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Is Mindfulness Enough

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PNSO11-3Going Beyond Acceptance to Healing

By Richard Schwartz

A psychotherapist discusses the next step: how to help clients transform the disruptive feelings and thoughts that they’ve learned to simply observe during meditation.

As therapists increasingly incorporate mindfulness into their work, they’re discovering what Buddhists have known for centuries: everyone (even those with severe inner turmoil) can access a state of spacious well-being by beginning to notice their more turbulent thoughts and feelings, rather than becoming swallowed up by them. As people relate to their disturbing inner experiences from this calm, mindful place, not only are they less overwhelmed, but they can become more accepting of the aspects of themselves with which they’ve been struggling. Still the question remains of how best to incorporate mindfulness into psychotherapy.

A perennial quandary in psychotherapy, as well as spirituality, is whether the goal is to help people come to accept the inevitable pain of the human condition with moreequanimity or to actually transform and heal the pain, shame, or terror, so that it’s no longer a problem. Are we seeking acceptance or transformation, passive observation or engaged action, a stronger connection to the here-and-now or an understanding of the past?

Many therapeutic attempts to integrate mindfulness have adopted what I’ll call the passive-observer form of mindfulness—a client is helped to notice thoughts and emotions from a place of separation and extend acceptance toward them. The emphasis isn’t on trying to change or replace irrational cognitions, but on noticing them and then acting in ways that the observing self considers more adaptive or functional. As an illustration, let’s consider how more traditional therapeutic approaches contrast with more mindfulness-based methods in helping a client dealing with the mundane challenge of feeling nervous about going to a party. A Cognitive-Behavioral Therapy (CBT) intervention might begin by identifying the self-statements that are generating anxiety—a part of the person that says, in effect, “Don’t go because no one likes you and you’ll be rejected.” The client might then be instructed to dispute these thoughts by saying, “It’s not true that no one likes me” and naming some people who do. A clinician trained in a mindfulness-based approach like Acceptance and Commitment Therapy (ACT) might have the client notice the extreme thoughts about rejection without trying to change them, and then go to the party anyway, despite the continued presence of the irrational beliefs. As this example shows, mindfulness allows you to no longer be fused or blended with the irrational beliefs, releasing your observing self, who has the perspective and courage to act in positive ways.

This shift from struggling to correct or override cognitive distortions to noticing and accepting them is revolutionary in a field that’s been so dominated by CBT. There’s a large body of research on ACT, from Jon Kabat-Zinn’s Mindfulness Based Stress Reduction, and from the ground-breaking work of Marcia Linehan’s Dialectical Behavior Therapy (DBT) with borderline personality disorder, suggesting that the shift is a powerful one. Clearly, learning to mindfully witness experiences helps clients a great deal, even those with diagnoses previously considered intractable.

A vivid cinematic example of this witnessing process can be found in the Academy Award–winning film A Beautiful Mind, in which we’re given a sense of what it’s like to be awash in an irrational thought system. In the beginning of the movie, the disturbed math genius John Nash (played by Russell Crowe) is so identified with the paranoid part of him (a black-suited FBI agent played by Ed Harris) that we, the viewers, are drawn into his scary world with him. Gradually Nash is able to separate from his paranoia—to observe his inner FBI agent with some distance and objectivity, rather than believing his conspiratorial rantings. With this mindful separation comes greater peace of mind and ability to function in his life. But while diminished in their intensity and their power to control his behavior, at the end of the film we see that Nash’s voices continue to reside in him. He’s simply learned to live with his extreme beliefs and emotions without being enslaved by them. But what if it were possible to transform this inner drama, rather than just keep it at arm’s length by taking mindfulness one step further?


The Second Step

As a therapist, I’ve worked with clients who’ve come to me after having seen therapists who’d helped them to be more mindful of their impulses to cut themselves, binge on food or drugs, or commit suicide. While those impulses remained in their lives, these clients were no longer losing their battles with them, nor were they ashamed or afraid of them any longer. The clients’ functioning had improved remarkably. The goal of the therapeutic approach that I use, Internal Family Systems (IFS), was to build on this important first step of separating from and accepting these impulses, and then take a second step of helping clients transform them.

For example, Molly had been in and out of hospital treatment centers until, through her DBT treatment, she was able to separate from and be accepting of the part of her that had repeatedly directed her to try to kill herself. As a result of that successful treatment, she’d stayed out of the hospital for more than two years, was holding down a job, and was connected to people in her support group. From my clinical viewpoint, she was now ready for the next step in her therapeutic growth. My goal was to help her get to know her suicidality—not just as an impulse to be accepted, but as a “part” of her that was trying to help her in some way.

In an early session, after determining she was ready to take this step, I asked her to focus on that suicidal impulse and how she felt toward it. She said she no longer feared it and had come to feel sorry for it, because she sensed that it was scared. Like many clients, she also began to spontaneously see an inner image, in her case a tattered, homeless woman who rejected her compassion. I invited her to ask this woman what she was afraid would happen if Molly continued to live. The woman replied that Molly would continue to suffer excruciating emotional pain. With some help in that session, Molly was able to embrace the woman, show her appreciation for trying to protect her from extreme suffering, and learn about the hurting part of her that the woman protected her from. In subsequent sessions, Molly, in her mind’s eye, entered the original abuse scene, took the little girl she saw there out of it to a safe place, and released the terror and shame she’d carried throughout her life. Once the old woman could see that the girl was safe, she began to support Molly’s steps into a fuller life and stopped encouraging her to try to escape the prospect of lifelong suffering through suicide. In this way, the “enemy” became an ally.

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