Impermanence: Being Present with Change and Loss
with Lawrence Ladden and Jale Cilasun
Twenty-five years ago, a journalist asked the Dalai Lama what he wanted to do next in his life. ‘To prepare for death,’ he replied. When the journalist asked if he was ill, he said no, ‘but the body is impermanent’. Hearing of this conversation, Stephen Levine, poet and best-selling advocate of mindfulness in palliative care, asked himself, ‘How would it be to live a year of my life, as if it were my last?’ How could this contemplation of impermanence and death actually enrich each year, each day, each moment that he still might have to live? His personal experiment grew into a book and a year-long course, based on bringing an open heart, a ‘soft belly’ and a willingness to forgive to all that’s unresolved in the life you’ve lived so far. Presenting this workshop as a taster for their own ‘Contemplating Impermanence’ course starting January 2019, Lawrence Ladden, a clinical pschologist, and Jale Cilasun, a consultant psychiatrist, introduced us to two of Levine’s core practices. The ‘Soft-Belly Meditation’ is deceptively simple – starting out like any other meditation on the breath, Levine gradually and poetically introduces the idea of softening the belly, combining embodied awareness with a clear intention to be present with whatever is there, to produce a truly effective ‘turning towards’ practice:
‘Let the breath breathe itself in a softening belly. / Soften the belly to receive the breath, to receive sensation, to experience life in the body. / Soften the muscles that have held the fear for so long…/ Letting go into soft-belly, merciful belly.’
As Jale read the text, we softened our bellies and let the images resonate. One participant commented afterwards that he’d been meditating for years but, ‘adding the sense of softening made a whole difference,’ and another person appreciated the phrase ‘merciful belly’ and the way it unites the muscles with the heart. ‘Merciful’ is not a word you hear very often in mindfulness literature, and it brought to mind a line from Shakespeare’s ‘Merchant of Venice’: ‘The quality of mercy is not strained; it droppeth as the gentle rain from heaven.’ In Levine’s second practice – a Forgiveness meditation – he emphasizes that forgiveness can’t be forced, and does not always succeed, but simply holding the intention to forgive and making it a regular practice, ‘is mercy in action in the same way that compassion is wisdom in action,’ allowing us to resolve as far as we can the resentments that continue to entangle us. Emphasizing the value of forgiveness as a way of preparing for death, Lawrence quoted Kabir, the 15thC mystic poet:
What we call salvation belongs to the time before death. / If you don’t break your ropes while you are alive, do you think ghosts will do it for you afterwards?
Hell is Disconnection from Other People
And moving from Kabir to Dante, Lawrence explained how the Divine Comedy provides a perfect analogy for the three stages of forgiveness: ‘Hell we can understand as this self-enclosed, non-reflective space where there’s no insight into the effect of actions and a total disconnect from other people. Purgatory is a relational realm where we can repair relationships that were not properly attended to – a healing process. Paradise is a realm of fulfillment and gratitude, and being able to see other people without objectifying them.’ Seen like this, forgiveness is a form of self-compassion, and one particular phrase from the meditation struck a chord for many in the group: ‘Send forgiveness into even the unforgiving mind’.
The ‘Contemplating Impermanence’ course will be a chance for Lawrence and Jale to bring their own unique and powerful Contemplative Group Dynamics approach together with Levine’s passionate contemplation of impermanence. Both have extensive experience at working with groups in clinical practice, and as Lawrence pointed out, it’s in clinical practice that, ‘we see how the mind creates a personal hell and if the person can’t see it then the group reflects it to them. It’s less painful in a group because these emotions are shared, and shared with humour. The contemplation of Impermanence really wakes you up – by not taking things for granted we can offer a caring attention to our unfolding lives.’
For full details: http://contemplativegroupdynamics.com/upcoming-fall-training-weekends/
Being Mindful of Mindfulness
with James Lawley, 8 July 2018
If you’ve done any kind of formal mindfulness training, at some point you probably found a teacher who sounded just right; whose voice, live or recorded, could bring you gently back again and again from mind-wandering, calmly and without judgment, in much the same way the voice in my car’s GPS will, with infinite patience, keep suggesting the next turning to take, however many times I ignore her advice. What would it be like, then, if such a teacher could be sitting right next to you, tuning in with gentle questions to what you – and only you – are experiencing in that moment, inviting you to go deeper and deeper into the living texture of that experience?
James Lawley’s deceptively simple questioning process, known as Clean Language, was an elegant reminder that the perfect teacher is actually always there, right inside you. Clean questions are built around a person’s own words and gestures; instead of paraphrasing, interpreting or analysing, they invite you to listen to what you just said and be curious about the metaphorical and embodied sense of that. It’s called ‘Clean’ because, in both intention and structure, the questions make it very difficult for the facilitator to import their own conscious or unconscious agenda into the space of the person who is at the centre of the process.
Modelling and mindfulness
Developed by New Zealander David Grove, Clean Language inspired James Lawley and his partner Penny Tompkins, to devise their own process – Symbolic Modelling – using the questions to help people model the metaphorical landscape of their inner experience. In the twenty years they have been developing it they have applied it in many contexts, from psychotherapy to coaching to academic research and corporate interviewing, even helping a police force design better ways to interview vulnerable witnesses. As James points out, a core principle is that, ‘It’s a modelling process and there’s no intention for the person to change. For some people, it’s better not to change, so as a Clean facilitator you’re aiming to have no investment in whether a person changes or not.’
So what brought him to modelling mindfulness? ‘I’m not a mindfulness expert,’ he readily admits, ‘but I’ve always been interested in it and I began to notice that when you ask people Clean questions, mindfulness seems to be a by-product of the process.’ Researching mindfulness with the intention of creating some kind of model of it, he asked himself, ‘What is common to all the different descriptions of mindfulness? There are many possible purposes in the literature: stress reduction, loving kindness, compassion and so on, but what is left if we take out every purpose except the ones that occur in every description of mindfulness?’ That led him to the conclusion that mindfulness is essentially about where we put our attention, how we know when that attention has wandered and how skilful we are at bringing it back.
Being mindful is like what?
The detailed theory of James’ model is set out in his article (see link below) but as he emphasized, no amount of theory can replace actual experience. With the help of one of the most experienced practitioners in the group as a volunteer (V), James began a demonstration by asking V where he would like to sit, and then where V would like James to sit. This very respectful set-up emphasizes that the whole approach is about the person making their own decisions and acknowledges the visceral intelligence of what it means to feel safe in one’s own space.
James began with one simple question: ‘And being mindful is like what?’ The exploration that followed, rich with metaphor and embodied sensation, took V in just a few minutes into a deep sense of ‘Nothing’. When James asked, ‘What kind of Nothing is that Nothing?’ V’s response was, ‘A cognizant Nothing. It’s there with each sensation – it’s reliable.’
The transcript can’t convey the resonance that began to build as V went deeper and deeper into his own experience. It was as if that ‘Nothing’ was rippling out into the room, inviting the whole group to resonate with it. Asked about his own experience of the process, V described it as ‘An opening to look, an enquiry, an unfolding’, while one member of the group described witnessing the process as ‘enthralling’ and another as ‘totally absorbing’.
Hints from the universe
Then it was our turn. Armed with a few of these clean questions, for example…
And is there anything else about…X…?
And what kind of….X….?
And where is…X…?
And does…X…have a size or a shape?
…we worked in pairs, starting with that same opening question, ‘And being mindful is like what?’
Feedback from this exploration was partly about the technical challenges – remembering the person’s exact words, deciding which ones to focus on, noticing that it really did make a difference to the person’s experience if their exact words were not used. But even as beginners, the experiences we had in this uniquely subjective exploration of mindfulness were rich. One person noted how extremely client-centered the process seemed to be. Another said it was, ‘Quite exciting, as if we were on a boat ride together, and the quality of attention felt very safe, very held.’ Another participant was surprised at how vividly a classic metaphor had come to her, and how suddenly it had dissolved into a simple awareness of all the detail in the room around her. Personally, I found myself at the receiving end of a very clear (and reassuring) ‘hint from the universe’ – one which I had read enough times in the literature but which was suddenly made emphatically real and personal.
Modelling ‘No Mind’
Summing up, James admitted that however you try to model mindfulness, you end up with a Zen koan. David Grove’s ultimate intention in devising Clean Language, he said, was that, ‘The I-ness of the facilitator should cease to exist.’ That certainly sounded like an echo from Buddhist psychology, and in fact James mentioned a fascinating session in which he helped a very experienced Japanese mindfulness teacher, Daso Saito, to explore the experience of ‘No Mind’, and how she could help her students access that. It did indeed sound very Zen – when an ‘I-less’ facilitator helps someone lose any sense of a discriminating self, what’s left? Just ‘No Mind’ looking for itself and using Clean Language to do that…
For James Lawley’s background article and website go to: http://www.cleanlanguage.co.uk/articles/articles/386/1/Becoming-More-Mindful-with-Clean-Language-and-Symbolic-Modelling/
For introductory courses: https://cleanlearning.co.uk/
Deepening Mindfulness – Nurturing Your Meditation Practice
with Alexander Irving and Zoe Shobbrook-Fisher, 14 April 2018
In our training to teach mindfulness, there are a lot of maps to choose from, often emphasizing very different parts of the territory, sometimes contradicting each other and – as the field evolves more rapidly than at any time in its history – sometimes simply out of date. Alex Irving and Zoe Shobbrook-Fisher are two members of ‘Mindfulness Beyond’, a new group offering courses and retreats for people who have already done an 8-week mindfulness course. Together they took up the challenge of guiding us through the relatively uncharted territory of how we can support ourselves as teachers when we ourselves may be a little lost.
Of course, feeling lost is clearly marked on any decent map of mindfulness, so what was it that seemed to make this day so powerful? The ingredients were mostly familiar enough: sitting, walking, standing, mindful listening to each other, silent breaks, a little poetry…yup, that sort of thing, but so deep and so gentle, so rewarding and so accessible, what, I asked myself, was really going on?
One answer was that Alex and Zoe were walking their talk so fluently that, for me, the initial sense of distance between facilitator and participant seemed to dissolve very quickly into a space of openness and potential. Drawing on various sources, from the classic guide to ‘Teaching Mindfulness’, (McCown, Reibel and Micozzi, 2011), with its step-by-step invitations to confront each new challenge of mindfulness teaching, to the mindful movement of Gabrielle Roth’s Five Rhythms, their personal styles complemented each other seamlessly, but left us plenty of room to explore things in our own way, privately and at our own pace.
What do you Love?
As the practices got gradually more challenging, there was noticeable care in setting them up safely and respectfully. So, for example, when Alex proposed the traditional form of asking a partner the same repeated question, he first paid attention to posture rather than content: ‘Sit as you would sit in meditation, so you have good access to your body sense, and say whatever emerges for you; it doesn’t necessarily have to be an answer to the question.’ In this case, the question we were supposed to ask each other was, ‘What do you love?’ – not everyone’s idea of something they might want to explore with a complete stranger. But instead of plunging us in at the deep end, Alex demonstrated it by first asking himself:
What do you love?
I’m feeling a bit nervous thinking about it.
Thank you. What do you love?
The feeling moves up to my chest.
Thank you. What do you love?
My mum just popped into my head.
‘The questioner cradles the question gently,’ he said, ‘it’s not an interrogation. And the person responding answers in any way they wish. It doesn’t have to have anything to do with the question in any cognitive way.’
With such a careful set-up, and such a powerful question, the process went very deep for many. As one participant commented to the group, ‘I was very surprised by the answers I came up with, and very enriched by the answers my partner came up with.’ In several opportunities to check in with each other as a whole group, this seemed to be a common experience: as well as our own personal insights, we were learning a lot from listening to each other’s.
Past, Present, Future
Equally powerful was Zoe’s guided meditation on how we see our mindfulness practice in terms of past, present and future. Using a tree as the metaphor, we explored what had brought us to mindfulness as the roots, our present practice as the trunk, and our sense of the future, of where our practice might be going, as the branches. In the group reflection afterwards, one image that emerged between us was the way the roots of trees connect to each other under the earth. As the day went on it seemed to me that we were communicating with each other in the same kind of way, not just brain to brain, but through embodied presence.
At lunch, we were given a choice of spaces – somewhere to be silent and somewhere to talk. A longer period of practice in the afternoon included standing, walking and sitting, and a chance to contemplate how, as Zoe put it, ‘Our intention for each period of practice is the compass for that practice.’
The Sangha not the Song
In the last hour, as Alex and Zoe began to realize they didn’t have time for all they’d planned, Zoe simply followed her intuition and talked very honestly about her relationship with her own personal practice. ‘I teach various different approaches, MBSR, and Mindful Self-Compassion. I dance the 5 Rhythms. I practice Yoga, and sing Kirtan Yoga. But I don’t attend a regular sangha. So how do I support myself? How do I avoid feeling scattered?’
Her question resonated for many in the group, and opened the space for a rich discussion on what the day had given each of us, and how these one-day meetings are developing the group itself as a space for nourishing ourselves and supporting each other. If you would like to be part of this evolving process, join us for the next one on ‘The Language of Mindfulness’ on 17th November.
– Nick Pole
The ‘Mindfulness Beyond’ group was set up by Alexander Irving, Zoe Shobbrook-Fisher, Rosalie Dores and Tessa Watt. For details of their courses and retreats: www.mindfulnessbeyond.org
Mindfulness and Psychosis
Dr. Pamela Jacobsen, 4th March 2018
Even experienced clinicians can find it challenging to work with people who experience what are commonly known as psychotic symptoms. Staying present with someone in the grip of psychosis not just as a patient but as a person, is not easy. Pamela Jacobsen, who recently completed a clinical trial on mindfulness for psychosis, gave us a masterclass in keeping a human connection with people whose reality seems so completely other, and how mindfulness practices can be adapted to work effectively with psychosis.
Insight and Acceptance
Acknowledging from the start that some of her colleagues question the safety of this approach, she began by asking what it brought up for us. When one participant asked if it was safe to use mindful methods with someone who lacked the insight to realize that the voices they’re hearing don’t actually come from other people, Pamela simply asked how that might be a barrier to mindfulness practice. ‘If they’re not seeking help, that’s a different thing, because you can’t force therapy on anyone, but insight is such a massive topic, and a controversial one. Actually, mindfulness can be very helpful for people who may not agree with their diagnosis. The vast majority of people I see don’t agree with their diagnosis, or even see the problem as a mental health issue. Over 50% of people in my study were under section and were in hospital involuntarily, so by a medical definition they wouldn’t be judged to have that kind of insight.’
Is My Psychiatrist Working for MI6?
In an emotionally powerful role-play, Pamela showed us how she would work with ‘Bob’, (played by her colleague Andy Phee) – someone in the grip of psychotic paranoia being interviewed about joining a mindfulness group. As Bob, Andy drew on his own experience of working with psychosis to create a vivid portrait of someone spending all his energies on either blocking out or struggling with the contents of his internal world. How would you respond, for example, if someone started to tell you in a matter-of-fact way, ‘I stay awake most of the night because I know they’re out there and I need to protect myself. During the day I watch them through the window. I don’t know whether they’re from MI5 or MI6, but I know it’s them because there’s always a four in the number plate.’
Avoiding all temptations to get lost in the content of his paranoid thoughts, Pamela simply accepted Bob’s subjective experience, focusing instead on building a ‘shared understanding’ of where and how she might be able to offer help. For example, she acknowledged Bob’s reality without challenging it by saying: ‘You have a real sense of feeling you’re in danger most of the day, so I really appreciate you taking the trouble to get here to talk to me today, and it’s understandable that you’re feeling so stressed.’ When Bob says, ‘Sometimes I wonder if my psychiatrist is working for MI5’, Pamela simply gives a respectful nod, and asks, ‘If things were a bit better for you, what would you be doing in your day?
In that way she helps Bob re-connect with more positive aspects of his life, at the same time noticing how easily he can slip back into the loop of paranoid thought: ‘I love to cook, and shopping for fresh fruit and veg, and walking along the canals. And time with my wife, but I’m worried sick that if she goes out they’ll get her and she’s never going to come back.’
And instead of imposing a view about where and how to intervene, she waits for Bob to tell her: ‘So, Bob, obviously things are really tough, I’m wondering what you’d like some help with?
Bob’s response is again a mix of paranoid and resourceful ingredients: ‘Someone I can trust who can speak to the authorities. Sleeping better. Getting some exercise again – just getting some fresh air’.
As the role play ends, Pamela’s reflection on her own experience is about needing to anchor herself so as not to get caught up in the helplessness, or drawn into fix-it or assessment mode. Andy’s feedback as Bob is, ‘It felt like you’d heard my most pressing issues. The issues were named and that helped.’
A Shared Understanding
As Pamela says, interviews like this are really about developing a shared understanding of what’s going on for a person and what they’d like to change. In CBT it’s called a formulation – a detailed analysis of symptoms and behavior, a diagnosis and a plan of action. But Pamela points out that this is ‘something everyone who teaches mindfulness does, even if they don’t think of it as a formulation, for example when you interview someone before they join a mindfulness group to see what it is that they would like to change in their life’.
And her apparent acceptance of psychotic delusion? ‘Some people,’ she says, ‘will say of a patient, ‘They think the voice is real’. Well, for the person hearing the voice, it is real. We’re not the truth police. We’re not imposing a model of reality. We don’t want to pathologize voice-hearing in itself. Some people hear voices in a positive way, even a spiritual way. So for me it’s no different from someone coming with back pain that they might want some help with coping with if it’s causing them distress. In fact, showing the person straight away that you take them seriously saves so much time. If I’d got into an argument with him about his story, all his energy would go into trying to convince me, and we’d both be stuck’.
Adapting Mindfulness for Psychosis
She then plays an audio clip of Jon Kabat Zinn guiding a meditation on breath, asking us to listen to what might need to be different for a group with psychosis. As a group, we manage to come up with most of the key adaptations she used in her clinical trial:
- Keep practices short – between 3 and 10 minutes. Remember medication can be sedating and participants may be coping with a lot of serious issues.
- In meditations, keep silences short and use more spoken guidance, since your voice in the room is an anchor for people.
- Some participants find it hard to focus on the breath. It can be easier to suggest some form of choiceless awareness.
- Remember that the Mind in psychosis can be extremely busy, so use a lot of grounding practices, focusing on physical contact points, for example, the feeling of your feet on the floor.
- Use simple concrete language without too much metaphor or abstraction.
- Make explicit reference to psychotic experiences in your guidance, for example, ‘Your mind may have wandered away to a thought, a voice, a worry.’
- Remember that some people may not want to practice at home at all, because they need the anchor of the teacher to make it safe.
- And finally, offer mindfulness as a skill, simply another mode of relating to one’s experience, and be clear that it might not be for everyone and that’s fine.
The results of Pamela’s clinical trial were very positive: satisfaction with mindfulness therapy was very high, averaging 9/10, with no drop outs among the 25 participants in the mindfulness group. She is now raising money for a further study. For more details you can contact her at: firstname.lastname@example.org. She will be co-presenting a seminar with Professor Paul Chadwick, the pioneer of mindfulness-based approaches for psychosis, at Kings College, London on 12th April: http://babcpconference.com/spring_2018/workshops_spring_2018.htm
Report by Nick Pole
Mindfulness and Trauma
with Nick Pole, 14 Jan 2018
Trauma, like laughter, is highly infectious. Just listening to narratives of trauma can easily disrupt your thoughts and induce uncomfortable feelings. How often do you frown, wince or hold your breath when you see other people’s suffering on TV? So the key question behind this workshop was simply, “How do you stay present as a mindfulness teacher when some apparently simple practice triggers a traumatic experience for someone on the group?’
Over the past 20 years, thanks to the work of pioneers in psychiatry and mind/body therapy like Bessel van der Kolk, Peter Levine and Pat Ogden, it is becoming increasingly accepted that treating trauma effectively involves working with both body and mind – with the ‘top-down’ methods of cognitive approaches as well as the ‘bottom-up’ techniques that work directly with trauma that has become embodied in posture, movement and breath.
This is because trauma is not just infectious, it is pervasive. Trauma suffered in adulthood can easily connect with childhood trauma still held somewhere in the bodymind, just as rain in driving wind can penetrate a wall and seep down into dampness that may have been there for a long, long time. So how do we ride the wave or, in the late Cindy Cooper’s phrase, ‘the wobble’, that can suddenly sweep through the whole group when trauma arises unexpectedly? Experience with embodied approaches to trauma seems to show that mindfulness is actually one of the best resources we have available to us. Research by professor Sonja Lyubomirski at the University of California indicates people who are able not just to move on from trauma but to learn from it – to experience ‘post-traumatic growth’ – tend to have the very same life skills we consciously cultivate in mindfulness teaching.
Almost every approach to trauma nowadays acknowledges the importance of establishing some positive resources for both client and practitioner before starting to work explicitly with the traumatic experience. In the first experiential part of this workshop, we used some basic Qi Gong postures to explore three fundamental resources in an embodied way.
Reggie Ray, the author of ‘Touching Enlightenment’ and one of the leaders in the field of embodied mindfulness practice, starts his trainings not with a raisin, not even with the breath, but with our sense of groundedness. How deep into the earth can you imagine your attention going? What happens to the busy mind when you simply kneel down with hands on the floor and rest your forehead on your fingers? And when you connect with the earth in this way, what sense of relationship do you have with it?
The second resource is a sense of safe personal space and boundaries. Filling your lungs with air to create space inside your chest, imagine that space expanding around you, extending your arms with index finger and thumb outstretched, to define the boundaries of that space. Then say, ‘This is my space.’
The third resource is the feeling that comes from folding your arms, something we naturally do when we need emotional protection. With the fingers of each hand wrapped around the opposite upper arm, notice whether you feel comfortable or constricted in that defended posture. Then, breathing gently into the area around your heart, begin to think of something that brings a sense of openness and let your hands widen out as if they’re holding an imaginary ball in front of you. How big is that ball? If it’s ok, imagine how you would be if you were about to hug a dear friend. How wide can your arms open without feeling forced? This spectrum between openness and protection is one we move back and forth through all the time in social life.
In the final experiential exercise, we explored the actual embodied experience of ‘sitting with’ another person when that person allows themself – gently – to connect with some personal sense of ‘wobble’. This exercise is inspired by the work of the Californian psychoanalytical psychotherapist Allan Schore, whose research, (along with that of British psychiatrist Iain McGilchrist), emphasizes the different way we listen to each other when we listen with the verbal mind (located for most people in the left side of the brain) and when we listen in an embodied way, drawing much more on the resources of ‘felt sense’ and empathy that are located mostly in the right hemisphere. Schore’s point is that the traditional model of talking therapy has been very much focused on the left-brain to left-brain conversation. His suggestion that the non-verbal right-brain to right-brain conversation is actually more important has had a huge impact on the way psychotherapists think about how to be more fully present with a client.
So in this exercise, in groups of three, Person A took the role of the teacher, sitting with Person B in the role of a group member, while Person C acted as assistant to A, gently asking non-intrusive questions to help A, as the teacher, explore their felt sense of what happens when B, in the role of group member, brings an experience of ‘wobble’ to mind.
The experiential exercises brought a whole range of results:
‘The opportunity to ground to begin with was very helpful for me, to really check in with how I was doing, including the difficulties in that.’
‘I was gripped by the emphasis on resourcing and safety and the complexity of listening…and so was everyone around me.’
‘Getting closer to the floor! Very grounding in a physical sense, and this helped me feel more grounded in an emotional sense.’
One person trying to tap into the ‘wobble’ found his muscles repeating a familiar pattern of spontaneous shaking, (common with trauma) but the difference this time was, ‘Allowing this to come out in public without feeling too awkward’.
Another participant, in the teacher role, found that, ‘What was really good for me was the feedback from the person in the group member role. Even though she did not have the same experience that I had felt, it didn’t matter. When I mentioned the word, ‘safe’, she reported that her intense feelings began to subside.’
Someone in the group member role didn’t notice any significant change in her experience of the ‘wobble’, and ‘felt our group was still feeling it’s way into being present with one another.’ A good reminder of how somatic listening can take time to build.
Someone else noticed that she didn’t feel safe opening up to this embodied presence herself, but learned something from listening to her partners’ experiences of it in the group.
Another participant felt the opposite: ‘I felt very connected to my body during the whole workshop, and this was the most useful thing for me’.
And an emailed comment a few days later summed up the potential of this embodied, relational approach: ‘How is it that the simplest of things are so profound! I have noticed a difference in the way I am with clients (and people in general). It is very ‘freeing’…I’m more aware of my need to be in control and to over-identify with the Teacher role – and remembering to be compassionate!
Nick Pole, http://www.nickpole.com
Some key references: (for a full list, please email Nick at email@example.com)
Levine, Peter (2010) In an Unspoken Voice
Schore, Alan (2012) The Science of the Art of Psychotherapy
Van der Kolk, Bessell (2014) The Body Keeps the Score
Ogden, Pat and Fisher, Janina (2015) Sensorimotor Psychotherapy
McGilchrist, Iain, (2012) The Master and his Emissary
Cornell, Ann Weiser (2013) Focusing in Clinical Practice
The Mind’s Eyes – A Mindful Approach to Eye Movement Therapy (EMDR)
with Joshua Isaac Smith, 5 Nov 2017
Eye movement, like breathing, is happening all the time whether you’re thinking about it or not. And just like the breath, bringing conscious awareness to how you move your eyes can have a profound effect on mind and body.
When might this matter in mindfulness-based therapy? According to Joshua Isaac Smith, a trauma therapist and corporate resilience coach, research into how neuroscience can influence therapy indicates that that to work successfully with trauma we need to involve both mind and body, left brain and right. The proven effectiveness of eye movement therapy (EMDR) is based on this principle. The left side of the brain governs our verbal, cognitive day-to-day thinking and is the side that most forms of talking therapy favour. But the right hemisphere is the realm of affect and it’s this side that we need to work with most in trauma therapy. By using embodied, relational techniques, we can help clients feel safe enough to turn towards traumatic memories, while bringing with them the kind of resources they need to desensitise and reprocess those memories so that traumatic experiences can be learned from and let go.
That’s what the ‘D’ and the ‘R’ in EMDR stand for: Eye Movement Densensitisation and Reprocessing – quite a mouthful, but those last three words hint at the very carefully structured protocols it uses to help free clients of repeated traumatic memories. It was developed by Francine Shapiro as she searched for a way to prevent a recurrence of the cancer she was treated for in 1979. Discovering that different kinds of eye movement can have different effects on memory and mental processing, she realized that the amount of energy the brain gives a traumatic memory first needs to be reduced – desensitised – before the memory can be successfully stored simply as a learned experience rather than an intense recurring flashback.
The Eyes Are The New Breath
Joshua packed this session with brief but powerful exercises, explaining how each one fitted with this emphatically mind-body approach. But he was careful to introduce the experiential practices with quotes from pioneers like Pat Ogden, whose Embedded Relational Mindfulness has made her a world leader in trauma treatment, and the brilliant psychoanalytic psychotherapist Allan Schore, whose decades of research on the ‘Right Brain to Right Brain’ approach to psychotherapy have had a profound effect on the field.
The eyes are the fastest moving part of our body, he explained, and even when you think they’re still, (as you might think in meditation) they’re actually making constant micro-movements, gauging balance, spatial relationship and internal state. This is about understanding there is a yin and a yang aspect to our eyes – the doing mind thinks of them (‘sees them’) as active agents of perception, while for the being mind they are also mirrors of our mental state.
And since the eyes are essentially part of the brain, they can be an even more direct and powerful way of influencing what’s going on in mind and body than simply working with the breath. In fact, by bringing some gentle but deliberate choreography to your eyes, you can influence the movement of the mind, almost in the way a rudder guides a ship through the waves.
Right Brain To Right Brain
After carefully checking for contraindications like recent eye surgery, or any eye movement that causes pain, Joshua’s introductory exercise included looking at a partner while focusing on their left eye. He cited research on human-to-human eye contact that suggests that looking at your partner’s left eye may signal an openness to empathic connection. So, inviting us to make that left eye gaze with our partner while holding each other’s hands palm to palm and at the same time making the sound of the heart mantra, a soft, open ‘Aaaah’, we got a strong multi-sensory impression of this non-verbal right-brain to right-brain kind of connection through eyes, sound and touch. Responses from the group reflected that; some said that they felt more vulnerable, others more connected.
One of the most powerful eye movements for helping the brain to reduce that intensity of charge is to follow the shape of the Infinty Symbol. This simple figure-of-eight movement is so flexible and effective that it can also be used to help free many kinds of emotional and somatic stuckness. Joshua invited us to move our closed eyes gently around, as if following the frames of a pair of glasses, first in one direction and then in the other, as we focused on some place in the body that felt tight. One participant admitted that in spite of his skepticism he was impressed at how effective it was in changing a physical sensation from uncomfortable to neutral.
Embodied And Relational
Many mindfulness-based approaches invite us to connect with positive resources, and this is particularly important in preparing the ground for working with trauma. One reason why EMDR has such a successful track record with trauma is because it uses eye movement and somatic contact to help the client embed these positive resources. This can be both faster and more effective than listening to a guided meditation, partly because it slips around the verbal mind’s amazing ability to raise doubts and queries about images delivered in verbal form. As an example, Joshua showed us ‘Butterfly Tapping’ – sitting with arms folded, each hand wrapped round the opposite upper arm, as you hold a real or imagined sense of a safe place in mind; then, gently tapping your right hand on your left arm, then your left hand on your right arm, you alternate this tapping continuously as you keep your image in mind. The physical tapping embeds the image directly in somatic memory, bypassing the cognitive mind while also anchoring the resource in a way that it can be easily recalled.
Joshua’s final point was that mainstream mindfulness needs to take on board this more embodied and relational approach, especially in working with trauma. While his own work draws deeply on the somatic intelligence inherent in yoga and meridian-based methods, it also integrates neuroscience and the proactive approach of positive psychology. It was, as one participant said, ‘The most unusual mindfulness session I’ve ever been to’, but the packed room (our biggest attendance ever), and the enormously positive feedback, are a strong hint that there is real enthusiasm among mindfulness practitioners for this more mind/body approach. Many thanks to Joshua for this highly engaging introduction to EMDR – and for showing us so convincingly what a difference a little eye movement can make.
Mindfulness Based Compassionate Living
with Greg Scott, 10 Sep 2017
An old friend who cringes whenever I mention mindfulness told me recently with a certain defiant pride, “I’m keeping my head down until this whole mindfulness thing is over.” He may be keeping his head down for some time. Mindfulness shows every sign of surviving its own success, and becoming as socially acceptable as jogging or yoga or watching Bake-Off. And one clear sign that mindfulness really is putting down roots is the number of people asking, ‘What can I do now that I’ve done the eight-week course?’
Greg Scott, who for many years has been working clinically with mindfulness-based approaches for problems like anxiety, depression, and alcohol and drug abuse, presented a strong case for Mindfulness-Based Compassionate Living as a front-runner in the rapidly evolving field of follow-up courses.
MBCL was originally developed by psychiatrist Eric Van Den Brink and former Buddhist monk Frits Koster in Holland. Greg explained that it attracted him because, “It’s an intelligent, accessible approach that links together the work of all the main players in the field – Paul Gilbert, Germer and Neff, Tara Brach and Rick Hanson, as well as MBSR and MBCT.” It also has a coherence and pragmatic flexibility, he said, and just as important, the teacher-training is a lot more affordable than many university-based courses.
A Supportive Wish
As Greg took us through a first experiential practice, it was obvious that a lot of careful thought had gone into the way language is used in MBCL. For example, in the first guided meditation the challenge of weaving an invitation to self-compassion into a simple Breathing Space practice was met with phrases like: ‘Expand the awareness to include the body as a whole. Then seeing if it’s possible to hold a supportive wish for yourself; a kind, gentle wish. You can choose something or just allow something to emerge if it wants to. Spread that into your whole being, softening areas of pain or difficulty. Maybe a wish doesn’t come. That’s fine. This is about what’s happening now, not about results.’
One participant said that she noticed this had a very different effect on her than the normal 3-Minute Breathing Space, and for her it was not just including the ‘supportive wish’ but the gentle invitation to ‘allow the wish to emerge if it wants to.’
This care with language is especially important in compassion training. ‘Self-compassion can bring up unexpected things,’ Greg pointed out, citing Chris Germer’s well-known Backdraft metaphor – long-smoldering issues hidden from consciousness which, given the oxygen of attention, can suddenly blow up in your face.
So it’s a risk, but one worth taking, Greg said, because the core principle here is that compassion can be learned – ‘If people don’t have it, they can learn to generate it. We’re building the capacity to imagine, and that creates a physical response; imagining things can bring on a whole cascade of physical responses enhancing the ability of the new brain into override the old brain.’ Then patients can benefit from the well-researched resources that self-compassion has to offer. For example, Greg mentioned the work of Deborah Lee at the Berkshire Traumatic Stress Service, where excellent results with complex trauma may owe a lot to patients being given compassion-based therapy before any specific work is done with the trauma itself, or the shame that trauma often brings in its wake.
A Safe Place…that wants you to be here
The second practice – a familiar-enough invitation to imagine ourselves in a safe place – was again given a compassion-focused twist. Once more, the language was careful, bringing us back to the body and a deliberate deeper, soothing kind of breath, and inviting us to:
‘Imagine a space that is safe, not worrying about pictures or how it arises, but allowing a sense of a space that is safe. See if it’s possible to open your senses to this, opening your eyes to what you see, your sense of smell, your skin, the touch and feel of this place. A space where you’re accepted. A space that can accept the part of you that you can’t accept yet. How does it feel in your body, face, neck, torso, arms, heart? Then allowing this image to come up again but with a real sense that this place wants you to be here; that it values you in all your humanity. How does it feel to be embraced by this safe place?’
For many of us, that second part, allowing the place to embrace us, brought a profound sense of self-acceptance. But even among a seasoned group of mindfulness practitioners, that was not everyone’s experience. One participant said this is an exercise she often struggles with. ‘I can’t settle in my mind on a safe place; it’s like I’m auditioning places, and each one I think of is somewhere I’ve felt safe sometimes but not at other times.’
Others in the group felt that they lacked the therapeutic experience to be able to hold the kind of responses that might arise with such a powerful exercise, or that there might be some in a group who just didn’t have the basic skills of self-compassion to do it.
‘It’s Not Your Fault’
Greg’s point was that such a practice can always be at least a first step towards recognizing that there can be such a thing as safety, even say, for a survivor of child abuse whose initial belief is that there’s no such thing as a safe place. ‘We’re bringing to awareness how much these negative thoughts are created by social conditioning, using phrases like, ‘You didn’t choose this.’ and ‘It’s not your fault.’* Later in the course we introduce the idea of a compassionate friend or ask, ‘What would that compassionate side of yourself advise in similar circumstances?’
‘In MBCL we always start by coming to a pause, and getting a soothing rhythm going,’ Greg said, ‘then, we invite people to bring up a difficulty and adopt a position of ‘No, I don’t want this,’ and just notice how that feels. Then coming back to a pause, with the same issue, we ask, ‘Can we say Yes to this?’ And then we come back to the pause again and just notice those two experiences. So it’s about realizing that you can go either way. Mindfulness isn’t about rolling over and accepting anything at all. Compassion isn’t about being a doormat. The point is to help us become conscious of this reactive resistance and recognize that reactivity, and then ask, ‘What’s the compassionate thing to do?’’
Many thanks to Greg for being such a reassuring embodiment of the principles he teaches, staying calm, kind and patient when questions, cautions and concerns were coming at him thick and fast in a very lively discussion.
report by Nick Pole, author of: ‘Words That Touch – How to Ask Questions Your Body Can Answer’ (Singing Dragon 2017)
You can find out more about MBCL at Erik van den Brink’s website: https://mbcl.org/
* For the classic scene from ‘Good Will Hunting’ where the line ‘It’s not your fault’ creates both backdraft and breakthrough, click here: https://www.youtube.com/watch?v=GtkST5-ZFHw
Embodied Awareness: Mindfulness and Feldenkrais
with Colin Poole, 4 June 2017
Do you notice the way your arms swing when you walk, or if one arm swings more than the other, or how the movement of your arms relates to your ribs or spine or hips? And can you imagine what it would be like to have someone walking beside you, tuning in sensitively to the pace, momentum and rhythm of your swinging arm, and with the gentlest touch helping it to swing a little more?
With this many-layered exploration of movement, awareness and empathic attunement, Colin Poole showed us the essence of the Feldenkrais approach to somatic experience and how well it can blend with – and add to – other mindful movement practices. As one participant put it, ‘In mindful walking I learned to be very aware of the sensations in my feet, but not much else. When you bring in the arms, there’s much more awareness of energy. The body takes over and space means something different.’
In another exercise, Colin asked us to walk around first on our heels, then toes, then the inside and outside edges of our feet, then to come back to ‘normal’ walking. Then he said, ‘Now change your mind, and notice what’s different’. At first, this instruction made no sense to me – I had no idea how to change my mind. Then I saw other people changing their direction or the way they were walking. That didn’t seem like changing your mind to me, but peer pressure is a wonderful thing and as I started walking sideways or backwards or walking just on my toes, I noticed my sense of myself and my relationship to people around me was indeed changing.
The suggestion was, Colin admitted, designed to provoke, to challenge our preconceptions about where mind and body begin and end. For Moshe Feldenkrais, engineer, physicist, judo expert and inventor of the mind/body education method that bears his name, there was no clear division between mind and body, apart from the artificial one the mind itself creates.
Colin explained how Feldenkrais was interested in ‘exploring the living body through sensations, rather than through the medical model, and how you might get a handle on those sensations by giving them names: lighter, heavier, bigger, smaller…a more foundational layer of body awareness that comes before we give meaning or attach emotions to it’.
Like Mindfulness, ‘Feldenkrais is not a corrective approach in which certain postures or movement are right or wrong,’ Colin said, ‘it’s about finding what your preferences are and bringing attention to them. For example, everyone has a right and a left, and a preference between them. One eye is more dominant, or you prefer one ear when you listen to your mobile phone. As mindfulness teachers, when someone is doing an action you can always get them to compare differences.’
For example, he asks us as we stand still to embody our ‘best’ posture and to notice how we do that, then to let it go and ‘notice what you’re letting go of’ – good question! Then to move back and forth between ‘best posture’ and ‘let go’ a few times. Some kind of somatic learning seems to happen automatically as we do. This sense of subliminal learning amplifies as he talks us through increasingly complex variations on extremely simple themes – turning our heads and chests to one side, for example, and then exploring what it’s like turning the chest without turning the head, or turning hips and head at the same time but in opposite directions, or turning the head without moving the eyes. Suddenly you are doing things with your body that you’ve never done before.
‘Doing familiar things in unfamiliar ways,’ was one of Colin’s phrases that stuck in my mind, but it wasn’t until the following morning that I found out how deep this kind of learning goes. Reaching to open the fridge door in my first-thing-in-the-morning automatic pilot way, I realized that my arm was saying ‘No’. It didn’t want to give the door handle its usual muscular tug; it wanted the movement come more collaboratively from arm, hips and legs. I tried it – much less effort, much less tug.
Colin’s essential message for us was that when you bring the core values of mindfulness to your way of being with your own body, you end up with something a lot like Feldenkrais. As a teacher, he embodies that message with such playfulness and poise that your mirror neurons do most of the learning well before your conscious mind has realized it. His current PhD research on the relationship between dance and the trauma of racism promises a way into a subject that conventional approaches often find too challenging, and one which the mindfulness field with its search for ways to increase diversity, could have a lot to learn from.
– Nick Pole
Nick’s book ‘Words That Touch – How to Ask Questions Your Body Can Answer’ is published by Singing Dragon, 2017
Still Gaze, Still Mind
with Lawrence Ladden and Jale Cilasun, 2 April 2017
In walking meditation we notice all the subtle transitions involved in shifting weight from heel to toes and from one foot to another. But in normal mindfulness teaching we pay almost no attention to the many layers of transition that accompany the return from meditative silence to being socially present with the group. The longer the silence, the harder that transition can be. Noticing people’s responses to this in his own group of experienced mindfulness teachers, clinical psychologist Lawrence Ladden drew on his knowledge of group dynamics to find a way to bring attention to what had been ignored before – that shifting back and forth between silence and speech, between solitary meditation and engagement with the group, is a transition that tells us as much about our socially-constructed sense of self as any amount of individual practice might do.
‘Speech re-connects us to the hundreds of roles we play in everyday life, and the postures that embody those roles,’ he explains. ‘If we limit our words to the simplest descriptions of actual body sensations – warm chest, stiff back – we allow ourselves to be in the group without those roles.’ Ordinarily our roles are necessary and facilitate meeting our goals; it is the automatic going into a habitual social pattern that the contemplative group suspends. This became very obvious even in this short session where we focused mainly on body sensation, but over a weekend, as the contemplative group develops participants are invited to notice and give voice to their more complex responses to being in the group, while remaining grounded in the body and the present.
In normal mindfulness-based trainings, the facilitator leads the practice; in this approach – as participants update each other moment-by-moment with simple sound-bites of embodied sensation – the facilitation becomes diffuse through the group. As Lawrence puts it, ‘Each time a member of the group puts sensations into words, the rest of us find ourselves comparing that experience with our own, so each contribution is an act of generosity, an invitation to cultivate mindfulness. Then we begin to notice how we affect one another as we name and give form to our experience.’
The Gaze and the Group
Lawrence asks how many of us in the group usually practice with eyes closed – nearly all of us. ‘In Buddhist practice,’ he points out, ‘the Southern tradition tends to be eyes closed, and the Northern and Zen traditions tend to be eyes open’. Starting with eyes closed, we begin to name our sensations; then after a while he invites us to open our eyes and gaze at the floor, the texture of the grain in the floorboards, then to widen our peripheral gaze to include the circle of people’s feet. After a couple of iterations and group reflections on the experience, we are invited back to silence and then to transition to speech, opening our eyes to the whole group, and whoever is speaking. We share our sensations in the moment as we open fully to the group like this:
Relaxing my shoulder…
Warmth in my chest…
Tingling in my legs…
A sense of being observed…
Lots of smiling as I open my focus…
Noticing my heart slowing…
One person mentions shyness towards this opening to the group. Another mentions a pain in her heart at hearing that, and a wanting to reach out to that shyness. Later another member brings in a pounding heart and anxiety. Our co-facilitator, Jale Cilasun, consultant medical psychotherapist and group analyst, points out that, ‘In a new group it’s very natural to feel shyness, to feel anxious. This is the first thing that happens in a group as it starts. Practicing like this softens the habitual distinctions we make between self and group, between you and me, which often is the cause of the anxiety’.
Opening to Openness
What this work brings into focus in a way that normal mindfulness training can’t, is just how much our apparently individual experience during meditation is actually influenced by the ‘field’ of the group we’re in. What appears to be an individual decision to open – or not open – to the group has already been influenced by the group’s developing ability to be open to each individual member.
This is a powerful practice for anyone who works with mindfulness. A week after participating in one of Lawrence and Jale’s weekend courses recently, I found myself in a foreign country about to teach a group of twenty people I’d never met and only able to communicate through a translator. Introducing myself, I soon found that to my surprise I was telling them where in my body I could feel the tension of being in a new group, and asking them where they felt that themselves. Instantly the atmosphere in the whole room relaxed – and so did I!
For more opportunities to experience Contemplative Group Dynamics, contact: firstname.lastname@example.org
Rosalie Dores, Mindfulness Teacher, Trainer and Supervisor
with Rosalie Dores, 5 Feb 1017
Looking silently into another person’s face for anything more than a microsecond is an amazingly intimate thing to do. It presupposes all kinds of things – a social context, a relationship (or perhaps the start of one) and some kind of shared intention, whether conscious or unconscious, hostile or affectionate. Meanwhile, the flood of mental events it triggers: judgments, assumptions, projections and impulses, consume so much brain space that self-awareness is temporarily suspended. If ‘all real living is meeting,’ as Martin Buber said, this is a literally in-your-face reminder of that aliveness.
The tug of inter-subjectivity is so strong that it can easily disrupt the mindfulness we cultivate in our personal practice. Rosalie Dores, (mindfulness teacher, trainer and supervisor and Insight Dialogue teacher in training) pointed out that in the traditional approach, ‘Even when we meditate in a group, we are meditating on our own’. Insight Dialogue, developed by Gregory Kramer from traditional Buddhist principles, is a way to move from meditation as an individual practice into something in which relationality becomes the focus of our practice. More recently, Kramer and colleagues at the University of Massachusetts devised ‘Interpersonal Mindfulness’ as a secular sibling to Insight Dialogue. Inviting us to explore its deceptively simple principles, Rosalie brought the essential paradox of any kind of relational mindfulness vividly to life – that by coming continually back to your own embodied sense of self, you become more and more present to the other.
The first principle is Pause, suspending all the busy mental networks we engage in ‘doing’ mode and coming back to the substantiality of the body you are sitting in right now.
‘Being in contact with another human being brings up so much in terms of social habit – wanting to be seen in a certain way, or not wanting to be seen at all. In the pause we can note these natural movements of the mind and come back to the body – the ground of our practice’, said Rosalie.
So, sitting in a relationally mindful pair, and with permission to look away from that demanding face-to-face gaze whenever we want, one person listens while the other allows words to emerge from silence to describe the simple body sensations that arise. Meanwhile, Rosalie invites the listener to notice what it’s like when ‘the exquisitely sensitive bodymind is touched by the voice of another’.
The next step is contemplating together the experience we just shared. This is where we begin to notice the power of the Pause. As speech speeds up and our conversational habits kick in, Rosalie explains, ‘permission to pause allows you to return to direct contact with yourself – it’s self care’.
‘What does the pause reveal?’ she asks us. ‘How would it be to be able to pause like this in a normal conversation? How would it be to be more mindful of how, when we encounter warm, friendly people, we usually experience pleasant sensations, and how sharp, brittle, cold experiences with people give us unpleasant sensations?’
LETTING GO OF THE STORY
As an experiment, she invites us to share an unpleasant experience with our listening partner, noticing the body sensations that arise as we do. Speaking about an experience of listening to a teenage girl bullying her friend on a bus in a voice so loud that it seemed like a dare to all the other passengers to interfere, I notice a watery feeling in my lower back, my chest empty, tightness in my neck, and remember the relief when she got off. Just as I get into this, Rosalie interrupts us by ringing the bell. ‘Notice how difficult it is to let go of that sentence; how hard it is to let go of stories. Notice what happens in the conversation if you see your partner frown in response to something you say, or how you relax when you see them smile.’
Next we’re asked to speak about a pleasant experience, and as I listen to my partner describing the simple pleasures of a perfect day, I find myself absorbed by finely-observed detail in a way a poem might absorb me, until ‘Ting!’ – again the bell invites me back to the Pause and MY bodily sensations and I realize how comfortable I feel now.
After Pause and Relax, the next two guidelines are – as in all process-oriented work – being ‘Open’ to what’s happening both internally and externally, and ‘Trust Emergence’ – being able to trust whatever arises. The final two are ‘Listen Deeply’ and ‘Speak the Truth’.
THE EFFECT OF THE PAUSE
Back in the whole group, the comments from participants reflect just how powerful an experience it was. Here are a few of them:
‘I felt quite peaceful that the other person wasn’t expecting a reaction or a response from me – that allowed me to fall into a very still place.’
‘I noticed how very subtle changes in my partner’s voice or expression affected my emotions, and being able just to notice that without getting swept away.’
‘The unpleasantness and how to work with that. I don’t know what to do, and then Pause and Relax, and it’s ok that I don’t know what to do.’
‘I had enormous difficulty interacting with others from that mindful space. I’m either in the mindful space or in my head again listening to them.’
‘I really noticed the constant process of reacting all the time to what the other person is saying, and how the Pause is such a gift to help you notice that.’
‘I was aware of my body as a whole, and then when my partner said something I responded to, how I was suddenly aware of a particular place in my body.’
‘Very lovely how we started with ourselves and then opened out into something reciprocal that flowed – beautiful. I felt so grateful.
‘I felt a deep sense of privilege for what we’ve been doing. A sense of the timelessness of it.’
Rosalie was a yoga teacher for many years before she came to Gregory Kramer’s work. Watching her silently pacing barefoot between pairs of participants absorbed in dialogue, her back aligned and her bell carefully balanced on her upturned palm, it was obvious that embodiment is not just another box to tick for her in mindfulness training, but the foundation of her whole approach. Many thanks to her for offering this very popular session, and you can find out more about her courses at: http://www.optimalliving.co.uk/
Dr Julieta Galante, with Nick Pole, photo by Maya Campbell
Beginner’s Mind, Researcher’s Mind
with Dr. Julieta Galante, 17 Dec 2016
The average randomized controlled trial, or RCT, that well-known gold standard of research, usually takes at least three years from initial funding application to final result and the budget on a major trial can run into millions. In a mini-masterclass in how to make a complex subject fun to learn, Dr. Julieta Galante guided us through her do-it-yourself version of an RCT in a couple of hours, on a budget of about five quid, including the post-it notes. Her perfect planning and playful structure allowed plenty of room for laughs, but also plenty of time afterwards to discuss the many issues that researchers face in their efforts to put the stamp of scientific ‘truth’ on their results.
Anything that involves the study of, and is carried out by, beings as complex and relational as humans, is going to involve all kinds of bias. ‘Just as we need to be compassionate with our monkey mind,’ Julieta said, ‘we also need to be accepting of this human capacity for bias. We can’t avoid it, but we can put systems in place that minimize it.’
Step 1: Design and Deliver
Soon we were on our feet, discovering how to do that. First there was a quick activity to design the protocol – the detailed statement of intention and methodology that any RCT needs. All we had to do was arrange the printed-out steps of our study on the wall in the correct order, and then peer-review another group’s version. This wasn’t quite fair, since two groups contained people who had already done their own RCTs and knew all the answers. But who ever said science was fair? Here’s the right sequence:
Baseline data collection
Delivering therapy Intervention and control intervention at the same time
Outcome data collection
Interpretation of findings
Dissemination of findings
In four groups we then planned our study: group one designing a mindfulness intervention, group two a control intervention, group three randomizing how we would be assigned to them, and group four thinking up an outcome question to assess the effectiveness of both the mindfulness intervention and the control group activity. Randomized by pulling pieces of paper out of a bag, we were assigned to either the control group or the mindfulness group. For both, people sat in a circle with one person as teacher. The mindfulness group had a guided meditation on the breath, and sat in one corner of the room, while the control group had the fiendish task of waiting for a thought to come and if it was a positive thought, changing it to a negative one, and if it was negative, changing it to a positive one.
Step 2: Assessing Results
With our brains suitably soothed or addled according to which group we’d been in, we then had to answer the following question, cleverly devised by the Outcome group, exploiting the fact that it was just a week before Christmas:
‘Bring to mind all the things you need to do during the festive season; to what extent do you agree with the following statement: ‘I feel able to cope with the stresses of Christmas’, from ‘1. Strongly disagree’ through ‘3, Neither agree nor disagree’, to ‘5. Strongly agree’. Each participant wrote a number down and popped it into the bag designated for their group. Julieta then labeled the bags so that only she knew which was which. The Outcome group then worked out the average score for each bag. Results: one bag had a mean of 3.6 and the other bag a mean of 4.5, and when Julieta told us it was the mindfulness group that had the higher mean, someone cheered, ‘So mindfulness does work!’ and mock sighs of relief were audible all round.
Okay, it was a lot of fun, but how robust was our study? For a start, even if the study was totally unbiased, the sample size of sixteen was far too small. As Julieta pointed out: ‘If we toss a coin five times and it comes up heads four times, how surprised would you be? If you toss it ten times and it comes up heads nine times, would you start thinking the coin is loaded? Once you’ve tossed it 100 times you get close to what’s real for that coin. But how many times do we read about research studies that have very small samples?’ With fake news on the rise and journalists always wanting to give their own twist to a story, you have to check the sample size carefully in any media research news. ’And remember,’ Julieta said, ‘the participants in mindfulness studies are rarely chosen on a purely random basis. For example, our population for this trial consisted entirely of experienced meditators, so it would be very misleading to extrapolate that to the population as a whole.
Even though we were randomized, there was still room for bias. For example, because we knew which group we were in, it was tempting to answer higher or lower on the Christmas stress scale to help the mindfulness group get the higher score. This kind of well-intentioned fraud can easily happen, for example, if a GP knows which group is the control and which is offering the therapy, they may decide to allocate a patient who is really in need of an intervention to the therapy group. That’s why robust randomization is vital.
What Do the Results Actually Mean?
Another big challenge for researchers is knowing exactly how to describe their results. Julieta asked, ‘If you were to write a paper and say what were the results of this study, how would you put it?’ The best we could come up with was: “A ten-minute mindfulness intervention may help the ability of mindfulness meditators to deal with Christmas stress”. But it could be that the control group activity made it harder to think about coping with Christmas, not that the mindfulness intervention made any difference to the average ability to deal with Christmas stress. In fact, it may turn out that the mindfulness group is actually worse at dealing with the Christmas stress, even though the intervention gives them the sense of being able to deal with it better before the event. You’d need to wait until the festivities are over and do the study again. ‘This is why science is so conservative,’ said Julieta. ‘Scientists will always say, ‘we need to do more research, As scientists we content ourselves with a low probability of being wrong, so scientific ‘truth’ is defined as being 95% sure that the differences in the sample can be translated into the population at large.’ In our study, unfortunately, the probability that we got the result by chance was 11.9%, well above the 5% needed to declare that the results were significant.
Beginner’s Mind, Researcher’s Mind
Julieta also talked about balancing her commitment to her personal meditation practice with the need for scientific equanimity. ‘The most important thing for me about being able to bring a beginner’s mind to the research I do is being able to ask, for example, who does mindfulness really work for? When I was doing my research into loving-kindness, it was remarkable how some people in the sample would say that the loving kindness component was too challenging, while the other meditation practices were useful, whereas others in the same sample said that they struggled with the basic meditation practices but found that the loving kindness component made all the difference. I really love my role of using scientific method to clarify where mindfulness can be most effective.’
Julieta’s workshop was truly fun and engaging for both science-phobics and experienced researchers. She devised it on a course at the National Science Learning Centre in York, (www.stem.org.uk) a Wellcome-funded initiative to encourage innovative approaches to science teaching in schools, and whatever benefits her day-job as a researcher brings us, she clearly has a great future as an ambassador for scientific method.
Dr Julieta Galante is a Research Associate at the Department of Psychiatry, University of Cambridge. In addition to her background as a qualified medical doctor, her main focus has been studying the effects of meditation on mental health. She is currently leading the Mindful Student Study, a pragmatic randomized controlled trial of a pilot scheme to provide mindfulness courses to students at the University of Cambridge (http://www.cambridgestudents.cam.ac.uk/welfare-and-wellbeing/mindfulness-cam/mindful-student-study).
with Maya Campbell, 11 Sep 2016
Maya currently works in London delivering mindfulness-based courses in a mental health setting and to the general public. She took up mindfulness meditation in 2009 after having been advised that it might help with the many physical and mental health issues arising from having a cardiac arrest, resuscitation and spending two months in a coma. In the following years having developed a strong interest in how the mind and body interact she did a Masters in Psychology and trained to teach mindfulness-based interventions (MBCT, MBSR and MBAR) at Oxford and Bangor and the Breathing Space in London. In the past few years she has become increasingly aware of the need for compassion both in her own practice and in mindfulness based interventions and has trained to teach Mindful Self-Compassion (MSC).
According to the novelist Graham Greene, who often wrote about troubled souls in dangerous places, ‘If you are reporting on human pain, you have a duty to share it’
At the core of Mindful Self-Compassion, the subject of Maya Campbell’s presentation, is a mirror image of that sentiment – if you are teaching self-compassion, you need to show some to yourself. Maya should know. She was working as a psychologist when a cardiac arrest put her into a coma for two months. Learning how to offer compassion to herself during years of physical rehabilitation and therapy played a key part in what she calls her ‘post-traumatic growth’. She first learned mindfulness as part of her recovery in a Buddhist context, where self-compassion was an essential part of the practice. Later, when she started training in MBCT at Oxford and asked why there was no specific mention of self-compassion in the program, all her teacher could say was, ‘It’s implicit in the way you teach it’.
But her own experience of compassion as an explicit ingredient of mindfulness eventually led her to the US to learn to teach the Mindful Self-Compassion (MSC) course developed by Kristin Neff and Christopher Germer, a course which owes a lot to Compassion-Focused Therapy developed by Paul Gilbert, with its very direct techniques for down-regulating the threat-response system.
In her presentation she took us through three experiential practices and the impression for many seemed to be not that they were so different from what you find in MBCT and MBSR, but how much more a little self-compassion seemed to bring to the experience. For example, Maya showed us how some simple self-touch gives participants a direct physiological way to activate the parasympathetic soothing system which underlies all our expressions of care, affection and social cohesion.
You can try it now by settling yourself for a moment, then bringing your hand gently to your face and head, using the gentle caressing touch that activates receptors in the skin that connect directly to that soothing response. Then bring your hand gently to your heart and experience that connection, or cross your arms and give yourself a hug, or maybe bring your hands to your belly and let them rest there, feeling the movement of your breath.
A similar exercise in some ways to bringing attention to the body and the breath, but so very different when there is an explicit intention to express kindness to yourself through your touch. MSC deliberately combines ‘bottom up’ methods that work directly through the body with the more normal ‘top down’ ones that work cognitively through the teacher’s words.
Of course, whichever direction it comes from, showing compassion to yourself can be challenging, and MSC uses the metaphor of ‘backdraft’ to describe how negative emotions can flare up when a little kindness opens a long-closed door, giving oxygen to a fire that may have been quietly smoldering for years.
Maya said that one key difference between Mindfulness and MSC is that ‘Mindfulness focuses on the acceptance of experience while Self-Compassion focuses on caring for the experiencer’. This did seem to be the thing that made most difference in the practices she introduced us to. In fact, bringing a clear intention to be kind to yourself whatever you’re experiencing seemed like a kind of spiritual WD40, something you can spray on any other mindfulness technique to make it more user-friendly and appropriate for each individual participant. Maya has also noticed that Compassion-Focused groups tend to be more caring of each other than do participants in the Mindfulness groups she teaches. Maybe this is one reason why it’s now planned to introduce self-compassion into the 8-week MBCT course. Anyone who experienced Maya’s carefully-argued and utterly compassionate style of facilitation will consider that’s a very welcome innovation.
For earlier meetings, scroll down, pick a title and email Nick at email@example.com to request a copy of the event you want.
7 Feb Mindfulness in Schools, Dominic Morris
3 Apr Opening to our Inner teacher, Barbara Reid
8 May Managing with Grace in the NHS, Valerie Iles
3 Jul Mindfulness for Social Change, Mark Leonard
11 Sep Teaching Self-Compassion, Maya Campbell
17 Dec Beginner’s Mind, Researcher’s Mind, Dr Julieta Galante
14 Mar Maintaining Practice after MBCT, Jiva Masheder
11 April Inquiring into Inquiry, Rosalie Dores
6 Jun Adapting Mindfulness for Special Groups, Dr Sonya Frearson
13 Sep Contemplative Group Dynamics, Larry Ladden
8 Nov DO Mention the B-word – Buddhism and Mindfulness Gary Born
8 Feb Introduction to Body-in-Mind Training, Dr Tamara Russell
9 Mar Mindfulness in he Workplace, Mark Leonard
1 June Anthropology of Mindfulness, Kitty Wheater
20 July The Power of Mindfulness, Maura Sills
7 Sep Mindfulness and Racial Difference, Eugene Ellis
2 Nov Embodiment and Mindful Touch, Nick Pole
6 Dec Contemplative Group Dynamics, Larry Ladden
6 Jan Mindful Dreaming, Olga Richterova
3 Feb Mindful Movement, Rosalie Dores
3 Mar Mindfulness and Psycho-Spiritual Perspectives, Maura Sills
9 Jun Mindfulness and Joy – Working with Cancer, Gary Born
7 July Mindfulness and Art Therapy, Nicky Roland and Joss James
8 Sep Embodiment and Dialogue, Nick Pole
6 Oct Mindfulness Research, Alison Armstrong and Sarah Hennelly
1 Dec Anaesthetic to Aesthetic, Dr Helena Fox
6 May Mindfulness and Psychosis Andy Phee and Pamela Jacobsen
1 July Listening in Presence Rosalie Dores and Cindy Cooper
7 Oct Communicating Through the Body Greg Scott
4 Nov Mindfulness Research with a Bi-Polar Group Dr Tamara Russell