Institute for Meditation and Psychotherapy
Cushion
 and Couch
 
Summer 2014
BCBS Buddha Hand
Top_of_pageWelcome to the Summer 2014 issue of Cushion and Couch, the journal for IMP members!
In this issue:



PedullaFour Ways to Integrate Mindfulness and Psychotherapy

By Tom Pedulla, LICSW

 

Four ways? Actually, there are almost as many ways to bring mindfulness practices into psychotherapy as there are therapists and patients. As Susan Pollak, Ron Siegel and I discuss in our new book, Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy, mindfulness is not a one-size-fits-all proposition. It's a living process that's most effective when we can remain flexible and respond skillfully to whatever is arising in the moment.

 

But in my own work with patients, I find that there are four basic areas where I tend to deploy mindfulness and other related practices most often, and most successfully:

 

As a personal refuge. Of course, the therapist's own meditation practice is the foundation of mindfulness-based psychotherapy, and staying connected with our practice is arguably the best way to stay open and connected with our patients. For me, this means making the time to do some formal meditation before the clinical day begins. But it also means looking for opportunities to practice informally throughout the day. Maybe it's remembering to feel my feet on the ground as I walk to the waiting room to greet a new patient. Or taking a few conscious breaths before responding to a patient's angry rant. Or trying to avoid filling the time between sessions with a lot of unrelated activity. 

 

As an opening ritual. I often suggest to patients that we start each session by sitting and breathing together for a few minutes, sometimes in silence, sometimes with guidance from me. Many find this to be a useful way to transition from the busyness of daily life to the quieter, more reflective space of the clinical hour. As an alternative, I sometimes suggest taking a brief "mindfulness break" when the patient is feeling lost, confused, triggered, or unsure what to talk about next. This has to be done judiciously, however, for it can easily feel like an empathic failure to a patient who wants to stay with his or her own process.

 

As a targeted intervention. This is the new frontier of mindfulness-based psychotherapy, where we attempt to tailor practices to fit a patient's particular problem. We discuss this at length in Sitting Together, and it's a complex subject about which we still have a lot to learn. But it sometimes can be as simple as offering a loving-kindness or self-compassion exercise to a patient who tends to be judgmental and self-critical. Or showing a depressed patient stuck in a downward spiral of negative thoughts and emotions how to be mindful of that distress in the body instead.

 

As homework. As we all know, the effectiveness of mindfulness practice is generally dose related, so I try to encourage patients to practice at home between sessions as best they can, even if it's just doing a 3-Minute Breathing Space (an exercise from the Mindfulness-Based Cognitive Therapy program) once a day. Sometimes informal practices can also make good homework assignments. Like asking that judgmental patient to simply count the number of times he judges himself and others in the course of a day. Or asking a patient who's trying to quit smoking to pause and check in with her thoughts and feelings before she lights up.

 

These are just some of the ways that seem to work for me as I explore the interface between meditation and psychotherapy. As we all continue the exploration, and share our discoveries in this professional sangha, I'm confident that many more will emerge. 

 

 

interviewAn Interview with Susan Pollak, MTS, EdD 

By Barbara Van Zoeren LICSW

 

Susan M. Pollak, MTS, EdD, is a clinical psychologist and current president of the Institute for Meditation and Psychotherapy. She received a degree in Comparative Religion from Harvard Divinity School, her doctorate in Psychology from Harvard University, and her clinical training through Harvard Medical School. She has been a clinician and Instructor in Psychology at Harvard Medical School for 20 years, specializing in the integration of meditation and psychotherapy. 

 

I spoke with Susan Pollak at her home in Cambridge. We spoke about her personal path with Psychotherapy and Buddhism, her thoughts about the intersection of the two, and about her new book, Sitting Together, Essential skills for Mindfulness-Based Psychotherapy; the subject of our book review, in this edition.

 

Barbara: What drew you to Psychotherapy, Buddhism and the intersection of them both?

 

Susan: When I was in elementary school my aunt Fay was a journalist and she was sent on assignment to cover the first Ashram in New York. She started meditating and doing yoga, and when she visited she would teach us what she learned. It just sort of clicked for me and I've been practicing since then. But as you can imagine I learned to keep it quiet. No one was doing yoga or meditation and it was thought to be pretty weird. My aunt was a consummate journalist, always going for the next story. That translated into her spiritual proclivities as well. Every time I would go visit there would be a new guru. The upside of that is that I was able to sit with some of the major teachers of meditation of the 60's and 70's. I continued practicing in high school and college and I became a religion major in college because that was my passion. I then went to divinity school, planning to be a professor of comparative religion. At that time there was a major ethical violation with one of the teachers I was studying with. This person, that everyone thought was enlightened, turned out to be psychotic. That event caused me to start wrestling with the question of: How can smart discerning people not be able to tell the difference between enlightenment and psychosis? And what was going on with all this abuse of power? And this wrestling drove me into psychology. I became interested in issues of abuse, hypocrisy, power dynamics, gender relationships and patriarchy. So I took a long sabbatical from the meditation world.  It was a real crisis of faith for me.  I started working with Carol Gilligan, who was my advisor, and after that with Judith Herman because I was so interested in feminist issues and Trauma.

 

Barbara: And somehow you integrated your meditation practice with your clinical training?

 

Susan: Well, in the clinical work with my clients, when we'd become stuck I began to return to my meditation practices to help them.

 

Barbara: How would you bring that to your clients?

 

Susan: Well, that's really what our book is all about. I'd offer it to clients as an option of something that might work. It was the mid 80's and I wanted to do it right so I asked my supervisor about it and she acted like I was suggesting something unethical. She said, "You can do what you want behind closed doors but I will not supervise you on that."

 

Barbara: Sounds like she saw it as a problem of some kind.

 

Susan: At the time it was considered marginal, there was no research and it was breaking the frame of psychodynamic treatment. So once again I learned to be really quiet about it my meditation practices. Then I met Phil Aranow (one of the founders and the first president of IMP) who introduced me to Trudy Goodman. They were the only people around who were talking about meditation and psychotherapy. We would spend time talking about the two, how they went together, what you could integrate etc. ... so I found others who thought as I did.

 

Barbara: So today in your psychotherapy practice, are you exclusively using meditation practices?

 

Susan: No. I have some people who are not interested at all. I think the goal is not to turn everyone into a meditator but to offer people different tools ... to help them find some balance, equanimity, compassion, calm and  to help them manage their lives. 

 

Barbara: Where do you see the most exciting work happening in this intersection and where would you like to see more?

 

Susan: I'm really excited about the brain research. I think it is part of the reason that mindfulness has become so mainstream. We find that it really does make a difference.  I'm also excited about the work on self-compassion that Chris Germer and Kristin Neff are doing. It is utterly transformative. I think that self -compassion work is the next wave. Dick Schwartz's IFS is a compassionate treatment and other treatments are bringing together yoga and body awareness and body understanding, such as Pat Ogden's Sensorimotor Psychotherapy.

 

Barbara: Would you talk about your new book and how it came to be?

 

Susan: This is a book I've wanted to do for a decade and it came from a class we had at Cambridge Hospital, called 'Stress and Self Care' that became a required class for psychology interns and other behavioral medicine clinicians. I structured it with the first half focusing on the clinician developing their own mindfulness practice and the second half with a focus on patients ... what you could do for anxiety, depression, trauma, pain, couples etc. and that became the book. The structure of the book, like yoga and learning mindfulness practices is sequential, starting with the basics and building on them.

 

Barbara: Do you have one message that you would like to have people get from your book?

 

Susan: I'm interested in helping people to get their mindfulness practice into their daily lives. A practice can be simple. Can you do 30 seconds? There's a practice in the book, which is just 3 breaths. Trudy Goodman says, "You can change your state of mind in just 3 breaths." You can practice while walking or eating. I'd like people to lose the guilt about practice.

 

Barbara: Thank you for your time Susan. I look forward to reading your book.

 

 

 

reviewA Mindfulness Book Written with Clinicians in Mind

A book review by Laura Fisher PsyD

 

Ever wonder how to implement mindfulness into your everyday life, client interactions and overall practice of psychotherapy? Then run (I said, "Run!") out to your local bookstore and purchase a copy of Sitting together: Essential Skills for Mindfulness-Based Psychotherapy by Susan Pollak, Thomas Pedulla, and Ronald Siegel. This book is chock full of useful ideas, mindfulness practices and sequences that one can easily integrate into his or her practice and overall life.  My copy is covered in highlight, underlined passages and dog-eared pages and will remain in close proximity as I prepare for sessions. What a gift to the clinical world!

 

This book is logically organized around three main themes: mindfulness in the therapist, mindfulness in the therapeutic hour, and mindfulness sequencing (how to use what technique when) in a psychotherapy practice. The authors break down the four main forms of mindfulness technique (concentration, open monitoring, loving-kindness and compassion practice, and equanimity) and give a rationale for using one technique over another when working with clients.  Throughout the book, examples and case vignettes are presented to give the reader a clear picture of how these techniques translate into clinical practice. In addition, the authors highlight a variety of practices one can use in each of the four broad areas of mindfulness as well as complete sequences therapists can use with specific clinical populations. Many of the meditation practices are also available for download at www.sittingtogether.com. And, unlike many other books in the field, the authors make clear arguments for when not to use mindfulness techniques or when to proceed with caution - an important consideration!

 

Practicing therapists will really enjoy the meditations geared towards clinicians.  Some of my favorites include: "walking to the waiting room" meditation; "no-show" meditation; "three objects of awareness" (a meditation focusing on the sensations, thoughts and feelings of the therapist coupled with the words, body language, and feelings of the patient); and "anchor at the bottom of a stormy sea" (helpful following more difficult client interactions).  It was also helpful to consider the conditions conducive for mindfulness to flourish: spaciousness, simplicity, single-mindedness, and slowing down.  As the authors so astutely note, these qualities help move individuals from the "doing mode" to the "being mode" both in our everyday lives as well as our interactions with clients. 

 

However, the meat of the book (and my most highlighted/dog-eared sections) focuses on ways to introduce mindfulness practices to our clients. Beginning with breath awareness exercises/affect tolerance practices and culminating in more intense equanimity practices, the authors offer a full range of meditations that therapists can weave into the clinical hour. Highlights include: "finding the pattern" meditation (looking more closely at how thoughts are interconnected to sensations, feelings and behaviors); "bringing compassion into daily life" (a walking compassion meditation); "mountain" meditation (image of a mountain and the passing of seasons over time - useful in tumultuous moments in clients' lives); and "four-elements" meditation (focusing on earth, water, fire and air as a source of balance in one's life). Each meditation is purposeful and insightful.  I highly recommend this book!

 

 

 
About Us
The Institute for Meditation and Psychotherapy (IMP) is a non-profit organization dedicated to the education and training of mental health professionals in the integration of mindfulness meditation and psychotherapy. MeditationandPsychotherapy.org