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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
- Veröffentlichungsjahr: 2014
Mindfulness for Therapists presents an innovative eight-week mindfulness protocol designed to aid therapists--which may be worked through alone or in small groups * Presents the first complete mindfulness program designed to improve the personal and professional well-being and effectiveness of therapists themselves * Features an 8-week introduction to mindfulness in the form of exercises designed to help therapists develop their own meditation practice and apply it to their lives * Integrates key research that includes the Five Facets of Mindfulness, the Three-Person-Perspectives approach, and the neurobiological foundations of mindfulness training * Supported by online meditations and exercises for therapists
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CONTENTS
Cover
Title page
Copyright page
Acknowledgments
Personal Acknowledgments – Gerhard Zarbock
Personal Acknowledgments – Siobhan Lynch
Personal Acknowledgments – Axel Ammann
Personal Acknowledgments – Silka Ringer
Image Credits
1 Welcome
Formal Mindfulness Exercises
Informal Mindfulness Exercises (Personal and Professional Lives)
Therapist Role Mindfulness Exercises
Joint Mindfulness Exercises
Intensive Exercises
Client Exercises
References
2 Mindfulness
Burden on the Helper
Mindfulness as Self-care
Mindfulness and Self-awareness
The Five Elements of Mindfulness
Relationships Between the Five Elements of Mindfulness
Mindfulness as Self-attunement
Mindfulness as a Flexible Change Between First, Second, and Third-person Perspective
Mindfulness as a Conscious Choice of Self-focus
Reflecting on Mirror Neurons
Summary: Why Give Attention to Helping Professions?
References
3 Bringing Mindfulness Into Your Life
3.1 Week 1: Introduction to Mindfulness
3.2 Week 2: The Five Elements of Mindfulness
3.3 Week 3: Integrating Mindfulness into Everyday Life
3.4 Week 4: Mindfulness as a Way of Life
3.5 Week 5: Mindfulness as a Home Base for Therapists
3.6 Week 6: Mindfulness of the Body
References
3.7 Week 7: Integrating Mindfulness into Therapeutic Practice
3.8 Week 8: Review and Next Steps
3.9 Your Oasis
4 Extending Your Practice
4.1 Going Deeper
References
4.2 Exercises in Everyday Personal and Professional Lives
References
4.3 Mindfulness Exercises for the Helping Role
References
4.4 Mindful Moments With Your Clients
5 Short Manual for Running a Group Based on the Presented Material
General Notes on Implementation
Week 1: Introduction to Mindfulness
Week 2: The Five Elements of Mindfulness
Week 3: Integrating Mindfulness into Everyday Life
Week 4: Mindfulness as a Way of Life
Week 5: Mindfulness as a Home Base for Therapists
Week 6: Mindfulness of the Body
Week 7: Integrating Mindfulness into Therapeutic Practice
Week 8: Review and Next Steps
Mindful Oasis
6 Frequently Asked Questions (FAQ)
1. What is the difference between attention and mindfulness?
2. How important is it to have a regular, formal practice?
3. I fall asleep when I’m meditating. Is that ok?
4. I sometimes feel restless and find myself short of breath when I try to meditate
5. I’m frustrated because I can’t seem to meditate properly. What do you suggest?
6. I’m interested in further training, what can you recommend?
7. I am interested in mindful movement. What do you suggest?
Further Reading
Index
Access the Companion Website
End User License Agreement
List of Tables
Chapter 04
Table 4.1
Chapter 05
Table 5.1 Mindful Oasis: A Day of Meditation
List of Illustrations
Chapter 02
Figure 2.1 The Mindfulness Circle
Guide
Cover
Table of Contents
Begin Reading
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Mindfulness for Therapists
Understanding Mindfulness for Professional Effectiveness and Personal Well-Being
Gerhard Zarbock, Siobhan Lynch, Axel Ammann and Silka Ringer
This edition first published in English in 2015English translation © 2015 John Wiley & Sons, Ltd.
This book is a translated version of: Gerhard Zarbock, Axel Ammann and Silka Ringer, Achtsamkeit für Psychotherapeuten und Berater
© 2011 Beltz Psychologie in der Verlagsgruppe
Beltz • Weinheim Basel
Registered OfficeJohn Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Offices350 Main Street, Malden, MA 02148-5020, USA9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, for customer services, and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.
The right of Gerhard Zarbock, Siobhan Lynch, Axel Ammann and Silka Ringer to be identified as the authors of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
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Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of Warranty: While the publisher and authors have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom. If professional advice or other expert assistance is required, the services of a competent professional should be sought.
Library of Congress Cataloging-in-Publication Data applied for
HB ISBN: 9781118760437PB ISBN: 9781118760420
A catalogue record for this book is available from the British Library.
Cover image: © lightstock / iStockphoto
Acknowledgments
Personal Acknowledgments – Gerhard Zarbock
I would like to dedicate this book to Shodo Harada Roshi, ShoE Sabine Huskamp Zenshi and all members of the ODZ-One Drop Zen sangha. They inspire, challenge and support me as I travel on the path. I would like to thank my wife Nicole and my daughter Tara for bearing witness to the fact that I am yet to master mindfulness at home. Siobhan Lynch’s work on mindfulness-based coping with university life (MBCUL) initially inspired the idea to ‘do the same’ for therapists. Without her dedication and mindful input, no English version of the book would have come into existence.
Personal Acknowledgments – Siobhan Lynch
I would like to thank Gerhard Zarbock for first approaching me about the project and for his continued enthusiasm for it. I would also like to thank Esther Coalter and Joanna Boysen for their support with the initial translation of the German version. The team at Wiley have been enthusiastic throughout the process and I would like to thank Darren Reed, Karen Shield and Olivia Wells in particular. I am fortunate to be part of the Breathworks community and the Mindfulness for Students Network, both of which are sources of inspiration. I am thankful for the kindness and encouragement shown to me by Katharine Rimes, Elena Antonova, Ben Baig and Nicola Fear. I would like to thank my PhD supervisor, Harlad Walach, and my friends Majella Horan and Margo Campbell for their words of wisdom. I am forever grateful for Andreas Sommer’s ongoing support and (brutally) honest feedback ☺. Finally, I would like to thank my mother, Ann Taylor, for her many hours of proofreading, which she did with good humour (often at short notice and at inconvenient times).
Personal Acknowledgments – Axel Ammann
I would like to thank all the countless great people who inspired me on my path, especially HoKai Österle, Norbert RinDo Hämmerle, Paul Stammeier and Stephen Kinryu-Jien Hayes. Special thanks go to my wife Tatjana – moon of my life – and my son Aaron – my sun and stars ☺.
Personal Acknowledgments – Silka Ringer
I would like to thank Dr. Angela Roth-Isigkeit for sparking my curiosity about yoga by talking about her own experiences and Dipl.-Psych. Petra Luck for being my first yoga teacher. Her early teaching helped me see the benefits of yoga for myself, especially how it could help both calm and energise. Since then I have continued to benefit from her weekly yoga classes. In my first intensive yoga training I discovered the versatility of yoga thanks to the integrated approach of Yoga Vidya e. V. and the yoga teachers who worked there. In terms of the relationship between my therapeutic work and mindfulness, I gained a great deal from attending seminars by Mrs Dipl.-Psych. Bettina Lohmann. I also benefited greatly from working together with Dr Alexandra Gall-Peters – we worked together in Skillsgroups with the mindfulness approach taught by Dialectical Behavior Therapy (DBT). There were and are, of course, many informal discussions with mindfulness practitioners – not least with the participants of our courses – which have been at least as influential both for me and for my contributions to this book as reading relevant literature. I would also like to thank Dr Antje Burfeind and Dr Susan Erler, who supported the development of the German version of this book by patient proofreading and thoughtful suggestions.
Image Credits
Illustrations: Claudia Styrsky, Munich
Photographs at the beginning of chapters: Gerhard Zarbock, Hamburg
Photographs in Chapter 3: Annika Sommerfeldt, Heiligenhafen; Axel Ammann, Hamburg
1Welcome
Before we begin you might like to pause for a moment and consider what ‘mindfulness’ means to you. What thoughts or images pop up? Perhaps you already know about mindfulness and have your own personal practice? Or maybe this is all quite new for you?
There is no single ‘right’ answer or absolute definition of mindfulness, not least because the term is used in many different ways in the literature (Hayes & Wilson, 2003). However, perhaps the most useful starting point is the ever-popular definition given by Jon Kabat-Zinn, who developed mindfulness-based stress reduction (MBSR) with colleagues back in the late 1970s. Kabat-Zinn describes mindfulness as: “paying attention in a particular way, on purpose, in the present moment, and non-judgmentally” (1994, p. 4).
While the modern Western psychological understanding of mindfulness does not simply adopt Buddhist notions, and although mindfulness is generally considered to be a natural human quality which can be cultivated with regular practice, it is important to acknowledge that secular mindfulness-based approaches have a strong grounding in Buddhist meditation. Within a Buddhist context, mindfulness has been described as:
characterized by dispassionate, non-evaluative, and sustained moment-to-moment awareness of perceptible mental states and processes. This denotes continuous, immediate awareness of physical sensations, perceptions, affective states, thoughts and imagery”
(Grossman, 2010, p. 88).
While these definitions emphasise that mindfulness encompasses more than ‘just’ attention, it is clear that attention plays a central role (Chiesa & Malinowski, 2011). How do these definitions fit in with your initial reflections?
We will touch on the scientific literature surrounding the nature of mindfulness and the established benefits of mindfulness training in Chapter 2, for those of you who are not overly familiar with the field. However, the purpose of this book isn’t to tell you what mindfulness is, but rather to serve as an invitation to explore it for yourself. The material is aimed at those who provide some form of psychological therapy or support, but may be equally useful for those in a variety of helping professions, such as social workers, mental health project workers or medical practitioners. Equally, the material may also be useful for those who work in other capacities, such as educators.
Being a therapist is mentally and emotionally draining, regardless of whether you are ‘freshly minted’ or an ‘old hand’. Research suggests that mindfulness training is beneficial for those in the helping professions and may serve as a useful self-care practice (Irving, Dobkin, & Park, 2009). There is some evidence that suggests that therapists who have trained in mindfulness may actually have better client outcomes, although the “jury is still out on this question” (Labbé, 2011, p. 30). The mindfulness for therapists programme presented in Chapter 3 includes a series of meditations and exercises to help you discover new ways of bringing your practice into your therapy room. Regular mindfulness practice supports the development of a decentred perspective, allowing you to step back and observe your attitudes, feelings and approaches to yourself and your client. Regular practice is absolutely essential and lies at the heart of all modern mindfulness training (Malinowski, 2008). Of course this is common sense – if you wanted to learn to play the piano you wouldn’t expect to be able to play after only a couple of lessons! This fits in with the research, where there appears to be a relationship between the time individuals spent practising formal meditation and the levels of change observed in measures of mindfulness and well-being (Carmody & Baer, 2008). It might be useful to take a moment to reflect on whether you’re really prepared to incorporate some regular practice into your life.
For those who use mindfulness therapeutically, this book offers a way to incorporate mindfulness practice into your working day. Several years ago, some of us offered training in MBSR for therapists. The participants were fascinated by the idea of mindfulness and MBSR, but they were really looking for the most useful exercises and approaches they could use with their clients immediately. While this may be appropriate in many therapeutic approaches, mindfulness is different in that it is not possible to apply the ‘see one, do one’ approach. It takes time and practice to develop a personal experience and understanding of mindfulness, which is necessary before one can instruct others in an authentic way. If the support you provide for your clients as they begin to develop their own mindfulness practice is based on your own practice you are able to give a different quality of support and encouragement, rooted in a deep understanding of the difficulties encountered in mindfulness meditation.
Of course, we do not want to judge those of you who may have tried mindfulness exercises with your clients without practising yourself! Instead we would like to emphasise our view that in order to support your clients with their mindfulness practice credibly and successfully in the long term, it is essential that your guidance is rooted in your own practice.
As you work your way through this book you will be introduced to different practices which we hope will help you to develop and embed your personal mindfulness practice into your daily life. Recordings of all of the exercises are available online (see www.wiley.com/go/zarbock/mindfulnessfortherapists). Please see About the Companion Website at the back of the book for more details. The key types of practices are presented below.
Formal Mindfulness Exercises
These include meditations that focus on the breath, the body and mindful movement. Such formal exercises are usually practised regularly throughout the week. It is helpful to practise at least five times per week for a minimum of 20 minutes. It can be helpful to have an established place to practise, perhaps a corner of your study or bedroom. It is also useful to think ahead and plan a regular time to practise (e.g. in the morning before work, during lunch, etc.). Many people choose to attend some sort of group to support their practice and provide inspiration. Depending on your own preferences, you may find that attending a weekly yoga or Tai Chi class may suit you better than attending a meditation group.
Informal Mindfulness Exercises (Personal and Professional Lives)
These exercises help you to create moments of mindfulness in your everyday life. The book provides many suggestions as to how you can create such mini oases of mindfulness in your day. For example, you may choose to make the first few sips of your morning tea or coffee a mindfulness practice, or perhaps you could use the walk from your desk to the door as an opportunity to notice the pressure and weight of your feet on the floor, the changing pressure as you pick up your foot and the motion as you move your leg forward, ready to take your next step.
Therapist Role Mindfulness Exercises
These exercises centre on you and your role as a therapist. They aim to help you embed your mindfulness practice in your therapeutic work. For example, you may ‘check in’ with yourself before your client arrives, noticing bodily sensations or any thoughts or feelings which surface. During the session you may take a moment to check in with yourself again, noticing how you are sitting in your chair or the tone of your voice. There are many such examples throughout the book.
Joint Mindfulness Exercises
These joint mindfulness exercises have been designed to be done together with your client. The book includes several examples, such as the use of a joint breathing space or of short joint meditations as a way of closing a therapeutic session.
Intensive Exercises
Regular periods of intensive practice are a mainstay of most mindfulness training. If you are serious about your personal practice and bringing mindfulness into your lives, an intensive period of practice is highly recommended. Such periods can range from a single day to seven or ten days (or more). There are a variety of accessible retreats, from different traditions, which you might like to attend as you develop and expand your practice. For example, you might like to try a Vipassana, Zen or Yoga retreat. As the evidence mounts that mindfulness training is beneficial for therapists, it seems likely that there will be an increase in the support available specifically for therapists and those in the helping professions. We hope that this book will contribute to the ongoing growth and development of this field.
Client Exercises
We have also included a number of exercises which you can use with your clients. It is important that the decision to embark on these exercises is made jointly, as of course the client actually has to be willing to practise them if they are to have any impact.
Mindfulness and mindfulness training isn’t a ‘magic bullet’ and won’t make your problems or concerns disappear. However, it can help you engage with yourself and your clients in a more open, empathic way and provide a strong foundation to choose how you respond to events rather than simply reacting automatically. We hope that you enjoy exploring the material!
References
Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program.
Journal of Behavioral Medicine
,
31
(1), 23–33.
Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same?
Journal of Clinical Psychology
,
67
(4), 404–424.
Grossman, P. (2010). Mindfulness for psychologists: Paying kind attention to the perceptible.
Mindfulness
,
1
(2), 87–97.
Hayes, S. C., & Wilson, K. G. (2003). Mindfulness: Method and process.
Clinical Psychology: Science and Practice
,
10
(2), 161–165.
Irving, J. A., Dobkin, P. L., & Park, J. (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR).
Complementary Therapies in Clinical Practice
,
15
(2), 61–66.
Kabat-Zinn, J. (1994).
Wherever you go, there you are: Mindfulness meditation in everyday life
. New York: Hyperion.
Labbé, E. E. (2011).
Psychology moment by moment: A guide to enhancing your clinical practice with mindfulness and meditation
. Oakland, CA: New Harbinger Publications.
Malinowski, P. (2008). Mindfulness as psychological dimension: Concepts and applications.
The Irish Journal of Psychology
,
29
(1–2), 155–166.
2Mindfulness
This chapter serves as a foundation to the more experiential approach taken in Chapters 3 and 4. Its purpose is not to provide an exhaustive literature review but rather a brief introduction to mindfulness. We will begin by addressing some of the pressures felt by therapists and how mindfulness can help, before taking a deeper look at what we mean by mindful awareness, the five elements of mindfulness and how they relate to one another. We will also reflect on how mindfulness relates to the first, second and third person perspective, and how this can impact you in your working day, be that alone or with your clients. Finally we will introduce mirror neurons and consider the role they may play in the therapeutic relationship.
Burden on the Helper
What made you choose to work as a therapist? Whatever your reasons, the strain of supporting others may take its toll on your health and well-being. For a profession which focuses on supporting others it is somewhat ironic that there isn’t a greater emphasis on supporting those of us who work as therapists or in helping professions (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2012). The continuous professional use of empathy alongside the frequent exposure to emotionally difficult situations, such as demanding or violent clients, can leave those who work in the helping professions at risk of burnout (Paris & Hoge, 2010). Burnout is the end result of chronic overload, which is characterised by fatigue, anxiety, tension, a sense of reduced effectiveness, a drop in motivation and the prevalence of dysfunction, negativity, and cynical attitudes and practices. Fengler (2008) has described four key ways of relating to stressful situations which may increase your risk of burnout: high self-set goals, a limited understanding of your own ability, a denial of the impact of taking on a lot of work, and a permanent suppression of the fact that you are overloaded. Another explanation for the high levels of burnout amongst therapists is that regular exposure to negativity, suicidal thoughts, pessimism and self-destruction are extremely stressful and emotionally contagious. Does any of this sound familiar?
The unique therapist–client relationship approximates a close friendship or partnership in terms of emotional intimacy, yet is asymmetrical in many ways. For example, within your professional role there is an expectation that you are always friendly, tolerant and understanding, regardless of how you happen to be feeling. You do not receive the sort of reciprocal support from your clients that you would usually receive from friends and family. Rather, it is up to you to facilitate your own recovery and restore your own equilibrium at the end of every session. Learning to be sensitive to your own needs throughout your working day can support this process, while also helping you to notice your workload, stress levels and how these affect you. We feel that developing your own mindfulness practice and bringing it into your working day is one helpful way of doing this.
Mindfulness as Self-care
Building on the early work of Kabat-Zinn and colleagues, who used mindfulness to support chronic pain patients (1982; 1985), the last 30 years have seen a steady increase in the use of varying forms of mindfulness training to support clinical (Praissman, 2008) and healthy populations (Chiesa & Serretti, 2009). Mindfulness training can lead to reductions in stress, anxiety and depression, while improving health and well-being. There are a huge range of mindfulness training programmes available, many based on Mindfulness-Based Stress Reduction (MBSR), which has served as a template for other client-specific programmes such as Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002) or Mindfulness-Based Eating (Kristeller & Hallett, 1999). Mindfulness plays an important role in programmes such as Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), where mindfulness is used to help create mental space, and Dialectical Behaviour Therapy (DBT; Linehan, 1993), where mindfulness helps to facilitate acceptance. Because of this growing interest, you may already be quite familiar with mindfulness!
As we mentioned in Chapter 1, in order to work with mindfulness in a therapeutic context, we believe that having your own personal practice is essential. In the MBCT manual, the authors describe how they discovered this for themselves through trial and error (Segal et al., 2002). Given the popularity of mindfulness-based approaches this may seem like a burden at first. If you want to use mindfulness exercises with your clients you are placed in the position of either ignoring this advice and ‘muddling along’, or devoting additional time to developing your own practice. From this perspective, developing a mindfulness practice is all about being a ‘good therapist’ and helping others. A qualitative investigation of mindfulness training for therapists found that the majority of the participants chose to attend mindfulness training in the hope that it would help them be more compassionate and present with their clients (Irving et al., 2012).
