How mindfulness and psychotherapy work together

Rob Fisher, MFT, on how mindfulness can help both therapists and clients make connections.

Mindfulness has recently become a popular word in psychotherapeutic circles—and with good reason. It can be used to become awake to the very fine grain of one’s experience in the present moment. Clients can intentionally use mindfulness to access deep information about their models of the world, self and others that are stored in implicit memory. Therapists can use it to become aware of exponentially more information from the client than ordinary conversation permits. Mindfulness Based Cognitive Therapy, Hakomi Mindfulness Based Experiential Therapy, Dialectical Behavioral Therapy are just some of the approaches that currently utilize it to address a wide range of issues from depression to anxiety to sleep problems to a general exploration of how your psychological world is structured.

By using mindfulness as part of therapy, deep levels of information can be accessed quite readily. Most therapists are used to asking questions such as, “How does that make you feel” and “What happens when you do that?” We are less familiar with guiding a client into a state where he or she can answer these questions from direct experience instead of simply trying to figure something out cognitively. Mindfulness basically involves paying careful attention, without judgment or preference, to the details of present moment that are often missed as we rush through our lives. Of course this is easier said than done, but can be facilitated successfully with the help of a therapist who is familiar with this process.

As an example, I recall a recent couples session. “John,” a client, would turn away from his partner, “Mary” whenever she was upset at him. I asked him to take a moment to let his attention go inside and to very slowly and carefully notice what happened to him when she would say one sentence of complaint. I then asked him to switch to a state very different from fighting with his partner, to one where he could observe his own automatic reactions. Instead of fighting back defensively, as he was accustomed to doing, he said, “I feel very small, and I feel like turning away.”

John was to stay with this impulse and actually allow it to happen slowly and mindfully. I also instructed him to notice what was familiar about this, and any memories or images that come up as he did so. Internally he could see the image of his mother blaming him and trapping him when he wanted to flee.” I also encouraged Mary to notice what happened inside of her when he turned away. This accessed, in a visceral way, the abandonments of her own family.

Mindfulness allowed them each to notice the deep emotional underpinnings of a fight which was occurring on a more superficial level. This involved purposefully asking each person to first become mindful and then studying his or her fine grain internal organization around the other’s actions. The byproduct of this was that they were each able to become more sympathetic towards their partner and to share on a vulnerable level that took them out of the fight and into intimacy.

Much happens inside the mind of a therapist during the course of a session. Being able to notice the subtle details of what is happening with a client in the present moment is quite useful and will direct both client and therapist towards core material. There is the content of what a client describes—the story; there is also her immediate experience, the quality of how she presents herself and what she is actually doing behaviorally moment to moment. Studies estimate that 70-80 percent of communication is non-verbal. Awareness and attunement on this level beneath words mirrors the preverbal attunement of early caregivers and contributes to earned attachment. As an infant, one needs the caregivers to to able to notice what is needed without the benefit of words—hungry? lonely?, cold? hot? poopy? Our needs, as adults are more complex, but the need for this kind of non-verbal conversation and responsiveness persists.

For instance, I noticed that “Emily,” who came to therapy to explore why she was not in a relationship, would look at the carpet or the ceiling, but rarely at me when she talked in session. In a gentle, curious and inviting way, I called her attention to this. I noticed this fairly mundane, but powerful fact of how she related in the moment. Asking her to mindfully explore what it was like to look at me (in real time) and then to look away provided rich information into the fears she had about intimacy and men in particular; information that was very impactful and meaningful to the client.

In addition to the content of a client’s narrative, here are some possibilities of what one can notice: gestures, posture, pace, any kind of repeated patterns like, “you know,” looking at the ground, gazing at you from the side of their eyes, tilting their head, subtle emotions such as shyness, shame, vocal volume, degree of animation or stillness, transitions, incongruencies, degree of focus, emotional transparency vs. hiding, compliance vs. opposition, aliveness, resources tensions and relaxation, breathing patterns, etc. Each of these elements is a potential experiential doorway to implicit beliefs that reside just below consciousness.

For instance, a large client of mine, as he stooped to get through the doorway, shook my hand. Despite his size, his grip was weak and flaccid. When we studied this more carefully in a future session, this led us to how he was organized around his strength and power. He had decided in sixth grade that he should not use it lest he hurt others… and then spent the next thirty years letting people roll over him. The implicit model of himself in the world was evident and viscerally accessible in his handshake.

The use of mindfulness in individual, couples, family and group therapy provides depth by accessing implicit models of the world, self and others from immediate experience, fosters earned attachment, and can access an internal drive that organically moves towards wholeness in the individual’s psyche.

Mindfulness allows us to tap into an exponentially deeper level of experience than simple conversation permits. By then allowing this visceral process to unfold, we can allow our basic creative drive towards health to return us to our essential selves.

Rob Fisher, MFT, is a psychotherapist, consultant and supervisor in private practice in Mill Valley, CA and Hakomi Mindfulness Based Experiential Psychotherapy Trainer. He is the co-developer and lead instructor of the Mindfulness and Compassion Certificate Program for Psychotherapists at CIIS and an adjunct professor at JFK University and SBGI. He is the author of Experiential Psychotherapy with Couples—A Guide for the Creative Pragmatist