Clients have a difficult time connecting with a sense of self that is not about the content of thought (e.g., “I am sad,” “I am Ralph,” “I am tall”). As we discuss in chapter 5, the persistence and ubiquity of our private verbal commentary obscures the distinction between self as knower and self as known. Contact with the present moment helps clients develop a more ever-changing, flowing, and therefore flexible sense
of self. This sense of self as process refers to a nonjudgmental, present, ongoing description of thoughts, feelings, and other private events (Hayes et al., 2001).
One of the easiest ways to help clients find this sense of self as process is through structured mindful-
ness exercises. In mindfulness exercises, the client is asked to gently observe without judgment a specific
event, or an ongoing set of events, that occurs inside the skin. Let’s take an example. One helpful eyes- closed exercise is Leaves on a Stream. In this exercise, clients are asked to picture themselves sitting next to a stream of water. They are then asked to imagine that leaves are floating down the stream and to place each thought gently on one of the leaves as it passes by. If a client notices he or she is getting hooked by a thought and dragged into a place where he or she is no longer observing the thoughts, the client is asked to note what just happened and to gently return to placing the thoughts on the leaves and allowing them to go down the stream. The therapist, at well-paced moments, can make comments to this effect, such as, “Notice if your mind has drifted onto other things, notice if it got caught by a thought. If so, gently bring it back, place the thought that got you caught onto a leaf, and send it down the stream, too.”
This exercise can be done using a variety of images, including having thoughts attached to signs carried by a marching band or vehicles passing by on the road. One client imagined a futuristic city that contained roads that ran on electricity, and the roads were floating in the sky and running all over the place. In such a case, going with the client’s image can work, too. Another image that can be used is clouds floating by in the sky. This transcript shows a short example of this kind of exercise led by the therapist.
Therapist: I would like you to take in a deep breath, and when you exhale, allow your eyes to close.
Take a couple more deep breaths and then gently settle into your normal breathing and just rest there for a moment. [pause] Now I would like you to imagine that you are lying in a field—a field of your choice. It could be one with grass or flowers. Just picture yourself lying there and imagine you can see the blue sky above you. In this sky, clouds of all shapes and sizes are gently floating by. [allows a few moments for the client to create and connect to this image]
Now I would like you to imagine that every thought you experience is magically attached to a cloud. It can rest in the cloud as a word or image, or the cloud itself can take on the image of your thought. The key here is to take each thought as it occurs and attach it to a cloud and allow it to gently float by. If you find you lose the image, that’s fine. When you notice this has happened, then without judgment just gently bring yourself back to lying on your back, watching each cloud float by, and attach the thought that took you away. I’m going to be quiet for a few minutes and let you practice this, just noticing each thought as it passes and placing it in or on a floating cloud. [lets the client quietly observe this process for a few minutes]
Remember, if you get lost in thought and are no longer viewing your thoughts, just gently come back. [allows another few minutes]
Now I would like you to gently leave this field in which you have been lying, and mindfully paying attention to the transition, come back to the room.
You can take time to process with the client the ongoing nature of thinking and point out how thoughts change, how they seem to be in motion—coming and going, sometimes chaotic and all over the place, sometimes more linear, sometimes as images, sometimes difficult to view. You can also discuss with the client how he or she went from looking at the thoughts (on the clouds) to looking from the thoughts (lost in the thoughts).
A second mindfulness exercise expands awareness of ongoing experience beyond the constant flow of thought to include the constant flow of all experience. In the “free experiencing” exercise (Walser & Westrup, 2007), the client is asked to pay attention to moment-by-moment experience:
Therapist: Let’s prepare for an exercise that points to the sense of self as an ongoing experiencer. First,
I would like you to get comfortable in your chair, and when you are ready, close your eyes. As your eyes close, notice that your ears tend to open. Take a moment and listen to what you hear. [pauses for about ten seconds] Now gently turn your attention to your breathing and simply follow your breathing as you inhale and exhale. Allow yourself to “be” your breathing for just a few moments. [ten-second pause] Now I would like you to follow—just as you followed your breathing—any sensation, thought, or emotion that arises. Be aware of each new sensation or thought or emotion and just simply observe it come and go. For instance, in one moment you may be aware of an itch, the next of a feeling of anxiety, the next of a thought, the next of a muscle pain or discomfort, and the next of a sound.
Your job in this exercise is to simply observe each new experience as it arises, as it comes into your awareness. For the next several minutes, I would like you to just notice the you that is an ongoing experiencing being—the you that senses, feels, and thinks in an ongoing fashion. Just let each new experience be there, observe, and then be aware of the next. [lets the client engage in this process for perhaps five to ten minutes]
Now I would like you to gently return to your breathing; spend the next few moments focusing on the rise and fall of the breath. And now open your eyes and return your attention to the room.
The key practice here is to help clients sustain a pattern of ongoing attention to, awareness of, pres- ence with, and contact with their immediate, ongoing, changing experience, without having to retreat from it or get pulled up into conceptual thought. Clients can also practice this skill through mindful aware- ness of simple, daily activities, such as eating, washing the dishes, driving, and waiting in line. As an in- session activity, the client might practice eating a raisin mindfully (Kabat-Zinn, 1994). Not only does this help the client develop an ongoing awareness of sensations, but as the exercise continues, the client can notice how experience continues to occur, even as the content of experience shifts over time. For example, at first the client does not have a raisin, then he or she does, then it is tasted and chewed and swallowed, and finally the client does not have a raisin anymore. Time moves forward, and with each passing moment, a new awareness arises.
Structured mindfulness practice outside of session can contribute to cultivating present moment awareness in everyday life. Possible exercises include focusing on the breath; walking meditations; simply noticing while doing a daily activity; sitting meditations; journaling reactions to daily events; and paying particular attention to feelings, sensations, and thoughts. Often, clients initially benefit from practice with basic awareness exercises and meditation, and eventually progress to more exposure-like mindfulness exer- cises in which they are asked to invite in distressing content (e.g., anxious thoughts). We provide a resource guide for meditations at the end of the chapter.