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Is Mindfulness for Everyone?

All this suggests that we’re beginning to move away from a simple, generalized approach to a more customized one. And we’re starting to ask more sophisticated questions: What effect does each practice have on the heart and mind? Who needs what practice when? Are there components of these traditions that we generally shouldn’t adopt, or shouldn’t adopt for particular individuals?

Perhaps the most important question is whether these practices are actually good for everyone. In our enthusiasm to develop mindfulness-based treatments, it’s been easy to overlook their downsides. Understanding these will require us to be much clearer about the effects of different mindfulness practices.

The Buddhist teacher Sharon Salzberg has identified three major skills that have been loosely lumped under the title “mindfulness”: concentration, mindfulness per se, and compassion toward oneself and others. Most meditation teachers suggest that concentration practices, in which one chooses an object of awareness and follows it closely, are generally a good place to start. These focus and stabilize the mind, forming a foundation for practicing other skills. Once the mind is somewhat focused, the more open-field awareness of mindfulness becomes useful for seeing how the mind creates suffering for itself. Open-field awareness helps reintegrate previously split-off or disavowed contents, and allows one to appreciate the richness of the moment.

But these things aren’t always so benign in the clinical arena. Clients can get overwhelmed by the intensity of what arises during concentration and open-field awareness practices. This is particularly true with those who’ve repressed intense feelings or memories. They may feel panic when a specific image arises—their father standing at the bedroom door, for instance—or when they feel their sense of self beginning to disintegrate. Clients can also find themselves trapped in self-critical patter. In such distressing moments, loving-kindness and self-compassion practices may be needed for holding and soothing. Alternatively, returning to concentration practices, particularly those that focus on external phenomena, can also sometimes restabilize the mind when it’s flooded by unwanted contents. We’re just beginning to understand the effects of these different practices, and have little research evidence to guide us.

Intimately connected with deciding which skills to emphasize is the question of how forcefully or quickly to nudge a client toward greater awareness. Almost all clinicians are sensitive to the challenge of timing or titrating interventions. It can be counterproductive to push clients too quickly into uncomfortable, destabilizing waters. We have general agreement, born from past mistakes in treating trauma, that people need to establish safety before either uncovering repressed memories or moving toward disavowed feelings. So we have to learn which meditation practices generally enhance safety and which ones bring people toward their growth edge—what’s called “moving toward the sharp points” in Tibetan Buddhist tradition.

Other forms of psychotherapy offer hints about how this might work, which mindfulness-oriented clinicians use for guidance. For example, some have observed that meditation practices that bring our attention to the body’s center move us toward the sharp points, while those that focus on objects further away—such as the soles of the feet, sounds, the taste of food, or the natural environment—tend to be more stabilizing. This is similar to the observation informing Eugene Gendlin’s Focusing, that paying attention to body sensations in the chest and belly connects us readily with memories and affects. Also, as mentioned earlier, clinicians are finding that loving-kindness and self-compassion practices can help move people toward safety.

Developing more detailed maps of how varied practices affect different people, as well as understanding when clients need more safety or would benefit from more emotional challenge, will be important if we’re going to develop safe, effective mindfulness-based interventions appropriately tailored to individual needs. These are cutting-edge issues for advancing the use of mindfulness in psychotherapy.

But Will They Practice?

As clinicians move beyond their initial enthusiasm for mindfulness practice, they’re encountering the problem that may well derail the whole enterprise: people find it hard to meditate regularly. It’s one thing to take up these practices in a monastery, where the whole day is structured around meditation and everyone is doing it, and quite another to take time out from a busy day and a long to-do list. Figuring out the best ways to get clients to practice is another challenge that’s just beginning to command the attention of researchers and clinicians.

Some people point out that cultivating mindfulness is like developing physical fitness. Without radically changing our lifestyle, we can take the stairs instead of the elevator or ride our bikes instead of driving, and develop some fitness. This is analogous to the informal mindfulness practices mentioned earlier: mindfully walking, showering, or driving. They don’t require extra time, just a shift in intention. These practices are relatively easy to get people to do.

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