Category Archives: Blogosphere

When it’s the wrong time for meditation, Part I

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.

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Mindfulness potpourri

Zen Habits has posted 9 Mindfulness Rituals to Make Your Day Better. Unfortunately for me the night owl, they include “sit in the morning.” Damn!

Ironically I struggle quite a bit with mindfulness in my workplace. Thankfully, I’m usually pretty mindful when I’m actually in session with a client. But between sessions when I’m supposed to be working on my documentation, responding to emails, making phone calls or faxing things to other agencies, I tend to get so overwhelmed with the many things on my to do list that I will start one before finishing another–a mortal sin in mindful living directly opposed to the last item on Zen Habits’ list, “Work with focus.”  I can tell you two things that have helped me work with more focus than I otherwise would:

  1. A literal to-do list that I keep on my desk. This isn’t so much a mindfulness trick as an ADHD trick. Hey, no one said I can’t have moments of both.
  2. Mindful breathing. My favorite short mindful breathing exercise that can be done anywhere, at any time is “The Relaxing Breath” that I first heard of through Dr. Andrew Weil. Maybe he invented it, I don’t know.  Here’s the rundown direct from his site:
  • Exhale completely through your mouth, making a whoosh sound.
  • Close your mouth and inhale quietly through your nose to a mental count of four.
  • Hold your breath for a count of seven.
  • Exhale completely through your mouth, making a whoosh sound to a count of eight.
  • This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

I do this exercise regularly–in traffic, when I’m flustered in my workday, when my puppy won’t stop ringing the bell to go to the yard at midnight, whatever. I also can tell you that it’s been the single most effective breathing exercise that I’ve used with my teenage and older clients (the single most effective breathing exercise that I’ve used with younger clients is the awesome “flower and candle” exercise, wherein a child is instructed to form two fists and envision a candle in one fist and a flower in the other. She’s then asked to smell the flower and blow out the candle in turns; a great intro to mindfulness for children).

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M&P Interviews Ariane de Bonvoisin

Elisha Goldstein at Mindfulness & Psychotherapy has a good interview up right now that may hold interest for people in recovery for addictions. He talks to Ariane de Bonvoisin, a humanitarian, businesswoman, and the author of The First 30 Days: Your Guide to Making Any Change Easier.

In the interview, de Bonvoisin talks about the difference between people who think they are “good at” change and those who say they hate it; offers tips on how to make sure you’re one of the former; and identifies the ways in which mindfulness can be used during life change.

Ariane de Bonvoisin

De Bonvoisin says:

“Change is always an opportunity to pause, go inside, listen to our ‘inner microphone’ and be in the present. Our lives get so busy, we live based on routines, we never really ‘think’ we don’t want to change. So when change does happen, either by courageous choice or from life circumstances, it is asking us to be honest with what is, and also what is not working for us and our lives.”

Read the interview here.

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How do we make mindfulness approachable?

The author of soon-to-be-released book The Mindful Child: How to Help Your Kid Manage Stress and Become Happier, Kinder, and More Compassionate, Susan Kaiser Greenland, recently wondered: can we make mindfulness approachable without diminishing it? She writes,

But as mindfulness meditation moves beyond the realm of academics and adepts (those who have developed an impressive degree of aptitude in the practice of Buddhist meditation) into popular culture there’s growing pressure to distill mindfulness down to programs that can be articulated in sound-bites — or what is called in Hollywood an “elevator pitch.” Programs that can be described in one or two lines, the amount of time it takes to ride between floors on an elevator. Sometimes I joke about what seems to be a race to create the “Velveeta Cheese” of mindfulness programs–where wide dissemination, sustainability and replication are paramount, even at the expense of the wisdom upon which the classical traditions (and the programs) are based. …Is it possible to translate mindfulness into something that can be of benefit to everybody regardless of religion, ethnicity, education, or age without dumbing it down and forfeiting authenticity?

Read more of her thought-provoking post here.

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Elisha Goldstein talks with John Briere

Elisha Goldstein’s blog has recently posted a great interview with John Briere, a clinician in Los Angeles who specializes in trauma and the use of mindfulness in addressing it. This is a fabulous post and could be of special interest to addictions professionals, given how many of the people we work with have experienced trauma.

Dr. Briere says:

Mindfulness is a learnable set of skills, involving ongoing, moment-by-moment focused awareness and openness to the here-and-now, without judgment and with acceptance. It is, in some sense, the polar opposite of avoidance. Mindfulness can be a useful component of trauma therapy in several ways: the therapist can be mindful, which will increase her compassion and empathic attunement toward the client; she can communicate non-judgment, and acceptance, which the client may then internalize; and the client can learn mindfulness during treatment.

See more at Mindfulness & Psychotherapy.

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Book Review: The 12-Step Buddhist

Readers of Addiction Blog are being treated to yet another good review of Darren Littlejohn’s The 12-Step Buddhist. Lee writes:

“In fact,  The 12 Step-Buddhist passes my “direction dive” test…when I’m in need of some divine wisdom, I pick up a book, or dictionary or encyclopedia, open to a random page and read where my finger falls.  Everytime I’ve picked up the 12-Step Buddhist, I hear what I need to hear in the moment.  For whatever reason, Littlejohn’s writing has both the density and the intention that help me in moments of question.  It has become a fixture in my recovery library.”

Full review: http://addictionblog.org/body/book-review-the-12-step-buddhist/

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