Mindfulness, Wisdom, Sati in Pali & Compassion in Connotes - - PDF document

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Mindfulness, Wisdom, & Compassion in Psychotherapy

Ronald Siegel, Psy.D.

What is Mindfulness?

• Sati in Pali

Connotes awareness, attention, & remembering

• In therapeutic arena, also includes

Non-judgment Acceptance

• Adds kindness & friendliness

Therapeutic Mindfulness

• 1. Awareness
• 2. Of present experience
• 3. With acceptance

Mindlessness

• Operating on “autopilot”
• Being lost in fantasies of the past and

future

• Breaking or spilling things because

we’re not paying attention

• Rushing through activities without

attending to them

Life Is Difficult, for Everybody

• Everything changes

Loss is inevitable

• We’re hard wired to try to enhance our

self esteem

But we win some and lose some And we get sick and die

Mindfulness Can Help Us

• To see and accept things as they are
• To loosen our preoccupation with “self”
• To experience the richness of the

moment

• To become free to act skillfully

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Mindfulness Practice is Not:

• Having a “blank” mind
• Becoming emotionless
• Withdrawing from life
• Seeking bliss
• Escaping pain

Breath Awareness The Roles of Mindfulness

• Practicing Therapist

Relates mindfully to patients regardless of therapeutic intervention

• Mindfulness Informed

Psychotherapy

Insights from mindfulness practice inform treatment

• Mindfulness Based

Psychotherapy

Teaches mindfulness practice to patients

Implicit Explicit

How it Works

Fly

Overwhelmed?

Capacity to bear experience Intensity of experience

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The Thinking Disease

• Analyze past

pleasure and pain

• Maximize future

pleasure and avoid future pain

Fitting the Practice to the Person Decisions, Decisions

• 1. Which skills to emphasize?
• 2. Formal or informal practice?
• 3. Which objects of attention?
• 4. Religious or secular practices?
• 5. Narrative or experiencing mode?
• 6. Relative or absolute truth?
• 7. Turning toward safety or sharp points?

Core Practice Skills

• 1. Concentration (focused attention)
• 2. Mindfulness per se (open monitoring)
• 3. Acceptance and Compassion

Concentration vs. Mindfulness

• Concentration

Choose an object and follow it closely

• Mindfulness

Attend to whatever

• bject rises to

forefront of consciousness

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Acceptance Loving-kindness Practice

• “Metta” practices

May I be happy, peaceful, free from suffering May my loved

• nes be happy. . .

May all beings be

• happy. . .

Continuum of Practice

Informal Mindfulness Practice Formal Meditation Practice Intensive Retreat Practice

Telephone Meditation Taillight Meditation Shower Meditation

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Formal Practice

(Results May Vary)

• Data supports

effects of formal meditation

• Structural and

functional brain changes.

Intensive Retreat Practice

Resources at: meditationandpsychotherapy.org

Objects of Attention

• Feet touching ground
• Sights and sounds of nature
• Taste of food
• Sound of bell
• Breath in belly
• Mantra
• Air at tip of nose

Coarse Subtle

Religious or Secular?

• “Spiritual” practices

Devotional and theistic

• Secular practices

Science grounded

• Seek cultural consonance

Narrative Mode

• Psychodynamic

Earlier, transference, other relationships

• Behavioral

How learned, how reinforced

• Systemic

Maintained by family, community, culture

Experiencing Mode

• How is it felt in the body?
• How does the mind respond?

Grasping Pushing away Ignoring

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Relative Truth

• Human story

Success & Failure Pleasure & Pain Longing Hurt Anger Envy Joy Pride

Absolute Truth

• Anicca

(impermanence)

• Dukkha

(unsatisfactoriness)

• Anatta (no enduring,

separate self)

Processing Trauma

1. Open to painful emotions 2. Explore the facts of trauma 3. See it through lens of dependent origination 4. Develop compassion

Timing is Everything

Turning toward Safety I

• Outer or distal focus

Walking Meditation Listening Meditation Nature Meditation Eating Meditation Open eye practices

Turning toward Safety II

• Inner focus

Mountain Meditation Guided Imagery Metta Practice DBT techniques

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Turning Toward the Sharp Points

• Moving toward anything

unwanted or avoided

• How is it experienced in

the body?

Pain, fear, sadness, anger Unwanted images or memories Urges toward compulsive behaviors

Different Strokes

• Need for frequent adjustment of

exercises

• Elicit feedback about the experience

Both during and after practice

• Titrate between Safety and Sharp

Points

When Mindfulness of Inner Experience Can Be Harmful

• When overwhelmed

by traumatic memories

• When terrified of

disintegration, loss

• f sense of self
• When suffering from

psychosis

Alternate Techniques when Overwhelmed

• Eyes open, external

sensory focus

Ground, trees, sky, wind, sounds

• Yoga practices to

stretch and relax muscles

Decisions, Decisions

• 1. Which skills to emphasize?
• 2. Formal or informal practice?
• 3. Which objects of attention?
• 4. Religious or secular practices?
• 5. Narrative or experiencing mode?
• 6. Relative or absolute truth?
• 7. Turning toward safety or sharp points?

Wisdom in Psychotherapy

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“Hard core pornography is hard to define” [but] “I know it when I see it.”

• - Justice Potter Stewart (1964)

“If we are doomed to die —let us spend.”

• - Mesopotamia (3000 BCE)

“Be not puffed up with thy knowledge, and be not proud because thou are wise.”

• - Egypt (2000 BCE)

“The narrow intelligence flashing from the keen eye of a clever rogue” is not wisdom.

• - Socrates (400 BCE)

A 15 year old girl wants to get married right away. What should she do?

Paul Baltes – Berlin Group

• 1. Factual knowledge
• 2. Procedural knowledge
• 3. Life-span contextualism
• 4. Value relativism
• 5. Awareness and management of

uncertainty

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Monika Ardelt

“A fool can learn to say all the things a wise man says, and to say them

• n the same occasions, but this

isn’t real wisdom.”

• -John Kekes

Meeks & Jeste

• 1. Prosocial behavior/attitudes
• 2. Social decision-making/pragmatic life

knowledge

• 3. Emotional homeostasis
• 4. Reflection/Self-understanding
• 5. Value relativism/tolerance
• 6. Acknowledgement of/dealing

effectively with uncertainty/ambiguity.

Not Knowing Beginner’s Mind Wisdom In Psychotherapy Susan Bluck and Judith Gluck

• 1. Intelligence
• 2. Insight
• 3. Reflective attitude
• 4. Concern for others
• 5. Problem-solving abilities

Buddhist Psychology

• Compilation of insights derived largely

from mindfulness practice

• Not a religion in Western sense, but the

results of a 2500 year old tradition of introspection

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Three Marks of Existence

• Anicca

(impermanence)

• Dukkha

(unsatisfactoriness)

• Anatta (no enduring,

separate self)

Mindfulness How Mindfulness Fosters Wisdom I

• Stepping Out Of the Thought Stream
• Being With Discomfort
• Disengaging From Automatic

Responses

How Mindfulness Fosters Wisdom II

• Transpersonal Insight
• Seeing How the Mind Creates Suffering
• Embracing Opposites
• Developing Compassion

R-A-I-N

• Recognize what is happening.
• Allow life to be just as it is.
• Investigate inner experience with

kindness.

• Nonidentification; rest in Natural

awareness.

• -Tara Brach

Factor Analysis Of Mindfulness Scales

• 1. Nonreactivity to inner experience
• 2. Observing/noticing/attending to

sensation/perceptions/feeling

• 3. Acting with awareness/automatic

pilot/concentration/non-distraction

• 4. Describing/labeling with words
• 5. Nonjudging of experience

Baer, R., Smith, G., Hopkins, J., Krietemeyer, J., & Toney, L. (2007). Using self-report assessment Methods to explore facets of mindfulness. Assessment, 13(1), 27-45.

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Stages of Acceptance

• Aversion: resistance, avoidance, rumination
• Curiosity: turning toward discomfort with

interest

• Tolerance: safely enduring
• Allowing: non-resisting
• Friendship: embracing, finding hidden value
• -Chris Germer

Anatta The Western View of the Self

• Emphasis on separateness vs.

connection to family, tribe, nature, etc.

• Healthy (Western) development:

Individuated Aware of Boundaries Knowing one’s needs Clear identity and sense of self

Narcissism in Western Psychology

• DSM

Character disorder

• Behavior therapy

Self efficacy

• Psychodynamic psychotherapy

Healthy narcissism or self esteem

Narcissism in Buddhist Psychology

• We suffer when we don’t know who we

really are

• Attempt to buttress self is central cause
• f suffering
• Our concept of “self” is based on a

fundamental misunderstanding

Buddhist Therapeutic Progress

”mine” about me Not about me about me ”mine” about me Not about me

• - Adapted from Engler & Fulton

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Where do I Begin and End? What about Boundaries? Boundaries Where is the Organism? Us and Them

Enemy Enemy Meat Meat Meat Meat Enemy Servant Servant Enemy Servant Servant Servant Servant

Constructing Experience

• Identity is a

construction project

• Mind is a world-

building organ

Makes order out of chaos Constructs reality from data streaming in at break-neck speed

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Sense Contact

• Coming together of

Sense organ Sense object Awareness of object

• Six senses

Seeing Hearing Smelling Tasting Touching Thinking

Perception

• Evaluates sense

experience

Conditioned by culture and language

• Constructs and

categorizes

Omits details Fills in missing information

VIDEO

Feeling

• We add an affective
• r hedonic tone to

all experience

Pleasant Unpleasant Neutral

Intention and Disposition

• We try to

Hold onto the pleasant Push away the unpleasant Ignore the neutral

• We develop habits of intention

Dispositions Learned behaviors Conditioned responses Personality characteristics Intention Feeling Perception Consciousness Sense Organ Sense Object

The Construction of Experience

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A human being is part of the whole called by us universe ... We experience ourselves, our thoughts and feelings as something separate from the rest. A kind of optical delusion of

• consciousness. This delusion is a kind of prison

for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from the prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its

• beauty. The true value of a human being is

determined by the measure and the sense in which they have obtained liberation from the self.

The Self

• A verb, not a noun

Selfing occurs

• We respond differently

when experiences belong to “me”

• Creates further

distortions

Copernicus of the Mind

• Identity is recreated

moment by moment

• Continuity of self is

illusory

• Like frames of a

movie

Selfing: Obstacle to Wisdom & Compassion The Failure of Success

• The pain of I, me, me, mine
• Narcissistic recalibration
• Narcissistic defenses are all

compensatory

Jung’s Shadow & The Separate Self

• Identifying with some

attributes while rejecting

• thers
• We become defensive

when shadow is illuminated

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We’re all Bozos on this Bus

• Dandelions in a field
• Not a path to perfection, but a path to

wholeness

Boundary of what we can accept in

• urselves is the boundary of our freedom

– Zen Patriarch

The Trance of Unworthiness

• Eastern meditation teachers are

surprised by Western self-criticism

• Anxiety is primal mood of the separate

self (Tara Brach)

• Related to Western cultural emphasis
• n the separate self

Compassion in Psychotherapy

Affect Regulation Systems .

Seeking pleasure Achieving and Activating Affiliative Soothing/safety Well-being Threat-focused Protection & Safety Seeking Activating/Inhibiting

Anger, anxiety, disgust Drive, excitement, vitality Contentment, safety, connection

Compassion

• Latin: pati; Greek: pathein (“to suffer”)
• Latin: com (“with”)
• Compassion means to “suffer with”

another person.

Compassion’s Relatives

• Empathy
• Sympathy
• Love
• Pity
• Altruism

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Lovingkindness Practice

• “Metta” practices

May I be happy, peaceful, free from suffering May my loved

• nes be happy. . .

May all beings be

• happy. . .

Heart over Head

• Conventional CBT

Modifies expectations, beliefs,

• r behaviors
• Metta practice

Attempts to modify emotional states directly

Research on LKM

• Builds positive emotions and resources
• Increases feelings of social connectedness.
• Changes the brain, which correlates with

empathy and generosity.

• Shifts away from fault-finding, self and other
• Reduces back pain.

How Mindfulness Develops Compassion

• Compassion for ourselves arises as we
• pen to our own suffering
• Compassion for others arises as we see

that everyone else also suffers

• Compassion arises naturally as we see
• ur interconnectedness

Condon, Desbordes, & Miller (2013)

Cultivating Compassion

• 2 wk x 30 min online

compassion training

Loved one Self Stranger Difficult person All beings

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Compassionate Economics

• Subjects received

$100, $75, or $50

• Allowed to keep or

give away any amount

• Meditators more

likely to share

Paradoxical Responses

• Universality of ambivalence

Highlight one pole, energize the

• ther
• Negative emotions may arise

Cynicism, anger, sadism

• Practice saying “Yes” to

these

Positivity Portfolio

• When do you feel close & trusting?
• When does a relationship spark joy,

gratitude, inspiration, awe?

• When do you

lean toward your beloved? have the urge to enjoy your beloved’s companionship?

• -Barbara Fredrickson

When Things Go Wrong

Unholy trinity of

• Self-criticism
• Self-isolation
• Self-absorption

An Antidote: Self-compassion

• Self-Kindness
• Common Humanity
• Mindfulness

First Noble Truth to the Rescue

The Story of the Mustard Seed

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5 Paths to Self-Compassion

1.

• Physical: Soften the body

2.

• Mental: Allow thoughts to come and go

3.

• Emotional: Befriend feelings

4.

• Relational: Connect safely with others

5.

• Spiritual: Commit to something larger
• -Chris Germer

The Big Picture

• What helps you to identify with

something larger than yourself?

Nature Friend, Family, or Community Spiritual Teacher Religious figure or image

Self-Compassionate Letter

• Describe something that makes you feel

badly about yourself

• Think of loving, accepting, imaginary

friend

• Write a letter to yourself from your

friend’s perspective

• --Kristen Neff

Research On Self-compassion

• Predicts psychological well-being
• Different construct than self-esteem
• Unrelated to narcissism
• Adaptive response to academic failure
• Alleviates shame and self-criticism
• Helps to avoid unhealthy food

Greeting Exercise

• Begin with breath
• Visualize the person behind the door,

suffering human being, once a child, has hopes and dreams, vulnerable and afraid, believing you can help

• Now open the door and say “hello.”

Equanimity Phrases

• Everyone is on his or her own life

journey.

• I am not the cause of my patient’s

suffering, nor is it entirely within my power to alleviate it.

• Though moments like this are difficult to

bear, I may still try to help to the extent that I can.

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Self-compassion is not…

• Sugarcoating - we’re opening to pain more

fully, not bypassing it.

• Complacent - it’s a force of will--good will.
• Pity Party - we’re disentangling from pain,

not wallowing in it.

• Exhausting - we’re struggling less, not

more.

• Selfish - it’s the first step to loving others.

Relationships Relational-Cultural Theory

• Grew out of feminist critique of conventional

psychology

• Benefits of mutual connection

Energy and vitality Greater capacity to act Increased clarity Enhanced self-worth (efficacy) Desire and capacity for more connection

Three Objects of Awareness

• Mindfulness of sensations, thoughts,

feelings in “me”

• Mindfulness of the words, body

language, mood of the other

• Mindfulness of the flow of relationship

Life in a Space Suit

• Defenses against

pain insulate us from one another

• We imagine they

keep us safe, but they leave us more vulnerable

For meditations & other resources: www.mindfulness-solution.com email: rsiegel@hms.harvard.edu