A sample review of mindful techniques in therapy

My client and I worked together over four sessions practicing mindfulness exercises based on psychological theories/principles.

Session 1

In the first session, my client, A, revealed that she was preparing to interview for a new job in her current vocation. She used the words “like a marriage” to describe the level of commitment that she expected to feel toward the people who would be hiring her if she got the job. I reflected to A the verbiage she used: marriage. She affirmed that was the strong level of commitment she knew she would feel and wanted to feel toward this role. I suggested trying an ACT “defusion” experiment and she was willing. According to Harris (2006): “Mindful, values-congruent living is the desired outcome of ACT” (p.2). What was foremost in the exercise pertaining to my client’s focus issue was the emphasis on how marriage is the union of two separate entities. She was being interviewed for a role by the partner (the community she would serve) and little focus was given to how important it would be for her (as the other partner in the union) to feel seen, heard, and valued in the “marriage” level of commitment she would enter if given the job. I reminded her of examples she had shared with me about past misogynistic treatment of her by past employment situations.

We discussed how she was preparing to interview the community, in turn, to see if she really felt like she could marry into their culture and value package. According to Larmar, Wiatrowski, & Lewis-Driver (2014, p. 218): “Clarifying values” is one of the steps of the ACT process: “to develop a greater awareness of the values that are important to them as a means of motivating acceptance, willingness and committed action that assists the individual to take control of their lives.” First, A and I discussed seeing her ideal role “out there” as a distant vision, and then what were some ways she could move toward that. In this way she spent the rest of the session brainstorming questions she could ask that would support her values-driven approach to the interview process so that her own needs and values were placed forefront as she entered the interview process.

A stated, “it’s helpful to walk into an interview remembering our worth and how we function at our best... I don’t want to just be always barely getting by.” She completed the session feeling as though she could remember to celebrate herself as a partner for whom she was willing to advocate. She was grateful that we had taken the time to explore the use of the marriage metaphor.

Session 2

The second session with A involved working with a somatic technique called EFT, or Emotional Freedom Technique. EFT is similar to, and partially based on, the work of EMDR (Eye Movement Desensitization and Reprogramming). Per Stapleton (2019), “the emergence of brief psychotherapies that include a somatic component [such as EFT and EMDR] ... are now being considered psychotherapy’s fourth wave”. Stapleton goes on to say that EMDR is recognized as “an empirically validated treatment for trauma, anxiety, and depression” and that she considers EFT to be “the most promising of the fourth-wave therapies”. On page 36, Stapleton (2019) shared the result of one study proving cortisol levels dropped significantly after just one hour of EFT (as much as 24 percent, compared with the placebos of talk therapy or no intervention) (Church, Yount, & Brooks, 2012).

A's check in revealed that she was feeling slightly overwhelmed as she prepared to drive 6+ hours with her two kids to visit family for a week. She would then have the kids stay with her siblings and cousins while she flew to Colorado to attend a conference. She was also preparing to say goodbye to her husband for a full 2 weeks while on these trips. None of this felt like an intensity above a 3 or 4 but she was still sensing the concern of time-crunch and multiple preparations, including schoolwork and packing for 2 kids plus herself, as part of her check in.

The first part of the session was an educational aspect of teaching the EFT technique certain acupressure points to tap and certain phrasing to state out loud). I teach it that the therapist is making statements about the client’s concern - in this case: overwhelm. Typically, one statement is made per tapping point. The initial rounds of tapping are intentionally addressing the challenging sensations, emotions, thoughts a person might be having. The middle part of a tapping session still involves gently tapping on the acupressure points, one point per statement, but the focus shifts a bit to possibility, hope, remembering other times/experiences of making it through something similar. The later rounds of tapping involve repeating statements such as: “I love myself”, “I accept myself”; “I forgive myself”; “I honor this process”. A final statement at the top of the head point also includes...”and all is well."

For A, the experience of tapping through her overwhelm was a welcome and beneficial experience. She appreciated the in-the-moment applicability and was also interested in offering the technique to her friends and family as appropriate. (EFT Tapping is an easily accessible technique and much more information can be found at at The Tapping Solution or in the references below).

Session 3

For the third session, A and I worked through the “Wheel of Awareness” (https://drdansiegel.com/wheel-of-awareness/) offered by Siegel (2020). A did not have any strong concerns at the time of our meeting, but it was an activity/exercise we were both interested in practicing. I offered this as a guided visualization, inviting her to center into a quiet space in her home (we met for each session remotely). Next was the invitation to notice the pace of her breath. The wheel of awareness is a mindfulness technique that suggests the imagery of a wheel. The hub of the wheel is the breath, and there are eight “spokes” that stem from this center of the chest/breath. The first five “spokes” are the five senses people are aware of: touch, taste, smell, hearing, and seeing. Each of these five senses are given a few minutes meandering, asking the client to connect with that sense individually and see it as a spokeconnecting from the breath to an imagined rim of a wheel layered over the body (one orientation could be vertically from head to lap; another option could be from a horizonal orientation like a circle drawn around the body like a hoola hoop). The sixth sense is that of an internal view outward. For example, one could guide the client to imagine seeing the inside ofthe skull of one’s own head, where the eye sockets are, or could imagine looking inside the marrow in the long bones. The seventh sense, or spoke that will connect to the wheel, is that of connecting to the world around the client. Starting very locally, sensing the people and beings in the immediate vicinity. The circles might widen as awareness of connection in one’s neighborhood, community, state, country, continent, and globe within the galaxy, etcetera, are brought into conscious awareness of connection.The eighth sense is an unusual approach to the transpersonal. The client is encouraged to send out a spoke from the center of the chest, from the breath, out toward the rim of the wheel. As the spoke is extended from the breath, it is conceived as bending back toward the breath, toward the center of the chest. Siegel uses the phrase: “the awareness that is aware of itself” as the focal point of this eighth sense, offering the client a shift in perspective that can be profound for many who have participated.

For A, the guided visualization process was relaxing, calming, and very welcome. The feedback she gave also included a wish that my wording had included the felt sense of looking from inside out, rather than only encouraging what that internal connection might “look” like. I appreciated the comments as both helpful for understanding her journey but also as a future shaping of the way I would offer this exercise.

Session 4

For this last session together, A did not have any pressing concerns but was more interested in practicing a different exercise. I had a Gestalt option that I had found entitled:Introjection. The client starts by writing down (over 5-10 minutes of quiet during the session) all the statements that are in one’s head with the words “I should”. The second step is to have someone read back the statements to the client with the starting words being “you should...”, one at a time, with processing time between statements. For example, “I should pay off debt” is written down, then the partner reads back that statement as “you should pay off debt.” The client is guided to notice sensations in the body, emotions that come up, and also curiosity as to whose voice is making that statement. It could be that a parent, a friend, a spouse, or one’s own voice is behind the statement.

Whether it is one’s own voice or belonging to another person, one can ask if the statement/sentiment is it truly something one wants to do or feels obligated to do for a different reason. Step three of this exercise is to decide and take ownership. Words that can be used instead of should are “I will” or “I won’t”. The main impetus is to give the client an option for self-empowerment to claim their decisions as their own, with their own parameters. This mindful approach takes the judgement out of the decision/expectation/should statement.

A appreciated this exercise, and we were able to review several of her “I should” statements on her list, looking for whose voice she heard when I read them back to her as “you should...”. She practiced rewording them so that they were affirmations of her own choices rather than still speaking words she might have heard from people who, at one point, had power over her decision-making processes. It was an exercise we both felt would be helpful for our future experiences in times of self-care and with future clients.

Resources

Church, D., Yount, G., & Brooks, A. J. (2012). The effect of emotional freedom techniques on stress biochemistry: a randomized controlled trial. The Journal of nervous and mental disease, 200(10), 891-896.

Harris, R. (2006). Embracing your demons: An overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 70-6.

https://drdansiegel.com/wheel-of-awareness/

Larmar, S., Wiatrowski, S., & Lewis-Driver, S. (2014). Acceptance & commitment therapy: An overview of techniques and applications. Journal of Service Science and Management, 2014.

Siegel, D. (2020). Aware: The science and practice of presence--the groundbreaking meditation practice. Penguin.

Stapleton, P. (2019). The science behind tapping: A proven stress management technique for the mind and body. Hay House, Inc.