Tag Archives: Elisha Goldstein

Mindfulness, Children and Parenting: An Interview with Amy Saltzman, MD

Elisha Goldstein’s, Ph.D. Psych Central, Mindfulness & Psychotherapy blog interview with Bridging the Hearts and Minds of Youth conference workshop leader Amy Saltzman,MD about her work and research with children and teens.

By Elisha Goldstein, Ph.D.

The theory and practice of mindfulness as a way for children to calm their busy minds, self regulate, become more hopeful and happy has been an area of increasing interest. The potential impact on our culture is great as it affects future generations.

It’s my pleasure to bring you this interview with Amy Saltzman, MD a holistic physician in Northern California who has been integrating mindfulness with children and teens for many years. Her current research has found significant impacts on children in the areas of attention, anxiety and compassion. I’ll be watching Amy speak at Bridging the Hearts and Minds of Youth Conference in San Diego on February 4 -5.

Today Amy talks to us about what the still quiet place is for children and teenagers, the impact of her research with children, and a little practice and advice to help us parents, caregivers and teachers along the way.

Elisha: What is the “Still Quiet Place” within for children and teenagers?

Amy: The Still Quiet Place is a way for children and teens to experience pure awareness. Awareness is a concept that may not make sense to young children. However, with guidance most children can discover that stillness and quietness (aka awareness) is alive inside of them. When I introduce mindfulness to children I begin by inviting them to attend to the breath– the feeling of the expansion of the in-breath, the stillness between the in-breath and the out-breath, the release of the out-breath, and the stillness between the out-breath and the in-breath.

They are encouraged to rest in the stillness, and to realize that this stillness and quietness is always with them—when they are breathing in, when the breath is still, when they are breathing out, when the breath is still, when they are frustrated with a math problem, or angry with someone, when they are doing sports, playing an instrument, or hanging out with friends. This stillness and quietness is always with them. They can rest in this stillness and quietness whenever they want. And when they rest in their Still Quiet Place they can observe their thoughts and feelings and then choose their behavior.

Elisha: Give us an overview of your research that originally started with Philippe Goldin, PhD at Stanford and now with renowned neuroscientist Amishi Jha PhD in working with young children and mindfulness.

Amy: This research, which will be published soon, looked at the benefits of offering mindfulness to children in 4th-6th grade and their parents. The children and parents participated in the Still Quiet Place course, an 8-week age-adapted mindfulness training. After becoming familiar with the Still Quiet Place they are supported in learning to rest in the stillness and quietness and observe their thoughts, feelings, physical sensations, and impulses. Through home practice and group discussion we explore how these observations allow us to choose our behavior, especially in difficult circumstances.

For example, say a student is really struggling with math. When he becomes aware of his struggle he could take a few deep breaths, settle into his Still Quiet Place, and observe his experience- a feeling of frustration, showing up in his body as a headache, and tight shoulders, and showing up in his thinking as what I call Unkind Mind- “I am stupid. I can’t do this. I am never going to get this….” Resting in his Still Quiet Place he can remember that “thoughts are just thoughts, and I don’t have believe them or take them personally” and then he can choose what he wants to do next. Take a quick break and get a snack, go for a run, call a classmate, check-in with his teacher in the morning, etc…

As for the results of our research, we showed that after 8 weeks of learning these skills the children had documented decreases in anxiety, and improvements in attention on an objective, computerized attention assessment called the Attention Network Task (ANT). In their own words the students reported decreased emotional reactivity, and increased ability to deal with day- to-day life challenges. Interestingly, the parents demonstrated similar improvements even though the “dose” of mindfulness was lower than that of a typical adult course. And most importantly for parents they experienced increased parenting self-efficacy; this means they felt they were more effective parents.

Elisha: What is an example you have that can show us how mindfulness has helped a child you’ve worked with to handle unhealthy stress?

Amy: This story demonstrates that mindfulness is a practice lived moment by moment. When we met, Malia was a lovely, very bright 4th grader and a competitive gymnast. She felt pressure, mostly self-induced, to perform well both in school, and in the gym. Her stress was so severe that she was suffering from migraines. After 4-6 sessions of learning to rest in her Still Quiet Place, attend to her breath, her thoughts, her feelings and her physical sensations she was able to happily participate in both school and gymnastics for about a year.

A year later, as she approached the state meet, her stress and headaches returned; she wanted to quit gymnastics. She let her family know and they called me. As we explored this it became clear that she was afraid of letting herself, her parents, and her coach down. She thought they would be angry if she didn’t perform well. Interestingly, given her level of distress, I initially considered that her assessment of her parents’ and her coach’s expectations was correct, and my basis was that if she were simply competing to fulfill others expectations, it would be healthier for her to quit.

However in discussing it with her parents they felt strongly that they wanted her to see the season through, not to perform at a certain level, rather to learn that she could move forward in the face of fear and distress. With my support her parents were able to hear her distress, minimize mixed messages, clarify why they wanted her to finish the season, and most importantly clearly express that that they loved her no matter what.

That reassurance, along with a funny tailored ritual, allowed to her compete in the state meet with both joy and success The ritual developed out my asking what pre-meet routine would help her remember that her parents loved her regardless of her performance. She said she wanted her dad to make her bacon before the meet. So their code word was “bacon”. As she approached each event she would look at her parents and they would mouth “bacon” to her. This of course made her smile and relax, and reminded her that they did love her not matter what.

When I wrote Malia to ask if I could use her story she wrote back

Dr. Amy,

Yes, you can use my Bacon Story and you can also use my name or I like the name Molly instead of Lilly.

By the way, I have quit gymnastics. I think I might like to try ‘excel’ gymnastics which is less hours a week and a more fun and relaxed competitive program. But right now I’m not doing anything so I can rest my foot and do physical therapy. I miss gymnastics but I don’t miss the practices. I miss bouncing on the trampoline and doing cartwheels.

Malia

This is a beautiful example of family mindfulness. Malia was aware of and expressed her feelings. Her parents heard her, and expressed their values, and their love. They created a joyful, humorous mindfulness ritual which will serve them well for a long time to come. Together they are practicing choosing freshly in each new moment.

Elisha: What is the message you give to parents who seem to be struggling with managing the children and stress?

Amy: As parents we need to recognize that our children’s lives are stressful, and that we contribute significantly to that stress. In fact research from Dr. Georgia Witkin at Mt. Sinai hospital in New York showed that the greatest source of childhood and adolescent stress is not school work, extracurricular activities, or peer pressure, but parental stress. So as parents one of the best things we can do to decrease our children’s stress is to decrease our stress. And of course one the best ways to do that is to take a mindfulness based stress reduction course, or perhaps use the excellent Mindfulness-Based Stress Reduction Workbook you co-wrote with Bob Stahl.

When we as adults learn mindfulness—paying attention here and now with kindness and curiosity and then choosing our behavior, we can support our children and teenagers in bringing these skills into their lives. If we are in the present, we aren’t worrying about our third grader getting into college and we aren’t passing this stress onto them in our day-to-day interactions. If we learn to witness our anger, fear and sadness with kindness and compassion we show our children that this way of working with intense emotion is possible. If we slow down and choose how to respond to a difficult situation in daily life, and especially if we do it during challenges with our children and “out loud,” “Honey I am really frustrated, that you did X again, I am going to take a few minutes and then we can discuss this.” Then they see that they can do the same with various difficulties. Children learn what they live; the best way to support them in practicing mindfulness is to practice ourselves.

Thank you so much Amy for your important work and what a wonderful message.

To learn more about Dr. Amy’s work visit her at The Still Quiet Place.

NEWLY ANNOUNCED FROM THE UCSD CFM

A Course in Mindful Parenting

UCSD Mindful Parenting Program
A 2-hour workshop in mindful parenting for those who are interested in learning about mindfulness or for those who have participated in a Mindfulness-Based Stress Reduction (MBSR) course.

Elisha Goldstein, Ph.D. is a clinical psychologist in private practice in West Los Angeles and is author of the upcoming book The Now Effect, co-author of A Mindfulness-Based Stress Reduction Workbook, Foreword by Jon Kabat-Zinn, author of the Mindful Solutions at Work App, the Mindful Solutions audio series, and the Mindfulness at Work™ program currently being adopted in multiple multinational corporations. Join Elisha Goldstein’s Facebook Community to keep up with important information, tips and events.

Mindfulness, Hypnosis and Psychotherapy: Where do they meet?

The following is the next in a series of informal conversations between Trudy Goodman, Ph.D., Elisha Goldstein, Ph.D. and Steven Hickman, Psy.D., the teachers for a unique upcoming professional training retreat entitled “Mindfulness in Psychotherapy” to be held October 2-7, 2011 at the Joshua Tree Retreat Center in Southern California. Enjoy! Today, Trudy Steve and Elisha talk about the relationship between mindfulness and hypnosis in psychotherapy and beyond.

Trudy Goodman, Ph.D.

Trudy: (I recently had an opportunity to explore the differences and similarities between mindfulness practice and hypnosis with a client. I thought it might be worth exploring here in our ongoing conversation on mindfulness and psychotherapy.) 

In mindfulness practice, we give our full attention to one subject at a time as a way of training our minds to be attentive to another dimension of awareness, “beneath” the discursive consciousness and the thinking mind (what the hypnotherapist calls executive functioning), and yes – the protective activity of the amygdala can be activated and trained via conscious, mindful breathing for example. Meditation does mirror the receptivity of hypnosis in this way.

In hypnosis, one is led and taught how to drop down beneath the flow of habitual patterns of thinking and perception to a receptive, open state where the therapist’s suggestions can be embedded and incorporated into conscious living. We are doing something similar but different, too. We may also invoke the relaxed, alert, receptive altered state, but we emphasize investigation, inquiry, and looking deeply at what is arising (with the intention to understand, rather than to judge, and the accepting, non-judgmental approach is similar in hypnosis).

One difference is that with mindfulness meditation we are learning how to be both receptive – open, relaxed, alert; and active – forming the intention to stay with experience as it arises and passes away. One goal of MBSR training is to establish and cultivate mindfulness — your ability to direct your awareness intentionally towards what is actually happening, in real time, moment by moment, so you can receive more information, understanding, and compassionate insight as your life unfolds.

There’s no conflict between what your hypnotherapist tells you and what we’re doing because we are actually engaging many capacities of consciousness simultaneously when we focus on one thing at a time – many cognitive and emotional qualities come into play, like the intention to aim or direct awareness, to sustain a close connection with the subject of awareness, AND with awareness of the ebb and flow of mindfulness itself – a kind of meta-awareness – with clear comprehension combined with the suffusion of warmth, acceptance, kindness, even affection, into our mindful awareness of ourselves, others and our world.

So yes, your mind can and does operate on more than one level at a time. What we are doing is bringing more and more of this activity into conscious awareness. We are cultivating strong mindfulness and metta, enabling us to make more conscious choices about the way we relate to experience.  Hopefully, wise choices that result in our living committed, compassionate lives, and enjoying more peaceful, harmonious, loving relationships along the way!

Steve: While I am no expert in hypnotherapy, I do have a strong sense that both mindfulness and hypnosis share an interest in helping people “get out of their own way” in regard to longstanding but dysfunctional, limiting or unskillful habits, attitudes and behaviors. The single-pointed, quiet and patient focus of both practices allows us (both client and therapist) to see these habitual patterns against a plain backdrop of awareness, rather than the cluttered one of everyday busy-ness.

I liken our attempts to make sense of our problems with our typically distracted, multi-tasking minds to trying to watch a movie when someone is trying to carry on a conversation with you at the same time. Both the movie and the conversation might make sense in their own rights, but together they become a mass of conflicting and confusing features that seems completely overwhelming and sometimes discouraging. Mindfulness practice (and therapy) allow the client to develop the attitudinal skills to observe this chaos and respond patiently and kindly, and the attentional skills to direct attention (and psychological resources) toward the “real” issues and perhaps away from imagined or feared ones. This shift can allow a person to see things for what they are, and to recognize where the constructions and stories that we all create are just that: creations, and not facts to be dealt with or resolved.

I am told that hypnosis cannot bring about behavior that is not first desired by the patient or client. If someone does not truly want to change a particular behavior, hypnosis has no magical ability to transcend that desire. Similarly, intention is at the heart of mindfulness in psychotherapy. We seek to tap into the natural intention that each of has to move toward ease, kindness, compassion and fulfillment, by reducing the “obscurations” of habit and conditioning, and thereby reduce suffering. Not much difference between hypnosis and mindfulness in that, is there?

Elisha: I want to make sure we’re differentiating here between mindfulness as a way of life and formal meditation practice. We can practice mindfulness in formal and informal ways and I think the guided formal meditation practice is the one that can be confused with hypnosis. Having been the recipient of both, I would say the big difference for me is that mindfulness is couched within a much larger context and can be seen as a way of life. Not in any dogmatic religious way, but as a philosophy and practice that we can bring into all the things we do.

Mindfulness at its core trains the mind to more actively drop into a kind attention, cultivating a natural warm presence to bring with us throughout our days. In my opinion, this is at the core of self-healing.

Mindfulness also brings people together in community who are interested in living a more present and compassionate life. This may be one of the most important pieces. Ultimately it’s my belief that the most helpful way for people to make change is through a community of peers who support them with this. I see people who engage with mindfulness in psychotherapy and beyond having an inclination toward wanting to be a part of a community that supports a more mindful life.

We invite you to join in this conversation.  Please share your thoughts, questions and stories below. Your interaction creates a living wisdom from which all of us can benefit. As these conversations accumulate, we are collecting them on a separate page of our blog (see the tab above labeled “Mindfulness and Psychotherapy” for the archive) for review and comment. Visit the UCSD Center for Mindfulness Professional Training site for information on Mindfulness in Psychotherapy retreat training.



How Does MindLESSness Inform Psychotherapy? Join the Conversation Amongst Teachers

The integration of Mindfulness and Psychotherapy is a topic of fast-growing interest among clinicians and clients worldwide. The following is the first in a series of informal conversations between Trudy Goodman, Ph.D., Elisha Goldstein, Ph.D. and Steven Hickman, Psy.D., the teachers for a unique upcoming professional training retreat entitled “Mindfulness in Psychotherapy” to be held October 2-7, 2011 at the Joshua Tree Retreat Center in Southern California. Enjoy!
 
In the first of a series of conversations,  Steve, Trudy and Elisha talk about the importance of mindlessness in the therapeutic session.

Steven Hickman, Psy.D.Steve: Today as I worked with a particularly frustrating client whom I experience as quite intransigent and unwilling (unable?) to make change despite constantly extolling his desire for things to be different, I was caught off guard. I had just pointed out his apparent lack of motivation to change (in appropriately therapeutic terms), and he replied by asking in a slightly defensive tone of voice, “Do you talk to all your patients like this?” I’m embarrassed to admit it, but he called me on my mindlessness in that session. Fortunately, I was able to make use of the moment clinically.

Call it countertransference if you like, but for that period of time I was not responding to the human being sitting across from me (and suffering, I might add), but was marching to the beat of some other drummer of my own mind’s making. It strikes me now that it is in these moments of having our mindlessness become vividly apparent, that we actually become more fully mindful, just as when we notice that our attention has wandered in meditation, we are actually as present as we can be! It seems that mindFULness actually becomes most apparent against the backdrop of mindLESSness. What do you think?

Elisha Goldstein, Ph.D.Elisha: There’s a very common misunderstanding in the practice of mindfulness that the practice is to stay focused on whatever we’re paying attention to and deviation from that is “bad” mindfulness. In my personal experience in session with a client or out of session in my own life, it is these moments that I wake up to recognize that I’ve been drifting that seem the most valuable to me. Why? It is this precise moment that I wake up to the fact that I have a choice to intentionally practice cultivating a sense of presence once again and this, in  my mind, is the foundation to mindfulness and psychotherapy.

Presence may be something that some people naturally have more than others, but the truth is, it’s a skill and we can all cultivate it through practice. For better or worse, our brains seem to make things more habitual after they are practiced and repeated. So we need the moments where we’re drifting off the path of being connected to the moment to exercise that intentional muscle of nonjudgmentally guiding our attention back to being present with what’s here.

Trudy GoodmanTrudy:   Since psychotherapy is a relational process, I look at the times of ‘mindlessness’ as a time of disconnection in the relationship. What’s interesting about drifting away from being present in the relationship is to look at what was happening the moment before, when I was still present? And what is happening now, when my attention has wandered away? Where did it go? And how might this be a mini/micro re-enactment of the client’s conditioned relational patterns, or my own?

Rather than see this temporary disconnect as a failure to practice either mindfulness or psychotherapy well, these times actually provide an opportunity to understand the relationship better. If, as the late psychoanalyst Paul Russell suggested, we define resistance as the therapist’s resistance to what’s happening in the clinical encounter, mindless disconnections can get much more interesting! What’s going on in the moment that makes us turn away in restlessness, boredom, frustration? What’s being revealed about the relationship?

As clinicians, we work to cultivate our own mindful presence in a way that is suffused with compassion towards oneself and others, so that we can choose more wisely how to respond to such moments of disconnection. Mindfulness offers us a bridge back to adjusting our stance as therapists to be more continuously curious, congruent and caring. Moments of mindful awareness are quite accessible, but continuity of this quality of compassionate presence has to be consciously chosen, intended, and developed through our own meditation practice.

For me, working with this kind of authentic attentiveness – while staying open to learning about myself in the process — is an act of love. And love is part of what mindfulness meditation is all about! Wisdom and clarity without compassion and love is like a bird with one wing. We need two wings to ‘fly’ in all our relationships — clinical, professional and personal. How wonderful that even moments of mindlessness can be a bridge to insight, to understanding what gets in the way of loving. Mindless moments of disconnection, when met with kindness and curiosity, can teach us how to connect and be wholeheartedly present with ourselves and all those whose lives we touch, just the way we are.

We invite you to join in this conversation.  Please share your thoughts, questions and stories below. Your interaction creates a living wisdom from which all of us can benefit. As these conversations accumulate, we will collect them on a separate page of our blog for review and comment. Visit the UCSD Center for Mindfulness Professional Training site for information on this and other trainings offered.

Letting everything become your teacher… absolutely everything!

“I’m going to give you a little advice. There’s a force in the universe that makes things happen; all you have to do is get in touch with it. Stop thinking…let things happen…and be…the ball.” – Ty Webb (played by Chevy Chase in the 1980 comedy Caddyshack)

By Steve Hickman
It’s not every day that you find 80s screwball comedies referenced in articles about mindfulness, so you’ve got to give me credit for even trying. Hang in there and see if you find any wisdom in this silliness. Who says meditation has to be so serious, anyway?

If you are a psychotherapist, then perhaps you recognize those moments with clients or patients when you don’t quite feel like you are JUST a therapist, but that your presence seems to transcend that role. It is as if your manifestation in the room extends beyond simply a treatment plan, case conceptualization or intervention. You have the sense that what is at work is something larger than that, that you are holding a space of equanimity, patience, non-judgment and curiosity that is allowing this person before you to finally have an opportunity to experience themselves and their troubles in a wholly different and powerful way. There is a palpable sense of healing taking place, a felt sense of transformation unfolding in the space you have created together.

In those moments, I believe that we ARE the mindfulness of the healing relationship, the therapeutic field. We don’t DO mindfulness in psychotherapy, we ARE mindfulness in psychotherapy. It just happens.

But is it possible to not only notice it when it happens, but increase the likelihood that it will? Can we learn to cultivate mindfulness in psychotherapy in such a way that we are more effective to our clients and patients, as well as happier, more satisfied human beings in our own right?

I think we can, although I also think that it’s not entirely clear how to go about making this happen. It goes beyond simple instruction to “BE the mindfulness (i.e. “BE the ball.”). It probably arises out of practicing mindfulness intensively, regularly and systematically to create a foundation of personal mindfulness from which we then practice psychotherapy. And then perhaps we can learn some ways to work from that platform to facilitate our day-to-day therapeutic work to infuse it with presence, non-judgment, equanimity and all the rest, for the betterment of those who seek our services.

This exploration fascinates me, which is why I sought out my esteemed colleagues Trudy Goodman and Elisha Goldstein to create and offer a professional training retreat on Mindfulness in Psychotherapy. This training, if you are interested, will be offered on October 2-7, 2011 at the Joshua Tree Retreat Center in Southern California, and will combine mindfulness practice with an exploration of the process of integrating mindfulness into therapeutic presence, mindfulness-based interventions and individual or group psychotherapy.

But my purpose in writing this piece was not solely to promote this training retreat. Instead it was to invite you to consider how you ARE the mindfulness of the therapeutic relationship and perhaps to offer your own comments on this topic. What do you do to integrate mindfulness into your clinical work? Do you think there is benefit in “Being the ball”?

I’m truly curious about your take on this topic. I’m basically a curious guy. “So I got that goin’ for me, which is nice.”