Mindfulness Practices for the Skeptical Client

Four Strategies for Helping Therapy Clients Embrace Mindfulness

Susan Pollak

Q: I’m trying to get my clients to meditate, but it isn’t working. Any suggestions for working with especially vulnerable clients?

A: Clinicians often make a variety of mistakes while trying to introduce mindfulness, and in my 30 years of trying to figure it out, I’ve made all of them. So let me share some of my bloopers with you in the hopes that you can avoid them. After all, meditation teachers often say, “This practice is simple, but it isn’t easy.”

Myth 1: Always Start with the Breath

I know this is what they teach in meditation classes, but with a clinical population this isn’t always a wise place to start. Let me tell you about my experience with Kayla many years ago, before we knew much about mindfulness meditation or trauma. She was a new patient and was anxious about an upcoming job interview. I thought some deep breathing would help her relax, so I asked her to take a number of deep breaths. After a few minutes, she began to hyperventilate and became angry with me. I was confused. How could a simple relaxation practice go south so quickly? It turned out she had a trauma history that she hadn’t disclosed and was in the middle of a flashback of being suffocated by her father. Starting with the breath had triggered her memory of struggling to breathe. So please make sure you take a thorough history before attempting to introduce mindfulness to your clients. It’s often best to start with a meditation on sounds or on sensations at the periphery of the body, which are less likely to evoke an adverse reaction.

Myth 2: Keep the Eyes Closed

Closing the eyes can be scary for vulnerable clients, and it’s not a good idea to ask them to do that right away—a mistake I made with my client Margaret many years ago. I knew she had trouble feeling safe, but since we had a good alliance, I thought it was okay to teach her some simple mindfulness exercises to help her with her tendency to ruminate about the past. However, when I asked her to close her eyes and bring her attention to the soles of her feet, I discovered she was more fragile than I realized. “But what if there’s an animal hiding under this couch?” she protested. “What if something happens when my eyes are closed? What if someone breaks in?” Since then, I’ve modified things for fragile clients. Before teaching simple practices, I have them keep their eyes open and ask them to look around (and under my couch, if necessary) to assuage any fear about safety. I respect hypervigilance, keep practices short—three to five minutes at most—and don’t include long periods of silence. Again, this is not what they teach in meditation classes.

Myth 3: You Have to Sit Still

Most people think you have to sit still to meditate. This isn’t the case. For many of my vulnerable clients, mindful movement can be a powerful tool to help them push forward, in therapy and in life. Barbara, for example, was an obese adolescent who struggled with depression and addiction. She didn’t like to be in my office at the city hospital where I worked, and she didn’t like to talk. Fifteen minutes into one seemingly interminable session—during which she sat silently except to inform me that all my questions were “stupid”—I had an idea.

“Let’s try an experiment,” I suggested. “Let’s move this session outside.” I then taught her walking meditation as a way to develop a new relationship with her body. We started by walking slowly, side by side, not talking, but simply feeling each footstep as it touched the ground. To my surprise, she liked it. It soon became a refuge for her, and she’d practice it when she needed a break from the constant fighting with her parents at home.

Myth 4: No Pain, No Gain

Perhaps the best piece of advice for helping people stay with mindfulness is to have them find something enjoyable in the practice. If it’s torture for them to sit and be aware of their thoughts or feel their breath, they won’t continue to do it. So you might introduce walking meditation instead. Or you could suggest loving-kindness or compassion meditation—traditional practices that involve the silent repetition of certain phrases, such as “May I be happy. May I be peaceful. May I be free from suffering,” designed to cultivate positive states of mind. Above all, do your best to make sure that the practice fits the patient.

The Zen master Thich Nhat Hanh was once asked how to keep a practice going. “Do you want to know my secret?” he responded with a smile. “I try to find a way to do things that is pleasurable. There are many ways to perform a given task, but the one that holds my attention best is the one that’s most pleasant.” So collaborate with your clients to find exercises that are both accessible and enjoyable. And if you make a mistake or two, don’t worry: the Zen masters joke that life is just one mistake after another.

This blog is excerpted from “Seven Myths about Meditation". The full version is available in the March/April 2015 issue. To subscribe, click here. >>

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Topic: Mindfulness | Trauma

Tags: add | addict | addiction | compassion meditation | deep breathing | depression | ED | fighting | meditate | meditation | meditation classes | mindful | Mindfulness Exercises | mindfulness meditation | parents | practices | SPECT | talking | TED | therapy | walking meditation | anxious | clients | Susan Pollak

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