I argued in the previous blog, that we need to develop the capacity for our presence to be therapeutic as a fundamental basis for our child psychotherapy work. What I hope to follow up with in this blog is how we might develop therapeutic presence. In my previous blog I ended by recommending sitting and attuning to our own body-brain-state through body awareness and breathing as a way to develop therapeutic presence. I used the analogy of allowing our internal snow globe to settle in order to be able to receive and attune to our client. The question is why might such a simple practice facilitate the development of therapeutic presence? To answer this I return to Daniel Siegel’s work (Siegel, 2007; Snyder et. al 2012).
Siegel has argued that when we practice mindful activities like body awareness or mindful breathing that we are self-attuning. We are tuning into our own body-brain-mind state in a particular way that he believes is emotionally self-regulating. Research has shown that those with higher dispositional mindfulness (an innate capacity to be mindful even when not practicing any mindfulness exercises) have greater volume in their Insula Cortex which may be to be due to greater interoceptive (inner bodily) awareness. Greater Interoceptive awareness has in turn been thought to positively impact upon emotional regulation as:
‘..the more aware people are of their internal states the better able they are to regulate the experience of those states by engaging in top down cognitive change.’ (Wheelan, 2017)
As Siegel argues, it may be through this, ‘intrapersonal attunement,’ that we are becoming ‘our own best friend’ (2007), through regulating ourselves emotionally. He even goes as far as to state that we are potentially developing a ‘secure attachment’ relationship with ourselves. His basis for this is that just as the baby whom receives contingent and attuned responses from their caregiver, develops neural firing patterns of safety in the brain, which are the foundation for secure attachment, so too can we do this for ourselves through mindfulness practices:-
‘We come to trust that we can rely upon ourselves for comfort and connection.’ (2007:76)
Siegel states that we can ‘imagine’ a parallel process with ourselves i.e. this needs further research. However the fact that the same circuits associated with secure attachment are activated with mindfulness practice, namely the pre-frontal cortex, he sees as very promising. I find the idea of becoming our own secure attachment figure a very powerful one for us as therapists. Daniel Hughes and Jonathan Baylin, writing about Attachment Focused Therapy with children and families, state that it is essential if we are engaged in such attuned, relational work with our clients (and/or their carers) that:
‘..we maintain a state of mind that is similar to the adult who is autonomously (securely) attached,’
as the attachment patterns of our clients/their carers can be ‘highly contagious’ and we are therapists have our own attachment histories too (Baylin and Hughes 2016). They stress the need for the therapist to feel safe in order to help their client feel safe. This is key to our therapeutic presence. Do we communicate safety even when we are faced with distress, anger, terror even?
Being able to create a sense of safety in oneself has been explored by those investigating the impact of self-compassion in therapy, such as Paul Gilbert and Christopher Germer. Gilbert (2010, 2014) argues that we become our own secure attachment figure through mindful self-compassion practices, which he asserts may activate our ‘soothing’ system in the brain. He sees the soothing system as synonymous with our attachment and affiliation systems, which help us to feel safe and nurtured. Gilbert has developed a form of therapy, Compassion Focused Therapy whereby we can activate a sense of safety through working with compassionate imagery, compassionate self-talk and compassion focused meditations, all of which he believes harnesses the soothing system in the brain. The main researched mindfulness programmes – MBSR, MBCT and now MSC – all contain compassion as a key element of their programmes. In fact, these mindfulness programmes see mindfulness and compassion as 2 wings of a bird, where both are needed.
A recent review of the research into the neuroscience of mindfulness by Wheelan et. al, sees mindfulness as accomplishing psychological change by strengthening one’s capacity to regulate emotions. We also know that emotional regulation is associated with secure attachment (Schore 2008). So through mindfulness practices (incorporating compassion) we can positively impact on our capacity to emotionally regulate, creating a sense of safety and security.
If we were to accept that mindfulness practices may lead us to developing a secure attachment relationship with ourselves, this would have enormous benefits to our clients. We would be in the best position to offer therapeutic presence, as in a state of secure attachment we are emotionally regulated and feel safe with our snow globe settled. Notice how I say the snow ‘settled’ rather than ‘gone,’ as this is a misunderstanding of mindfulness, that it means having a clear or blank mind. Rather it is about being able to watch the snow (feelings/thoughts/sensations) without the need to get caught up in the snow itself (feelings/thoughts/sensations) itself. If we are a secure base to ourselves, we can be a secure base to our clients and this will be communicated through our therapeutic presence. Thus intrapersonal or self-attunement can lead to interpersonal attunement. The more we are able to be aware of ourselves and our own body-mind-brain state in a compassionate way, the more we are able to attune to others. Having a compassionate, accepting, non-judgemental attitude towards our thoughts, feelings, sensations, may through our mirror neuron system be communicated to our clients, so that they feel our therapeutic presence is compassionate, accepting and non-judgemental.
Now, to sharing ways in which we might do this. One practice which I have found can be useful not only between sessions, but also actually in a session with a client, is The Soles of the Feet mediation. It is particularly useful if we feel ourselves becoming emotionally dys-regulated and needing to calm our own snow globe in order to remain a secure base for our client. It can be done standing or sitting down and can be done in the presence of a distressed client or their carer. The Soles of The Feet mediation has been used in some small research studies to successfully help regulate anger in adolescents with ASD (Singh 2011).
Soles of the Feet Meditation
1.In a stressful situation first recognise we are feeling stressed/ angry/ anxious/ frustrated and take a pause. Just allow the emotions to be there non judgementally
2.Now shift your all your attention into your feet. You can do this standing up/sitting down. Feel your feet in contact with the floor and push down into the floor to feel solid ground beneath your feet.
3.Now slowly move your toes, feel what your feet are in contact with (e.g. the texture of socks, shoes, carpet). Just notice – the sensations may be pleasant, unpleasant or neutral but simply notice them.
4.Feel the curve of your arch, the heels and balls of the feet and how your weight is balanced. Feel gratitude and kindness towards your feet for all they do for you.
5.Keep breathing a little bit deeper than usual and focus on the soles of your feet until you feel calmer
My suggestion would be that before you try using this in the midst of an emotionally charged session with a client, that you practice it regularly on your own. In fact, if we truly wish to be a therapeutic presence for our client’s then we need to be practicing regularly. Much of the mindfulness research has now demonstrated the more mindfulness practice, the more impact upon the brain, which of course makes sense if we accept that neutrons the fire together wire together and therefore they need to fire together regularly enough in order to create a wired network.
I have to end by owning my own bias within this topic, as I have practiced mindfulness meditation for over 20 years having learnt it as a form of self-care when I first began working as a therapist. I began practicing at a time when mindfulness was a term barely known outside of Buddhist circles and there was certainly little research to demonstrate its impact. Yet I kept practicing because I found it worked for me. Then I began teaching it to children, teachers and families in schools long before (2003) there were any established mindfulness programmes in schools. Again I did this as I found that people told me it worked for them. Neuroscience is now beginning to support why this might be the case (see Wheelan et. al 2017) but my own experience was crucial. Mindfulness cannot be known simply through reading or studying about it. It has to be experienced, for only then can it be known from the inside and be something we can truly make use of in our work as integrative child psychotherapists.
References
Germer, C (2009) The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Emotions and Thoughts. Guilford Press
Gilbert (2010) Compassion Focused Therapy: Distinctive Features. Routledge
Gilbert (2014) The Origins and Nature of Compassion Focused Therapy. In The British Journal of Clinical Psychology (53) 6-41.
Hughes, D and Baylin, J (2016) The Neurobiology of Attachment Focused Therapy. Norton & Co.
Schore, J and Schore, A (2008) Modern Attachment Theory. The Central Role of Affect Regulation in Development and Treatment. In Clin Soc Work J 36:9–20
Siegel, D (2007) The Mindful Therapist. A Clinician’s Guide to Mindsight and Neural Integration. Norton.
Singh et. al (2011) Adolescents with Asperger syndrome can use a mindfulness-based strategy to control their aggressive behaviour. In Research in Autism Spectrum Disorders 5 (2011) 1103–1109
Snyder et. al. (2012) Mindfulness and Attachment. In J Child Fam Stud (2012) 21:709–717
Wheelan, M et. al (2017) The Neuroscience of Mindfulness: How Mindfulness alters the Brain and Facilitates Emotional Regulation. In Mindfulness. June 2017
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