Emotion-Focused Mindfulness for Self-Care and Therapeutic Presence. Bill Gayner, BSW, MSW, RSW GMSH March 15, 2018

Transcription

1 Emotion-Focused Mindfulness for Self-Care and Therapeutic Presence Bill Gayner, BSW, MSW, RSW GMSH March 15, 2018

2 Learning Objectives To be with ourselves and our experience gently and empathically To reflect on how being a therapist and growing up GBQ can interfere with self-empathy Empathy is the ability to follow one s own and others thoughts and feelings with a warm, kind intention To learn how cultivating compassionate self-empathy through mindfulness can address this To experience and reflect on how mindfulness can help us get better at feeling, so feelings can help us better navigate our lives and our work with clients 2

3 Introduction Mindfulness meditation cultivates our ability to attend to current experience With a nonjudgmental, accepting, decentered attitude towards the body, senses, feelings, thoughts and intentions Decentered: recognizing feelings and thoughts are not direct apprehensions of reality Mindfulness approaches do not emphasize emotional processing, but experiential therapy experts recognize mindfulness can create optimal conditions for further emotional processing Emotion-focused mindfulness therapy is a mindfulness-based approach that integrates emotional processing within meditation and therapeutic processes 3

4 I initially developed emotion-focused mindfulness therapy to help HIV + gay and bisexual men to better cope with internalized stigma around HIV and sexual orientation Therapists to deepen self-care and therapeutic presence Clients and therapists to develop mature mindfulness meditation practices within a secular context Integrates compassion and mindfulness by enhancing empathy and emotional processing, cultivating our capacity to experience, modulate, process, make sense of and respond to our own and others emotions and thoughts in kind, compassionate, assertive, and effective ways 4

5 Mainstream Clinical Mindfulness Meditation Cultivates embodied attention of the body, sensory experience, feelings, thoughts, all the aspects of experience Nonjudgmental, accepting Non-elaborative: allowing thought processes, but decentering from and letting go of thought content Present-oriented: sensory, cognitive and affective processes happening now Letting go of memories and planning May start with concentration on narrow objects such as the breath or a body scan, and then open to choiceless awareness, the simple awareness of cognitive, affective and somatic processes as they are happening and letting go of them when they pass 5

6 Therapeutic Presence (Geller & Greenberg, 2011) Mainstream mindfulness meditation can help therapists be grounded and present before they meet with clients Therapists who know how to fully immerse themselves in the present moment are then better able to engage with, empathically follow and facilitate clients emotional processes, providing a relational encounter that infuses the client s moment-by-moment experience with significance (Greenberg, 2015, p. 94) 6

7 Going beyond simple presence Mainstream mindfulness establishes presence, which is the ground of, but not the same as empathy Empathy involves being able to follow and facilitate emotional and cognitive processes in clients while attending to our own processes and reflecting on the interpersonal dynamics between you and your client Emotion-focused mindfulness includes emotional processing in meditation and therapeutic processes Free to think, remember, plan, allow complex implicit feelings to emerge and reflect on and feel them forward, making sense of adaptive emotions and transforming maladaptive ones 7

8 Befriending Ourselves Self-care and self-awareness key in developing therapeutic presence We helping professionals tend to be better at focusing on other people than ourselves We tend to have difficulties acknowledging our own needs and feelings Self-sacrifice: suppress emotional deprivation, and seek to help others meet their needs (Young, Klosko & Weishaar; 2006) Including self-empathy in meditation can be a way of cultivating towards ourself the same sustained positive regard, authentic concern, and empathic attunement we aspire to provide for our clients 8

9 Most Researched Mindfulness-Based Interventions Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy Training in mindfulness meditation practice Typically 8-week groups and 1-day retreat 8 to 20 + people, depending on the program Adapted from Buddhism Research growing exponentially Most research on mixed medical populations and cancer patients Helpful for symptoms of anxiety and depression 9

10 My research Our randomized-controlled trial of mindfulness for HIV+ gay men first to find psychological benefits Bill Gayner, Mary Jane Esplen, Peter DeRoche, Jiahui Wong, Scott Bishop, Lynn Kavanagh, Kate Butler, J Behav Med, 2012 (published online first 2011) Same effect size pre post change, but baseline mindfulness in our study significantly below pooled data from mixed medical and cancer patients used to validate Toronto Mindfulness Scale Led me to explore how to more deeply integrate selfcompassion into mindfulness to better address the psychological effects of internalized stigma associated with sexuality and HIV 10

11 Wise Self-Compassion Involves Empathy Compassion: being moved by others suffering and wishing that they feel better Wise compassion includes empathy: ability to follow and respond to people s thoughts and feelings Self-compassion is the same Depends on cultivating gentleness and curiosity towards all of our thoughts, feelings and bodily experience Not just being with and letting go of thoughts and feelings, but enhancing our ability to use them as adaptive resources Allowing and facilitating implicit feelings to emerge and be reflected on, expressed and felt forward 11

12 Emotion-Focused Mindfulness Therapy(EFMT) An approach to mindfulness meditation that emphasizes deepening experiencing, empathic following and responding to emotions as adaptive resources in meditation: Process-experiential (PE) emotion-focused therapy (EFT) (Greenberg, 2015 [2002]; Elliott, Watson, Goldman & Greenberg, 2003) emphasizes empathy: Emphasizes therapeutic relationship for creating optimal conditions for therapeutic work through empathic attunement, therapeutic bond, and task collaboration Empirically established markers and emotion tasks that enhance therapists attunement and responsiveness to clients availability for working on specific emotional processes 12

13 Emotion-Focused Therapy: Research Considerable body of process and outcome research supporting emotion-focused therapy, including for Depression, depression relapse, and personal injuries (Greenberg, 2010, 2015) Complex trauma (Paivio & Pascual-Leone, 2010; Mlotek & Paivio, 2017) Promising research trends in eating disorders, social anxiety disorders and generalized anxiety disorders (Greenberg, 2015; Watson & Greenberg, 2017) Emotion-focused couples therapy (Greenberg & Goldman, 2008; Greenberg & Johnson, 1988; Johnson, 2004) one of the most researched and effective marital therapies 13

14 Emotion-Focused Mindfulness Meditation More emphasis on being experientially open and deepening our experiencing of and processing states already occurring Sensitive to the way instructions can backfire, including guided meditation, and the ferocity with which so many of us respond to instructions 14

15 Many of us had parents who Didn t know how to calm themselves down, let alone how to calm us down Didn t know what they themselves were feeling, let alone help us identify and express our feelings All of this compounded with adverse childhood events (ACE): GLBTQ have higher ACE scores including Higher physical, emotional, sexual abuse Higher witnessing household dysfunction: adult mental illness, substance abuse, and domestic violence in the household; incarceration of a household member; and parental divorce or separation Higher schoolyard bullying 15

16 Three Emotion Systems Identity Agentic self-organization, maintain self-coherence and grow Strengthened through empathic validation of emotions when growing up Absence of this: diminishment, shame Attachment To comfort and sooth us when we feel threatened Depends on the real or imagined proximity of attachment figures and their attunement to our fear and distress Bonding Feelings of affection, warmth, compassion and attraction Nurturing responsiveness In its absence, coldness, disconnection and disdain Greenberg and Goldman, (2008). Emotion-Focused Couple Therapy : The Dynamics of Emotion, Love, and Power, Washington, DC: APA. 16

17 To Cope with Painful Feelings We learned to block them By tightening our muscles, holding our breath, and going up into our heads to try to stay in control Prone to: Worry and anxiety Rumination and depressive feelings Self-criticism and self-anger Rejecting anger towards others 17

18 Gentleness, Friendliness, Compassion, and Curiosity Too much emphasis on concentrating attention narrowly, trying to be calm, and letting go of difficult thoughts and feelings can collude with these defences against emotions In this practice, we put the emphasis on receptivity towards the states that are already happening, being gentle and curious towards what s happening in your body, what are you sensing, how are you resonating in your body with whatever is happening and whatever you are thinking about Feeling our way into and reflecting on deeper, core feelings 18

19 Self-Compassion Key Adapted from Kristin Neff 1. Self-kindness, friendliness Instead of beating yourself up, being kind and friendly towards yourself 2. Common humanity Remembering that, whatever you are struggling with, many other people are struggling with this too 3. Mindfulness Cultivating gentleness, curiosity and empathy towards your bodily and sensory experience, feelings, and thoughts 19

20 Learning to acknowledge, make sense of, and express our feelings Cultivating gentleness and curiosity towards whatever mind states emerge in meditation Expanding the range of mind states we can experience In this meditation, you are free to think, see images and colours, have feelings, plan, remember, and experience body and senses Any mind state welcome, even sleepiness 20

21 If you like, can start with a focus For example Experiencing your breath or Sensing what your hands are touching, your body s contact with the chair, and your feet s contact with your shoes and the floor Don t try to hold your attention there and no need to go back to the focus unless you want to Whatever draws your attention, go with that For example, you might find yourself doing a to-do list, planning out the day; worrying; reflecting on a relationship; finding yourself floating in vague feeling tones; following imagery and associated feelings; noticing sensations 21

22 See if you can notice various dimensions that might also be part of your experience, e.g., bodily experience, feelings, thoughts, images, intentions Let processes occur so you can feel your way into them, to get a sense of the core feelings, what they are about If you find yourself not thinking, that s fine Find a posture you can maintain, but if you become uncomfortable, you can move, quietly Close your eyes or half-close and unfocus them 22

23 You are welcome to do other forms of meditation Invitation to loosen up around the instructions If you start beating yourself up in the meditation, for example, criticizing yourself for not meditating properly, remember to be self-compassionate 23

24 Self-Compassion in Meditation Self-kindness: remember to be kind towards yourself Common humanity: remember, whatever you are struggling with in the meditation is not evidence that you are not meditating or are a bad meditator, it is evidence you are having a meditation experience, the kind of thing that happens to people when they meditate Mindfulness: let your struggle become a meditation experience, take some time and notice what is happening to you in the meditation, for example, to experience your thoughts, feelings and sensations 24

25 If you feel overwhelmed by difficult thoughts, feelings, or physical pain Helpful to calm down Bring something pleasant or neutral into the foreground of your attention and let everything else fall to the background Tends to soothe and calm (no technique works perfectly all the time) Some possible things to focus on: The anchor, i.e., whatever your initial focus was, such as the breath or the sensations of contact in your hands, body in chair, feet on floor An area of the body that feels pleasant or neutral Soothing, kind, compassionate phrases; may be spontaneous or familiar, e.g., May I be well, may I be healthy, may I be safe, may I live with ease Visualization, e.g., someone who loves you, your pet, a safe or favourite place, flowers, colours 25

26 If you feel dissociated It means you are shutting down Symptom of trauma Might feel numb, unreal, out of the body, spacey Helpful to stimulate senses and ground in the body Open your eyes, take in the colours and forms Could slap the legs (if meditating with others, try quietly rubbing the legs), wiggle toes, wiggle body in chair Feel contact with chair and floor An option: could go for a walk and then come back and rejoin us 26

27 Journaling Write down whatever you remember in as much detail as you can No need to try to remember everything Try to get a sense of the general themes of your thoughts and feelings and how these themes shifted in the sitting More differentiated language than broad labels Metaphors helpful 27

28 Journaling A way of reflecting on and deepening your practice Remembering, writing down or sketching, and reflecting on what happens deepens our familiarity and intimacy with the patterns of how we think and feel Helps us better express our experience in meditation to others 28

29 Six Meditative Processes (Siff, 2010) Explorative Process Connected Process Receptive Process Generative Process Conflicted Process Letting Go (Not taking up) 29

30 The experience of emotion woven from coproducing processes Bodilyexpressive Perceptualsituational Emotion scheme Symbolicconceptual Motivationalbehavioural Elliott, Watson, Goldman, Greenberg (2015). Learning Emotion-Focused Therapy, Washington: APA, Figure 2.1, p

31 Resources Mindful Psychotherapy Mount Sinai Psychotherapy Institute, Toronto Bill Gayner, with Jeanne Watson Annual three-weekend course on how to provide emotion-focused mindfulness therapy Usually first weekends of Oct, Nov, Dec adjusted for high holidays Optional six monthly 2.5-hour, small-group mentoring for certification Info and contact: Connie Kim x Bill Gayner 31

32 Resources Emotion-Focused Mindfulness Retreat Ecology Retreat Centre, Mono, ON Bill Gayner Assisted by three social workers and a psychiatrist Cleo Haber, Rodelyn Wisco, Justina Zatzman, Paul Uy Annual summer retreat, open to anyone Thursday dinner to Sunday lunch Next one: August 23-26, 2018 Info and contact: Bill Gayner emotionfocusedmindfulness.ca bill@emotionfocusedmindfulness.ca 32

33 Resources Meditation for Mindful Living and Clinical Practice Health Arts and Humanities Program, University of Toronto Mount Sinai Hospital, Toronto Bill Gayner For mental health clinicians in the broadest sense as well as residents and students Third Tuesday of each month, 6:30-8:30 p.m. Next one: March 27, 2018 Info and contact: Bill Gayner 33

34 Resources Emotion-Focused Therapy Training Emotion-Focused Therapy Clinic, York University Les Greenberg and others Three levels of 4-day individual EFT workshops EFT Couple workshops International Society of Emotion-Focused Therapy (ISEFT) Training, supervision, certification, conferences 34