As Head of Psychiatry Research, Sinai Health System, Bob Maunder, MD FRCPC, regularly sends out papers published by staff in our department to the rest of the department, accompanied by a short, thoughtful introduction. Bob is also Chair in Health and Behaviour at Sinai Health System, Deputy Psychiatrist-in-Chief, and Professor, Department of Psychiatry, University of Toronto. I appreciate the warm way he welcomed my paper on February 11th, 2019:
Bill Gayner has been working on a labour of love, a paper about his development of emotion-focused mindfulness therapy, for a while, and it is great to see it in print at last. The paper provides a theoretical background for this new mindfulness-based intervention, describes its development and how it is implemented, and presents a case. I particularly appreciated Bill’s description of the development of the idea on pages 11 and 12. “The development of EFMT was inspired by research colleagues and I conducted on MBSR for gay men living with HIV. When we compared our data to pooled samples of mixed medical and cancer patients… our baseline mindfulness was so far below the pooled data that even though we had the same amount of pre-post change they did, our post-group mean was statistically below their baseline. This led me to reflect more deeply on how to adapt mindfulness to better address interactions between the psychological effects of internalized stigma… and the developmental traumas prevalent in this population. I explored integrating self-compassion techniques, emotional alchemy and acceptance and commitment therapy… It was only when I began reflecting on recollective awareness meditation from an emotion-focused perspective that I realized that wise compassion is empathic, involving not only feeling moved by suffering, wishing it be alleviated, and wanting to help, but also the ability to follow thoughts and feelings in oneself and others with kindness…”
This style of meditation emphasizes cultivating a gentle, participatory curiosity toward all the processes that weave consciousness and deepen experiencing, including bodily sensations and other senses, feelings, thinking, imagery, and needs. You are welcome to plan, remember and reflect on your experience.
You may start by simply opening into your experience, perhaps initially taking some time to settle into your body, or by focusing attention on something such as the breath, the contours of pressure of your body sitting on whatever you are sitting on, or the sounds of the HVAC system in the room you are in. If you do focus your attention somewhere, you do not have to try to hold your attention there. If your attention is drawn somewhere else, you could go with that and allow yourself to develop a deeper sense of what is happening.
We tend to alternate between being up in our heads preoccupied with propositional meanings and disconnected from feelings or too immersed in and buffeted or driven by difficult emotions. Mindfulness enables us to deepen experiencing by coming alive to our implicit feelings about whatever is happening and being able to reflect on them in a more spacious, friendly way.
It can be helpful to remember to be self-compassionate. Kristin Neff has developed a robust self-compassion scale. She says there are three key dimensions to self-compassion: kindness, common humanity and mindfulness.
Say you are having a difficult day or have made a mistake, it can feel like just the thing to do to beat yourself up, but this only fogs up your mind and makes it difficult to empathize with yourself or others. The first dimension involves cultivating kindness toward yourself.
When we are beating ourselves up, we can feel so alone with whatever we are struggling with. The second dimension, common humanity, involves remembering that whatever you are struggling with, many, many other people struggle with it as well, and this is part of our shared ground with other people, our existential limitations and imperfections. The more we can let ourselves in on this, the more we can let our family, friends, colleagues and the people we serve in on it as well, and things get a little easier.
The third factor is mindfulness. Beating ourselves up is an attempt to suppress feelings of vulnerability and push forward. Mindfulness involves taking a moment and softening into ourselves with kindness and cultivating a deeper sense of what is happening in our body, feelings, and thoughts.
Many people believe that if they are struggling in meditation they must be doing it wrong, but suffering in meditation provides an opportunity to deepen self-empathy and transform our relationship with difficult experience.
If it starts to feel overwhelming, then it is skillful to calm down. Nothing works perfectly all the time, but bringing something pleasant or neutral into the forefront of your awareness and letting everything else fall to the background tends to be calming. This could be your body breathing, the pressure of your body on the chair and the floor, or imagining you are with someone who cares deeply about it, or that you are in a favourite place. If your attention wanders somewhere else, you can acknowledge where it has gone and then gently bring it back to your chosen focus. Once you feel more calm, you can decide if you would like to continue with that calming practice or open into wider experiencing again.
Dissociating is another way of feeling overwhelmed, but instead of emotional arousal it involves shutting down. This can feel numb, unreal, spacey, or as if you were out of your body. Instead of calming, it will likely be more helpful if you stimulate your senses. You could open your eyes and taking in the colours and the forms around you. If you are alone, you could slap your legs gently to stimulate them, if you are meditating with others, you could massage your legs silently. You could wiggle your toes and feet and your body in your chair, and invite yourself back down into your body. Once you feel grounded and in your body, you might try some calming meditation before opening it up again if you like.
You can meditate by sitting on a chair or meditation cushion and mat, by lying on a mat or a bed, or you could try astronauts’ pose, by lying on a mat and putting your legs and feet up on a chair. Find a posture you can settle into for a while. If it becomes uncomfortable, feel free to shift your posture quietly or even stand up for a while if you like.
It is recommended that you close your eyes or half close them and allow them to unfocus to help you shift your attention inwards.
In EFMT, we meditate in silence, varying from twenty to thirty-five minutes in the clinical groups and up to forty or forty-five minutes in the monthly clinical continuation groups or on residential retreats.
With the exception of brief, guided meditations for calming or grounding, the [emotion-focused therapy] principles of freedom, pluralism and self-determination are honored by silent meditation in which people are not subjected to the subtle, unintended coercion of the therapist guiding meditation, as well as by permission to do any form meditation they wish, with an invitation to loosen up around the meditation instructions they are following.
There is a deep implicit gentleness in letting people follow where their attention goes, rather than having them follow someone else’s guidance who has no way of knowing what they are feeling and thinking in meditation. Everybody goes in a different direction.
After the meditation, we journal what we recall happened during the meditation and perhaps how things are continuing to unfold. In workshops and clinical groups, we take ten minutes for this. Many of us enjoy taking longer to journal at home.
Journaling is not intended as a test of your memory, rather, it is a way of deepening intimacy with your experience. Perhaps all you remember is what you were thinking when the bell rang, that’s fine, jot that down. Perhaps you can recall how you were feeling then and so you describe that with as much richness as you can. Then you might remember something you were thinking about earlier in the meditation and jot that down.
In the clinical groups and the professional mentoring groups, after journaling, each person takes a turn and describes their meditation experience. EFMT therapists listen to the whole description of their meditation and then empathically explore with them, helping them cultivate gentleness and curiosity and deepen experiencing.
My paper, Emotion-Focused Mindfulness Therapy (Gayner, 2019), has been published online by Person-Centred and Experiential Psychotherapies. It will be available in print in April 2019. The journal allows me, as the author, to post a pdf of the paper on my website that you can download, which includes all the edits but without the journal’s formatting. You can find the Version of Record (the official, beautifully formatted version) at Person-Centred and Experiential Psychotherapies <2019> http://www.tandfonline.com/article/ /https://doi.org/10.1080/14779757.2019.1572026.
Abstract With emotion-focused mindfulness therapy (EFMT), we are exploring integrating mindfulness-based interventions (MBIs) into the process-experiential (PE)/emotion-focused therapy approach, oriented to its neo-humanist principles, emotion theory, and dialectical constructivist epistemology. Both MBIs and EFMT value the role of implicit experience in meditation. While MBI meditation may include allowing the felt sense to arise, it does not specify symbolizing it in order to fully resonate with, receive and carry forward its implications. Instead, MBIs emphasize attending to present-oriented experience and decentering from and letting go of distractions from this, such as thoughts and feelings about the past or the future. In doing so, MBIs create optimal conditions for, but do not specify, experiential and emotional processing. In contrast, EFMT uses its emotion-focused perspective to integrate process-diagnostic, marker-oriented tasks such as focusing into meditation, journaling, and empathically exploring clients’ experience in order to deepen experiencing, address unfinished business and inner conflicts, better navigate life, and cultivate growth and flourishing. Research is needed.