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Mindfulness in Psychotherapy

The Application of Mindfulness in Psychotherapy
A Master’s Paper Submitted

In partial fulfillment of the requirements for the Degree of

Master of Arts

Transpersonal Counseling Psychology Department

Naropa University

Joe Soma

May 3, 2004

Table of Contents 2

Abstract 3

Introduction 4

Literature Review 5

Mindfulness in Eastern Psychological and Contemplative Practice 6

Mindfulness in Psychotherapy 9

Current Applications of Mindfulness in Psychotherapy 12

Dialectical Behavior Therapy. 12

Stress Reduction and Relaxation Program. 13

Hakomi Body-Centered Psychotherapy. 14

Focusing. 15

Theoretical Perspective 16

Perceiving 16

Understanding 17

Transforming 18

The Therapist 18

Clinical Application 19

Sally 20

Linda 24

Discussion 25

Mindfulness in the therapist 25

Mindfulness in the client 26

Expression. 26

Attention. 27

Acceptance/Insight. 27

Witness. 28

Transcendence. 28

Conclusion 29

References 30

Appendix A. Interventions 32


This paper argues that the application of mindfulness skills to psychotherapy will increase efficacy and promote lasting change. This is fostered by the therapist both modeling and instilling in the client the ability and desire to; (a) objectively perceive his or her habitual thoughts, emotions, and somatic experiences, (b) bring understanding to the broader context of those habits, and, (c) encode in his or her organization new ways of functioning. A review of the literature, a theoretical perspective of the application of mindfulness, case studies, discussion, and interventions are presented.

In this paper I explore the use of mindfulness in psychotherapy as a way of creating conditions that cultivate positive therapeutic outcomes. In my view, the focused addition of mindfulness into any therapeutic modality will increase the receptivity of the client to self-directed and lasting change. I don’t offer a new type of therapy, or a new approach. Indeed, what I offer is perhaps the oldest possible approach to self knowing there is; deliberate, clear, and non-judgmental attention to one’s gestalt. My aim is to not to add to the seemingly overwhelming assortment of techniques, but instead to offer a point of view that seeks to tap into the core clarity available in the client and in the present moment. Mindfulness in psychotherapy is less a set of techniques and more a context or mindset in which interventions are delivered. It’s how I am in therapy more than what I do.

In this paper, I will (a) review applicable literature from both Eastern and Western thought, (b) discuss my theoretical perspective of why mindfulness and awareness have proven useful, (c) discuss relevant clinical applications, (d) discuss further applications and areas of interest, and (e) offer interventions that are useful in cultivating mindfulness.

For the purposes of this paper, I will define some terms used:

Meditation is a core component of Eastern psychology and contemplative practice. It is the act of meditating, which is to engage in a formal practice of contemplation or reflection. I will use Buddhism as representative of Eastern psychological and contemplative practices.

Mindfulness is a key formalized component of meditation and is generally considered to be focused attention toward a single object or phenomenon, such as one’s breath, or in psychotherapy, a somatic experience, sensation, feeling, thought, memory, etc. Mindfulness is both a skill and a state that promotes self-awareness which leads to the possibility for profound transformation.

Mind is a broad term that encompasses one’s entire being, body, thoughts, and emotions. Mind is one’s experience.

Awareness is considered a broader application of attention that includes more than one single object, for example one’s breath as well as one’s emotions, environment, and mind. Ken McLeod (2001) says, “the definition of awareness is knowing what is going on. Mindfulness is being present with the object of attention, but awareness enables you to know what is happening” (p. 67). In therapy, a client who is mindful is able to bring attention to some experience he or she is having. A client who is aware is able to bring both attention (mindfulness) and understanding to his or her experience. Mindfulness is a technique that will foster awareness. Awareness as defined here differs from the typical use of awareness such as, “I am aware that I need to change” or “I’m aware that I drink too much.” This type of awareness doesn’t necessarily lead to change.

Witness is the part, or function, of one’s self that can reference one’s internal experience with neutrality, non-reactivity, and objectively observe whatever arises in oneself. Witness can also be called Self, internal locus of control, consciously perceiving experience as figure rather than ground, relating to experience in a larger context rather than being lost in content, objective rather than subjective, higher self, observing ego, observing self, or self-wisdom to name a few. Witness is cultivated by mindfulness and awareness.

Literature Review

In Eastern thought, the application of mindfulness moves one toward a deeper understanding of one’s suffering and one’s true nature. In psychotherapy, the application of therapeutic techniques move a client toward a deeper understanding of cause and effect of symptoms, the understanding of which will reduce those symptoms. The deliberate application of mindfulness in the therapeutic setting is a powerful addition to Western psychotherapy and will move clients beyond symptom reduction and allow them to gain a deep, real-time, understanding of how they create and respond to discord in their lives. This understanding will provide the path to effect lasting change. McLeod (2001) states that, "I came to understand the central role of attention in internal transformative work, and I saw how all aspects of Buddhist practice (and all forms of internal transformative work) can be described in terms of the operation of attention" (p. 18). He also says, “…the initial work of internal transformation is cultivating attention” (p. 51).

Similar to Eastern psychology and contemplative practices, psychotherapy is also a set of tools for relieving suffering and, with the use of mindfulness, can wake a client up to his or her true nature. In Buddhism, the work of waking up to the true nature of things is traditionally accomplished through working with a teacher. In psychotherapy, the work of waking up to the true nature of one’s suffering can be best accomplished through working with someone who is outside of a one’s habituated patterns. McLeod (2001) states this well:

When we start exploring the mystery of being, we are still mired in habituated patterns. Limited in perception to a world projected by these patterns, we do not and cannot see things as they are, we need a person, a teacher, who, standing outside our projected world, can show us how to proceed. (p. 6)

The therapist is taking on the role of witness for the client until the client can do this for him or herself. Once the client starts to develop the ability to do it alone, the duty can be handed over to the client and he or she can continue to develop awareness.

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