Using Mindfulness with Trauma Survivors

How to work skillfully with victims of physical or sexual assault

Posted Apr 21, 2014

A few weeks ago, I was giving a workshop on mindfulness at a local rape crisis center. As we talked about which mindfulness practices could be useful with trauma, I had some new insights about how to adapt the practice of Touch Points for rape victims and those who have been physically abused.

Concentration, or what researchers call “focused attention,” is the foundation of meditation and the cornerstone of mindfulness. It can serve as an anchor whenever we are distressed or overwhelmed. Touch Points is an excellent tool to develop concentration, present-moment awareness, and a sense of safety and comfort in the body. By grounding awareness in the body, it in turn helps calm the mind. Because the attention is focused on the periphery of the body, it’s usually a good practice for those with a history of trauma. In the traditional practice of Touch Points we bring attention to the places where the body is touching: the eyelids touching, lips touching, hands touching, sitting bones touching, knees touching, and feet touching. At times when more grounding or stability is needed, it is also effective to start with the feet, noticing that the feet are touching the ground, knees are touching, sitting bones are touching, hands are touching, lips are touching and eyelids are touching. This variation parallels a basic concept in yoga, that you start your practice close to the ground.

However, for people who have been physically or sexually abused, sometimes the word “touch” can trigger traumatic memories, which is not what the therapist wants when introducing mindfulness into psychotherapy. If your patient is recovering from abuse, try using the following variation, omitting the word “touch.”  

  • Start by sitting comfortably, assuming a posture of dignity, keeping your spine erect and your feet firmly touching the ground. Eyes can remain open with a soft gaze, resting on the floor in front of you.
  • Take a few breaths to let the mind and body settle and come into the present moment.
  • Bring your attention to your feet on the ground, your knees, sitting bones, hands, lips, and eyes.
  • Repeat the sequence, finding a comfortable rhythm, bringing gentle and compassionate awareness to the feet, knees, sitting bones, hands, lips, and eyes. Note these places silently to yourself it if helps you focus.
  • When you get distracted, no problem, no blame. Just start again.
  • When you are ready, take a deep breath, stretch, wiggle your fingers and toes, rotate your wrists and ankles. Try to extend your attention into your next activity.

Collaborate with your patient to see what is effective. Depending on the nature of the abuse or assault, it is fine to keep the focus on just the feet, feeling the body anchored and grounded, and not moving to other parts of the body. As with any practice, listen to your patient’s feedback and adapt the practice to support safety and recovery. 

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.