Mindfulness Meditation and Psychotherapy
How mindfulness meditation and psychotherapy can complement the goals of each.
Posted February 3, 2019
As part of my initial session with new clients I invariably inquire about their past experiences with psychotherapy. Additionally, I ask clients to identify specific practices they have used to help them deal with their anger, anxiety, or depression as well as stress in general. Increasingly, they cite mindfulness and mindfulness meditation practices to support their well-being. I make this inquiry, in part, because mindfulness and mindfulness meditation have received increased recognition for supporting both emotional and physical well-being. Additionally, I have increasingly integrated these practices as part of my clinical practice during the past ten years.
The nature of their mindfulness meditation practice
When new clients cite their use of mindfulness meditation, I find it extremely informative to determine the specific nature of their practice. I ask about the type of practices then engage in, their goals and, most importantly, how they relate their practice to their daily lives. Their answers greatly inform me about their understanding of mindfulness meditation as well as their relationship with their body, thoughts and feelings.
For example, some individuals report engagement in the traditional practice of sitting upright, some with their eyes open and others with their eyes closed–as they attend to their breadth. Consistent with this practice they report gently returning attention to their breath when they find the mind wondering –whether to thoughts, feelings or body sensations.
Others report spending time each day listening to a guided meditation-someone gently directing them to focus their attention on their breath, other body sensations, thoughts or feelings. Some of these meditations encourage various forms of visual imagery supportive of increasing such attention or mental calmness.
By contrast, some individuals have described engaging in mindful practices that help address a specific concern-whether it be creativity, anxiety, procrastination, motivation or difficulties with sleep. And many report listening to music as part of their practice.
Applying their practice to everyday life
I find it extremely informative to inquire how their meditation practice informs and impacts their daily lives. For, all too often, I have found that while clients are increasingly drawn to meditation, many fail to apply what they learn during their practice to their everyday lives. Many seem to engage in some of these exercises not so much in an effort to master the focus of their attention, but primarily as an emotional massage–often used in reaction to the stress of the day or to provide a baseline of calmness to enhance resilience for the day’s stress.
While this use of meditation may certainly enhance a more calm and resilient mindset, it does not address a key tenet of mindfulness meditation-specifically, expanding our capacity for awareness of the focus of our attention and the ability to choose the direction of our attention throughout our day. I’ve observed numerous examples of this challenge in and out of my clinical work.
Through my inquiry over the years, it has become apparent that some individuals try to use meditation in place of psychotherapy. While this may be helpful for some, its important to know that while mindfulness meditation may address some of the goals of treatment, it is significantly different than psychotherapy.
Mindfulness, mindfulness meditation and psychotherapy
This difficulty became apparent in my work with Scott, a young man who reported practicing mindfulness an hour each day. He was very committed in his practice and reported great frustration with himself when he missed doing so. On occasion his frustration entailed self-criticism that only undermined his openness to resume his practice. It became apparent that Scott engaged in meditation in order to deal with an overriding sense of anxiety. This was reflected in his intense facial expression, posture, his tone of voice and in the content of what he shared.He described a long history of being highly perfectionistic and highly self-critical. He sought treatment feeling that he had not made the gains he had hoped to make in dealing with these tendencies.
It became apparent that Scott gained a powerful sense of equanimity during his practice of meditation. However, he was challenged in his capacity to translate his learning when dealing with perfectionistic thoughts and his self-criticism in his everyday life. He struggled at times with meditation because he brought to it his same tendencies for perfectionism and self-criticism. As such, he experienced great tension as he focused on his breath.
It was as if he was engaged in a highly competitive video game–and was irritated with himself each time a thought, feeling or body sensation arose and disrupted his attention to his breath. He had not been aware that because of his anxiety, focusing on the breath might not have been the best starting point for a meditation practice. In such cases, the meditation practice might best start with a focus on sounds (Pollak, et. al, 2016).
His further elaboration revealed a history of experiencing shame, never feeling good enough. In part, this derived from early interactions with a highly rigid, authoritarian father who, in effect, often shamed him for mistakes, focused on his weaknesses rather than his strengths, and adamantly expressed his expectations of perfection. Scott indicated that he would never raise his hand to answer a question in school unless he was absolutely sure he was right. Socially, his anxiety similarly silenced him, often convinced he had nothing important to say or that he would be criticized for what he would say.
Another client I encountered, David, described practicing meditation for an hour each day, for over ten years. He sought my services for anger outbursts he had recently experienced in his relationship with his girlfriend. His anger had contributed to the loss of two previous relationships and this time, he was determined to do whatever it took to address it.
Our work together soon revealed that David had used meditation as an escape, as a defense against actually being in touch with feelings, rather than as a tool to help him increase his connection with himself. He described his practice as being traditional, sitting and observing his breath and the moment he had a thought or feeling, redirecting his attention back to his breath. He became very disciplined in his ability to redirect his attention especially when his thoughts or feelings took on a depressive tone. In fact, David used this practice on the cushion–and in his daily life–in an attempt to ward off intense feelings of any kind–in effect. Like a ninja warding off a physical attack, he would defend himself from these thoughts and feelings by grounding himself in his attending to his breathing.
Exploring his past helped David to better understand factors that supported his tendency toward emotional avoidance. His father was distant and in words and actions communicated that feelings should be ignored. At the same time, David grew up with a mother who suffered mood swings. These models left him feeling terribly uncomfortable with feelings, especially if they were intense-either positive or negative ones.
As David described his practice, it also became apparent that he had rigidly interpreted the Buddhist philosophy of non-attachment. This concept emphasizes that much of our suffering is based on becoming overly attached–in a highly dependent and clinging manner–to things, ideas and even people. This perspective, in part, fueled by the lack of emotional availability of his parents, left him overly cautious about emotionally investing, whether with regard to relationships or other commitments in his life.
Both of these cases exemplify the fact that the mindset we bring to our mindfulness practice mirrors the mindset that shapes our lives in general. Additionally, they are examples of practicing mindfulness in a way that inhibits full presence with and awareness of that mindset. By contrast, psychotherapy encompasses a focus on recognizing experiences and their resulting thoughts and feelings that may inhibit our actual acceptance of feelings. With regard to anger, for example, what distinguishes therapy from mindfulness is “…its encouragement to stay with the emotion long enough for some understanding of the feeling to emerge, and the constructive use of anger to motivate appropriate action (Aronson, 2004).
Each of the clients discussed needed to more fully recognize and move past some of the wounds that contributed toward their “experiential avoidance”. While mindfulness meditation emphasizes engagement in observing ourselves with “non-judgment”, each of these individuals approached their practice inhibited in this capacity. Additionally, therapy (including practices in self-compassion meditations) was essential to help them cultivate self-compassion to be open to the full range of their experience.
There are many distinctions between psychotherapy and mindfulness meditation even though some of their goals and practices may seem to overlap. Psychotherapy looks at the larger picture of our self and “script” by which we live. Scott needed to more fully explore the shame that had become a core issue influencing much of his emotional life and behavior. He needed to grieve and mourn for the little child he once was, who didn’t deserve to be denigrated and who needed compassion instead. He needed to develop skills in self-compassion, flexibility of thinking and feeling that allows for striving for perfection while recognizing his humanity. Scott also needed further guidance in developing a variety of self-soothing skills to address his tendency to feel less than. And by letting go of his past, he was helped in cultivating the self-compassion to sit without judgment and open curiosity when practicing meditation.
As part of our work together, I encouraged him to take time for a “daily check-in” several times daily, a moment to attend to his feelings and thoughts. I encouraged him to engage in meditative moments throughout the day, whether when walking down the street or when taking a shower, to observe his surroundings and his sensations of the moment rather than losing himself in his head. In this way he developed increased flexibility in being able to direct his attention to the full range of his experience. In essence, he was helped to recognize that there was a time to work on expanding his insight and there were times when he truly needed to redirect his attention from the grasp of negative self-critical internal dialogue to simply observe it.
Each of these clients needed help in recognizing the origins of their thoughts and feelings. Most importantly, they needed to know and emotionally understand how their reactions, were a natural outgrowth of the early challenges they endured. Each had developed a constellation of habits in thinking, feeling and behaving that were intended to help them to dodge the feeling of shame. While these defensive strategies worked to some extent, they consume energy and led to constriction in their thoughts, feelings and behaviors. Their strategies made perfect sense in the context of their early developmental experiences.
Mindfulness and mindfulness meditation helps us to become more aware of the inner workings of our minds–enhancing our capacity to recognize, observe and experience our thoughts, feelings and sensations without our being overwhelmed by them. At the same time, it can help us train our brain to make us less reactive to what we observe, thus allowing us to more assertively choose how we wish to define our lives. It is a powerful approach that has become greatly accessible through a variety of media. But it’s important to identify our goals for engaging in such practice and to develop realistic expectations regarding it. And it is equally important to be aware of the mindset we bring to our practice. Are we genuinely open, curious and non-judgmental? It often takes great self-reflection and personal work that might include psychotherapy to free us up to be more fully present in our lives in general–including when we sit on the cushion.
Pollak, S., Pedulla, T. & Siegel, R. (2016). Sitting Together: Essential Skills For Mindfulness-BasedPsychotherapy. N. Y., New York: Guilford Press.
Aronson, H. (2004). Buddhist Practice on Western Ground. Boston, Mass: Shambhala Publications, Inc.