Back at the beginning of March I decided I would have a
“mindfulness month” in which I would read five books about the topic of
mindfulness and perhaps begin practicing. About a week later I realized that I
was only about one chapter into the first book I wanted to read and that I
should probably revise the project to a mindfulness year and give periodic
updates. I’m pleased that I finished my first book today (two and a half months
after starting, which puts me on track for finishing five books in a year, I
think). I am starting on the second book and have begun experimenting with some
simple mindfulness practices, mostly breath awareness and body scans. I am also
working on teaching my toddler to use deep breathing when she is upset so that
she can learn healthy ways to self soothe.
The book I just finished is “The Mindful Therapist” by Dr.
Daniel Siegel. This was definitely a challenging book for me; I found myself
taking extensive notes on each chapter as I went along because there was so
much novel information. Over the next few weeks I plan to reflect on those
notes and do some writing about what I learned in order to further consolidate
my understanding. I have already talked about the first chapter in the book,
which was about presence, a necessary quality for a therapist. The second
chapter is devoted to attunement. Attunement is the process of focusing on
another person and bringing their experience into our own inner world. Presence
is required for attunement, but it is not the same thing. The idea of
attunement in the second chapter then links to the idea of resonance in the
third chapter. Resonance is the process of linking two people into a whole, so
that a person recognizes that another person is attuned to him.
The most fascinating part of this chapter for me was Dr.
Siegel’s description of the theory of how, biologically, attunement takes
place. The reason the neurobiology is so fascinating for me is that it unites
the two halves of psychiatry. When I was in training I found it very
frustrating to have a lecture one hour on neurons and neurotransmitters and
then the next hour on defense mechanisms and empathic listening. I couldn’t
find a way to make those two worlds, the biological and the psychological,
relate to each other. Yet they both seemed to have validity. Finally the work
of Dr. Eric Kandel (a Nobel prize winning psychiatrist and neuroscientist)
opened my eyes to how experiential learning can actually shape our physical
brains. Since then I have been hooked whenever I find someone writing or
talking about ways to base our psychology in our biology.
According to Dr. Siegel’s book, the biological process of
attunement is likely to start in mirror neurons. These neurons have been shown
to operate in preparing us to imitate the observed behavior of another person –
for example, if I see you reach for an apple, the mirror neurons in my brain
will fire as if I had reached for the apple myself. Mirror neurons also are
likely to operate with emotional behavior as well, so that if I observe someone
crying I myself will probably experience sadness. What I found even interesting
is that mirror neurons relay to other neurons down into the body through the
autonomic nervous system, so that I will literally “feel” what I observe in
someone else, without my conscious awareness. Those internal bodily sensations
are then carried back up through the spinal cord and finally relay back into
the cortex of the brain in a particular area called the anterior insula, which
is the point at which we develop conscious awareness of our internal feelings.
This attunement can then be sensed by the other person, which creates
resonance.
Interestingly, just the experience of attunement and
resonance between two people can actually modify each person’s internal mental
and emotional experience towards the direction of health. Hence the importance
of the therapist maintaining his or her capacity to be present, to attune and
to resonate when seeing a patient. One of the comments Dr. Siegel made in both
of these chapter that I strongly agreed with is that attunement and resonance
in the clinical encounter are hard, much harder than simply asking a patient
questions designed to establish a diagnosis. You have to be humble and willing
to let the patient lead, and you have to be willing to acknowledge that you
don’t know. Being attuned and resonating also means keeping open your own
“window of tolerance,” another metaphor Dr. Siegel introduced, for that
emotional experience. You have to be able to tolerate feelings of fear,
sadness, rage, etc… while remaining flexible and functional.
Dr. Siegel offers many exercises in these chapters designed
to help therapists widen and stabilize their windows of tolerance. One exercise
which I found very informative and also calming is a body scan exercise. In his
book Dr. Siegel “talks” you through a slow scan of all of the different parts
of the body. This exercise reminded me strongly of the Yoga Nidra exercise by
Robin Carnes that a colleague recommended to me for sleep. It is very peaceful
but it is also an exercise that builds your skill in attuning to yourself, so
that you can have increased skill in attuning to others. Dr. Siegel also
suggests ways to evaluate your own experiences with attunement and resonance
(or the lack thereof) and how those experiences might be affecting your own
capacities for presence, resonance and attunement today.
As I read these chapters I am struck by how well what he
states matches my own experiences, not just as a therapist but as a spouse,
parent and friend. When I am within my window of tolerance I am able to be
present with others, open to my current experience and the information they are
giving me so that I can attune and resonate. However when I am outside my own
windows of tolerance: too uncomfortable, too stressed, too sad, etc… I can’t
maintain that state. I shut down and try to shut the other person down too. I’m
not listening, I’m not present, and I’m not mindful. I can see how the
exercises Dr. Siegel suggests can be helpful in broadening the emotional and
mental space in which I can be present and I can see how that is important for
strong relationships in both professional and personal aspects of my life.
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