第七章 同理觉知：正念修炼之路

第七章

同情心觉知：培养正念

在我们理解CFT（同情聚焦疗法）过程的分层方法中，我们首先考虑了治疗关系，在这种关系中，治疗师通过示范同情，作为来访开始感到安全的稳固基地，以便他们能够面对困难的情绪和经历。接着，我们在第4至第6章中发展了下一个层次——帮助来访在进化和塑造他们的情感的发展因素方面发展同情的理解。这种理解旨在帮助来访以同情和非评判的态度对待他们的困难——许多困难他们并未选择或设计，但仍需应对。在本章中，我们将考虑CFT方法的下一个层次：正念觉知。重要的是要认识到，这三个层次从治疗一开始就存在，关系从初次接触时就开始发展，治疗师甚至在最初的几次会话中就开始融入理解和正念觉知的元素。

在过去几十年中，正念已成为当代心理治疗中最常用和研究最多的实践之一。它为基于正念的认知疗法（Segal, Williams, & Teasdale, 2001）提供了基础，并长期出现在其他“第三浪潮”认知行为方法中，包括DBT（Linehan, 1993）、ACT（Hayes, Strosahl, & Wilson, 1999）等。大量的证据支持正念干预用于多种问题的有效性，尤其是抑郁症和焦虑症（Hofmann, Sawyer, Witt, & Oh, 2010）。有许多现有的资源可以帮助了解正念并将其应用于治疗，因此这里不会尝试全面介绍正念。相反，我将简要讨论正念的概念及其在CFT中的位置，介绍CFT中常用的几种正念练习，并提供一些有效引导来访参与正念练习的建议。

正念

正念涉及一种特定的觉知。最常用的正念定义来自乔恩·卡巴金（Jon Kabat-Zinn, 1994）：有目的、不加评判地关注当下。正念意味着有意地将我们的当下觉知导向一种方式，使我们能够看到面前的事物，无论是外部环境还是内心，都如其本来的样子。通过正念觉知，我们避免评判、批评、执着或拒绝我们的体验。相反，我们允许自己注意到、接受并好奇地探索体验的内容——无论这些体验是通过感官从外部世界传来的，还是我们内在体验的产物，如思想、情感、动机和身体感觉。通过正念觉知，我们允许自己好奇地观察所有这些体验——准确地注意到它们是什么，既不执着也不回避。

正念觉知对来访来说是非常有用的能力，特别是那些被强烈的羞耻感和自我批判思想困扰的来访。问题不在于他们有这些思想——几乎所有人都会有不同程度的这些思想。问题是他们反复思考这些思想，排练它们，并相信它们。有时，来访还会表现出强烈的情绪，这些情绪似乎突然袭来，强烈地组织他们的身体体验、注意力、思维、动机和行为，正如我们在前几章中所讨论的。这样的来访可能会感到被困在这些情绪体验的即时性中。这些体验不仅会在当下触发不想要的情感和问题行为，还可能导致来访害怕思想和情感本身——潜在地导致他们在试图管理这些可怕且看似不可控制的心理体验时发展出不健康的体验回避模式。

练习正念可以帮助应对这些挑战，并为来访提供（以及我们自己）准备同情的基础。正念涉及许多与CFT相关的好处。正念训练可以增加来访对注意力的觉知和控制，帮助他们学会以有益的方式引导注意力。它可以帮助他们学会注意到内心的动态，更快地意识到有害的思想和情感的出现。当这些思想和情感被注意到时，正念觉知的观察品质可以帮助来访避免陷入这些体验中——而是将它们视为在心灵和身体中暂时发生的事情。通过这种方式，来访可以理解思想和情感是心理和身体的体验，而不是“我是谁”。

与此相关的是，正念觉知的接受和非评判品质可以帮助来访避免以不健康的方式反应或详细阐述这些体验（例如反复思考，或因感到愤怒或有不符合他们想成为的人的想法而自我批评）。能够在不与困难的思想和情感融合也不通过转移注意力来避免它们的情况下，有意识地观察这些思想和情感，也有助于来访发展应对压力的能力，这对于同情至关重要。如果我们要克服回避并应对痛苦，我们必须能够接近它并在这样做时保持与其的联系。正念为来访提供了一种实现这一点的方法。

准备来访进行注意力工作

由于正念首先是一种处理注意力的方式，因此在引入正式的正念练习之前，让来访熟悉这一点是有帮助的。通过一个简单的体验练习，我们可以引导来访将注意力指向不同的目标——内部的、外部的、广泛的、狭窄的、现在的、过去的、具体的、概念性的——这样他们可以直接体验自己的注意力是如何工作的。

让我们来看一个例子，看看这可以如何操作：

治疗师：Josh，正如我们在上次会谈中讨论的，今天我们将会介绍一种叫做正念的练习。正念是指以特定的方式集中注意力，这有助于我们更加意识到自己的体验，并帮助我们不被无益的思想和情感所困扰。你觉得怎么样？ Josh：听起来值得一试。 治疗师：很好。但在深入正念之前，我认为了解我们所说的注意力是什么意思可能会很有用。我们可以把注意力想象成“心灵的聚光灯”。这盏聚光灯可以指向很多不同的东西，以不同的方式引导我们的意识。你愿意做一个小练习吗？ Josh：好的。 治疗师：太好了。我会简单地说一系列词语——当你听到词语时，试着将注意力指向词语所指示的地方。所以，如果我说“左肘”，你就将注意力集中在你的左肘上。明白了吗？ Josh：（点头） 治疗师：好的，开始了：右耳。（等待两到三秒）左脚。（等待两到三秒）舌头。（等待两到三秒）呼吸的感觉。（等待两到三秒）灯光的嗡嗡声。（等待两到三秒）你最喜欢的颜色。（等待两到三秒）土豆条！（等待两到三秒）正义。（等待两到三秒）世界和平。（等待两到三秒）南美洲。（等待两到三秒）你想晚餐吃什么。（等待两到三秒）让你的脸形成微笑，微笑的感觉。 Josh：（微微一笑） 治疗师：你注意到了什么？我指示的地方你能移动你的注意力吗？ Josh：是的，挺有意思的。 治疗师：很好。你注意到自己能多么轻松地移动注意力了吗？当你从一个事物转移到另一个事物时，是迅速的还是缓慢的？ Josh：迅速的。几乎是立即的。 治疗师：所以你能非常迅速地将注意力从一个事物转移到另一个事物。你可能还注意到，你可以将注意力的焦点从外部的身体感觉转移到内部的感觉，再到想法和记忆，从过去到未来。你还可以将注意力集中在一个具体的事物上，比如你的肘部，或者扩展到广泛的概念，比如正义。 Josh：（点头） 治疗师：你怎么看？挺酷的吧？ Josh：（微笑并轻蔑地翻了个白眼）挺酷的。（停顿）其实，确实挺酷的。我以前从未这么想过。 治疗师：所以这只是我们如何以不同方式引导注意力的聚光灯的一个例子。让我们通过学习第一个正念练习继续探索这一点。

正念检查

我在CFT中通常引入的第一个正式正念练习称为正念检查（Kolts, 2012）。正念检查涉及依次将注意力带到身体体验、感受的情绪和思考，速度相对较快。这个练习并不是为了进行长时间的冥想，尽管来访可以根据自己的喜好花费任意多的时间。相反，这个练习有几个特定的目的：

• 帮助来访养成将注意力带到身体体验、情绪和思想的习惯——习惯于注意到这些体验。
• 帮助来访开始以这些体验本来的样子看待它们——身体感觉、情感和心中的词语或图像——而不对其进行评判。
• 帮助来访习惯在日常生活中练习正念练习（和家庭练习）——从容易做到的小事开始。

让我们看看这个练习如何在治疗会谈中引入：

治疗师：我们将做的第一个正念练习称为正念检查。就像之前一样，我会提示你将注意力带到某些体验。这次，我们将注意力依次带到身体体验、情绪和思想。听起来不错吗？ Josh：当然。 治疗师：在正念中，我们希望意识到这些不同的体验，将注意力带到它们上面。这与思考我们的体验不同。所以如果你的脚冷，正念觉知会涉及注意到它是冷的，并且可能会好奇地关注这些冷的感觉是什么样的——就好像你要描述它们，或者向一个没有脚的人解释这种体验是什么样的。这与思考脚冷不同，后者可能涉及心中的词语，比如“糟了，我的脚又冷了。我应该穿暖和的冬袜。真烦！”明白区别了吗？ Josh：（轻笑）我想明白了。 治疗师：所以如果你发现自己在思考而不是观察——你很可能会有这种情况——不用担心。当你注意到这一点时，只需尝试将注意力带回到体验上。我们稍后再讨论思考部分以及如何处理。另外，我将打开数字录音机，这样我们可以录制这个练习的mp3文件，今天结束前可以加载到你的手机上，如果你愿意，可以在家练习时听。听起来不错吗？ Josh：听起来不错。我可以直接用手机录音。 治疗师：很好。（等待Josh设置好手机录音）首先，坐直，保持警觉的姿势，头抬起来。我们不想驼背。让你的呼吸变得舒适，如果你觉得舒服的话，可以闭上眼睛。如果你更喜欢，也可以睁着眼睛，将目光投向前方六到八英尺的地面上，让目光柔和——稍微失焦。如果我们进行过程中你需要动一动，清清嗓子，或者做任何让你更舒服的事情——不用担心，尽管去做。 Josh：（调整姿势并闭上眼睛） 治疗师：让我们从注意到房间的温度开始。试着注意到温暖或凉爽的感觉……（等待十五到二十秒）……

• 现在将注意力带到外部身体感觉……脚在地板上的感觉……腿、臀部和背部在椅子上的感觉……手放在膝盖上的感觉。（等待十五到二十秒）
• 现在注意到其他感官传入的信息……耳朵听到的声音……我的声音、暖气系统的呼啸声、灯光的嗡嗡声……眼皮上的光线图案……（等待十五到二十秒）
• 现在跟随这些感觉进入身体，注意到任何内部身体感觉。将注意力带到饥饿或饱腹感、紧张或放松、舒适或疼痛的感觉。只是注意到这些感觉，如其本来的样子。（等待五到十秒）如果有任何感觉特别吸引你的注意力，让它去到那里，专注于这种感觉，注意它是怎样的……（等待十五到二十秒）
• 现在将注意力带到呼吸的感觉。注意到呼吸进出的速度。注意到心跳……（等待十五到二十秒）
• 随着这些唤醒或放松的感觉，将注意力转移到你可能感受到的任何情绪。兴趣？无聊？期待？好奇心？只是将这些感觉视为心理事件。（等待三十秒）
• 现在我们已经将注意力带到了感觉上，让注意力转移到另一种心理体验……思想。注意到任何在你心中升起的词语或图像。像“他会一直用那种慢悠悠的声音说话吗？”这样的思想。只是注意到任何可能在你心中浮现的思想，观察它们的出现和消失。（等待三十秒）
• 如果你愿意，可以将注意力带到思想和情绪之间的关系……也许注意到当你有某种类型的思想时，某种类型的感觉往往会随之产生。也许注意到当你感受到某种情绪时，某些思想往往会随之产生。（暂停三十秒）
• 当你准备好时，让呼吸恢复到舒适的节奏，轻轻地睁开眼睛，将注意力带回房间……

正念检查

第一次练习时，这个过程需要五到十分钟，但我们希望让来访知道，实际上这个过程可以更快完成。这个练习不是设计成长时间的冥想——虽然如果来访希望在这些体验的某个方面花更多时间，它当然可以作为长时间冥想的一部分。相反，这个练习是为了让来访高效地学会定期检查自己的身体、情绪和思想。目的是建立能够高效地注意到自己的身体体验、感受和思想的能力（和倾向）；正念地注意到并接受这些体验，正如它们本来的样子——感觉、思想和情感。经过一点练习，这个检查可以在三十秒到一分钟内完成，因为来访可以快速地将注意力依次带到身体、感受和思想。通过这种方式学习，来访不需要花三十分钟坐在冥想垫上就能正念地连接自己的体验——他可以在电视广告期间、在交通堵塞时，或在超市排队时进行这项练习。

当我们给出这些指示时，我们希望使用一种平静、略带缓慢的语调——但记住，我们不是要让来访入睡。我发现，自然的语调变化和讲话速度的变化可以帮助来访保持参与练习。虽然这个练习相当直接，但也最好将练习录音，以便来访在家使用（或作为提醒如何进行练习）。我在我的网站上有这个练习和其他几个练习，来访也可以通过这种方式访问。如今，许多来访都有手机应用程序，可以在会话期间录制这些练习。

来访可能会发现一些练习变体有用。一旦他们掌握了基本练习，我们可以建议他们检查三个圈。他们可以尝试注意到三个圈（威胁、驱动力、安全感）中哪一个在他们的身体、情绪和思想中最占主导地位，或者对每个圈在1-10或1-100的范围内进行评分。再次强调，目的是让来访养成习惯，注意他们感到的威胁、动机或安全的程度。我们还可以建议他们在注意到（或注意到自己陷入）特定情绪或一系列思想时暂停进行这项检查。我们可以在会话中示范这一点（例如，“看起来你现在有些事情正在发生。这三个圈的情况如何？这种体验在你的身体上是如何表现的？出现了哪些感受？脑海中有什么想法？”）。通过这种方式，我们以一种不带羞耻的方式向来访介绍谈论和应对情绪体验的方法，这些体验以前可能是不可预测和压倒性的。

我们可以利用这些观察作为平台，帮助来访探索和熟悉思想和情绪如何在他们的身体和心灵中展开。这可以帮助我们仔细而好奇地审视这些体验，不再将其视为令人恐惧的东西，而是作为他们体验的有效方面，我们试图理解的部分。我们帮助来访以好奇、可管理和有益的方式接近这些基本的人类体验——这是同情的核心部分。

让我们来看看如何在一个疗程中引导进行这个练习： 治疗师：珍妮，很高兴看到你上周我们提到的正念自查这周有了实践。你感觉怎么样？ 珍妮： 一开始真的很难记得去执行。后来我试着在手机上设定了提醒，这真的很有帮助。 治疗师：真是个好主意。你对这些练习有什么体会？ 珍妮： 我发现这让我做起事来轻松多了。 治疗师：（身体略微前倾，表现出极大的兴趣）能详细说说吗？ 珍妮： 很多时候，当我开始做某件事情时，脑子里会冒出很多想法，比如‘我为什么要这么做？这有意义吗？’或者想象各种可能出错的情景。但是这周，有几次我虽然意识到了这些想法，但还是选择了继续。 治疗师：也就是说，虽然‘焦虑的珍妮’有很多话要说，但你还是能让她说完后继续自己的路。这很好。 珍妮： 是的。不过我也在想，什么时候能有除了‘焦虑的珍妮’之外的声音出现。 治疗师：不用着急——我们会一起努力发展出一个‘有同情心的珍妮’——一个更加同情、友善、坚强、明智且自信的你。 珍妮： 这是我所希望的。 治疗师：从你的描述来看，我觉得‘有同情心的珍妮’已经开始出现了。正是她，在‘焦虑的珍妮’表达了担忧后，仍然鼓励你继续前进。 珍妮： （看起来若有所思。） 治疗师：接下来我们要加强‘有同情心的珍妮’的力量，其中一个方法就是上次提到的第二个正念练习——正念呼吸。你觉得如何？ 珍妮： 听起来不错。 治疗师：正念呼吸就像是给‘有同情心的珍妮’健身一样——研究表明，长期坚持正念呼吸练习可以促进大脑中负责情绪管理和人际关系部分的成长。首先，请以一个舒适且直立的姿势坐好，头部保持直立但不要太高。（示范姿势。） 珍妮： 像这样吗？ 治疗师：没错。这个练习比自查要久一些，所以如果过程中你需要调整姿势、清喉咙、吞咽等，不必担心，随时可以做。另外，你可能会觉得微微张开嘴巴，舌头轻轻贴住牙齿后的上颚会有帮助。 珍妮： （稍作调整。） 治疗师：现在，请闭上眼睛…… 珍妮： （闭上了眼睛。） 治疗师：通过鼻子自然地呼吸，让呼吸找到一个舒适的节奏——不要刻意放慢或加快。将注意力放在呼吸上，选择一个最能感受到呼吸的地方集中注意力。可能是鼻尖处呼吸进出的感觉，也可能是腹部的起伏，或者是跟随呼吸进出体内的过程。（停顿三十秒。） 呼吸时，你的注意力有时会被思想、声音或其他事物吸引而从呼吸上移开。这并不是坏事，实际上，这有助于我们学会觉察内心的活动。当这种情况发生时，无论是短暂的分心还是一段时间的走神，只需觉察到这一点，并温柔地将注意力重新带回到呼吸上，一次又一次地重复这个过程。这是练习的核心——将注意力集中在呼吸上，觉察分心，温柔地回到呼吸。觉察，回归。 珍妮： （安静地坐着，进行呼吸。） 治疗师：（停顿三十秒。）觉察分心，回归呼吸。 治疗师：（停顿一分钟。）觉察并回归。 治疗师：（停顿一分半钟。）当你准备好了，轻轻地睁开眼睛，将注意力拉回房间。 珍妮： （大约三十秒后慢慢睁开了眼睛。）嗯。 治疗师：停止指导后大约过了三分钟。你有什么感受？ 珍妮： 感觉像是过了很久。虽然很放松，但也有点挫败感。总的来说，我还是挺喜欢的。 治疗师：所以感觉比实际的三分钟要长？ 珍妮： 长得多。我很少这么长时间静静地坐着。 治疗师：确实，当我们的大脑习惯了忙碌的状态时，静下来就会感觉特别漫长。大脑需要时间适应这种状态，学会静静地观察呼吸。你提到的挫败感，是因为发现自己容易分心吗？ 珍妮： 是的，每当我觉得自己只专注了几秒钟就又开始胡思乱想了，就感到很挫败。 治疗师：（微笑并轻声笑。）是的，就是这样！我刚开始学习时也是这样，甚至现在偶尔也会如此。 珍妮： 真的吗？ 治疗师：当然！有时我会产生一些非常狡猾的想法——比如我会坐在那里想，‘这真是一次很好的冥想，我完全专注于呼吸，没有任何杂念。我真的很擅长这个。’但实际上，我当时一直在想这些！ 珍妮： （微笑，轻声笑。） 治疗师：如果我们把专注于呼吸当作一个目标，很容易因为分心而感到挫败。关键在于记住，练习的目的之一就是学会觉察内心的活动。那些让人分心的想法恰恰给了我们这样的机会。如果我们从不走神，就永远不会学会如何觉察到被思绪带走的感觉。所以，分心并不是问题——明白了吗？ 珍妮： 这对我有帮助。 治疗师：想再试一次吗？这次我们试试五分钟？ 珍妮： 听起来不错。 治疗师：太好了。我会设定计时器，让我们再次调整到直立的姿势，闭上眼睛，将注意力集中在呼吸上……

练习后的跟进

练习结束后跟进很重要，以了解来访对此的体验，并探索、验证和解决可能出现的任何障碍。请注意，治疗师提到了自己的练习，并向来访分享了自己遇到的挑战，期间加入了一些幽默。这样做突显了练习的重要性（重要到治疗师自己也在练习），验证了难度，并减少了相关的自我批评（即使是“专家”治疗师有时也会遇到同样的困难），同时展示了如何用幽默处理这些障碍（通过一些轻松的方式软化隐含的挫败感）。此外，注意治疗师如何使用CFT（同情心聚焦疗法）的语言，提及“焦虑的珍妮”、“同情心的珍妮”和驱动系统——帮助她掌握正在学习的CFT概念。

最后评论

如果你打算在治疗中使用正念呼吸（或任何其他正念练习），我强烈建议你自己也要练习该技术（最好是持续的练习）。这将为你提供解释练习时可借鉴的经验。它可以帮助你从内部观察障碍及其应对方法。最终，正念本身会产生许多实用的好处，有可能提升你作为一个有效CFT治疗师的能力。从实用角度来看，想想看——正念和同情不仅仅是治疗“技术”。它们是我们帮助来访发展的复杂能力和技能。你会选择从未演奏过某种乐器或从未参与过某项运动的人作为老师吗？虽然最好的实践者不一定是最优秀的教师（反之亦然），但教师应该掌握他们指导的技能。

其他正念练习

有许多其他的正念练习，我们的来访可能会在将这种有意的、以当下为中心的、接受的、无评判的意识带入生活中时发现它们有用。几乎任何活动或经历都可以成为正念的焦点。其理念是，我们选择要集中注意力的地方，将我们的意识带到这个体验中，然后无评判地注意到并探索它。每当分心出现时，我们注意到它们，并将注意力重新带回到选定的焦点上。通常，我们希望从感官体验开始，如呼吸、身体感觉或来自外部的感官输入。然而，我们也可以使用心理图像或甚至想法作为专注的焦点，或者我们可以停留在开放的意识中，不将注意力固定在任何特定的焦点上，简单地注意到在我们的体验中出现的任何事物，而不执着或排斥任何事物。以下是一些常用的正念练习：

• 身体正念：将无评判的意识带到身体感觉上
• 正念进食：缓慢地进食，注意到食物或进食的所有感官方面
• 正念行走：缓慢行走，将正念意识带到行走时的所有感觉上
• 正念沐浴：沐浴时正念地专注于水击打皮肤的感觉
• 正念任务完成：做洗碗或清洁等任务时，正念地注意到完成活动时的所有感官体验
• 正念运动：正念地将注意力集中在物理活动（如瑜伽）上

其理念是想出多种活动，让来访可以应用正念意识。我们与他们合作，想出他们感兴趣的活动，以保持练习的动力。 随着时间的推移，这种心智训练可以帮助来访学会安定心灵，逐步减少不断涌现的思想，因为他们越来越善于将注意力带到现在。这可以为许多好事铺平道路。随着来访学会忍受最初与忙碌心灵安静相处的不适，他们学会了容忍痛苦并在困难时坚持不懈，当他们的努力开始见效时，他们会得到强化。这些练习也为发展同情智慧奠定了基础。几个世纪以来，佛教修行者一直使用如上所述的正念呼吸练习，为更复杂的分析冥想做准备——学习稳定心灵，以便深入思考诸如慈悲和现实本质等问题。一旦来访对更集中的练习感到舒适，他们可能会希望花一些冥想时间来探讨同情推理常常引发的问题：我想成为什么样的人？我的生活应该围绕什么？我想如何为他人的生活以及世界做出贡献？

处理正念训练中的障碍

当我们向来访提供我们希望他们遵循的练习时，解决可能出现的障碍非常重要。当我们教授正念——特别是正念呼吸时，有一些常见的障碍可能会阻碍进展。我们能在多大程度上预先计划并解决这些障碍，可以增加来访建立持续正念练习的可能性。

• 忘记 最常见的障碍可能是简单地忘记了练习。我建议在规划家庭作业时就指出这可能是一个障碍，并与来访合作规划合适的练习时间（例如，当他们警醒而不是困倦时），以及提示自己的方法（如设置闹钟）：“在学习正念时，一个常见的挑战就是简单地忘记进行练习。你认为什么可能帮助你记住？”
• 回避和低动机 据我的经验，如果我试图让来访每天开始做30分钟的正念练习，他们往往无法做到，也不一定愿意这样做。对于一个没有静坐和观察呼吸经验的人来说，30分钟是一个很长的时间。我们需要记住两件事：首先，考虑在你的生活中创造20到30分钟的空闲时间来做新的事情有多么困难——即使是你有动机去做并且知道对你非常有益的事情。不容易吧？这对我们的许多来访也是如此。此外，我们的许多来访（就像我们一样）生活在充满不断变化的媒体、电子设备、短信对话等过度刺激的环境中，这些环境可能已经使他们的神经系统适应了持续高水平的刺激。当你适应了在不断闪烁的屏幕、哔哔作响的手机和快速互动的环境中运作时，相对安静、不活跃的正念冥想状态最初可能会让人感到迷失方向、不安甚至直接不舒服。 那么该怎么办？首先，我们可以承认这些潜在的障碍，以便当它们出现时，我们的来访能理解它们是常见且完全可以理解的现象，而不是自己出了什么问题。其次，我们要从小处着手。虽然这取决于个别来访，但我通常建议第一周每天进行2到5分钟的正念呼吸——然后根据来访的感受和效果，以5或10分钟的增量增加。我们希望从一个可以持续的水平开始，并让来访在能够完成时有一种成功的感受。如果一开始门槛设得太高，初次失败可能会摧毁来访的动力。然而，如果在任何时候发生这种情况，我们可以与来访一起解决问题——以不责备、不指责的方式，验证经常会遇到障碍。同情地对待生活中的挑战包括学习同情地对待障碍：“开始维持正念练习可能会非常难，有很多障碍可能会阻碍你。是什么阻碍了你按照我们的计划进行？让我们看看是否能找到一些办法让它更容易。”

感觉自己像失败者

如果我每遇到一个决定尝试正念呼吸然后很快放弃，觉得自己“就是做不到”的人就能得到一美元的话，我怀疑我会有足够的钱资助我的研究助手直到我退休。指导语“将注意力集中在呼吸上，当你注意到它游离时温柔地带回来”听起来很简单。确实简单。只是不那么容易。许多怀着善意的实践者们一开始会非常兴奋地尝试这种宁静的冥想体验，但很快就会因为发现自己的思维四处跳跃，几乎没有时间真正专注于呼吸而感到沮丧。即使我们的理智告诉我们注意力会游离，这并不是失败，但我们的情感中心往往会因为我们一次又一次地被思绪分散而感到沮丧。 为了缓和这种倾向，我们可以提前告知来访，他们会分心，但这不是坏事。真的不是坏事。正如我前面提到的，正念的一个目标是学习更多地控制注意力——随着时间的推移，实践者将能够更长时间地保持注意力集中在呼吸上。然而，我们还可以强调，正念冥想的另一个目标是学会注意到心灵的运动。当思想、情绪和感觉带我们远离呼吸时，我们有机会注意到这种运动——如果我们注意力从未游离，这种机会就不会存在。因此，这些干扰实际上给了我们宝贵的机会，学习注意到思想和情绪的产生，注意到我们何时陷入了它们，并在发生这种情况时将注意力带回呼吸。 最后一个部分：来访有时会在冥想时遇到不想放下的思想。这种情况经常发生在我身上，因为我通常会在早上坐下来写作之前进行正念冥想。会出现一些我想包含在我的写作中的思想。你可以想象，试图在脑海中保留这些思想的同时回到呼吸是练习中的一个问题。但这不是问题——我在冥想垫附近放了一张纸和一支笔，这样就可以记下我不想丢失的任何思想。这个做法对来访也有用。

本章知识点阐述

进一步阐述的知识点

1. 治疗关系与正念

• 治疗关系：

  • 示范同情：治疗师通过示范同情，作为来访开始感到安全的稳固基地，帮助他们面对困难的情绪和经历。
  • 发展过程：治疗关系从初次接触时就开始发展，治疗师在最初的几次会话中就开始融入理解和正念觉知的元素。

• 正念的重要性：

  • 正念定义：正念是有目的、不加评判地关注当下，帮助来访如其本来的样子观察外部环境和内心体验。
  • 避免评判：通过正念觉知，来访可以避免评判、批评、执着或拒绝他们的体验，而是好奇地探索这些体验。

2. 正念与情感管理

• 应对有害思想：

  • 反复思考：问题在于来访反复思考有害的思想，排练它们，并相信它们。
  • 情绪冲击：来访有时会表现出强烈的情绪，这些情绪强烈地组织他们的身体体验、注意力、思维、动机和行为。

• 避免体验回避：

  • 体验回避：来访可能会害怕思想和情感本身，导致不健康的体验回避模式。
  • 正念练习：练习正念可以帮助来访避免陷入有害的思想和情感中，而是将它们视为暂时的事件。

3. 正念与同情

• 正念的好处：

  • 增加觉知：正念训练可以增加来访对注意力的觉知和控制，帮助他们学会以有益的方式引导注意力。
  • 应对压力：正念可以帮助来访发展应对压力的能力，这对于同情至关重要。

• 准备同情：

  • 接近痛苦：正念为来访提供了一种接近并保持与痛苦联系的方法，这对于克服回避和应对痛苦非常重要。
  • 非评判态度：正念的接受和非评判品质可以帮助来访避免以不健康的方式反应或详细阐述这些体验。

总结

在CFT中，正念觉知是帮助来访发展同情和非评判态度的重要工具。通过正念，来访可以学会有目的、不加评判地关注当下，避免陷入有害的思想和情感中，而是将它们视为暂时的事件。正念训练可以增加来访对注意力的觉知和控制，帮助他们学会以有益的方式引导注意力，发展应对压力的能力。正念为来访提供了一种接近并保持与痛苦联系的方法，这对于克服回避和应对痛苦至关重要。通过正念，来访可以更好地准备面对和管理自己的困难，从而发展出更深层次的同情心。

进一步阐述的知识点

1. 正念与注意力

• 正念的定义：
  • 正念是一种处理注意力的方式，涉及以特定的方式集中注意力，这有助于我们更加意识到自己的体验，并帮助我们不被无益的思想和情感所困扰。
• 注意力的比喻：
  • 我们可以把注意力想象成“心灵的聚光灯”，这盏聚光灯可以指向很多不同的东西，以不同的方式引导我们的意识。

2. 体验练习的目的

• 熟悉注意力：
  • 通过体验练习，来访可以直接体验自己的注意力是如何工作的，了解他们可以如何轻松地将注意力从一个事物转移到另一个事物。
• 多样的注意力目标：
  • 练习中包括了内部的、外部的、广泛的、狭窄的、现在的、过去的、具体的、概念性的目标，帮助来访全面了解注意力的不同方面。

3. 实际操作示例

• 对话示例：
  • 治疗师通过一系列词语引导来访将注意力指向不同的目标，来访通过实际操作体验了自己的注意力如何工作。
• 反馈与总结：
  • 来访在练习后反馈了自己的体验，治疗师总结了注意力的特点，强调了正念练习的价值。

总结

在CFT（同情聚焦疗法）中，正念首先是一种处理注意力的方式。通过简单的体验练习，治疗师可以帮助来访熟悉注意力的概念，了解他们可以如何轻松地将注意力从一个事物转移到另一个事物。这种练习不仅有助于来访更好地理解注意力的工作原理，还为后续的正念练习打下了基础。通过正念，来访可以更加意识到自己的体验，不被无益的思想和情感所困扰，从而更好地管理自己的情绪和行为。通过实际操作和反馈，来访可以更好地理解正念的价值，为接下来的正念练习做好准备。

进一步阐述的知识点

1. 正念检查的目的

• 培养习惯：
  • 帮助来访养成将注意力带到身体体验、情绪和思想的习惯，习惯于注意到这些体验。
• 非评判性观察：
  • 帮助来访开始以这些体验本来的样子看待它们——身体感觉、情感和心中的词语或图像——而不对其进行评判。
• 日常生活中的练习：
  • 帮助来访习惯在日常生活中练习正念练习（和家庭练习）——从容易做到的小事开始。

2. 正念与思考的区别

• 正念觉知：
  • 正念觉知涉及注意到当前的体验，如身体感觉、情感和心中的词语或图像，而不是思考这些体验。
• 思考：
  • 思考涉及心中的词语，如“糟了，我的脚又冷了。我应该穿暖和的冬袜。真烦！”
• 区分方法：
  • 通过正念练习，来访可以学会区分觉知和思考，将注意力带回到当前的体验上。

3. 实际操作示例

• 引导来访：
  • 治疗师通过一系列指导语句引导来访将注意力依次带到房间的温度、外部身体感觉、其他感官信息、内部身体感觉、呼吸、情绪和思想。
• 逐步练习：
  • 练习从简单的身体感觉开始，逐步过渡到更复杂的情绪和思想，帮助来访逐步建立正念的技能。
• 记录练习：
  • 治疗师记录练习的音频，来访可以在家练习时听，帮助巩固练习效果。

总结

正念检查是CFT中常用的第一个正式正念练习，旨在帮助来访养成将注意力带到身体体验、情绪和思想的习惯，习惯于注意到这些体验。通过正念练习，来访可以学会以这些体验本来的样子看待它们，而不对其进行评判。此外，这个练习还有助于来访习惯在日常生活中练习正念，从容易做到的小事开始。通过实际操作和逐步练习，来访可以逐步建立正念的技能，更好地管理自己的情绪和思想。通过记录练习的音频，来访可以在家继续练习，巩固练习效果。

进一步阐述的知识点

1. 正念检查的效率

• 快速完成：
  • 第一次练习时，这个过程需要五到十分钟，但随着练习的增加，可以在三十秒到一分钟内完成。
• 灵活应用：
  • 来访可以在各种场合进行这项练习，如电视广告期间、交通堵塞时，或在超市排队时。

2. 正念检查的目的

• 建立习惯：
  • 帮助来访养成定期检查身体、情绪和思想的习惯。
• 非评判性观察：
  • 帮助来访正念地注意到并接受这些体验，正如它们本来的样子——感觉、思想和情感。

3. 练习变体

• 三个圈：
  • 来访可以尝试注意到三个圈（威胁、驱动力、安全感）中哪一个在他们的身体、情绪和思想中最占主导地位，或者对每个圈进行评分。
• 即时检查：
  • 来访可以在注意到特定情绪或一系列思想时暂停进行这项检查。

4. 指导语调

• 平静语调：
  • 使用平静、略带缓慢的语调，但不是为了让来访入睡。
• 自然变化：
  • 自然的语调变化和讲话速度的变化可以帮助来访保持参与练习。

5. 录音和资源

• 录音：
  • 将练习录音，以便来访在家使用或作为提醒。
• 在线资源：
  • 在网站上提供练习和其他资源，方便来访访问。
• 手机应用程序：
  • 许多来访可以使用手机应用程序在会话期间录制练习。

6. 示范和引导

• 会话示范：
  • 在会话中示范如何进行这项检查，帮助来访更好地理解和实践。
• 非羞耻的方式：
  • 以一种不带羞耻的方式向来访介绍谈论和应对情绪体验的方法。

7. 探索和熟悉

• 身体和心灵的体验：
  • 帮助来访探索和熟悉思想和情绪如何在他们的身体和心灵中展开。
• 好奇和管理：
  • 以好奇、可管理和有益的方式接近这些基本的人类体验，这是同情的核心部分。

总结

正念检查是一个高效的练习，旨在帮助来访定期检查自己的身体、情绪和思想。通过正念地注意到并接受这些体验，来访可以更好地管理自己的情绪和思想。这个练习可以在短时间内完成，并且可以在各种场合进行，如电视广告期间、交通堵塞时，或在超市排队时。通过自然的语调变化和讲解，来访可以更好地参与练习。此外，录音和在线资源的提供也方便来访在家继续练习。在会话中示范如何进行这项检查，可以帮助来访以一种不带羞耻的方式理解和应对情绪体验。最终，通过探索和熟悉思想和情绪在身体和心灵中的展开，来访可以以好奇、可管理和有益的方式接近这些基本的人类体验，这是同情

知识点阐述

正念练习的重要性

正念练习是一种心理训练技巧，旨在帮助个体通过全然地关注当下，减少因过去或未来而产生的焦虑和压力。这种练习强调非评判性的观察，即观察者对自己的想法和感受保持一种旁观者的态度，而不是立即对其作出反应。

正念自查与正念呼吸

• 正念自查：这是一种简短的日常练习，旨在提高个人对自己内在状态（如情绪、思维、身体感觉）的意识。通过定期的自查，人们可以更好地识别和理解自己的心理模式，从而做出更健康的应对策略。
• 正念呼吸：作为更深入的正念练习，正念呼吸涉及将注意力集中在呼吸上，以此作为锚定点，帮助练习者在分心时能够温和地将注意力重新引回呼吸。这种练习不仅有助于提高专注力，还有助于减少情绪波动，增强情绪调节能力。

分心与回归

在正念练习中，分心是正常现象，甚至是学习过程的一部分。关键在于认识到分心，并能够温和地将注意力带回到练习的目标上，如呼吸。这种反复的过程有助于训练大脑学会更好地控制注意力，减少不由自主的思维跳跃。

发展同情心的自我

治疗师提到的‘有同情心的珍妮’是指通过正念和其他心理技术，帮助个体发展出更加积极、支持性的自我形象。这种转变不仅能改善个体的情绪状态，还能增强其面对挑战时的韧性。通过持续的练习，个体可以逐渐学会如何在困难面前保持冷静，同时给予自己更多的理解和接纳。

知识点阐述

练习后的跟进

练习后的跟进不仅有助于评估来访的体验，还可以及时解决他们在练习中遇到的任何障碍。通过这种方式，治疗师可以更好地支持来访，确保他们能够在日常生活中持续进行正念练习。此外，治疗师分享自己的练习经验和挑战，可以增强来访的信心，让他们意识到即使是专业人士也会遇到类似的困难，从而减少自我批评。

正念练习的重要性

正念练习是一种心理训练技巧，旨在帮助个体通过全然地关注当下，减少因过去或未来而产生的焦虑和压力。这种练习强调非评判性的观察，即观察者对自己的想法和感受保持一种旁观者的态度，而不是立即对其作出反应。通过持续的正念练习，个体可以学会更好地管理自己的情绪，提高专注力，并在面对困难时保持冷静。

其他正念练习

正念练习不仅限于正念呼吸，还包括许多其他形式，如身体正念、正念进食、正念行走、正念沐浴、正念任务完成和正念运动。这些练习的共同特点是将注意力集中在当下的某个具体体验上，通过无评判地观察和探索，帮助个体更好地理解自己的内心世界。通过多样化的练习，来访可以选择他们感兴趣的活动，从而保持练习的动力。

处理正念训练中的障碍

在正念训练中，常见的障碍包括忘记练习、回避和低动机。治疗师可以通过提前规划和解决这些障碍，帮助来访建立持续的正念练习。例如，建议来访设置提醒、选择合适的时间进行练习，并从短时间的练习开始，逐步增加练习时间。此外，治疗师应以同情和支持的态度帮助来访应对障碍，避免责备和批评，从而增强来访的信心和动力。

知识点阐述

感觉自己像失败者

很多人在尝试正念呼吸时会感到沮丧，因为他们发现自己的注意力很难集中在呼吸上，而容易被各种思绪所分散。这种现象非常普遍，甚至专业的正念练习者也会遇到类似的问题。关键在于，我们需要认识到注意力的游离并不是失败，而是正念练习的一部分。正念的目标之一是学会更多地控制注意力，但另一个同样重要的目标是学会注意到心灵的运动。当思想、情绪和感觉带我们远离呼吸时，我们有机会注意到这种运动，这是非常宝贵的。因此，这些干扰实际上为我们提供了学习的机会，帮助我们更好地理解和管理自己的内心世界。

缓解沮丧的方法

为了缓解来访的沮丧情绪，我们可以提前告知他们，注意力的游离是正常的，不是坏事。我们可以通过以下几种方式帮助来访：

1. 提前告知：告诉来访，注意力的游离是正念练习的一部分，每个人都会经历。
2. 积极的视角：强调注意力的游离为我们提供了观察内心的机会，这是一种学习的过程。
3. 实际的解决方案：建议来访在冥想时准备好纸和笔，记录下那些不想放下的思想。这样可以在不影响冥想的情况下，确保这些思想不会被遗忘。

正念练习的目标

正念练习不仅仅是为了让注意力集中在呼吸上，更重要的是通过这种练习，学会观察和管理自己的内心世界。具体来说，正念练习的目标包括：

1. 观察和接受：学会以接纳和非评判的方式观察自己的情绪和体验。
2. 注意心灵的运动：学会注意到内心的活动，包括思想、情绪和感觉的变化。
3. 控制注意力：逐渐提高对注意力的控制能力，能够在更长的时间内保持专注。
4. 应对困难情绪：学会用注意力来处理和容忍困难的情绪，而不是逃避或压抑。

总结

正念意识是CFT（同情心聚焦疗法）中培养同情的重要基础之一。正念练习帮助来访学会以接纳和非评判的方式观察自己的情绪和体验，注意到内心的活动，并用注意力来处理和容忍困难的情绪。这些能力为后续的同情力量的培养奠定了基础。

CHAPTER 7 Compassionate Awareness: Cultivating Mindfulness

In the layered approach we’re taking to understanding the process of CFT, we began by first con- sidering the therapeutic relationship, in which compassion is modeled by the therapist, who serves as a secure base for clients to begin feeling safe so they can approach difficult emotions and experi- ences. We then spent chapters 4 through 6 developing the next layer—­helping clients develop a compassionate understanding of their emotions in relation to evolution and the developmental factors that shaped them. This understanding is in the service of helping clients relate compassionately and nonjudgmentally to their difficulties—­many of which they didn’t choose or design, but must cope with nonetheless. In this chapter, we’ll consider the next layer of our approach to CFT: mindful awareness. It’s important to recognize that all three of these layers will be present from the begin- nings of therapy, with the relationship developing from the point of initial contact, and the thera- pist weaving in the understanding and mindful awareness pieces even during the first few sessions. Over the past few decades, mindfulness has become one of the most used and studied practices in contemporary psychotherapy. It has provided the basis for mindfulness-­based cognitive therapy (Segal, Williams, & Teasdale, 2001), and has long been featured in other “third wave” cognitive behavioral approaches, including DBT (Linehan, 1993), ACT (Hayes, Strosahl, & Wilson, 1999), and others. A body of evidence supports the use of mindfulness-­based interventions for a host of problems, particularly depression and anxiety (Hofmann, Sawyer, Witt, & Oh, 2010). There are many existing resources for learning about mindfulness and using it in therapy, so I won’t be attempting an exhaustive introduction to mindfulness here. Rather, I’ll briefly discuss the concept of mindfulness and how it fits into CFT, introduce a couple of mindfulness practices commonly used in CFT, and touch on some tips for effectively engaging clients in mindfulness practices.

MINDFULNESS Mindfulness involves a particular sort of awareness. Probably the most common definition of mind- fulness comes from Jon Kabat-­Zinn (1994): paying attention in the present moment, on purpose, nonjudgmentally. Mindfulness means intentionally directing our present-­moment awareness in a way that allows us to see what is before us, both in our external environment and in our minds, exactly as it is. With mindful attention, we refrain from judging, criticizing, clinging to, or rejecting our experience. Rather, we allow ourselves to notice, accept, and curiously explore the contents of our experience—­ whether that experience comes to us from the outside world through our senses, or is the product of our own internal experience, as in thoughts, feelings, motivations, and bodily sensations. With mindful awareness, we allow ourselves to curiously observe all of these experiences—­noticing them for exactly what they are, neither clinging to them nor pushing them away. Mindful awareness can be a very useful ability for clients, particularly those who are haunted by powerful shaming and self-­critical thoughts. The problem is not that they have these thoughts—­to a greater or lesser extent, pretty much all of us do from time to time. The problem is that they ruminate on these thoughts, rehearse them, and believe them. Clients will also sometimes present with powerful emotions that seem to take them by storm, powerfully organizing their bodily experi- ence, attention, thinking, motivation, and behavior in ways we’ve discussed in previous chapters. Such clients can find themselves feeling trapped in the immediacy of such emotional experiences. The experiences can trigger unwanted feelings and problematic behaviors in the present moment, but can also lead clients to fear thoughts and emotions themselves—­potentially leading to the development of unhelpful patterns of experiential avoidance as they try to manage these scary and seemingly uncontrollable mental experiences. Practicing mindfulness can help address these challenges, and help prepare our clients (and ourselves) for compassion. Mindfulness involves numerous potential benefits that are relevant to CFT. Mindfulness training can give clients increased awareness of and control over their attention, helping them learn to direct their attention in helpful ways. It can help them learn to notice move- ment in the mind, to more quickly become aware when unhelpful thoughts and feelings arise. When these thoughts and emotions are noticed, the observing quality of mindful awareness can help keep clients from becoming stuck and fused with these experiences—­instead relating to them as temporary events playing out in the mind and body. In this way, clients can come to understand thoughts and emotions as mental and bodily experiences rather than who I am. Relatedly, the accepting, nonjudgmental quality of mindful awareness can help clients refrain from reacting to or elaborating upon these experiences in unhelpful ways (such as ruminating, or criticizing themselves for feeling anger or thinking certain thoughts that don’t fit with the person they want to be). The ability to mindfully observe one’s difficult thoughts and emotions without either fusing with them or avoiding them by redirecting the attention can also help our clients develop distress tolerance, which is of vital importance for compassion. If we’re going to overcome avoidance and work with suffering, we have to be able to approach it and stay in contact with it while doing so. Mindfulness gives our clients a way to do that.

Preparing Clients to Work with Attention As mindfulness is first and foremost a way of working with the attention, it can be useful to orient clients to this—­to help them get to know their attention a bit before introducing formal mind- fulness practices. This can be done quickly and easily with an experiential exercise in which we prompt clients to direct their attention to different targets—­internal, external, broad, narrow, present, past, concrete, conceptual—­so that they can see firsthand how their attention works. Let’s consider an example of how this might be done: Therapist: Josh, as we discussed in our last session, today we’ll be introducing a practice called mindfulness. Mindfulness involves paying attention in a particular way that helps us to become more aware of our experiences and helps us keep from getting caught up in unhelpful thoughts and emotions. How does that sound? Josh: Sounds like it’s worth a try. Therapist: Great. Before we dive into mindfulness, though, I think it might be useful to get to know what we mean by attention. We can think of attention as the “spotlight of the mind.” That spotlight can be pointed at lots of different things, directing our awareness in different ways. Are you up for a little exercise? Josh: All right. Therapist: Fantastic. I’m going to simply say a series of words—­and when you hear the word, try to direct your attention where the word indicates. So if I say, “Left elbow,” you’ll bring your attention to your left elbow. Got it? Jenny: (Nods.) Therapist: Okay, here goes: Right ear. (Waits two or three seconds.) Left foot. (Waits two or three seconds.) Your tongue. (Waits two or three seconds.) The feeling of your breath. (Waits two or three seconds.) The buzzing of the lights. (Waits two or three seconds.) Your favorite color. (Waits two or three seconds.) Tater tots! (Waits two or three seconds.) Justice. (Waits two or three seconds.) World peace. (Waits two or three seconds.) South America. (Waits two or three seconds.) What you’d like to have for dinner. (Waits two or three seconds.) And allowing your face to form a smile, the sensation of smiling. Josh: (Smiles slightly.) Therapist: What did you notice? Were you able to move your attention where I indicated? Josh: Yeah. It was kind of interesting. Therapist: Excellent. Did you notice how effortlessly you could move your attention around? When you moved your attention from one thing to another, did it happen quickly or slowly? Josh: Quickly. Like, immediately. Therapist: So you were able to very quickly shift your awareness from one thing to another. You may have also noticed how you were able to move the focus of your attention from external to internal bodily sensations, to ideas and memories, to the past and the future. You could also narrow it down to something like your elbow, and widen it onto broad ideas like justice. Josh: (Nods.) Therapist: What do you think? Pretty cool, eh? Josh: (Smiles and offers a slight, good-­natured eye-­roll.) Pretty cool. (Pauses.) Actually, it was kind of cool. I never thought of that before. Therapist: So that was just an example of how we can direct the spotlight of our attention in different ways. Let’s continue to explore that by learning our first mindfulness exercise. MINDFUL CHECKING-­IN The first formal mindfulness exercise I usually introduce in CFT is called Mindful Checking-­In (Kolts, 2012). Mindful Checking-­In involves bringing our attention sequentially to bodily experi- ences, felt emotions, and thinking, in fairly rapid succession. This exercise isn’t meant to be an extended meditation, although clients can certainly spend as much time as they like. Rather, the practice has a few specific purposes: • To help clients develop the habit of bringing their attention to their bodily experiences, emotions, and thoughts—­to get used to noticing these experiences. • To help clients begin to relate these experiences as they are—­physical sensations, feel- ings, and words or images in the mind—­without judging them. • To help clients get used to practicing mindfulness exercises (and home-­practice gener- ally) in their daily life outside the session—­starting small with something they can hopefully do with little difficulty. Let’s take a look at how this exercise can be introduced in a therapy session: Therapist: The first mindfulness exercise we’ll do is called Mindful Checking-­In. Just like before, I’ll prompt you to bring your attention to certain experiences. This time, we’re going to direct attention to body experiences, emotions, and thoughts. Sound good? Josh: Sure. Therapist: In mindfulness, we want to be aware of these different experiences, bringing our attention to them. This is different from thinking about our experiences. So if your foot is cold, mindful awareness would involve noticing that it is cold, and maybe curiously paying attention to what those sensations of coldness feel like—­as if you were going to describe them, or explain what the experience was like to someone who didn’t have feet. That’s different from thinking about having cold feet, which might involves words in our minds like Crap, my feet are cold again. I should have worn my warm winter socks. Darn it! Get the difference? Josh: (Chuckles a bit.) I think so. Therapist: So if you notice yourself thinking instead of observing—­and you probably will—no worries. When you notice that, just try to bring your attention back to the experience. We’ll talk more about the thinking bit and how to handle that later. I’m also going to turn on my digital recorder here so that we can record the exercise in an mp3 that we can load onto your phone before we finish today, so that you can listen to it if you’d like, when practicing at home. Sound good? Josh: Sounds good. I can just record it on my phone right now. Therapist: Great. (Waits a few moments while Josh sets up his phone to record.) First, sit up in an upright, alert posture, with your head up. We don’t want to slump. Allow your breath to take on a comfortable rhythm, and if you feel comfortable doing so, allowing your eyes to close. If you prefer, feel free to keep your eyes open and lower your gaze onto the floor about six to eight feet in front of you, allowing your gaze to soften—­to unfocus a bit. If you need to shift about a bit as we go, or clear your throat, or anything like that, to remain comfortable—­don’t worry about it; just do it. Josh: (Straightens his posture and closes his eyes.) Therapist: Let’s start by bringing our awareness to the temperature in the room. Try to notice sensations of warmth or coolness… (Waits fifteen to twenty seconds)… • Now bringing your attention to external bodily sensations…the feeling of your feet on the floor…legs, buttocks, and back on the chair…the sensation of your hands resting in your lap. (Wait fifteen to twenty seconds.) • Now noticing information coming in through your other senses…sounds coming in through your ears…my voice, the rush of the heating system, the buzz of the lights… patterns of light on your eyelids… (Wait fifteen to twenty seconds.) • Now following these sensations into the body, noticing any internal bodily sensations. Bringing awareness to sensations like hunger or fullness, tension or relaxation, comfort or soreness. Just noticing these sensations, just as they are. (Wait five to ten seconds.) If any of these sensations call out for your attention, let it go to them, settling on the sensation and noticing what it is like… (Wait fifteen to twenty seconds.) • Now bringing awareness to the sensation of the breath. Noticing how quickly or slowly the breath enters and leaves your body. Noticing the heart rate… (Wait fifteen to twenty seconds.) • Following these sensations of arousal or relaxation, shifting your awareness to any emo- tions you may be feeling. Interest? Boredom? Anticipation? Curiosity? Just noticing these feelings as events in the mind. (Wait thirty seconds.) • Now that we’ve brought the attention to our feelings, allowing it to shift to another mental experience…thoughts. Notice any thoughts—­any words or images—­arising in your mind. Thoughts like, Is he going to talk in that slow voice the whole time? Just noticing any thoughts that might be coming through your mind, watching them arise and pass. (Wait thirty seconds.) • And if you like, you might bring your attention to the relationship between your thoughts and emotions…perhaps noticing that when you have certain types of thoughts, certain types of feelings tend to arise as well. Perhaps noticing that when you’re feeling certain emotions, certain thoughts tend to arise. (Pause for thirty seconds.) • And when you’re ready, allowing the breath to take a comfortable rhythm, gently opening the eyes, and returning the attention to the room… The first time, this practice will take five to ten minutes to go through, but we want to let clients know that it can actually happen much more quickly. This practice isn’t designed to be a long meditation—­although it can certainly serve as one if the client wants to spend more time on any of these aspects of his experience. Rather, it is designed to be an efficient way for the client to learn to establish the habit of checking in with his body, emotions, and thoughts. The purpose is to establish the ability (and the tendency) to efficiently notice his bodily experience and what he is feeling and thinking; mindfully noticing and accepting these experiences exactly as they are—­ sensations, thoughts, and feelings. With a little practice, this check-­in can be done in thirty seconds to a minute, as the client efficiently brings his attention to his body, feelings, and thoughts in fairly rapid succession. Learned in this way, the client won’t need thirty minutes on a meditation cushion to mindfully connect with his experiences—­he’ll be able to do it during a television commercial, or stopped in traffic, or in the line at the supermarket. When we’re giving these instructions, we want to use a generally calm, slightly slowed tone of voice—­but remember, we’re not trying to put the client to sleep. I find that some natural variation in vocal tone and speed of speech can help keep clients engaged in the exercise. While the practice is fairly straightforward, it’s also good to record the exercise so that the client can use it (or listen to it for a reminder of how to do the practice) at home. I have this exercise and a few others avail- able on my website so that clients can access them that way as well. These days, many clients will have phone apps that can record the exercises during the session. There are some variations of the exercise that clients may find useful. Once they’ve gotten the basic practice, we can suggest that they check in with their three circles. They can either try to notice which of the three circles (threat, drive, safeness) is most dominant in their bodies, emo- tions, and thoughts, or perhaps rate each of the three circles on a 1-­to-­10 or 1-­to-­100 scale. Again, the idea is to get clients in the habit of noticing how threatened, motivated, or safe they are feeling. We can also suggest that they pause to do this whenever they notice the arising of (or after noticing they are caught up in) a particular emotion or string of thoughts. We can model this in session (for example, “It looks like something is happening for you right now. What’s happening with those three circles? How is that playing out in terms of your bodily experience? What feelings are showing up? What thoughts are running through your mind?”). In this way, we’re introducing clients to a nonshaming way of talking about and relating to emotional experiences that may previ- ously have been experienced as unpredictable and overwhelming. We can use these observations as a platform for helping clients explore and become familiar with how thoughts and emotions play out in their bodies and minds. This can help take the sting out of such experiences as we look closely and curiously at them not as something to fear, but as valid aspects of their experience that we seek to understand. We’re helping clients learn to approach these basic human experiences in a curious, manageable, and helpful way—­which is a core part of compassion.

MINDFUL BREATHING While the Mindful Check-­In gives us an easy way to introduce mindfulness to clients that doesn’t require extensive practice time, there is much to be gained from longer, more meditative mindful- ness practices as well. First, there’s a growing body of scientific literature that supports the ability of such practices to quite literally grow the parts of our brains that are involved with things like emotion regulation and interpersonal relationships. Second, more extended mindfulness sessions are likely to be more helpful in assisting clients in developing attentional control, the ability to notice movement in the mind, and the capacity to tolerate distress. Teaching Mindful Breathing In essence, mindful breathing is a fairly straightforward practice: we’re training the client to settle her attention on the sensation of the breath, and to bring it back to the breath whenever she notices the attention has strayed. Notice and return—­that’s the practice. While different mindfulness teachers will give the instructions in slightly different ways, there are some basic components that tend to be present: • Sitting in an upright, comfortable posture. • Eyes closed, or gaze lowered to a spot six to eight feet in front with an unfocused, or “softened,” gaze, or a gaze focused on the tip of the nose. • Breathing at a natural, comfortable rate. • The attention settled on the breath, wherever it can be found most easily. This can include the tip of the nose, where it enters and leaves the body, the rise and fall of the abdomen, the path of the breath through the body, or any place the client finds it com- fortable to anchor the attention. • When the client notices her attention has wandered—­distracted by thoughts, emo- tions, or sensations—­she gently brings it back to the breath. Some teachers prompt the practitioner to label the distraction: thinking, listening, and so on. • It’s good to set an external timer to remind the meditator that the session is completed. There are numerous meditation timer applications with soothing gong tones that work well for this purpose. Let’s look at an example of how this exercise can be introduced in a session: Therapist: Jenny, I’m glad you found time to do the Mindful Check-Ins we introduced last session this week. How did you like them? Jenny: In the beginning, it was hard to remember to do it. So I started setting the timer on my phone. That really helped. Therapist: Good thinking. What did you notice about the practices? Jenny: One thing I noticed was that it made it easier to get things done. Therapist: (leaning in a bit, with an interested look) Tell me more about that. Jenny: Well, a lot of the time when I start to do something, I’ll have lots of thoughts like, Why should I do this? There’s no point to it. Or I’ll go through all the different ways that it could go wrong. This week, a few times, I was able to notice those thoughts, but keep going anyway. Therapist: So “Anxious Jenny” still had a lot to say, but you were able to let her have her say and keep going anyway. That’s great. Jenny: Yeah. I do find myself wondering when someone besides Anxious Jenny will have something to say. Therapist: No worries—­we’re going to work on developing “Compassionate Jenny” as well—­a version of you that is compassionate, kind, strong, wise, and confident. Jenny: I’d really like that. Therapist: Actually, it sounds to me like Compassionate Jenny is already showing up. That’s the version of you that kept you going even after Anxious Jenny shared her reluctance. Jenny: Hmmm. (Looks a bit thoughtful.) Therapist: We’re going to be sending Compassionate Jenny to the gym, and one way to begin doing that is by introducing that second mindfulness practice we mentioned last session—­mindful breathing. How does that sound? Jenny: Sounds good. Therapist: Mindful breathing is quite literally sending Compassionate Jenny to the gym—­ there are scientific studies showing that practicing mindful breathing over time can actually grow the parts of the brain that help us with managing our emotions and relationships with others. To start, let’s sit up in a comfortable, upright position, head held up but not too high. (Models position.) Jenny: Like this? Therapist: Just like that. This exercise will take a bit longer than the check-­in, so again, if you feel the need to shift, clear your throat, swallow, or anything like that—­ don’t worry about it, just go ahead and do it. You may also find it useful to have your mouth slightly open, with the tongue touching the roof of the mouth just behind the teeth. Jenny: (Shifts a bit.) Therapist: Now, allowing your eyes to close… Jenny: (Closes eyes.) Therapist: Breathing in and out through the nose, allowing your breath to take on a comfortable rhythm—­just breathing naturally, not attempting to slow down or speed up anything. Settling the attention on the breath, wherever you feel it most easily. That could be the tip of the nose where the breath enters and leaves the body, the rise and fall of the abdomen, or following the breath in and out of the body. (Waits thirty seconds.) As you breathe, you’ll sometimes find your attention moving away from the breath as you become distracted by thoughts, sounds, or other things. This isn’t a bad thing. It actually helps us learn to notice movement in our minds. When this happens, whether you’ve been distracted for a moment or for quite a long time, just notice the distraction and gently bring your attention back to the breath, over and over, again and again. This is the practice—­settle the attention on the breath, notice the distraction, gently come back to the breath. Notice, and return. Jenny: (Sits quietly, breathing.) Therapist: (Waits thirty seconds.) Notice the distraction, return to the breath. Therapist: (Waits one minute.) Notice and return. Therapist: (Waits one minute, thirty seconds.) And when you’re ready, gently opening the eyes, bringing your attention to the room. Jenny: (Slowly opens her eyes over the course of thirty seconds or so.) Mmmm. Therapist: So that was three minutes or so after I stopped giving instructions. What did you notice? Jenny: It felt like a really long time. It was relaxing, but also a little frustrating. Overall, I liked it. Therapist: So it felt like longer than three minutes? Jenny: A lot longer. I never just sit quietly like that. Therapist: It can feel like a lot longer, particularly when our minds are used to being so busy all the time. It can take a while for them to get used to sitting quietly, watching the breath. You mentioned a little frustration—­did you find yourself getting distracted? Jenny: 100 That’s when I’d get frustrated. It seemed like I’d be focused on the breath for just a second and then I’d start thinking, over and over again. Therapist: (Smiles and chuckles a bit.) Yep—­that’s just what it’s like! The same thing happened for me when I was learning. Sometimes it still does. Jenny: Really? Therapist: Oh yeah! Sometimes I’ll have really sneaky thoughts—­I’m sitting there like, This is a great meditation session. I’m completely focused on my breath. No thoughts at all. I’m getting really good at this. I’m thinking the whole time! Jenny: (Smiles and laughs gently.) Therapist: It’s easy to get frustrated if our drive system sets up sticking to the breath as a goal. When we get distracted, we think we’re failing at our goal. The key is to remember that one purpose of the practice is learning to notice movement in the mind. And these distracting thoughts give us the perfect opportunity to do this. If we never got distracted, we’d never learn to notice what it feels like when thoughts take us away. So it’s not a problem—­does that make sense? Jenny: That helps. Therapist: Want to try it again—­say, for five minutes this time? Jenny: Sounds good. Therapist: Excellent. I’ll set my timer then, and let’s move into an upright posture, close our eyes, and bring the attention to the breath… The above example demonstrates one way of presenting mindful breathing to clients. Again, assuming that mindful breathing will be assigned as homework, it’s good to record the exercise or to provide the client with links to online mp3 recordings of the practices. Notice that in the vignette above, the therapist introduces the practice by giving brief instructions on how to hold the body and speaking briefly to various obstacles that might come up (instructing Jenny to shift if she needs to, for example).

It’s also important to follow up after the practice, to see how the client experienced it, and to explore, validate, and address any obstacles that may have come up. Notice also that the therapist refers to his own practice, and shares his own challenges with the client, using a bit of humor along the way. Doing so underscores the importance of the practice (it’s important enough that the therapist practices as well), validates the difficulty, and reduces the likelihood of related self-­ criticism (the “expert” therapist sometimes struggles with the same things), and models how to handle such obstacles with good humor (working to soften the implicit frustration response with a bit of levity). Also note how the therapist utilizes the language of CFT, referring to “Anxious Jenny,” “Compassionate Jenny,” and the drive system—­helping shape her mastery of the CFT con- cepts she’s been learning.

One last comment: I strongly, strongly advise, if you’re going to be using mindful breathing (or any other mindfulness practice) in therapy, that you will have practiced using the technique your- self (and optimally will have an ongoing practice). It will give you an experience of the practice to draw upon when explaining it to the client. It will help you observe the obstacles from the inside out, and what it takes to work with them. Finally, mindful awareness itself produces many practical benefits that can potentially improve one’s capacity to be an effective CFT therapist. At a practical level, think about it—­mindfulness and compassion aren’t just therapy “techniques.” They are complex capacities and skills that we’re helping clients develop. Would you choose to learn to play an instrument or a sport from someone who had never played it? While the best practitioners don’t always make the best teachers (and vice versa), teachers should have some mastery of the skills they are instructing.

OTHER MINDFULNESS PRACTICES There are numerous other mindfulness practices our clients might find helpful as they work to bring this purposeful, present-­focused, accepting, nonjudgmental awareness into their lives. Almost any activity or experience can be chosen as a focus of mindfulness. The idea is that we select where we’re going to focus our attention, bringing our awareness to this experience and then nonjudg- mentally noticing and exploring it. Whenever distractions arise, we notice them, and bring the attention back to our chosen focus. Typically we’ll want to start with sensory experiences like the breath, physical sensations in the body, or sensory input coming in from outside the body. However, we can also use mental images or even ideas as the focus of concentration, or we can rest in open awareness, not anchoring the attention to any specific focus, and simply noticing whatever arises in our experience without clinging to or pushing away any of it. Here are a few commonly used mind- fulness exercises: • Mindfulness of the Body—­bringing nonjudgmental awareness to bodily sensations • Mindful Eating—­eating slowly and noticing all sensory aspects of the food or the eating • Mindful Walking—­walking slowly, bringing mindful awareness to all the sensations that come with walking • Mindful Showering—­showering while mindfully focusing on the feeling of water hitting the skin • Mindful Task Completion—­doing tasks like dishwashing or cleaning and mindfully noticing all the sensory experiences one has while completing the activity • Mindful Exercise—­mindfully focusing the attention on physical activity (such as yoga) The idea is to come up with a variety of activities in which clients can apply mindful awareness. We work collaboratively with them to come up with activities that they are interested in, to keep motivation for the practice high. Over time, this sort of mind training can help clients learn to settle the mind, gradually quiet- ing the endless torrent of thoughts as they get better and better at bringing their attention to the present moment. This can pave the way for lots of good things. As clients learn to endure the initial discomfort of sitting quietly with a busy mind, they learn to tolerate distress and persevere when things are difficult, and are reinforced as their efforts begin to pay off. These practices also set the stage for the development of compassionate wisdom. For centuries, Buddhist practitioners have used exercises like the mindful-­breathing practice described above to prepare the mind for more involved analytical meditations—­learning to stabilize the mind so that they could deeply contem- plate things like compassion and the nature of reality. Once our clients have gotten comfortable with the more focused practices, they may wish to take some meditation time to explore the ques- tions that compassionate reasoning will often bring up: What sort of person do I want to be? What do I want my life to be about? How do I want to contribute to the lives of others, and to the world?

WORKING WITH OBSTACLES IN MINDFULNESS TRAINING When presenting clients with practices we’d like them to follow through with, it’s important to troubleshoot around obstacles that might arise. There are some common obstacles that can get in the way when we’re teaching mindfulness—­particularly mindful breathing. The extent to which we can plan for and address these obstacles on the front end can increase the likelihood that clients will be able to establish an ongoing mindfulness practice. Forgetting Perhaps the most common obstacle is simply not remembering to practice. I’d recommend naming this as a likely obstacle when planning the homework to begin with, and working collabora- tively with clients to plan good times to do it (for example, when they will be alert, not sleepy), and ways to prompt themselves (such as setting an alarm): “One common challenge that can come up when learning mindfulness is simply forgetting to do the practice. What do you think might help you remember?” Avoidance and Low Motivation In my experience, if I try to have clients start out by doing thirty minutes of mindfulness prac- tice per day, they often won’t be able do it, and may well not want to do it. That’s a long time for someone with no experience of sitting quietly and watching the breath. We need to remember two things: First, consider how hard it can be to create twenty to thirty minutes of free space in your life to do something new—­even when it’s something you’re motivated to do and know will be very good for you. Not so easy? It’s the same for many of our clients. Additionally, many of our clients (like us) live in overstimulating environments filled with constantly shifting media, electronic gad- getry, text-­message conversations, and so on, that may have tuned their neurological systems to expect high levels of ongoing stimulation. When you’ve adapted to function in the face of an ongoing cacophony of flashing screens, beeping phones, and rapid-­fire interactions, the relatively quiet, inactive state of mindfulness meditation can initially feel disorienting, agitating, or down- right uncomfortable. So what to do? First, we can acknowledge these potential obstacles, so that if and when they arise, our clients understand them as common, completely understandable occurrences and not as some- thing that’s wrong with me. Second, we want to start small. While it depends on the individual client, I’ve often begun with two to five minutes per day of mindful breathing for the first week—­then increasing by five-­or ten-­minute increments, paced according to how the client is feeling and how it’s working. We want to start with a level of practice that can be sustained, and which gives clients a feeling of success when they’re able to complete it. If we start with the bar too high, an initial failure to follow through can kill the client’s motivation. However, if this happens at any point, we can problem-­solve around obstacles with the client—­in nonshaming, nonblaming ways which vali- date that there will often be obstacles that get in our way. Part of working compassionately with life challenges is learning to work compassionately with obstacles: “It can initially be really hard to keep up a mindfulness practice, and there are lots of obstacles that can get in the way. What got in the way of you being able to follow through with our plan? Let’s see if we can figure out something that will help make it easier.”

Feeling Like a Failure If I had a dollar for everyone who has decided to take up mindful breathing and then has given it up soon after, feeling like they “just can’t do it,” I suspect I’d have enough money to fund my research assistants until I retire. The instruction to “settle your attention on the breath, and gently bring it back when you notice that it has wandered” seems like a simple one. It is simple. It’s just not easy. Well-­meaning practitioners will often start out very excited to have this tranquil meditation experience, only to give up in frustration as they observe that their minds are bounding about in every which way, with almost no time in which their attention is actually focused on the breath. Even if our fancy new brains know that our attention will wander and that this isn’t a failure, our old-­brain emotional centers will often register frustration as we find ourselves distracted by thoughts again and again. To soften this tendency, we can let clients know ahead of time that they will become distracted, and that this isn’t a bad thing. It’s really not a bad thing. As I mentioned above, one goal of mindful- ness is to learn greater control over the attention—­and over time, practitioners will be able to keep their attention on the breath for longer and longer periods of time. However, we can emphasize that another goal of mindfulness meditation is learning to notice movement in the mind. When thoughts, emotions, and sensations take us away from the breath, we have the chance to notice this movement—­an opportunity that wouldn’t be there if our attention never strayed. So these distrac- tions actually give us valuable opportunities to learn to notice the arising of thoughts and emotions, to notice when we’ve disappeared into them, and to bring our attention back to the breath when this happens. One last piece: Clients will sometimes struggle with having thoughts that come up during meditation that they don’t want to let go. This happens for me a lot, as I’ll often do my mindfulness meditation in the morning before settling down to write. Thoughts come up that I’ll want to include in my writing. As you might imagine, attempting to hold these thoughts in mind while simultaneously returning to the breath is problematic for the practice. But it’s no problem—­I keep a pad of paper and pen in close proximity to my meditation cushion so that I can jot down any thoughts I want to make sure not to lose. This practice can be useful for clients as well.

SUMMARY Like relational safeness and understanding the unchosen factors that shape how we develop, mindful awareness is an important part of the foundation that underlies the development of compassion in CFT. Mindfulness practices help clients learn to observe their emotions and experiences in accept- ing, nonjudgmental ways; to notice movement in their minds, and to use their attention to work with and tolerate difficult emotions. These capacities set the stage for what will be our focus for much of the rest of the book: the purposeful cultivation of compassionate strengths.