Introducing Mindfulness to Clients

Making Exercises a Regular Part of Clients' Lives in and Outside the Therapy Room

Shai Lavie

My work with Suzanne began two years ago. At the time, she was in an emotionally abusive relationship with Ken, who raged at her regularly. Over and over again, she tried to walk away from his tirades, but panicked every time about losing him, caved in, and accepted the abuse. She came to therapy, in her words, “to learn to value myself.”

For about five months I worked with Suzanne using my own style of talk therapy, informed by my training in Self Psychology. Suzanne experienced me listening to her carefully and empathically, implicitly valuing her needs and feelings. Through this and other supports in her life, especially a group of devoted friends, she finally found the strength to leave Ken. “I really want to be happy,” she declared, “and I won’t let myself be squashed anymore.”

“Suzanne,” I said, “can I invite you to try something that may help you take in the words you just said much more deeply?” She looked at me curiously and nodded. I explained that certain experiences go deeper into the nervous system when we apply mindfulness. I invited her to close her eyes (assuring her she could open them anytime she needed to), and to feel her feet on the floor, her hands on her knees, and the breath entering and leaving her body.

After about five minutes of guiding her through the awareness of different bodily sensations, I said, “Okay, Suzanne, I’m going to invite you to repeat the words you spoke earlier—‘I really want to be happy’—and to notice how you feel in your body as you say this.”

Slowly, she repeated the words and, after a pause, said, “I feel my shoulders just drop way down. My belly is breathing more fully. This feels good, like how I want to feel—solid. What is this called, what we’re doing now?”

“We’re using mindfulness to help you really take in this new possibility of solidity, to anchor this important way of experiencing yourself.”

“Great,” she said, opening her eyes and smiling. “Whatever it is, let’s do more of it.”

Why did I choose this particular moment to introduce mindfulness to Suzanne? First, I was looking for a moment that would likely yield a positive experience of mindfulness, so as to set the stage for future mindfulness-based work. Second, I was waiting for the therapeutic relationship to feel strong enough. In doing mindfulness-based work, the therapist is essentially inviting clients to explore a new way of experiencing themselves, so there must be sufficient trust and rapport.

For the next few months, we practiced mindfulness techniques, integrated into regular talk therapy, which taught Suzanne to “resource” positive experiences of herself. She began looking forward to the times she could close her eyes, go inward, and feel better about herself.

Self-Regulation

It wasn’t long before Suzanne’s enthusiasm for this first foray into mindfulness work began to wear thin. “I come in here, and have these great experiences, where I feel relaxed and clear,” she said one day, clearly frustrated. “But then I go out on a date with a guy, and I can’t find that calmness in myself anywhere.”

I acknowledged her frustration and suggested that we start to apply mindfulness in a new way that might help her in her dating life. She was skeptical, but curious.

“Suzanne, can you tell me what your experience is like when you’re waiting to hear from the man you’ve just had that first date with?”

“Oh, it’s like I can’t stop going. I get edgy and fidget and clean the house and just keep thinking, ‘If I don’t call, he’ll make plans with someone else.’ It’s terrible!”

The things we do in life that get us into trouble are usually done when our nervous systems are highly charged or activated. Outbursts of anger, compulsive behaviors, sudden decisions—these reflect an overactivated and temporarily deregulated nervous system. In mindfulness-based therapy, we teach clients to track their level of activation as a first step toward self-regulation.

“I can see that even as you talk about this, you seem agitated. How would you rate your level of agitation, on a scale of 1 to 10, with 1 the calmest you’ve ever felt and 10 the most agitated?”

“I’m about a 6 right now—not nearly as bad as I get when I’m at my worst, waiting for the phone call. Then I’m about an 8 or 9.”

“Okay, so it’s not as bad as sometimes. . . . Do you feel okay about exploring this?”

“Yes,” she said, “I’m good to stay with this.”

“Okay, can you identify where in your body you feel the agitation?

“It’s in my belly—that awful grinding feeling. Also in my jaws—I’m clenching them. And my breath is shallow and tight; it feels crappy.”

“Yeah, not such a good feeling! Is it okay to stay with this?” I waited for a nod. “So, let yourself bring a gentle awareness to the grinding feeling in your belly, the clenching in your jaws, and the tightness in your breath. Stay with all that and notice what happens next.” I waited in silence as Suzanne went inward.

“I notice things start to ease up,” she said. “My breath returns. It’s like another part of me is saying it’s just going to be okay.”

These are powerful moments. We often find that by simply staying with an uncomfortable experience and bringing a gentle awareness to it, the experience shifts on its own. We start to realize we don’t have to fight against what’s been scaring us.

For several more months, Suzanne practiced this kind of mindfulness. I assigned homework: for example, to track her level of activation after the next date with a man. She used the 1-to-10 scale to track the sensations in her body. When she noticed herself getting more than a 5, she practiced resourcing herself. First, she tried just bringing awareness to a part of her body that wasn’t agitated. If that wasn’t enough, she called up an image that had been powerful for her in the therapy session; for example, her grandmother, who’d always been there for her. In the most difficult situations, she engaged in an activity, like going for a walk, which actively disrupted the increasing agitation.

All good therapies use the therapeutic alliance as an opportunity for the client to internalize positive relational experience and learn self-soothing from the support that comes from the relationship. In mindfulness-based therapy, we also develop the client’s capacity to attend directly to disruptive internal experience and bring to bear their own self-regulatory capacities.

Longing for intimacy, pulling away from people, getting needs met in self-destructive ways, shielding our hearts—we all share these all-too-human states. For exploring these wilder shores of the self, we can take no more promising a journey of discovery than in the vessel of our own mindful body awareness. Our great privilege is that we, as therapists, have the opportunity to guide our clients on these journeys.

***

Shai Lavie, MA, works with adults, adolescents, and families in private practice in San Rafael. A Certified Hakomi Teacher on the faculty of the Hakomi Institute of California, he leads transformational groups with adults and teens that integrate Hakomi, Somatic Experiencing, group process, ritual, and Jungian dreamwork.

This blog is excerpted from "In Search of a Lost Self," by Shai Lavie. The full version is available in the September/October 2009 issue, The Mindfulness Movement: Do We Even Need Psychotherapy Anymore?

Photo © Dreamstime/Dirk Ercken

Topic: Mindfulness

Tags: breathing exercises | deep breathing | divorce | guided meditation | guided mindfulness meditation | healthy relationships | intimacy | love | love and relationships | meditation mindfulness | Mindfulness | Mindfulness Exercises | mindfulness meditation | mindfulness techniques | Mindfulness Therapy | relationships | romantic relationships | Shai Lavie | stress | stress anxiety | therapeutic breathing

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