Sunday, July 21, 2013

Mindfulness, Truth and Trust: Chapters 4 and 5 in The Mindful Therapist

I am still working on my mindfulness project, in and around all the other events in my life. I find that it does tend to get pushed to the back burner as I get busy, but I think that is probably when I most need to be practicing mindfulness. Which continues to be very hard for me to do; something in me strongly resists sitting down quietly for 10-15 minutes on a regular basis and engaging in a mindfulness practice. I know the benefits but somehow when it comes down to it I always find something else I’d rather be doing.

One of the benefits research demonstrates of a mindfulness practice is increased compassion and less burnout as a physician. That sounds pretty good to me, and my guess is that it would sound good to my patients too. Dr. Daniel Siegel writes about this in his book “The Mindful Therapist.” In Chapter 4 he focuses on trust, and how the practices of presence, attunement and resonance create a space in which people can trust, a space in which it is safe to be vulnerable. Most developmental psychologists would agree that our first experience of trust comes with our parents, when we are very small and very vulnerable infants. Our parents, by consistently and lovingly meet our needs, make that state of utter dependency safe. As infants we can relax, secure in knowing that our parents will accurately perceive and adequately meet our needs. We experience a loving connection that has been shown to have a profound impact on brain development itself. This pattern is internalized in our deepest implicit memories, and translates into the capacity to trust self, environment and others as an adult.

Mindfulness practices as an adult can build our capacity for trust. One specific mindfulness practice is a loving kindness meditation. I’ve heard a version of this many times. It consists of a few short phrases; the ones Dr. Siegel uses are: May I be happy and live with a joyful heart. May I be healthy and have a body that gives me energy. May I be safe and protected from harm. May I live with the ease that comes from well-being. These phrases are repeated first with intention towards the self, next towards a dearly loved person (changing pronouns as appropriate, of course), next towards a neutral or casual acquaintance, then again towards someone you are experiencing hostility towards or from, then to the entire creation of living beings, and then finally once again toward the self. In repeating these phrases consistently the neurons in the brain actually grow in new ways that promote a greater sense of well-being, connection with others, and trust.    

Mindfulness also increases our ability to be open to truth, to recognize and address the truth in our lives. Which is something that most of us aren’t good at. We lie to ourselves, although perhaps lie is the wrong word because frequently our self-deception is not anything so deliberate or conscious. We lie to others, also unconsciously although at times consciously as well. At other times we are just mistaken, caught up in what we perceive in the moment as it bounces off our memories of past events and creating interpretations that generate a storm of emotional reactions. Unfortunately at times these intepretations just don’t match the current reality of our experience. Mindfulness exercises help us separate our sense of “me” from what we are currently thinking and feeling so that we can build a calm space from which to look at ourselves and our world. We can then function in a more adaptive way; Dr. Siegel uses the word integrated and describes an integrated state with the acronym FACES (flexible, adaptive, coherent, energized and stable). Which sounds like a great way to live life.

It makes sense to me that with a greater sense of trust in myself, a greater sense of compassion and connection with others, and a greater ability to perceive and respond to truth a physician would be less vulnerable to burnout and also more effective. I know the times in my life that I’ve felt the closest to being burnt out were the times I felt disconnected and focused on my own perceptions of lack. It’s not a good state to be in, for me as a doctor or for the patients I encounter when I’m in that place. So this week I am committing to start each day with the loving-kindness meditation. The more I can do to mindfully care for myself, the better for everyone around me.