Compassion in the Clinical Hour

A number of weeks ago, I was invited once again to teach about mindfulness and compassion at the Boston Area Rape Crisis Center, BARCC, an organization that has been committed to ending sexual violence for over 40 years. On a previous visit, a question helped me design a mindfulness practice that addressed the needs of survivors of physical and sexual abuse. My colleagues and I have found that in order to be most effective, these practices must be tailored to the needs of the patient. One size does not fit all.

During this visit, I asked the staff to talk about ways they wanted to incorporate mindfulness into their clinical practice. Lois Glass, LICSW, a social worker and the Clinical Director of BARCC, asked a question that has stayed with me, and that has profound implications for the ways we work with our patients. “With the challenges of assessing the survivor's needs, how can we find ways to prioritize compassion during the intake?" she asked. As we discussed this, she explained that many survivors report incidents of rape and violence, and struggle not to blame themselves. How can we acknowledge and be with the pain and violation, strengthen compassion, yet not derail the clinical intake?

I have been impressed with a simple but powerful intervention designed by Christopher Germer, Ph.D., and Kristin Neff, Ph.D., called the “Self-Compassion Break.” The practice is part of their Mindful Self-Compassion course, a transformative mindfulness-based intervention (MBI). This intervention is designed to meet suffering whenever it arises, in whatever form it appears. First, it brings in mindfulness by acknowledging what is happening: “This is a moment of suffering.” Then it acknowledges our common humanity, and that we are not alone in suffering: “Suffering is a part of life.” Finally, it helps us respond with compassion to the difficulties of life rather than beating ourselves up or telling ourselves to get over it already: “May I be kind to myself.”

I adapted the practice so that it becomes a relational interaction between therapist and patient, and can be used in the clinical intake or the clinical hour. For example, when a patient raises a traumatic incident or memory, you might respond by saying, “This is a very painful experience. Validate for yourself that you are experiencing difficulty. You might want to say to yourself, 'this is hard.' Let’s both pause for a moment and acknowledge that.” You may even want to invite your patient to put a hand, or both hands, one over the other, on his or her chest, feeling the warmth and softness of the touch. You can do the same, showing the patient that you are present by mirroring this gesture. Feel free to take a few breaths. “You are not alone with this." Pause. Let yourself resonate with and be with your patient, so he or she, to use Dan Siegel's phrase, "feels felt." Finally, you can talk about putting compassion in action. “Let’s talk about ways that you can be kind to yourself.” In this way, the practice can become psychoeducational as well. Since so many of us were not raised to be compassionate, we often don’t know what it looks like and misunderstand it as form of self-pity, weakness, or self-indulgence. This is not the case. Research shows that compassion contributes to healing and resilience.

And there’s no need to wait for a disaster to strike before practicing compassion. You can use it for the small slights and hurts that happen on a daily basis. As the Dalai Lama says, “If you want others to be happy, practice compassion. And if you want yourself to be happy, practice compassion.”

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