Dialogue-Based Mindfulness Training

Most meditation is taught the way it is taught on retreat: the teacher gives the instructions, the students sit in silence, and whatever happens inside each person stays inside. That works well for experienced practitioners working with subtle states. It works badly for someone in the middle of strong emotion, which is most people who come to therapy. The same instruction to enjoy the breath can give one person the best sit of their life and leave another feeling constricted and ashamed, and the teacher never finds out.

In Dialogue-Based Mindfulness Training the person practicing tells me what is happening while it is happening. I adjust the instructions to what they report. If a sensation is too much, we work with that. If a thought has hijacked the exercise, we work with that. The practice gets built around the person’s actual experience rather than an average one.

Three things follow. People hit obstacles in these practices, and with dialogue I can see the obstacle and guide them through it instead of losing them to it. People give up on practices that do not help quickly, and with dialogue most people get real benefit in the first session. And it works: I have used it with hundreds of clients and taught it to thousands of therapists, and it is the way every practice in my books is meant to be used.

It is also how I do meditation coaching.

From Self-Compassion in Psychotherapy · Chapter 4

If you were to attend a public talk by Thich Nhat Hanh or the Dalai Lama, you might hear something like, “Mindfulness is just paying attention to the present moment,” or “Mindfulness is bringing your awareness to the here and now.” This is true, but there is also a lot more to it. If you were to continue studying with either of those teachers, you would be given more and more specific, detailed, and nuanced instructions about exactly what kind of awareness mindfulness is and exactly how we can cultivate it.

One of the core analogies that Thich Nhat Hanh uses to describe mindfulness is of a mother holding her newborn baby—that kind of open, loving, accepting awareness. When we bring mindfulness to our breathing, our fear, or any other object, we don’t just watch it in a way that is emotionally flat or cold, nor are we merely “nonjudgmental.” There is a kind of tenderness and open-heartedness that is vital to the practice of true mindfulness. Take a moment and see if you can connect with that energy in yourself.

This way of construing mindfulness is not unique to Thich Nhat Hanh. It is fundamental to how the term is understood in every traditional school of Buddhist psychology. In the original collection of Buddhist teachings (the Pali Canon), the main treatise on Buddhist psychology, the Abhidhamma, defines mindfulness as having 18 necessary characteristics, which include love, generosity, and respect. In other words, if our mindfulness doesn’t have warmth and tenderness, it isn’t real mindfulness.

Another essential aspect of mindfulness is what Buddhists call Right View. When we practice mindfulness or compassion, our practice is informed by how we understand the world. If our worldview is materialistic and individualistic, then that will color our mindfulness practice in a way that is different than if our worldview were based on interdependence.

Different schools of Buddhism explain Right View differently, but all of them emphasize that our basic worldview is the foundation upon which our meditation practices are built. Thich Nhat Hanh often says, “If you are practicing mindfulness without right view, then you are practicing Wrong Mindfulness.”

From the perspective of Right View, our suffering is not ours alone. It comes to us from many different causes and conditions. The anxiety in you might have come from your mother’s anxiety. Her anxiety might be the product of growing up without enough food to eat or from her grandfather’s trauma in World War I. Some therapists attempt to help their clients stop blaming themselves for their suffering by encouraging them to blame their parents. However, we know that our parents didn’t ask for their suffering either. Right View is connected to compassion because we see that there is no one to blame. The suffering of the world belongs to all of us, and we all share responsibility for transforming it.

From Self-Compassion in Psychotherapy · Chapter 5

When someone describes an emotion, I think about it in terms of the sensations in the body and the thoughts/perceptions that go with those sensations.

In Buddhist psychology, there is no real correlate for our concept of emotions. What we call an emotion, say, anger, would be seen as a bodily state (e.g., tightness in the chest and jaw), a negative valence (i.e., it’s an experience we don’t like), and whatever thoughts or perceptions go with it (e.g., “That person is an idiot!”). In fact, Buddhist psychology categorizes anger (pratigha) as a mode of thinking (caitasika: mental factor). If you’ve seen “feelings” mentioned in Buddhist sutras, that’s because the Pali word, vedanā, is often translated as feelings. However, since there are only three possible vedanās—positive, negative, and neutral—I believe the word would be better translated as affective valence. Some call it feeling tone. Although either term might seem a little abstract, the experience of exploring our emotions at this level of detail can be really clarifying.

From Self-Compassion in Psychotherapy · Chapter 3

Here is an example of how DBM might look in a session that’s focused on teaching mindfulness of the body to calm performance anxiety.

Therapist: Would you be willing to try an exercise to see if it might help when you need to perform and are feeling anxious?

Client: Sure, if you think it might help.

Therapist: It might. Let’s see. (pause) Let’s start by picturing yourself just before a performance, and let me know when you feel like you’re really there.

Client: (Closes eyes.) I’m there.

Therapist: Great. Seeing all those people in front of you, what are the sensations you notice in your body? Is there tension, relaxation, heaviness, or lightness? Anything like that?

Client: Well, my chest is really tight and my whole body feels like it’s shaking.

Therapist: Perfect, thanks. (slowly) So there is tightness in your chest and your whole body feels shaky. (pause) Now let’s see if it’s possible for you to just let those sensations be there in your body without trying to change them at all. See if you can, for a minute or so, let yourself just feel that tightness in your chest and shakiness in your body.

Client: It doesn’t feel good. It’s pretty intense.

Therapist: That’s OK. That’s perfect. You’re doing it. So even though it feels really unpleasant, you are just letting that tightness in your chest and shakiness be there in your body. Just feeling them and not trying to make them go away.

Client: (Eyes still closed.) I want them to go away.

Therapist: Yes. That’s totally fine. It’s OK to want them to go away. Just let yourself feel all of it. The tightness in your chest and the shakiness are there. And the feeling that you want them to go away is also there. We are letting all of those things be true in this moment. See if you can let them all be there and feel them.

Client: Yeah, I can. It’s not easy, but I can.

Therapist: Great. (pause) As you are staying with all of these feelings in your body, let me know if they get stronger or change in any other way.

Client: I guess they are getting weaker, but they are still there.

Therapist: Great. Remember, we aren’t trying to make them go away. We are just learning that we can feel them and tolerate them. They might get stronger, and that’s OK, or they might continue to relax. We are just watching.

Client: Yeah. They are really relaxing. I feel like just not fighting them helps them to relax. I feel better.

From Self-Compassion in Psychotherapy · Chapter 3

I believe that DBM is a more effective way to teach mindfulness and self-compassion to a clinical population for three reasons. First, our clients deal with a lot of mental obstacles when attempting these practices. This client could have easily gotten stuck in a negative thought pattern if I weren’t able to track him. In the mindfulness of breathing example from earlier, I mentioned that it’s fairly common for even simple meditation instructions to trigger shame, self-criticism, or anxiety. DBM allows therapists to monitor these potential pitfalls and guide clients to safety.

The second reason is that our clients are much more likely to give up on a practice if they don’t find real benefit right away. The more traditional way of learning mindfulness and self-compassion requires a lot of persistence and willingness to sit through (seemingly) unproductive meditation sessions. However, I’ve found I can often help a client experience real benefit from these practices in our first session using DBM.

Finally, it just works. Having to verbally describe one’s experiences during a meditation session is not appropriate for advanced meditators when they are working with more subtle levels of thought, feeling, and perception. When the mind is very peaceful, it is distracting to have to verbalize anything. However, therapy clients are mainly dealing with strong emotions and loud, persistent thoughts. Having worked with thousands of clients and therapists using this method, I’ve found that DBM can be enormously helpful in these kinds of situations.

Philosophy · Self-Compassion in Psychotherapy