About a year ago, Elisha Goldstein over at Mindfulness & Psychotherapy published one of his typically excellent interviews on his blog; this one was with John Briere, the psychologist and trauma expert. I found the interview interesting at the time–and indeed linked to it from this site–because Briere is also an expert on mindfulness. In my professional practice right now, I am working quite a lot with traumatized children and adolescents; I therefore I return to the interview frequently in my mind.
Lately I’ve been thinking about it for another reason. As anyone who has read my blog even casually knows, I have been watching the rising tide of mindfulness-based therapy with a mixture of excitement and fear because I don’t consider all forms of mindfulness as being totally benign with all clients….or in the hands of all therapists, for that matter. But it seems so refreshing and exciting to many (and rightfully so) that it’s being widely practiced by therapists and clients who may not have the experience and hence tools to deal with the negative side-effects such as dissassociation or anxiety that can arise when mindfulness such as meditation is practiced.
Meditation is awesome, don’t get me wrong, and I think nearly everyone can benefit from it in when they are exposed to it in the appropriate fashion. But many of the clients who come into our clinical practices are vulnerable and already experiencing anxiety, emotional lability, stress and/or trauma that is completely overwhelming. They quite frequently have overwhelming and pervasive thoughts that intrude on them even when distractions are attempted. They may not be ready to attempt mindfulness, even outside of meditation.
In the M&P interview, Briere notes:
“An unfortunate aspect of psychological trauma is that, in order to move out of pain, we have to sit with pain, even if we may prefer the seeming protection of deadened emotions and reduced awareness. The journey of the trauma survivor can sometimes require great bravery — to approach rather than avoid, to reach out when isolation seems like a better idea. ….Initially, the individual may be too overwhelmed to engage in formal psychotherapy, let alone learn mindfulness.”
I’ve been to countless presentations on mindfulness and/or meditation aimed at orienting and educating therapists on how to use it in their practices. I’ve very rarely heard any presenter say anything along the lines of the above, even though I would venture to guess that any serious meditation practitioner is aware that it can be overwhelming when practiced before a person is properly prepared. Though scholarship on this subject (and frankly, all mindfulness-based clinical interventions) is relatively thin, there have been several studies devoted to the phenomenon of “relaxation-induced anxiety,” a phenomenon which appears to be especially frequent in clients practicing meditation over, say, progressive muscle relaxation. There is even some evidence to demonstrate that some forms of meditation, specifically objectless meditation like some Zazen, is particularly likely to cause this.
A study on the use of meditation in therapy (“Meditation as an Adjunct to Pyschotherapy,” Kutz, Ilan et al.) found “[The intervention] resulted for some patients in feelings of defenselessness, which in turn produced unpleasant affective experiences, such as fear, anger, apprehension, and despair. At times such emotions were accompanied by sobbing during the meditation session. At other times the meditation resulted in the arousal of latent content. For example, 4 patients had a dramatic unveiling of screen memories and meaningful material from their past that had been blocked during a protracted course of therapy. Hidden themes from the past, such as incest, rejection, and abandonment appeared in intense, vivid forms and challenged the patients’ defensive image of their past and themselves.
They continued on to say, “Those unpleasant affective experiences were on other occasions counteracted and balanced by an enhanced sense of self and centeredness which allowed the patients to contain their fears and to therefore continue their self-exploration in meditation…It was then the role of the therapist to reflect back to the patient the meaning of his or her sense of self, both in its positive expression of healthy self-esteem and in its potential function as a narcissistic defense against conflict and psychic pain.”
All well and good and everyone benefits–if the therapist is appropriately prepared for this phenomenon to occur. Consider the potential risk to be found in unknowingly provoking feelings of defenselessness and fear in a client who has a trauma history; consider the alarming unveiling of screen memories in a client who is already overwhelmed by emotion and pervasive anxiety.
More on this topic to come later this week.