Welcome back to part two of our discussion about mindfulness-based interventions. Last time, I shared some of my experiences of leading mindfulness groups for Veterans. I also introduced the concept of a Zen koan as a way of approaching the question, “should I be teaching Veterans to meditate?” In the second part of this blog, I will discuss some additional considerations you might want to make when deciding if you should offer mindfulness to your clients. Before we launch into that, did you do your homework? Have you spent some time sitting with your koan since the last blog? If so, feel free to write any questions or considerations that came up during your practice in the comments section.
Here are the considerations that I make when engaging with this koan (I made a fancy Venn diagram to illustrate them for you. You’re welcome.).
Figure 1 Fancy Venn Diagram
The first consideration that I make has to do with my intentions and motivation for suggesting mindfulness to a client. I want to be sure that my clinical decision making process is not being guided by the importance of mindfulness in my life. To make this determination, I think about my conceptualization of my client’s presenting issues and determine if there is a compelling rationale for including mindfulness into the treatment plan. These are a several questions that I have found helpful in this process:
- “What are the main issues that need to be addressed in therapy?”
-“How does my theoretical orientation account for the factors that are maintaining these problems?”
-“In what way would mindfulness address these factors?”
- “Am I thinking about suggesting mindfulness simply because I have found it helpful?”
If it seems that my motivation is sound and there is a clear rationale for including mindfulness into the treatment plan, I move on to considering my level of competence. Here are some questions that could be helpful in this domain:
- “Have I been maintaining my personal mindfulness practice?”
- “What training do I have in the mindfulness-based interventions that I am considering?”
- “Do I have the necessary training and experience to provide these interventions with fidelity?”
- “Are there other, more appropriate professional or community-based resources that will be able to provide my client with instruction in mindfulness-based practices?”
Best Practice Guidelines:
We have limited time with our clients, and it’s incumbent upon us to provide the absolute best care available within these time constraints. Luckily, we are living in an age where there are evidence-based treatments for PTSD, Major Depressive Disorder, Insomnia, and many other presenting issues common among Veterans and Service members. We should take this into account when developing our treatment plans. Here are some questions that help me to think about this issue:
- “What are the evidence-based treatments for my client’s presenting issues?”
- “Do I have the training necessary to provide these treatments?”
- “Have I offered these treatments to my client?”
- “Have I done an adequate job informing my client about all of the available treatment options?”
- “Is it possible to provide an evidence-based treatment to my client and also refer them for adjunctive, mindfulness-based treatment or vice versa?”
After thinking about these questions, I usually chat with a trusted colleague before making a decision. Then, I have a frank discussion with my client about the pros and cons of including mindfulness practice into their treatment plan, and we make a collaborative decision about what to do. As you can see, this decision is likely to be different depending on many different factors. Koans don’t lead to simple rules to follow in every circumstances. They challenge us to really appreciate what is appropriate in this situation.
If you are interested in using mindfulness-based interventions with Veterans and Service members, I hope that this two-part blog has challenged you to think more deeply about this prospect. Ultimately, the choice about whether or not to incorporate mindfulness into therapy will be made collaboratively between you and your client. However, I strongly urge you to be honest with yourself about your motivation, level of competence, and commitment to providing evidence-based psychotherapy to your clients. Our Veterans and Service members deserve the best care available. Sometimes that will include mindfulness. Many times, it probably won’t.
Thanks for reading! If you are interested in continuing this discussion and learning more about recent developments in the provision of mindfulness-based interventions to Veterans and Service member, I hope that you will join me on May 11 for CDP Presents for my webinar entitled, “Promising Mindfulness-Based Interventions for Service Members and Veterans to Promote Resilience and Address Post Traumatic Stress.”
Andrew Santanello, Psy.D is a licensed, clinical psychologist and CBT trainer at the Center for Deployment Psychology. Dr. Santanello joined CDP after over a decade of service in the Veterans Health Administration where he was a staff psychologist in the Trauma Recovery Program.