Getting Beyond I, Me, Mine Mindfulness, Wisdom, and Compassion in Psychotherapy Ronald Siegel, Psy.D.
Therapeutic Mindfulness
1. Awareness 2. Of present experience 3. With acceptance
Life Is Difficult, for Everybody
What is Mindfulness? • Sati in Pali Connotes awareness, attention, & remembering
• In therapeutic arena, also includes Non-judgment Acceptance • Adds kindness & friendliness
Mindlessness • Operating on “autopilot” • Being lost in fantasies of the past and future • Breaking or spilling things because we’re not paying attention • Rushing through activities without attending to them
The Problem With Selfing
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Mindfulness Can Help Us • To see and accept things as they are • To loosen our preoccupation with “self” • To experience the richness of the moment • To become free to act skillfully
Mindfulness Practice is Not: • • • • •
Having a “blank” mind Becoming emotionless Withdrawing from life Seeking bliss Escaping pain
Breath Awareness
How It Works
Overwhelmed?
Intensity of experience
Capacity to bear experience
Fly
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The Thinking Disease • Review past pleasure and pain • Try to maximize future pleasure and avoid future pain
How Does Mindfulness Help? • Reinforces experiential approach
The Roles of Mindfulness Implicit
• Practicing Therapist
• Helps free us from believing in our thoughts • Reduces narcissistic orientation
• Mindfulness Informed Psychotherapy
• Connects us to the world beyond our personal pleasure and pain
• Mindfulness Based Psychotherapy Explicit
Dodo Bird Hypothesis
What Matters Most in Psychotherapy?
Patient variables Placebo & Expectation Model & technique Common Factors
“Everybody has won, and all must have prizes.”
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“Evenly Hovering Attention”
And I, Sir, Can Be Run Through with a Sword
• “Listen and not to trouble to keep in mind anything in particular” – Freud, 1912
Affect Tolerance • Not “my,” but “the”
Anger Fear Lust Joy
Embracing Affect • Beyond affect tolerance – embracing emotion Our patients can only be with those emotions that we can embrace
• All emotions experienced as transient A teaspoon of salt in a pond
Not Knowing
Beginner’s Mind
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Decisions, Decisions 1. 2. 3. 4. 5. 6. 7.
Which skills to emphasize? Formal or informal practice? Which objects of attention? Religious or secular practices? Narrative or experiencing mode? Relative or absolute truth? Turning toward safety or sharp points?
Focused Attention vs. Open Monitoring
Core Practice Skills 1. Concentration (focused attention) 2. Mindfulness per se (open monitoring) 3. Acceptance and Compassion
Acceptance
• Concentration (FA) Choose an object and follow it closely
• Mindfulness (OM) Attend to whatever object rises to forefront of consciousness
Loving-kindness Practice • “Metta” practices May I be happy, peaceful, free from suffering May my loved ones be happy. . . May all beings be happy. . .
Continuum of Practice Informal Mindfulness Practice
Formal Meditation Practice
Intensive Retreat Practice
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Informal Practice
Taillight Meditation
Formal Practice
Shower Meditation
(Results May Vary) • Data supports effects of formal meditation • Structural and functional brain changes.
Objects of Attention
Intensive Retreat Practice Coarse
• • • • • • • Resources at: meditationandpsychotherapy.org
Feet touching ground Sights and sounds of nature Taste of food Sound of bell Breath in belly Mantra Air at tip of nose
Subtle
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Religious or Secular? • “Spiritual” practices Devotional and theistic
• Secular practices Science grounded
• Seek cultural consonance
Narrative Mode • Psychodynamic Earlier, transference, other relationships
• Behavioral How learned, how reinforced
• Systemic Maintained by family, community, culture
Relative Truth
Experiencing Mode • How is it felt in the body? • How does the mind respond? Grasping Pushing away Ignoring
• Human story
Success & Failure Pleasure & Pain Longing Hurt Anger Envy Joy Pride
Absolute Truth
• Anicca (impermanence) • Dukkha (unsatisfactoriness) • Anatta (no enduring, separate self)
Timing is Everything
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Turning toward Safety I • Outer or distal focus
Walking Meditation Listening Meditation Nature Meditation Eating Meditation Open eye practices
Turning Toward the Sharp Points
Turning toward Safety II • Inner focus
Mountain Meditation Guided Imagery Metta Practice DBT techniques
Different Strokes
• Moving toward anything unwanted or avoided
• Need for frequent adjustment of exercises
• How is it experienced in the body?
• Elicit feedback about the experience
Pain, fear, sadness, anger Unwanted images or memories Urges toward compulsive behaviors
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
Both during and after practice
• Titrate between Safety and Sharp Points
Life Preservers • Concentration Practices Stepping out of the thought stream
• Eyes open, external sensory focus Ground, trees, sky, wind, sounds
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Decisions, Decisions 1. 2. 3. 4. 5. 6. 7.
Which skills to emphasize? Formal or informal practice? Which objects of attention? Religious or secular practices? Narrative or experiencing mode? Relative or absolute truth? Turning toward safety or sharp points?
“Hard core pornography is hard to define” [but] “I know it when I see it.”
Wisdom in Psychotherapy
“If we are doomed to die —let us spend.” -- Mesopotamia (3000 BCE)
-- Justice Potter Stewart (1964)
“Be not puffed up with thy knowledge, and be not proud because thou are wise.”
“The narrow intelligence flashing from the keen eye of a clever rogue” is not wisdom. -- Socrates (400 BCE)
-- Egypt (2000 BCE)
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Paul Baltes – Berlin Group 1. 2. 3. 4. 5. A 15 year old girl wants to get married right away. What should she do?
Monika Ardelt
Factual knowledge Procedural knowledge Life-span contextualism Value relativism Awareness and management of uncertainty
Not Knowing
“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
Beginner’s Mind
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
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Three Marks of Existence
• Anicca (impermanence) • Dukkha (unsatisfactoriness) • Anatta (no enduring, separate self)
How Mindfulness Fosters Wisdom I
Mindfulness
How Mindfulness Fosters Wisdom II
• Stepping Out Of the Thought Stream
• Transpersonal Insight
• Being With Discomfort
• Seeing How the Mind Creates Suffering
• Disengaging From Automatic Responses
• Embracing Opposites • Developing Compassion
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
Anatta
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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 Buddhist Psychology • We suffer when we don’t know who we really are
Narcissism in Western Psychology • DSM Character disorder
• Behavior therapy Self efficacy
• Psychodynamic psychotherapy Healthy narcissism or self esteem
Therapeutic Benefits of Glimpsing Anatta • Increased affect tolerance • Radical acceptance of parts
• Attempt to buttress self is central cause of suffering
• Freedom from self-esteem concerns • Deeper connection to others
• Our concept of “self” is based on a fundamental misunderstanding
Thinking
Homunculus?
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Default Mode Network
Where do I Begin and End?
What about Boundaries?
Boundaries
Superorganism
Us and Them Servant
Meat
Servant
Enemy Enemy Servant Servant Meat Meat Enemy Servant Meat Servant
Enemy
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Constructing “Me”
Sense Contact • Coming together of
• Identity is a construction project • Mind is a worldbuilding organ
Sense organ Sense object Awareness of object
• Six senses
Makes order out of chaos Constructs reality from data streaming in at break-neck speed
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 or conditioned responses Personality characteristics
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The Construction of Experience
No one Home Intention Feeling
Perception
New “self” born and dies each moment
Consciousness
Sense Organ
• Continuous flow of moment-to-moment experience
• Not even a stable witness Sense Object
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.
Just impersonal experience unfolding
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
Affect Tolerance
• Continuity of self is illusory • Like frames of a movie
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And I, Sir, Can Be Run Through with a Sword
Selfing & Affect Tolerance • Not “my,” but “the”
Embracing Affect
Anger Fear Lust Joy
Not Knowing
• Patients can only be with those emotions that we can embrace • Emotions experienced as transient • Teaspoon of salt in a pond
Beginner’s Mind
Radical Acceptance of Parts
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Our Polytheistic Mind
How Was Your Meditation? • Part trying to attend to the breath • Part fantasizing about the future • Part judging myself • Ask the committee!
Jung’s Shadow
We’re all Bozos on this Bus • Dandelions in a field
• We identify with some attributes while rejecting others
• Not a path to perfection, but a path to wholeness
• We become defensive when shadow is illuminated
• Boundary of what we can accept in ourselves is the boundary of our freedom – Zen Patriarch
The Trance of Unworthiness • Eastern meditation teachers are surprised by Western self-criticism
Self-Esteem
• Anxiety is primal mood of the separate self (Tara Brach) • Related to Western cultural emphasis on the separate self
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Self-Evaluation
What Defines Me? • • • • • • •
Lake Wobegon
Physical beauty Athletic talent Financial status Artistic creativity Academic degree Designer outfit Alma matter
The Failure of Success • The pain of I, me, me, mine
Where all the women are strong, all the men are good looking, and all the children are above average.
• Narcissistic recalibration • Impossibility of winning consistently
Wrong Wall?
As If by an Unseen Hand • Adaptive value to identifying with “self” Evolved through natural selection Useful for survival Self-preservation instinct shared by other animals
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It’s Getting Worse
Egos Inflating Over Time: A Cross‐Temporal Meta‐Analysis of the Narcissistic Personality Inventory
Journal of Personality, Volume 76, Issue 4
Connecting to Others
Relational-Cultural Theory • Grew out of feminist critique of conventional psychology
Three Objects of Awareness • Mindfulness of sensations, thoughts, feelings in “me”
• Benefits of mutual connection
Energy and vitality Greater capacity to act Increased clarity Enhanced self-worth (efficacy) Desire and capacity for more connection
• Mindfulness of the words, body language, mood of the other • Mindfulness of the flow of relationship
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“Do unto others as you would have them do unto you” It’s not just a commandment, but a law of nature.
Judgments
Life in a Space Suit • Defenses against pain insulate us from one another • We imagine they keep us safe, but they leave us more vulnerable
It’s About Other People
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Poor Prognosis
Embracing Insignificance
King of England, 1387
Narcissistic Threats • Anxiety often involves threats to us or our loved ones
Self image Health Wealth Fantasized loss of pleasure Anticipated disappointment
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Wat Tham Sua
Tiger Cave Temple Krabi, Thailand
Why Are You Unhappy? Because 99.9% of everything you think, and everything you do, is for yourself. And there isn’t one.
Compassion in Psychotherapy
-- Wei Wu Wei
Affect Regulation Systems Drive, excitement, vitality
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Contentment, safety, connection
Affiliative Soothing/safety
Seeking pleasure Achieving and Activating
Well-being
Threat-focused Protection & Safety Seeking Activating/Inhibiting
Anger, anxiety, disgust
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Looking Through Another’s Eyes
Compassion • Latin: pati; Greek: pathein (“to suffer”) • Latin: com (“with”) • Compassion means to “suffer with” another person.
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