Category Archives: Individual Therapy

8 TIPS to Help Clients Do Homework

Posted June 6, 2018


Preparing for a Provider Appointment

Posted October 23, 2017

It can be sometimes feel daunting to get all of your goals met during your provider appointment. Between your questions and goals, the treatment planning of the provider, and limited appointment length it can feel like there isn’t enough time to get everything accomplished. This can be frustrating and disheartening for individuals who experience chronic pain and medical conditions. To avoid feeling shut down during your appointments, it is important to take active steps in preparing for these meetings. This planning can help to build confidence and sense of control, in addition to working towards efficiently meeting your goals.

Prior to your appointment, take some time to plan ahead. Write down your list of questions and goals. Gather any medical history, medication lists, and any symptom tracking details you have been collecting. It can be helpful to store these details in a folder or binder. Plan out your transportation, and make sure to allow for plenty of time for unexpected traffic or road construction. Will there be parking on or off site? What is the schedule or call ahead policy for scheduling transportation? When you arrive at your appointment, ask your provider to establish the timeline, and share the tools you have gathered and your top priority goals for that meeting. Bring a notepad and pen, and make sure to write down any questions or next steps recommended by your provider. These tips can allow you to not only increase your experience of feeling heard during the appointment, but can also increase your ability to understand the treatment and to follow through effectively afterwards.

Written by:
Morgan Cusack, PsyD
Program Coordinator of Thrive for Mental Health and Chronic Pain Management at MHS

10 Days to a 10-Minute Meditation Practice

Posted March 23, 2017


Click HERE to view the handouts.

Mindfulness Exercises: 73 Ways to Practice the Technique

Posted March 16, 2017

UPDATED: October 17, 2019

Mindfulness is one of the pillars of DBT and has become increasingly important across contemporary therapies. Yet many therapists are at a loss for examples to suggest and use with their clients. Mindfulness Exercises for DBTTaken from Dr. Lane Pederson’s new second edition of The Expanded Dialectical Behavior Therapy Skills Training Manual, enjoy this free list and handout you can use with any client looking for mindfulness exercises…and remember, mindfulness is not what you’re doing, but how you are attending to what you’re doing!

Mindfulness Exercises

CORE CONCEPT: Use these exercises to practice your mindfulness skill

These mindfulness exercises will strengthen your ability to practice mindfulness and happen to be quite enjoyable too! With all of the exercises, remember to engage each of your senses and to take your time. The text following each exercise just scratches the surface. Go deeper and make the exercise your own! During your practice, when judgments, other thoughts, or any other distractions occur, do not fuss over them, but gently turn your attention back to the exercise.

  1. Explore a fruit: Use Observe and Describe to explore an orange. What are the visual features, what does it feel like, and what does it smell like? Now, slowly start to peel the orange and continue to tune in to each sense. Notice any emotions, thoughts, or other experiences that you have during this process, but cling to nothing, instead of staying engaged in the activity. Ultimately, you may choose to mindfully eat the orange.
  2. Create with Play-Doh: Study the Play-Doh container, noticing the writing, colors, and design elements. Slowly peel the lid off the container, and notice the smell. What comes up for you? Notice any associated feelings, memories, or other experiences, and then tum your attention back to the Play-Doh. Feel it in your hands and begin to knead and work it. Notice the texture, the temperature, and whether there are changes in its flexibility as you handle it. Experience the Play-Doh without the need to create anything. (Alternatives: Create what you choose with the Play-Doh, be it an animal, a sculpture, or something else. Let go of judgments as to how the creation is shaping up. Or, imagine you are a child experiencing Play-Doh for the first time. Allow yourself to be immersed in this discovery!)
  3. Connect with a sound: Put on music; listen to the sounds of waves, nature, or another soothing sound; or pick up on the naturally occurring sounds around you (the hum of an appliance, the sound of traffic, or the bustle of a workplace). Close your eyes and tune in to your chosen sound. Stay with the sound, returning to it when a distraction happens, and perhaps notice how you breathe along with it
  4. Guided imagery: Use imagery from a CD, from a website, or recorded from your therapist or another person. Visualize that you are in the place that is being described, hearing the sounds, and feeling the other sensations. Lose yourself in this experience, and, when the exercise is over, bring its benefits back to the present moment.
  5. Create a safe place: Similar to guided imagery, create a place that is safe and comfortable. It may be a room, a cabin in the woods, or an imaginary land where you are protected by fire-breathing dragons! Use your senses to fully enter the safe place. Notice how it looks, paying attention to even the smallest details. Notice the sounds or the silence. How does it feel? Stay in this place for a while, and go there whenever you need to soothe and calm yourself.
  6. Sounds of a bell: Strike a bell or chime, or clang mini-cymbals to create a tone. Listen to the sound until it fades into complete silence. Repeat as many times as you wish. This can be done anytime during the day, before meetings, before meals, or at any other time that you want a break or to return to the moment.
  7. Mindful eating: Strive to eat mindfully each time you sit down to eat. Notice your food, seeing the shapes, colors, and textures. Smell the aromas. Take it all in before experiencing your first small bite. Our taste buds register tastes more vividly during the first few bites. Eat these bites slowly, experiencing the tastes, smells, temperature, and textures of each bite. Chew slowly, noticing the release of flavors and the sensations associated with eating. Continue thoughtfully, deliberately, until you notice feeling satisfied, and then stop and reflect. As they say, if you love food, spend some time with it!
  8. Mindfulness of smell: Gather a variety of scented candles or essential oils and spend some time exploring the smell of each one. Notice the differences and any reactions you have to each kind of smell. Alternatively, disguise the labels on your candles or oils and see whether you or others can guess each scent.
  9. Mindful listening: Pick a song, close your eyes, and listen closely to the music. Follow the lyrics, notice the different instruments, or take in the song as a whole experience. If you have heard the song before, did you notice anything new? Alternatively, pick a song that has a repetitive lyric, phrase, or melody line. Count how many times you hear the reoccurring detail.
  10. Mindfulness of touch: Take any object into your hands. Explore the object with your hands and fingers, feeling the shape(s), texture(s), and temperature of the object. This can be done in combination with vision or done with your eyes closed, focusing exclusively on touch. Alternatively, gather various fabrics such as silk, cotton, wool, and velvet and experience the different feels. Of course, this exercise can be done with any collection of objects (e.g., stress ball, worry stone, sandpaper).
  11. Mindfulness of nature/thunderstorms: Put on a nature CD or the sound of a thunderstorm. Listen and notice what emotions, thoughts, and sensations start to come up.
  12. Mindful walking: Take a walk outside or around your room. Pay attention to the sensation of your feet in contact with the ground. Let go of thoughts, emotions, and other distractions and just walk, as if being mindful of every step is vitally important. Alternatively, play a game and avoid cracks (or step on them) or count steps between fixed objects such as light poles or mailboxes.
  13. Mindful nature walk: Take a walk outside through nature. Notice the sounds and smells. What do you see? Take this time to observe, as if this is the first time you have experienced this scenery and the surrounding elements of nature. When you find yourself getting distracted, come back to the scenery around you.
  14. Objects in a bag: Take a bag and add in various types of objects. Make sure the objects are different in texture and shape. Pass the bag around and take turns using your sense of touch to guess what each object is. Observe and describe the sensations.
  15. Making sounds: Go around the group making funny sounds, one person at a time. Pass the sound from one person to another. Notice and release judgments, staying with the game. Alternatively, break into small groups or dyads and create a mantra (word or phrase to repeat) for relaxation, connection, energy, teamwork, or some other concept. Share your mantras and repeat them as a large group for 1 minute each, noticing the connection between the mantra and the resulting emotions and experience.
  16. Meditate on an object: Find something in the room to focus on and use that object to ground you while you breathe. It could be a painting, a vase, or any ordinary household object. Fix your gaze on your chosen object, staying with it as you breathe. If you get distracted just pull yourself back to the object of focus.
  17. Spaceship: Imagine you have a spaceship that can rocket you to your favorite place, real or imagined. Climb into your ship and count down from 1 0 to 1 and then blast off to your destination. Stay at your destination awhile and practice breathing, and then ride back home via your rocket ship or another means feeling relaxed and refreshed.
  18. Easy and enjoyable sitting meditation: Sit in a comfortable chair, on a park bench, or out on your deck or porch. You are alive! So breathe the air, see your surroundings, listen to the sounds, and feel bodily sensations such as your physical connection to your seat, the air temperature, the breeze, etc. You have no place to be but here. Keep it simple.
  19. Mindfulness apps: Search your smartphone, tablet, or computer for free or inexpensive mindfulness apps. Practice each one you find several times, and share them with your friends and family.
  20. Breathing colors: Choose two different colors, one to breathe in and one to breathe out. Blue works well for the in-breath since it matches the cool feeling of the air coming in. Red works well for the out-breath, as it matches the warm feeling of the air leaving your body. However, choose the colors you want, for the reasons you want. Close your eyes and pair each color with its breath.
  21. Square breathing: Start by breathing in for four seconds. Hold your breath for four seconds, and . then breathe out for another four seconds. Repeat four times.
  22. Deep breathing: Breathe in through your nose and out through your mouth. To increase focus and quiet the mind, you can use a mantra such as “in” for when you breathe in and “out” for when you breathe out.
  23. Belly breathing: Lie down on your back on the floor or in bed (preferred), or sit upright in a chair. Place a hand on your belly, and as you breathe in watch how your belly expands. Breathing in this way promotes deep breathing, which helps to get oxygen into your system. More oxygen helps us relax our bodies and think more clearly. Set an alarm and breathe deeply for a minimum of 1 minute.
  24. Progressive muscle relaxation: Use the classic “squeeze and release” relaxation technique, beginning with your toes and working all the way up to your face. Squeeze each part of your body, holding the tension for a couple of seconds, and then release. Notice both the state of tension for each body part as well as the state of release. Although this exercise works best using your whole body, it can also be condensed to use fewer body parts, such as just squeezing and releasing your hands (making fists and then shaking them out), or by just scrunching up your face before relaxing it. For more directions, search for progressive muscle relaxation scripts online or on YouTube.
  25. Body scan: Use Observe and Describe to scan your body from top to bottom, noting areas of tension and discomfort. Gently dismiss judgments that arise, and take a deep breath into each area of the body where this discomfort exists. Do not have an agenda about changing how these areas feel, but do notice differences that happen as you continue to breathe and connect. Also, notice areas of your body that feel relaxed and comfortable. Breathe into these areas too.
  26. Rigid body/relaxed body: Stand and tighten your body, assuming a rigid and stiff stance. Hold that pose for 10 seconds or more. Then, relax your body and assume a loose, flexible, and comfortable stance. Identify the different emotions and sensations that came up with each pose.
  27. Half-smile (or full smile): Sit in a chair and take a couple of deep breaths. As you continue to breathe, slowly start to turn the sides of your lips upward to make a small smile. Relax your face and take on this more serene look. Notice whether your emotions begin to change, as your face communicates acceptance to your brain. Alternatively, look in a mirror, make a peace sign with your first and middle fingers, and use those fingers to push up the sides of your mouth into a goofy smile. This moment need not be so serious, even if your life sometimes ist
  28. Positive memories: Remember a positive event from your life, and use your imagination to transport yourself back to that time and place. Play it in your mind as if it is a movie, and tune in to your senses to fully enter into the memory. Notice what emotions come up as you immerse yourself in the experience. Let this positive memory have an impact on you.
  29. Compassion for others: Think of a person who has offended you or others with his or her behavior. Imagine what factors would lead a person to behave in ways that hurt or put off others. Or imagine that person as a child or a baby with innocence. Send this person compassion from your heart, wishing them well in this world. Does sending compassion feel different from holding on to painful feelings about this person?
  30. Pictures and judgments: Look at photos in a magazine and describe what comes to mind. What judgments do you notice? Now take a second and describe what you see in a matter-of-fact manner, sticking to the facts. Notice the difference in the experience.
  31. Gratitude lists: Make a gratitude list with everything you can think of on it, both big and small. Mediate on the list for several minutes. Note any changes in your emotions. Alternatively, write a thank you letter to someone, being specific about what the person did to receive your gratitude.
  32. 5, 4, 3, 2, 1 senses: To increase your awareness and ground yourself in the present moment, list five things you see, four things you hear, three things you feel, two things you smell, and one thing you taste.
  33. Standing like a tree: Stand up and pretend your legs· are the roots of a tree, reaching your arms up to be the branches. Start to sway side to side as if you are blowing in the wind. Notice that your legs don’t move, keeping you grounded. Imagine yourself being a tree when the winds of life whip up. Be flexible yet grounded, like strong tree weathers a storm.
  34. Finding your center: Sit upright in a comfortable position and take several deep breaths. On the next exhale lean as far to the right as you can without falling over. Inhale and return to center. Then exhale and lean far to the left. Inhale to the center. Slowly start to repeat, leaning less and less every time. When you finally reach the middle, your center, take several deep breaths and notice what it feels like to be in balance.
  35. Seeking clarity: Take a jar, fill it with water, and put in fine sand, glitter, or another substance that can be shaken up. Once the lid is tight, shake up the jar. Notice the chaos as the sand or glitter moves about the water, with the water being cloudy or unclear. Then, mindfully watch as everything slowly settles, ultimately bringing clarity to the water. Think about the parallels between Emotion Mind and chaos compared to Wise Mind and clarity.
  36. Yoga: Take 5 minutes and assume simple yoga poses (check out a book or video on yoga). Notice your body and remember to breathe as you hold each pose. Just notice emotions, thoughts, and sensations that arise, clinging to none. With practice, this exercise is grounding and relaxing and promotes regulation of body and mind.
  37. Mandalas and coloring books: Mediate on the process of coloring, losing yourself in the activity.
  38. Simon says: This game is all about focusing and sustaining attention. Remember to let go of judgments and have fun!
  39. Jenga: Focus with one mind as you remove blocks and build the tower higher and higher. Notice your connection to removing and stacking the blocks, immersing yourself in the activity. When the tower tumbles, remember that this is the natural outcome of the game.
  40. Categories: Pick a category such as animals or foods and list as many items from that category as possible. In a group setting, go around the circle with each person repeating the items already listed before adding to the category.
  41. Picnic game: Start with the phrase “I am going on a picnic and I’m bringing . .. ” Go around the circle with each person adding something they are bringing, but only after he or she has said all the items that were mentioned before, in order. For an added challenge, this game can be played listing items from A to Z.
  42. Riddles: Buy a book on riddles or search for them online. Contemplate possible solutions. An example: ” I am an ancient invention that allows people to see through walls. What am I?”
  43. 20 Questions: Play 20 questions with a friend, a child, or your family.
  44. Untie knots: Start with string or a shoelace that has been tangled and knotted up. Start to untangle and untie the knots. What emotions come up. Frustration? Impatience? Breathe and practice acceptance as you mindfully complete this activity.
  45. Blow bubbles: Blow bubbles and watch as they float through the air, eventually popping. Notice sensations, such as your breathing, the air you blow into the bubble, and any emotions that arise from the activity.
  46. Play catch: Play this simple game with the goal of being in the moment.
  47. Play catch with categories: Take one ball to throw around a group of people standing in a circle. Pick a category such as countries, music artists, or movie stars. Every time someone catches the ball, they add to the list. If a person cannot add to the list, he or she can create the next category and continue the game.
  48. Energy ball: Imagine a ball as a source of negative emotional and mental energy. Hold on to the ball in your hand and take some time to process what it is like to hold on to your negative energy. Do you want to continue to hold on to it? Tell yourself that you have the choice to let the ball go and put it down. Alternatively, decide to bounce the ball off the floor or wall, imagining the negative energy leaving the ball with each bounce until the ball becomes neutral again.
  49. I spy memory game: Find a page in a magazine full of various objects and take 1 minute to mindfully look over the page. After the minute is up, close the magazine and write down all of the things that you remember.
  50. Write with your nondominant hand: Create an encouraging or coping statement and write it out 10 times with your non-writing hand. Notice any frustrations or judgments that come up and practice releasing them. Engage in the process, noting the level of focus needed to have the writing be legible . ..
  51. Attention to small moments: Small moments in our lives include those that we do not typically notice and those we take for granted. A small moment may be having a cup of coffee or a cool glass of water, spending a moment with a child or pet, or performing any everyday activity that goes by without our attention. Enjoyment, peace, and serenity in life happen in the small moments. Each hour, orient yourself to the small moments that you might otherwise miss.
  52. Focus on senses: Take time to notice what comes through your five senses: what you see, hear, smell, taste, and/or touch. Your senses are your gateway to the world. (See Self-Soothe in Module 3: Distress Tolerance.)
  53. Breathing: We all breathe, and we can all breathe more effectively. Our breath is our anchor and is an excellent way to center ourselves. Take time to breathe mindfully in and out. Stay focused on the sensation of the air coming into your air passages and lungs, holding it, and then letting it out. Use a mantra, such as ” in” as you breathe in and “out” as you breathe out, or count each breath from l to 10, starting over when you reach 10 or if you lose count.
  54. Breathing life cycle: Another way to breathe mindfully is to notice the beginning, middle, and end of each inhalation and exhalation (like how you can hear the beginning, middle, and end of sound another mindfulness exercise). Concentrate on the life of each breath going in and out.
  55. Quiet/still time: Set time aside each day to be quiet and to experience that quiet. Be One-Mindful with the stillness, finding your center and noticing comfort in the moment.
  56. Your favorite song (or album): Listen to your favorite song or album with your full attention. Listen closely to the lyrics and their meaning. Be mindful of each word and phrase. Listen to the sounds of the different instruments. Pay attention to the guitar, bass, drums, vocals, or any other instrument that is central to the music. Notice the production values: Is the song basic or elaborate? Barebones or highly orchestrated? Be mindful of things you have never noticed in music you have listened to many times.
  57. Your favorite show: Watch your favorite TV show, paying attention to the small details. Notice what the actors are wearing, how the sets are designed and decorated, and other elaborate details that go into your show.
  58. The room you know so well: Observe and Describe details that you never noticed about your bedroom, living room, office, or any other place in which you have spent a significant amount of time.
  59. 10 details: Anyplace, Anywhere, pause and Observe and Describe 10 details you would not have otherwise noticed.
  60. Turn down the noise (or embrace it): Turn off all extra sources of noise in your home. If you are not mindfully listening to the radio or TV, turn it off. Work on being present without the competition for your attention. If you are unable to turn down certain noises, practice being mindfully aware of them, noticing them without judgment.
  61. People (or anything) watching: Be a watcher of people, or of anything that might hold your interest. Remember not to judge what you see, but simply let it into and out of your experience like clouds floating through the sky. –
  62. One chore/one task: Do one chore or one task, such as washing the dishes or folding laundry, with all of your attention and care. Be One-Mindful with the experience without adding or subtracting.
  63. “Holding” a feeling: Hold your present feeling like it is a baby. Calming a distraught baby involves compassion and One-Mindfulness. Babies can tell when we are either frustrated or do not want to be with them in the moment. Our feelings are like babies: They too can tell when we either reject them or are not fully present with them. Holding your feeling and being mindful of it will usually cause it to diminish in intensity. If not, consider distraction skills.
  64. Interconnection: Contemplate how you are connected to all of the items around you, to your surroundings, to all of the people in your life, and/or to the universe in general.
  65. Relative thinking: Contemplate the upsides and downsides of any judgment without sticking to any conclusions. See how “good” and “bad” depend on the circumstances and are not fixed.
  66. 5/60: Plan 5 minutes out of every hour to engage in a mindfulness activity. This may include breathing, doing a scan of your body for tension and then relaxing, or one-mindfully accomplishing any task.
  67. Find your center: Before engaging in thoughts and behavior, spend a moment to breathe and find your center. Know that finding your center helps you to access your Wise Mind. Practice the directives of the mantra: Pause, breath, center . . . enter.
  68. Write and release: Write what you would like to let go of on paper and shred it, burn it, or place the paper underwater and watch the ink wash away and disappear.
  69. Lie in the grass: On a day with nice weather, find a patch of lush, green grass in your yard or a park. Lie down, close your eyes, and turn your attention toward the connection and sensations between your body and the grass, feeling yourself supported by the ground. Breathe in the sensations and stay there awhile. Following the exercise, notice what you are feeling. Alternatively, keep your eyes open and gaze at the sky, watching the clouds float into and out of your field of vision. Contemplate the connection between yourself, the earth, and the sky. Take your time in this place, and breathe.
  70. Practice compassion for yourself and others: Sit or lie down in a comfortable spot, and turn your attention to your breathing. As you breathe say to yourself over and over, “May I experience peace and happiness.” Once you have settled into meditating on this mantra, change the mantra to focus on another person by saying, “May (Person) experience peace and happiness.” Continue to breathe as you meditate on this thought from your heart. Extra credit: Make the person you wish peace and happiness to someone you dislike.
  71. Report on your experience or surroundings: Write or narrate what is happening right now with your emotions, thoughts, physical sensations, and/or behavior. In doing so, pretend that you are a reporter giving an objective account to your audience. Notice what it is like to Observe and Describe your experience in this somewhat detached manner.
  72. Explain a task (and then participate in it): Take any daily task or chore, such as making coffee, sweeping a room, or watering plants, and break it down into its component steps. Imagine that you would have to explain how to do this to a child or even an alien, and go into minute detail. Now, actually engage in the task or chore, noticing each step and participating in it mindfully.
  73. Look through a new window: Pick a window in your home, school, or office that you never (or almost never) look through. Sit down and spend 5 or more minutes gazing through the window, observing what is outside. Notice the scenery and whether anything is happening outside the window. Describe the scene and/or action to yourself and connect with it. Extra credit: Contemplate the “windows” in your life you do not or refuse to look through. Wlrnt would you notice if you chose to look through one or more of these windows?


5 Tips for Completing Paperwork on Time

Posted January 30, 2017


1. Routine

2. Consistency

3. Backup Plan

4. Support

5. Reward


Myths About Mindfulness

Posted May 5, 2016

By: Dr. Lane Pederson

Many people, therapists included, have misconceptions about what mindfulness is and what it is not. Sometimes these misconceptions get in the way of engaging in mindfulness practice. Below are some of the most common myths about mindfulness.

• Mindfulness is Buddhist (or some other philosophy or religion)
While a large variety of philosophies and religions promote mindfulness practices, mindfulness is best thought of as a human activity that is owned by no group or person. Mindfulness belongs to us all, and furthermore, mindfulness and its benefits are supported by robust research that clearly shows its psychological, emotional, physical, and performance-based benefits.

• Mindfulness is all new-age-y, wavy-gravy or (insert your judgment here)
For some reason, mindfulness seems to conjure images of people in flowing robes, sitting in serene settings, existing in some unreal world disconnected from your or my reality (admittedly, many photos showing people practicing mindfulness promote those stereotypes). The facts are that mindfulness is for everyone, and that people across all races, ethnicities, cultures, religions, occupations, and socio-economic statuses practice mindfulness.

• Mindfulness is a fad or trend
Mindfulness has been around since the dawn of consciousness, making the Beatles or Rolling Stones look like fads by comparison. Not much stands that test of time. When the end of the world comes, only cockroaches and Keith Richards, practicing mindfulness, will remain. Enough said.

• Mindfulness takes a lot of time
While some advocates of mindfulness stress 45 minutes (or more) of meditation or other mindfulness practice daily, the fact is that you can achieve benefits from taking just a few minutes (or even moments in some cases) to re-center yourself mindfully in the moment. When you consider how much time we all spend distracted by problems, taking a few minutes to breathe or otherwise practice mindfulness is a great tradeoff.

• People who practice mindfulness are always mindful (and effective)
A mindfulness student once saw his teacher eating while watching TV. Angry at the apparent hypocrisy of doing more than one thing at a time, the student challenged his teacher. “You always teach one-mindfulness, lecturing ’when you walk, walk, when you pray, pray, and when you eat, eat,’ and now I see you both eating and watching TV!” The teacher calmly replied, “When you eat and watch TV, eat and watch TV!” Mindfulness does not create perfection, and practitioners will likely experience the benefits but will certainly not always be in the moment. Further, seeking to be ever-mindful means you are clinging to a goal and as such not in the moment.

• Mindfulness is done only during meditation or other mindfulness practice
This myth is one of the biggest, and it is analogous to saying people only move their bodies when they exercise. Think of meditation and other mindfulness practice as exercise for the brain, building the skills needed to collect and focus your attention and then guide your behavior. Just as physical fitness is about developing a healthy body, meditation and other mindfulness practices are about building healthy mental processes so you can be mindful in the moments of everyday life.

• Mindfulness is only about pleasure, peace, and relaxation
While mindfulness can be pleasurable and promote peace and relaxation, mindfulness is also about relating to experiences that can be aversive, uncomfortable, and even painful. Think about how often we try to escape these types of experiences only to make them worse! Perhaps paradoxically, using mindfulness to accept and relate to what is painful can transform it; mindfulness is fundamentally acceptance-based and non-judgmental, which releases the helping of suffering we often dump on pain.

• Mindfulness can turn off problems, or otherwise make them go away
Mindfulness is not about turning anything on or off. Rather, it is about deciding what to focus on and when. What mindfulness can do is offer a way to focus away from your problems when you choose, getting a break, and to focus on your problems when you choose with a different approach that might transform your relationship to them, as mentioned above.

• People with attention-deficit, racing thoughts, intrusive thinking, or other problems cannot practice mindfulness
Even though mindfulness does not turn off or make problems go away, it is a set of skills you can practice to eventually minimize the impacts of these problems on your life. For example, if your problem was racing thoughts, you would simply notice when they distract you (gently and non-judgmentally), and then turn your mind to the chosen focus of your attention. If your problem is attention deficits, then practicing the skill of (re)focusing your attention (i.e., mindfulness) is perfect for you!

• Children, people with cognitive disabilities, or (insert another category of people) cannot do mindfulness
Watch young children eat, play with their toys, and explore. They are engrossed, and there. This is mindfulness. People of most developmental and cognitive levels have the ability to focus their attention and connect to the present moment, and can have that ability fostered. To this end, having a parent, friend, or loved one practice mindful engagement with them will gently pull along their mindfulness skills, even if they cannot explain mindfulness conceptually. For those without abstract thought, we simply make explanations of mindfulness more concrete. Smell the flowers, and blow out the candles.

• You are unable to do mindfulness
See above, and also remember that you already practice mindfulness sometimes, with some things, in some places. Where and with doing what do you find yourself totally connected and inhabiting the moment? Maybe it is when you play an instrument or sport, or when you are doing a hobby, or into the flow of your work. Maybe it’s when you are in your garden, cooking, or connecting spiritually. Use existing times of mindfulness to branch out and develop your skills, remembering that mindfulness is like any other skill-set: You get out of it what you put into it. Practice your practice, and the rewards will come with time.

Practical Advice for Stuck Clients

Posted November 30, 2015

So many of us consult on the intervention level when a client is not making significant progress.  We offer therapists advice like, “try a cognitive reframe,” or “be mindful of the behavioral contingencies,” or offer some other “ingredient” from our preferred therapies that we think will be the catalyst for change.  And why not?  We need interventions to do therapy, and our treatment manuals are basically recipe books full of ingredients that promise results for our clients.  In fact, most seminars rally around a particular treatment manual, and some even go so far to say they have the 5 (or 10) best strategies to help even your most stuck client!

Therapy manuals and their ingredients are important, and we should learn to do our therapies well, but research shows that the interventions we use in therapy actually account for a small amount of the variance in change.

So what influences outcomes more than interventions? 

Unsurprisingly, the therapy alliance is of vital importance.  However, you may be  surprised to learn that the therapy alliance accounts for 5 to 7 times more of the variance in change than treatment manuals and techniques!

Thus, while intervention-based consultation will always have its place (again, we need interventions to do therapy), it may be more wise to consult on the how the quality of the alliance is affecting the outcome.  To this end, consider these three factors related to alliance, ALL of which research shows need to be present for a positive outcome:

1) Relationship: This is the third of alliance most obvious to therapists.  Relationship is definitely about rapport and the therapist-driven variables of authenticity, empathy, and respect.  While providing these qualities along with a nonjudgmental stance seem like common sense, it can nonetheless be difficult at times when working with a stuck client.

2) Agreement on a Goal: Having a common goal for the therapy defines the work and speaks to the active part of alliance.  Often when therapy is not working it is because there is not a shared goal to bind the alliance and create active roles in the therapy.  Ask yourself: “What does the client want?”  Without a shared goal, there is no therapy!

3) Agreement on the Therapy and its Methods as being Legitimate to Reach the Goal/Solve the Problem: This third part of alliance speaks to how successful outcomes result from an interactive connection between therapist, client, and therapy/interventions in the pursuit of the identified goal.  To be effective, agreement on the therapy and methods needs to be based in genuine belief and expectancy on the part of the client and allegiance on the part of the therapist.

Without therapy alliance, virtually no intervention will carry much success. Therefore, whenever you have a stuck client, start with making sure all three parts of the alliance are present and in play!

5 DBT Skills to Enjoy the Holidays

Posted November 18, 2015


1. Build Positive Experience (BPE):

2. Attend to Relationships (A2R):

3. Contributing:

4. Self-Soothe:

5. Participate:

5 DBT Skills for Surviving the Holidays

Posted November 10, 2015






