Instructor Responses to Week 4 Homework

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    Patricia Burke

    Mindfulness in Behavioral Health Counseling

    Responses to Lesson 4 Homework

    Patricia A. Burke, MSW

    Question 1:

    1) What did you notice about your physical experience during the Urge Surfing exercise? What was it like for you to focus on an impulse and refrain from acting on it? What did you notice about how the sensation in your body associated with your impulse change over the course of the exercise? How would you evaluate the effectiveness of this mindfulness practice to “ride out” addictive cravings or impulses to engage in other risk behaviors like binging, self-harming, gambling, smoking, etc.? How would you envision adapting and integrating Urge Surfing into your clinical work with people with addictive behaviors? Be specific.

    The key to urge surfing is a willingness to become curious about the physical sensation and then use self-will with the positive intention of refraining from acting on the impulse. Curiosity is the key to enhancing our ability to take this kind of witnessing position in relationship to discomfort or pain. Once we allow ourselves to notice without judging, the urge loses its power and often diminishes. This can be quite empowering.

    When we refrain from acting on the impulse, we give ourselves the message that the impulse is not bad or good and we also gain experience with the reality that impulses have a beginning, middle and an end. Impulses, like all phenomena, come and go in and out of awareness.

    Refraining from acting on an impulse can be challenging, but if we stay with the practice it can yield many benefits. Craving, like all feelings, thoughts, impulses, and sensations lessen in intensity and often disappear from awareness when we simply notice them without judgment.

    One of the reasons many people return to drinking or using drugs after a period of abstinence is the powerful physical cravings characteristic of addiction to alcohol or drugs. Physical craving is also associated with some eating disorders, like binge eating disorder. Teaching clients to “surf” these powerful urges is an important relapse prevention tool.

    While it can sometimes be helpful for people to engage in distraction as a way to shift the attention away from a craving, imagine how empowering it could be for your clients to practice focusing on the urge to drink, use drugs, or binge eat but not give into it; and how with each small success at refraining they will build a sense of confidence, mastery and hope for a different future.

    Mindfulness is actually something we already know how to do, but we don’t necessarily call it mindfulness or are that conscious of doing it. One of the goals of practicing different mindfulness exercises is to bring the process into conscious awareness. As with the other mindfulness practices we have worked with over the past few weeks, Urge Surfing can enhance awareness of present moment experience and mental focus.

    When you are teaching Urge Surfing to clients, it might be useful to first practice in a session with an impulse that is less intense than the urge to drink, use drugs, or binge and then build up to imagining an impulse to drink, use drugs, or binge. Just like desensitizing people from reactions to anxiety-provoking situations, for some clients, we may need to work up to more intense impulses, so clients can gain mastery over less intense impulses. Some of the ways you suggested for adapting or integrating Urge Surfing in your work with clients include:

    * This exercise can help clients shift the focus form long term recovery (for now) to a minutes, 5 minutes, one hour – even with support that is one hour you did not give into the urges/craving and then build off of that.

    * I think this would work well with clients because it is another way to show them that through a bit of brain power, they really can overcome the difficulties they’re being faced with.

    As with all of the mindfulness practices we have tried in this class, Urge Surfing can be challenging. As Melissa noted, “This has been by far the hardest one for me to adapt to … only because as soon as I saw ‘itch’” I scratched!” And Elaine noted, “I had a constant urge to shift my weight and move around on my cushion on the floor for some reason . . .Working to resist the urge to shift my weight and allow my legs to relax is embarrassing for me to be honest, but once I shifted my attention to my breath, I was able to calm myself and get into my groove eventually.” It may take time, with practice, to master so don’t be discouraged if first attempts are challenging.

    If after practicing a few times and Urge Surfing doesn’t work for you, that’s okay, too. Feel free to discovery your own images, adapt it, or discard it.

    Another realization that we can have during mindfulness exercises, is that when we turn our attention to our thoughts, feelings, sensations, and urges in a curious, friendly and non-judgmental way, we find that the experience is not what we feared. Again, so much of our suffering is about how we judge our experience in the moment based on previous experience or anticipation of what the experience will be like in the future. In my experience, when I am able to be with my experience in this moment, it is never as bad as I imagine it will be. When self-awareness increases, people increase the chance of postponing that first drink or drug. Not only can we realize that the urge is not what we feared, but when we bring mindful attention to it, we can actually find peace in the middle of the experience. And at times we can even “befriend” the urge.

    It is also important to note that when we initially turn our attention to uncomfortable sensations, feeling or urge that it can intensify the experience. It is important to let clients know that this might be a possibility and to encourage them to stick with the exercise until something changes.

    The key to Urge Surfing is to not simply focus on the uncomfortable sensation, but to focus on it with a sense a curiosity. Developing this curious attention is also a practice. And as, I have mentioned repeatedly in this course, if a particular mindfulness practice is uncomfortable to the point that you or your client find it more distressing than helpful, it is perfectly okay to revise it or try a different practice that is less challenging.

    I commend you for sticking with the practice in spite of any discomfort you may have experienced. This is a key to recovery from SUDs and addictive behaviors. Our clients need to build a facility for refraining from urges to use and begin to experience for themselves that urges are not “true needs,” that they will pass, that they are not to be feared, that they might be more intense initially, but will pass with time, and that they are not as bad as we imagine them to be.

    Question 2:

    Describe which of the mindfulness practices you picked and why? What did you notice about your physical experience and feelings, and your relationship to your thoughts during the mindfulness practice? How would you evaluate the effectiveness of this mindfulness exercise to meet your physical, emotional and mental experience in the moment with a sense of compassion and/or expand your sense of connection to something greater than the self? How would you envision adapting and integrating this mindfulness exercise into your clinical work with people with behavioral health issues? Be specific.

    Below is a sampling of your responses to these mindfulness practices.

    Loving Kindness

    * Using the guided mediation: Sharon’s voice was calming and soothing which helped me relax into the meditation.

    Elaine made an important point about encouraging clients to start a mediation practice using guided meditations: “I think that is something important to remember when encouraging clients to start a meditation or mindfulness practice – they have to feel comfortable with a guided meditation leader/or professional helping them with such sessions. Otherwise, they may lose interest or feel agitated for instance. I remember when I first started my meditation practice, I would focus on the smallest details of the guided meditation, such as the way the speaker would pronounce a certain word– it was only once I found sessions that worked for me that the light bulb went on for how relaxing the practice could truly be.”


    Question 3:

    Take a moment to reflect on your experiences with mindfulness over the past four weeks. How would you evaluate your experience with mindfulness as a way to alleviate suffering in your own life and help you enhance your connection to a felt sense of spirituality and meaning? How do you envision bringing this mindful self into your work with people who suffer from substance use, addictive, or mental disorders?

     Below are some of the realizations you have had during this course about mindfulness as a way to alleviate suffering and how you might bring your mindful self into your work with your clients:

    * What I found was the more focused I was on “doing it right” the harder it was. in doing each thing twice (for the 15-20 minutes) the first time was “learning” and the second “practicing.” This is something I can take back with me and remind client’s that we are all always learning and growing.

    *In my own life it will be more about having the tools and not trying to “do them right” but use the framework and my way of doing it, will be my own and that is perfect.

    * In the scope of learning, using this class as a teaching tool, I can say (and reference) my own struggles with learning new ways to think and be mindful and show that we can adapt tools given to us to meet our own needs and where we are at.

    * I really enjoyed taking this course and while some weeks I may have struggled to find the time to fit in the meditations, I enjoy that we were provided with so many different options of guided and written meditation practices.

    * The course allowed me to enhance my practice on some techniques that I was already familiar with, while re-visiting other techniques that I’ve hesitated to use, such as the urge surfing meditation.

    Final Thoughts

     Thank you all for your thoughtful reflections on all of the mindfulness practices we worked with over the past four weeks. I will share one last story with you all about the power of mindfulness in clinical practice. Recently in a session with a young woman who suffers from social anxiety and was feeling overwhelmed with her inability to manage her feelings, I was able to guide her through a brief mindful breathing exercise. By the end of the session she felt calm and was able to gain a sense of mastery and more confidence in her ability to keep anxiety from taking over her life. She agreed to practice the mindful breathing 5 times a day (whether or not she was feeling anxious) between now and the next time we met. This was an exercise that she was able and willing to do outside of the session, because she had a positive experience of it in the session. She now has a practice that will continue to empower her to lessen the hold anxiety has had over her life. As a version of an old saying goes, “Give a woman a fish and she will eat for one day. Teach a woman to fish and she can feed herself, her family, and her community for the rest of her days.”

    Whether or not you teach clients mindfulness practices in a session or simply be mindful in your work and hold the space of curious, non-judgmental awareness in the session, you will be helping to lessen the suffering of your clients who have behavioral health issues. Bravo to you all for taking this course, for your willingness to engage in the exercises, and for your thoughtful reflections and comments. I applaud your commitment to self-reflection and your intention to bring a more aware, compassionate and mindful self into your work with others. You have enhanced my faith in the power of mindfulness to lessen suffering in ourselves and our clients, which is a tremendous gift to the world. It has been an honor and a deep pleasure to have been your guide for the past few weeks.

    Be well. Be in peace. Have a happy, safe, and healthy holiday season.


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