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Mindful Clinical Attention

Mindfulness of connection and close process attention are two elements of mindful clinical attention. They are not distinct dimensions of clinical focus but are, rather, interwoven threads in the clinician’s experience of the patient and of the therapeutic interaction.

In seeking to clarify the essential components of mindful clinical attention in inquiring deeply, several additional points come to mind.

First, mindfulness of connection and exploration of relational suffering come together in inquiring deeply in the framework of relational psychotherapy. It should be emphasized that mindful clinical attention encompasses many layers of the felt sense of being with another, not only the bare attention of mindfulness meditation. It is inclusive of the experience of intimacy or distance, the complex texture of the feelings evoked by the other, and the mental representations of Self and Other. This focus on the experience of connectedness helps illuminate the dynamics of relationship and illuminates the mechanisms by which we get entangled in interpersonal suffering. Mindful clinical attention also helps the patient develop the capacity to self-reflect on the nuances of emotional life. Both process and content of what emerges can be valuable points of focus.

Second, I want to address the question often raised by skeptical clinicians as to whether mindfulness of connection really adds anything new to close process attention. Psychoanalysts, in particular, often tend to think that mindful awareness is already implicit in process of clinical work: isn’t every good clinician necessarily mindful, just by virtue of the conscious and self-reflective work of psychoanalysis?

I do agree that dynamic psychotherapy (and relational therapy in particular) entails a kind of home-grown mindfulness. The felt sense of clinical process is not dissimilar to the intuitive awareness cultivated in mindfulness meditation. However, the reader is reminded that mindfulness is a dimension of awareness, not a discrete state. Mindfulness meditation practice hones the clinician’s capacity to attend with depth and clarity of focus to the here-and-now of the therapeutic relationship.

Inquiring deeply begins from the premise that the human mind is relationally organized. Relationships are the hub around which each person’s life revolves; they are the fundamental point of reference used to make sense of experience. One bottom line in inquiring deeply about relationship which derives from dharma practice is an emphasis on discerning the difference between subjective experience and external (so-called “objective”) reality. Inquiring deeply highlights how the external world is constructed by the internal one (and vice versa); man’s mind mirrors a universe that mirrors man’s mind (Pearce, 1971).

In the clinical vignettes which follow, the reader will be able to see how mindful noticing, investigation, and self-reflection about interpersonal life can be incorporated into the process of working with emotional problems (within relational psychotherapy or by oneself). Sometimes, inquiry arises spontaneously; sometimes the therapist guides the process as a psychotherapeutic intervention or strategy.

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