Clinical Handbook of Mindfulness (115 page)

extreme physical and sexual abuse.

Sara was not able to participate in the last sequence of mindfulness class

because she was too frightened to lie on the floor in the presence of other

people. Her understandable fear of lying down in public paralyzed her so that

she was unable to focus on anything else. Sara’s experience is not uncommon

in this setting and demonstrates clearly how painful emotions can interfere

with even the most basic activities.

The first challenge when working with Sara was to help her identify her

fear and view it – even for a fleeting moment – from the perspective of

a
friendly and impartial spectator
. Over a period of several weeks Susan

integrated the mindful process scram into her work with Sara. First, Susan

encouraged Sara to simply notice the fear when it occurred by
stopping

doing whatever she was doing when it happened. Period. There was no

expectation that She lie down or engage in another, less frightening, intro-

spective practice. It was enough for Sara to make the connection that her

fear was triggered by lying on the classroom floor.

Eventually Sara made that connection and was able to
calm
her body

and quiet her mind with breath awareness practices. Once she felt calmer,

she could
remember
that these emotions occurred every time the class

practiced introspection while lying down. By the end of the 12-week course,

Chapter 22 Mindfulness with Children

421

Sara was able to
act
mindfully and cautiously lie down with the rest of the

class with
metta
or kindness toward herself by understanding her feelings.

Sara was never able to close her eyes during the body scan, nor was she able

to physically relax. But she overcame her fear and lay on the floor with her

peers. Sara discovered the courage to do so by practicing mindfulness and

metta
.

The case of Sara illustrates an important caveat about working with chil-

dren suffering from posttraumatic stress disorder. The potential for flooding,

especially in classroom situations, must be taken seriously and mentors must

be trained in recognizing signs that flooding may be immanent. Safety and

flexibility are most important in clinical settings, as well. When attention

is destabilized by traumatic memories and strong emotions, the mentor can

support a child by helping turn their attention
away
from awareness of inner

feelings and toward awareness of the outer world.

Emotions Are Viewed as Visitors

To a child, a difficult emotion sometimes feels strong and solid, particularly in

the early years when children are concrete thinkers. Children can get stuck

in painful emotional states because they believe them to be permanent and

an inherent aspect of who they are. Children often become so caught up

in a feeling that they immediately act on it, unable to imagine that there

could be a more objective perspective. We have found the Buddhist teach-

ing of impermanence, that everything changes and nothing stays the same,

an extremely useful concept that children can easily recognize and under-

stand when embodied by their mentors. Mentors with a visceral understand-

ing of impermanence will model how to relate to emotions as impermanent

states, inside and out. Practicing mindfulness, children and their mentors see

together how emotions arise with each moment of experience, in a contin-

uously flowing, changing stream. Through relationship with a mentor who

sees through the lens of impermanence, children can learn to experience

difficult emotions as transient and situational, rather than a permanent con-

dition intrinsic to them.

One way that emotions are described in Buddhist psychology is as pass-

ing, or adventitious, visitors to the heart. Emotions are viewed as healthy

(leading to wise actions and happiness) or unhealthy (leading to unwise

expressions that bring unhappiness in their wake). We recognize that this

view of emotions is a simplification and propose it only as a practical

and therapeutic way of approaching complex emotional processes with

children who often find it easier to view psychological pain more clearly

if they personify the emotion.

Negative emotions that naturally accompany the inevitable painful aspects

of relational life can get blown out of proportion and become damaging

when children are left alone with them, or if their mentors get frightened or

angry when they don’t know how to help. Then both children and mentor

naturally try to avoid the emotions (to
scram
); thus giving them an authority

they don’t have. From the perspective of
scram
, it doesn’t matter whether

emotions are positive or negative, we work with both in the same mindful

way as. Simply the integrative, dynamic activity of the mind, an expression of

being alive. But when emotions are blown out of proportion, they obscure

awareness of both clear mind and its objects.

422

Trudy A. Goodman and Susan Kaiser Greenland

Personifying difficult emotions and the problems they cause as visitors,

albeit unwelcome ones, allows children and their mentors to consider many

aspects of mood, emotion and the possibility of their transformation by:

• Talking about emotions as impermanent, like guests who visit and then

leave. We cannot overemphasize the compassionate role of the mindful

mentor in helping children gently slow into their experience so they can

begin to identify their emotions, to stop themselves from acting them out,

and to see how they change.

• Experimenting with purposeful attention in the company of a mentor,

children may see that it is possible to have some control over how they

respond to their emotions. While children cannot choose their feelings,

with guidance and support, they can learn and practice new ways of

responding to them.

• Acknowledging we have a choice about how to entertain our visitors; a

child may not be able to prevent them from arriving, but with help, she

may choose whether to invite them to stay. This may open new possibil-

ities. Together with her mentor, a child can reflect about how long she

is willing to stay with this particular guest. For the time of a play date? A

sleepover? Does she let them move in, take over and cause problems? Or

even get in the way of growing up?

• Recognizing times when she is not bothered by unwelcome guests, where

she is able to relax and be herself. Acknowledging those times with her

mentor, even celebrating them together. These moments when nothing

else seems to be happening can be an opportunity for quiet non-verbal

sharing of attention and connection.

The quiet nonverbal sharing mentioned above describes an important way

of teaching mindfulness, without necessarily saying a word. Through atten-

tive, quiet presence, a mentor can
embody
mindfulness and model how

scram
can be used in real-life relationships. Embodied mindfulness may also

be an effective means by which a mentor becomes better attuned with (or

“felt by”) a child. From Dan Siegel, “As this joining evolves, we begin to

resonate with each other’s states and become changed by our connection.

Attunement can be seen as the heart of therapeutic change.” Attunement

is expressed in the safety, comfort, and relief a child may feel when seen

through a mentor’s eyes, as being whole and complete just as she is. By

accompanying, by staying with the child as all the child’s “visitors” come and

go, the mentor embodies trust in the child’s underlying, inherent clarity and

wisdom. As trust and attunement with the mentor deepen, a child may be

better able to integrate the mentor’s positive view and make it her own.

In the following example, Trudy models mindfulness in her response to a

boy’s provocative actions.

A 7-year-old boy, Xavier, was referred to psychotherapy for being opposi-

tional with teachers and fighting at school. Xavier was a perfectionist who

would angrily destroy his work if he made the slightest mistake. He came to

therapy clutching his after-school snack, a big box of Fruity Pebbles cereal.

He was bright and presented himself as friendly and playful. But the fun play

immediately broke down when he couldn’t have his way. He would regress

and become furious, expressing intense self-hatred. Inevitably, Xavier would

lose control and the cereal would suddenly fly all over the room. The first

Chapter 22 Mindfulness with Children

423

time it happened, he and Trudy both stopped, stunned. They looked at the

rug covered in multi-colored tiny pieces of cereal. Xavier was visibly fright-

ened by the aggression in his act of flinging the cereal around Trudy office.

He became defiant and hostile, daring her to get mad.

Just stopping and looking at the therapeutic space bedecked in colorful

fruity pebbles, Trudy understood why this tightly controlled little boy, an

only child who lived in an environment where no misstep went unnoticed

or unpunished, needed to let his precious snack fly all over the space. Sud-

denly it was funny, the office was a mess! It became a
scram
practice when

the cereal flew; they
stopped
, saw what was happening at the moment it

happened, and
calmed
down to
remember
that the mess was not a big deal.

After taking these first three steps, Xavier was able to
act
mindfully as they

swept up the cereal together with an attitude of kindness, understanding

why Xavier acted as he did.

Trudy’s stance of mindfulness and kindness allowed Xavier to feel safe

enough to talk about the beatings he received when he was “bad.” Trudy

and his school counselor found help for his mother and a therapy group

for Xavier, where he could work on improving relationships with peers and

develop self-regulating behaviors. This was a case where a mentor’s com-

passion, mindfulness and humor allowed a frightened, angry boy to express

his truth.

We understand that limits may need to be set for children to keep them

and their peers safe. By embodying mindfulness the mentor can both estab-

lish boundaries, and convey empathic attunement of a child just the way

she is, without needing to fix, rescue or change her. Together mentor and

child can use
scram
to help build the child’s capacity for self-compassion

and understanding.

Because children are deeply embedded in a
family system
, it is not surpris-

ing that the degree to which a child benefits from mindfulness-based therapy

is highly associated with the amount of parental involvement.
(Semple et al.,

2006.)
A parent’s capacity to reflect on her inner life, and the inner life of her child, can also be a significant predictor of the child’s security of attachment

to the parent
(Fonagy & Target, 1977).
Thus it is important to look at practicing mindfulness with children from a systems perspective and, whenever

possible, involve parents from the outset. In keeping with this approach a

pilot pediatric obesity study currently underway at University of California,

San Francisco, is delivered to the child through the adult caregiver (whether

overweight or not). The pilot intervention extends MB-EAT
3
(Kristeller & Hallett,
1999)
to children and parents, using
MB-EAT
and
InnerKids
programs adapted for this population. It is deliberately focused on preadoles-

cent children who are embedded in the family unit. Michele Meitrus-Snyder,

lead investigator of the study, is persuaded from limited pilot experience that

the mutual understanding gleaned through the shared mindfulness experi-

ence, fosters improved connections between parent and child that may be as

important as any other facet of the intervention.
(Mietus-Snyder et al., 2007).

3 MB-EAT is a mindfulness-based intervention for adults with binge eating disorders.

It was developed by Jean L. Kristeller, Department of Psychology, Indiana State Uni-

versity, Ruth Quillian-Wolever, Center for Integrative Medicine, Duke University and

their colleagues.

424

Trudy A. Goodman and Susan Kaiser Greenland

While the application of
scram
is simple and can be taught to the entire

family, the embodiment of this steady, gentle way of being is not easy. From

Buddhist meditation teacher and psychologist Jack Kornfield: “An important

part of mindfulness practice is being conscious of and taking responsibility

for
embodying
mindfulness through our own thoughts, feelings and actions”

(Kornfield, 2007).
Taking responsibility for your own mindfulness, learning to walk-the-walk, is the most effective way to transmit compassionate mindfulness skills to children.

If you are not already a practitioner, we recommend you gently introduce

yourself to mindfulness practice in order to get a felt sense of the experience.

Dr. Jon Kabat-Zinn, who first taught and researched clinical applications of