Mindfulness in Counselling

Mindfulness is becoming increasingly important as a tool in counselling and features as a central feature of Mindful CBT, but what is mindfulness and how does it help in counselling. This article hopefully provides some answers.

Mindfulness stems from ancient Buddha practice and has profound relevance for our present-day lives. This relevance has nothing to do with Buddha per se or with becoming a Buddhist, but has everything to do with waking up to and living with harmony with the world. It has to do with examining who we are, with questioning our view of the world and our place in it, and cultivating some appreciation for the fullness of each moment we are alive. Most of all, it has to do with being in touch. (Kabat-Zinn, 2004)

The value of incorporating mindfulness into our lives is that it has the potential to teach us be aware, in the moment, of our thoughts and sensations without judgement. There are considered to be two main modes of mind:

• Doing mode
  A goal-oriented state. Often gives rises to a sense of discrepancy between how things are versus how the mind wishes things to be. If the mind continuously dwells on discrepancies, then negative feelings and emotions arise leading to habitual patterns of the mind designed to close that gap.
• Being Mode
  Not focused on achieving specific goals but, instead, on accepting what is without any immediate pressure to change. The mind processes from moment to moment, enabling the person to be completely engaged in the present.

In doing mode, goals are used to ensure good or bad feelings continue, whereas in being mode thoughts and feelings are viewed simply as events that arise in the mind, become objects of awareness, and then are allowed to pass from the mind.

Although meditation and guided visualization are examples mindfulness practice (Kabat-Zinn, 2001), mindfulness is not by definition meditation and this is an important insight for those whom meditation is a new experience (Wellings & McCormick, 2000). One seemingly unlikely example of mindful functioning I like to use is that of Formula 1 racing drivers who are able to observe and respond to events, bodily sensation and their existence in their environment with microsecond resolution by being mindfully present in the the process. Paradoxically, while the aim of the driver is to be first over the finish line to be greeted by the chequered flag, he can only do this by experiencing at the deepest level every turn, straight line and pit stop and being mindfully present in every millisecond.

Mindfulness and counselling

The skills we seek to promote in counselling are intended to avoid rumination about events and feelings that would tend to reinforce depression or anxiety. Instead, we seek to create a curiosity and awareness of the processes and how we experience them, allowing the client to focus less on reacting to stimuli and more on accepting and observing them without judgment.

A key feature of mindfulness is that it changes our relationship with our internal experiences. Although anxiety prompts us to turn away from uncomfortable or painful experiences, mindfulness allows us to approach them. Rather than judging some internal experiences to be acceptable and others to be unacceptable or loathsome, mindfulness involves bringing curiosity and compassion to all or our experiences. (Susan M Orsillo, 2011).

Again, paradoxically, by not being focussed on the outcome of forcing changes to behaviour, mindfulness encourages us to observe without judgement changes that occur through the practice mindfulness. In this way it is a powerful aid to developing the self-observer who is able to fully participate in, for example, the development of a formulation rather than to be the recipient of an expert diagnosis.

Using mindfulness with clients

My inclination in using mindfulness with any client is introduce it at a cognitive level. In this way is linked with the autonomic arousal model that illustrates how mental states and physical states are intimately linked. Of particular interest is the effect of raised levels of cortisol in the brain (Gerhardt, 2004) and in maintaining depression or anxiety (Greenfield, 2002). To counter this I enjoy sharing with clients the concept of mental strawberries which promote endorphins (Bloom, 2001) through being mindfully present during all moments in life.

One client who benefitted from this approach was a young woman who suffered with depression and low self esteem. Over a number of sessions we worked with a graphical representation of her significant relationships in which she used symbols to represent significant others. She elaborate symbols for her mother,  father, and siblings and her husband. She depicted herself as a plain unadorned letter D.

We worked a visualization for which we developed the image of a large shallow and rock strewn Canadian stream with sun glinting off the surface rapidly flowing water, “Like diamonds”. This was the symbol she chose to adopt to represent herself. The effect of this was to allow her to observe herself with much more kindness than before and free herself from a overwhelmingly powerful inner critic.

CBT is Not the Only Talking Therapy: A point of view

It's tough finding a counsellor that suits every individual and any one counsellor will not suit every client. Also, the increasing medicalisation of mild to moderate mental distress does not always help the individual to get better.  This is why properly qualified independent counsellors need to be allowed to offer a range of alternatives.

Wide spread ignorance in general practise leads to the belief that CBT is the only model of talking therapy that works and that it must be administered only by the NHS. As powerful as CBT is, the widespread dismissal of psychoanalytic theory by many of its practitioners means that it does not always provide lasting relief from emotional distress, especially with the strict rationing number of sessions allowed. It is effective for rapid symptom relief and does work over the long term for many, but not all. The medical model of "treatment" means that the client is seen as a "patient" with a set of "symptoms", and the client is reduced to a set of problems and any failure in the client to improve can be seen as a failure in the commitment of the client.

It is interesting that in many areas of the country that those providing treatment for mental illness under the IAPT (Improved Access to Psychological Therapies) schemes specifically exclude those with training in counselling in favour of those more accepting of a strict medical model. They also make high demands on their practitioners in terms of numbers of clients they must see. This can often result as the patient being seen in terms of outcomes that favour, or not, the practitioner and the genuine relationship between them becomes strained.

By contrast, integrative counselling is founded on the intersubjective relationship between the client and counsellor and offers a talking therapy that truly respects the individuality of the client. It provides an holistic approach to counselling that embracing humanistic, psychoanalytical, and cognitive psychological theories and encourages a detailed exploration of phenomena and from this exploration the meaning underlying a client's distress. Any development of negative regard by the client of the counsellor are seen as just one phenomenon which can usefully be explored to reveal the underlying meaning and how this meaning is played out in the present, often to the detriment of the client's relationships.

There are many well regarded colleges and institutions that offer well-founded training to degree level and beyond, ensuring that their graduates are fit to practise as counsellors and psychotherapists.  With advent of the voluntary regulation by the Professional Standards Authority (PSA) for Health and Social Care, GPs and potential clients can have confidence that those included in the approved registers of accredited counsellors maintained by the BACP, UKCP and other ethical bodies have proper training and experience and are subject to a complaints procedure designed to protect the client.

CBT has many virtues and is a model I use in my own practise when requested, but it is not the only talking therapy. Let's please keep it that way.

Listening is hearing, right?

During a counselling session a while ago, a young female client looked at me with a quizzical look and said, "I told my boyfriend that you wear hearing aids and yet you seem to be the only person ever to have heard me!"

It seems to me that this illustrates perfectly the difference between hearing and listening. Having severe hearing loss in both ears, I need some pretty expensive technology to help me hear clearly which, thanks to our dear old NHS, I have. But that's only half of it. In order to "hear the other" I have to "listen", to give that person my undivided attention and to switch off the noises of prejudice and preconception in my own head.

Paradoxically, in counselling, listening actually involves some speaking. Not in an uncontrolled way and not with the intention of imposing your own thoughts or seeking those moments of gratification that you get when chatting with friends, but to explore the thoughts, ideas and fears of your client. The mutual, intersubjective understanding that arises from this is the bedrock of the counselling relationship in which trust and attunement develop allowing the client to feel heard. This, then, allows the client to feel safe enough to explore the roots of their unhappiness. Over time, this act of listening is experienced as therapeutic and allows the client to heal.

What I have learned from this is that listening is really an act of loving kindness and that when talking to friends and family if you take the time to listen, you may hear so much more and may even find it deepens your relationships.

The Growing Pains of Private Practice

It is widely accepted among counsellors that it is rare to make a living from private counselling practice. When you consider the sheer cost of qualifying, it makes you wonder why any of us would bother. What does it say about those that would propose to help cure the emotional ills of others and help them live more happily? Why go to all this trouble and expense?

In addition to the course tuition fees, books and so on, there is the requirement to undertake personal therapy, to pay for clinical supervision while in placement. At the end you come out with a degree and title to put on your business card. If I am honest obtaining a degree appealed to my ego and was a huge incentive for undertaking the course but so was the notion of being able to do something worthy. Following qualification, then the next steps were to become a member of the BACP and registered with the UKCP.

Now what? Having qualified, and having got the credentials, the next task was to launch a counselling practice.

• Prepare a suitable room at home, find a room to rent in town, or both. Check!
• Sort out professional indemnity insurance and appropriate property insurance. Check!
• Get a listing on the Counselling Directory. Check!
• Build my own website. Check!

Now sit back and wait for clients who would be inclined to undertake counselling and  would be willing to pay a realistic fee. But even if they are willing, how do they spot you in among all of the others? Networking with groups of other practitioners is useful for professional development but still does not raise your profile among the public. Writing umpteen letters to GPs did very little to boost trade either.

Clearly, we still need more. It seems we now have to be more subtle and use social media to reach a wider audience, but even this has to be done in two characters. My personal page is only open to family and very close friends but my Inner Calm page on Facebook is starting to show encouraging signs of life.

Now that they can find me, how do potential clients know if I am any good?

What does appear to have helped here is to make myself visible "in the flesh" which is what I tried in March at a Mind, Body and Soul festival in Norwich. This has brought a few solid enquiries and has encouraged me to rebook for November and also attend the Mind, Body and Spirit Festival at the Forum in Norwich on 27th and 28th April. There people get the chance to put a face to the brand and get to see in person what I'm about.

Let's not get carried away with the gloom here. Since I began private practice as my main occupation just over a year ago, I have not been without at least a couple of clients at a time, and my work at Off the Record Counselling Service in Norwich means that counselling is paying its way. Working with employees referred by Aviva Health Insurance has also boosted my work load and means that I may well soon reach the limits of my capacity to practice.

While at the Mind, Body and Spirit Fair, I promoted and then presented a successful mindfully-based anger management workshop  and will be promoting more wellbeing workshops at the Forum. These are really enjoyable to do as you can get such a sense of involvement between those that attend. Limiting the group size to just eight is essential to this.

So, over the next year the aim will be to solidify the counselling, develop and grow the workshops and to offer my services as a wellbeing facilitator and presenter to individuals and organisations. Overall, I have enjoyed the challenge of growing Inner Calm through these incredibly tough financial times to a point where it is starting to happen.  Here's to a viable and fulfilling way of working over the longer term future that is Inner Calm.

Do celebrities make depression hip?

I'm hugely encouraged that depression seems to have lost much the stigma that it has had over the years, or has it? There has been a great deal of publicity in recent months arising from high-profile suicides of men who apparently suffered in silence while friends were blissfully unaware just how bad things had become. Suicide is the number one killer of young men, and stress is the number one reason for workplace absence. Losing your job because of stress could make a difficult situation impossible to live with.
Stephen Fry, Ruby Wax and other equally famous celebrities are open about their experience of depression and good on them! Sometimes, it seems that it is utterly hip for a celebrity to have experienced depression. But what if you are an ordinary anonymous bloke with an ordinary job in an ordinary company?
Around 10 years ago I worked for one of our leading technology companies in Cambridge, one of those who could probably count Stephen Fry as a huge fan. For reasons to do with work related stress, which was so badly handled by my line managers, I ended up having a complete breakdown. I can remember hiding in the toilets with my fist rammed in my mouth to silence uncontrollable crying. This was followed by 3 months when simply I could not get out of bed and another 6 months or so  getting myself back to work. What was the approach of this company? To immediately to begin disciplinary proceedings related to my need to be off sick. Once I returned, they could not get me out of the door quick enough!
Despite this experience, I am still hugely proud to have worked for this company and believe that, as an entity, "the company" did not treat me that badly. But an ambitious personnel officer and my line managers definitely made it their mission to get me out, and so they did.
So why does it matter today? Now?
Since this experience, and while still working in the technology sector, I trained as a psychotherapeutic counsellor, graduating in 2010. I am proud that I now work with men and women suffering from depression and can use my experience for the benefit of others.
Often depression in the workplace arises from work-related stress, or the dilemmas of trying to balance work and home life or trying to be a successful career woman and domestic goddess.
On the whole it seems companies today are very supportive, often paying for counselling. However, what is utterly apparent is that too many line managers still see depression in their staff as a sign of weakness or as a lack of commitment. Nothing has really changed.
Likewise, spouses and partners often see depression as personal criticism and become angry. Depression can be very self indulgent, in a sense, because when you are in it it can be tough to see out and to empathise with the effect your depression has on others.
Depression is definitely not hip or trendy but can be downright dangerous if left.
Depression takes many forms, so if you or someone you care for are suffering from depression, first consult your GP but also consider seeing a trained counsellor. You do not need to suffer and talking therapy by a trained counsellor really does works! You can find these through your GP or on http://www.counselling-directory.org.uk/. Look for counsellors who are members of professional bodies such as BACP or UKCP as this indicates that they have achieved a professional level of competence and work within an ethical framework.

Anchor Images for Meditation

Do you have an anchor image that you use when you meditate?

Today I hosted an anger management workshop in Norwich about using Mindfulness to regulate the feelings that arise from anger. I offered the audience a lighted candle in a glass vase as a focus the meditation. After the meditation, one of the audience described how she preferred to create an image for herself, finding the vase too prescriptive. I do too when I meditate alone.

The background image on this page has been my anchor for many years and has helped me when feeling very low. It was taken looking out over the sea in the town where I up. I tend not to use it now as it is associated too much with my parents who passed away the year before last, an association that is still too hard for me to tolerate quite yet.

Nowadays I often use a mental image of sunlight reflecting on water and it is an image I hope to be able to photograph one day.

The other image I use, is the dragonfly you see on my counselling practise website, (http:www.innercalm.co.uk website), a photograph I took at Howe Hill in Norfolk a couple of years ago. The dragonfly offers a wonderful metaphor of what counselling seeks to impart upon the client. When I think of the dragonfly I think of its mastery of flight, its part in nature and how it belongs among the reeds, the light falling on those magnificent wings.

Whatever image you use, always make sure you use it in a spirit of kindness to yourself. Never judge the image as being any more or less worthy than any other and allow it to become nourishment for your soul.