Mindfulness in Social Work Practice | Dr. Betty Kramer | UW-Madison School of Social Work

Mindfulness in Social Work Practice | Dr. Betty Kramer | UW-Madison School of Social Work

I’m Betty Kramer, and I’ve been asked to talk today about Mindfulness, Self-Awareness, and Self Care in Social Work. And this is a talk that I had given to our 185 Social Work Supervisors recently, and it’s something that I love talking about and love helping people understand. Because I feel it’s very important. And so today, really, my goal is to help you understand why this is an important topic and how we can be more mindful. Like–well I’ll tell you what the objectives are in a minute. But just a little bit of background information. I am a Gerontological Social Worker and had worked in the field for a number of years before accepting an academic position here. And I also volunteer at Hospice, and I do a lot of stuff in the field of Palliative and end-of-life care. And I supervise students who are doing field placements in Social Work in aging settings. My experience is in many different settings and observing professionals and kind of what happens at the bedside and end of life. And what happens when professionals are confronted with painful emotions like grief, is that people are really challenged to be present–and that causes a lot of problems. And it causes a lot of harm. And I have been someone, for some reason as a young adult I started meditating and I knew that I needed to do that and I knew that it was important for my own well-being. And so I have many years experience with meditation and different kinds of meditation. But it’s only in the last, probably, 2-3 years that I’ve studied more about the mindfulness type of meditation. I received a grant from the Center for Contemplative Mind and Society to develop curriculum for our Social Work Practice Course– our foundation theory and methods course–to teach social workers about the value of mindfulness for self-awareness, for self-care, and also for engaging in social justice. And so, through that process, I learned a lot. And it really helped me to think more deeply about how to integrate mindfulness into my daily life, and how to teach people about it. And so, I use mindfulness in the classroom. I teach at the Bachelor’s, Master’s, and PhD level, and I start all of my classes with some type of mini-mindfulness exercise. Partly because we are in a better position to learn when we are really there. So actually, today why don’t we just start with a very brief exercise–and we’ll talk about what mindfulness is–but basically what we’re trying to do is gather your awareness so that you can fully arrive here, so that you’re not thinking about what you have to do next or worried about what you just left. But just fully arrive. So to do this very simply, you can follow your breath. And so I’m going to invite you, just you know you can sit in a very comfortable position and just take a few breaths. Just breath in and just observe your breath–observe where you feel it. You might notice it coming in at the nostrils, or you might feel it in your tummy or your chest, as your body expands and deflates. And this process of bringing the awareness to the breath…helps you to arrive in the body, so that you can actually be here. So just–we’ll do a little more with that in just a little bit. But I would like to provide a little bit of background about why, umm, kind of an introduction in terms of thinking about these issues from the perspective of social work. The National Association of Social Work has a position statement on the importance of professional self-awareness and self-care. And I see self-awareness as very akin to mindfulness. As we talk about what mindfulness is, you’ll see a direct link between awareness of self and what mindfulness is. And they say that the practice of self-care is critical to the survival and growth of the profession of social work. And that self-awareness and commitment are key to promoting self-care. So we see very much a commitment and a policy statement about why this is important from a professional organization. We know that lack of awareness causes harm in many, many different ways–clinical errors–and all sorts of research about how people get into patterns of responding to things in rote ways. This is a natural occurring process, but this natural occurring process results in clinical errors 95% of the time. And clinical errors can be very serious. We know people die from clinical errors, we know people are harmed from clinical errors. And it’s really about missing details. And all the horrible things that happen in society because people are not really present. I knew someone who–a man who worked for an insurance company–and he was driving home one day and he dropped his phone. And he’s fumbling around and he goes to grab his phone and he accidentally hit a construction worker and killed him. And he’s in prison now. So these very simple things, you know, that we think “oh my gosh, we do this all the time.” I drive down the road and I see people putting on their make-up or texting on the phone and these kinds of things. And it’s just really scary. More and more there are things that are pressing upon us that cause us to not be present with what we’re actually doing. Of course the issue of counter-transference and professional practice, and the ways that we can cause harm by not being aware of how we’re influenced by an encounter. And also, I want to tell you the story of the ants. One day I was walking–I just took a short walk with my dog. And I was about to step down, and I looked and I saw an ant that I would have stepped on if I had just been walking mindlessly. And I thought, wow, and I moved my foot and I just started paying attention. And decided I was going to count the number of ants that I would step on if I weren’t being mindful. And within a 3 block period, there were 47. So I would have, unknowingly, killed 47 living beings by mindlessly walking. And we might think, “well you know, ants, how important are ants?” But let me tell you, ants have families, they have a social structure, they care and nurture their children. Many species of ants come and collect dead bodies and take care of them. They’re wonderful problem solvers. I mean–they have a life. And they’re missed, you know, when they leave this world. And so being someone who cares very much about not doing harm, that really taught me something about being more mindful in these very simply daily activities. In social work our mind is our instrument–we’re the instrument of the work that we do with people. And, you know, much like if you think about someone who, someone who works in a symphony. Well their instrument is their cello or whatever instrument they play. And you can bet that before they go out on stage, they tune their instrument, and they make sure that their instrument has all its parts, and that it’s all complete and together. And then they go out and play. And like that, I think that we should be thinking about ourselves in this way. Do we have all our parts together, or is our mind somewhere else? Are we in-tune? Are we aligned, with our awareness? So this, you know, this is just really foundational. And it’s really essential for integrity and competent practice, I believe. We serve as models for others. As family members, we’re models for people we share our life with, for our children. We’re models for other professionals. What we do, and how we live our life, and how we engage in practice–others see that. And we can influence them by how we behave. And we’re models for our clients. You know, many social workers, most of the mental health services in this country are provided by social workers. And, you know, what are we modeling for our clients, in terms of mental health? In terms of being alive, being present? Being aware? It’s very important–what are we modeling? And I, in exploring these topics I’ve really begun to investigate the issue of multitasking, because it’s really one thing that’s conspiring against our mindfulness. And what I’ve learned from several research studies is that multitasking is a fallacy, in terms of our idea that we’re exceptional multitaskers, we can be more efficient because we multitask. Research shows that in fact, the part of the brain, the front lobe, that we use to engage in these various tasks can literally only process one thing at a time. And so what happens–it’s very efficient at switching back and forth between tasks, it can be very rapid, giving us this illusion that we’re doing several things at once. But in fact, studies are showing that it takes time for people, for that part of the mind to recover. And so they’ve done studies where they took really high multitaskers and low multitaskers, and gave them various tasks to work on. And much to their surprise, they discovered that the low multitaskers actually performed much better on all outcomes than the high multitaskers. So, it’s very interesting. It’s something to contemplate and…be aware that multitasking actually over-excites the brain and makes you less efficient in the long run. So, one of the–this is the outline of the topics I hope to cover. So one is just, I want to acknowledge some of the occupation challenges of social work, that have relevance for mindfulness. And then we’ll talk about what is it? What are the benefits, in terms of what has the research shown us are the benefits? We’ll talk about the implications for the profession, and then we’ll do some experiential mindfulness exercises too. So I love this quote from–have any of you read “Kitchen Table Wisdom” by Rachel Naomi Remen? It’s a beautiful book. She’s a physician–I think she might be a psychologist or psychiatrist. But this book is a book of stories that are really about her practice, and her relationships, and what she’s learned. And she’s, I believe she’s a mindfulness practitioner. But she says, “We can no more be present with the suffering of others and not be affected by it, than walk through water and not get wet.” So everything we do, you know, with our clients touches our lives. And social workers work with the most vulnerable in society, the most traumatized often. And so, we’re touched by that. There’s a lot of literature on this concept called Compassion Fatigue. And I just want to say up front, I actually do not like this term, because it implies that it’s compassion that is harmful. And a lot of research now that’s going on on true compassion shows, in fact, that people who have true compassion are tireless–Mother Teresa, Elizabeth Cooper Ross–we can see many examples, exemplars, of individuals who have altruistic, great compassion alive in them who never burn out or get Compassion Fatigue. They keep going. Their love for others, their passion for others inspires them. It doesn’t deplete them. Some of the research Richie Davidson is doing now says that the concept of like empathy or sympathy is a different construct–and that that, depending upon how it’s being used, can cause people to have difficulty in practice. So anyway… But nevertheless, this is the term you’ll see in the literature. They talk about it being a reduced capacity or interest in being empathic or bearing the suffering of clients. And this is often–the literature says that professionals who are working with people who are traumatized are people who are really vulnerable to this. And it’s kind of like this combination of vicarious traumatization–so I’ll talk with you about that in a minute–burnout, and also chronic lack of self-care. So you can see where the issue of mindfulness comes in, because people are doing this work and they’re pushing themselves through, and they’re never really bringing mindfulness to what it is that’s happening to them and what they’re experiencing. Vicarious Traumatization occurs for individuals who are repeatedly exposed to trauma. And those who have a prior history of trauma are much more susceptible to experiencing this. And we know that social workers, often, because of their personal experiences are drawn to the helping profession. And so many social workers have had their own personal experiences with grief and loss and trauma in their lives. Not all. But studies show that social workers have a larger proportion of these experiences than those who have never really had that. And what happens is that people who have Vicarious Traumatization actually experience symptoms of PTSD through their, you know, the imaging they receive from clients and their work with hearing stories…Oh, and one of the hallmarks of this is this pushing away, this avoidance of the traumatic event, trying to block it out. And so, a lot of the research on mindfulness now is helping people not push it away, but be present–and it’s bringing healing to them. So, we’ll talk about the research in a little bit. Burnout is another occupational challenge in the profession. There are many domains of social work where social workers burn out. And we have high rates of job turnover. And individuals basically have the sense of demoralization and diminished caring. And, you know, I’ve met social workers who are experiencing this, and you just wish that there was something we could do to help support them so we can help prevent this from happening. And there is. And then finally, the other occupational challenge I’m aware of that I think is very relevant is Chronic Bereavement, Where many social workers who are working in health care settings in particular, or with populations experiencing lots of violence, experience multiple deaths. And, you know, I’ve had social work students take my grief course who felt like they were completely unprepared for what they were experiencing in terms of deaths in their professional lives, and needed help to figure out what to do with that. And self-awareness, and also supports in the work environment, are really critical to helping people deal with Chronic Bereavement and heal with Chronic Bereavement. Ok, so I want to share a clip with you. We’re not going to watch the whole thing, but it’s a clip of John Kabat-Zinn kind of talking about our busy lives. And I want you to just kind of reflect on what you can relate to in this film. In this brief clip here. I hope you can hear it. “There is a yearning; there is a hunger in this society which we sense deeply, for some place that I can be real; some place that I can just be myself. That I’m okay the way I am. That I don’t have to change, that I don’t have to do anything. Now that we’re in the digital age, all bets are off about what’s going to happen with stress because we have introduced entirely new methods of stress in our lives. The stress of information processing and the speed at which things are going. While you may not be able to change all the outside pressures and forces in your life, how you actually work with them and respond to them-you do have a huge amount of say over. But you have to be in touch with what’s going on in your life, otherwise it’ll just kill you or mow you over. It’s not the stress so much but how you handle it, within limits, that is what really makes the difference.” And his clinic is based on a Mindfulness model. “Now that we live in a kind of very complex society, the stresses tend to be somewhat different. The stress of whether you can make a living, or the stress of getting your kids through high school. Or the stress of feeling like your job is being downsized, or you’re no longer happy in your work, or you’re having a hard time in your relationship with people. Those things can be very, very stressful. In some sense or other stress is in the eye of the beholder. What’s stressful to one person is not stressful to somebody else. So somebody might deal with the pressure of work extremely well and, in fact only thrive under periods of pressure. Whereas somebody else just goes to pieces under that same kind of pressure. Now there’s more and more of a fuzzy boundary between work life and home life because your electronics goes with you at home, and between working the week and weekend, and between night and day. So that if you’re not careful, you could be working virtually all the time-on your cell phone all the time, or faxes, or email, or this or that. To the point where you’re always reacting or responding to something else and you have no time to actually be. So always doing. So one of the key dimensions of stress reduction and of the work of mindfulness is to actually recapture the being in human-being. So that we don’t, as the cliche goes, become entirely fantastic human ‘doings’, and in the process stress ourselves out enormously. ” Yeah, I can remember before all this technology came, believe it or not, there was a time we didn’t have cell phones; I can remember getting a cell phone was like, “wow.” You know, just being available to people that way. And email, I remember a time before email. And we would send letters, you know, call people on the telephone if we had something. It was a much slower pace in a lot of ways. We thought with the advent of these technologies that it would simplify our lives, but in fact, it’s had the opposite effect. It’s really created much more complexity. Well this is really important, so just having so many things, like every minute of your day scheduled, but I promise you you can be. And so this is where the the mindfulness comes in. There are ways to be wherever you are. And we start by practicing this in small ways. And then you can find that your mind isn’t always thinking because when we’re thinking about all of the other things we’re doing, we’re actually not even doing what we’re here to do. And so that becomes very important, and there are ways that your life becomes so much more alive when we be. And you can, you wanna be while you’re doing. So being doesn’t mean you’re not doing. But it’s possible to be alive and be fully present while you’re doing, and then your activities actually become much more meaningful and skillful. But we are not taught how to do this. So this is the dilemma we have. So we have to learn how to do this. And when you learn mindfulness techniques, and that’s why it’s so helpful in anger management and in behavior change protocols, because when you learn mindfulness, you don’t just stop to get other information. But you stop to pay attention to what it is you’re actually experiencing. Because what you’re experiencing is going to influence how you react. Usually what you’re experiencing is anger or injustice or judgment or something, and then we just go, “blah.” And we cause harm that way. So mindfulness teaches people to stop, observe, be aware. Often emotions are liberated just from the awareness. And then we can be more skillful in thinking about how to respond, so thank you for sharing that. There are a lot of things that Social Workers talk about, too. Just the competing roles and values that can play on our minds. When we have multiple responsibilities and having to take care of kids, or working in different environments where we feel like the values of the organization maybe aren’t consistent with our values. And we’d like to do things differently. And that can cause great stress. The social problems in our work world, organizational structures and climate, and our personal limitations. So kind of, we don’t have all the skills that we need to do the work we’re doing. And we need mindfulness to be able to evaluate that and help us think about that. So there’s lots we could talk about here. So what is mindfulness? We’re just gonna–another little clip from John Kabat-Zinn about this, and then we’ll talk about what it is. “Mindfulness. It’s the awareness that arises through paying attention, on purpose, in the present moment, and non-judgmentally. So it’s awareness, and the awareness is cultivated by paying attention. And in a particular way, on purpose. In other words, intentionally. In the present moment, which is the only moment we ever have to be alive in. And then most challenging of all, non-judgmentally. And that means–of course we have judgements about everything–but to not be caught in those judgements. Or that we color everything through our likes and dislikes. So that sounds pretty simple. Ok, paying attention, I can do that. But actually, when you start to pay attention to how much we pay attention, a lot of the time our minds are all over the place and we have a very hard time sustaining attention. And our attention is not very vivid, it’s not very stable. And teachers go out of their minds screaming and yelling at classes of students ‘pay attention! pay attention! pay attention!’ But nobody learns to pay attention by being screamed at to ‘pay attention’. But it’s something that we can teach to people, how to pay attention. It is very, very powerful to learn how to sustain attention moment by moment by moment.” Let’s take a moment and just do that, let’s pay attention to what you’re experiencing in your body right now. So I just invite you to rest your eyes and just kind of bring your awareness to your experience sitting here in this room. And see what you can notice about what you experience. Do you notice the feeling of your body on the chair?…Do you notice particular feelings or thoughts?…Tension in the body? Anything you wanna, you know, just feel what you can be aware of in your experience. So we’ll play with that just a little bit more. But just to reiterate what he’s saying, what is mindfulness. Paying attention in a particular way, on purpose–so this means we have to stop and actually do it. In the present moment and non-judgmentally. That’s often the trick, because what happens is we start to pay attention and then we start to judge it. Judge something, I feel ‘this person’s irritating me’ or ‘this is really stupid’ or ‘I can’t do this, I’m not capable of doing this, ‘I’ve never been able to.” All the things that we might say to ourself about it. So we try to let that go and observe. And one thing you can do, like when you notice these thoughts coming, you can say ‘Oh, thoughts’, and you just name them–thoughts, judgement–and then watch it float away, just like clouds in a blue sky, they form, just let them float away. And then come back to bring your awareness to whatever it is you’re attending to. Presence of heart. This symbol in the upper right corner there, the top part means–it’s a Chinese symbol, this is the symbol for mindfulness–and the top part of the symbol means ‘presence.’ And the bottom part of the symbol means ‘heart’. And in Asian culture, when they talk about their mind, they actually– let me ask you, where is your mind? Point to where your mind is. Ok, so a lot of you think the mind is here right, in the brain right? Ok, so when you’re dead, is your mind in your brain? Does a dead brain have a consciousness? No…the mind actually is not a physical thing. You can’t locate it. And what happens in Western society,we tend to bring our mind to our brain. Ok, let’s say–let me give you an example. You have a hammer and you hit your thumb. Where is your mind? It’s in the thumb. It goes right to your thumb. And it goes ‘whoom’. Where you bring your awareness–that’s a great example of how our awareness can intensify something or whatever. And in Western Society, what happens is many people actually get stuck in the brain. The brain is an organ, and it has a function, and we need it for certain types of activities. We need it for sequential thinking and processing particular, like when you’re working a lot with numbers and that sort of thing–you need the brain as the processing unit. But ideally in a healthy person, your mind, your consciousness, will return to the heart. That’s where it’s meant to reside. And it can go other places, to do other things. But it’s meant to reside here. Most Westerners get stuck here and think that’s where the mind is. But it’s not. And that’s one of the reasons why we feel uncomfortable, and anxious, and stressed, because we’re not actually at home, in the heart. But if you ask people in many Asian societies, if you ask them were their mind is, they’ll say here. It’s very interesting. Mindfulness is both a process and an outcome. So the process is doing mindfulness, practicing mindfulness, bringing our awareness. But we also can experience the outcome, which is mindfulness. And it’s something that requires training. It requires training because we have trained ourselves to not be mindful. Which is very interesting. If you look at very young children–how many of you have very young children? Ok. Would you say they’re kind of in the present moment? Yea. Many children are just, you know like, they see a flower and it’s like everything, bubbles–everything is just magical. And you know it’s magical because they’re really experiencing it. They’re really alive when they’re experiencing it. To us, it’s ordinary because we’re actually not even experiencing it. But when you start to become mindful, you’ll be amazed by how much joy you can experience. I was walking down the street one day, and because I’m teaching a lot of mindfulness now and being more aware, I was really there. And as I came really in the present moment, I felt this breeze come and blow against my face. And I’m telling you, I felt bliss. You’re not gonna get that if you’re not mindful. It’s amazing, it’s absolutely amazing. One day I was walking at the dog park with my husband and our dog and I said let’s really practice just being really mindful. Because we had been walking and talking about this and that, and what we were gonna do. I said, let’s practice this just really being present. And I look up, and all of a sudden it’s like the sky is this brilliant blue and the clouds are so beautiful, and feeling the breeze, and smelling the leaves that are changing. All of it together, the awareness of this experience, came so vivid and so alive, that afterwords I had like these flashbacks of beauty from this walk–that you don’t get when you’re just walking and talking and not paying attention. And so it’s wonderful….So let’s take just–actually we won’t do 60 seconds, because that would be intolerable, we’ll do 30 seconds ok. And I just want you to observe your mind. Just see what’s going on in your mind. Ok, ready, go. Ok. So I just–this image is very powerful because these are images of what the mind is like without mindfulness. And so you can imagine kind of being on this horse, and sometimes–so the mind is sitting on the horse–and sometimes the horse is kind of going over here, and then the mind kind of goes over here munchin on some grass here, and then they go over here. But we don’t quite know where it’s going to go, we just kind of follow it and follow the mind wherever it’s going. Sometimes the mind is racing, from this to that, this to that. And ‘woooo’, back on its hind legs. We just don’t know, ok. Or it’s also been akin to kind of the chimpanzee experience of jumping from this to that. And so people who–generally, the usual day for the mind involves these kinds of things: Wandering, like the horse. Judging, kind of having a critical mind about whatever we’re thinking about. We might be replaying something that happened in our day–‘I can’t believe they said that!’ ‘I should have said this!’ You know, we go off on these tangents about our experience. Dwelling on memories. And we might dwell on memories that are pleasant or unpleasant. Regretting, what we’ve done, having regrets about something that’s happened. Worrying. Our mind will often start Planning–‘Ok, I have to do this next, I have to do that next.’ And sometimes you might find you’ll be sitting there with a client and you’re already planning what you’re gonna be doing with the next client. And then often there’s this “either-or” mind. So just kind of observe this in your mind. Is it kind of wanting something, not wanting something. Or we have an experience like “oh, I don’t like this” or “oh, this is great! I want more of this.” You know, you’re eating your chocolate and you’re thinking “Oh, I wish I had a bigger one.” Loving or hating and attraction and aversion. These are–so much of our day is spent having an opinion, deciding, having judgement, choosing, discriminating, ordering, arranging. And these things aren’t inherintly wrong. But they’re not always the most skillful. So sometimes we do need to do planning, and we do need to discriminate about what’s the best course of action. So we need some of these tools. But to just be at the mercy of whatever is not helpful. And what we’re doing may not be skillful. So mindfulness facilitates these kinds of qualities, as John Kabat-Zinn said, mindfulness facilitates being. And I love that quote, that we’re human beings not human doings. And who you are, the essence of who you are that is completely unique and completely you–you can only access in your being. And that’s what makes you beautiful. And that’s what makes you special. And what we want to do is bring our being to our life as fully as we can. And not just be machines that are just enacting tasks all day. Mindfulness facilitates stillness. And people who practice mindfulness say that it’s like, you know, when you have a glass of muddy water and there’s a lot of sediment and it’s all shook up. When we’re not mindful, our mind is like that, it’s kind of muddy and it’s all shook up. And when you practice mindfulness the sediment settles and you get greater clarity in the mind. So you can think more clearly. But importantly, you feel a stillness in your being. Mindfulness facilitates observing. And you can observe sounds–let’s take a minute just to observe the sounds. So close your eyes and let us take a little bit of time just to bring your awareness to any sounds that you hear. So that’s another mindfulness practice you can do, is just being aware of what you hear in the environment. And it’s amazing–like sometimes… you know, like when you’re really, really stressed–where is the bird song? You can’t even hear it. You know, but sometimes you just stop and pause. Like when you’re out walking, just listen. And it’s amazing, all the different sounds that can come into our awareness that are beautiful, you know. (Audience member: It’s nice that this room, I know it’s not air conditioned and shut in. It’s nice that you have open windows. I was thinking how nice it would be to work in that environment. In an over air conditioned room.) Mindfulness facilitates being like a mountain. And what this means is that when you bring your awareness fully into the present, you become stable and steady–like a mountain. And there’s actually a beautiful meditation you can do where you visualize in front of you, actually let’s just take a second to do this, because we aren’t going to have a lot of time to do a lot of mindfulness exercises at the end so we might as well do them now. So visualize in front of you a beautiful mountain. And try to see it with as much clarity as you can. You might notice if it’s snow-capped or green, kinds of trees, but just this strong stable mountain. And just breathe in and out while you’re observing the mountain…And now I want you to imagine that that mountain is going to come and become a part of you. So you become the mountain. Just breathe in and out and feel the strength of that mountain that you’ve become. You have within you the sacred energies that are you. No one else has them. And they’re always there and they’re always accessible to you. And, like on a cloudy day–you know what the clouds are there– we don’t see the sun, but the sun is always there. And mindfulness helps you gather your energies back so you can be more complete. And so this is really related to this issue of being like a mountain because when you have all your energies gathered, and you’re there, you become more steady and stable and whole. And you think about how different would your activities be when you’re in that place, versus when all your energies are scattered out– like when you think about things you’re sending energy out to those things. And if you’re not calling them back you’re operating on fewer cylinders than you could be . You can be sitting in a meeting at work and you can be following your breath and bringing your awareness together so that you can be more whole when you’re interacting with others. I love doing this at the beginning of class because it helps everyone arrive, and it helps all of us be more present for whatever it is we’re about to do. And, you know, we feel more stillness so we’re less afraid and worried. So we can receive information and share our experiences more readily. It’s just wonderful. Non judging and non striving– so, we don’t, when we are doing mindfulness, we don’t say, “Oh, my mind’s supposed to be empty. My mind isn’t empty.” We start beating ourselves up for whatever reason. But it’s mindfulness. We’re just observing and accepting whatever we experience. And not striving to experience something. So if you sat down and said, “Oh, I want to be still. I really want to be still. I’m trying to be still.” And you’re striving to do that, you’re not able to because you’re not practicing mindfulness. So mindfulness is actually something that’s practiced in many of the world traditions, but it originally came to America by folks like Joseph Goldstein, Jack Komfield, and Sharon Salzburg who traveled to Asia. I think, I don’t know if they went to Thailand–I don’t remember the exact country they went to. But what they did was they went to these and they traveled and they were immersed in cultures where many people were practicing mindfulness, and they learned about it and brought it back to the West and started centers. So these folks started the Insight Meditation Center that teaches people mindfulness and insight meditation. John Kabat-Zinn was someone else who had traveled and learned a lot about mindfulness techniques, and he developed the mindfulness based stress reduction program we heard a little bit about. This is a program that is sweeping the nation. It is, you know, in all major US teaching hospitals there is mindfulness based stress reduction programs. And there are many studies that are documenting the wonderful success in treating many kinds of disorders. And this is what’s involved. I actually took this class a couple years ago when I was just learning about it. And I learned a lot about body scan meditation, which is one of the practices. Have any of you heard of that? Yea. So it’s already infusing our culture. Many of us are learning it. But you’re basically going through a process of observing, bringing your awareness through the body, to see just what you’re experiencing in the body. And then you can do different things with that, or just observe. They teach sitting meditation in mindfulness. And they also encourage people to do mindfulness meditation formally in their daily lives. So if you take this 8 week class you’ll be asked as part of the class to everyday practice for like 15 minutes. In addition to being mindful in daily activities. There’s also another, a mindful practice model, that I really like that was developed by a woman Shapiro who is a assistant professor in, I think, family therapy. And she took mindfulness concepts and developed this model for helping professionals to use with clients and themselves. And she said there’s three things–and this is very consistent with Kabat Zinn’s work–that our practice and outcomes we experience are influenced by: our intention, our attention, and our attitude. And the intention is really speaking to the reason that we’re practicing mindfulness. And basically what this says is that whatever your goal is, whatever your intention for doing mindfulness–that will directly influence what outcomes you experience. So if you want to practice mindfulness to reduce stress in your life, and you set that intention, your mindfulness exercises will have that effect. But you may have another intention. There may be something else. It may be that at work you say, “my intention is to be completely present with this client today that I’m going to sit with. And if my mind wanders, I’m going to bring it gently back to the situation.” And so in that practice, that’s what you will experience. So intention is very important. Attention is little bit of what we’ve been practicing where we are observing our experience or our environment. And it’s really just being conscious moment by moment. And she says that cultivating attention that is discerning and non-reactive, sustained and concentrated–to see clearly what’s arising. And then the other element, the third element, is attitude. And this has to do with the qualities we bring to our attention. So we’ve talked about a lot of these: non-judging, non-striving, patience. I love this one–openness called Beginner’s Mind. So it’s kind of like, we get used to doing things, and so like I said before, we do them in a rote way. But imagine if you just acted like you’ve never ever done this before. And you just bring this really fresh perspective to what you’re doing–it changes. And also bringing it to your mindfulness practice. Like to say, “What am I experiencing? Isn’t it curious that I see this color when I observe my headache? Where do I feel this pain in my body?” And so you have this really open beginner’s mind. Bringing a curiosity to your experience and a gentleness is very important. And loving-kindness is also another element that you’ll see in a lot of the mindfulness practices. And again presence of heart. And you know, if you take the mindfulness-based stress reduction program, they actually teach a loving-kindness practice. Where we wish ourselves well. You might say something like, “May I be happy. May I be at peace and ease in the world. May I be free from suffering.” And then you might go through this process where you think of someone that you love and you say, “May they be happy. May they be at peace and ease in the world. May they be free from suffering.” And then you can expand it out. And you might think about someone who is your enemy…and you might say, “May they be happy. May they be at peace and ease in the world. May they be free from suffering.” And I’ve done this before where we did the whole– we do all of Dane country, then we do the nation. And it’s amazing how when you bring your awareness to this loving-kindness practice, how healing it can feel. It’s really wonderful. So mindfulness practices are both–I’m sure you’re getting this already because we’re talking about it. They can be formal, where you say, “Every morning I’m going to get up and I’m gonna take 10 or 15 minutes to sit and practice mindfulness.” And you might sit and you might do body scan. You might follow your breath. And actually I have a handout that I’m just gonna pass around, because it has a lot of these. The other thing is that it can be informal. And the first page of this talks about some very informal mindfulness practices that you can do throughout your day. So these will give you some wonderful, there’s lots of wonderful information in here on same basic things about mindfulness that you can practice. The benefits of mindfulness–so I’m just going to say there have been more than 1,000 lab studies done, there’s extensive evidence on the benefits. We don’t have time to go into depth, but I’m just going to give you highlights. Many physiological and health effects–it affects immune system function, chronic pain, improves sleep, addressed blood pressure problems. There’s lots of research going on in our campus with Richy Davidson, who’s studying the changes in the brain that occur because of mindfulness. He’s the first one to document that actually the brain has neuroplasticity–in other words, it can change. And they used to think that that wasn’t possible. So this is very exciting research. A lot of people are looking to what’s going on here in the research lab. It enhances attentional stability and reduces cognitive task effort. So, it helps us be more adaptive to stress, through the cognitive changes that can happen. There’s a wonderful book called “Mindfulness Based Cognitive Therapy for Depression” that has become very popular. They’re using mindfulness based cognitive therapy to show that people who do mindfulness, they actually have benefits equal to what people are experiencing with medication. And this book has transcripts in it that you can use to teach people mindfulness. It’s wonderful! And that you can use for mindfulness. So again, it’s called “Mindfulness Based Cognitive Therapy for Depression.” This is a social work scholar who’s been studying mindfulness for reducing PTSD in traumatized women who live in a shelter for women and homeless women and kids who have addiction problems. And she has found that these women when they do mindfulness–I mean, you can imagine how horrific their lives are–and she compares the women who get the intervention to those who don’t. And on like 20 outcome indicators, these women have more joy, less depression, less PTSD symptoms. It’s amazing, the benefits. And it’s something that you can do, in any setting. So very vulnerable populations, prisoners–these great interventions that can help change their mind to more happy states of mind and bring healing, that anyone can do anywhere. You don’t need a lot of money to do it. It’s wonderful. And this is a book called “Integrative body, mind, spirit social work.” And it talks about a lot of the research they’re doing in this area. It’s been found to affect eating disorders and alcohol and drug use. And basically, as this woman up here had said, you’re stopping the chain of reaction with mindfulness, so that people have a chance to slow down and change their behaviors. And it also has positive effects on social relationships. And professional self-care, they’ve done studies looking at the decrease in stress in professionals who practice it. And it’s getting good results there. So implications for the profession–I think this is probably the most important slide here. But we’re out of time. Do you guys have to go? Should we end? I could take questions, if you’d rather, or should I present a little bit more? (Audience asking about getting slides) Why don’t you email me, yea? Yea, that’d be fine. So I think the implications for clinical practice based on the research and just what I know about this is that there’s the attention, the curiosity, the beginner’s mind, and presence you get from mindfulness can affect quality of care, quality of caring, and well-being. And there’s ample evidence to support this. I think for social workers, we expand our toolkit by understanding that mindfulness is used to treat many different kinds of problems that we often are working with, to help individuals with. And it’s being used in many different settings. I mean there are–lawyers are very interested in this, for helping them manage stress and being more skillful in their work. But healthcare, mental health, schools. There’s a preschool, Waisman Preschool now is teaching mindfulness to little children. And they have this long waiting list of parents who want to get their kids into this program. And how it’s shifting their behaviors and changing the climate of the classroom. There’s a book I wanted to tell you about called “Mindfulness and Social Work” that’s edited by Steven Hick. He’s a social work professor who had an accident and had a really severe brain injury. He got a concussion. And he went to the doctor and he was having all sorts of problems performing at work, and they said you need to relax. You need to calm your mind. And he’s like, “I don’t know how to do that.” And he finally came upon a mindfulness course. And the mindfulness practices healed his cognitive disability. And so he became really fascinated with this. This book is wonderful. It gives all sorts of exercises and models for working with different groups. And then there’s also the book by Shapiro called “The Art and Science of Mindfulness.” And she wrote this for helping professions. And this is where the model came from on attention, intention, attitude. And then there’s also a report out on how mindfulness enhances social justice work. This is available online. It’s called “Inviting the World to Transform” and this was a report that interviewed 72 leaders who were involved in social justice around the country, and asked them to talk about the benefits of this in their work. And these are the benefits. Sorry we don’t have time to go over this. And also enhancing sense of aliveness. We’ve talked a little bit about this, but I’d like to tell you just a couple stories about this, and then I think we’ll conclude. I had an experience once where I was with my father who had come to visit, and I hadn’t seen him in a long time. And he came to meet my 6 month old daughter. And we went out to Blue Mounds and we hiked up the towers. And he was holding my daughter, and I took a picture of him with her and the camera died. And somehow it got my attention, and I said, “Pay attention! Be present.” And I knew that something important was going to happen. I just knew it. And two weeks later I get a call in the middle of the night that he had been killed in a crash. And it was just so amazing– because I was really present with him while he was there, we had these amazing conversations about his regrets in life and all of this stuff. But I was really present with him because I had this knowing from paying attention. And it made a big difference in how I grieved, in contrast to my sister, who when he called my sister to see if she wanted to get together she didn’t pick up the phone because she was too busy doing other things. And because she didn’t pick up the phone, the guilt and the grief she felt was just tremendous. And I had a student last year who–you know, we were learning the mindfulness stuff in the seminar–and one day she just all of a sudden had a thought about a client. And she paid attention to it. And she decided to go out and visit him. And when she arrived and she walked in, she caught him in the act of attempting suicide. And she called 911 and got him help. So, you know, yea this is “intuition”, we can say “well that’s intuition, that’s not mindfulness.” But the mindfulness comes in when we pay attention to what is arising. And so it becomes very important. And also, we don’t want to get to the end of our lives–a nurse wrote a book called “The Top Five Regrets,” and what happens is people are dying, and THEN they start to think about it. “I wish I had done this. I wish I hadn’t worked so hard. I wish I had paid attention to my children.” All the things that you can pay attention to now, don’t wait until you’re on your deathbed. So when you live mindfully, you’re likely to approach the end of your life– which could be tomorrow, we don’t know–but you’re likely to approach it with less regret. And less worry. And so, we can be alive in this way. So this is just an introduction. And I hope you have enough information to inspire you to find ways to learn more and maybe take a mindfulness class. If you want to start a formal practice, it’s good to take a class where you can learn how to do it and get support from others who are doing it. But most importantly, just practice doing it in your daily life. And see what happens. Let me know! So it’s been really wonderful sharing with you today. And I hope some of the handouts will help you have ideas about practices you can do. And best wishes to you! Thank you for your interest.

7 thoughts on “Mindfulness in Social Work Practice | Dr. Betty Kramer | UW-Madison School of Social Work

  1. Thank you for posting.  I'm working on shifting this topic from conversations to actions and appreciate this so much! xo

  2. This is a really great video/presentation! I have seen other videos on mindfulness but the other ones did not give as much direction as this one does. Excellent!

  3. meditation has been around for thousands of years now coming to the for front one person doing great work in hypnotherapy is alba weinman much to learn still today we are just now expanding in all fields

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