Wisdom in Psychotherapy Deepening Mindfulness in Clinical Practice - - PDF document

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Wisdom and Compassion in Psychotherapy:

Deepening Mindfulness in Clinical Practice

Ronald D. Siegel

Wisdom in Psychotherapy

“Hard core pornography is hard to define” [but] “I know it when I see it.”

• - Justice Potter Stewart (1964)

“If we are doomed to die —let us spend.”

• - Mesopotamia (3000 BCE)

“Be not puffed up with thy knowledge, and be not proud because thou are wise.”

• - Egypt (2000 BCE)

“The narrow intelligence flashing from the keen eye of a clever rogue” is not wisdom.

• - Socrates (400 BCE)

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A 15 year old girl wants to get married right away. What should she do?

Paul Baltes – Berlin Group

• 1. Factual knowledge
• 2. Procedural knowledge
• 3. Life-span contextualism
• 4. Value relativism
• 5. Awareness and management of

uncertainty

Monika Ardelt

“A fool can learn to say all the things a wise man says, and to say them

• n the same occasions, but this

isn’t real wisdom.”

• -John Kekes

Not Knowing Beginner’s Mind Buddhist Psychology

• Compilation of insights derived largely

from mindfulness practice

• Not a religion in Western sense, but the

results of a 2500 year old tradition of introspection

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Three Marks of Existence

• Anicca

(impermanence)

• Dukkha

(unsatisfactoriness)

• Anatta (no enduring,

separate self)

Mindfulness How Mindfulness Fosters Wisdom I

• Stepping Out Of the Thought Stream
• Being With Discomfort
• Disengaging From Automatic

Responses

How Mindfulness Fosters Wisdom II

• Transpersonal Insight
• Seeing How the Mind Creates Suffering
• Embracing Opposites
• Developing Compassion

Anatta The Western View of the Self

• Emphasis on separateness vs.

connection to family, tribe, nature, etc.

• Healthy (Western) development:
• Individuated
• Aware of Boundaries
• Knowing one’s needs
• Clear identity and sense of self

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Narcissism in Western Psychology

• DSM
• Character disorder
• Behavior therapy
• Self efficacy
• Psychodynamic psychotherapy
• Healthy narcissism or self esteem

Narcissism in Buddhist Psychology

• We suffer when we don’t know who we

really are

• Attempt to buttress self is central cause
• f suffering
• Our concept of “self” is based on a

fundamental misunderstanding

Therapeutic Benefits of Glimpsing Anatta

• 1. Increased affect tolerance
• 2. Radical acceptance of parts
• 3. Freedom from self-esteem concerns
• 4. Deeper connection to others

Thinking Homunculus? Default Mode Network

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Who Am I?

• Two types of self-reference
• Narrative focus (NF)
• Enduring traits
• Talking to ourselves about ourselves
• Experiential focus (EF)
• Moment-to-moment

experience

• The mind-body in action

Medial Prefrontal Cortex (mPFC)

• Links subjective

experiences across time

• Holds memory of
• Self traits
• Traits of similar
• thers
• Reflected self-

knowledge

• Future aspirations

1) Affect Tolerance

And I, Sir, Can Be Run Through with a Sword Selfing & Affect Tolerance

• Not “my,” but “the”
• Anger
• Sadness
• Fear
• Joy
• Lust

2) Acceptance of Parts

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Our Polytheistic Mind How Was Your Meditation?

• Part trying to attend to

the breath

• Part fantasizing about

the future

• Part judging myself
• Ask the committee!

Jung’s Shadow

• We identify with some

parts while rejecting

• thers
• We become defensive

when shadow is illuminated

We’re all Bozos on this Bus

• Dandelions in a field
• Not a path to perfection, but a path to

wholeness

• Boundary of what we can accept in
• urselves is the boundary of our

freedom

– Zen Patriarch

3) Freedom from Self-Esteem Concerns

Self-Evaluation

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What Realms Define Me?

• Skills & Talents
• Accomplishments
• Pedigree or Group

Membership

• Moral Standing
• Appearance

Lake Wobegon

Where all the women are strong, all the men are good looking, and all the children are above average.

The Failure of Success

• The pain of I, me, me, mine
• Narcissistic recalibration
• Impossibility of winning consistently

Wrong Wall? It’s Getting Worse Narcissistic Personality Inventory

• I just want to be reasonably happy
• I want to amount to something in the eyes of the world
• If I ruled the world it would be a better place
• The thought of ruling the world scares the hell out of me
• I am much like everybody else
• I am an extraordinary person
• I always know what I’m doing
• Sometimes I’m not sure of what I’m doing

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Egos Inflating Over Time: A Cross‐Temporal Meta‐Analysis of the Narcissistic Personality Inventory

Journal of Personality, Volume 76, Issue 4

Self-Esteem Autobiography

I get my money from Mommy.

4) Connecting to Others

Love Self-Esteem

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“Do unto others as you would have them do unto you”

It’s not just a commandment, but a law of nature.

Judgments

Make a connection, not an impression.

It’s About Other People

Embracing Insignificance

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Wat Tham Sua

Tiger Cave Temple Krabi, Thailand

King of England, 1387 Loving-kindness for the Competition Self-Compassion

• Self-kindness
• Common Humanity
• Mindfulness

Therapeutic Progress

“mine” about me Not about me “mine” about me Not about me

• - Adapted from Engler & Fulton

Why Are You Unhappy? Because 99.9% of everything you think, and everything you do, is for yourself. And there isn’t one.

• - Wei Wu Wei

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Compassion in Psychotherapy

Affect Regulation Systems .

Seeking pleasure Achieving and Activating Affiliative Soothing/safety Well-being Threat-focused Protection & Safety Seeking Activating/Inhibiting

Anger, anxiety, disgust Drive, excitement, vitality Contentment, safety, connection

Compassion

• Latin: pati; Greek: pathein (“to suffer”)
• Latin: com (“with”)
• Compassion means to “suffer with”

another person.

Compassion’s Relatives

• Empathy
• Sympathy
• Love
• Pity
• Altruism

Lovingkindness Practice

• “Metta” practices
• May I be happy,

peaceful, free from suffering

• May my loved
• nes be happy. . .
• May all beings be
• happy. . .

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Heart over Head

• Conventional CBT
• Modifies

expectations, beliefs,

• r behaviors
• Metta practice
• Attempts to modify

emotional states directly

Research on LKM

• Builds positive emotions and resources
• Increases feelings of social connectedness.
• Changes the brain, which correlates with

empathy and generosity.

• Shifts away from fault-finding, self and other
• Reduces back pain.

How Mindfulness Develops Compassion

• Compassion for ourselves arises as we
• pen to our own suffering
• Compassion for others arises as we see

that everyone else also suffers

• Compassion arises naturally as we see
• ur interconnectedness

Condon, Desbordes, & Miller (2013)

Paradoxical Responses

• Universality of ambivalence
• Highlight one pole, energize the
• ther
• Negative emotions may arise
• Cynicism, anger, sadism
• Practice saying “Yes” to

these

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When Things Go Wrong

Unholy trinity of

• Self-criticism
• Self-isolation
• Self-absorption

An Anidote: Self-Compassion

• Self-kindness
• Common Humanity
• Mindfulness

First Noble Truth to the Rescue

The Story of the Mustard Seed

5 Paths to Self-Compassion

1. Physical: Soften the body 2. Mental: Allow thoughts to come and go 3. Emotional: Befriend feelings 4. Relational: Connect safely with others 5. Spiritual: Commit to something larger

• -Chris Germer

The Big Picture

• What helps you to identify with

something larger than yourself?

• Nature
• Friend, Family, or Community
• Spiritual Teacher
• Religious figure or image

Self-Compassionate Letter

• Describe something that makes you feel

badly about yourself

• Think of loving, accepting, imaginary

friend

• Write a letter to yourself from your

friend’s perspective

• --Kristen Neff

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Research On Self-compassion

• Predicts psychological well-being
• Different construct than self-esteem
• Unrelated to narcissism
• Adaptive response to academic failure
• Alleviates shame and self-criticism
• Helps to avoid unhealthy food

Greeting Exercise

• Begin with breath
• Visualize the person behind the door,

suffering human being, once a child, has hopes and dreams, vulnerable and afraid, believing you can help

• Now open the door and say “hello.”

Equanimity Phrases

• Everyone is on his or her own life

journey.

• I am not the cause of my patient’s

suffering, nor is it entirely within my power to alleviate it.

• Though moments like this are difficult to

bear, I may still try to help to the extent that I can.

Going Nowhere

For meditations & other resources: www.mindfulness-solution.com email: rsiegel@hms.harvard.edu