion and kindness in one’s attitude toward one’s suffering.
For this the role of the therapist and the relationship of patient and therapist is critical. The therapeutic relationship is the vehicle by which a person learns to become less reactive and judgmental toward their particular difficulties – to identify with their problems less while tolerating the pain of those difficulties more. This gradual process gradually eases tension in the psyche and personality.
When therapy is successful people often come to the realization that compassion, mindful presence, sensitive awareness without judgment, empathy – are each high level psychological skills that are more than worth their weight in investment. The development of these skills allow people to accomplish their goals better, not worse. They help people become more effective, not interfere with their plans. They are developed through the intentional effort of therapist and patient, to create and hold a space together for what is difficult and unworked.
Mindfulness-based Cognitive Therapy (MBCT) and other forms of mindfulness therapies
There are a number of specific forms of mindfulness-based therapies that have been developed to address specific needs, and which call upon the skills described here.
These include Mindfulness-based Stress Reduction (MBSR) founded by Jon Kabat-Zinn, initially for the application of mindfulness to pain and chronic illness management; Mindfulness-based Cognitive Therapy (MBCT) created by Zindel Segal and colleagues as a form of melding mindfulness to the tools of Cognitive Behavioral Therapy (CBT) to address depression; Dialectic Behavior Therapy (DBT) developed by Marsha Linehan to shore up emotional regulation and consequent behavioral breakdowns; and Acceptance and Commitment Therapy (ACT) developed by Steven Hayes, a step-by-step model integrating mindfulness strategies such as not identifying with one’s thoughts and feelings yet enhancing consciousness of them. The effectiveness of these modalities in treating populations with challenging problems such as the management of chronic pain, addictions, self-harming behavior have been demonstrated through well-researched positive outcome studies and can be viewed as a kind of “proof of concept” for the skills of mindfulness.
The role of embodied awareness in mindfulness and psychotherapy
Mental and emotional states can be so varied and textured, and each individual’s personal experience of their own psychic life is very different from the next person’s. Therefore in discussing mental, emotional or spiritual phenomena it is easy for language to become abstract or amorphous.
By necessity we put language to it, but it doesn’t mean everyone understands the same thing when that language is used. This is the peril of a psychological discussion or a mindfulness one. However in reality we are biological, embodied beings. All experience is grounded within the body that houses our psyche. The body then, is the portal by which awareness can anchor. Bodily experiences are sincere and authentic. The body does not lie. Both mindfulness and psychotherapy is able to advance when awareness is anchored in embodiment.