Saturday, April 28, 2018

Mindfulness is Not “Therapy”: Understanding Healing vs Fixing in the Practice of Mindfulness

Mindfulness is Not “Therapy”

Understanding Healing vs Fixing in the Practice of Mindfulness

The psychological community has whole-heartedly embraced ‘Mindfulness’ in response to the many mental health benefits that are reported by individuals and documented in peer-reviewed literature.  The research continues to develop with more robust design, and the scientific community has just begun to quantify and qualify the effectiveness of this practice that has been proven through the millennia (it is, after all, a 2500 year old practice!) 

As a passionate mindfulness teacher this is encouraging and exciting; however, it comes at a cost. As with the wide-spread adoption of any new technology or idea, critical elements and understandings can become lost or diluted, and as a result so does its impact - sometimes to the extent that its very nature becomes distorted. While I applaud that mindfulness is being adopted so broadly, and that it is being offered for so many to benefit, I also see how misperceptions about what the practice is have impacted what is offered in the name of ‘mindfulness’ in many cases.

Over the past several years mindfulness has become widely utilized as another ‘modality’ in Psychological practice as a result of this embrace. However, when therapeutic practitioners seek to incorporate mindfulness into their work as a modality without appropriate understanding, the practice loses its integrity (‘coherency with itself’,) meaning and efficacy. I’d like to unpack the crux of this misunderstanding in an effort to champion the power that authentic mindfulness practice can offer, as I have been a fortunate witness to many, many individuals’ process and transformation through the learning of a true embodied and integrated mindfulness practice.

Although we may hear this often, or maybe because we do (and it therefore it becomes merely white noise,) the understanding that ‘mindfulness is not a technique’ often goes unheeded in the pursuit of its adoption. The issues this presents are two-fold: one is the very nature of mindfulness and many of the benefits it can provide are no longer being offered when a technique-based teaching is utilized; the other is that a technique-based approach can, in some instances, cause harm.

To understand why this occurs in the context of the therapeutic community there are a few concepts to unpack: how the therapeutic encounter is understood, what the elements of a therapeutic encounter involve, and finally what it looks like to teach mindfulness in this context (or any context.)

Recognizing Healing vs Fixing

Most therapists would acknowledge that the most powerful work they do is in the realm of ‘healing’ rather than ‘fixing’; and that the catalyst for this healing work rests within the relational field, rather than with any techniques or approaches. So, too, does the art of teaching mindfulness exist firmly in the realm of healing in this way. However, in the therapeutic encounter there are also necessary elements that function as intervention, with an intention to ‘fix’ or help.

The movement between these two intentions is where the use of Mindfulness in a therapeutic context can become confused and lose its impact: the therapeutic power of mindfulness lies, at its very heart, with the paradox of letting go of the need to fix in order to heal. This doesn’t mean that we give up trying to help ourselves or others; but the ability to recognize the difference between these intentions informs the understanding of the practice of mindfulness. This can be difficult to understand because it can’t be grasped through conceptual framework and is therefore easily lost in the push to utilize mindfulness as another ‘modality’ in therapy.

While the work a therapist does is relational in nature, it is generally held within some conceptual framework or theory of psychology that informs that relationship (think: psychodynamic, humanistic, cognitive, integrative, etc.) Additionally, there are the many therapeutic ‘modalities’, often informed by these paradigms or theories, which function as intervention, technique, or tool-kit. Modalities might be conceived of as methods to work with a set of symptoms or issues (EMDR, CBT, DBT,) or to work with a particular kind of resource (equine therapy, sand-play, etc.) in the interests of therapeutic ‘work’. However, to treat mindfulness as a one more ‘modality’ involves a fundamental flaw.

Why Mindfulness Doesn’t Work as ‘Modality’

To approach Mindfulness in terms of therapeutic modality is problematic in a number of ways. The problem begins with a fundamental operating principle of mindfulness practice in the context of trying to ‘fix’ something. 

In order for mindfulness to be in integrity with itself – to be truly the practice of mindfulness and not something else – a practitioner has to be willing to set aside all goals other than awareness of what is happening in the present moment. This doesn’t mean that there is anything invalid about learning mindfulness practice because we want to change something in our lives; it’s perfectly legitimate to have a reason or motivation for wanting to learn. In fact, most find the practice because they are suffering in some aspect of their life and looking to find the way out of that suffering.  Those dealing with anxiety, depression, or chronic pain… or any number of physical and emotional difficulties have found relief and healing after coming to mindfulness intentionally for that purpose. 

But it’s also where things can get a bit messy in the utilization of mindfulness as a modality in a therapeutic environment, because this very benefit is only to be found in the subtleties and paradox within the practice - where embracing *what is* allows change and healing to happen. This isn’t something that can be easily translated through the introduction of a few ‘techniques’ to employ when difficulties arise, or by practicing in order to achieve change directly: 

Jon Kabat-Zinn’s definition of mindfulness includes the descriptor ‘non-judgmental’; and understanding what this means can be helpful in seeing how this is so.

What is “Non-Judgmental” Awareness?

A critical capacity in teaching mindfulness is guiding others to recognize the various ways we hold ‘lenses’ which obscure our ability to see clearly what is happening in the present moment. 

Recognizing the presence of these lenses is rolled-in with the definition of mindfulness offered by Kabat-Zinn when he includes the ‘non-judgmental’ attitude/element in mindfulness practice. The judgement which he is referring to goes beyond (but includes) what we generally think of as making a judgement or being judgmental, and points to the ability to recognize any bias or perception beyond direct sensory experience (direct sensory experience as the bare phenomena at the sense-doors: seeing, hearing, sensations, etc.)  These biases and perceptions function as lenses through which we evaluate (judge) our experience. 

One hard to recognize lens is the one I like to call ‘in-order-to mind.’ This arises even with experienced practitioners, and a mindfulness practitioner must always be on the lookout for this lens because it can be a little sneaky! 

For example, when a practitioner has the experience of bringing mindful awareness to painful sensation and notices that this often times shifts the experience of pain, sometimes to the degree of no longer feeling pain at all, the practitioner can easily slip into the habit of bringing awareness to painful experience in order to get rid of it, rather than to simply observe. Sadly, the possibility that mindfulness would have this impact is pretty much lost when that lens is present! As soon as we begin chasing a particular outcome, it becomes elusive.

Poetry is often used in the teaching of mindfulness through its similar non-conceptual nature. I like this poem by the 15th century mystic poet, Kabir, (translated by Robert Bly) which points to this nature of our minds to want to grab on to one lens or another, he says:

Friend, please tell me what I can do about this world
I hold to, and keep spinning out!

I gave up sewn clothes, and wore a robe,
but I noticed one day that the cloth was well woven.

So I bought some burlap, but I still
throw it elegantly over my left shoulder

I pulled back my sexual longings,
and now I discover that I'm angry a lot.

I gave up rage, and now I notice
that I am greedy all day.

I worked hard at dissolving the greed,
and now I am proud of myself.

When the mind wants to break its link with the world
it still holds on to one thing.

Kabir says: Listen my friend,
there are very few that find the path!

Seeing beyond ‘lenses’ (and techniques)

In mindfulness practice we are cultivating the ability to recognize these various lenses when they are present – to see them for what they are - so that we are less likely to be unconsciously influenced and pushed around by them. This is the ‘path’ that Kabir is pointing towards.  So, when mindfulness is approached as a ‘modality’, which by very nature is a means to an end – a lens of ‘fixing’ – it undermines the fundamental nature of the practice itself.

As a result, the usage of a few basic mindfulness techniques, in the absence of a greater framework of practice, in the interests of offering one more ‘approach’ or tool for handling difficulties will have limited value and impact. 

That isn’t to say those techniques by themselves can’t be beneficial in some ways – they can be useful in moderating behavior when they are used intentionally. It’s just that, like any other similar intervention, one needs to be able to access it in that moment of difficulty, which is when it’s most difficult to call on. In order to have a capacity to drop in in the midst of day to day living more spontaneously and fluidly – particularly at times of great stress - the practices must be cultivated and developed. This is something that just doesn’t happen in offering up a set of techniques:  Jon Kabat-Zinn, the father of mindfulness in healthcare, speaks of the difficulty of trying to apply mindfulness in our daily experience:

“It’s a conceit, and probably delusional to think that; oh since mindfulness is just about being in wise relationship with the present moment, well, I can just do that in any moment throughout my day.. It sounds good but it’s the hardest work for us human beings, to even string two moments of mindful presence together…”
(From "Mindfulness as a Love Affair with Life: An Interview with Jon Kabat-Zinn

The techniques themselves are just not going to provide the same experience that learning mindfulness as a robust practice offers. It’s not going to work at the transformative level which embodied practice does; it won’t fundamentally shift the relationship with experience, which is where all of the power of mindfulness lies. 

Most of the research to-date has utilized outcomes from programs offering a robust practice taught by highly qualified instructors who are able to impart not only techniques, but how to work with them skillfully in the full range of experience, along with the spirit of the practice rather than a collection of procedures to employ. 

Learning mindfulness in the way it was intended cultivates deep insight into our experience which leads to change and healing at a very different level that, over time, becomes self-perpetuating.


On a regular basis articles appear in the news media criticizing and casting doubt on mindfulness as a valid or useful approach, or suggesting that its impacts are overstated. While it’s true that mindfulness isn’t a cure-all the way it is sometimes discussed, these articles are generally a response to the fact that what is often offered in the name of mindfulness are significantly watered-down techniques, or even something completely different. 

For example, among the many usages I’ve encountered, the word ‘mindfulness’ is regularly misappropriated to describe meditation in general (rather than the very specific form which is mindfulness meditation,) other spiritual and ‘new-age’ practices, positive-psychology, or as a catch-all for wellness in general. This can cause confusion for those therapeutic counselors or organizations seeking to offer programs that are ‘mindfulness-based.’ This confusion has resulted in the proliferation of what is becoming known as ‘pop’- mindfulness or 'McMindfulness'; which tries to appropriate the results of the authentic practice of mindfulness with band-aides and feel-good instant fixes - where mindfulness is merely relegated to a buzz-word.

Additionally, the offering of basic techniques and instructions that are not informed by a depth of understanding and experience can bring a potential for causing harm. Without experience with the subtleties of practice, an instructor would not know how to effectively and safely guide a practitioner confronted with obstacles of varying nature

Most often this would only result in providing instruction that is misguided; however, it is also possible –particularly when working with individuals who are dealing with varying degrees of psychological distress -  that pushing a particular technique without fully understanding it could exacerbate mental health problems, including trauma

It’s not hard to understand when some who work in the therapeutic community find fault with ‘mindfulness’ in light of this. However it’s not the practices themselves which are problematic; rather the use of something else in the name of mindfulness, or a lack of understanding of the practices that are being taught which has created this confusion.

Mindfulness as Service: Where Mindfulness Works in a Therapeutic Environment

There are, however, many therapists and counselors who have spent time with their own mindfulness practices and who are adept at offering mindfulness as an element within a therapeutic context, or even trained to provide instruction. 

These therapists recognize that the practice of mindfulness is the practice of being present ‘in service’ to our own experience, and that the most impactful benefit to the client is this service to themselves in their role and relationship with the client.  A therapeutic practitioner with such a practice is able to stay more present and open to the healing that takes place within the relationship. This is incredibly powerful; far more impactful than the offering of a few techniques. This simple act of being fully present with another human being can in itself provide a profound catalyst for change and healing.  

The following, a Zen Koan, points to this:

One day Chao-chou fell down in the snow, and called out, ‘Help me up! Help me up!’
A monk came and lay down beside him.
Chao-chou got up and went away.

Mindfulness can only ever be held as an offering and taught in a context of ‘service’ and relationship; it can’t be taught as a commodity or used as a modality without losing its integrity with itself. It can’t be provided as another technique to add to a bag of tricks without losing its essence.  

Rachel Naomi Remen, MD, clinical professor at UCSF School of Medicine, is considered a pioneer in relationship-centered and integrative medicine; she describes the differences between, and the nature of, healing versus fixing in the role of a medical health professional and within a therapeutic environment:

“Service…  is an experience of mystery, surrender and awe. A fixer has the illusion of being causal. A server knows that he or she is being used and has a willingness to be used in the service of something greater, something essentially unknown… fixing and helping are the basis of curing, but not of healing… Only service heals.” (link)

Mindfulness practice is ultimately a way of holding ourselves in service to – and as a witness to - our experience. Mindfulness can be profoundly healing when related to from this perspective.  To teach from the idea of ‘in order to’ is to teach as a way of trying to fix or change something which is not mindfulness at all.  While therapy necessarily includes elements of both, mindfulness is fundamentally based in healing.

Identifying Therapeutic Programs that are Truly Mindfulness-Based

So, with the profusion of ‘mindful’ choices available, how does one determine whether a program or therapist is truly mindfulness-based? How can you identify authentic mindfulness when it is offered?

The first thing one would want to ask is the qualifications of the instructor:  do they have their own dedicated mindfulness practice, and for how long?  Working with mindfulness is cumulative in nature and developing a momentum of practice strengthens and deepens it; so experience level and background will say a lot about what might be offered by any individual teacher. In what ways are they continuing to work with and develop their own practice?

Does their experience include formal practices along with working with mindfulness in daily life? While daily life ‘dropping in’ is an important aspect in cultivating an embodied practice; the formal practices are what inform that capacity.

Can they describe the differences between mindfulness and other meditation or spiritual practices? Many other practices and traditions (yoga, centering prayer, hiking in nature, etc) hold components of mindfulness, and may be done with mindfulness, but in and of themselves are not necessarily actively and intentionally cultivating the practice.  Can a teacher articulate the components of mindful awareness and how that is cultivated?

Have they spent any time in intensive silent retreat – specifically mindfulness (aka Vipassana) retreats? Dedicated, intensive retreat time is critical in deepening the practice and learning the subtleties of practice and the way the mind works in general and in relation to the practice. MBSR trained teachers must have done a minimum of two, week-long silent mindfulness retreats (in additional to other trainings,) which might be a helpful criteria to apply to any teacher offering mindfulness instruction.

Additionally, do they have training to be a teacher of mindfulness by a recognized organization, or by an authorized teacher?  While taking a few workshops or a class in school may provide a baseline for someone to offer a little guided meditation, or even to discuss the benefits of mindfulness, it isn’t likely to be sufficient preparation for teaching mindfulness as a practice. 

Learning mindfulness and working with the practice is an interactive and engaged process, and finding the right teacher will make a significant difference in how that process unfolds and ultimately how it may impact one’s life. Further, although mindfulness practices can serve us in many ways that are therapeutic and can support the therapeutic process; its essence is in service to our experience, not a way to fix it.


  1. Genevieve - this is a really useful exploration of an important topic. Thanks for writing it!

    1. Thank you Kate, I'm glad you found it interesting!