Clinical Handbook of Mindfulness (126 page)

adjusted. Mindfulness posits the opposite that by being curious about all

inner sensorial experiences, (body, emotions, cognitions) an uncovering of

intrinsic health occurs, and in this insight lies the recognition of being a part

of a greater whole
(Kabat-Zinn, 1996).
This has important implications for those mental health illnesses that present with excessive attachment to ego-centric thinking.

Awareness in Dialogue

Mindfulness stays firmly in the present moment. Its focus is on what is here

right now; what is present. This stance has a different center from many

psychological methods, where examination of past history as it relates to

current difficulties is a critical focus. A central and important theme in the

MBSR and MBCT programs is allowing awareness and attention to be directed

toward the inner exploration of the unfolding nature of physical, emotional

and cognitive sensations in the present, and also the outward articulation of

that process. This requires a special kind of responsiveness on the part of the

teacher.

The word “inquiry,” often used to describe this process, can sometimes

convey a sense of looking for something in particular, and has its deriva-

tion in the Latin, “quaerere” and “inquirere” to seek (Concise Oxford Dic-

tionary,
2004.
Eleventh Edition). This suggestion that there is something to
Chapter 25 Training Professionals in Mindfulness

467

find can create a more narrowly focused framework for what is unfolding

in the MBSR and MBCT groups. Using the word “dialogue” to describe the

unfolding meaning of the process of inquiry allows for a more spacious frame

of reference which supports a sense of discovery and “exploration of a sub-

ject”
(Concise Oxford Dictionary, 2004.
Eleventh Edition.) rather than looking for answers.

To some extent the instruction and delivery of the mindfulness practices

in MBSR and MBCT can be learned through modeling and repetition until

the basic language of instruction is committed to memory. But the teacher

who operates solely from a position of rote learning and intellect will find it

difficult to facilitate the discussion and exploration of mindfulness practice,

which comprises a significant portion of the classes. The teacher who relies

primarily on technique will be challenged to learn to sit with and be with

the comments, questions and experiences arising from mindfulness practice.

To respond from a mind solely orientated toward the concepts of patient,

diagnosis, illness, or disease is to leave out what mindfulness has the potential

to offer.

Instead the MBSR/MBCT teacher encourages the group participants to

encounter a place of “not-knowing.” Where meaning is uncovered moment

by moment without moving to “fix” or shape the essence of what is being

experienced. The teacher offers and invites open-ended conversations that

can reveal the unfolding nature of what is present in the room rather than

a quest for answers, closure, or even requiring anything to be found. The

conversations open up into the possibility of rediscovering and befriending

empirical connections to meaning. This requires from the teacher a gentle

and compassionate attentiveness and steadiness, an understanding born of

her/his own encountering of what comes up in personal practice. Otherwise

there is a tendency to rationalize this observed learning. This is where the

instructor’s personal practice becomes central to working with the material

presented by the participants. It is where Segal et al. noticed, when observ-

ing the MBSR instructors at the Center for Mindfulness (Appendix B) “the

remarkable way they were able to embody a different relationship to the

most intense distress and emotion in their patients. And we had seen the

MBSR instructors going further in their work with negative affect than we

had been able to do in the group context, by staying within our therapist

roles.”
(Segal et al., 2002).

Experiential Engagement

Both MBSR and MBCT emphasize that the instructor teach from an experien-

tial engagement with mindfulness rather than through a cognitive process.

The reasons for this are described by the developers of MBCT when they

articulate their own learning process in
Segal et al. (2002).
Their initial view was that mindfulness-based interventions could be taught in very much the

same way as any other therapy, through learning about the rationale for the

techniques and then applying them. However as they continued to observe

the MBSR teachers at the Center for Mindfulness, they came to appreciate

the qualitative difference it made to the teaching when the instructor spoke

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Susan Lesley Woods

from a place of personal experience with the practice of mindfulness. As they

noted, “A vital part of what the MBSR instructor conveyed was his or her own

embodiment of mindfulness in interactions with the class
. . .
Participants in

the MBSR program learn about mindfulness in two ways: through their own

practice, and when the instructor him- or herself is able to embody it in the

way issues are dealt with in the class.”
(Segal et al., 2002).

The transformational potential of mindfulness practice can only be avail-

able to participants and teachers alike if one is living with the practice by

actively employing the attitudinal foundations within the fabric of one’s own

life. It is this quality that is referred to in the reference manual of the Center

for Mindfulness. “In order for a class or for the program as a whole to have

any meaning or vitality, the person who is delivering it must make every

effort to embody the practice in his or her own life and teach out of personal

experience and his or her own wisdom, not just in a cookbook fashion out

of theory and out of the thinking mind. Otherwise, the instruction becomes

a mechanical didactic exercise at best and the true virtues of the mindful-

ness approach will be lost. We never ask anything of our patients that we

are not asking of ourselves to a greater degree, moment to moment and day

by day.”
(Kabat-Zinn & Santorelli, 1996).
In teaching MBSR and MBCT, the teacher is embracing a specific way of being with and engaging in experience, by paying deliberate attention to it with an attitude of kindly interest.

There is nothing foreign about awareness and paying attention for it is an

innate human ability, but mindfulness illuminates and reinforces this faculty

in a clearly defined and organized manner. This is because there are specific

aspects within the attending – that of non-striving, compassionate listening,

deepening self-inquiry and self-acceptance – which require an ongoing and

sustained focus. The intention is that nothing is pushed away, chased after or

tuned out. Eventually, more difficult mind states such as anger, hatred, hope-

lessness and helplessness can be seen for what they are – the proliferation

of unconstructive qualities of mind created by contact with an unpleasant

moment.

Often it is our reactions to difficult and stressful situations, or from wanting

to hold onto and find ways to replicate pleasurable experiences, which lead

to much “thinking,” problem solving and “doing.” Sometimes this method of

processing the emotional, cognitive and feeling material born out of experi-

ence works well. But at times it can lead to an impasse. Then it is as though

thinking takes over and we become engaged in creating a potent narrative

about what we are going to do, what we could have done and what we

should have been able to do.

The MBSR/MBCT teacher will encounter this type of thinking many times

from the group participants as they struggle to make sense of their relation-

ship to difficulties, disappointments and pain. It is here, at this intersection

that mindfulness (and the teacher’s manner of embodying this) offers the

possibility to step out of all this “doing” mode, and into “being” mode, by

moving toward all sensations just as they are in this moment. It is an insight-

ful process of attending to and allowing for what is here. In acknowledging

what is present, observation of the sensations can include a narrow focus of

attention or a broader frame of awareness. This is not easy and requires con-

centration and effort that kindly notices when the attention has moved away

from the present moment. It involves a gentle mindful intention to return

Chapter 25 Training Professionals in Mindfulness

469

back to a commitment to be present for each moment along with patience

and a quality of friendliness and openness. This requires practice over time

because it needs remembering and reinforcement. It is difficult to see how

this process can be revealed and acknowledged by the teacher in any other

form than from a deep sense of having encountered these moments many

times in one’s own practice.

It is when meeting suffering in its entirety and in the present moment

that a quality of awareness and self-kindness, directed toward the unwanted,

is embodied by the teacher through the discovery in personal meditation

practice of being able to be with her/his own unconstructive and difficult

modes of mind. Over time and with practice, aversive states (a need to create

distance from negative affect and to remove and reject difficulty and suffer-

ing) are lessened. This is not a passive stance but rather one of receptivity,

acknowledgment and compassionate action. A “willingness to embrace in

awareness and nonjudgmentally those aspects of oneself that one is most

highly defended against, are essential qualities for the successful pursuit of

this work”
(Kabat-Zinn & Santorelli, 1996).
It is only through the instructor’s own experience with mindfulness practice, that she/he improves the possibilities of representing these qualities of acceptance, nonjudgment, kindness,

continuing investigation, self-inquiry and compassion in their fullness.

Relevance of Personal Practice

Directing awareness through personal mindfulness practice toward strength-

ening such positive mind states as loving-kindness and compassion requires

attention, receptivity, patience, and trust, all attributes of a practical engage-

ment with mindfulness. This takes practice and time. By working regu-

larly and directly with what arises from her/his experience of mindfulness

practice, and cultivating such attitudinal modes of mind as nonjudgment,

patience, beginner’s mind, trust, non-striving, acceptance and letting go, the

teacher conveys the possibility to MBSR and MBCT participants of develop-

ing a different relationship to difficulties and stress
(Kabat-Zinn, 1990).
These attitudinal elements of mindfulness become very much a part of what the

teacher embodies in instruction and can also be seen as important features

of psychotherapy.

Highlighting the efficacy of continuous personal work in this particular

way is a somewhat unusual approach in the delivery of clinical training pro-

grams, although there is a similar association in of undergoing personal ther-

apy when training as a psychodynamic therapist. The difference here is that

embedded in the practice of mindfulness is the assumption that continuing

to practice in this way provides an authentic way of being that adds a rich-

ness for living in the world.

By sustaining effort, patience and friendliness to the contents of our own

mind/body, particularly those aspects of thinking and feeling that we have

the most difficulty with, understanding grows about hearing, receiving and

being with all the reactions and responses presented by the MBSR and MBCT

group participants. Curiosity and compassion are conveyed by the clini-

cian’s ability to authentically present the process of returning to the present

moment. This is the platform the instructor can offer to the participants,

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Susan Lesley Woods

originating as it does from having met oneself again and again in personal

practice with a sense of nonjudgment, self-acceptance and compassion.

Professional Training Programs in MBSR and MBCT

Combining an emphasis on the clinician’s personal mindfulness practice

alongside her/his development of knowledge and theory requires careful

consideration when designing professional training for MBSR and MBCT

teachers. At a basic level, professional training in MBSR and MBCT will

develop and advance teaching skills for the practice of mindfulness. It will

foster the enhancement of group process as it relates to mindfulness, encour-

age and support interpersonal skills, such as warmth, acceptance, compas-

sion and respect alongside appropriate professional and personal bound-

aries. In the case of MBCT, it will also include the understanding, placement

and implementation of the cognitive behavioral segments embedded in the

program. Additionally, there is a responsibility to convey intention and mean-

ing to the unfolding nature of mindfulness practice and the various ways that

this can be communicated by the clinician.