MINDFULNESS

AND
ACCEPTANCE IN
COUPLE AND FAMILY
THERAPY

Agenda

Introduction to Mindfulness
Overview of Mindfulness and Acceptance
Based Therapies
General
Couple, Family, and Child Applications

Review of Evidence Base

Therapy outcome
Neurological foundations

Constructivist Philosophy
Teaching Mindfulness in Therapy
Mindfulness
Compassion Meditation for Couples and
Families

Diane R. Gehart, Ph.D.

California State University,
Northridge
[email protected]

Model for Couple and Family Therapy

Therapeutic relationship
Assessment
Treatment planning
Intervention

Therapist Self Care

THIS PRESENTATION
RATED:
PG-B
J

Why Mindfulness and Acceptance in MFT?

Shared constructivist foundations
MFT
Buddhist psychology

Simple practices to increase compassion and empathy

Bypass common areas of conict
Easy to implement
Results often rapid

Contains discussion of
Buddhist psychology
(not religion)

Impressive, growing evidence base

Mindfulness Deni0on
WHAT IS
MINDFULNESS?

Self-regulated, present-moment
awareness
that welcomes all experience without
preconception
or judgment,

accepting what is with curiosity and

compassion

This being human is a guest house.

Every morning a new arrival.

The Guest House

A joy, a depression, a meanness,

some momentary awareness comes
as a unexpected visitor.

RumiTranslated by Coleman
Barks (2003)

Welcome and entertain them all!

Even if they re a crowd of sorrows,
who violently sweep your house
empty of its furniture, still,
treat each guest honorably.
He may be clearing you out
for some new delight.

Mindfulness Prac0ce: In a Nutshell

Observing a single phenomenon (e.g. the breath)
while compassionately and non-judgmentally
quieting the inner chatter in the mind

The dark thought, the shame, the malice,

meet them at the door laughing
and invite them in.
Be grateful for whoever comes.
because each has been sent
as a guide from beyond.

Looks Like This

Focuslose focusgently refocus.
Focuslose focusgently refocus.
Focuslose focusgently refocus.
Focuslose focusgently refocus.

Is Religion Involved?
Virtually all cultures and religions have
forms of mindfulness practice
Buddhists have highly developed
meditation practices
Christians (esp. Catholic monastic
traditions) have very similar practices
Contemplative prayer

A TASTE OF
MINDFULNESS

MINDFULNESS IN
THERAPY
Mindfulness-based therapies
Mindfulness-informed
therapies

The Original Mindfulness-Based Therapy

Mindfulness-Based Stress Reduction
(MBSR)
John Kabat-Zinn, University of
Massachusetts
Behavioral medicine in medical context
Intensive 8-10 week course (2-2.5 hours per
week with one 6 hour session)
Up to 30 participants; very cost effective
Includes
(a) body scan meditation
(b) mindfulness meditation (breath focus)
(c) basic yoga positions
(d) mindfulness with everyday activities

Other Mindfulness-Based Therapies

Mindfulness-Based Cognitive Therapy
Teasdale, Segal, Williams
A manualized 8 week group based on Kabat-Zinn s program.

Mindfulness-Based Relationship Enhancement

For non-distressed couples
Uses compassion meditations primarily

Mindfulness-Based Parenting
Several versions

Mindfulness-Based Eating Awareness

Address body image, weight, eating habits

Mindfulness-Based Relapse Prevention

Observing urges

Participants do daily mindfulness practice at

home (20-45 min)

Mindfulness-Informed Therapy
Dialectical Behavioral Therapy
Linehan uses mindfulness to help borderline
clients work with the most central dialectic of
acceptance and change.
Evidence-based treatment for borderline
personality disorder

Acceptance and Commitment

Therapy
Hayes, Strosahl, and Wilson encourage clients
to recognize an observing self similar to
mindfulness meditation.
Based in contemporary behavior analysis; do
not actually term work as mindfulness but use
similar principles.

Mindfulness and Adult Attachment

Trait Mindfulness
Negatively correlated with anxious and
avoidant attachment styles

Anxious attachment
More dicult to be non-judgmental

Avoidant attachment
More diculty with being in present
moment

Increased trait mindfulness

Buers against eects of anxious
attachment

Mindfulness and Acceptance-Based Therapies

for Couples
Integrative Behavioral Couples Therapy
Acceptance of partner added to original Behavioral Couples Therapy to
improve long-term outcomes
Acceptance mediates link between partners behavior and ones relationship
satisfaction and own behavior.

Acceptance and Commitment Therapy for Couples

Reduce avoidance of distressing thoughts
Become less identied with ones thoughts
Increase commitment to valued life direction

Mindfulness-Based Couple Enhancement

Based on MBSR
Emphasizes compassion meditation
Shared activity linked to program eectiveness

Mindfulness-Based Therapies with Children

Sitting meditation for youth
Similar (but slightly smaller) eect size
compared to adults
Feasible and acceptable treatment
Increased focus of research

Mindful Parenting
Several forms, all based on established
parenting programs
Mindful Parenting focuses on
Teaching parents to self regulate
Bring greater acceptance and compassion

Mindfulness-Based Parent Training focuses on

Reducing rigid, mindless interaction patterns

Mindfulness for Child and Adolescent ADHD &

Conduct Issues
ADHD
Potential to rehabilitate underfunctioning of
prefrontal context
Teach parents also when work with children under 12
Teaching parents alone improved ADHD symptoms

THE EVIDENCE BASE

Conduct and Oppositional Issues

Mindfulness
Reduced expulsion in one study

ACT
Focus on accepting emotions, detach from thoughts, and
choose action based on personal values

MBCT-C
Reduces internalizing and externalizing behaviors

Studies on Physical Disorders

Chronic pain
Cancer: Psychological,
biological, and sleep
outcomes
Cardiovascular disorders
Epilepsy
HIV/AIDS
Psoriasis
Rheumatoid arthritis
Fibromyalgia
Organ transplant

Type II diabetes
Multiple sclerosis
Sleep disturbance
Mixed medical diagnoses

Mental Health Disorders

Psychological Benets
Increased Positive Emotion
and Wellbeing
Reduced Stress
Increased Emotional
Regulation
Increased Metacognitive
Awareness
Decreased Rumination
Improved Attention
Increased Acceptance and
Decreased Avoidance
Clarification of Values
Increased Self Compassion

Depression/relapse
Bipolar Disorder
Anxiety and Panic
Substance Abuse
Eating Disorders
Borderline Personality
Attention Deficit Disorder
(ADD)
Oppositional and Conduct
Issues
Trauma and PTSD (emerging)
Sexual Abuse (emerging)
Psychosis (emerging)

Rela0onal Benets
Increased Marital Satisfaction
Increased Empathy and Compassion
Increased Acceptance of Self and Partner
Increased Awareness of Interactional Patterns
Increased Ability to Respond with Awareness
Greater Sense of Freedom and Safety in
Relationships
Greater Sense of Unity and Separation

Proposed Mechanisms of Change

Your Brain on Mindfulness

Increased/Enhanced:
Trait Mindfulness
Emotional Regulation
Self-Compassion
Decentering Relationship to Thoughts (Observing)
Psychological Flexibility
Values
Spirituality
Working Memory
Neurological Changes

General Findings: Mindfulness & the Brain

Increases left-sided anterior activation, brain pattern associated
with positive disposition
Eects continue long after practice

Reduced grey matter density of amygdala (stress response)

Increase grey matter density of hippocampus (memory)
Experienced meditators
Greater grey matter density in brain stem (relaxation response)
Greater grey matter density in prefrontal cortex
Improved attentional processing
Increased activity in anterior cingulate cortex, believed to govern self-
regulation

Neural Integration

Stress Response and Mindfulness

Stress Response
Amygdala scans sensory data for
danger
Triggers an autonomic response long
before prefrontal cortex has
assessed reasonableness of the data
Fight, flight, freeze response
Prefrontal cortex only part of the
brain able to shut off stress response
Mindfulness
Increases a persons ability to
consciously shut down stress response
and invoke relaxation.

The Brain: An An0cipa0on Machine

Dan Siegel proposes mindfulness increases neural integration

Correlated with
Mindfulness
Secure attachment

9 Characteristics
Body Regulation
Attuned Communication
Emotional Balance
Fear Modulation
Response Flexibility
Insight
Empathy
Morality
Intuition (Siegel, 2009)

Mirror Neurons and SIMA (Superior temporal regions;

sensory implications of motor actions)
Creates a map of now by anticipating immediate next-ofnow action.
Not planning but anticipating immediate next action
Violations to this create varying levels of startle to trauma
Breath Meditation and SIMA
By focusing on in-out of breath brain enters into a highly
integrated state because able to perfectly predict next
moment

Interpersonal and Intrapersonal Attunement

Secure attachment
Correlated with integrative
neural patterns

Interpersonal attunement
Secure attachment with
others
Intrapersonal attunement
Secure attachment with the
self
(Siegel, 2009)

Trauma and Neural Integration

Trauma
Greatly impedes neural integration

Trauma experience scatters memory

Hippocampus unable to develop explicit memory
Amygdala sears trauma into implicit memory
Trauma memories stored primarily as implicit memory
Implicit memory
Automatic, little consciousness
No distinction of time and place
Feels like happening now

Resolving trauma
Link explicit to implicit memory into coherent memory/narrative

Mindfulness increases capacity for neural integration

Bottom-Up Processing and Not Knowing

Top-Down Processing
Using top 3 layers of cortex
Using categories to interpret
experience
Creates sense of order,
consistency, predictability
Bottom-Down Processing
Using bottom 3 layers of cortex
Use immediate lived experience to
generate meaning and categories
Encourages openness, exibility,
growth

MINDFUL BODY
SCAN

Mindfulness bottom-up process

(Siegel, 2009)

Mindfulness:
Everybodys Doing It . . .

Many of us
practice
mindlessness
on a regular
basis

What mindfulness medita0on isn t

Receptive, non-judgmental and non-interfering awareness

Accepting What is vs. What I think should be or How I want
things to be

Cul0vate Inner Witness

Witnessing automatically
generates new perspectives
The ability to witness inner life
increases ones

And another layer . . .

Mindfulness encourages a shift in focus from the
fusing with the content of experience to observing
its process.

Mindfulness as Compassion
Perhaps the most important
aspect for Westerners is to
practice mindfulness
compassionately.

Self Regulation

This isnt a competition.

Proactivity

You can t do it wrong.

Expect your mind to drift.

Ability to manage emotional reactivity

Responsive decision making

Ability to Reflect on actions and

decisions
Self Acceptance and Self Compassion
greater predictor of happiness than self
esteem

Acceptance of Others

Careful attention to the moment-by-moment flow of experience

both internal and external

Simply a relaxation
technique
Stopping thoughts
Going into a trance
Developing special powers
Running away from reality
Only for monks

Another layer . . .

What mindfulness medita0on is

Most Common Pitfall for

Westerners
Becoming frustrated at self for not
doing it perfectly.
That s the point: it is a PRACTICE!

How to Add Compassion to Your Prac0ce

Redirecting Focus Compassionately
When (note I did not say if ) your mind wanders, gently and
compassionately bring focus back on breath. Options include:
Compassionately labeling thought as worrying, thinking, etc.
Visualize thoughts as cloud drifting off or soap bubbles popping
Smile to yourself saying that too and return to focus
Whatever you do, make it a moment of compassion and gentleness
with yourself

Note on Sleepiness
Common to feel sleepy when rst start practicing
Often a sign the person lives in chronic, mild stress state
Body expects to sleep when mindfulness triggers the relaxation
response.

The Therapy
is in the return to focus rather than the sustained focus.

The BoNom Line

So, let s try it . . .

Mindfulness is NOT about changing or controlling your

experience
Rather, it is about changing your RELATIONSHIP to your
experience

SUFFERING
101.

Suering

Suering and ANachments

Attachments
and

Suffering

The First Noble Truth

There is suffering (dukkha).
Inescapable Forms of Pain
Some pain is inherent to the human condition (illness, loss, death).

Self-Generated Forms of Suffering

However, much of our suffering is created through our
attachments to ideas, things, and constructs.
Note: Buddhist definition of attachment different than Western psychological
definition.

My Way or It s a Problem
When we are attached, we
insist that life go according to our
preferred story.
Anything outside of this is
interpreted as problematic.

Reducing Problems
Reducing attachments is the
easiest means to reduce selfgenerated suffering.

Attachment: Content vs. Process

Content vs. Process

Buddhists maintain that it is not the particular story
(content) but rather the strength of our attachment
(process) to it that creates suffering.
Ex. Cinderella story: it is not the story or one s particular
interpretation of it but rather the strength of one s
attachment to it that causes suffering.
Both the woman who is determined to live the perfect
Cinderella story and the one who adamantly fights it are
its prisoners.

Resource for Change: Mindfulness

Mindfulness: Moments without Language

Pure Experience: Moments of pure experience, those brief moments
when the mind is not involved in the construction of meaning.
Embodied Knowing: Mindfulness involves a visceral or bodied
knowing rather than a more intellectual type of knowing.
Freshness in the Gap: These un-languaged moments create space
for fresh experience and new ways of relating to our suffering.
Interrupts old patterns for relating, which is key to clinical usefulness.

Mindfulness and Non-ANachment

Mindfulness Cultivates Non-Attachment
Non-attachment is not emotional detachment.
Compassionate Witnessing
Instead, it involves being a patient, compassionate
witness of one s experience without judging the
experience as good or bad, preferred or not preferred.

Non-judgmental
The challenge is always to experience without
judgment or interpretation.

Philosophical Correlates: Buddhism and MFT

Shared Constructivist Principles
Emptiness (sunyata)
All meaning is constructed

Interdependence and Interbeing

Being comes from relationship

Nonself (anatman)
No essential self
Identity constructed

Impermanence
Everything is constantly changing

Not Knowing
Stance toward life

Compassion
Loving acceptance of what is

MEDITATION ON FIRE AND ICE

Teaching Mindfulness
Group Format: Most Common
Many formats to choose from
Mindfulness-Based Stress Reduction
Mindfulness-Based Cognitive Therapy
Mindfulness-Based Eating Awareness
Mindfulness-Based Relapse Prevention
Mindfulness-Based Parenting
Mindfulness-Based Relationship Enhancement

TEACHING
MINDFULNESS IN
THERAPY

Mindfulness in Therapy
More Challenging than Group Format
Little sense of community
Less group pressure
More isolated activity
Generally, less motivation
Easier with Couples and Families
Have more social reinforcement
However, may trigger arguments if not set up
correctly

10

Key Principles for Teaching Mindfulness in

Therapy

6 Steps for Teaching Mindfulness

1.
2.
3.
4.
5.

Identifying Need and Interest

Strengthening Motivation
Introducing the Practice
Developing a Practice Plan
Anticipating Barriers to
Practice
6. Fine Tuning and Follow Up

Generate Motivation
Develop a realistic plan
Keep it small: 2-5 minutes to start
The technique is actually the easy part

Identifying Need and Interest

Counterindica0ons

Not for everyone

Indications for readiness
Strong motivation to change
Asking what should I do?
Desire to avoid psychiatric
medications
Current spiritual practice
Couple/family agree on common goals
and can acknowledge positive feelings
(relatively low conflict)

Raise Tenta0vely
Suggest but identify challenge of regular practice
Be skeptical of casual interest
Suggest group option too

Current crisis or chaotic situation

Lacking sense of ownership of
problem
High conflict couple or family
Extreme exhaustion or sense of
overwhelm
Active psychosis, mania, or
trauma (intrusive memories)
symptoms

Strengthening Mo0va0on
Most important step
Potential motivators:
Interrupt stress reaction
Rewire brain for happier disposition
Specific health disorders that respond to
mindfulness
Other Benefits
Reduce medication
Reduce relapse
Long term happiness and relational wellness

11

Introducing the Prac0ce

Practice Opportunity (and since it
is mindfully based, okay to
practice being imperfectJ).

FIND A PARTNER AND

TAKE TURNS
DEVELOPING
MOTIVATION TO
PRACTICE

Focus--lose focus--refocus
Focus: On breath while quieting the mind
Lose Focus
Internal thoughts, feelings, or bodily sensations
External sounds, temperature, etc.
Refocus
Return to focus without berating self
Can label, visualize bubble/cloud, say that too

Focusing Aids

Prac0cali0es

Counting to 10
Mantra
Visual
Sound

Eyes: Closed or open with soft gaze

Posture: Erect and comfortable
Hands: rest in lap
Timer
Start small: 2-5 minutes; add more
once practice is established

Accepting
distractions
Part of process
Help with rewiring
process

Practice Aids
Recorded meditations: Free at
www.dianegehart.com
Handout to take home

In Session Prac0ce

Develop Prac0ce Plan

1-2 minute practice session

Identify an existing daily, routine activity.

Attach mindfulness practice to the selected routine
Set realistic length of time for practice

With Timer
Therapist practices too

Answer questions

Links to free recorded meditations

Books

Identify a potential recording or timing device

Use a practice log or diary

12

Iden0fying Barriers

Couples and Families

Typically use compassion meditation instead

Schedule Issues
What things are likely to come up in their schedule that would lead to
not practicing at all one day?

Common Barriers
Differing levels of motivation

Distractions

How are they going to handle varying levels of

motivation or priority-making each day?

Are certain people, sounds, noises, phones, etc. likely to interrupt

practice sessions?

Differing Schedule/Moods

Attitude and Priority

How will they handle if one person wants to

do it one day and the other does not and/or if
their practice timeline gets off?
General Attitude Toward Mindfulness

What internal thoughts or feelings might come up that would lead to not
practicing?

How will they handle it if one person is

consistently more motivated than another to
practice?

Compassion Meditation

Guidelines for Teaching Children

Loving Kindness Meditation

Phrases for Loving Kindness Meditation
May X be happy and joyful.
May X be free from suering.
May X be healthy and in radiant health.
May X have a sense of wellbeing and live with ease.
May X be at peace with people in his/her life.
May X dwell in peace.

X=Persons to Whom to Direct Loving Kindness
A neutral other (e.g., acquaintance, co-worker)
Signicant others (e.g., partner, family)
Dicult other (e.g., someone with whom there is conict)
Self
All beings (e.g., everyone)

Encourage Mini-Meds
Trigger relaxation response
Interrupts negative cycles
Reconnecting with preferred Identity
Reframing problem
Reboot brain

Involve parents whenever possible

Keep it fun
Include real world practice
Before test/studying
Before going to school

Reinforce with repetition

Oer more explanation and metaphors
Include breath awareness
Rocking monkey to sleep

Kindness meditation
Provide variety
Keep practice short (3-5 minutes)

Add Other Media0ons

Compassion
Body Scan
Eating
Walking
Daily Activities
Washing dishes
Straightening room
Sipping coffee or tea
At stop light

13

MINDFULNESS IN
MOTION

A MINDFULNESS- AND
ACCEPTANCE-INFORMED
APPROACH TO COUPLE
AND FAMILY THERAPY

Based on Mindfulness and

Acceptance in Couple and Family
Therapy (Gehart, 2012, Springer)

Mindfulness- and Acceptance-Informed Couple

and Family Therapy

Addresses 3 Relationships
Self: Self acceptance and
self regulation
Other: Emotional safety
and compassion
Life: Sense of safety,
cohesion, and
benevolence

Universal Set of Philosophy and Practices

Approach includes
Philosophy
Practices

Can be used to enhance and complement

most traditional forms of therapy
Can be added with some or all clients
And/or used as self care

Hopefully, you will go home with at least one
idea you want to use

Components of Approach
Mindfulness-based therapeutic relationship
Case conceptualization
Goal setting and treatment planning
Interventions
General principles
Specic interventions for couples and families

Mindfulness-informed Therapeutic Relationship

Compassion vs. Empathy
Spiritual/existential vs. individual/phenomenological
view
Embracing complexity of the human condition
Humanity of therapist
Embracing the whole catastrophe
Humor
Humility

14

Neural Integration and Relational Resonance

Being Present with Clients

Therapist neural integration

Allows for relational attunement

Without being weird

With dicult emotions and conict
With trauma

Requires suspending the brains anticipation function

Shift from top-down to bottom-up processing
Follow moment-by-moment experiencing
Clients feel felt by therapist

With mandated and unenthusiastic clients

With children

Enter relational resonance

With adolescents
With couples and families

Similar to mirroring with young children

Creates a mutually inuencing system: brains link up

Treating trauma
Client borrows neural integration of therapist to integrate traumatic
memories (implicit and explicit)
Client then able to resolve trauma
i.e. remember trauma and remain in a relatively integrated neural state

Mindfulness-Informed Case Conceptualization

Practice Opportunity

BEING PRESENT IN
CONVERSATION

Part 1. Relationship to Self: Having an accepting relationship

with oneself that includes an ability to regulate dicult
emotions and thoughts.
Conceptualized by clients:
1. Ability to mindfully experience thoughts and emotions
What unbearable reality are you afraid to let yourself experience?

2. Ability to accept and have compassion for what is

Struggle vs. acceptance
Analysis vs. compassion

3. Attachment to and investment in constructions of selhood

Are identities/roles uid or rigid?
Able to experience observing self?

Mindfulness-Informed Case Conceptualization

Part 2. Relationships with Others: The ability to develop and
sustain emotionally safe and satisfying intimate relationships
with partners, parents, children, and signicant persons in
ones life. Conceptualized by clients:
1. Awareness of mindless relational patterns

Normal:
Homeostasis

Tension Rises:
Early signs of
symptoms

Tension
Subsides

2. Ability to be mindfully present with others

3. Ability to accept and have compassion for others

Symptom and
Problem
Interactions:

Mindfulness-Informed Case Conceptualization

Mindfulness Part 3. Relationship to Life: Having a sense of
connection with life (e.g., God, the universe) that is characterized by
a sense of safety, cohesion, and benevolence (or at least non-
malevolence).
Conceptualized by clients:

1. Construction of their relationship to suering

It is unfair.
If only X, then life would be ne.
This should not have happened (to me).
I dont understand why things turned out this way.
2. Life philosophy and values
By what rules does the universe operate?
Purpose and meaning of life in general; your life specically?
Do things happen for a reason?
Why do we suer?

15

Overarching Goals in Therapy

1. Increase equanimity
Ability to move with the
ups and downs of life

2. Increase capacity of
compassion

Practice Opportunity
Identify current client (or use yourself)
Conceptualize situation based on three core relationships
Relationship to self
Relationship to others
Relationship to life

And/or discuss how overarching goals t

Safe, fullling
relationships
Self and others

Couple/Family Treatment Plan Template:

Early Phase
Early Phase Treatment Tasks
1. Develop a compassionate therapeutic relationship with
both members of the couple/family.
2. Develop a case conceptualization to guide treatment.
Early Phase Client Goals
1. Increase capacity for mindful experiencing and acceptance/
compassion for what is in the relationship and life.
2. Increase awareness of mindless interaction patterns and
compassion for how each experiences this pattern.

Equanimity (relationship with life)

Compassion (relationship with self and others)

Couple/Family Treatment Plan Template:

Working Phase
Working Phase Treatment Tasks
1. Monitor therapeutic alliance with each to ensure a balanced
alliance.

Working Phase Client Goals
1.

Interrupt and restructure mindless interaction patterns using

mindfulness to consciously choose more eective responses.
2. Increase ability to be emotionally present and compassionate with
others.
3. Decrease rigid attachments to individual identity and relational
constructs and increase role exibility and uid, evolving sense of self.

Couple/Family Treatment Plan Template:

Closing Phase

Late Phase Treatment Tasks
1. Develop aftercare and maintenance plan.

Late Phase Client Goals
1.

Reduce unnecessary suering by learning to reduce attachment to

outcomes and increase equanimity and openness to what is.

2. Increase relational cohesiveness by articulating shared life philosophy

and values to provide foundation for relationship.

PRINCIPLES OF
INTERVENTION

16

Philosophy-in-Action Practices
Befriending Problems
Shift relationship to problem
Key for therapist
Direct invitations:
What potential lesson is here for you?
How does this situation make sense in context of your
spiritual beliefs?
What would happen if you struggled less against what is
happening? How might that look?
Humor

Philosophy-in-Action Practices
Cultivating Wisdom and Compassion
Reecting on wisdom and lessons in life challenges

Wisdom Commonly Stumbled Upon in MFT
You cannot change another person.
You are usually a large part of the problem you attribute to others.
The things that bother you most about another person are things that you
have an issue with yourself (either you do it too or go to an ridiculous
extreme to not do it).
Most things that seem to be xed qualities of a person are generally only a
quality that is demonstrated in certain contexts, situations, and
relationships.
Inconsistent reinforcement of and responses to a particular behavior tend
to reinforce it.
Love is most precious thing in life.
Its more important to show someone you care than to have a clean
house.

Philosophy-in-Action Practices
Embracing What and
Who Is
Curious, not-knowing
questioning: where? when?
how? why?
Putting into words what has
been unspoken

Practices for Cultivating Equanimity

Not-Knowing Expertise
Cultivating equanimity in the good times
Preparing for setbacks
Ebb-and-ow perspective
Cultivating equanimity in the bad times
Separate actual experience from worry
Contextualizing with current good/
future perspective
Cultivating equanimity in between
Mindful experience of in-between
period
Observing ups and downs

In-Session Mindful Experience of

Thoughts and Feelings
You said you felt/thought X. Can you take a moment to just watch
and notice the thought/feelingnotice the details about it:
Is it one thought/emotion or many?
Does it dominate your mind or itter in and out?
Is it familiar or unfamiliar? Do you have secondary thoughts or feelings
about it?
Is it strong or weak?
Do you experience it anywhere in your body?
Are there colors or images associated with it?
What other thoughts and feelings seem to be associated with it?
Does it make your feel tired, wired, or some other way?

SELECTED
INTERVENTIONS FOR
COUPLES AND
FAMILIES

How does it aect your sense of self? Your feelings about the day? Your
feelings about life?

17

A Model of Mindful Relating

Two Levels:
1. Relational Processes
Emotional Presence: Being emotionally
present and available to the other
Compassion and Acceptance: Experiencing
and expressing compassion for and
acceptance of the other
2. Personal Processes

Guided Meditation

COMPASSIONATE LIFE
REVIEW

Self-Regulation: Regulating ones own

emotions
Self-Acceptance: Practicing acceptance of
and compassion for the self

Couple Interventions

Guided Mindful Communication

Facilitated Mindful Communication

Enactments with mindful reection
on inner and relational processes
Characterized by
Presence
Slowing Down
Pauses
Reection
Carefully Chosen Words

Reection on Cycle for Mindful Enactment

Identify Pattern
I want to pause right here and invite
each of you to take a step back and
look at the dance or interaction
pattern that is emerging.
Identify Individual Moves
How is each person moving the
conversation forward with his or
her particular response?
Identify Contextual Issues
How does each response make
sense in the context of the prior
one?
Identify Possibilities
What things are you willing to do to
make things move in a new
direction?

Guide Couple Through One or More Area of Mindful Reection

Present Moment Emotions and Experience
Sense of Safety
Present Moment Thoughts
Bodily Sensations
Invite Acceptance and Compassion for what is
Imagine Partners Emotions, Sense of Safety, Thoughts, Bodily
Sensations
Partners Bodily Sensations
Appreciation

Mindful Awareness of Internal Experiences

Make Public Inner Experiences of Each
What is going on inside for each person
during the various phases of normal
tension risingheight of tensionresolution
of tensionreturn to normal?
Make Public Sense of Safety
What happens to a sense of feeling safety for
each person at various points? How do they
express their sense of not feeling safe: anger,
hurt, attacking, avoiding, etc.?
Consider Experience of Others
What is going on for others that may be
aected by this cycle?

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Bringing Compassionate Awareness to

Interaction Patterns
Invite Compassion
After identifying this cycle, are there elements that are now
easier to understand or have compassion for?
Consider Emotional Safety and Dynamics
When you step back and begin to understand others
experiences of not feeling safe as well as your own of not
feeling safe, can you see the interaction cycle any dierently?

Can you have compassion for each persons experience of
feeling that the relationship suddenly seems unsafe or
unsupportive?

Intervention with Kids and Families

Out-the-door mindfulness
2-5 minutes of mindfulness before go to school
Ideal for ADHD
Changes tone of morning rush

Mindful Pause

Using Mindfulness to Pause

Similar to time-out
If person has mindfulness practice,
can quickly trigger relaxation
response
Can be extremely brief (1-5 seconds)
Or take minutes or hours

For couples or families

Begin in session
Transition to out-of-session
Can use multiple foci
Sip of water (try to taste water)
Feel feet or hands
Breath
Notice air temperature

Intervention with Kids and Families

Rocking the monkey
Use stu animal on belly with
younger child
Watch as rock animal to sleep

Intervention with Kids and Families

Mindfulness for Parents
To enhance emotional attunement
Helpful if emotional bond needs attention

THERAPIST SELF CARE

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Self Care for Therapists

Possible Motivations
General stress management;
improved ability to manage stress
Happier disposition
Separate work from personal life
Improve clinical skills; ability to be
present
Physical health benets
Improved sleep
Improved personal relationships:
my partner, children, friends

Formal Meditation Practices for Therapists

Compassion meditation
Vipassana
Strategies for regular practice
Pair with established everyday habit
Integrate into work day

Deepen spiritual practice

COMPASSION
MEDITATION FOR
THERAPISTS
VIPASSANA

Self Care for Therapists

Informal At-Work Practice
Mindfulness breath meditation
Upon arrival: gift to clients and self
Upon departure: gift to your sig
other(s)

Mindful daily activity

Wash hands
Touch doorknob

Yoga
Between sessions

Community and Relational

Practices
Couple and family practice
Community/groups

Clients (individually or as a whole)

Colleagues
Self
All beings (e.g., everyone)

My Self Care Plan

Formal Practice
Daily activities
Vipassana
Hand washing
Compassion
Door knob
Prayer
Signing notes
Regular time period to practice Locking le cabinet
Turning on lights
At work practices
In-oce yoga
Mindfulness
Upon arrival
Community
Upon departure
Couple/family/friend practice
Community/group/friends
Other???

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THANK YOU FOR

YOUR PRESENCE

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