By Kate Cohen-Posey
Are you a regular meditator but feel stymied when it comes to making mindfulness a vital part of client treatment?
You aren’t alone. Solitary meditation is one thing; two-way mindfulness in an attuned relationship is another.
A regular sitting practice eluded me until I discovered Tim Desmond’s Dialogical Based Mindfulness (2016) and then, later, mindfulness-centered psychotherapy (now called Hakomi, Weiss et al., 2015). I fell in love. I learned how to summon states of curious, compassionate consciousness as the agent of change in therapy sessions. Every approach I had learned over fifty years coalesced. I began to dance with my clients mindfully. But not all of them.
When clients come to us in crisis with racing thoughts, potent emotions, and harsh inner voices, didactic approaches to awareness training are not easy. After noticing their breath for a few minutes, people may be accosted by thoughts: I can’t do this; It’s just another thing for me to fail at; or I have too much to do. Beginners need to practice persistence before they experience meditation’s benefits, like improved concentration, reduced reactivity, and even lower blood pressure. In a culture where immediate gratification is expected, people often give up.
Interpersonal Mindfulness: Chatham
When I saw Chatham’s name on my schedule, my heart sank. Thus far, I had not found the spigot to turn off his firehose of words. Attempts to establish treatment objectives slipped through my fingers like sand. What am I supposed to do to help this person? I thought.
And so, we began our fourth telehealth session. Chatham was going on about his investments and then launched into the details of a conflict over the equity in a house he owned with his mother and how she “manipulated” him into doing a 9-1-1 check. In a voice edged in ire he said, “She found out I would respond to her in an emergency. She has so much power over me!”
Somehow, I managed to establish a therapeutic alliance by rephrasing key points of the topics he unleashed, saying, “All of these issues are truly important; how can this session help you with them?”
To my astonishment, there was a brief pause, and Chatham asked, “Is my anger valid?”
In mindfulness-based therapies, the next classic move is to connect people with their bodies. Arousing thoughts are accompanied by somatic sensations. Focusing on tightness, heat, or heaviness in the body is like dropping an anchor to steady a ship in a stormy sea. Sensations are a great focal object for mindfulness.
But, before I could even ask Chatham how he noticed his anger, my “difficult” client added, “Wow, my heart is really pounding, and there’s all this tightness below my shoulders.”
