17 - Mindfulness in the psychotherapy of personality disorder

Summary

Summary Mindfulness has become a popular topic among psychological therapists. This chapter explains what mindfulness is and how it can be developed, before exploring how it has been incorporated within psychoanalytic and cognitive– behavioural psychotherapies that can be used with people with personality disorders. These reflect general as well as specific presumed therapeutic actions. At present, variations in the way mindfulness is understood, taught and applied mean that it is too early to fully assess its potential, but its capacity to potentiate other kinds of intervention and to reduce reactivity to several kinds of problematic experience recommend it in work with people with clinically complex needs.

‘Mindfulness’ is a common translation of a term from Buddhist psychology that means ‘awareness’ or ‘bare attention’. It is frequently used to refer to a way of paying attention that is sensitive, accepting and independent of any thoughts that may be present. The definitions in Box 17.1 represent some different ways of expressing this. Although mindfulness can sound quite ordinary and spontaneous, it is the antithesis of mental habits in which the mind is on ‘automatic pilot’. In this usual state, most experiences pass by completely unrecognised, and awareness is dominated by a stream of internal comment whose insensitivity to what is immediately present can seem mindless. Although most people knowingly experience mindfulness for very brief periods only, it can be developed with practice.

Differences can be discerned in how different practitioners use mindfulness. Some of these reflect the hazards of translation and others reflect long-standing ambiguities within Buddhist psychology (for an extended discussion see Mace, 2008, 2009). One nuance that should not be overlooked, because it has implications for therapeutic practice, is evident from the way ‘mindfulness’ can be used to denote self-awareness or selfconsciousness as well as an awareness of what is immediately present. There is an important element of self-recollection in traditional Buddhist conceptions of mindfulness too, evident when the awareness of internal psychological events such as feelings and patterns of thought is promoted through deliberate verbal reflection, as in: ‘Now I am doing x, now I am feeling y’. This aspect has been played down in the contemporary definitions quoted in Box 17.1, but it has been important in the therapeutic use of mindfulness, particularly within dialectical behaviour therapy (DBT).