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Interpersonal Mindfulness for Clinicians

interpersonal mindfulness for cliniciansFrench Buddhist monk Matthieu Ricard recently wrote:

“self-transformation is meaningful only if it allows us to be of greater service to others.”

What good is meditating for hours each day if we get up from the cushion and treat our loved ones poorly or cannot then be present with them? And as clinicians, attending meditation retreats and memorizing all the mindfulness-based protocols in the world won’t be of much use if we are ultimately unable to communicate mindfully with clients.

Interpersonal mindfulness is what happens when we are able to apply the way we relate to ourselves through mindfulness practice to the way we relate to others. It allows us to access the deeper meaning behind what people say and to recognize the way their words affect us personally, from one moment to the next.

Why Interpersonal Mindfulness?

Being present with our own difficult feelings is challenging enough. Where are the direct benefits to focusing on interpersonal mindfulness in therapy?

Interpersonal mindfulness can reduce burnout by helping clinicians to be less overwhelmed by the emotional experiences of clients. When you’ve developed skills in mindful communication, you can share what you’ve learned with your clients so that they may more effectively navigate their own interpersonal challenges outside of the therapy room.

When you are communicating mindfully, you are perpetually tuning in, and back in, to what is being communicated and what impact it’s having on your own internal experience. Interpersonal mindfulness is not something that you will ever perfect, but through practice it can radically improve your relationships with clients.

What Mindful Communication Is

According to Lisa Fortuna, M.D., and Zayda Vallejo, who co-wrote a book about treating co-occurring adolescent PTSD and addiction:

“Mindful communication is paying attention, on purpose, with the intention to be present to what the client is saying, moment-to-moment, with affectionate curiosity and nonjudgmental awareness. It also means attending to the impact of the client’s words in your internal landscape of bodily sensations, emotions, and thoughts. Finally, interpersonal mindfulness involves practicing mindful listening as well as expressing oneself mindfully.”

The goal of listening mindfully is to not only observe what is being communicated in a nonjudgmental way, but to observe your internal reactions to that information as well.

This goal is perhaps one of the most useful applications of mindfulness practice because like Matthieu Ricard mentioned, it allows us to use our ability to be present in the service of others.

In this way, each session becomes a practice in present moment awareness. How often during a session while a client is talking do you find yourself thinking about other things? When something particularly harrowing or painful is shared, how often do you say or doing something to shift out of being present, whether impulsively or on purpose?

“When you’re sharing a moment of intense personal pain with somebody, something that maybe they haven’t made contact with in years, it takes a willingness to stand in the moment and to not run away yourself, because that’s what your client is going to try to do,” says Kirk Strosahl, Ph.D., co-founder of acceptance and commitment therapy and author of “Inside This Moment: A Clincian’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy.”

When you make it a goal to practice mindful communication in your sessions, you will start to be aware of some of the ways you attempt to escape from the present moment when what’s being shared feels uncomfortable.

In those moments, do you start to think about something similar that happened to you? Do you latch onto evaluations about how you handled or mishandled it at the time? Do you secretly judge your client?

In their book, Fortuna and Vallejo outline two foundational principles for the practice of interpersonal mindfulness.

The First Principle of Mindful Communication

The first principle is about listening to what the client is saying with an unbiased and nonjudgmental stance.

This mindset will take practice and will involve first noticing when judgmental thoughts emerge and gently pulling yourself back to a neutral place. Note that this will not be strictly verbal. She may be presenting body language,or her own avoidance behaviors like covering her face, changing the subject or laughing nervously. To the extent that you’re tuned in, you’ll be better equipped to help her stay tuned in as well.

Here are some helpful reminders adapted from Fortuna and Vallejo’s book about what interpersonal mindfulness looks like:

• To the best of your ability, listen to your client as if you were meeting her for the first time. Limit any assumptions you might be tempted to make based on her clinical history and what she’s told you in previous sessions. Be curious, and rely entirely on her to fill in any blanks you may be tempted to fill in for yourself.
• Practice trusting the therapeutic process. If you feel yourself judging your competence as a clinician when you see that a client is still stuck in his or her patterns or maladaptive behaviors, gently bring yourself back to trusting in the tools you have gathered along the way.
• Stay open to whatever your client is saying, even when it feels painful or uncomfortable for you. Watch for any behaviors you may be tempted to engage in that will take you away from the present moment, and watch for them in your client as well.
• A few moments of focusing on the breath before speaking can work wonders for setting a mindful tone for the conversation.

The Second Principle of Mindful Communication

The second principle is about the intention we set when we enter into a session. When we’re communicating mindfully, we are approaching clients with the intention to serve. And serving does not mean fixing.

“Fixing or helping implies authority and conveys the message that you know more about that person than he or she does. When we feel that we know best for someone else, we create dependency. We take away a person’s self-efficacy, self-worth, and faith and trust in him- or herself. Put another way, we can listen with our minds, or listen with our hearts,” say Fortuna and Vallejo.

Compassionate Communication

Evidence touting the benefits of compassion-focused techniques in therapy is mounting. When we intercept on the mind’s evolved tendency to want to judge, fix, and seek out negatives, we make way for a style of listening that allows a deeper and more profound level of healing.

The idea here is that if we as clinicians can view our work as an action of service, we absolve ourselves of the inherently evaluative job of “fixing” people. It can help us to stay connected with our reasons for getting into this work in the first place and can ultimately reduce burnout.

Like any mindfulness practice, interpersonal mindfulness also takes practice and a commitment to returning to the present moment as often as possible, not just in sessions but throughout the day.

It takes a willingness to occupy our bodies when the physical sensations that come with fear, anxiety, stress, anger or grief emerge. And it requires the same willingness to stay present without pulling away when our clients experience similar distressing sensations.

If you already have a personal mindfulness practice, you’ll find that cultivating interpersonal mindfulness in your sessions to be a natural next step to deepening your practice.

Therapy session photo available from Shutterstock

Interpersonal Mindfulness for Clinicians