Mindfulness in psychotherapy: Reflections on the therapeutic value of an age-old practice

Individual Psychotherapy
It is not an exaggeration to say that our Western culture has come to claim mindfulness meditation as one of the chief resources for coping with stress and all sorts of other modern-day conditions and problems. Not a week goes by without a major magazine, public figure, or scientific journal extolling its virtues and powers: to calm an anxious mind, to heal a troubled relationship, to rewire the brain and change ingrained habits and responses, to lessen physical pain. Although its important place in the pantheon of self-care rituals seems so firmly established, mindfulness remains elusive and frequently misunderstood.

In both my personal and clinical experience, I have found that mindfulness is a singularly powerful, even life-transforming practice that indeed deserves the widespread attention it has been given in recent years; this being said, what its power is and how it can be harnessed is often very much at odds with the mainstream assumptions about it. What follows is a reflection on what mindfulness is, what it does (and does not do) and why as therapists, we would like everyone to practice it.

What is mindfulness? 

Simply put, mindfulness is the practice of bringing intentional focus to the present moment and doing so with curiosity and nonjudgment. Of course, we cannot control our minds’ natural tendency to judge and evaluate so the task isn’t to push anything out of the mind. Instead, when practicing mindfulness, we aim to notice whatever shows up, accept its presence and to choose to place attention back on what we have determined to focus on, whatever it may be – our breath, conversation with a friend, leaves fluttering in the wind.

When I first began my mindfulness practice, like many of my psychotherapy clients I did not exactly grasp that acceptance of the inner content is a core component of mindfulness. After all, I read about mindfulness as a stress management, depression-and anxiety-reducing tool so it seemed like the purpose of the practice was to remove negative emotional charge present in my body and mind. It is not. This very assumption, followed by inevitable disappointment when mindfulness does not quite get rid of our pain and tension, causes so many people to prematurely give up on it altogether. In my early months of practice, I would often find myself irritated with the fact that my mind was just as busy or unsettled after I mindfully followed my breath for ten minutes as before I chose to do so. I would find myself thinking that “this isn’t doing anything” although I intellectually understood that it wasn’t meant to do things. But then the dilemma I faced was: if mindfulness isn’t immediately bringing more peace or calm into my life, why commit precious time to it?

There is no destination, just the path

In some ways, my frustration reflected our Western obsession with outcomes and performance. I conceptualized mindfulness as a technique to be mastered that would yield specific outcomes in my life. Once mastery was achieved, I would simply bask in the rewards, with permanent state of happiness and contentment chief among them. As I now teach mindfulness to my clients, I see the same set of expectations reflected in their responses to the practice: “I didn’t do a good job,” “I couldn’t quiet down,” “I didn’t like it, it was uncomfortable.”

To practice mindfulness, we need to let go of the notion that it is a tool that will melt away our stress. Instead, we must grasp that it is a practice, a way of relating to the world and to our inner experience that is not outcome-oriented. In other words, we do not practice mindfulness to get somewhere, but to meet each moment with an attitude of openness and curiosity, no matter what it brings. In not forcing reality to be different in the moment in which it unfolds, in accepting it without judgment, we are able to consciously choose that one thing in life that we fully do get to control: our response.

By responding to our reality with full awareness and non-resistance, we can effect needed change in our lives that truly reflects who we are and what matters to us. We cease being prisoners of particular thought patterns or problematic habits although the thoughts or urges to act in a certain way may still arise in us. The paradox of mindfulness is that the ability to greet experiences with acceptance creates a sense of choice that enables us to make meaningful changes in our lives. Thus, the sort of active acceptance we are cultivating through mindfulness has, contrary to popular thinking, nothing to do with resignation.

We are not our thoughts

In the absence of mindfulness, we typically respond to our thoughts, memories and sensations as though they were facts. Thoughts like “No one loves me!” “I hate my job!” or “I will never be successful” have the power to profoundly shape our actions and mood. Although they pain us, over time these familiar statements become so ingrained that we perceive them as indisputable facts, much like our eye color or height. Depression and anxiety are characterized by the stubborn presence of painful negative self-evaluations and insistence on the part of the sufferer that they represent undeniable reality.

What does it look like to greet these painful thoughts with mindfulness and how is that different from our habitual way of responding? First, we notice the thoughts themselves as thoughts, and not the reality. We appreciate that the mind has created these thoughts and observe their powerful emotional charge. We might see that the moment they showed up, our shoulders started tensing up or the mind jumped to recent experience that prompted similar thoughts. We observe and then we let go, recognizing that, to use a helpful analogy, these thoughts represent transient weather of the mind – clouds passing through the sky. We are the sky. To grasp that is to become free, not of the thoughts themselves but of the powerful, ingrained meanings we may have been giving to them for years.

Mindfulness in psychotherapy   

In many highly effective psychotherapy approaches, mindfulness is central to what happens in the space shared by the therapist and his/her client. In psychotherapy, we gently examine how our minds continually interpret everything and how the stories we tell ourselves shape our lives. We seek to bring more compassion and curiosity to inner experience. We explore beliefs and expectations and reflect on how these have come to shape our value systems and to potentially limit us or cause us ongoing pain. We come to tolerate aversive emotions and memories, and as we do so, greater flexibility and resilience develop. None of this can happen without mindfulness; in many ways, psychotherapy is mindfulness.

The intense interest in mindfulness in recent years speaks to how badly we need this practice in our lives. We all feel overwhelmed at times by constant demands on our time, nonstop connectivity, informational overload and multitasking that characterize so much of modern daily life. We may even forget that we are human beings and not human doings. The pace and intensity of everyday life may leave us feeling disconnected from ourselves and others. We sense that something is not right, that the feeling of inadequacy, of being behind in life and not good “enough” gets in the way of living. We often do not know how to change that so we do what we know how to do well: we try to work harder at being happy. Though meant to lift us out of dissatisfaction, this self-improvement project often becomes the source of unhappiness itself as we compare ourselves to others and feel we come up short.

Through mindfulness, we cultivate the ability to expand our experience of ourselves and others. In the process, we breathe, we slow down, we recognize the fleeting nature of the moment and honor it by giving it our full attention. While mindfulness is not simply another “quick-fix” stress management technique, I encourage everyone, children and adults alike, to integrate this age-old practice into daily life.


Wherever You Go There You Are — Mindfulness Meditation in Everyday Life, by Jon Kabat-Zinn, PhD
Radical Acceptance and True Refuge by Tara Brach, PhD