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MINDFULNESS AND SELF-DEVELOPMENT
IN PSYCHOTHERAPY
Seth Robert Segall, Ph.D.
Cheshire, Connecticut
ABSTRACT: This article explores how the Buddhist concept of mindfulness and techniques for fostering
it can, when expropriated by Western clinical psychology, play a valuable role in self-development in
psychotherapy. Mindfulness practice expands the field of awareness, allowing for improved monitoring
of somatic and affective experiencing, and thereby enhancing the capacity for self-regulation of arousal,
affect, and behavior. It facilitates the development of a sense of embodiment and the capacity to tolerate
and accept painful experience. It promotes the self-monitoring and decontextualization of automatic
thoughts that serve to sustain pathological structures. Mindfulness also facilitates the development of inner
resources that help stabilize affect and reduce impulsivity. Case examples of the use of mindfulness-based
techniques in individual and group therapy sessions illustrate these points.
Mindfulness is a skill derived from Buddhist meditative practice that the scientific
literature suggests may be of benefit in the symptomatic relief of chronic pain
(Kabat-Zinn, 1982; Kabat-Zinn, Lipworth, & Burney, 1985; Kabat-Zinn, Lipworth,
Burney, & Sellers, 1985; Kabat-Zinn et al., 1986) and anxiety (Kabat-Zinn et al.,
1992; Miller, Fletcher, & Kabat-Zinn, 1995; Roemer & Orsillo, 2002; Toneatto,
2002), the prevention of relapse in recurrent depression (Teasdale et al., 2000; Segal,
Williams, & Teasdale, 2002; Ma & Teasdale, 2004), the treatment of addictive
disorders (Marlatt, 2002; Breslin, Zack, & McMain, 2002; Kavanaugh, Andrade, &
May, 2004; Marlatt et al., 2004), borderline personality disorder (Linehan, 1993;
Robbins, 2002), binge eating disorder (Kristeller, 2003b), body image disorder
(Stewart, 2004), posttraumatic stress disorder (Urbanowski & Miller, 1996; van der
Kolk, 2002), and stress-related medical disorders such as psoriasis (Kabat-Zinn
et al., 1998). Mindfulness may also be of value in improving quality of life in cancer
(Speca et al., 2000; Carlson et al., 2003) and traumatic brain injury patients (Bedard
et al., 2003), and in supporting immune system function (Robinson, Mathews, &
Witek-Janusek, 2003; Davidson et al., 2003). It has also been of suggested value in
increasing positive hedonic tone in non-clinical populations (Easterlin & Carden˜a,
1999; Davidson et al., 2003), reducing stress in professional caregivers (Shapiro,
Schwartz, & Bonner, 1998; Rosenzweig et al., 2003; Cohen-Katz et al., 2005a;
Cohen-Katz et al., 2005b) and promoting changes in brain function (Davidson et al.,
2003) and structure (Lazar et al., 2005). Efforts have also been made to extend the
use of mindfulness meditation to populations that span the age spectrum from
childhood (Ott, 2002; Wall, 2005) through old age (McBee, 2003; Smith, 2004).
Ruth Baer (2003) reviewed the experimental literature on the quantitatively assessed
value of clinical mindfulness applications and concluded that ‘‘mindfulness-based
interventions may help alleviate a variety of mental health problems and improve
psychological functioning’’ (p. 139). A meta-analysis of mindfulness studies
Email: seth.segall@yale.edu
Copyright Ó2005 Transpersonal Institute
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2 143
(Grossman et al., 2004) also supported the value of mindfulness-based stress
reduction in a broad range of chronic disorders. Future quantitative studies of
mindfulness will no doubt be aided by current efforts to develop scales for the
measurement of mindfulness such as the Toronto Mindfulness Scale (Bishop et al.,
2003) and the Kentucky Inventory of Mindfulness Skills (Baer, Smith, & Allen,
2004). In addition, several recent review articles have suggested directions for future
research from both a cognitive-behavioral point of view (Dimidjian & Linehan,
2003) and a humanistic/transpersonal point of view (Shapiro & Walsh, 2003).
Transpersonal psychologists (c.f., Weide, 1973; Boorstein, 1983; Kasprow &
Scotton, 1999) were the earliest pioneers in exploring how meditation and
mindfulness practice might contribute to the process and outcome of psychotherapy.
Boorstein (2000), for example, suggested that meditation could lower psychological
defenses to repressed material, enhance awareness of psychological patterns, and,
provide glimpses of non-dual reality. Early explorers in this domain provided case
histories which illuminated the potential of mindfulness meditation to facilitate
aspects of psychotherapy or complement therapeutic efforts (Deatherage, 1975;
Wortz, 1982; Boorstein, 1983). There are also authors who cautioned clinicians
about the potential iatrogenic effects of meditation (Epstein & Lieff, 1981; Miller,
1993). Researchers have only just begun to supplement the theoretical and anec-
dotal exploration of the integrative and complementary effects of meditation on
psychotherapeutic process and outcome through quantitative assessment (c.f.,
Weiss, Nordlie, & Siegel, 2005).
While the value of mindfulness as a self-control or symptom management strategy
has been discussed at some length in the literature (Marlatt & Kristeller, 1999;
Kristeller, 2003a), less has been said about its role in self-experiencing and
self-development. Engler (1984) examined how persons with certain types of self-
pathology might be drawn to meditation, and Epstein (1986) examined how
mindfulness might counteract narcissistic tendencies, but these explorations were
solely from within a psychoanalytic perspective, and dealt primarily with the
conceptual tension between certain kinds of self-pathology and the Buddhist concept
of anatta, or non-self. Relatively little attention has been spent on looking at
a potential role for mindfulness in the remediation of the broader spectrum of self-
pathology. One exception to this relative neglect can be found in the work of
Brown and Lindsey (2001) who have explored the role of meditative techniques
in stabilizing the sense of self and the self-concept, and I would like to extend my
gratitude to them for helping to stimulate some of my own thinking in this area.
MINDFULNESS IN BUDDHISM AND IN PSYCHOLOGY
Mindfulness can be defined as a mode of bare attention to the process of
experiencing. I have elsewhere described it as a practice in which:
... [one opens] oneself up and [is] receptive to the flow of sense perceptions,
emotions, and thought processes in each given moment while attempting to hold
judgment in abeyance. This is done with no other goal than to be as present as
one can possibly be within each and every moment. One does this with an
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2144
intimate attention that is very different from a scrutinizing, objective stance.
Rather than being a distant observer of a set of experiences, one is a participant-
observer, and what one observes is not only the sense impressions of the
‘‘outside’’ world, but also one’s own subjective reactions to that world. (Segall,
2003, p. 79)
In Buddhist practice, mindfulness is the sixth aspect of the Eightfold Noble Path,
one of the central teachings of Buddhism. As such, there are a number of excellent
contemporary Buddhist texts that explicate the concept of mindfulness for Western
readers. The interested reader is referred to books by Bhante Henepola Gunaratana
(1991) and Thich Nhat Hahn (1987).
The development of mindfulness is fostered and nurtured by a variety of classical
and novel meditative practices. These practices include: (a) formal sitting meditation
with attention focused on the experience of breathing, (b) formal sitting meditation
without single-minded focus, but with attention to the ever-changing field of
consciousness, (c) formal sitting or lying supine meditations in which attention is
focused on bodily sensations, (d) walking meditation with attention to changing
bodily sensations in the feet, (e) stretching and movement meditations with attention
to changing bodily sensations, and (f) informal meditations where the instructions
are to maintain mindfulness during routine tasks such as eating, cooking, showering,
dressing, conversing, and so on.
These practices support a greater depth of experiencing of one’s body, one’s
emotional life, one’s felt senses (cf. Gendlin, 1996), one’s fantasy life, and, to
the extent that they are available to consciousness, one’s conative and cognitive
processes. Practitioners of mindfulness report a growing sense of their own
embodiment, and an ever more precise and intricate awareness of their own expe-
riential field. They also report becoming more aware of the ways in which this field
and their responses to it are distorted by motivational processes. In the classic
Buddhist analysis, percepts are accompanied by pre-reflective evaluations infused
with an affective tone that occupy a borderland between affects and judgments. These
pre-reflective evaluations are called vedenas (in the ancient Pali language of early
Buddhism), and they lead the experiencer to try to prolong or truncate moments of
experiencing based on the positive or negative hedonic tone of the evaluation.
Buddhists identify this movement of the mind towards or away from experiencing
as attachment and aversion. Mindfulness practitioners are encouraged to notice this
process and see it transparently as part of the process of experiencing. As an observer
of this process, it is believed that one can learn to occupy a different stance towards
experience, one that is less enslaved to more primitive motivational factors.
Mindfulness serves a soteriological purpose in Buddhism. Within the Buddhist
framework, mindfulness is one aspect of the path to liberation from existential
suffering. Buddhism does not concern itself, however, with many of the issues that
preoccupy modern psychology and psychotherapy. It is not concerned with
increasing interpersonal intimacy, or with strengthening ego functions, or with
increasing sexual pleasure, or with improving work efficiency, or with helping one
to be more assertive or more popular, for example. In fact, the monastic ideal within
Theravada Buddhism calls for abandoning the worlds of family life and work, and
Mindfulness and Self-Development 145
for sexual celibacy. Nevertheless, it is not hard to imagine how mindfulness can be
detached from the purpose it serves within Buddhism and put to other uses within
psychotherapy. Any process that encourages embodiment and an enriched self-
experiencing can play an important role in self-development within psychotherapy.
The importance of this process is even more apparent when the process is one which
can also lessen aversion to formally avoided contents of consciousness, and
attachment to inadequate images of self. One might add that this process can also
build a tolerance for and acceptance of unpleasant mental states that have hither-to-
fore been triggers for impulsivity, dissociation, and self-harming actions.
Discussing the value of mindfulness in self-development might, at first, seem
paradoxical to readers who have a passing familiarity with the Buddhist teaching
about non-self or anatta. There is really no paradox here, however. In positing the
doctrine of non-self, the Buddha did not deny that human beings have personalities,
or that it was valuable for human beings to develop their characters. The doctrine of
anatta only denied certain kinds of ontological statements about the nature of the self
(Engler, 2003) such as the immutability of the self, the separateness of the self from
the body and the social, physical, and natural worlds, and the idea of a metaphysical
soul. Traditional Buddhist practice can, in fact, be understood, in part, as an organized
character development program designed to enhance moral development, and
decrease egocentricity, narcissism, and emotional and attentional instability.
SELF-PATHOLOGY IN PSYCHIATRIC DISORDERS
A variety of disorders (dissociative disorders, borderline personality disorder,
narcissistic personality disorder, posttraumatic stress disorder, affective disorders)
have self-experiencing and definition problems as core features. This is most evident
in the developmental failures of integration in the dissociative and borderline
disorders, but can also be seen in the disrupted and damaged sense of selfhood in
Post Traumatic Stress Disorder (PTSD), and the deflated or inflated sense of self in
the affective and narcissistic disorders. At the base of all these self-distortions,
however, are distortions in self-experiencing and self-definition.
In borderline, posttraumatic, and dissociative disorders, the difficulty in self-
experiencing is at least partly due to a phobic attitude towards experiencing emotion,
re-experiencing traumatic memories, and experiencing the body. These self-
experiencing difficulties are often characterized by symptoms such as psychic
numbing, emptiness, depersonalization, splitting, amnesias, and conversion anes-
thesias. Clients will also resort to a wide range of often impulsive and self-defeating
actions designed to circumvent affective and somatic experiencing including sub-
stance abuse, overdosing, cutting, and engaging in high intensity risk-taking and
consumatory behaviors which serve as distracters. At the base of these strategies and
symptoms is the belief that experiencing of affects, memories, or somatic expe-
riencing will be so intense and uncontrollable that the experience will be unendurable
and intolerable. Overwhelming experiences of intolerable sensation and affect rein-
force a sense of the self as weakened, depleted, and damaged, and undermine the
development of beliefs and feelings of mastery, competence, and worth.
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2146
As is the case in all phobias, healing and recovery from these disorders of self-
experiencing and self-definition depend in part on successful exposure to what is
most feared under conditions that enhance the development of a sense of mastery
and competence. Mindfulness can play an important role in the process of exposure;
most importantly, exposure can take place under conditions that respect a client’s
limits, give the client a sense of control, and occur within an intention of self-
acceptance and self-care.
When one examines the developmental level of self-functions in clients with
complex PTSD, borderline personality organization, and dissociative symptomatol-
ogy stemming from early childhood neglect and abuse, one quickly discovers that
every developmental line has been disrupted: there are disturbances in the biological
regulation of affective arousal, the hypothalamic-pituitary-adrenal axis, and the
autoimmune system; in the stability and continuity of memory, attentional processes,
and consciousness; in the regulation of sleep, appetite, and libido; in self-soothing,
identity formation, and the regulation of self-esteem; in the planning, self-regulation,
and performance of health-maintenance, house-keeping, budgeting, academic
and vocational activities; in the self-regulation of intimacy and control, and the
maintenance of boundaries and stable affectional bonds in interpersonal relations.
MINDFULNESS AND SELF-PATHOLOGY
Mindfulness and Self-Regulation
Mindfulness has a crucial role to play in the amelioration of the developmental
disruptions outlined above. Many of these disruptions are disturbances of self-
regulatory processes that require the conscious monitoring of subtle cues for their
successful execution. For example, cortical, sympathetic, and adrenal hyper-arousal
can be dampened if one is aware of the somatic and affective cues that signal their
presence and can engage in self-soothing or assistance-seeking behaviors that can
down-regulate them. Regulation of appetitive behaviors depends on awareness of
states of hunger and satiety. The regulation of social behavior requires awareness of
internal affective states such as attraction, anxiety, shame, or anger, and awareness
of external cues such as facial expressions, body language, and vocal inflection.
Another domain of self-regulation is the regulation of self-concept and self-esteem.
One’s sense of adequacy and worth is based, in part, on cognitive appraisals that are
internalizations of past feedback from significant others. These internalized
appraisals are automatically triggered by a wide variety of events that provide
information about momentary fluctuations in our competence or acceptability. A
stable sense of adequacy and worthwhileness develops from aggregating social and
environmental feedback across a broad range of experiences over time. Once a stable
sense of self-worth and adequacy has been achieved, small fluctuations in feedback
do not destabilize that system. If, on the other hand, a core sense of an adequate and
good-enough self has not developed, small amounts of negative feedback can trigger
a cascade of unduly negative self-evaluations. This core sense of an adequate and
good-enough self can be developmentally derailed when the mirrors one relies on
for its construction are inadequate and distorted. The resulting internalized negative
Mindfulness and Self-Development 147
self-distortions often persist, even when more adequate mirrors are supplied in later
life, partly because the feedback from these improved mirrors is not adequately
sampled, and partly because when it is sampled, it is not trusted. If novel feedback is
too discrepant from the cognitive model that is already in place, it tends to be dis-
regarded. Mindfulness can be an important tool in rectifying a distorted self ap-
praisal process because: (a) it fosters the sampling of actual events rather than relying
on previously formed cognitive models, (b) it allows one to transparently see in real
time how the old appraisals that are triggered automatically replay in spite of dis-
crepant new information, and (c) it allows the experiencer to experience appraisals
as appraisals per se rather than mistaking them for reality.
Mindfulness and Contractions in the Field of Consciousness
Mindfulness also plays an important role in the amelioration of self-pathology by
expanding the field of consciousness. The dissociative and somatoform symptoms
of complex PTSD (van der Kolk et al., 1996) derive from a contraction in the field
of awareness, and the active avoidance of cues that signal potential awareness of
traumatic material. Janet (1907/1965) was the first to identify these contractions in
consciousness, and to point out that the process of contraction of the field of
awareness was similar, whether one talked about dissociation of sensation, affect,
cognition, or behavior. Wickramasekera (1993) has pointed out that a similar
contraction in awareness of somatic states is commonly encountered in many
patients with psychosomatic disorders. These patients will exhibit a disjunction
between their verbal descriptions of conscious awareness and what biofeedback
instruments are reporting about their somatic arousal.
The resolution of somatoform, psychosomatic, and dissociative symptoms requires
an expansion of the field of consciousness and either a restored, or a newly
developed, ability to monitor the complete field of somatic and affective
experiencing. Mindfulness practice provides direct training in this regard.
Mindfulness practitioners uniformly report an increased ability to attend to and
differentiate formerly ignored domains of conscious experience. For example,
practitioners of the body scan meditation typically report that they notice
increasingly subtle sensations within the body as they advance in their practice.
While initially they may experience their bodies as relatively silent, as they continue
their practice day after day, the body eventually becomes a continuous three-ring
circus of vibrant sensation. They often report enhanced feelings of aliveness and
vitality as a consequence. For patients who routinely feel numb, devitalized, or dead
inside, a new sense of aliveness and vitality can be the cornerstone of establishing
a vibrant sense of self.
Mindfulness and Automatic Thoughts
As Beck (Beck et al., 1979) and Ellis (1962), have pointed out, and as has been
discussed above in the section on self-regulation, automatic thought processes play
a crucial role in sustaining internal assessments of identity, adequacy, competence,
and worth, as well as assessing the degree to which one values and trusts relationships
with others. The thoughts that constitute the warp and woof of these mental
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2148
constructions and attributions require attention and monitoring if they are going to
either be modified, or if one is going to have a changed relationship toward them.
Mindfulness encourages the monitoring of thought processes as well as somatic and
affective experiencing. It also encourages the monitoring of thoughts without
attaching a truth value to the thoughts, i.e., to observe thoughts as transient
phenomena rather than as objective statements about oneself or the world. Hayes,
Strosahl, & Wilson (1999) have referred to this changed relationship to thinking as the
‘‘decontextualization’’ of thought. This is a little different than the correction of
cognitive errors recommended by Beck, or the challenging of irrational thinking
recommended by Ellis. One might add that in traditional Buddhist philosophy,
thoughts are identified as kusala (skillful or wholesome) or akusala (unskillful or
unwholesome) rather than as correct or incorrect, or rational or irrational. It is not so
much their truth value that is important as the consequence of taking them for real that
is important. The question to be asked is a functionalist one: ‘‘If one continues to think
in this way, what will be the consequence of doing so?’’ Will one’s life, in the long
run, be happier or better? The ‘‘happier’’ or ‘‘better’’ implied here takes into account
that one’s happiness depends to some degree on the harmony of one’s relationships
with others, and not simply on fulfilling one’s hedonistic impulses. In traditional
forms of meditation, after observing thoughts as thoughts, one can also inquire as to
their outcome if continued. If they are seen as unskillful or unwholesome, they can just
be dropped. The idea that one does not have to believe all one’s own thoughts and that
unskillful thoughts can be dropped allows patients to increase their own sense of self-
control and self-efficacy. One may not be able to control what thoughts cross one’s
mind, but one can control how one responds and relates to them.
Mindfulness and the Development of New Internal Resources
The practice of mindfulness allows one to cultivate an inner sense of stillness and
quiet. The fact that there is an inner feeling of calm and peace that can be accessed
under virtually any circumstance constitutes an important new internal resource for
patients. It means that when one is roiled and tormented, one can pause, breathe, and
within a few minutes find a safe port. Reaching that safe port does not depend on any
assistance from outside oneself. Reaching that safe port also means that one does not
feel impelled to act recklessly as a means of reducing inner tension. Marlatt (1994)
has described this ability to ride out impulses as ‘‘urge surfing,’’ and it constitutes an
important new skill for patients who have, in the past, seen their impulsivity wreak
havoc with their lives. Knowing that one can be calm and responsive to situations
rather than reactive to them helps patients to develop a greater sense of self-efficacy
and self-competence. Knowing they can do this for themselves also lessens their
degree of dependence on others for solace and succor.
TWO INDIVIDUAL THERAPY CASES:THE CASES OF MISS AAND MISS B
The following two case examples are intended to delineate the potential value of
mindfulness-based interventions in the treatment of patients with severe self-
pathology. Both patients have a history of significant dissociative and borderline
pathology, posttraumatic stress disorder, and accompanying comorbid disorders. In
both cases the primary treatment has been long-term individual psychotherapy, with
Mindfulness and Self-Development 149
additional treatments including inpatient hospitalizations (Miss A & B), partial
hospitalization (Miss B), and a variety of outpatient interventions including a DBT
skills group (Miss A), an eating disorder program (Miss B), trauma-survivor groups
(Miss A and B), Alcoholics Anonymous (Miss A), and supported housing and
vocational rehabilitation (Miss B). Clearly, mindfulness-based interventions have
constituted only a small part of the treatment these women have received, and yet in
each case, mindfulness-based interventions have added to the successful outcome in
a dramatic way. While neither of the women portrayed in these case histories could be
currently classified as completely recovered or well, each has made substantial
progress in her own way. They have left behind the kinds of troubling and impulsive
behaviors that in the past would have gotten them labeled as ‘‘borderline’’ including
suicide attempts, cutting, drinking, and purging. They have struggled to construct
lives that are imbued with meaning and dignity. They have also struggled to create
relationships that are well-bounded, fair, and equitable. People who know them are
impressed by who they are as people: their humanity, their intelligence, their wisdom,
and their good hearts. They demonstrate that even when residual pathology persists,
there are healthy parts of the personality that can develop, grow, and offset pathology.
The Case of Miss A
Miss A is a middle-aged woman who spent her adolescence in facilities for wayward
youth, and her early adulthood on the streets and in mental hospitals. When she was
a preadolescent, her father was tried and convicted for sexually abusing her. The
patient was sexually abused, not only by her father, but by other children in her
neighborhood. Her home was a dangerous and violent place: she was often severely
beaten by her father who would throw her against the walls, and her parents often
fought. On one occasion, for example, her mother set her father on fire. After her
father’s arrest, she was removed from her home and put in a residential facility, a move
which began her downward spiral through a variety of state-sponsored institutions.
Miss A was diagnosed as a ‘‘sociopath’’ during one of her young adult
hospitalizations. She drank and used drugs, and was married to a series of violent,
substance abusing, and sexually degrading sociopaths. When she began therapy, she
was divorced from her abusive husbands, and had already achieved prolonged
sobriety through involvement with Alcoholics Anonymous. She was experiencing
voices, however, which were inside of her head, and which she attributed to split-off
childhood parts of herself. As we explored these voices, it became clear that she had
poly-fragmented dissociative identity disorder, and that each of these child-fragment
personalities were associated with different traumatic events in her development.
Over a decade of continuing therapy she has managed to explore, re-experience, and
understand these traumata, and she eventually developed a core sense of herself that is
always present and is positively valued. She has remained substance free and abusive-
relationship free, and has ceased engaging in any self-harming behaviors. She still has
fragments of herself that are not fully integrated, and she still has occasional thoughts
of suicide and self-harm which she is, however, able to resist acting upon. She is not
on any medication. At the moment she is not depressed, but she still has occasional
bouts of depression which last a month or so and then resolve. She has not been able to
become competitively employed, but she has become an advocate for other patients,
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2150
has served on a variety of mental health and research committees, and has testified
multiple times before the state legislature about issues affecting the mentally ill. She
writes a column for a local mental health newsletter, and has appeared in a film about
recovery from abuse which the state uses as a teaching resource for mental health
workers. She attends therapy today on a once a month basis, and is about to transition
to every other month. The content of therapy, more often than not, hinges on her
continuing efforts to take good care of herself, manage her budget, shopping, laundry
and other household activities, and explore being part of a church community. Other
recurring issues include the ebb and flow of her interpersonal connectedness to family
and peers, and her current spiritual search within the Christian community.
Mid-way through her treatment with me, and before joining her current church, Miss
A found her way to a Buddhist meditation community run by a local minister at an
Episcopalian church. The patient attended weekly group meditation sessions under his
aegis, and practiced meditation at home. She also attended several all-day meditation
retreats that were sponsored by a local Buddhist organization which I was a member
of, and which I also attended. In so doing, Miss A struggled with a number of obstacles
including her arthritic knees, which prevented her from joining her co-congregants
on the cushion, and her doubts about whether this group of largely middle-class
congregants genuinely accepted her as an integral part of their community. Her
attendance at these sessions ended when the meditation community migrated from the
church to another venue, and she was unable to attend due to transportation problems.
It is notable that no one offered her a ride to the new site, perhaps confirming her sense
of not really being a fully accepted member of the community.
In spite of these obstacles, Miss A found that mindfulness meditation and the intention
behind it, namely, to trust in the ability to be with experience as it is, significantly
helped her in being able to work with her own sadness without trying to medicate it
away. She saw her sadness not as a clinical phenomenon that needed treatment, but
as the core residual sadness of never having been sufficiently loved or cared for as
a child. Her sadness was the mourning of the wished-for past relationships with
parents and siblings that were finally being relinquished, and the complete
acknowledgement that her earlier life really had been as bad as it had seemed.
Miss A writes of finally getting in touch with her sadness using her mindful-
ness skills:
I once got a glimpse of my sadness: its color, shape, and texture ... From this
glimpse, I learned that I can sit with my sadness, not push it away. I can touch it
and not become absorbed by it. I can identify types of sadness and ask ‘‘what can
I do to help?’’ My sadness usually occurs when I am learning new ways of being
and letting go of old ways. My sadness is not always depression and is not always
something to be avoided. As I learn to feel more and more, I become more
present, whole, and alive. I can allow myself to become soft and vulnerable in
more situations. I don’t have to be ‘‘on’’ or ‘‘off.’’ I can just be with whatever
presents itself at that moment. I have made peace with my sadness and no longer
fear that it will consume me; it is a part of me, and I am always changing. So
sadness, as many other feelings, is not permanent, even when it feels like it will
always be this way. It is an illusion. Sit with it and watch it change.
Mindfulness and Self-Development 151
In the above paragraph, Miss A clearly illuminates many of the benefits of
mindfulness for patients like herself, including: (a) the increasing ability to tolerate
unpleasant affect, (b) the increasing ability to ‘‘feel more’’ in general, (c) the
ability to become more interpersonally open once one can allow oneself to feel
more and to tolerate what one feels, and (d) the appreciation that all mental states
are transient.
More recently, Miss A wrote about the aftermath of another encounter with a
dissociated part of herself:
My recent bout with my uninvited shadows left me feeling very exposed and
vulnerable and emotionally raw. I allowed myself to feel what I needed to feel,
to cry and to grieve, not only for myself but for others. My recovery has taught
me to move beyond myself and self-centered fear. I am deeply connected to the
greater whole of humanity and that which is spiritual. I am so glad to have a God
that can stand whatever I take to him and understand, and who will not leave me.
I am the one who is the wayward and rebellious child at times. I used my supports
during this time even while feeling disconnected and confused. I have grown
more in my recovery and I have changed, never to be the same, because I am
more awake to the present moment, not stuck in the past.
Miss A’s sense of her own recovery is clearly linked to a number of themes that are
important themes within the meditation and transpersonal literature: the movement
from isolated ego to inter-connected self, and from past-stuckness to present-
centeredness. Her sense of a God that can take whatever she brings to him and not
desert her is also clearly linked to her own increased capacity to endure the unen-
durable and continue to stay with herself in a friendly manner. Miss A’s writing also
points to the oft-noted paradox of needing to both develop self, in psychodynamic
terms, and move beyond self in Buddhist terms, as one ameliorates suffering.
The Case of Miss B
Miss B is in her thirties and lives in a half-way house for psychiatric patients. She
has made several failed attempts to go to a community college and to do retail work,
and is currently embarked on a new attempt, so far successful, to sustain part-time
employment in retail work for at least six months. She suffers from recurrent
depressions, has had multiple paranoid episodes which are kept at bay with a
neuroleptic, and struggles with an eating disorder. She also has multiple identities
that are separated by amnestic barriers. Earlier this year she was shocked and
dismayed to discover that she was working at night as a prostitute for a pimp; she did
this work without any reimbursement for herself, but only to derive self-worth from
feeling she was pleasing others as she had been forced to do as a preadolescent. Her
host personality, who is asexual and who abhors any physical contact with others,
including shaking hands, had no knowledge that this had been occurring. Miss B
comes from a family in which she was sexually abused by her father, her brother,
and her father’s friends. Her father was undoubtedly psychotic (he was hospitalized
several times) and allegedly may also have been involved in a child pornog-
raphy ring.
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2152
Miss B graduated from high school, and attempted a working career in retail, but
following a rape by a co-worker was hospitalized with what was assumed to be
schizophrenia, and spent her days hiding in a hospital dayroom under a blanket.
Psychological testing revealed the presence of her dissociative disorder, and she was
subsequently treated for several years within a specialized partial hospital program
for persons with dissociative and posttraumatic disorders, where she showed
considerable growth. She is currently in individual therapy with me on a twice-a-
week basis.
Miss B has been pathologically unable to assert herself, say no to or displease others,
or create interpersonal boundaries. She also reported that she had no internal
feelings, and no sensory awareness of her body. Early in therapy she seemed to live
in a perpetual fog, and her answer to most questions about herself was ‘‘I don’t
know.’’ As therapy proceeded, she gradually and increasingly revealed herself to be
a bright, curious, and lively individual. She began to become interested in the world
of ideas and to develop her own opinions about things. She aspired to become
a writer and help others.
Several years into her treatment I decided to directly address her complete lack of
experiential contact with her body, which was adversely affecting her ability to
identify her internal states. I suggested that she attempt a body scan at home, and
handed her an audio-taped recording of a guided body scan that I had made several
years earlier for a meditation class. The body scan is a therapeutic technique adapted
by Kabat-Zinn (1990) and colleagues from a Burmese meditative practice. In it, the
meditator slowly moves his or her attention from body part to body part as he or she
gradually traverses the entire body over a forty-five minute period. The meditator is
instructed to attend to the sensations (or lack of sensations) in each body part with
bare attention, clearly noting the sensations with care, but neither prolonging,
amplifying, nor avoiding whatever is noticed. In addition, the meditator attempts to
hold judgment of the sensations in abeyance, and to avoid getting lost in discursive
thought about them.
Miss B attempted the body scan, and immediately became aware that her torso and
limbs were made of material substance and had weight to them. This sense of having
mass and weight persisted for several days and was extremely troubling to her,
intensifying her eating disorder. The sensation was so persistent, vivid, and dis-
turbing that we considered increasing her neuroleptic medication to help re-close the
door to bodily sensation. Fortunately, we resisted that urge, and the patient was
instead encouraged to just allow the feelings to exist. Our patience was rewarded
when a week or two later the patient reported sitting outside and becoming aware of
a novel bodily sensation: she felt a warm Spring breeze brush against her cheek, and
reported it felt as if she was being ‘‘kissed by God.’’ From that point on, the patient
began increasing her awareness of internal bodily and affective states, even though
she did not repeat the body scan.
Miss B’s gradual increase in her abilities to both experience herself and articulate
that experience are clearly expressed in her private daily journal. In the therapy
session previous to the diary entry included below, we discussed the idea that her
experience of hatred did not make her a bad person. I have italicized portions of her
Mindfulness and Self-Development 153
journal entry to emphasize those aspects of the passage which exemplify her new
awareness of embodiment:
I always thought of anger as a bad thing. Now I’m thinking it’s part of a human
thing, which makes me feel something inside. I’m trying to figure out how to
describe the feeling. It’s like something opened up inside of me. It’s like a little
kid that opens a gift and discovers something she didn’t know she wanted. It’s
more like a feeling of being relieved, or like you’ve just been forgiven for a sin
and everybody still likes you. It’s like telling someone you did something
wrong, then finding out that it’s not wrong and nobody is going to hurt you or
hate you . . . . When you told me that feeling hate doesn’t mean I’m bad, it kinda
touched me like kind of a tickle inside of me that I’ve been feeling since therapy,
kinda like a weight being lift off of me. Feels like a kind of silly laughter inside
of me. You know what? That word ‘‘laughter,’’ I think I’ve been using it or
feeling it a lot lately. I think I’m actually starting to thaw out ...I feel like a part
of me is coming alive . . . . I feel like I’m becoming human. I don’t have to hide
my non-perfectness from other people any more. Maybe other people can see my
dirtiness and my ugliness, but they don’t notice because they’re no different than
me? We’re all human. Wow, this human thing is cool! ... I just had another
thought: was my father human, too?
For Miss B the benefits of mindfulness are: (a) a new sense of embodiment, (b)
a new sense of permission to feel, and (c) support for the therapeutic idea that
feelings are tolerable, and in themselves are neither good nor bad. What she
discovers when she actually allows herself to experience her inner world directly
contradicts her core belief that she is indeed evil and dirty inside. She is then able to
begin exploring the possibility that she might extend this new sense of humaneness
to those who have hurt her as well. Lastly, there is a spiritual dimension to this
growth, reflected in her experience of being ‘‘kissed by God.’’ This was the
beginning of a religious search that eventually led her to seek membership in her
current Church.
TWO BRIEF CASE EXAMPLES FROM A CLINICAL MINDFULNESS GROUP
For several years I have been exploring the value of a mindfulness curriculum
for severely disturbed psychiatric patients within group settings. For a period of
two years I ran a one-hour-a-week mindfulness training program for a heteroge-
neous group of psychiatric patients who were attending an intensive outpatient
program (IOP). Patents would attend the IOP for an indeterminate length of
time, and would attend the mindfulness groups within the IOP anywhere from 2–10
times during their stay in the program. For the past two years I have also been
running an extended mindfulness curriculum within a dialectical behavioral ther-
apy intensive outpatient program (DBT-IOP) for patients with borderline person-
ality disorder.
I should note parenthetically that not everyone thinks that teaching mindfulness
meditation in DBT is a good idea. For example, while Dimidijan and Linehan (2003)
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2154
believe in the importance of mindfulness skills training in DBT, they are skeptical
about the value of teaching formal mindfulness meditation because of their belief
that ‘‘it is not possible for seriously disturbed clients to engage in meditation,
because of lack of motivation, or capacity, or both’’ (p. 168). While I understand the
reasons for their cautionary note, I have been interested in exploring the degree to
which Dimidjian and Linehan may have underestimated the extent of patients’
motivation and capacities, or the ways in which the limitations of their motivation
and capacity might be overcome.
In both the regular IOP and DBT-IOP groups, my curriculum has been similar to the
curricula outlined by Kabat-Zinn (1991) for MBSR and by Segal, Williams, and
Teasdale (2002) for MBCT, namely, the use of a variety of formal and informal
meditative exercises including the body scan, mindful yoga, walking meditation, and
both breath-centered and present moment-centered sitting meditations. Meditation
periods themselves tend to be truncated (10–15 minutes for sitting meditations; 20–
30 minutes for the body scan and yoga) with time for preparatory and follow-up
discussion. The preparatory discussion often clarifies the reasons why mindfulness
training might be helpful for the patients’ particular diagnoses and symptoms, while
the follow-up discussion examines the difficulties the patients might have had while
attempting the exercises, and suggests ways that patients can work with these
difficulties. The philosophy that underlies these discussions is that all problems are
workable, and that making the effort to work through these problems is, in itself,
a pathway for self-development.
Dimidijian and Linehan’s (2003) cautions seem best heeded for patients with acute
psychoses and severe affective episodes. Patients with flight of ideas, racing
thoughts, or persistent auditory hallucinations find this kind of work to be arduous,
challenging, and unrewarding. On the other hand, as the acute symptomatology of
these same patients begins to abate under the influence of antipsychotic and mood
stabilizing medications, they often begin to experience mindfulness meditation as
grounding and restorative, and become ardent champions for these techniques.
Severely depressed patients who try to sit with being mindful of unremitting
depression hour after hour also find the practice pointless, and need to wait until they
can experience some variation within their mood state in order to experience the
benefits of meditation. Patients with PTSD-related flashbacks and anxiety states also
find this work challenging within a group setting: as they quiet down internally, the
feared affective states often spontaneously present themselves. With encouragement,
however, many patients persist in the practice and find lasting benefit in it.
The following two brief case examples demonstrate how different patients can self-
pace and titrate exposure to painful feelings based on their own inner wisdom as
to what is presently tolerable. In these examples, meditation can be used for either
exposure or distancing, depending on what is needed in the moment. The therapist
must be attuned to the patient and must find that balance in which the patient is
neither pushed to experience the intolerable, nor allowed to avoid what is merely
painful. The painful experiencing must occur, however within the context of
compassion: both the therapist’s compassion for the patient, and the patient’s
growing capacity for self-compassion. The Case of Mrs. C involves a patient with
a simple straightforward diagnosis of PTSD, whereas the Case of Miss D involves
Mindfulness and Self-Development 155
a complicated patient with a bipolar disorder characterized by a severe intractable
depression, and borderline personality disorder. The first case called for simple
symptom abatement without any major issues of self-development beyond learning
to tolerate unpleasant experience. The second case involved a more complicated
process of learning of how to self-titrate exposure to unpleasant experience based
upon discriminating judgment and self-caring.
The Case of Mrs. C
Mrs. C was a non-complex PTSD patient who had been involved in a motor
vehicle accident in which the driver of the other automobile had been killed. When
Mrs. C sat still to meditate, images of the automobile accident would repeatedly
present themselves, and she would begin to sob. The group leader gave her
permission to cry during the meditations, and the patient felt safe enough within
the group setting to allow herself to do so. Mrs. C spent the next several weeks
meditating and quietly crying with the group. After several weeks of this, she
reported that her experience while meditating had begun to change: the images of the
accident would come up, but they would only stay for a few moments and then pass.
In addition, she no longer found herself crying when they came up. After discharge
from the IOP program, Mrs. C. joined an outpatient PTSD group, and eventually
regained her ability to drive her car. She also became involved in a variety of
compassionate activities as part of her personal project of atoning for the loss of life
in the accident.
The Case of Miss D
Miss D, on the other hand, was a complex patient who suffered from both rapidly
cycling bipolar disorder and borderline personality disorder. She took to mindfulness
meditation quite readily, and found that it helped her to become grounded when she
was not severely depressed, but was painful to her when she was at the deepest point
in her depressions. Encouragement to be active and use distraction techniques
seemed more helpful at those moments.
Miss D had completed an outpatient DBT program, and was being treated in
a regular (non-DBT) IOP due to cyclical recurrent depressions with suicidal ideation.
At one point in her treatment, while she was in the midst of an ECT trial because of
an unyielding severe depression, the patient received word that her daughter had
been murdered. Her ECT treatment was stopped at that point because the patient
could not remember her daughter’s murder from day to day, and this was severely
complicating the grieving process.
Miss D came to meditation group in an emotionally numb state with the question of
whether she should engage in concentration meditation and use a focus on her breath
as a distraction from her deep inner pain, or whether she should use mindfulness
meditation to stay with her grief. The patient was told to use her ‘‘wise mind’’ and
decide what she really needed in this moment. The patient decided that she needed
to remain numb, and that she could not possibly tolerate beginning to grieve. For
several months she came to group and focused on her breath as a distraction and
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2156
as a form of self-soothing. At the end of those months, she told the group that she
was ready to begin grieving, and then used mindfulness meditation to allow herself
to touch and remain with her sadness in a productive way. Miss D’s example
demonstrates the kind of complexity that is involved in using meditative techniques
with severely ill patients, but also demonstrates how a deep understanding of
mindfulness can help a patient to develop self-care skills and a friendly approach to
inner experiencing that allows for an increased trust in one’s own judgment, and
an increased ability to self-titrate one’s exposure to disturbing emotions.
CONCLUSION
Fritz Perls (1947/1969) used to say that awareness per se—by and of itself—was
curative. While some might consider that an overstatement, the fact is that an
expansion in the realm of awareness is believed to be an important curative factor in
a wide variety of therapies; becoming aware of what has previously been implicit or
unnoticed is a component of experiential and insight-oriented therapies, and also of
cognitive and behavioral therapies that utilize self-monitoring and self-regulation
techniques. In addition, the ability to tolerate exposure to disturbing mental contents
by focusing and maintaining awareness on them is an important part of behavioral
therapies that rely on the process of exposure and desensitization. Mindfulness, both
as a philosophical approach to inner experiencing, and as a behavioral technology
for modulating attentional processes, holds promise as an adjunct to all of these
therapies. While it can be valued as a specific skill which can be acquired and used
for the purpose of symptom reduction, it can also be appreciated for its broader role
as a facilitating factor in personality development.
Human beings grow and develop by: (a) expanding their schemas through the in-
corporation of new information, (b) becoming increasingly hardy through a growing
tolerance for the unpleasant, (c) increasing their ability to inhibit responding so there
is sufficient time to detect and evaluate relevant information, (d) increasing the in-
tegration of previously disparate informational realms, and (e) a continuing process
of self differentiation and integration. Mindfulness can assist in many of these
developmental processes by encouraging alert observation, non-reactivity, and
acceptance. In addition, it can assist its practitioners to develop an inner space that
can be characterized by calm equanimity. This new inner space, in turn, serves as a
venue for the integration of cognitive and affective processes, which Linehan (1993)
calls ‘‘wise mind,’’ and Buddhism identifies as our ‘‘true nature.’’ Our ability to
develop this space with practice over time takes us out of the realm of psycho-
pathology and into the realm of positive and transpersonal psychology
1
.
There has been a lengthy discussion within transpersonal psychology about the
relationship between psychopathological, normal, and transpersonal psychological
functioning, development and organization, and whether these lie along a single
continuum or reflect orthogonal or semi-independent processes, and whether there
might be discrete stages involved in the progression from one realm to another (c.f.,
Engler, 1984; Wilber, 1985; Rubin, 2003.) The model proposed here sidesteps the
contentious issue of stages, but views human development as advancing along many
separate continua which are semi-independent, but which exert mutual influence on
Mindfulness and Self-Development 157
each other, similar to the view expressed by Wilber (1999). These developmental
lines include the twin lines of self-definition and interpersonal relatedness (Blatt,
1990), multiple lines of cognitive (Sternberg, 1985) and moral development
(Kohlberg, 1984), and the development of a variety of spiritual attitudes, capacities,
and understandings involving: (a) multiple decentrations (in Piagetian terms) of the
self, (b) an increasing awareness, balancing, and integration of the experiential and
rational information processing systems (Epstein, 1994), (c) increasing capacities for
mindfulness and sustained focused attention, (d) an increasing sense of intimate and
immediate connectedness to Being, and (e) an increasing capacity to extend one’s
caring to ever widening circles of beings. It is perfectly possible for exceptional levels
of functioning on one continuum to exist side by side with pathological levels of
functioning on another, and unremarkable levels on yet a third. This lack of
synchrony between functional attainments is commonplace in psychology. For
example, Strauss and Carpenter (1977) have pointed to a similar functional asyn-
chrony in recovery from schizophrenia in which the reduction of positive
symptoms, improvement in ability to work productively, and improvement in social
relatedness are semi-independent realms, or what Strauss and Carpenter term ‘‘open-
linked systems.’’ In the model proposed here, there can be genuine de´calages
between these semi-independent developmental lines, but the functional level of
one line can assist or hinder progress in another. Recovery from psychopathology,
therefore, is often the result not so much of curing basic faults within the organism, as
in compensating for innate or experientially induced deficits in one or more lines by
developing areas of compensatory strength in others. This is precisely what Patients
A and B have done, and it is why they can be, at one and the same time, still suffering
from residual symptoms of illness, and impressive and admirable human beings.
The Buddhist Yogacara tradition posits the existence of bija, or seeds, that can be
planted, and either flourish or wither in the alaya-vijnana, or what Waldron (2003) has
called the ‘‘Buddhist unconscious.’’ One need not necessarily completely uproot harmful
seeds if one is busy nourishing beneficial ones. This is very much like cultivating a lawn,
providing the right conditions for a desired grass seed to grow; the crabgrass then has no
place to multiply and take hold. Indeed, the Buddhist term for meditation itself is
bhavana, an agricultural term meaning ‘‘cultivation.’’ Mindfulness is an essential aspect
of the cultivation process that enables healthy seeds to develop and thrive.
NOTES
1
The terms ‘‘positive’’ and ‘‘transpersonal’’ in this sentence are not being used interchangeably. The positive
psychology movement was launched five years ago (Seligman & Csikszentmihalyi, 2000) to counterbalance
psychology’s historic emphasis on psychopathology. Its aim has been to explore those factors that promote human
flourishing and optimize human well-being and happiness. It emphasizes the development of positive human states and
traits (e.g., love, wisdom, aesthetic appreciation, spirituality) and civic virtues (e.g., altruism, responsibility, tolerance).
To the extent that positive psychology and transpersonal psychology share an interest in the cultivation of eudaimonic
states, there is overlap between them. Taylor (2001) has pointed out, however, that positive psychology has taken up
some of the themes that have been the traditional concerns of the humanistic and transpersonal psychologies, but that it
has constrained them within a logical positivist methodological and philosophical orthodoxy. So far, positive psychology
has been wary of exploring non-ordinary states of consciousness, or the specific claims of non-Western spiritual systems.
For example, when Seligman et al. (2005) discussed the domain of transcendence, the traits that defined that category
were ‘‘gratitude,’’ ‘‘hope,’’ ‘‘humor,’’ and ‘‘religiousness.’’ Religiousness was defined as ‘‘having coherent beliefs about
the higher purpose and meaning of life’’ (p. 412). This is a watered down concept of transcendence in which nothing is
actually transcended; not the ego, and certainly not dualistic consensual reali ty. It is still gratifying, however, that
mainstream psychology is finally returning to the exploration of the possibilities of human potential, even within this
limited and limiting view of what human potential is.
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2158
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The Author
Seth Robert Segall, Ph.D., is an assistant clinical professor of psychology at the
Yale School of Medicine where he teaches an elective seminar on the Application
of Buddhist Theory and Practice to Psychotherapeutic Change. He is the former
Director of Psychology and Director of Psychological Training at Waterbury
The Journal of Transpersonal Psychology, 2005, Vol. 37, No. 2162
Hospital, where he now works as a senior clinical therapist. He is a founding board
member of Lotus: The Educational Center for Integrative Health and Wellness, and
a former president of the New England Society for the Treatment of Trauma and
Dissociation. He is the editor of and a contributing author to Encountering
Buddhism: Western Psychology and Buddhist Teachings published by SUNY
Press in 2003.
Mindfulness and Self-Development 163