Wisdom in Psychotherapy Deepening Mindfulness in Clinical Practice - PDF document

Wisdom and Compassion in Psychotherapy: Wisdom in Psychotherapy Deepening Mindfulness in Clinical Practice Ronald D. Siegel “Hard core pornography is hard to define” “If we are doomed to die [but] —let us spend.” “I know it when I see it.” -- Mesopotamia (3000 BCE) -- Justice Potter Stewart (1964) “Be not puffed up with thy “The narrow intelligence flashing knowledge, and be not proud from the keen eye of a clever because thou are wise.” rogue” is not wisdom. -- Socrates (400 BCE) -- Egypt (2000 BCE) 1

Paul Baltes – Berlin Group 1. Factual knowledge 2. Procedural knowledge 3. Life-span contextualism 4. Value relativism 5. Awareness and management of uncertainty A 15 year old girl wants to get married right away. What should she do? Not Knowing Monika Ardelt “A fool can learn to say all the things a wise man says, and to say them on the same occasions, but this isn’t real wisdom.” --John Kekes Beginner’s Mind 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 2

Three Marks of Existence Mindfulness • Anicca (impermanence) • Dukkha (unsatisfactoriness) • Anatta (no enduring, separate self) How Mindfulness Fosters How Mindfulness Fosters Wisdom I Wisdom II • Stepping Out Of the Thought Stream • Transpersonal Insight • Being With Discomfort • Seeing How the Mind Creates Suffering • Disengaging From Automatic • Embracing Opposites Responses • Developing Compassion The Western View of the Self • Emphasis on separateness vs. connection to family, tribe, nature, etc. Anatta • Healthy (Western) development:  Individuated  Aware of Boundaries  Knowing one’s needs  Clear identity and sense of self 3

Narcissism in Western Narcissism in Buddhist Psychology Psychology • DSM • We suffer when we don’t know who we  Character disorder really are • Behavior therapy  Self efficacy • Attempt to buttress self is central cause • Psychodynamic psychotherapy of suffering  Healthy narcissism or self esteem • Our concept of “self” is based on a fundamental misunderstanding Therapeutic Benefits of Thinking Glimpsing Anatta 1. Increased affect tolerance 2. Radical acceptance of parts 3. Freedom from self-esteem concerns 4. Deeper connection to others Default Mode Network Homunculus? 4

Who Am I? Medial Prefrontal Cortex (mPFC) • Two types of self-reference • Links subjective experiences across  Narrative focus (NF) time • Enduring traits • Holds memory of • Talking to ourselves about ourselves  Self traits  Traits of similar others  Experiential focus (EF)  Reflected self- • Moment-to-moment knowledge experience  Future aspirations • The mind-body in action And I, Sir, Can Be Run Through with a Sword 1) Affect Tolerance Selfing & Affect Tolerance • Not “my,” but “the” 2) Acceptance of Parts  Anger  Sadness  Fear  Joy  Lust 5

Our Polytheistic Mind How Was Your Meditation? • Part trying to attend to the breath • Part fantasizing about the future • Part judging myself • Ask the committee! Jung’s Shadow We’re all Bozos on this Bus • Dandelions in a field • We identify with some • Not a path to perfection, but a path to parts while rejecting wholeness others • Boundary of what we can accept in • We become defensive ourselves is the boundary of our when shadow is freedom illuminated – Zen Patriarch Self-Evaluation 3) Freedom from Self-Esteem Concerns 6

What Realms Define Me? Lake Wobegon • Skills & Talents Where all the women are strong, all the • Accomplishments men are good looking, and all the • Pedigree or Group Membership children are above average. • Moral Standing • Appearance Wrong Wall? The Failure of Success • The pain of I, me, me, mine • Narcissistic recalibration • Impossibility of winning consistently Narcissistic Personality It’s Getting Worse Inventory • I just want to be reasonably happy • I want to amount to something in the eyes of the world • If I ruled the world it would be a better place • The thought of ruling the world scares the hell out of me • I am much like everybody else • I am an extraordinary person • I always know what I’m doing • Sometimes I’m not sure of what I’m doing 7

Egos Inflating Over Time: A Cross ‐ Temporal Meta ‐ Analysis of the Narcissistic Personality Inventory Self-Esteem Autobiography Journal of Personality, Volume 76, Issue 4 4) Connecting to Others I get my money from Mommy. Love Self-Esteem 8

Judgments “Do unto others as you would have them do unto you” It’s not just a commandment, but a law of nature. It’s About Other People Make a connection, not an impression. Embracing Insignificance 9

Wat Tham Sua King of England, 1387 Tiger Cave Temple Krabi, Thailand Loving-kindness for the Self-Compassion Competition • Self-kindness • Common Humanity • Mindfulness Therapeutic Progress Why Are You Unhappy? Not about me Not about me Because 99.9% of everything you think, and everything you do, is “mine” for yourself. And there isn’t one. about me “mine” about me -- Wei Wu Wei -- Adapted from Engler & Fulton 10

Compassion in Psychotherapy Affect Regulation Systems Compassion Drive, excitement, vitality Contentment, safety, connection . • Latin: pati; Greek : pathein (“to suffer”) Affiliative Seeking pleasure Soothing/safety • Latin: com (“with”) Achieving and Activating Well-being • Compassion means to “suffer with” Threat-focused another person. Protection & Safety Seeking Activating/Inhibiting Anger, anxiety, disgust Compassion’s Relatives Lovingkindness Practice • “Metta” practices • Empathy  May I be happy, peaceful, free • Sympathy from suffering • Love  May my loved • Pity ones be happy. . . • Altruism  May all beings be happy. . . 11

Heart over Head Research on LKM • Conventional CBT • Builds positive emotions and resources  Modifies • Increases feelings of social connectedness. expectations, beliefs, or behaviors • Changes the brain, which correlates with • Metta practice empathy and generosity.  Attempts to modify • Shifts away from fault-finding, self and other emotional states directly • Reduces back pain. How Mindfulness Develops Condon, Desbordes, & Miller (2013) Compassion • Compassion for ourselves arises as we open to our own suffering • Compassion for others arises as we see that everyone else also suffers • Compassion arises naturally as we see our interconnectedness Paradoxical Responses • Universality of ambivalence  Highlight one pole, energize the other • Negative emotions may arise  Cynicism, anger, sadism • Practice saying “Yes” to these 12

An Anidote: Self-Compassion When Things Go Wrong Unholy trinity of • Self-kindness • Self-criticism • Common Humanity • Self-isolation • Mindfulness • Self-absorption First Noble Truth to the 5 Paths to Self-Compassion Rescue 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 The Story of the Mustard Seed --Chris Germer The Big Picture Self-Compassionate Letter • What helps you to identify with • Describe something that makes you feel something larger than yourself? badly about yourself • Think of loving, accepting, imaginary  Nature friend  Friend, Family, or Community • Write a letter to yourself from your  Spiritual Teacher friend’s perspective  Religious figure or image ---Kristen Neff 13

Research On Greeting Exercise Self-compassion • Begin with breath • Predicts psychological well-being • Visualize the person behind the door, • Different construct than self-esteem suffering human being, once a child, has hopes and dreams, vulnerable and • Unrelated to narcissism afraid, believing you can help • Adaptive response to academic failure • Now open the door and say “hello.” • Alleviates shame and self-criticism • Helps to avoid unhealthy food Going Nowhere 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. For meditations & other resources: www.mindfulness-solution.com email: rsiegel@hms.harvard.edu 14