Buddhism and therapy - from the helpers perspective

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Johnny Dangerous
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Re: Buddhism and therapy - from the helpers perspective

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Figured since ACT was talked about I would post a short interview with Stephen Hayes. I think it gives a brief explanation of the philosophical orientation of ACT. Funnily enough, one of the things that got me reading first existentialist philosophy, and then Dharma in my teens was that I'd concluded that "happiness" (as normally envisioned by most of our society) is not a real thing.

It would be hard for me to adopt a therapeutic model that assumes that people are somehow "normally" happy and healthy, and that people who are not are somehow dysfunctional or in need of "fixing", I do not have that view of things, and would have a hard time orienting myself towards clients/patients that way.

BTW I have worked at places in the US that use both terms, as an aside.
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Re: Buddhism and therapy - from the helpers perspective

Post by KristenM »

Johnny Dangerous wrote: Wed Jul 06, 2022 1:26 am
KristenM wrote: Wed Jul 06, 2022 12:34 am

My main professor was a big fan of ACT, too. I actually sat in on one of Steven Haye's lectures while I was in school. I think ACT may be (of course, I may be wrong) more appropriate for people who have a fair amount of insight, but I'm not sure. The whole linguistic part of ACT seems a bit hard to utilize with some clients (like mine). I've pondered how to explain that to a kid, and I haven't found the way to do it, yet. I will definitely have to get back to you with some specifics on what I mean, though. Right now I'm just conjecturing based upon vague ideas without looking over my books.
Hmm, I mean it shouldn't require any more insight than CBT does, perhaps even less. My test is always whether or not the person recognizes that that the way they view their thoughts and feelings is important. For sure plenty of people I've worked with, including adults, do not have that awareness.

I have had lots of clients (maybe a slim majority) that struggle to even understand the CBT-based treatment stuff that is a standard part of my job - stuff like substance abuse triggers, etc. Plenty of the people (well, especially men) I've worked with also lack basic emotional intelligence. Those would not be good candidates. With those people in an SUD environment it's all just Motivational Interviewing anyway - they are usually pre-contemplative and mandated to be there, and will have little buy in. I think the hardest thing about ACT is maybe figuring out how to present it to clients without seeming like you are trying to "teach meditation" and to make it feel natural.

I've found that slightly brighter, more neurotic types who get really fixated on their own dramas are some of the best candidates, and often seem open to learning news ways of dealing with things. A lot of it is learning how to effectively use metaphors to communicate cognitive defusion and other ideas to clients. The two best books I've found for that are ACT Made Simple by Russ Harris and ACT for adolescents by Sherry Turrell and Mary Bell. They are written in completely plain language and just meant to be used.

My favorite metaphor is to have them write their "big issue" (whether it's anxiety, family drama, whatever) on a sticky note and have them hold it really close to their face, so it takes up most of the visual field, then pan out so that it only takes up a small part of their vision. This kind of illustrates the goal, not that the issue somehow "goes away", but that it takes up less of their attention and they can focus on living life because it is not in the way anymore.

Kids seem to take to this kind of stuff, you can do more with this metaphor too, for instance have them crumple up their Big Issue and squeeze it as hard as they can in an effort to destroy it, as an illustration of how much energy we can spend fighting our thoughts. Then instead of squeezing it just ask them to let it go. Obviously these are pretty on the nose metaphors to anyone who has done meditation, but for some people they are a big revelation, I think.

I agree with your thoughts on pure CBT. I tend to incorporate mindfulness, radical acceptance and self-compassion. It all sounds a bit cheesy, I know. But when I'm sitting with a young person who has been sexually abused, CBT alone usually doesn't suffice. And sad thing is that as much as we, or I, at least, mock these concepts for being too hokey and soft, the kids I work with have never been given any tools like that whatsoever in their lives. They have been raised by dysfunctional families to blame themselves and keep things hidden. So, for them these ideas really are eye-opening.
Not at all, but honestly if you are doing that stuff you are already much of the same ground as ACT, which would probably just give you more tools. Advocating for self-compassion and acceptance with some of the hurt kiddos I've worked with so far is huge, so not cheezy to me at all and I'm on the same page with how vital that is.
I’m down to give it another try. I even bought that book for adolescents so thanks for the tip. Sounds like some good interventions/activities. :)
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Re: Buddhism and therapy - from the helpers perspective

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KristenM wrote: Thu Jul 07, 2022 1:29 am
Johnny Dangerous wrote: Wed Jul 06, 2022 1:26 am
KristenM wrote: Wed Jul 06, 2022 12:34 am

My main professor was a big fan of ACT, too. I actually sat in on one of Steven Haye's lectures while I was in school. I think ACT may be (of course, I may be wrong) more appropriate for people who have a fair amount of insight, but I'm not sure. The whole linguistic part of ACT seems a bit hard to utilize with some clients (like mine). I've pondered how to explain that to a kid, and I haven't found the way to do it, yet. I will definitely have to get back to you with some specifics on what I mean, though. Right now I'm just conjecturing based upon vague ideas without looking over my books.
Hmm, I mean it shouldn't require any more insight than CBT does, perhaps even less. My test is always whether or not the person recognizes that that the way they view their thoughts and feelings is important. For sure plenty of people I've worked with, including adults, do not have that awareness.

I have had lots of clients (maybe a slim majority) that struggle to even understand the CBT-based treatment stuff that is a standard part of my job - stuff like substance abuse triggers, etc. Plenty of the people (well, especially men) I've worked with also lack basic emotional intelligence. Those would not be good candidates. With those people in an SUD environment it's all just Motivational Interviewing anyway - they are usually pre-contemplative and mandated to be there, and will have little buy in. I think the hardest thing about ACT is maybe figuring out how to present it to clients without seeming like you are trying to "teach meditation" and to make it feel natural.

I've found that slightly brighter, more neurotic types who get really fixated on their own dramas are some of the best candidates, and often seem open to learning news ways of dealing with things. A lot of it is learning how to effectively use metaphors to communicate cognitive defusion and other ideas to clients. The two best books I've found for that are ACT Made Simple by Russ Harris and ACT for adolescents by Sherry Turrell and Mary Bell. They are written in completely plain language and just meant to be used.

My favorite metaphor is to have them write their "big issue" (whether it's anxiety, family drama, whatever) on a sticky note and have them hold it really close to their face, so it takes up most of the visual field, then pan out so that it only takes up a small part of their vision. This kind of illustrates the goal, not that the issue somehow "goes away", but that it takes up less of their attention and they can focus on living life because it is not in the way anymore.

Kids seem to take to this kind of stuff, you can do more with this metaphor too, for instance have them crumple up their Big Issue and squeeze it as hard as they can in an effort to destroy it, as an illustration of how much energy we can spend fighting our thoughts. Then instead of squeezing it just ask them to let it go. Obviously these are pretty on the nose metaphors to anyone who has done meditation, but for some people they are a big revelation, I think.

I agree with your thoughts on pure CBT. I tend to incorporate mindfulness, radical acceptance and self-compassion. It all sounds a bit cheesy, I know. But when I'm sitting with a young person who has been sexually abused, CBT alone usually doesn't suffice. And sad thing is that as much as we, or I, at least, mock these concepts for being too hokey and soft, the kids I work with have never been given any tools like that whatsoever in their lives. They have been raised by dysfunctional families to blame themselves and keep things hidden. So, for them these ideas really are eye-opening.
Not at all, but honestly if you are doing that stuff you are already much of the same ground as ACT, which would probably just give you more tools. Advocating for self-compassion and acceptance with some of the hurt kiddos I've worked with so far is huge, so not cheezy to me at all and I'm on the same page with how vital that is.
I’m down to give it another try. I even bought that book for adolescents so thanks for the tip. Sounds like some good interventions/activities. :)
Cool, hope it's helpful.

I did a ton of video watching and book reading when I decided to try to get deeper into ACT. Believe it or not I was taught some ACT group work with my associates degree, and I knew the basics for years but never really looked at it that closely.

I don't know what your experiences will be like but I feel like I ended up with like 3 metaphors or so to use with clients, and then just a general shift in how I talk to people and address their problems. There are so many defusion techniques that you can't even count them, in many ways I think of it as more an overall orientation. ACT really lends itself to SUD stuff I think, and a lot of the activities work out really well for groups, which is a big part of my job.

I am strongly considering taking the ACT for adolescents course with Russ Harris. I didn't want to spend the money at the time so I bought that book, the course is expensive but my guess is it's really good.
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Re: Buddhism and therapy - from the helpers perspective

Post by KristenM »

Toenail wrote: Wed Jul 06, 2022 10:38 am
KristenM wrote: Wed Jul 06, 2022 12:42 am
Toenail wrote: Tue Jul 05, 2022 9:33 pm

Yes. In my country we call clients patients. And I am an expert on mental illnesses because I studied it for 8 years and have much work experience. In the same way in that a cook is an expert of his dishes, a teacher is an expert of his curriculum etc. It does not mean I know everything, i tried to convey that people usually come to me because I know more about their condition than themself. they actively seek help and they want someone to interfere (of course this interference is usually empowerment for self help by explaining maintaining behaviours of for example a mental illness like ptsd and then helping them to do less of it etc)
I want to make a point about this, especially as I know some people have some well-justified skepticism and distrust of the therapeutic profession in part due to this type of thinking, i.e. that therapists are the "Expert." Maybe in Germany things are different than in the US, but my training is quite the opposite. The client is the actual expert on themselves, not the therapist. We help empower clients to make their own decisions and choices.

There's a lot of distrust towards the psychological establishment because of many historical reasons, including dictating what is best for the client, diagnosing and labeling people wrongfully, and like Johhny said, pathologizing people as "abnormal." My training is that there is no such thing as "Normal" when it comes to human behavior, there's not a standard way of being/living for people to conform to. That said, you may be very helpful to people who are looking for someone to tell them what to do, but in California that is not considered best practice, it's actually more like Malpractice.
That is not true at all and it would not be considered malpractice. This is the standard framework in all cbt. You are just mixing things up and are irritated by my rough wordings. The therapist is the expert in regard to mental disorders. The patient dictates his or her goals and what he or she wants. Then based on his expert knowledge the therapist explains which methods lead to achieving the patients goal (which is usually to get rid of their mental disorder). A therapist without expert knowledge on mental disorders should not be practicing. It is however not the task of the therapist to dictate goals etc. or to tell the patient how to live. The patient comes to the therapist because they are suffering from a condition. The therapist knows methods of treatment and helps the patient to implement them.
I realize that using the word "malpractice" was not the best use of the term, sorry about that. I also don't want to get bogged down in semantics when it comes to the term "expert." Yes, a person practicing therapy should be an expert of sorts, on mental conditions and therapeutic techniques etc. However, even the DSM is revised every few years because our understanding of human psychology evolves. We don't know everything there is to know. It sounds like you understand this. So, I think we agree. For example, we used to use a term here in California called "Cultural Competency," but have now shifted to "Cultural Humility." It's basically the difference between assuming competence is a static end-goal that is attainable as opposed to a practice (culture humility) where we are always curious and learning from other cultures. It actually makes quite a difference in how we approach things.

I'm a fan of CBT, but there is some debate about its limitations. I've posted a link below that has some interesting points. I lean towards a more integrated approach, personally.

http://www.johnbartontherapy.com/blog/t ... cbt-debate
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Re: Buddhism and therapy - from the helpers perspective

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That's some good food for *thought* .....about thought

I think CBT is great, but I feel like it is has been presented as a bit of panacea in the US until pretty recently, and it isn't one. I mean ACT and DBT see themselves as "third wave" cognitive behavioral therapies, so there is a continuum there. CBT is important stuff with some very specific (and IMO pretty obvious once you work with a few people and seeing it not work for them in the same ways) limitations.

Incidentally, the best Substance Use Disorder protocols out there are CBT/MET combos, they are pretty much the standard professional treatment outside of 12-step facilitation...which is actually just another form of CBT. You have to do CBT in SUD work because substance use triggers, and the cognitions connected to them are a huge part of people figuring out their patterns of substance abuse. It does almost nothing to directly address the emotional/somatic component of things though, which is friggin' huge in addictions, and is why things like Mindfulness Based Relapse Prevention etc. are needed.

So I think it's vital stuff, I see it being challenged in some very necessary and valid ways though, I do think CBT-based approaches can oversimplify problems in the way mentioned in the article, and are too one-size fits all.
Meditate upon Bodhicitta when afflicted by disease

Meditate upon Bodhicitta when sad

Meditate upon Bodhicitta when suffering occurs

Meditate upon Bodhicitta when you are scared

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Re: Buddhism and therapy - from the helpers perspective

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In doing some research on another subject, I came across this really interesting (at least for me) short interview clip by Brene' Brown on her use of the Buddhist concept of near enemies:

"...I came across a concept from Buddhism that I remember reading many years ago, it didn't hit me. When I came across it this time, I thought this is the piece missing for the framework on meaningful connection. And it's the concept of the near enemy. And what a near enemy is, it is an emotion or a virtue that looks and feels and masquerades like the thng we are looking for or want to be, but it sabotages it.
....the far enemy of connection is disconnection, right? That makes sense. But the near enemy of connection is control."

This interview was about her most recent book, Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience.

For those not familiar with Brown, you can check out this wikipedia page about her. ("Brown is known in particular for her research on shame, vulnerability, and leadership.") She has several worthwhile Ted talks.

Shame and vulnerability might be interesting topics for this thread.
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Re: Buddhism and therapy - from the helpers perspective

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Johnny Dangerous wrote: Thu Jul 07, 2022 1:12 am

Figured since ACT was talked about I would post a short interview with Stephen Hayes. I think it gives a brief explanation of the philosophical orientation of ACT. Funnily enough, one of the things that got me reading first existentialist philosophy, and then Dharma in my teens was that I'd concluded that "happiness" (as normally envisioned by most of our society) is not a real thing.

It would be hard for me to adopt a therapeutic model that assumes that people are somehow "normally" happy and healthy, and that people who are not are somehow dysfunctional or in need of "fixing", I do not have that view of things, and would have a hard time orienting myself towards clients/patients that way.

BTW I have worked at places in the US that use both terms, as an aside.
Back to the ACT stuff, I have been using that book you suggested for adolescents here and there and it’s been really helpful with some of my clients. I’ve had training in ACT before, as I said, but it was helpful to have a little schema of how to relate it to teens and preteens. I actually had a kid today have an “Ah ha” moment thanks to it. I’m incorporating it with the Cognitive Processing (CBT) stuff. The two models may seem in conflict with each other, but I think they can complement different parts of the therapeutic process. On one hand, you have to challenge some beliefs and become aware of your automatic thought processes. But you still need to have something else larger to leverage that awareness into a more meaningful outlook as you challenge those unhelpful beliefs.

And I do use “normalizing” as a way to deal with kids’ feelings etc. So when I said “there’s no normal” I really wasn’t fully taking into account my own use of the concept of “normal.”

I know we often have criticism about “Mindfulness” practice as a cheesy, watered-down faux Buddhist practice, and there’s valid criticism of Mindfulness as a corporate tool. But, you might agree that mindfulness practice with a small “m” is essential to therapy. It’s been such an overused term, but really, is there any better way to explain to someone how they should be relating to their thoughts and experience?

I don’t feel uncomfortable sharing mindfulness as a basic tool if it’s therapeutically appropriate, without the Buddhist teachings, but it seems like a touchy point on DW.
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Re: Buddhism and therapy - from the helpers perspective

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KristenM wrote: Fri Aug 12, 2022 3:08 am
Johnny Dangerous wrote: Thu Jul 07, 2022 1:12 am

Figured since ACT was talked about I would post a short interview with Stephen Hayes. I think it gives a brief explanation of the philosophical orientation of ACT. Funnily enough, one of the things that got me reading first existentialist philosophy, and then Dharma in my teens was that I'd concluded that "happiness" (as normally envisioned by most of our society) is not a real thing.

It would be hard for me to adopt a therapeutic model that assumes that people are somehow "normally" happy and healthy, and that people who are not are somehow dysfunctional or in need of "fixing", I do not have that view of things, and would have a hard time orienting myself towards clients/patients that way.

BTW I have worked at places in the US that use both terms, as an aside.
Back to the ACT stuff, I have been using that book you suggested for adolescents here and there and it’s been really helpful with some of my clients. I’ve had training in ACT before, as I said, but it was helpful to have a little schema of how to relate it to teens and preteens. I actually had a kid today have an “Ah ha” moment thanks to it. I’m incorporating it with the Cognitive Processing (CBT) stuff. The two models may seem in conflict with each other, but I think they can complement different parts of the therapeutic process. On one hand, you have to challenge some beliefs and become aware of your automatic thought processes. But you still need to have something else larger to leverage that awareness into a more meaningful outlook as you challenge those unhelpful beliefs.
Yeah, ACT is pretty fundamentalist in it's refusal to judge thoughts, to a degree where it'sa little inflexible, ironically. Usually if I'm lucky enough to have a client who is actually interested in stuff (many of mine are pre-contemplative and are not), I tend to operate more on the CBT idea of just examining thoughts for their relative value, rather than disputing them. DBT strikes a nice middle ground with that.

There are some papers out there by Hayes, etc. explaining how Third Wave cognitive therapies both embrace and critique traditional CBT. Similarly, if you want to understand why ACT claims refuting thoughts is a waste of time, read up on Relational Frame Theory, basically according to RFT because of how language works it is basically impossible to deal with thought-based suffering by trying to manipulate it, dispute it, etc. I don't know if I fully buy into it, but it is interesting.
And I do use “normalizing” as a way to deal with kids’ feelings etc. So when I said “there’s no normal” I really wasn’t fully taking into account my own use of the concept of “normal.”
My idea of normal is that everyone is somewhere on the continuum of f'd up. I've never met anyone who didn't have issues, and the ones that laid the greatest claim to being fully healthy often had the biggest problems. It's cliche, but true in my experience.
I know we often have criticism about “Mindfulness” practice as a cheesy, watered-down faux Buddhist practice, and there’s valid criticism of Mindfulness as a corporate tool. But, you might agree that mindfulness practice with a small “m” is essential to therapy. It’s been such an overused term, but really, is there any better way to explain to someone how they should be relating to their thoughts and experience?
I agree absolutely. I think most of the criticisms of Mindfulness on this forum are well-meaning but not always in the know. As far as therapeutic intervention, there is a reason everything has mindfulness as a foundation now, part of it is hype, but part is because it works better than anything else we've tried - in combination with other stuff, and building on what has worked. I find it strange how many people on this forum will argue against the effectiveness of it, I think a big part of it is failing to understand the difference between clinical practice and what you get at a random wellness retreat or something. I mean don't get me wrong, there are issues on the clinical side too, but they aren't the same issues really.

Anyway, I used to be more skeptical of clinical mindfulness, simply working as a counselor helped changed my opinion over time, but another thing that really contributed was volunteering in a prison. I was part of a Prison Dharma group, we would go each week with some planned topic, lead a little meditation and simple Dharma talk (no, of course I am not qualified to teach anyone, but when it comes to Prison Dharma who shows up is who does stuff, and our teacher was all for it). Over time I noticed the guys weren't that interested in much other than meditation. At first this really bugged me, and I think some of the others involved too. Eventually we gave in and realized we were only truly serving these guys if we did what would help them, which wouldn't necessarily be what made us happy as Dharma people.

We ended up with two groups, one Buddhist group and one that was a program called Path of Freedom put together by Fleet Maul, specifically for prisons. It's mindfulness , emotional intelligence, and conflict resolution stuff. The Buddhist group was way smaller, and even those guys didn't want to talk Dharma much...they wanted directly applicable tools to ease their suffering and get them through the truly awful, dark experience which is prison. Seeing the effect that "just mindfulness", maybe some basic Metta or similar had on their lives and situation really sold me. Sorry, but the secular stuff works wonders when it's a good program. Some of those guys had a stronger practice than some Buddhists I've known, frankly, at least in terms of visible changes. It's never gonna lead someone to liberation from Samsara, but it may significantly improve their lives and help them into a personal level of maturity and equanimity that wouldn't be possible otherwise, and that is not some small thing. IMO it is a good thing for Dharma people to offer these kinds of services where appropriate - basically meditation for non-Buddhists for "worldly" things to improve people's lives, there is plenty of precedent in the tradition for such things too.
I don’t feel uncomfortable sharing mindfulness as a basic tool if it’s therapeutically appropriate, without the Buddhist teachings, but it seems like a touchy point on DW.
I use it with any client who is interested. That's not many now that I work with kids, but some populations I've worked with actually asked me to teach them basic stuff once they knew I had done that stuff in prisons. Am I great at it? No, but I learned a few things about how to present the concepts to different sorts of people and I had people thank me and tell me how helpful it was for them...that is enough confirmation for me.

Like I said, I get a lot of the criticism here, but much of the time I don't think it comes from a very informed place, if I'm honest. I personally also bristle when someone confuses such practices with Buddhism proper, or denigrates Buddhism in favor of them, but in my experience that is actually quite rare. So, I simply see it as a means to improve the lives of my clients and anyone else who wants to make use of it to help ease mental suffering, IMO that is the generous thing to do - offer such skills unconditionally, not with the requirement that the practitioners necessarily be Buddhist. That is also the approach of any Dharma center I've been involved with personally, as far as basic meditation instruction goes.
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Meditate upon Bodhicitta when suffering occurs

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Re: Buddhism and therapy - from the helpers perspective

Post by Anders »

From my POV, both as a Buddhist practitioner and how I was trained as a therapist, I would say the major shortcoming of many modern therapies is the lack of bodily inquiry, treatment and integration.
So much of Western understanding of the human experience is still predicated on the idea that we are talking heads with an instrument of extremities attached at the base of our skull to interact with the world around us.
In my therapeutic experience it seems almost unthinkable to work with deep issues and lasting transformation without engaging the issues at a bodily level.

CBT has a lot going for it and for sure it is something I feel a need to receive proper training in at some point. But most clients that I, and my similarly trained therapists I talk to, receive that have had negative prior experience with therapy comes from them visiting CBT therapists and a very recurring feeling of being put through the conveyor belt treatment.
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Re: Buddhism and therapy - from the helpers perspective

Post by Anders »

Mindfulness is a great tool, but also has potential downsides. In the longterm, whether in therapy or Buddhist practice, it has disassociative potential when it doesn't lead into embodiment.

That said I am very glad it has become such a big part of modern discourse and personally have no issue with McMindfulness. The only Buddhists who should be troubled by this are the ones who reduce Buddhist practice to mindfulness alone.
"Even if my body should be burnt to death in the fires of hell
I would endure it for myriad lifetimes
As your companion in practice"

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Re: Buddhism and therapy - from the helpers perspective

Post by Johnny Dangerous »

:good:
I agree on the embodiment. However, I do see somatic work popping up here and there now. I agree that there is a tendency for mindfulness to be basically an intellectual skill when it is taught...the way it often seems to be in clinical settings.

For the mindfulness in say DBT or ACT, I can't see a danger of disassociation though because it generally is not "meditation" proper, it's short in duration, etc. I can see that if someone is predisposed to derealization or similar it might be a danger, but so would a lot of interventions.
Meditate upon Bodhicitta when afflicted by disease

Meditate upon Bodhicitta when sad

Meditate upon Bodhicitta when suffering occurs

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Re: Buddhism and therapy - from the helpers perspective

Post by KristenM »

Anders wrote: Fri Aug 12, 2022 8:12 am From my POV, both as a Buddhist practitioner and how I was trained as a therapist, I would say the major shortcoming of many modern therapies is the lack of bodily inquiry, treatment and integration.
So much of Western understanding of the human experience is still predicated on the idea that we are talking heads with an instrument of extremities attached at the base of our skull to interact with the world around us.
In my therapeutic experience it seems almost unthinkable to work with deep issues and lasting transformation without engaging the issues at a bodily level.

CBT has a lot going for it and for sure it is something I feel a need to receive proper training in at some point. But most clients that I, and my similarly trained therapists I talk to, receive that have had negative prior experience with therapy comes from them visiting CBT therapists and a very recurring feeling of being put through the conveyor belt treatment.
What ways do you do that out of curiosity? Gestalt therapy? I have a lot of clients who are victims of abuse and sexual molestation.
But they are kids, so their abuse is quite recent. I use some grounding and relaxation practices but am pretty careful not to have them re-experience trauma. Or have therapy seem like a conveyor belt.
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Re: Buddhism and therapy - from the helpers perspective

Post by KristenM »

Johnny Dangerous wrote: Fri Aug 12, 2022 6:49 am
KristenM wrote: Fri Aug 12, 2022 3:08 am
Johnny Dangerous wrote: Thu Jul 07, 2022 1:12 am
Figured since ACT was talked about I would post a short interview with Stephen Hayes. I think it gives a brief explanation of the philosophical orientation of ACT. Funnily enough, one of the things that got me reading first existentialist philosophy, and then Dharma in my teens was that I'd concluded that "happiness" (as normally envisioned by most of our society) is not a real thing.

It would be hard for me to adopt a therapeutic model that assumes that people are somehow "normally" happy and healthy, and that people who are not are somehow dysfunctional or in need of "fixing", I do not have that view of things, and would have a hard time orienting myself towards clients/patients that way.

BTW I have worked at places in the US that use both terms, as an aside.
Back to the ACT stuff, I have been using that book you suggested for adolescents here and there and it’s been really helpful with some of my clients. I’ve had training in ACT before, as I said, but it was helpful to have a little schema of how to relate it to teens and preteens. I actually had a kid today have an “Ah ha” moment thanks to it. I’m incorporating it with the Cognitive Processing (CBT) stuff. The two models may seem in conflict with each other, but I think they can complement different parts of the therapeutic process. On one hand, you have to challenge some beliefs and become aware of your automatic thought processes. But you still need to have something else larger to leverage that awareness into a more meaningful outlook as you challenge those unhelpful beliefs.
Yeah, ACT is pretty fundamentalist in it's refusal to judge thoughts, to a degree where it'sa little inflexible, ironically. Usually if I'm lucky enough to have a client who is actually interested in stuff (many of mine are pre-contemplative and are not), I tend to operate more on the CBT idea of just examining thoughts for their relative value, rather than disputing them. DBT strikes a nice middle ground with that.

There are some papers out there by Hayes, etc. explaining how Third Wave cognitive therapies both embrace and critique traditional CBT. Similarly, if you want to understand why ACT claims refuting thoughts is a waste of time, read up on Relational Frame Theory, basically according to RFT because of how language works it is basically impossible to deal with thought-based suffering by trying to manipulate it, dispute it, etc. I don't know if I fully buy into it, but it is interesting.
And I do use “normalizing” as a way to deal with kids’ feelings etc. So when I said “there’s no normal” I really wasn’t fully taking into account my own use of the concept of “normal.”
My idea of normal is that everyone is somewhere on the continuum of f'd up. I've never met anyone who didn't have issues, and the ones that laid the greatest claim to being fully healthy often had the biggest problems. It's cliche, but true in my experience.
I know we often have criticism about “Mindfulness” practice as a cheesy, watered-down faux Buddhist practice, and there’s valid criticism of Mindfulness as a corporate tool. But, you might agree that mindfulness practice with a small “m” is essential to therapy. It’s been such an overused term, but really, is there any better way to explain to someone how they should be relating to their thoughts and experience?
I agree absolutely. I think most of the criticisms of Mindfulness on this forum are well-meaning but not always in the know. As far as therapeutic intervention, there is a reason everything has mindfulness as a foundation now, part of it is hype, but part is because it works better than anything else we've tried - in combination with other stuff, and building on what has worked. I find it strange how many people on this forum will argue against the effectiveness of it, I think a big part of it is failing to understand the difference between clinical practice and what you get at a random wellness retreat or something. I mean don't get me wrong, there are issues on the clinical side too, but they aren't the same issues really.

Anyway, I used to be more skeptical of clinical mindfulness, simply working as a counselor helped changed my opinion over time, but another thing that really contributed was volunteering in a prison. I was part of a Prison Dharma group, we would go each week with some planned topic, lead a little meditation and simple Dharma talk (no, of course I am not qualified to teach anyone, but when it comes to Prison Dharma who shows up is who does stuff, and our teacher was all for it). Over time I noticed the guys weren't that interested in much other than meditation. At first this really bugged me, and I think some of the others involved too. Eventually we gave in and realized we were only truly serving these guys if we did what would help them, which wouldn't necessarily be what made us happy as Dharma people.

We ended up with two groups, one Buddhist group and one that was a program called Path of Freedom put together by Fleet Maul, specifically for prisons. It's mindfulness , emotional intelligence, and conflict resolution stuff. The Buddhist group was way smaller, and even those guys didn't want to talk Dharma much...they wanted directly applicable tools to ease their suffering and get them through the truly awful, dark experience which is prison. Seeing the effect that "just mindfulness", maybe some basic Metta or similar had on their lives and situation really sold me. Sorry, but the secular stuff works wonders when it's a good program. Some of those guys had a stronger practice than some Buddhists I've known, frankly, at least in terms of visible changes. It's never gonna lead someone to liberation from Samsara, but it may significantly improve their lives and help them into a personal level of maturity and equanimity that wouldn't be possible otherwise, and that is not some small thing. IMO it is a good thing for Dharma people to offer these kinds of services where appropriate - basically meditation for non-Buddhists for "worldly" things to improve people's lives, there is plenty of precedent in the tradition for such things too.
I don’t feel uncomfortable sharing mindfulness as a basic tool if it’s therapeutically appropriate, without the Buddhist teachings, but it seems like a touchy point on DW.
I use it with any client who is interested. That's not many now that I work with kids, but some populations I've worked with actually asked me to teach them basic stuff once they knew I had done that stuff in prisons. Am I great at it? No, but I learned a few things about how to present the concepts to different sorts of people and I had people thank me and tell me how helpful it was for them...that is enough confirmation for me.

Like I said, I get a lot of the criticism here, but much of the time I don't think it comes from a very informed place, if I'm honest. I personally also bristle when someone confuses such practices with Buddhism proper, or denigrates Buddhism in favor of them, but in my experience that is actually quite rare. So, I simply see it as a means to improve the lives of my clients and anyone else who wants to make use of it to help ease mental suffering, IMO that is the generous thing to do - offer such skills unconditionally, not with the requirement that the practitioners necessarily be Buddhist. That is also the approach of any Dharma center I've been involved with personally, as far as basic meditation instruction goes.
Sounds like you've been doing some good work, Johnny. As far as RFT goes, it's interesting stuff but challenging to convey it in actual therapy imo. The ACT manuals have exercises where you have the client repeat a word/concept like "Milk" until it becomes meaningless. That would not work very well with my kiddos. But I'll work on it.

With mindfulness, there's going to be people who can't comprehend the big picture. When I did an adult mindfulness group a while back, there was a lady who really couldn't understand "mindfulness" and kept going to distracting as a way to deal with her emotions. She was all about questioning how mindfulness was going to benefit her and make her feel happy all the time. Still, I don't think the group was pointless. Everyone else got it.
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Re: Buddhism and therapy - from the helpers perspective

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KristenM wrote: Sun Aug 14, 2022 1:12 am ]

Sounds like you've been doing some good work, Johnny. As far as RFT goes, it's interesting stuff but challenging to convey it in actual therapy imo. The ACT manuals have exercises where you have the client repeat a word/concept like "Milk" until it becomes meaningless. That would not work very well with my kiddos. But I'll work on it.
Thanks, I try to. Again though, I am working with a mandated population, and also working within the generally screwed up community mental health paradigm, so some days it is enough to have the occasional victory and to simply not be perpetuating a broken system. I'll bet you can identify somewhat. Anyway Yeah, I'm familiar with that ACT technique, way too sophisticated for most people I've worked with. I will tell you what I stick to technique wise, with most people I start off with "breathing exercises" where you focus on lengthening the exhale with purse lips, and slowing the breath. Honestly with most people that's been enough to make a difference because they are just so keyed up. If they are really into I've done a couple of thought, sensation, etc. "noticing" exercises, as well as general somatic stuff - "where in your body do you feel this", etc. Of course if I'm doing this with people in a group setting it's a relapse prevention thing.
With mindfulness, there's going to be people who can't comprehend the big picture. When I did an adult mindfulness group a while back, there was a lady who really couldn't understand "mindfulness" and kept going to distracting as a way to deal with her emotions. She was all about questioning how mindfulness was going to benefit her and make her feel happy all the time. Still, I don't think the group was pointless. Everyone else got it.
Oh for sure, at the job where I did the most meditation there were always a few people that were really down on it...weirdly enough it's also provoked clients to disclose a relapse to group a number of times. This kind of thing is why for a chunk of my professional career, I have stuck to "breathing exercises" and expanded it to other stuff when people were more receptive. I have also had people do observational CBT stuff where you sneak in mindfulness by having people think about a certain event quietly, then write down or talk about what their emotion was in reaction to the thought, how they felt it, etc., I usually start with the CBT triangle as an explanation. That one I've found is simple enough for a broad group of people to get it. This and the ACT metaphors I've found to be pretty practical.

Anyway, some people are completely concrete thinkers and have never even examined their thoughts, have really poor recognition of emotions, etc...it can be an uphill battle, I wish I was better at teaching these basic skills, but I imagine I am pretty average. If you've run a mindfulness group you've done way more than me professionally, my deepest experience there was the prison, then my first job where people were really receptive and interested in meditation. The other two main gigs I've had I use this stuff sparingly, and most of my job is relational really..90% motivational interviewing and just helping people process their crappy situations, then some didactic SUD themes that we have to do by law.

I hope one day to be working with more motivated people, but for now I keep these things in my back pocket until I get a kid who is really keyed up and basically asks for this kind of help. With kids I've really found they have such poor attention spans and are so socially hyper vigilant that I usually just do this stuff individually, they are so squirrely and weird in groups lol.
Meditate upon Bodhicitta when afflicted by disease

Meditate upon Bodhicitta when sad

Meditate upon Bodhicitta when suffering occurs

Meditate upon Bodhicitta when you are scared

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Re: Buddhism and therapy - from the helpers perspective

Post by KristenM »

Johnny Dangerous wrote: Mon Aug 15, 2022 1:56 am
KristenM wrote: Sun Aug 14, 2022 1:12 am ]

Sounds like you've been doing some good work, Johnny. As far as RFT goes, it's interesting stuff but challenging to convey it in actual therapy imo. The ACT manuals have exercises where you have the client repeat a word/concept like "Milk" until it becomes meaningless. That would not work very well with my kiddos. But I'll work on it.
Thanks, I try to. Again though, I am working with a mandated population, and also working within the generally screwed up community mental health paradigm, so some days it is enough to have the occasional victory and to simply not be perpetuating a broken system. I'll bet you can identify somewhat. Anyway Yeah, I'm familiar with that ACT technique, way too sophisticated for most people I've worked with. I will tell you what I stick to technique wise, with most people I start off with "breathing exercises" where you focus on lengthening the exhale with purse lips, and slowing the breath. Honestly with most people that's been enough to make a difference because they are just so keyed up. If they are really into I've done a couple of thought, sensation, etc. "noticing" exercises, as well as general somatic stuff - "where in your body do you feel this", etc. Of course if I'm doing this with people in a group setting it's a relapse prevention thing.
With mindfulness, there's going to be people who can't comprehend the big picture. When I did an adult mindfulness group a while back, there was a lady who really couldn't understand "mindfulness" and kept going to distracting as a way to deal with her emotions. She was all about questioning how mindfulness was going to benefit her and make her feel happy all the time. Still, I don't think the group was pointless. Everyone else got it.
Oh for sure, at the job where I did the most meditation there were always a few people that were really down on it...weirdly enough it's also provoked clients to disclose a relapse to group a number of times. This kind of thing is why for a chunk of my professional career, I have stuck to "breathing exercises" and expanded it to other stuff when people were more receptive. I have also had people do observational CBT stuff where you sneak in mindfulness by having people think about a certain event quietly, then write down or talk about what their emotion was in reaction to the thought, how they felt it, etc., I usually start with the CBT triangle as an explanation. That one I've found is simple enough for a broad group of people to get it. This and the ACT metaphors I've found to be pretty practical.

Anyway, some people are completely concrete thinkers and have never even examined their thoughts, have really poor recognition of emotions, etc...it can be an uphill battle, I wish I was better at teaching these basic skills, but I imagine I am pretty average. If you've run a mindfulness group you've done way more than me professionally, my deepest experience there was the prison, then my first job where people were really receptive and interested in meditation. The other two main gigs I've had I use this stuff sparingly, and most of my job is relational really..90% motivational interviewing and just helping people process their crappy situations, then some didactic SUD themes that we have to do by law.

I hope one day to be working with more motivated people, but for now I keep these things in my back pocket until I get a kid who is really keyed up and basically asks for this kind of help. With kids I've really found they have such poor attention spans and are so socially hyper vigilant that I usually just do this stuff individually, they are so squirrely and weird in groups lol.
I knew you primarily worked with the substance use population, but I also thought you were doing some school counseling? And unfortunately, yes, I'm very familiar with dealing with a broken system, so to speak. Here in my area, we can't meet the needs of our clients simply because we have so few trained or licensed therapists available. Have you thought about getting training in EMDR? Everyone talks about it like it's the most amazing thing. I'm interested but not 100% certain it's the cure-all for trauma people these days seem to think it is.

I'm NOT an expert on mindfulness, alas, but just doing a very simple mindfulness group was a good experience. I would love to do some more like it. I also want to do other types of groups, like I want to do trauma/sexual abuse survivor group, but we're always so short-staffed here, so groups usually don't become reality.
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Re: Buddhism and therapy - from the helpers perspective

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KristenM wrote: Tue Aug 16, 2022 2:10 am
I knew you primarily worked with the substance use population, but I also thought you were doing some school counseling?
Both, I'm an SUD counselor in schools. Of course it involves way more than that, but that is what we technically are - Substance Use Disorder Professionals that work in schools. I'm based at a high school and share work at Middle Schools etc. in a district with a couple other people.

And unfortunately, yes, I'm very familiar with dealing with a broken system, so to speak. Here in my area, we can't meet the needs of our clients simply because we have so few trained or licensed therapists available. Have you thought about getting training in EMDR? Everyone talks about it like it's the most amazing thing. I'm interested but not 100% certain it's the cure-all for trauma people these days seem to think it is.

I think I need my Mental Health professional designation before I can do EMDR (working on the education etc. for that now), though I'm not certain. I have actually been through EMDR and am pretty enthusiastic about it. Depending on who is doing it, it can be a pretty uncomplicated skill...as fr as efficacy, it's just exposure therapy, with the advantage that the exposure comes from thoughts instead of external stimuli, so it's easier to do. The last I checked studies they basically said something like "slightly better than normal exposure therapy, maybe"...which isn't bad, but doesn't make it a panacea.

Anyway, I am trying to get my mental health designation so that I can take on co-occurring clients and do MH counseling. Functionally there is little difference, but of course since insurance companies basically dictate how everything works, here we are.
I'm NOT an expert on mindfulness, alas, but just doing a very simple mindfulness group was a good experience. I would love to do some more like it. I also want to do other types of groups, like I want to do trauma/sexual abuse survivor group, but we're always so short-staffed here, so groups usually don't become reality.
Ah, yeah, I'm hoping once I have MH trainee status at my job (need to finish my bachelors and get started on my Masters which should be happening reasonably soon) I can suggest we do something like DBT groups. After a few years of doing SUD groups I would love to do something else group wise.
Meditate upon Bodhicitta when afflicted by disease

Meditate upon Bodhicitta when sad

Meditate upon Bodhicitta when suffering occurs

Meditate upon Bodhicitta when you are scared

-Khunu Lama
KristenM
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Re: Buddhism and therapy - from the helpers perspective

Post by KristenM »

Johnny Dangerous wrote: Tue Aug 16, 2022 3:18 am
KristenM wrote: Tue Aug 16, 2022 2:10 am
I knew you primarily worked with the substance use population, but I also thought you were doing some school counseling?
Both, I'm an SUD counselor in schools. Of course it involves way more than that, but that is what we technically are - Substance Use Disorder Professionals that work in schools. I'm based at a high school and share work at Middle Schools etc. in a district with a couple other people.

And unfortunately, yes, I'm very familiar with dealing with a broken system, so to speak. Here in my area, we can't meet the needs of our clients simply because we have so few trained or licensed therapists available. Have you thought about getting training in EMDR? Everyone talks about it like it's the most amazing thing. I'm interested but not 100% certain it's the cure-all for trauma people these days seem to think it is.

I think I need my Mental Health professional designation before I can do EMDR (working on the education etc. for that now), though I'm not certain. I have actually been through EMDR and am pretty enthusiastic about it. Depending on who is doing it, it can be a pretty uncomplicated skill...as fr as efficacy, it's just exposure therapy, with the advantage that the exposure comes from thoughts instead of external stimuli, so it's easier to do. The last I checked studies they basically said something like "slightly better than normal exposure therapy, maybe"...which isn't bad, but doesn't make it a panacea.

Anyway, I am trying to get my mental health designation so that I can take on co-occurring clients and do MH counseling. Functionally there is little difference, but of course since insurance companies basically dictate how everything works, here we are.
I'm NOT an expert on mindfulness, alas, but just doing a very simple mindfulness group was a good experience. I would love to do some more like it. I also want to do other types of groups, like I want to do trauma/sexual abuse survivor group, but we're always so short-staffed here, so groups usually don't become reality.
Ah, yeah, I'm hoping once I have MH trainee status at my job (need to finish my bachelors and get started on my Masters which should be happening reasonably soon) I can suggest we do something like DBT groups. After a few years of doing SUD groups I would love to do something else group wise.
Okay, now that makes sense that you are a SUD counselor in schools. High school and middle school is a fun population to work with, imo. Interesting info on EMDR. I think I'll do a training in 2023 so it can count towards the CE's I need for the next year.

Congratulations on working on getting your degrees. I'm a late bloomer when it came to getting my master's and becoming licensed, but it was one of the best decisions I've ever made professionally. It's clear to me that you are already a highly competent counselor. It's great what opportunities open up once you have the credentials on paper.
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