Simple But Not Easy: Mindfulness Strategies a Powerful Clinical Tool

Mindfulness-based treatment strategies have captured much attention among clinicians, but challenges remain in implementing these concepts both in clinical practice and in professionals' own lives. On the first day of the March 6-9 Freud Meets Buddha conference in Chicago, trauma and addictions trainer Jamie Marich, PhD, will present two sessions that will explore the intersection of concepts in mindfulness, trauma-focused care and other therapeutic innovations.

Addiction Professional spoke with Marich, director of the Institute for Creative Mindfulness, about these timely but often misunderstood topics in clinical care. Her March 6 sessions are “Dancing Mindfulness: A Trauma-Focused Approach to Expressive Arts Therapy” and “EMDR Therapy and Mindfulness: Redefining the Therapy for Trauma-Focused Care.” Marich's responses have been edited for space and style.

Why do mindfulness-based approaches in therapy work so effectively as a component of many different treatment strategies?

Mindfulness-based interventions, when delivered with care and attention to the context of treatment settings and clinical counseling, introduce our clients to whole-brain healing. Mindfulness strategies require that we use our entire brain—the neocortex, the limbic and the brainstem. They can have great power in teaching clients how to begin unifying their brain and working toward a sense of healing integration.

Mindfulness strategies are simple, and yet not easy … they are challenging interventions that are ultimately the best at teaching clients how to embrace “one day at a time” living and living in the moment. Too often as clinicians we just tell people to do these things without showing them how, and mindfulness-informed strategies help us to show them how. Moreover, whatever your primary clinical orientation (e.g., CBT, EMDR therapy, 12-Step facilitation, psychodynamic), these strategies can work to teach clients distress tolerance and proactive coping.

What are the most important steps clinicians can take to be genuinely trauma-focused in their work with patients?

For me to best answer this I will explain the subtle yet profound differences between trauma-informed care and trauma-focused care.

Trauma-informed care:

• Recognizes the role that unhealed trauma plays in human behavior.

• Provides a template for minimizing harm in the delivery of human services.

• Offers an educational framework for human services systems.

Trauma-focused care:

• Assumes that unhealed trauma plays a major role in presenting issues.

• Denotes greater action in the delivery of treatment services.

• Promotes proactive treatment planning to heal the legacy of trauma.

I feel that everyone working in behavioral health care needs to be trauma-informed as a first step. People committed to being truly trauma-focused will take it a step further. Whether taking this extra step comes through further training, engaging in one's own trauma-focused therapy, or committing to a combination of both, the trauma-focused clinician is willing to go that extra mile.

What do you see as the most common misconceptions that clinicians have about mindfulness-based approaches in treatment?

I see problems happening when one of two extremes is practiced. Problem one is when therapists without a personal mindfulness practice try to teach clients mindfulness skills from a worksheet or workbook. Mindfulness skills have to be adapted to the context and needs of the individual clients or groups. Teaching strictly from a workbook can never account for this finesse, which is required to be trauma-focused. Some groups can handle a 15-minute meditation, as is instructed in many workbooks, yet many groups cannot. A therapist with a personal mindfulness practice will know how to deal with clients who say things like, “I can't meditate, I can't sit still,” because they will have experience adapting for themselves in practice.

The other extreme is when clinicians with their own strict mindfulness meditation practice, perhaps developed in a strict Buddhist or other religious context, will blaze ahead doing what works for them in monasteries and retreat settings without knowing how to adapt it for clinical settings. In traditional contexts it's not uncommon for people to engage in sitting meditation for a minimum of 25 minutes, with longer practices usually common. If you try to do such extreme work clinically, clients will get easily frustrated.

To what degree must clinicians have practiced mindfulness and expressive arts themselves in order to incorporate these approaches successfully in their work?

For me this is everything, it's imperative. The deeper you engage in your own practices with mindfulness and the expressive arts, the better you will be able to adapt, especially when clients resist. You will be able to roll with clients' resistance because you know what it's like to address your own resistance. And the best facilitators of mindfulness and expressive arts are those with a personal practice to share. You can read and study these concepts out of a book all you like, yet the passion for it will not come through unless you've practiced yourself.

What do you want attendees to experience as the most important takeaway for those who attend the Freud Meets Buddha session on EMDR Therapy and Mindfulness?

To recognize that EMDR therapy really is an extension of traditional mindfulness practice. The method that Dr. Shapiro developed that has become the phenomenon of EMDR therapy grew out of her own personal mindfulness practice. Taking this part of the history into consideration, participants will be oriented to EMDR therapy like they never have before. They will realize that combining the two practices more directly (since they have already been subtly intertwined) provides the field with a game changer, engendering the healing of trauma and all of its related problems.