Teaching Clients to Use Mindfulness Skills

A practical guide

Maggie Stanton, Christine Dunkley

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135017651
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoterapia

Mindfulness has become a vital skill for many people working in the fields of physical and mental health, teaching, business, leadership and sports. While plenty of books explain the uses of mindfulness, until now none has addressed the particular challenges of effectively passing these skills on to clients in a user-friendly way.Designed to help professionals introduce mindfulness to clients, the skills laid out here can help those struggling with problems of recurrent stress or ruminative thought, and benefit people wanting to live in a more effective, rewarding way. Incorporating a series of practical exercises and drawing on their own professional experience, the authors clearly demonstrate the most effective methods for presenting mindfulness techniques to those with no previous experience. Topics covered include:

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• Orienting the client to the skill

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• Obtaining and using client feedback effectively

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• Introducing simple practises

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• Teaching clients to utilise mindfulness in everyday life

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• Case scenarios demonstrating the skills in practice

This practical, structured guide is essential for professionals already teaching or planning to teach mindfulness skills, those taking courses or workshops and for anyone interested in learning more about mindfulness.

1 What is mindfulness?

DOI: 10.4324/9780203758809-1

Being a competent teacher of mindfulness skills means being well prepared. This includes being able to answer questions about what mindfulness is, developing our own practice and knowing the evidence base. These are topics we will cover in this chapter.

When we first started teaching mindfulness to clients, ‘What is mindfulness?’ was a question we were often asked. Nowadays people are far more aware of mindfulness, whether as part of a weight loss programme at their local community centre or seeing Goldie Hawn talking on breakfast television about her book 10 Mindful Minutes (2012). In answering the question, we suggest resources to clients that they can easily access to find out more about mindfulness for themselves. A range of formats in which information is presented will cater for clients’ different learning styles and preferences. For instance:

• an easy introduction is found in: The Miracle of Mindfulness (Hanh, 2008)
• clips on YouTube (e.g. Kabat-Zinn, 2007)
• articles on the internet (e.g. Mitchell, 2012).

Over the course of learning mindfulness, clients will develop their own understanding and experience of what mindfulness is for them. To aid this, an effective teacher of mindfulness skills will have at their fingertips some simple definitions of mindfulness. When Jon Kabat-Zinn (1990) described his experience of incorporating mindfulness into a programme for stress reduction he was concerned that preconceptions about eastern meditation could stop people from seeing the relevance of mindfulness to their difficulties. He purposefully used words and phrases that were familiar in western culture to enable patients and medical colleagues to be open to the idea that mindfulness could be relevant to them. In large part this is still true today. The more we can put mindfulness in simple everyday terms that people are familiar with, the more accessible we will make it for our clients.

Definitions of mindfulness

Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.

(Kabat-Zinn, 1994:4)

This definition is the one people will come across most frequently and, in our experience, is liked by many clients. Kabat-Zinn also talks about mindfulness being concerned with the present moment: ‘Like it or not, this moment is all we really have to work with’ (1994: xi). He points out that we often spend our lives thinking about what might happen or what has happened and treating these thoughts as if they are facts. This is mindlessness. Being awake to the present moment and choosing where to put our attention, noticing when we have got caught up in our mind’s story of how it is, is mindfulness.

To bring these definitions alive and make them real for people therapists need a number of examples that will resonate with aspects of their clients’ lives. We might use the following.

Amy got an email from her boss saying that he wanted to see her. She began thinking that he would tell her that her job was under threat. She imagined that he was unhappy with the standard or speed of her work. As she walked to his office, with her heart racing and mouth dry, she remembered her mindfulness practice. She recognised that being caught up in why her boss wanted to see her was mindlessness. She brought her focus onto the experience of walking along the corridor, with the carpet under her shoes and the sound of people talking from the offices. When Amy ‘woke up’ to realise she was paying attention to her mind’s version of events, she was being mindful. In noticing her experience of walking along the corridor, she brought her attention into the present moment.

Automatic pilot

An example of being unmindful, or of mindlessness, that people will often find easy to recognise is when we are on ‘automatic pilot’, i.e. doing things without being aware of what we are doing.

I work in two locations during the week: the clinic and the university. The first part of the journey is the same. Sometimes I can set off for the university and, before I realise it, I am turning into the clinic. I have been driving on automatic pilot. If I had been driving mindfully, I would have been aware of where I was, the road in front of me, changing gear, and would have gone to my intended destination.

This story usually brings a smile of recognition from the client. As therapists, we can use a shared experience like this to have a discussion with the client about how much of the time they live in ‘automatic pilot’ and how it might make a difference to their life to learn to be mindful. It can also provide an opportunity to make the teaching point that these processes are natural things that all minds do.

Taking control of your mind

Marsha Linehan’s description of mindfulness emphasises that it is a skill that can be acquired. She makes the point that mindfulness puts you in the driver’s seat so that you are in control of your mind, rather than your mind being in control of you (Linehan, 1993b: 65). In defining mindfulness she breaks it down into what we need to do to be mindful (i.e. observe, describe, participate) and how we need to do it (i.e. one thing in the moment, non-judgementally, effectively). This emphasis on mindfulness as a skill is very much what we teach.

Developing our own practice

An important part of our capability to teach mindfulness is the development of our own mindfulness practice. We came to mindfulness through becoming Dialectical Behaviour Therapists, developing our own ability to be mindful and gradually incorporating this mindfulness into our lives. We continue to develop this practice both individually and with others. There are several reasons why this is significant. We will come back to this point throughout the book but we will summarise briefly here.

• Our own practice will enable us to model being mindful when we are with clients.
• Our own practice will give insight into difficulties clients may face (although we are all individuals).
• Our own practice will provide examples we can share with clients (as appropriate) of when we have used mindfulness in our everyday life.
• As mindfulness teachers we should not ask our clients to commit to more mindfulness practice than we are willing to engage in.
• Clients will very quickly catch us out if we are trying to teach a skill we don’t have ourselves!

Whilst we previously highlighted the advantages of using everyday language to describe mindfulness, Williams and Kabat-Zinn (2011) point out that by doing so there is a danger of losing the essence of mindfulness practice present in its eastern origins. They emphasise that, as mindfulness teachers, we must have knowledge and experience of mindfulness so that our compassion, acceptance and enquiry are apparent in what we do as much as in what we say. They suggest that any mindfulness based interventions will only be as effective as the mindfulness instructor teaching them. ‘Mindfulness can only be understood from the inside out’ (2011: 284). A recent study by Kuyken et al. (2010) observed mindfulness teachers model a compassionate stance towards others when leading practices and taking feedback. They suggested this could be an important mediating factor in the success of mindfulness interventions for people with recurrent depression (e.g. Kuyken et al., 2008).

Mindfulness based therapies

Since Jon Kabat-Zinn incorporated mindfulness into his Mindfulness Based Stress Reduction (MBSR) programme, several therapies have been developed with mindfulness as a core component. As a teacher of mindfulness skills it is important to have some knowledge of the common therapies your clients may have heard about. If delivering one of these therapies, therapists should be suitably qualified, supervised and aware of the differences in how mindfulness is taught. For instance, Mindfulness Based Cognitive Therapy (MBCT) and MBSR both have strict guidelines about the training and supervision required (UK Network of Mindfulness-Based Teacher Trainers, 2010).

Marsha Linehan incorporated mindfulness as a core skill in the therapy she developed for highly suicidal and self-harming individuals: Dialectical Behaviour Therapy (DBT) (Linehan, 1993a). This therapy is based on the idea that clients need to learn skills in managing distress, regulating their emotions and being effective in relationships. Mindfulness is practised in every DBT skills group session, and there are two sessions dedicated to teaching mindfulness at the start of every eight-week skills training module. It is at the heart of many of the skills taught, e.g. keeping mindful in interpersonal relationships (Interpersonal Effectiveness module) or mindfully observing and describing emotions (Emotion Regulation module).

One therapy that has had increasing attention in recent years is Acceptance and Commitment Therapy (ACT), developed by Steve Hayes (Hayes and Smith, 2005). It emphasises getting in touch with the present moment and developing a non-judgemental and accepting approach to our experiences, including difficulties such as anxiety and depression. In ACT, as in DBT, mindfulness is described as a skill to be learned and used in everyday life. Like Kabat-Zinn, Hayes recognises that meditation in western culture has been given a ‘bad rap’ and that how we introduce mindfulness is important in determining whether people will be willing to practise it or not. Similar to DBT, he advocates short practices that can be built upon over time.

As the name suggests, Mindfulness Based Cognitive Therapy (MBCT) has mindfulness at its core. Since its introduction in 2000 (Teasdale et al.) it has had increasing popularity. Initially it was introduced as a therapy to prevent relapse for people with three or more episodes of depression (Segal et al., 2002), and it is recommended by the National Institute for Health and Clinical Excellence (NICE) for this client population. In more recent times research has been carried out into its use in a number of diverse areas, such as for those in receipt of a cancer diagnosis (Carlson and Speca, 2011).

Unsurprisingly, a common theme in therapies that incorporate mindfulness is the emphasis on changing our relationship to experiences rather than changing the experiences themselves. Paul Chadwick developed Person-Based Cognitive Therapy (PBCT) for distressing psychosis (Chadwick, 2006). In addition to cognitive strategies, clients learn mindfulness skills. In this way they are able to develop a different relationship to a voice-hearing experience so that it no longer evokes the same levels of distress. Rather, the acceptance of the experience without judgement allows the individual to have the experience without reacting to it. In studies by Dannahy et al. (2011) and Goodliffe et al. (2010) the researchers describe how they used PBCT in group therapy for people who hear distressing voices. Over the period of the group, clients reported learning to cope with voices differently and started to see the voices as symptoms of a disorder rather than an intrinsic part of themselves. We have experience of running these groups within our own service and have seen how the changes for clients can be truly remarkable, enabling them to start doing activities they had previously given up or going into situations they had been avoiding.

Contraindications

In this book we do not go through risk assessment and management, formulation and treatment planning as these will be part of the normal clinical work we carry out with clients. When considering teaching mindfulness skills it will always be as part of our clinical formulation and treatment plan for that individual. As with any therapeutic approach, we will have carried out a risk assessment and developed a risk management plan. As therapists we need to ensure that we have an up-to-date knowledge of the research base for the area we are working in, that we have the appropriate level of skill to carry out any intervention we are offering and that we maintain this level of competence through continuing professional development and supervision activities.

Evidence base

Research into mindfulness has grown at a tremendous pace. In their introduction to a special issue of Contemporary Buddhism, Williams and Kabat-Zinn (2011) cite the results of a search for the term ‘mindfulness’ on the ISI Web of Knowledge database on 5 February 2011 by David Black. This showed the number of publications with ‘mindfulness’ in the abstract or keywords (English language only) had grown from very few in the 1980s and 1990s to 50 by 2003 and over 350 by 2010. Its application has grown from medicine and psychology to education, business and leadership. When MBSR was introduced to the University of Massachusetts Medical Center by Jon Kabat-Zinn in 1979 he could never have know...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Dedication
• Contents
• About the authors
• Preface
• Acknowledgements
• List of abbreviations
• 1 What is mindfulness?
• 2 Orienting clients to mindfulness
• 3 Introducing a mindfulness practice
• 4 Taking feedback after a practice
• 5 Mindfulness of thoughts
• 6 Living mindfully
• 7 Acting wisely
• 8 Mindfulness as a skill: case examples
• Concluding comments
• Bibliography
• Index