INTRODUCTION TO MINDFULNESS

Palliative Care Quality Network

Denise Hess, MDiv, BCC, MFTI

Providence Little Company of Mary Medical Center –Torrance

February 13, 2014

Listen to the following statements about your everyday experience. Using the scale below, please indicate how frequently or infrequently you currently have each experience. Please answer according to what really reflects your experience rather than what you think your experience should be. Please treat each item separately from every other item.

1: Almost always

2: Very frequently

3: Somewhat frequently

4: Somewhat infrequently

5: Very Infrequently

6: Almost never

SELF ASSESSMENT

• Habits

• Routines

• Automaticity

• Multi-tasking

• Depersonalization

• Judgment

“Compared to what we ought to be,

we are only half awake.”

William James

Mindlessness

• Attentiveness

• Genuine interest

• Curiosity

• Compassion

• Presence

“Simultaneous engrossment in a task or person

as well as a recognition of one’s own perspective.”

(Epstein, 2003)

Mindfulness

Context

Other Self

Mindfulness

Attention to and awareness of what is occurring

in the present moment in:

with a stance of open, non-judgmental curiosity

0 0 1 1 3 5 0 0 2 1 5 2 8 10 7 11 7 11 13 18 21 28 44 52

76 77

122

167

228

290

353

397

477

0

50

100

150

200

250

300

350

400

450

500

550

19

80

81

82

83

84

85

86

87

88

89

19

90

91

92

93

94

95

96

97

98

99

20

00

01

02

03

04

05

06

07

08

09

20

10

11

12

Nu

mb

er

of

Pu

blic

atio

ns

Year

Mindfulness publications by year, 1980 - 2012

Source: DS Black (2013). Mindfulness Research Guide. www.mindfulexperience.org

Research

• Anxiety, depression, stress, burnout (e.g., Cohen-Katz, Wiley, et al ., 2005; Ma & Teasdale, 2004; Teasdale, Segal, Williams, et al., 2000)

• Chronic pain (Kabat-Zinn, 1982; Kabat-Zinn, Lipworth, & Burney, 1985)

• Substance abuse (Bowen, Witkiewitz, Dillworth, et al., 2006)

• Arthritis(Pradhan et al., 2007)

• Diabetes(Gregg, Callaghan, et al., 2007)

• Fibromyalgia(Sephton et al., 2007;Grossman, et al., 2007)

• Psoriasis (Kabat-Zinn et al., 1998)

Outcomes

VICARIOUS TRAUMA: similar emotional, physical and cognitive symptoms to that of traumatized patients

“Five out of six doctors say that medicine is in decline and close to 60 percent would not recommend it as a

career for their children.”

www.physiciansfoundation.org

Burnout, CF, & STS

A Hardening of Heart?

Newton, et al. Academic Medicine, Vol. 83/3, March 2008

PREVENTING VICARIOUS TRAUMATIZATION OF MENTALHEALTH THERAPISTS: IDENTIFYING PROTECTIVE PRACTICES

RICHARD L. HARRISON AND MARVIN J. WESTWOOD

University of British Columbia

This qualitative study identified protectivepractices that mitigate risks of vicarioustraumatization (VT) among mental healththerapists. The sample included six peer-nominated master therapists, who re-sponded to the question, “How do youmanage to sustain your personal andprofessional well-being, given the chal-lenges of your work with seriously trau-matized clients?” Data analysis wasbased upon Lieblich, Tuval-Mashiach,and Zilber’s (1998) typology of narrativeanalysis. Findings included nine majorthemes salient across clinicians’ narra-tives of protective practices: counteringisolation (in professional, personal andspiritual realms); developing mindful self-awareness; consciously expanding per-spective to embrace complexity; activeoptimism; holistic self-care; maintainingclear boundaries; exquisite empathy; pro-fessional satisfaction; and creating mean-ing. Findings confirm and extend previ-ous recommendations for amelioratingVT and underscore the ethical responsi-

bility shared by employers, educators,professional bodies, and individual prac-titioners to address this serious problem.The novel finding that empathic engage-ment with traumatized clients appeared tobe protective challenges previous concep-tualizations of VT and points to excitingnew directions for research, theory, train-ing, and practice.

Keywords: vicarious trauma, preven-tion, compassion fatigue, countertrans-ference, empathy

The risks of working directly with traumatizedindividuals on a regular basis are well docu-mented (Arvay, 2001; Buchanan, Anderson,Uhlemann, & Horwitz, 2006; Figley, 2002; Pearl-man & Mac Ian, 1995). McCann and Pearlman(1990) first identified the problem of vicarioustraumatization (VT), which they defined as thecumulative transformative effects upon therapistsresulting from empathic engagement with trau-matized clients. As part of their work, these cli-nicians must listen to graphically detailed de-scriptions of horrific events and bear witness tothe psychological (and sometimes physical) af-termath of acts of intense cruelty and/or violence.The cumulative experience of this kind of em-pathic engagement can have deleterious effectsupon clinicians, who may experience physical,emotional, and cognitive symptoms similar tothose of their traumatized clients (Pearlman &Saakvitne, 1995a, 1995b; Sexton, 1999). How-ever, there is consensus in the field that there isnot enough empirical literature on the definitivefactors that contribute to VT, nor the practicesthat may prevent or ameliorate its harmful effects(Arvay, 2001; Figley, 2004; Pearlman, 2004).

Although research and theory have begun toemerge about VT vulnerability and treatment(Figley, 1995, 2002; Saskvitne & Pearlman,

Richard L. Harrison and Marvin J. Westwood, Department

of Educational and Counseling Psychology, and Special Ed-

ucation, University of British Columbia.

This article was based on the doctoral dissertation research by

the principal author, which was generously funded by the Social

Sciences and Humanities Research Council of Canada and the

Michael Smith Foundation for Health Research in partnership

with WorkSafe BC (Worker’s Compensation Board of British

Columbia). The primary author wishes to thank his dissertation

committee (Drs. Marvin Westwood, Marla Buchanan, and Wil-

liam Borgen) for their insight, rigor, and warmhearted support.

Correspondence regarding this article should be addressed to

Richard L. Harrison, Vancouver Couple and Family Institute,

Suite 270, 828 W. 8th Ave, Vancouver, BC, Canada, V5Z 1E2.

E-mail: dr.richardharrison@shaw.ca

Psychotherapy Theory, Research, Practice, Training © 2009 American Psychological Association2009, Vol. 46, No. 2, 203–219 0033-3204/09/$12.00 DOI: 10.1037/a0016081

203

Preventing Vicarious Trauma

How do you manage to sustain your personal and professional well-being, given the challenges of your

work with seriously traumatized clients?

Peer nominated master clinicians:

• Countering isolation

• Holistic self-care

• Clear boundaries

• Embracing complexity

• Creating meaning

• Mindfulness

• Exquisite empathy

Themes

Wherever you are,

be all there…

Jim Elliot

When clinicians maintain clarity about interpersonal boundaries, when they are able to get very close without fusing or confusing the client’s story with their own, this exquisite kind of empathic attunement is nourishing for therapist and client alike.

Connection is protection

Circles of suffering

http://www.fammed.wisc.edu/mindfulness/pip/pause

Circles of suffering

Circles of suffering

The Mindful Clinician

Upbeat Relational Focused Efficient Satisfaction

The Mindful Clinician

Depression Anxiety Burnout Persisted one year later AND

• Attention- expected/unexpected, central/peripheral, biases & filters

• Curiosity- seeing what is as it is, allowing doubt, awareness of one’s own humanity

• Beginner’s mind- cultivated naïveté, holding contradictions, non-habitual thinking

• Presence- undistracted connection to self, other, context

Essential Components

– Non-religious

– Focused attention on breath

– Not mantra

– Not emptying your mind

– Not relaxation

– Notice what is:

• thoughts

• emotions

• sensations

Formal Practice: meditation

• Informal: mindful awareness in daily activities

– Eating

– Listening to music

– Reading

– Journaling

– Driving

– Walking

– Connecting

– Uni-tasking

Informal Practice

Practice, practice, practice

http://www.fammed.wisc.edu/mindfulness

The pause is an active, nimble, often intense state, as when an Olympic diver pauses at the end of the diving board until that precise hundredth of a second when

every muscle is tensed in harmony.

And at that instant he dives.

Rollo May, Freedom and Destiny

Pause

Presence

Be Still by Lao Tzu

Do you have the patience to wait till your mud settles and the water is clear?

Can you remain unmoving

till the right action arises by itself?

The master doesn't seek fulfillment,

but not seeking, not expecting, is present,

and can welcome all things.

Presence

Proceed

The rush and pressure of modern life are a form of violence. To allow oneself to be carried away by a multitude of

conflicting concerns, to surrender to too many demands, to commit oneself to too many projects, to want to help everyone in everything, is to succumb to violence. The

frenzy neutralizes our work for peace. It destroys our own inner capacity for peace because it kills the root of inner

wisdom which makes work fruitful.

Thomas Merton

Open minded presence in the context of medical expertise is the skeleton key that opens many locks.

(Hutchinson, 6)

The Mindful Clinician

Whole Person (Clinician) Care

Flourishing

Compassion Satisfaction

Post-Traumatic Growth

Burnout

Compassion Fatigue

Post-Traumatic Stress

• Free:

– iTunes U “Mindful Meditations” by UCLA

– Smiling Mind http://smilingmind.com.au/

– University of Wisconsin: http://www.fammed.wisc.edu/mindfulness

• Books:

Resources