The following is an excerpt from Teaching the Mindful Self-Compassion Program: A Guide for Professionals by Chris Germer and Kristin Neff. Translations of the Professional Guide are forthcoming throughout 2020 and 2021. See scheduled release dates here. May this Professional Guide serve you and inform your teaching!
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Working with Trauma
A number of emotional challenges may emerge during contemplative training, ranging from mild distress to functional impairment (Compson, 2014; Lindahl, Fisher, Cooper, Rosen, & Britton, 2017; Magyari, 2016; Treleaven, 2018). At the mild end of the adverse effects continuum, practitioners can experience anxiety, difficulty sleeping, headaches, or social withdrawal. At the severe end, practitioners may develop irrational beliefs, hallucinations, suicidality, or anhedonia. Factors that influence the development of adverse effects are the practitioner (e.g., medical and psychological history, personality, motivation), the practice (e.g., amount, intensity, consistency, type, and stage of practice), relationships (e.g., early life, practice community, cultural context), and health behaviors (e.g., diet, exercise, medication, drugs). To reliably assess adverse effects, teachers should ask their participants directly if they are having uncomfortable experiences during their MSC training (Lindahl et al., 2017). MSC teachers are encouraged to take the meditation safety training developed by Willoughby Britton at Brown University (www.brown.edu/research/labs/britton/news/2018/02/ first-do-no-harm-meditation-safety-training).
Old traumas are likely to emerge during self-compassion training. This is because trauma is more prevalent than many people realize. In the United States, 89.7% of the population reports having been exposed to a traumatic event (e.g., fire, physical battery, sexual assault, war zone combat, disaster) (Kilpatrick et al., 2013). Furthermore, self-compassion training tends to attract people who are looking for better ways to manage the sequelae of trauma (i.e., shame, self-criticism, hypervigilance, numbing, avoidance, or intrusive memories). This is why we suggest that a mental health professional be in the room at all times and that applicants be carefully screened. MSC was not designed as a clinical program, but since there is so much trauma in the general population, MSC has been continually modified over the years to make it as safe as possible. We sincerely hope that teachers are conscientious about applying the safety measures currently contained in the curriculum.
“Safety first” is a general rule of MSC training and it applies particularly when working with trauma survivors. Like everyone else, trauma survivors like to challenge themselves, but they also need special instruction in how to titrate the intensity of their experience and return to safety. For example, in the Compassionate Body Scan (a meditation in the retreat session; see Chapter 15), teachers can invite trauma survivors to do the practice in a sitting position rather than lying down, or to move their bodies rather than remaining motionless. Most MSC practices are taught with closed eyes, but participants with trauma histories can be invited to keep their eyes open (either partially or fully). Some parts of the body are more likely than others to hold traumatic memories—for example, the pelvic area for women. When teachers are guiding the Compassionate Body Scan, they should provide participants with the option to skip over a difficult body part if it becomes too activating. Explicit options for grounding are also helpful, such as anchoring attention in the soles of the feet, or mindfully exhaling.
Teachers should not assume that participants with a trauma history will be able to access safety strategies when they need them. Some teachers invite participants to write their safety options on a card that they can consult when they feel overwhelmed. When a teacher notices that a participant seems overwhelmed during an exercise, the teacher can add instructions designed to provide support. Here is an example: “If at any time you find yourself edging into the overwhelmed circle [of the three-circle safety model described in Chapter 6], please feel free to ignore my instructions and go back to the rhythm of the breath, or focus on a point where your body makes contact with the chair or cushion. Opening your eyes, or get-ting up to take a break from the exercise, are other options.” Often a sense of being in control is all that a trauma survivor needs to feel safe
Teachers need to be especially sensitive and discerning when working with trauma survivors. For example, what may appear like willful determination not to participate in group activities could actually be an effort to stay in the room without becoming overwhelmed. A teacher can ask, “What do you need?”, but some trauma survivors will not be able to answer that question since they may be dissociated from their bodies. In that case, a more specific question such as “What do you need to feel safe?” or “What could be soothing to you right now?” might be more helpful. However, when trauma shuts down a survivor’s executive functioning, sometimes any question becomes unanswerable. Then teachers need to use their intuition, such as suggesting as short walk outside the room (perhaps with a co-teacher) or giving the student space to be comforted by the rhythm of her own breathing.
Trauma can surface at unexpected times, even during periods of rest and ease. If a student experiences persistent flashbacks, a teacher should have a collaborative conversation with the student about ways of coping and, when necessary, consider the option of discontinuing the course and seeking outside help until the participant is more able to safely engage in the course.
Students themselves are usually the best judges of whether the MSC program is safe for them. Some trauma survivors make significant progress during MSC, despite the intensity of their symptoms. For example, a woman who was numb to her body because of childhood sexual abuse discovered that she could feel her breath for the first time when she focused on how her breath rhythmically rocked her body. On many occasions, Soles of the Feet (the practice of feeling the soles of the feet while walking) has been effectively applied by trauma survivors to anchor their attention in the present moment and away from traumatic memories. Sometimes, the further away from the body that participants place their attention—outside the body (sights, sounds) or at the periphery of the body (touch points, like the soles of the feet)—the safer the participants are likely to feel. Most reliably, behavioral self-compassion (ordinary activities, such as listening to music or chatting with friends) is what keeps the MSC program safe for trauma survivors. (For more on teaching self-compassion to trauma survivors, see Part IV of this book; see also Brähler & Neff, in press; Germer & Neff, 2015).