A curious paradox of Western psychotherapy has been the neglect of consciousness – or awareness as Mace, in this stimulating and timely book prefers to call it – as both a focus for research and a target for therapeutic work. Freud took consciousness for granted and saw his project as plumbing the depths of that which we are unaware of; Beck acknowledged the need to work with the conscious mind, but the complexities and pathologies of cognition cannot be equated with consciousness itself. Both psychoanalysis and cognitive–behavioural therapy typically focus on the mind's ‘content’ rather than differing states of awareness themselves.
By contrast, Eastern, especially Buddhist, psychology takes consciousness as its object. Various types of mindfulness-training, ranging from meditation and yoga practices to the contemplation of Zen koans (apparent paradoxes, whose ‘solution’ produces sudden leaps in consciousness) aim to produce calm, clarity of apperception and grounding in the ‘present moment’, thereby freeing the mind from neurotic fears, miseries and self-defeating desires.
A minority of pioneering psychotherapists, notably Jung and Fromm, acknowledged this alternative psychotherapeutic resource, but only recently has mindfulness as a therapeutic technique entered the psychotherapeutic mainstream. Kabat-Zinn's mindfulness-based stress reduction for the physically ill, Linehan's dialectical behaviour therapy for borderline personality disorder and Williams and Segals' mindfulness-based cognitive therapy for recurrent depression are the best known.
Mace's compact, accessible and well-written book surveys the field with a sympathetic but not uncritical eye. He covers the embryonic science of mindfulness (there are as yet few relevant functional magnetic resonance imaging (fMRI) studies) and looks at both psychoanalytic and cognitive attempts at rapprochement between mindfulness and their core discipline. He shows how cognitive–behavioural therapists have found standard technique insufficient to change the long-standing patterns of dysfunctional thought found in individuals with borderline personality disorder and chronic depression, and how adding mindfulness training can significantly reduce relapse rates. There is a fascinating discussion of the parallels between the Buddhist ideal of ‘no mind’ and the psychoanalyst Bion's injunction to therapists to approach their patients without ‘memory and desire’. Mace cites studies showing how mindfulness training for professionals (including the remarkable Monash programme for medical students) can improve outcomes for their patients. He sees the key contribution of mindfulness as enhancing the capacity for compassion by opening awareness to suffering – one's own and that of others. He deconstructs the concept of therapeutic mindfulness into three components: ‘de-chaining’ (slowing down perception, thus breaking the automatism of dysfunctional thoughts and actions), ‘re-sensing’ (acceptance rather than avoidance of problematic feelings) and ‘de-centering’ (seeing mental pain as ‘just thoughts’).
I have but two critical comments. First, the book opens with an off-putting exposition of Buddhist psychology that is hard-going even for the initiated (admittedly, Mace disingenuously invites the reader to skip this chapter). Second, there is no mention of mentalisation, a related concept from the psychoanalytic tradition that forms the basis of Bateman's evidence-based programme for borderline personality disorder. With those caveats, I strongly recommend this book for any aware – or even semi-conscious – mental health professional.
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