PARTICIPANT RESPONSES – AMSTERDAM 2015 Wise Psychotherapist
1. Non-judgmental
2. Warm, compassionate 3. Patience
4. Sees the whole person 5. Calm
6. Nuanced
7. Beginner’s mind – open-minded 8. Discernment
9. Interested
10. Curious, asking 11. Knowledge 12. Honest, real 13. Human 14. Playful
15. Understanding 16. Sees larger context 17. Sensitive
18. Courageous 19. Friendly
20. Experienced – having lived life 21. Mentalizing
22. Intuitive
23. Present
24. Empathic
25. Supportive
26. Humility
Foolish (Unwise) Moments
1. Being so excited about my new idea, that I missed where my patient was entirely
2. Using the wrong name – thinking that my patient was someone else
3. Pouring tea over my patient’s arm 4. Forgetting my appointment
5. “Please look me in the eye” missing the cultural needs of the other 6. Thinking too much – what intervention she needs next
7. Anxiety about getting it right got in the way
8. Stuck on preconceived idea about what treatment should be 9. Making assumptions based on limited information --- and
thinking I could do more than I could
10. Overloading my client with my brilliant insights
11. Undervaluing my own value – not noticing that we matter 12. Judging supervisee – having preconceived ideas color my view
What Gets in the Way
1. Me
2. Afraid to not be good enough – smart and talented, or ethical and caring
3. Feeling people can’t change
4. Allergies – automatic reactions to certain types of people
c. Arrogant people d. Rigid
e. Externalizes f. Lazy
g. Complainers h. Driven
5. Striving 6. Impatience
7. Taking on more than I can handle
8. Not being able to admit that we’re not the right person
Wisdom and Compassion in Psychotherapy:
Deepening Mindfulness in Clinical Practice
Ronald D. Siegel, Psy.D .
Wisdom in Psychotherapy
“Hard core pornography is hard to define”
[but]
“I know it when I see it.”
-- Justice Potter Stewart (1964)
“If we are doomed to die
—let us spend.”
-- Mesopotamia (3000 BCE)
“Be not puffed up with thy knowledge, and be not proud
because thou are wise.”
-- Egypt (2000 BCE)
“The narrow intelligence flashing from the keen eye of a clever
rogue” is not wisdom.
-- Socrates (400 BCE)
A 15 year old girl wants to get married right away.
What should she do?
Paul Baltes – Berlin Group
1. Factual knowledge 2. Procedural knowledge 3. Life-span contextualism 4. Value relativism
5. Awareness and management of uncertainty
Monika Ardelt
“A fool can learn to say all the things a wise man says, and to say them on the same occasions, but this isn’t real wisdom.”
--John Kekes
Meeks & Jeste
1. Prosocial behavior/attitudes
2. Social decision-making/pragmatic life knowledge
3. Emotional homeostasis 4. Reflection/Self-understanding 5. Value relativism/tolerance 6. Acknowledgement of/dealing
effectively with uncertainty/ambiguity.
Not Knowing
Beginner’s Mind
Susan Bluck and Judith Gluck
1. Intelligence 2. Insight
3. Reflective attitude 4. Concern for others 5. Problem-solving abilities
Buddhist Psychology
• Compilation of insights derived largely from mindfulness practice
• Not a religion in Western sense, but the results of a 2500 year old tradition of introspection
Three Marks of Existence
• Anicca
(impermanence)
• Dukkha
(unsatisfactoriness)
• Anatta (no enduring, separate self)
Mindfulness
The Roles of Mindfulness
• Practicing Therapist
• Mindfulness Informed Psychotherapy
• Mindfulness Based Psychotherapy
Implicit
Explicit
What is Mindfulness?
• Sati in Pali
Connotes awareness, attention, &
remembering
• In therapeutic arena, also includes
Non-judgment
Acceptance
• Adds kindness & friendliness
Therapeutic Mindfulness
1. Awareness
2. Of present experience 3. With acceptance
Formal Meditation Skills
• Concentration (focused attention)
to observe clearly
• Mindfulness (open monitoring)
to see how the mind creates suffering
• Acceptance (loving-kindness;
self-compassion; equanimity)
to soothe and comfort
Acceptance
R-A-I-N
• Recognize what is happening.
• Allow life to be just as it is.
• Investigate inner experience with kindness.
• Nonidentification; rest in Natural awareness.
--Tara Brach
How Mindfulness Fosters Wisdom I
• Stepping Out Of the Thought Stream
• Being With Discomfort
• Disengaging From Automatic Responses
How Mindfulness Fosters Wisdom II
• Transpersonal Insight
• Seeing How the Mind Creates Suffering
• Embracing Opposites
• Developing Compassion
Anatta
Why Are You Unhappy?
Because 99.9% of everything you think, and of everything you do, is for yourself—and there isn't one.
- Wei Wu Wei (Terence James Stannus Gray)
The Western View of the Self
• Emphasis on separateness vs.
connection to family, tribe, nature, etc.
• Healthy (Western) development:
Individuated
Aware of Boundaries
Knowing one’s needs
Clear identity and sense of self
Narcissism in Western Psychology
• DSM
Character disorder
• Behavior therapy
Self efficacy
• Psychodynamic psychotherapy
Healthy narcissism or self esteem
Narcissism in Buddhist Psychology
• We suffer when we don’t know who we really are
• Attempt to buttress self is central cause of suffering
• Our concept of “self” is based on a fundamental misunderstanding
Where do I Begin and End?
What about Boundaries?
Boundaries
Where is the Organism?
Us and Them
Enemy
Enemy
Meat Meat
Meat
Meat
Enemy Servant
Servant
Enemy
Servant Servant
Servant
Servant
Constructing Experience
• Identity is a construction project
• Mind is a world- building organ
Makes order out of chaos
Constructs reality from data streaming in at break-neck speed
Sense Contact
• Coming together of
Sense organ
Sense object
Awareness of object
• Six senses
Seeing
Hearing
Smelling
Tasting
Touching
Thinking
Perception
• Evaluates sense experience
Conditioned by culture and language
• Constructs and categorizes
Omits details
Fills in missing information
VIDEO
Feeling
• We add an affective or hedonic tone to all experience
Pleasant
Unpleasant
Neutral
Intention and Disposition
• We try to
Hold onto the pleasant
Push away the unpleasant
Ignore the neutral
• We develop habits of intention
Dispositions
Learned behaviors
Conditioned responses
Personality characteristics
Intention
Feeling Perception
Consciousness
Sense Organ Sense Object
The Construction of Experience
A human being is part of the whole
called by us universe ... We
experience ourselves, our thoughts
and feelings as something separate
from the rest. A kind of optical delusion of
consciousness. This delusion is a kind of prison
for us, restricting us to our personal desires and to
affection for a few persons nearest to us. Our task
must be to free ourselves from the prison by
widening our circle of compassion to embrace all
living creatures and the whole of nature in its
beauty. The true value of a human being is
determined by the measure and the sense in which
they have obtained liberation from the self.
The Self
• A verb, not a noun
Selfing occurs
• We respond differently when experiences
belong to “me”• Creates further distortions
Copernicus of the Mind
• Identity is recreated moment by moment
• Continuity of self is illusory
• Like frames of a movie
The Failure of Success
• The pain of I, me, me, mine
• Narcissistic recalibration
• Narcissistic defenses are all compensatory
Flowers Wilt When We Pick Them
Jung’s Shadow &
The Separate Self
• Identifying with some mental contents while rejecting others
• Creates split off
“Shadow”
Mild dissociation caused by trying to avoid pain
The Trance of Unworthiness
• Eastern meditation teachers are surprised by Western self-criticism
• Anxiety is primal mood of the separate self (Tara Brach)
• Related to Western cultural emphasis
on the separate self
We’re all Bozos on this Bus
• Dandelions in a field
• Not a path to perfection, but a path to wholeness
Boundary of what we can accept in ourselves is the boundary of our freedom – Zen Patriarch
Therapeutic Progress
”mine”
about me Not about me
about me
”mine”
about me Not about me
-- Adapted from Engler & Fulton
Wise Therapeutic Presence
Dodo Bird Hypothesis
“Everybody has won, and all must have prizes.”
What Matters Most in Psychotherapy?
“Evenly Hovering Attention”
• “Listen and not to trouble to keep in mind anything in particular”
– Freud, 1912
And I, Sir, Can Be Run Through with a Sword
Affect Tolerance
• Not “my,” but “the”
Anger
Fear
Lust
Joy
Embracing Affect
• Patients can only be with those emotions that we can embrace
• Emotions experienced as transient
• Teaspoon of salt in a pond
Challenges and Obstacles
You Have to Become a Somebody Before Becoming a
Nobody
• Dangers:
Fragmentation
Dissolution
Aggrandizement
• Analogous to stage-based trauma treatments
• Traditionally some practices are esoteric
Spiritual Materialism I
• Remarkably robust tendency to compare ourselves with others
Last neurotic pattern to fall away
• Look how selfless I am!
• Getting hooked on the enlightened role
Spiritual Materialism II
• It’s easy to become attached to the positive effects of mindfulness
Craving clarity
Seeking “higher” states of consciousness
Feeling superior to others who we imagine are less awake or aware
Compassion in Psychotherapy
Affect Regulation Systems .
Seeking pleasure Achieving and Activating
Affiliative Soothing/safety
Well-being
Threat-focused Protection &
Safety Seeking
Activating/Inhibiting
Anger, anxiety, disgust
Drive, excitement, vitality Contentment, safety, connection
Compassion
• Latin: pati; Greek: pathein (“to suffer”)
• Latin: com (“with”)
• Compassion means to “suffer with”
another person.
Compassion’s Relatives
• Empathy
• Sympathy
• Love
• Pity
• Altruism
How Mindfulness Develops Compassion
• Compassion for ourselves arises as we open to our own suffering
• Compassion for others arises as we see that everyone else also suffers
• Compassion arises naturally as we see our interconnectedness
Lovingkindness Practice
• “Metta” practices
May I be happy, peaceful, free from suffering
May my loved ones be happy. . .
May all beings be happy. . .
Research on LKM
• Builds positive emotions and resources
• Increases feelings of social connectedness.
• Changes the brain, which correlates with empathy and generosity.
• Shifts away from fault-finding, self and other
• Reduces back pain.
Positivity Portfolio
• When do you feel close & trusting?
• When does a relationship spark joy, gratitude, inspiration, awe?
• When do you
lean toward your beloved?
have the urge to enjoy your beloved’s companionship?
--Barbara Fredrickson
Equanimity Phrases
• Everyone is on his or her own life journey.
• I am not the cause of my patient’s suffering, nor is it entirely within my power to alleviate it.
• Though moments like this are difficult to bear, I may still try to help to the extent that I can.
Developing Compassion
• Imagine being a deeply compassionate person.
• Imagine being wise; knowing that “we all just find ourselves here” by the tide of evolution.
• Imagine yourself with the confidence, strength, and authority that arises from this understanding.
--Paul Gilbert
Condon, Desbordes, &
Miller (2013)
Cultivating Compassion
• 2 wk x 30 min online compassion training
Loved one
Self
Stranger
Difficult person
All beings
Compassionate Economics
• Subjects received
$100, $75, or $50
• Allowed to keep or give away any amount
• Meditators more likely to share
Paradoxical Responses
• Universality of ambivalence
Highlight one pole, energize the other
• Negative emotions may arise
Cynicism, anger, sadism
• Practice saying “Yes” to these
Self-Compassion
When Things Go Wrong
Unholy trinity of
• Self-criticism
• Self-isolation
• Self-absorption
An Antidote:
Self-compassion
• Self-Kindness
• Common Humanity
• Mindfulness
Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85-102.
Self-compassion is not…
• Sugarcoating – we’re opening to pain.
• Complacent – it’s a force of will - good will.
• Pity Party – we’re disentangling from pain.
• Exhausting – we’re struggling less.
• Selfish – it’s the first step to loving others.
Self-Compassionate Letter
• Describe something that makes you feel badly about yourself
• Think of loving, accepting, imaginary friend
• Write a letter to yourself from your friend’s perspective
---Kristen Neff
First Noble Truth to the Rescue
The Story of the Mustard Seed
The Big Picture
• What helps you to identify with something larger than yourself?
Nature
Friend, Family, or Community
Spiritual Teacher
Religious figure or image
Greeting Exercise
• Begin with breath
• Visualize the person you’re about to meet, suffering human being, once a child, has hopes and dreams,
vulnerable and afraid, believing you can help
• Now say “hello.”
Research On Self-compassion
• Predicts psychological well-being
• Different construct than self-esteem
• Unrelated to narcissism
• Adaptive response to academic failure
• Alleviates shame and self-criticism
• Helps to avoid unhealthy food
Adult Attachment Styles
1) I find it relatively easy to get close to others and am comfortable
depending on them and having them depend on me.
I don't worry about being abandoned or about someone getting too close to me.
2) I find that others are reluctant to get as close as I would like. I often worry that my partner doesn't really love me or won't want to stay with me.
I want to get very close to my partner, and this sometimes scares people away.
3) I am somewhat uncomfortable being close to others; I find it difficult to trust them completely, difficult to allow myself to depend on them.
I am nervous when anyone gets too
close, and often, others want me to be
more intimate than I feel comfortable
being.
Relationships
Relational-Cultural Theory
• Grew out of feminist critique of conventional psychology
• Benefits of mutual connection
Energy and vitality
Greater capacity to act
Increased clarity
Enhanced self-worth
Desire and capacity for more connection
Three Objects of Awareness
• Mindfulness of sensations, thoughts, feelings in “me”
• Mindfulness of the words, body language, mood of the other
• Mindfulness of the flow of relationship
Life in a Space Suit
• Our defenses against pain insulate us from contact with one another
• We imagine they
keep us safe, but
actually leave us
more vulnerable
Suffering in Isolation
• If we’re not happy, it’s our fault
Failure to buy the right consumer product
Inherent weakness
• Psychiatric diagnostic system can exacerbate problem
Only sick people have the disorders
Clinical Decisions
Narrative Mode
• Psychodynamic
Earlier, transference, other relationships
• Behavioral
How learned, how reinforced
• Systemic
Maintained by family, community, culture
Experiencing Mode
• How is it felt in the body?
• How does the mind respond?
Grasping
Pushing away
Ignoring
Relative Truth
• Human story
Success & Failure
Pleasure & Pain
Longing
Hurt
Anger
Envy
Joy
Pride
Absolute Truth
• Anicca
(impermanence)
• Dukkha
(unsatisfactoriness)
• Anatta (no enduring,
separate self)
Processing Trauma
1. Open to painful emotions
2. Explore the facts of trauma
3. See it through lens of
dependent origination4. Develop compassion
Timing is Everything
Turning toward Safety I
• Outer or distal focus
Walking Meditation
Listening Meditation
Nature Meditation
Eating Meditation
Open eye practices
Turning toward Safety II
• Inner focus
Mountain Meditation
Guided Imagery
Metta Practice
DBT techniques
Turning Toward the Sharp Points
• Moving toward anything unwanted or avoided
• How is it experienced in the body?
Pain, fear, sadness, anger
Unwanted images or memories
Urges toward compulsive behaviors
Different Strokes
• Need for frequent adjustment of exercises
• Elicit feedback about the experience
Both during and after practice
• Titrate between Safety and Sharp
Points
When Mindfulness of Inner Experience Can Be Harmful
• When overwhelmed by traumatic memories
• When terrified of disintegration, loss of sense of self
• When suffering from psychosis
Life Preservers
• Concentration Practices
Stepping out of the thought stream
• Eyes open, external sensory focus
Ground, trees, sky, wind, sounds
Common Factors in Psychological Disorders
Fly
Overwhelmed?
Capacity to bear experience Intensity of
experience
The Thinking Disease
• Review past pleasure and pain
• Try to maximize future pleasure and avoid future pain
The Problem With Selfing
How Does Mindfulness Help?
• Reinforces experiential approach
• Helps free us from believing in our thoughts
• Reduces narcissistic orientation
• Connects us to the world beyond our personal pleasure and pain
Stepping into Life:
Treating Depression
All or Nothing
Turning Away from Experience
• Depression involves turning away from pain
• Mindfulness turns toward the
experience at hand, challenging the
depressive stance
Psychosocial Models of Depression
• Learned Helplessness
• Cognitive Models
• Psychodynamic Models
• Relational/Ecopsychological Models
Learned Helplessness
• Mindfulness redirects attention to present
• Practice seeing moment to moment experiences as workable
Murder in the 180 th Degree
Aliveness
You become sensitive to the actual experience of living, to how things actually feel. You do not sit around developing sublime thoughts about living. You live. - Bhante Guanarantana
Attention to Present Affect
• Focus on what, not why
What is happening right now?
Can you be with or breath into what is happening right now?
• Similar to Eugene Gendlin’s focusing and Gestalt Therapy techniques.
Moving Toward Pain
• What do you experience in your body?
• What is your relationship to your pain?
• Do you feel
compassionate
toward yourself?
Perspective on Thought
• Refuting thought often falls flat
• Changing relationship to all thinking is more powerful
Thoughts are not facts. . . I am not my thoughts. . .
Affective Meteorology
• When in the past did you not feel depressed?
• How were your thought patterns different?
Entering Dark Places
• Following our patient into
Despair
Loneliness
Un-lovability
Self hate
Surviving & Connecting
• Patients need to know that they will not kill us off with their anger or despair
• “You cannot draw a depressed person out of his misery with love. . .you can, sometimes, manage to join someone in the place where he resides”
– Andrew Solomon
Hope
• Premature offers of hope are empathic failures
• Empathic
connection itself
offers hope
Medication
• Is patient caught in downward spiral?
• Does depressed affect lead to behavior which results in more depression?
• Is therapeutic relationship sufficient to reverse this?
The Guest House This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness, some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they're a crowd of sorrows, who violently sweep your house
empty of its furniture, still, treat each guest honorably.
He may be clearing you out for some new delight.
The dark thought, the shame, the malice, meet them at the door laughing,
and invite them in.
Be grateful for whoever comes, because each has been sent
as a guide from beyond.
~ Rumi ~
Befriending Fear:
Treating Anxiety Disorders
Components of Anxiety
• Physiological
Psychophysiological arousal
• Cognitive/Affective
Future oriented thinking, fear
Accurate and inaccurate risk appraisal
• Behavioral
Avoidance and rituals
Toppling Forward
• Most of time we’re lost in thoughts about the future
• Next, next, next
Looking forward to pleasure
Dreading pain
Anticipation
• All anxiety is anticipatory
• Even people in terrible present situations worry about the future
Worry
• Keeps me safe
• Helps me cope
• Prepares me for what may come
Trying to Be Happy by Avoiding Pain
• The “Diver Dan”
approach to life
Phobic avoidance &
constriction
• Medicating discomfort
• Hooked on distraction
TV, Internet, Shopping