Twenty-four years ago I pondered how the concept of “openness to experience” could be leveraged to support the emotional healing of adult children of alcoholics. I searched the literature and discovered an “openness to experience” scale that I integrated into the analytic structure of my dissertation research. I treated “openness to experience” as an indicator of our willingness to change, as a measure of what we might call “psychological flexibility.” My personal work since then has continued to question how I can know when my likes and dislikes, attitudes, preferences and dispositions are sensible and life affirming or the results of taken-for-granted family rules that constrict my openness to new experiences.
According to the model of Acceptance and Commitment Therapy (ACT), psychological flexibility may be the antidote for emotional rigidity and the attachment to our view of ourselves from the past. Some say that it is emotional rigidity that interferes with our capacity to be present and have a range of choices available.
I recently attended an ACT Bootcamp taught by Steven Hays, Robyn Walser and Kelly Wilson. While Acceptance and Commitment Therapy is a data-driven approach that emerged from cognitive behavioral therapy (CBT), the ACT model aims to support the development of psychological flexibility through six core, non-linear processes: the acceptance of our experience; a view of the self as the context of our experience, not as the resulting content of our history; contact with the present moment; the deconstruction of thoughts as without substance rather than fused to their content; a commitment to take steps toward achievable goals; and, the identification of the core values that we want our life to be about that can help guide the direction of therapist-client collaboration.
With psychological flexibility as the central measure of mental health and emotional functioning, different technical paradigms can be readily assimilated within the ACT model. Most attendees were either behavioral analysts or CBT therapists. These therapists could emphasize a functional analytic framework primarily concerned with the ABC’s of behavioral conditioning and operate comfortably within the model. While less common, others who emphasize mindfulness and somatic practices could also employ the model by emphasizing values and present time experience. While armed with different tools, we all can agree on one fundamental principle: it is our relationship with our patients that is the most critical factor in their healing.
While it is widely accepted that the therapeutic alliance is the most critical factor in clinical outcomes, David Wallen, in his book Attachment in Psychotherapy, throws a wrench into this equation as he shows that clinical outcomes are profoundly affected by the relational quality of the therapist and clients attachment strategies.
I would suggest that a fundamental job for us as therapists is to clearly see, in the most intimately personal ways, our own areas of rigidity and the hurts that created them, to embrace and accept them, and to take the opportunities to release them in the interest of a hopeful future. From this place of embracing our own work, being present to it, and using the lessons learned from it, we can affect the world around us in life affirming ways. While we do it in relationship and we do it in community, we are ultimately alone in our process. And this aloneness potentiates the process of change. If we are lucky or sufficiently skilled, we can articulate this process and share it experientially in our personal relationships and in the professional services we offer.
Mindfulness can be both the container that holds our moments of insight, and the means through which we directly examine our experience. This requires a two-step process in which it is particularly helpful to develop the capacity to hold a stable awareness before we attempt to use that awareness to transform an intimate experience of distress.
What do we mean by mindfulness? Isn’t it just a form of awareness? Let’s take the example of eating ice cream. With great awareness go to your favorite store and buy your favorite ice cream. With great awareness bring your attention to the taste and texture of each spoonful. Eat it slowly, savoring each spoonful completely. Pause between spoonfuls. Repeat, with increasing attention. Notice the details of your experience, how your body responds, how your thoughts focus on the details of the moment-to-moment experience. As you finish the container, notice that it was delightful to the last drop.
I think we can all agree that eating an entire container of ice cream is not a good thing, no matter how much moment-to-moment awareness we bring to the experience. Nor do we want to sit with intrusive thoughts for prolonged periods and just watch. Sitting still with fixated attention on a single object does not mindfulness make. A dog can watch his owner hold a treat for a long time, but a dog cannot develop mindfulness. Mindfulness is not simply non-judgmental moment-to-moment awareness.
No one “invented” mindfulness. Mindfulness is a naturally occurring state of mind. It is not thinking but it does require an active cognition that can be taught. The teaching of mindfulness dates back to the early discourses of the Buddha. The core teaching is contained in the Satipatthana Sutta, or the Discourse on the Four Foundations of Mindfulness. This teaching explains that mindfulness arises by cultivating attention in four different domains: the activities of the body, the sensations of the body, the activities of the mind, and in the awareness of the transformation of one’s own body-mind system. Now you don’t have to read the discourse to learn and practice mindfulness. It will appear unintelligible to the uninitiated. But if you are looking for a mindfulness teacher and find one who is not conversant with that foundational teaching, keep looking.
I think of the Buddhist practice of mindfulness as the first form of response-side therapy. We keep our attention focused on our reactions to our internal experience rather than the “things” outside us that may stimulate those reactions. For example, when we meditate on sound, we attend to how we react to it internally and how the vibration is felt on our body. Do thoughts or secondary sensations arise? Do subsequent reactions to those thoughts or sensations arise? Do I respond either positively or negatively; that is, do I crave more or less of the experience?
Some contemporary presentations of mindfulness emphasize the cognitive aspects and in so doing tend to forget that we have a body. Some have introduced the notion of “somatic mindfulness” to describe nervous system activity and the awareness of sensations. The early teachings are grounded in the concept of namo rupa, what has become commonly referred to as body-mind or perhaps more accurately, the body-mind system. The mind and body are not simply related, they are intrinsically integrated as a continuously changing activity.
I like to think of mindfulness as a form of emotional regulation. Through it we can achieve several things. As a container, we learn to observe our body-mind system without craving, clinging or attaching to any aspect of our experience. We learn to recognize how we respond to pleasant experiences as well as to unpleasant ones. With attention to our internal processes of craving and aversion, we hold the cognitive perspective of the observer, responding to pleasant and unpleasant experience the same, noticing when that is not the case, and modulating our reactions. This process is said to lead to a greater sense of the present moment and openness to new experiences without the reactivity generated from the our past.
So in order for us as psychotherapists to support our clients to open themselves to experiences beyond the hindrances of their past, we must walk at the edge of our own comfort, stretch our boundaries of confidence, and mindfully reflect on how we embrace the experience of our lives.
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Wallin, David J. Attachment in Psychotherapy. The Guilford Press, New York, 2007.