Ethics, Meditation, and the Need for Therapists Self-Care

“This client is a mess!” On multiple occasions, I have heard therapist talk about the people who seek their consultation in patronizing, disrespectful, or even abusive ways. This ranged from lack of empathy and reducing somebody to a psychopathology to blunt insult. Sometimes I felt outraged. Why do marriage and family therapists, clinical counselors, social workers, and psychologists who have chosen a profession dedicated to serving people to recover from mental illness lose empathy?

I came to the conclusion that it must be about burnout in a high-stress work environment. Of course, there were times when I was talking or at least thinking of clients in less than appreciative ways, sometimes probably without being aware of it. When I’m not doing well I can’t support others. Psychotherapists have the responsibility to be their best selves in order to assist their clients and to make ethical decisions on an ongoing basis. I believe that self-care can help prevent burnout and compassion fatigue through a reflective meditation practice.

Today, self-care is an imperative in highly stressful therapeutic work environments with ever-higher workloads and training requirements. It has become a buzzword in the mental health profession than can obscure larger social and organizational problems that cannot be resolved by individual therapists. Burnout, compassion fatigue, and vicarious trauma may be the result of unrealistic expectations of productivity in which numbers rather than people count. In order to prevent them large health care companies commonly encouraged therapists to “take care” of themselves. Meditation and mindfulness are readily associated with self-care in order to recharge exhausted therapists so they can get the job done. I found that self-care through reflective meditation can be more than just becoming better equipped to stay on a treadmill. It may be about changing body and mind as well as relationships with others in unexpected ways. For me meditation has become a comprehensive form of self-care that helps me to cultivate pleasure, to know myself better, and to become ethical.

 

Caring means cultivating pleasure

The first avenue towards self-care through meditation is probably the most intuitive: meditation can help relax and recharge the exhausted therapist in order to foreclose knee-jerk reactions to challenging situations. It can help shift gears and activate the parasympathetic nervous system that makes me ‘rest and digest’ – if I allow it.

“Is it selfish to just take time for myself to rest and enjoy?” a colleague asked me recently. I was able to relate to the question. For me a main obstacle to benefiting from tranquil and pleasurable states during meditation has been my reluctance to allow them.

Many years into my meditation practice I noticed that there was a sense of guilt when it came to relaxation and pleasure. In part this was a result inflexible instructions that caution practitioners vehemently to not become attached to pleasurable states. I often worked too hard to calm the mind, which was of course counterproductive. Now I know for sure that I don’t want meditation to be some sort of self-discipline that has the result of treating myself harshly. Don’t get me wrong, it can be helpful to have a schedule for sittings and to stick with one particular instruction for a while, but I found that this only makes sense when it leads to more ease and gentleness with myself, more care.

I don’t want self-care through meditation become another “should” that makes me feel bad about myself when not performed “correctly”. For me just taking some time to step out of everyday life’s busyness and to do nothing in particular can be a form of meditation. I found that adjusting my posture, changing it, laying down, and letting my mind wander can all be part of an open meditation practice. I don’t have to pay attention to anything in particular to allow a whole range of pleasurable states to arise. Just permitting myself to rest may lead into deep relaxation that can come with a feeling of interconnection and being cared for, perhaps the ultimate form of ‘self-care.’

Once my nervous system has calmed and becomes less emotionally reactive, I am usually in a better position to make ethical decisions in everyday life as well as in consultations with clients. Relaxing, calm, and pleasurable states during meditation may set the stage for distinguishing ‘right’ from ‘wrong’ off the cushion. Yet, I found that the cultivation of tranquility is not enough for self-care to become fully transformative.

 

Caring means getting to know the self

Self-care through meditation can be about more than taking a break from hard work to recharge and go back to the same situation. It can lead to self-knowledge and insights about how to act ethically. In order to care for the self I have to know the self. For me this can include an awareness of a boundary crossing that had gone unnoticed. During meditation and in reflections afterwards, I can catch unconscious needs and wants. Just noticing them during the sitting and redirecting myself to the save heaven of the breath might not be enough to really get to know what is going on in my inner world.

Self-care through meditation can also be about processing and integrating thoughts, emotions, body sensations, and desires. For me this is only possible if I am ready to follow a train of uncomfortable, embarrassing, or even painful experiences for a bit during meditation. For me this became an ethical practice that requires ongoing self-reflection. When I meditate I allow myself to experience whatever comes to mind. It is not about getting rid of my needs and wants but rather to become aware of them. Attended to with care my inner world may hold surprising answers to ethical dilemmas that I’m unable to tackle through linear rational thought. I might get answers to questions I couldn’t even think of when I allow myself to be curious. As a result it may become easier to feel empathy and more likely that I remember values that I want to live by because I am able to put thoughts and feelings about my own and other’s actions into perspective.

For me the key to knowing myself and my experience through meditation is a sort of doubling that can take place by writing down what has been going on during the sitting and thereby opening up the possibility of reflecting upon it afterwards. Moreover, talking with other people about the experience and being asked questions about it sheds light on blind spots that I would not have thought of before. An awareness of my unconscious habits and desires is key to making choices about where to go next and what ethical decisions to take in order to take care of others and myself. This reflective process may result in the development of longer-term dispositions in regards to how I want to present with people who seek my consultation as well as in relationships more generally.

 

Caring means becoming ethical

Finally, self-care through meditation can result in the development of moral qualities. If I get to know my inner world and myself, I can start to make conscious choices about how I want to act and about the type of person or therapist I want to be. This is about the development of ‘character’ or a preferred identity.

Momentary insights about myself in relationship with others gained upon meditative reflection can lead to what has been called virtue in philosophy. Virtues such as honesty, integrity, or kindness may have universal value. However, what qualities to focus on and how to apply them may depend on where you come from as well as on the particularities of an ethical challenge. I learned that in Greek philosophy the care of the self was the foundation of ethics, a notion of self-care that has been largely forgotten today. It was about skillfully monitoring, managing, and challenging personal needs and wants to develop one’s moral character. Today, virtue ethics can complement the ethical codes of professional organizations that require conformity rather than personal development on behalf of the therapist.

Virtue ethics take into account that the personal and the professional are interconnected. It is about how to be a good person or a morally good therapist who can make choices about how to show up with people who seek consultation and how to handle power differentials adequately. Thus, virtuous therapists are motivated to do what is right because they judge it to be right, not just because they feel obligated by their professional associations or the fear of negative consequences of an action.

A reflective meditation practice that includes journaling and conversation about the content of one’s experience allows for an ongoing ethical development of the therapist. It does not give universal answers but rather prepares the ground for better-informed decision-making that takes into account more variables of a situation. This approach goes with questions like: What thoughts, emotions and body sensations am I aware of as I consider this ethical dilemma, and what are they telling me to do? What decision would best define who I am as a person or who I want to be as a therapist? Caring here is about cultivating personal qualities that I can feel good about in the face of ethical dilemmas and actions that are congruent with my therapeutic approach as well as my self-image.

 

Comprehensive self-care

During meditation self-care can take the form of relaxation, self-knowledge, or the development of virtues. One session may be primarily focused on one of these processes. However, for me most of the time they are interlinked, both in a particular meditation sitting as well as in an ongoing practice over time.

Sometimes self-care requires calm states of mind for undervalued or hidden thoughts and feelings to arise. Once I get to know them better within a particular situation I can make conscious decision about care that is often no longer just about myself. It involves making decisions about who I want to be in relation to others. This may involve correcting some of the stories my mind makes up to divert my attention from boundary crossings or violations. Insights in the wake of meditation can lead the way. Some bright moments have made me reduce my workload and therefore the risk of burnout and compassion fatigue. Other insights motivated me to challenge unethical practices at work. When they were resolved, I felt less stressed, no need to return to a treadmill.

A comprehensive approach to self-care cannot guarantee ethical decision-making in everyday practice of clinical counseling, psychotherapy, and life. But it can make it more likely to move into a more thoughtful, considerate, and compassionate direction. This is an ongoing process that does not end with relaxation, a particular insight, or virtue. Self-care through a reflective meditation practice seems to require the whole person to become ethical anew again and again in every new situation in order to take ‘good’ care.

 

Valuing ‘Monkey Mind’: Towards Experience-Near Mindfulness

Long live monkey mind. Over the past years, I explored innovative forms of mindfulness that help me understand my world and experience better by allowing thoughts and emotions in meditation. I used to be convinced that I’m not a good meditator or that I will never be able to be fully mindful. Then I found out that this was largely the case because the instructions I used were counterproductive.

baby-monkey

For a long time I thought that I have a “monkey mind” that can never be still and calm. In some respects I do, but things are a bit more complicated and interesting. There is hope for anybody who cannot calm one’s inner chit chat by force. In an open and experience-near form of mindfulness having a “monkey mind” or being easily distracted and driven by seemingly random thoughts and feelings is not an obstacle but an entry point into exploration, insight, and more knowledge about ourselves and our worlds.

For many years I set myself up with instructions that told me to come back to the breath or the body when my mind wants to go somewhere else. But when I force myself to focus on some object of attention for a longer period of time my mind naturally wanders. Standard mindfulness instructions suggest to gently take attention back to the original object of focus.

The metaphor used is training a puppy who constantly wants to run away. Well, I found that constantly telling myself “sit, sit, sit” does not have the effect of being gentle with myself. Most long-term practitioners have difficulties with focusing their attention on an ongoing basis without being distracted. For me sustained concentration has only been possible when I was removed from society and everyday life. Many years ago I thought the inner silence reached on long-term retreats would be ideal meditation. It became the gold standard for measuring the progress and quality my meditation: having a clear mind without thoughts, just perfect balance, ideally all the time. But this was a set-up.

I found out that my mind settles down naturally when I don’t try hard to be a good meditator and when I allow myself to be with whatever experience comes up in an open and nonjudgmental way. It may be only for a couple of minutes in a longer sitting but these moments come with ease. On the one hand, this makes meditation much easier because I don’t set myself up for failure by trying to do the impossible, that is forcing myself to not have thoughts and emotions. On the other hand, it is also challenging since the thoughts and emotions that come up may be scary, annoying, or uncomfortable.But even if they are, when I take an accepting or tolerant stance towards them they become less threatening. In fact, there is a lot to learn about how I routinely deal with myself and my world.

When I get insights about how automatic patterns of thoughts, feelings, and behavior work, it becomes clearer to me what conditions have negative effects and what kind of conditions have positive ones. This is the first step towards making informed choices based on understandings gained during meditation.

Another effect of allowing thoughts and emotions into meditation is that even if I think of my experience as negative, I might find that there is much positive content in my mind that is pushed towards the periphery of awareness. Bringing this content more to the center of attention helps me to become aware of things that make me feel good about myself and others. This positive and life affirming inner self-talk would go largely unnoticed or pushed aside when I would constantly try to focus on a precontemplated object of focus.

For more information about experience-near mindfulness see Sati Sangha https://satisangha.org/and read “Unlearning Meditation.”

 

 

Mental Noting: An Insight Meditation Technique

Noting or naming my inner experience has helped me to be more aware of what is going on in my body and mind without getting automatically carried away by it. It enables me to get some distance from the mental chatter or bodily discomfort and to become a participant observer of my experience. Noting is a simple exercise that can make meditation more insightful because things that usually keep me busy unconsciously come out into full awareness. 

 

There are many ways to note breathing, body sensations, emotions, and thoughts. I think creativity is key. Come up with your own labels and find names that match your experience best.

Noting breath

It helps me immensely to focus my attention on the breath when I note it’s quality in each new moment. When I want to focus my attention on the breath, I can note “rising, falling, rising, falling” with reference to what I feel in my abdomen or chest. Counting the breaths is also a way of noting that can help keep track of what is going on in the body. In some meditation traditions it is recommended to continuously count to ten and the start again from the beginning. For me personally this has never worked very well.I become more focused when I note the nature of my bodily experience of breathing such as “quick” or “short”, “slow” or “steady”. Is the in-breath shorter than the out-breath or the other way around? If this is the case, I can note “short, long, short, long…” until I observe a change in pattern that calls for different labels.

Noting pain

Noting can help me to manage pain through meditation. I try to be as specific as possible and I don’t just settle for a broad term like “pain”. My intention is to note how it exactly feels. It may be “sharp”, “stiff”, “itchy”, “heavy”, “raw”, “tight” and the like. I don’t want to encourage anybody to sit through heavy pain that comes up because of an uncomfortable meditation posture. Noting pain makes most sense when there already is a physical problem such as migraine or back pain. I might enter meditation in awareness of it or it might just spontaneously strike my attention because of the hightened sensitivity that comes with contemplation of body and breath. If I continuously observe it, I might gain insight into the nature of the sensation.

What seemed to be one unified unpleasant sensation addressed with a vague label at the beginning, may have multiple aspects, some of them may have been completely hidden before because I avoided to explore them more fully. The same is true for emotional pain as I will illustrate in another post. If you become aware of the actual nature of pain in a more objective and dispassionate manner it may even disappear, but this is not necessarily the case. Through the practice of noting I can externalize bodily discomfort.Instead of avoiding or juding the sensation I develop a more accepting and compassionate relationship to it. This practice makes it easier to manage difficult sensations in everyday life. Sometimes all it needs is a shift in perspective to alleviate suffering.

Noting thoughts

When my mind wanders and I start to think about other things rather than to focus my attention on the object of meditation this can also be noted. I can simply note “wandering, wandering…” as soon as I start to think of doing the laundry, going shopping, or any other task my mind is preoccupied with. When my mind is directed into the future and what I still need to do, I might also note “planning, planning, planning” and let go of it.

Some people find it difficult to note because they get caught up in associations of thoughts and stories that take them away from the present moment. This technique is not about investigations on cause and effect. I can ask myself the question “What is it about?” but there is no need to name more than what is most apparent. Here it is important to stay with the present experience and give it a name and nothing more.

As a qualitative social researcher I often feel like coding my experience similar to an interview transcript. The aim is to identify, name, and categorize a phenomenon without judging it in any way. I just summarize what presents itself in a word or two on a continuous basis. Sometimes it gives me insight into how my experience works. It is about the processes that go on in the mind-body rather than their content.

Try out noting to externalize breath, sensations, and thoughts for a while and see if it helps to focus your mind or to gain insight into what is going on with you in the present moment. Be aware that you might reach as state in which your thoughts become “light” and your attention more focused. This is the time when noting may actually become distracting. Once noting leads me into a still and calm state or I just slip into such as state without noting, the noting itself becomes superfluous. In this case, I don’t use it, or just drop it and stay with the concentration I have gained. This can lead to other forms of insight.

 

Good News: Thoughts are not the Enemy!

The provocative title of Jason Siff’s brand-new book “Thoughts are not the enemy” summarizes an unorthodox approach to meditation. During a recent workshop at the Van Hanh Temple in Santee the post-modern Vipassana teacher simply told the participants to sit with whatever comes up. In contrast to traditional meditation instructions, he also encouraged everybody to follow thoughts into the past or the future without redirecting one’s attention to the breath or some other object. This stands in contrast to most approaches to meditation, including the modern mindfulness movement.

A large number of books and research articles suggest that “mind wandering” is the source of human distress, rumination, and delusion. In line with this idea, the implicit goal of meditation is to strengthen one’s ability to re-direct attention away from obsessive thoughts and as a result to become better equipped to regulate one’s inner experience or to move away from the notion of “self” tied to inner narratives. However, at the workshop Jason argued that for many meditators this doesn’t work. Even if we are told to “gently” move our attention back to the breath during meditation there is a high likelihood that thoughts become considered an “obstacle” that needs to be avoided or overcome in favor of some transcendental state of consciousness. I resonated. This had definately kept me stuck for a while.

After a sitting period, there was time to write down what came up during the meditation. Having relatively unspecific instructions gives the mediator the freedom to choose where to go or what aspect of experience to attend to. Thus, the participants were asked to reflect upon and journal about the choices made during meditation. This is an integral part of “recollective awareness”.

I was glad that Jason mentioned “choice”. For me Recollective Awareness seemed to be a rather passive process in which the meditator is asked to drown in a flood of restless and automatic thoughts. But as the critique of mainstream meditation pointed out, “it’s not about choiceless awareness but about becoming aware of the choices we make.”

The recollective reflection period gave me the chance to become more aware of how I want to relate to my inner self-talk and its content. First, it became pretty clear that I don’t want to beat myself up for having thoughts of any kind during meditation. Second, to follow uncomfortable thoughts gave me more insight about where they might come from in my own life. Third, I felt that some thoughts may be more helpful than my judgmental mind tends to assume. Rather than to cut them off, they are something to cultivate. Finally, I figured that once I become more aware of the choices I make during meditation, I may become more aware of the ones that come up in everyday life.

The awareness of the fact that there are choices at all makes a huge difference. Since the Recollective Awareness approach does not tell me where to go this makes me responsible for making sense of my experience and of choosing what seems to be right and appropriate for me at the moment. This individualized approach is highly contextual and lacks the prescriptions given by both traditional Buddhist approaches and the secular Mindfulness Movement. It is more complicated because choices seem to become more self-determined within the meditation process. Although some of my questions were left open, I resonated with a notion of change that takes into account meaning and narrative.

Recollective Awareness is interested in what Jason called “transformative conceptualization”. By exploring thoughts, their causes and contexts one may find that the categories, labels, and stories through which we think about ourselves and others may not really fit our experience. He pointed out that in the process of giving a fuller description of what is going on in the mind one starts to “crack down” the language through which we perceive our worlds.

We may become more aware of multiplicity and the need to come up with new conceptualizations that better fit our personal experience, an experience that cannot be fully grasped by any religious dogma or meditation teacher. From this perspective, meditation is not about a transcendental state without thought but about a more experience-near labeling of thoughts that is open to reconceptualization. Instead of getting away from thoughts, if I understood this correctly, it is about getting away from concepts that categorize us in habitual and unhelpful ways and be open to new ones that are more beneficial and in line with our personal struggles and aspirations.

As somebody who was exposed a lot to Narrative Therapy during my training as family therapist, I was pleased to hear Jason Siff’s perspective. There is an approach to mindfulness that seems to encourage the deconstruction and transformation of stories rather than to cut them out as residual “mind wandering” that can be reduced to rumination and ultimately overcome through some universal experience of stillness. But don’t get me wrong. Although Jason criticizes conventional approaches to meditation and mindfulness I did not feel that I have to give up “directive” practices after the workshop. They will continue to be part of my meditation practice.

I will continue to enjoy the moments of stillness when they come up naturally; and I will actively create them – probably with a bit more awareness of why I feel the need to do so.

 

 

Eight Misconceptions about Mindfulness

There are at least eight misconceptions about mindfulness that I have read or heard about so far. They can also be seen as traps one may fall into when practicing Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT) without proper guidance. If you don’t practice mindfulness read the list and be aware whether or not one of the misconceptions resonates with you. Ask yourself why this is the case and what personal values inform your thoughts. If you are practicing mindfulness ask yourself kindly and honestly whether or not a particular misconception applies to you right now. Then see if you like your conclusion or not and ask why this is the case. By asking these questions you can actually strengthen and develop mindfulness of your intentions and values.

  1. Just about me? Mindfulness meditation leads to a state of isolated self-absorption that makes you withdraw from social relationships.

  2. Just stay the same? Mindfulness does not require a change of lifestyle and you can keep your practice separate from other spheres of your life.

  3. Just do whatever? Mindfulness is not based on a set of values linked to social ethics that would prevent you from using it to harm others.

  4. Just consume? Mindfulness is a commodity that can be sold and bought just like any other product or service available for modern consumers in a market economy.

  5. Just believe? Mindfulness is a religious practice and cannot be separated from Buddhist believes and rituals.

  6. Just relax? Mindfulness is a technique that makes you feel relaxed rather than leading to personal transformation that would make you become kinder with yourself and others.

  7. Just escape? Mindfulness is a way to escape from the stressors of everyday life and enables you to cope for some time without having to deal with the real problems.

  8. Just adapt? Mindfulness makes you accept everything uncritically. It is a way to adapt to untenable social relationships, oppressive cultural or religious norms.

Take some time to reflect upon the questions you posed and answered. They can help you become more aware of your values and intentions as they relate to mindfulness meditation.

misconceptions2

The eight misconceptions help me to evaluate my practice in an ongoing manner. They can serve as a wake up call. When I start to agree with any one of them at the moment, I know it’s time steer into a different direction. If you are aware of other misconceptions, critiques, or concerns about mindfulness feel free to share them.

Three Things about Mindfulness

Three Things about Mindfulness

Sometimes, it is helpful to break down what’s mindfulness. Mindfulness is about at least three things: our intention, attention, and attitude. First, mindfulness is said to be based on intention or making a conscious choice, a decision to shape one’s experience. This includes the intention to practice, as well as the intentionality one brings to directing, sustaining or switching attention. The intention to consciously focus attention on a object such as the breath is the basis of mindfulness.

Second, focused attention itself is a defining feature of mindfulness. It includes focused, broad and sustained attention, and skills in switching attention from one stimulus to another. Attention is tied to the ability to pay close attention to details in tasks or activities and not to be overwhlemed by extraneous stimuli. Attention can be considered a form of self-regulation and can help us to deal with difficult emotions. Evidently, sensations, emotions, and thoughts can never be kept from coming up. This brings us to the next dimension.

Third, mindfulness is not merely about focusing attention but about a focus in a particular way. It is grounded in particular attitudes that allow for acceptance of whatever arises in the mind. These attittudes commonly include non-judgment, acceptance, trust, patience, non-striving, curiosity, and kindness. They are developed by intentionally sustaining attention to internal and external stimuli without immediately evaluating them as either “good” or “bad” through an awareness of their transitional and changing nature. It involves a stepping back from mostly unconscious habits that shape what we do, feel, and think in everyday life. This does not mean that we have to just accept everything that happens to us or other people. But more about that later.