Using meditation is session with therapy clients

Mindfulness is a central idea to many of the most successful therapies available today. Dialectical Behavior Therapy has an entire module on the process of becoming mindful due to the direct impact that a mindful state can have on decreasing harmful behaviors and increasing the likelihood of skillful choices. But how do we get our clients to use meditation to become mindful? Answer: make meditation one of your go-to, in-session techniques. Let's talk about when and how to use meditation in-session to enhance the therapeutic experience.

Mindfulness is a state of consciousness in which we "pay attention, on purpose, in a particular way, non-judgmentally," (John Kabat-Zinn) to whatever is happening right now. Meditation is one process through which we cultivate mindfulness by taking specific steps to engage with the present moment. We breathe, hold our bodies in an alert way, and turn our attention away from the chatter of the mind and toward the now.

Our clients are often experts at getting caught up in mindlessness--that state of being swept away by thoughts, judgments, emotions, and beliefs--and are likely in counseling as a direct result of the struggle to be present, though they probably won't articulate it in that way. For the anxious client, what is anxiety if not a preoccupation with negative predictions about the future, their abilities, or the treatment they will get from others? One antidote for anxiety built on past and future mind stuckness is present moment awareness. Eckhart Tolle brilliantly and annoyingly says in The Power of Now, "in this moment, there are no problems," which can shock us into the realization that our minds buzz furiously with content that we feel we have to act on or avoid when in reality, thinking, worrying, and planning are often bigger contributors to our anxiety than the situations that trigger the mental activity in the first place.

Teaching clients how to be mindful by engaging them in meditation helps them to see an alternative way of experiencing their inner worlds. Anxiety can be experienced mindfully (and tolerated) as a set of physical sensations and mental formations, reducing the urgent need to avoid anxiety at all costs. When anxiety can be tolerated, clients can dig deeper into the origin of their anxiety without fear that they will trigger emotion that will overwhelm them completely. 

You're sold on meditation, but want to know how to use it in session. Great news! You don't have to be yoga certified, have spent weeks or months in silent meditation, or be at some other arbitrary point of guru development to lead your clients in meditation. In fact, there are so many apps for meditation out there that you may not have to lead the meditation at all. Your job is to recognize when mindfulness is needed. 

1. Know the signs-- Clients can benefit from mindfulness any time, but can have really transformational experiences if they meditate during intense emotional distress. If a client is becoming tearful, agitated, dissociating, or showing signs of a panic attack, a meditation can help them to be still with their emotion. Additionally, when clients are stuck in cognitive distortions and you feel yourself trying to convince them that there could be an alternative way of seeing a situation, meditation can help connect them to flexibility in thinking. Finally, when clients are processing difficult memories, meditation can create a compassionate, loving inner space for hurtful experiences to arise and be integrated. 
2. Know your tools-- If you are dipping your toe into meditation in session, and would rather stick with scripts or prerecorded guided meditations, check out Insight Timer. You can sort through thousands of guided meditations based on length and key words like "anxiety," "hopelessness," or "anger." The app is free and available for Apple and Android.
3. Introduce the idea using validation-- Meditation isn't an effort to get rid of any emotion or thought, though it will likely serve to reduce the intensity of discomfort.  When I use meditation to address an issue in real time, I start with validation--"I can see in your body language and hear in your voice that you are feeling a big feeling right now, can we do a quick mindfulness to see if we can make it a little more tolerable for you?" It's important to communicate that the goal is to reduce the suffering around the feeling not get rid of a "bad," emotion or internal experience.
4. Meditate! Use a prerecorded option or lead your own. Meditations do not have to be fancy to be effective. The most powerful tool we have as therapists is our ability to hold space. Meditate along with your client for increased impact.
   
5. Debrief-- I like to ask non-leading follow ups after a meditation such as "what did you experience?" In this way, we make room for clients to have positive, negative, and neutral experiences without feeling they did something wrong or getting too attached to a specific outcome. I'm almost less excited when clients have incredibly positive experiences after a meditation because that can turn into an expectation that will not always be met. We allow whatever shows up, to show up. Their feedback gives me opportunities to offer positive reinforcement, and strengthen the likelihood that they will meditate again. You might reflect on the client's willingness to try something new, or bravery for leaning into something painful. Authentic reflection helps clients tune into their inherent resilience and wisdom, which they often discredit or ignore.

Meditation can seem daunting, but it is a natural expression of our healthiest state of being: presence. When we help clients connect openly to the present moment we are teaching them a skill that can dramatically improve their lives. Your willingness to dive into meditation in session will increase client buy-in, help dispel any misconceptions they may have about meditation, and will cultivate awareness that can only deepen the therapeutic experience. Take a chance on yourself and give it a try!