The Art of Now

Essential skills for mindfulness

How to Make Mindfulness Accessible

"Entry-level" meditations for vulnerable clients

Many clinicians wonder how to bring mindfulness to chaotic or vulnerable clients. There are many people in my caseload who simply aren’t interested in closing their eyes and sitting still. It’s often hard enough to get folks to show for therapy.

 I have worked, taught and supervised at public, urban hospitals since the mid-1980’s, and have developed ways to adapt mindfulness practices so they will work for most clients. As meditation teachers tell us, even a few moments of practice can be beneficial. Recent research, presented at the American Psychiatric Association in May of 2014, found that a seven-minute mindfulness intervention reduced inpatients’ anxiety and depression.

 The following “entry-level” meditations are accessible for even the most vulnerable and chaotic clients. I have taught these practices to homeless addicts, trauma survivors, and those with severe depression and anxiety, as well as to clients who are not candidates for more in-depth mindfulness practices.  

A few caveats before starting. Before introducing mindfulness to others, it’s important for the clinician to develop his or her own personal practice. Teaching mindfulness effectively is difficult if you don’t have a sense of the terrain and haven’t experienced the benefits. It would be like trying to teach tennis if you had never played. So please take the time to cultivate your own mindfulness practice. You don’t need decades of practice, but taking a course to familiarize yourself with the basic concepts and skills is sound clinical practice.

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Also, mindfulness should never be forced. Even if you’re fairly certain that mindfulness will help a client, trying it should always be the client’s choice. If a client is not receptive, don’t make it a problem. The aim is not to turn all clients into meditators, but to give people tools to help them live more fulfilling and productive lives. When introducing a practice to those who are interested, it’s helpful to mention that there are decades of research that support it. Presenting mindfulness as a valuable and enjoyable experiment, which the client can stop at any time, is a skillful way to start.   

Eyes Open.  Because I work with many clients who have been physically and sexually abused, I realize they need to feel safe, in control, and able to see what is happening. So I don’t ask them to close their eyes while learning mindfulness. This was not always the case. When I was just starting my practice, I thought that teaching an agitated client a breathing exercise with eyes closed would be calming. Sometimes it is. Rashida entered the session upset about a difficult interaction with her boss. Not knowing she had a history of trauma, I asked her to close her eyes and take a few slow, deep breaths. Within moments, she was in a full-blown panic attack, hyperventilating, and having a memory of her father molesting her. We stopped the exercise immediately. While this approach is fine for well-integrated clients, it’s not a safe place to begin for traumatized individuals.

In addition to formal mindfulness exercises, I like to weave in informal mindfulness suggestions clients can use in the midst of their daily lives. Here’s one possible script you could adapt for your clients. These instructions work for individuals as well as groups. Allow three to five minutes for this practice.

  • There’s been a lot of research and media attention lately on the benefits of mindfulness. Studies show it can help with anxiety, depression, as well as the stresses of our daily lives. Would you like to try it for just a few minutes? I’ll join you in this practice.
  • Mindfulness isn’t complicated. It’s about being present in the moment with awareness and without judgment.
  • Start by sitting comfortably, eyes softly focused on a spot on the ground.
  • Let yourself be here, in this room, knowing that you are sitting in this chair.
  • Often when we are in a mall, or a park, or a new place, there is a map with a dot that reads, “You are here.”  Try saying to yourself, “I am here.”
  • Let yourself settle into your seat, resting with a sense of dignity. Often people don’t treat us with dignity and respect, but see if you can do this for yourself.
  • When you are ready, simply listen to the sounds in the room. Let yourself listen with your entire being.
  • Imagine that your body is like a huge ear or satellite dish. Listen to the sounds above you, below you, behind you, in front of you.
  • If your mind wanders, no problem, no judgment, just return to the sounds around you.
  •  Notice that all the sounds you notice--the traffic, a plane overhead, birds singing--have a beginning, a middle, and an end.
  • Let yourself rest in the sounds. There’s no need to change them, hold on to them, or push them away. Let them be as they are.
  • Know that this moment is unique, and that these sounds will never repeat themselves in precisely this way again.
  • When you are ready, stretch, wiggle your fingers and toes, and let me know what it was like for you.

As not all clients take to mindfulness immediately, expect a wide range of reactions. Many have the misconception that the mind should go blank, or that they should immediately become happy or peaceful. Mindfulness is not about achieving an altered state, but learning to accept life as it is, and bringing kindness and compassion to whatever is arising in the present moment.

Susan Pollak, MTS, Ed.D., co-author of the book Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy, (Guilford Press) is a clinical instructor in psychology at Harvard Medical School

 

 

Susan M. Pollak, MTS, Ed.D., is a clinical instructor in psychology at Harvard Medical School.

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