Clinical Handbook of Mindfulness (11 page)

toward one’s experience that is characterized by curiosity, openness, and

acceptance” (p. 232). The second part of this definition captures an essential

emotional or intentional attitude of mindfulness in clinical settings.

A stripped-down definition of “therapeutic mindfulness” that we and our

colleagues at the Institute for Meditation and Psychotherapy find useful

is
awareness, of present experience, with acceptance
(Germer, Siegel, &

Fulton,
2005).
These three elements can be found in most modern psycho-

logical literature on mindfulness. Although the “acceptance” component is

implied in the classical Buddhist texts, it helps to make it explicit for clini-

cal application. Other related shorthand expressions we might use for ther-

apeutic mindfulness include “affectionate awareness,” “mindful acceptance,”

“openhearted presence,” and “mindful compassion.”

The explicit addition of acceptance to the mindfulness formula makes

sense to most psychotherapists. This is especially the case when our patients

are confronted with overwhelming traumatic circumstances. Awareness

without acceptance can be like looking at a scary scene under a bright flood-

light. Sometimes we need softer light—like a candle—to approach difficult

experience. The more intensely we suffer, it seems, the more we need accep-

tance and compassion to be able to work with what is occurring in our lives.

Conversely, kindness without clear awareness can lead to sugar coating the

difficulties of life that need to be addressed.
Sans
awareness, acceptance

could become a form of defensive avoidance.

When patients come to psychotherapy, they are often in dire distress, seek-

ing a person who will take the time to understand who they are and why they

suffer. They desperately want a strategy for relief. Compassion is the invisible

matrix that holds the entire enterprise. The word “compassion” comes from

the Latin roots
com pati
, meaning to “suffer with.” That’s how we really come

to understand what our patients are going through—we suffer
with
them. If

we offer helpful advice to a patient without first providing acceptance and

compassion, he or she simply feels misunderstood.

20

Ronald D. Siegel, Christopher K. Germer, and Andrew Olendzki

Similarly, in the
intra
personal, therapeutic relationship—the one we have

with ourselves—compassion is also important. Self-compassion and self-

acceptance are “skillful means” for being aware under trying circumstances.

We need an open heart to have open eyes. When we practice mindfulness

by ourselves, self-acceptance is hopefully part of our emotional landscape;

in the therapy relationship, acceptance and compassion are essential for the

process to be effective.

Mind
ful
ness and Mind
less
ness

A psychotherapist needs to experience mindfulness in order to integrate it

into his or her clinical practice. Learning meditation from an experienced

teacher is the best way to begin and is strongly recommended. Psychother-

apists also benefit from a conceptual road map to guide their work. To this

end, we suggest using the definition of mindfulness just mentioned: (1)

awareness
, (2)
of present experience
, and (3)
with acceptance
(Germer

et al.,
2005).
A moment of mindfulness contains these three intertwined

elements. The mindfulness-oriented therapist may ask, moment to moment,

“How do I cultivate awareness of present experience with acceptance, for

myself and my patient?” This can be a touchstone for practice.

While its definition is easy to remember, the direct experience of mind-

fulness is more elusive. Sometimes mindfulness is easiest to understand by

examining its opposite. Even casual self-examination reveals that our typi-

cal mental state is remarkably mindless. We spend most of our time lost in

memories of the past and fantasies of the future. More often than not, we

operate on “autopilot,” where our minds are in one place and our bodies are

in another.

An embarrassing example of this happened to one of us recently while

driving to present a workshop on mindfulness and psychotherapy:

I was in a rush and running late. Suddenly, a few minutes into my drive, I real-

ized that I was heading in the wrong direction on the Massachusetts Turnpike—

a toll road on which the exits can seem as though they are 50 miles apart. I

wondered, “Who was driving the car?” “Who decided to head west? My mind

was busy preparing my presentation, while my body was steering the car auto-

matically, skillfully heading in the wrong direction.

Similar examples abound. Consider the leading cause of emergency

room visits to New York hospitals on Sunday mornings: bagel-cutting acci-

dents. While interacting with family members on the weekend, many peo-

ple are so distracted by interpersonal events that their bodies cut bagels

automatically—and their bodies aren’t very good at this without guidance

from the conscious mind.

Another less painful example of everyday mindlessness occurs in restau-

rants. Have you noticed how much restaurant conversation revolves around

where you ate in the past or where you might eat in the future? Only occa-

sionally do we actually taste the food that we’re eating.

And then there are our
deliberate
efforts to escape the present moment—

trying to get to the “good stuff.” Do you ever find yourself rushing through

the dishes to get to your cup of tea, book, or television program? Have you

ever had the thought, perhaps 10 minutes, into a psychotherapy session with

Chapter 1 Mindfulness

21

a frustrating patient, “Darn, forty minutes to go!” When we reflect honestly,

we notice that we’re rushing through, or trying to get rid of, much of our life

experience.

You may notice this even in the present moment: As you read these sen-

tences, where has your mind gone? Have you had thoughts such as, “I won-

der if this book is going to be worthwhile?,” “Maybe I should’ve gotten

another one,” or “This is pretty interesting, I hope the rest of it is good too.”

Perhaps your mind has left the book entirely, and you’re thinking about what

you’ll do later or what happened earlier today.

The pervasiveness of everyday mindlessness is particularly striking when

we inquire into what really matters in our lives. Take a few seconds to recall a

moment in your life that you really valued. (Really, stop reading for a moment

and think of one.) Perhaps it was a special time with someone you love or

a magical experience in nature. During this moment, where was your mind?

Was it focused on recalling the past or imagining the future? Most people

find that the moments they value the most are those in which they’re fully

present, noticing what is happening here and now.

These are moments of mindfulness. We notice the positions of our hands

and the sensations of holding a knife and bagel. We are aware of our bodies

sitting in the car when we drive, and we notice the other cars, the road,

and the scenery. We taste the food we eat, and we actually experience the

sight, sound, and emotional presence of our patients during psychotherapy.

Right now, try noticing the position of your hands as you hold this book, the

physical experience of sitting or lying down, and how your mind reacts to

these words. Mindfulness involves being present to our lives.

While notoriously difficult to convey with words, the Zen Haiku tradition

endeavors to capture moments of mindfulness. Here is a classic example

from Matsuo Basho, a wandering Japanese poet of the seventeenth century:

An old pond!

A frog jumps in —

The sound of water
.

(Toyomasu, 2001)

Mindfulness Practice

While it can be disturbing to notice how frequently we are mindless, and

how much of our lives we wish away, there is also good news: Mindfulness

can be cultivated. Just as we can improve physical fitness through regular

physical exercise, we can develop mindfulness through deliberate mental

practices.

Mindfulness practices all involve some form of meditation. Especially in the

West, misconceptions about meditation practice abound. It may therefore be

helpful to examine some of the most common misunderstandings.

Not having a blank mind
: While some concentration practices are

designed to empty the mind of thought, this is not an aim of mindfulness

practice. Nor do we wish to become stupid or lose our analytical abilities.

Instead, mindfulness practice involves training the mind to be aware of what

22

Ronald D. Siegel, Christopher K. Germer, and Andrew Olendzki

it is doing at all times, including being aware that we are thinking when

we think.

Not becoming emotionless
: Many people secretly hope that mindfulness

practice will relieve them of the burden of emotion. Especially when in dis-

tress, the fantasy of becoming emotionless can be quite appealing. In reality,

mindfulness practice often has quite the opposite effect. Because we prac-

tice noticing the contents of the mind, we come to notice our emotions
more

fully and vividly. Our ability to recognize how we feel increases as we relin-

quish normal defenses, such as distracting ourselves from discomfort with

entertainment or eating.

Not withdrawing from life
: Because most meditation practices were orig-

inally refined by monks, nuns, and hermits, people often assume that they

involve withdrawing from living a full, interpersonally rich life. While there

are certainly benefits to be derived from practicing mindfulness in a sim-

plified environment, even in these settings, one isn’t exactly withdrawing.

Instead, the vicissitudes of life are experienced more vividly, because we’re

taking the time to pay attention to our moment-to-moment experience.

Not seeking bliss
: The image of the spiritual master blissfully smiling while

the rest of us struggle with existential reality is very appealing. Early in their

meditation careers, many people become distressed when they find that their

minds wander and they feel agitated or unsettled. While exceptionally pleas-

ant states of mind do occur, in mindfulness meditation we allow them to

arise and pass—not clinging to blissful states nor rejecting unpleasant ones.

Not escaping pain
: Rather than escaping pain, mindfulness practice helps

us to increase our capacity to bear it. We deliberately abstain from auto-

matic actions designed to make ourselves feel better. For example, if we

are meditating and an itch arises, a typical instruction is to observe the

itch and notice any impulses that arise (such as the urge to scratch)—

but to not act on the urge. As a result, we actually experience pain and

discomfort more vividly. This extends beyond itches and physical pain to

include the full spectrum of emotional discomfort as well. As we explore and

accept these unpleasant experiences, our capacity to bear them increases.

We also discover that painful sensations are distinct from the suffering

that accompanies them. We see that suffering arises when we react to

pain with resistance, protest, or avoidance rather than moment-to-moment

acceptance.

Forms of Practice

There are many ways to cultivate awareness of current experience with

acceptance. Not surprisingly, all of them involve repeated practice. If we

want to improve our cardiovascular fitness, we might begin by integrating

physical exercise into our everyday routine—taking the stairs instead of the

elevator or riding a bicycle instead of driving to work. If we want to become

even more physically fit, we might set aside time to exercise formally, per-

haps at a gym or health club. To really accelerate the process, we might go

on a fitness-oriented vacation in which much of the day is spent in vigorous

exercise. Similar options are available for cultivating mindfulness.

Chapter 1 Mindfulness

23

Everyday mindfulness
: This involves reminding ourselves throughout the

day to pay attention to what is happening in the moment without radically

altering our routines. It means noticing the sensations of walking when we

walk, the taste of our food when we eat, and the appearance of our sur-

roundings as we pass through them. The Vietnamese Zen teacher Thich Nhat

Hahn suggests a number of techniques to enhance everyday mindfulness.

For example, when the telephone rings, try just listening at first, attending

to the tone and rhythm of the sound as one might listen to a musical instru-

ment. Or while driving, when the red tail lights of another vehicle appear, try

appreciating their color and texture as one might do in looking at a beautiful

sunset.

Formal meditation practice
: This involves setting aside time to go to the

mental “gym.” We regularly dedicate a certain period to sit quietly in med-