Why is leading formal mindfulness exercises so stressful? Engage more effectively with this essential component of third wave therapies.

I've been thinking a lot about the rewards and challenges of mindfulness recently. Specifically, leading formal mindfulness exercises in therapy. It took me years to approach leading mindfulness exercises with anything other than abject fear, and I find that it is similarly scary for many of the mental health trainees and professionals with whom I've worked. What is it about leading a formal mindfulness exercise that leads to such stress? I suspect that a lot of it has to do with the imperative to slow down and show up: there is not a lot of room to hide. Of course, showing up without hiding is part of what makes us effective therapists. But this is often not how many of us approach clinical work, at least at first. As a therapist, it is definitely easier to retreat behind a veil of expertise and professionalism, no matter how much this can hurt the therapy.
So, what to do? First, understand the function of formal mindfulness within the therapeutic modality you are using and for the particular person sitting in front of you. In ACT, formal mindfulness exercises are intended to help clients practice present-moment awareness, as attending to internal experiences such as emotions and thoughts is critical to learning how to approach such experiences with willingness. In DBT, mindfulness includes awareness of internal and external experiences (observe and describe skills) while also specifically emphasizing throwing oneself into those experiences fully (the participate skill). This leads to slightly different emphasizes in the types of formal mindfulness exercises you might include in each of these therapies (e.g., in DBT, having clients stand up and sing a song might serve as an excellent participate exercise, while this might be less likely to occur - though certainly not off-limits depending on the intended function - in ACT). Additionally, given the widespread use of the term mindfulness, many clients associate formal mindfulness practices with relaxation or stress reduction, assuming that this will also be the intended function in therapy. Understanding the specific therapeutic processes you are trying to target in any mindfulness exercise you lead will help you effectively choose how to pace, what language to use, when to end the exercise, etc. Recognizing how this practice fits into your overall case conceptualization and treatment plan will also help you tailor the exercise to meet the specific needs of your client.
Engage in a personal mindfulness practice. Is this challenging? Yes. Does it take time out of your day that you could use to watch Netflix? It does. Is it worth it if you plan to lead formal mindfulness exercises in therapy? Absolutely. In addition to the many benefits that mindfulness can offer you personally, practicing mindfulness as a therapist will (a) help you observe what choices others make when they lead exercises, and (b) give you a lived sense of what it is like to participate in formal mindfulness exercises. Hearing how others do it will give you real world examples of effective and ineffective language, pacing, content of the exercise, and strategies for inviting participants into the exercise initially and helping them exit the experience at its conclusion. Do you love how that mindfulness teacher on YouTube sometimes directs participants to attend to the feeling of their breath in their hands? Integrate this into exercises you lead! Do you find yourself jarred by practices in which the leader abruptly rings a bell? Work on gradually reintroducing your clients to the room at the end of exercises you lead. Practicing mindfulness on your own will also give you a sense of what exactly we are asking of our clients. I find that many therapists are surprised or irritated when their clients fail to immediately implement a daily mindfulness practice until they attempt to develop a daily practice themselves. What we are asking of our clients is not easy, and holding a true understanding of that will help you scaffold and validate your clients' efforts much more effectively.
Speaking of which, make sure to participate in the exercise with your clients! I often hear therapists approaching mindfulness exercises as a chance to disengage from the therapy rather than join with their clients, which is actually the opposite of what we want. It's okay to start by reading mindfulness scripts in session, but try to graduate relatively quickly to leading exercises without a script.
You can certainly write short notes that you glance at occasionally, but the real benefit of mindfulness is being in the moment. You can't be in the moment if you are reading from a script. Worse, there is a substantial difference in the felt quality of reading rather than participating. It may seem like a simple change, but shifting to closing your eyes and attending to your own breath/body/emotions alongside your client will allow you to lead the exercise from a more natural place. When you find yourself having a hard time disengaging from the sounds in the room to focus on your breath, make a comment encouraging the client to notice the rise and fall of their belly. When you realize that you've gotten distracted and have been thinking about what to have for lunch, encourage the client to notice their distractions and return their attention to the breath. Your experience is likely not all that different from the experience your client is currently having - use it as a guide to shape the intervention.
Leading formal exercises can be scary, and yet, from a stance of mindful awareness, feelings of anxiety, doubts about your abilities, and embarrassment about the quiver in your voice are all present-moment sensations that can be attended to without judgment. Remember that much of what we are doing in third wave therapies is modeling the experience of being human. Allow yourself to show up authentically as you lead mindfulness exercises and you will create space for your clients to do the same.
Comments