Tag: psychotherapy

Satipatthana Insights and Integration into Counselling

Thus the dhammas mentioned in this satipaṭṭhāna are not “mental objects”, but are applied to whatever becomes an object of the mind or of any other sense door during contemplation.

Analayo, Satipatthana, The Direct Path to Realization

In the previous blog we had explored the Johari Window. to examine Prejudices and Presumptions. In this blog we will discuss Mindfulness (Sati-patthana), Countertransference (Classical Freudian and Refined-Heimann Racker view) with some examples in Therapy sessions -Couples in conflict and an exhausted caregiver of an elderly aunt.

I use my own experiences with mentors in Mindfulness and life experiences and how they were processed through psychotherapy to illustrate some points. In the end there are downloadable worksheets on PEARLS of Mindfulness with exercises which will help orientation.

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For the first quarter of 2025, I formally studied Satipatthana meditation under the guidance of Mentors from Barre Centre of Buddhist Studies (BCBS) based on commentaries and talks of Bhikhu Analayo. 

  After finishing my graduate studies in Psychotherapy, I had choices to deepen my understanding of the many approaches which we were introduced to in this program. Being from the medical world, I was initially attracted to the structure of CBT- Cognitive Behavioural Therapy, and studied the Third Generation CBT approaches – based on Acceptance and Commitment, and Dialectical Behavioural therapy.

I still use these tools , but my path was more towards understanding existential issues – and hence the first guided retreat I did was at BCBS on the theme of Death- Maranasati (Nikki Mirgafori-2024-February). Before that I had been guided on Metta Meditation-Living Kindness (Kevin Griffin- Spring 2024). After that I have done silent retreats at Barre and Manresa-Pickering

Background of Satipatthana 

The seven spokes of Satipatthana- Mindfulness Foundation Meditation- 

Satipatthana is a compound of Sati-Mindfulness and either Patthana- foundation or upatthana- presence.

The spokes of Satipatthana are based on

1- Body – 

       Spoke 1- Anatomy

       Spoke 2- Elements

       Spoke 3- Death

note – having been in medicine since 1985, first starting anatomy in cadaver labs of Maulana Azad medical college, Delhi -1985, and then studying Radiological Anatomy – Seth G Medical – KEM Mumbai ( 1993), I have an intricate knowledge of different body tissues, and how they look in different imaging modalities. Having studied and practiced Manual Osteopathic medicine in Canada, have revised and updated my concepts of Functional Anatomy.

2- Feelings 

       Spoke 4 – Feelings

3- Mind/Consciousness

       Spoke 5- Thoughts-

4- Principles (Dhammas)

      Spoke 6- Hindrances

      Spoke 7- Awakening factors

PEARL Application on Transference and Countertransference

PEARL- Protective Embodied Attentive Reflective Liberating- Analayo,2015

One of my motivations to formally study the Satipatthana was to see for points of transference and countertransference, and to use Sati (Mindfulness) to strengthen the Therapeutic Alliances 

Freud wrote in 1910:

“We must recognize that the doctor too has his unconscious, which can interfere with the analytic work… We must not neglect to reckon with this countertransference…”

Transference refers to a client redirecting emotions from another person or experience (people, places, principles, things, thoughts, emotions, feelings, memories, sensations) to the counselor . Countertransference refers to a counsellor redirecting emotions from the past, unto a client.

Freud’s classical view of countertransference as a hindrance, a contamination of the therapeutic process due to unresolved unconscious conflicts has been challenged by Theorists like Melanie Heimann (On Counter-transference, 1950) and Heinrich Racker (1957, 1968)in which the understanding and utilization of countertransference was redefined.

Freudian Classical View

Countertransference is obstacle

To be avoided, own work to be done

Heimann/Racker Refined View

Countertransference is a valuable clinical tool

Illuminate patient’s unconscious Communication

Viewed as a part of mutual field

Counsellor is a participant-observer

Eg- Classical view can help us Examine our Biases and Blindspots

Refined View can use our own reactions to Empathize, identify dynamically with the client’s internal object relations

Classical view -self disclosure to be avoided

Refined View : Self disclosure- if it is beneficial to client- is encouraged

Can be used to develop alliance

For example

Client( C) – My aunt is struggling with dementia and it is affecting my mother

Therapist(PB)- Countertransference-Classical– Remembering his own parents, how they passed before becoming old, father in accident, mother widowed at age 54. View it as a hindrance and have processed it in therapy myself 

(One of the few times I have cried in a therapy session was when I discussed being called to the hospital to identify my father’s body..

 Experience– Men -especially South Asian Men- Cry Alone 

Strength- Through Therapy I finally made that list of traumas which I have never talked about with anyone 

Hope- through these open safe alliances was able to process how these affect my life and relationships)- so do I bring this up – Classical view does not encourage self disclosure

 Countertransference-Refined- Does view the way relationships affect each other and in a spirit of openness can tune in to the day to day life of a caregiver, what it is like to open up about one’s self care as a caregiver, the advantages and disadvantages of Taking a Pause

Energy field as- Participant Observer– see the tone of the client, as she shares about these struggles, watch for any points when the client hesitates, see for topics which open up the flow of discussion.

Eg- C- It is difficult to talk to my mother as she faces a lot of stress

     PB- How has your day been affected by these conversations? (Invite/Open and then Monitor-Modify the Therapeutic alliance)

PB- Participant Observer- Self Disclosure mode

          The rhythm of my family life changed forever after my father suddenly passed away. How does the rhythm of your day change after you discuss about identity and belonging with your mother? What routines of grounding have you imbibed? For example- after my father passed- I was mindful of what programs I would watch on television, as one day I found my mother and sister weeping in front of the television as old Hindi movie songs which my father used to sing were being aired.

     C- Well- (pausing to think) – it is painful to talk about this with my mother, she doesn’t really know what to do, and the medical carers have told there is really no point in trying to revise her diet, though she has gained a lot of weight.

  PB (Participant Observer mode) – feels the shift in energy- as we bring the discussion back into how client feels, rather than how her mother feels, how the organized medical care system is different from family carers.

Debrief of Invite-Open-Monitor-Modify

Principle- Therapist as temporary Attachment Figure

Invite- To share about conversations and their effects

Open- Field of Alliance to the energy of those shared moments with mother, shared moments in therapy, and integrating them into one’s patterns.

Monitor- The tone, energy, hesitation, flow

   Tone- she paused, there was a deeper slower flow

   Energy- maintained neutral tone- was mindful of body language, non verbal cues

     Hesitation- let that moment hold- (did not give any further cues)

     Flow- Integration of awareness of nuances of flow when she talks to persons, topics

PEARL and Communication on Conflicts

Using Sati-Mindfulness and my knowledge of Countertransference as a tool to develop therapeutic alliance, made me use the Feelings tone (Neutral, Unpleasant, Pleasant) to balance the energy when the partners would get involved in the attack-defend mode. Instead of jumping into summarizing what one has heard, what the partner hears-how the feel about it, we agreed to take these moments of shared alliance as protective embodied moments of healing in a neutral balanced tone.

Application in session

Counsellor (PB)- So how has the past week been

Wife (W)- It has been up and down, at times I was angry, at times afraid to express

Husband (H)- We are working on the tools you suggested, and recording and re-hearing our discussions to make us both more aware of how we sound, how the other person reacts.

Classical Counselling View- would be to summarize the thoughts, feelings, sensations, emotions, memories and try to gather moments of connection, compassion, clarity.

Mindfulness – Modified Application- Pause and feel the energy, watch for unpleasant, pleasant and neutral moments and create a spectrum of Ease to Unease, see how communication does not turn into a contest into who is right, who is wrong.

PEARL Summary

Protective-  Contest is diminished

Embodied- Alliances are strengthened

Attentive- to Calm

Receptive- Absorb shared moments

Liberating- De-link from Drama cycles

 Reflection Questions

1- Are you aware of your body, the sore points, your posture, gait, and how do you ground yourself? How will you apply this to impermanence, fading, cessation and letting go?

2- Freudian Classical view takes countertransference as a hindrance. How does the refined view differ? Have you experienced or discussed this with a therapist?

3- The Mindfulness – Satipatthana view will observer the hindrances and awakening factors. How was the classical CBT method- (summarizing, reflection of feelings, creating SMART-specific measurable achievable realistic timed goals) different from the Mindfulness approach- of acceptance, observation and letting go? Did you notice the difference in the couples therapy- where we collaborated rather than contested?

SUMMARY

Through the lens of Sati-patthana, I reflect upon my experiences as a counsellor and see how Countertransference and Therapeutic Alliances can be refined. 

             Being guided by experienced practitioners helped me develop nuances. The energy field of a therapeutic alliance can explore and examine, express and expand personal and interpersonal themes. 

            In Couples therapy the use of Neutral Feelings tone helps. In Individual Therapy of persons caring for elderly, I used countertransference and self disclosure to open up the flow of sessions. The seven spokes of Satipatthana can be applied in many creative ways as they interact with each other. 

            In helping map these journeys, examine their territories through the lens of psychotherapy and mindfulness, we try to be more wholesome.

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RESOURCES

You can download the worksheets on PEARL Application and also give a call to try out this approach to building Personal Family alliances and Therapeutic Alliances

References

Anālayo, B. (2015). Understanding and practicing the Satipaṭṭhāna-sutta. Buddhist foundations of mindfulness, 71-88.

Heimann, P. (1956). Dynamics of transference interpretations. The International Journal of Psycho-Analysis, 37, 303.

Holmes, J. (2014). Countertransference before Heimann: An historical exploration. Journal of the American Psychoanalytic Association, 62(4), 603-629.