Internship Sites with Mindfulness Emphasis

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It will be hard to tease this out because aspects of mindfulness will come up across settings, but I doubt there will be a defined emphasis at a site. I completed a residential substance abuse rotation in a VA that included mindfulness training, though it was only a component of a larger curriculum.

Sites that offer DBT or DBT-informed treatment may have more exposure to mindfulness work.
 
If you are really interested in mindfulness then you will find opportunities for developing that wherever you are at. I would suggest focusing on other clinical skills during training and shoring up areas of weakness and exploring new areas. You don't want to be "just the mindfulness" guy or gal.
 
smalltownpsych said:
If you are really interested in mindfulness then you will find opportunities for developing that wherever you are at. I would suggest focusing on other clinical skills during training and shoring up areas of weakness and exploring new areas. You don't want to be "just the mindfulness" guy or gal.
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Agreed. If I were you, I'd probably pick the environment/population/training model you want to work with first. There's mindfulness in VA, UCCs, AMCs, etc.
 
Mindfulness is one construct that could be applied to many different therapeutic approaches or evidence-based treatments. I concur with others: Look into VAs that offer a DBT rotation and AMCs. Montiefore in NYC has great (and intense) DBT training.
 
CheetahGirl said:
Mindfulness is one construct that could be applied to many different therapeutic approaches or evidence-based treatments. I concur with others: Look into VAs that offer a DBT rotation and AMCs. Montiefore in NYC has great (and intense) DBT training.
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I would argue there's no real mindfulness in DBT. Wise mind, emotional mind, etc. eh.
 
LAPsyGuy said:
I would argue there's no real mindfulness in DBT. Wise mind, emotional mind, etc. eh.
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Just got back from a conference on mindfulness and how to implement it in DBT that was given by Marsha Linehan. She was pretty clear that mindfulness is the core feature of DBT and that her own experience as a zen master is what led her to apply this construct to treatment of emotional dysregulation. She emphasizes that meditation is a form of mindfulness, but that not all mindfulness is meditation. That could be where you are mixing stuff up. The four domains of skills in DBT are Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. Marsha stated that mindfulness is at the core of all of them.
 
She definitely calls it mindfulness. Some minor elements are gestured lightly to, but it's not mindfulness. ACT does a better job at communicating the whole of mindfulness.
 
smalltownpsych said:
Just got back from a conference on mindfulness and how to implement it in DBT that was given by Marsha Linehan.
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I presented at a conference yrs ago and ML was presenting right after me (which I didn't know). I had a pretty good turnout, but towards the end I had a lot more ppl showing up. I figured a talk let out early and ppl stopped by to see my talk. Nope...they just wanted a good seat for ML's talk. :laugh:

I joked with her that I really knew how to draw a crowd...the trick was to present before her. I stayed for her talk and she was excellent.
 
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Therapist4Chnge said:
I presented at a conference yrs ago and ML was presenting right after me (which I didn't know). I had a pretty good turnout, but towards the end I had a lot more ppl showing up. I figured a talk let out early and ppl stopped by to see my talk. Nope...they just wanted a good seat for ML's talk. :laugh:

I joked with her that I really knew how to draw a crowd...the trick was to present before her. I stayed for her talk and she was excellent.
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Jealous you got to see her present, not gonna lie!
 
Therapist4Chnge said:
I presented at a conference yrs ago and ML was presenting right after me (which I didn't know). I had a pretty good turnout, but towards the end I had a lot more ppl showing up. I figured a talk let out early and ppl stopped by to see my talk. Nope...they just wanted a good seat for ML's talk. :laugh:

I joked with her that I really knew how to draw a crowd...the trick was to present before her. I stayed for her talk and she was excellent.
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I attended a panel that she was a little late getting to, and when she arrived she entered with this funny response to another panelist and got entrance applause. It was quite the moment.
 
LAPsyGuy said:
She definitely calls it mindfulness. Some minor elements are gestured lightly to, but it's not mindfulness. ACT does a better job at communicating the whole of mindfulness.
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Still confused as to how you can say mindfulness in DBT is not mindfulness. Can you explain?
 
Enlightened1 said:
Little to no formal mindfulness meditation in DBT. Mostly "informal" practice. DBT= Mindfulness Light.
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That DBT mindfulness does not have as much emphasis on meditation is accurate and Dr. Linehan states that very clearly. She also stated that is because of the inherent difficulties of implementing standard meditative practices with trauma patients. The other point she makes is that mindfulness and meditation are not the same. For her, mindfulness is about increasing awareness and ability to focus. You might have a different point of view but without evidence, can you really say that one conceptualization is better than the other?
 
Folks, let's ponder this: :thinking: Meditation is something you do alone...albeit in the presence of others, if necessary. Mindfulness is something you can do with others, in front of others, in a group, with your therapist, ....and reflect on what was happening for you at the time. All of which is useful and integral in DBT. Meditation (as in the sense of "mindfulness meditation") is something that is both existential and personal (think Karma Yogi on a mountain contemplating his/her existence, past, present and future), and not necessarily something that would require you to practice and chat about later (in session or group).

I would 100% disagree with DBT being mindfulness "light." It is, in my book, apples and oranges, but both fruits and both clinically helpful. Although, I consider meditation to be more spiritually helpful (coming from the perspective of being a born & raised practicing Hindu, who is also trained in DBT).
 
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cara susanna said:
Thich Nhat Hanh would very much disagree with your view that mindfulness without formal meditation is "light" or not mindfulness.
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Of course TNH believes in informal practice. My point is that the content of the Mindfulness Skills (TM), yes she has trade marked this, is fine. Observing, describing, an being nonjudgmental are all parts of real mindfulness, but they are taught purely behaviorally/intellectually and they are taught, for the most part, by people who do not have their own practices. Both of these problems lead to a very shallow experience of mindfulness. It's not practiced enough to generate the concentration skills needed to become mindful in the moment, and most of the therapists don't know how to manage issues that come up in meditation because they don't do it themselves, and this in turn leads to a rather intellectualized and behaviorally focused transmission of mindfulness. It's a bit of a mess. I think the formulation that ACT uses makes more sense if you're not going to teach meditative skills.
 
LAPsyGuy said:
Of course TNH believes in informal practice. My point is that the content of the Mindfulness Skills (TM), yes she has trade marked this, is fine. Observing, describing, an being nonjudgmental are all parts of real mindfulness, but they are taught purely behaviorally/intellectually and they are taught, for the most part, by people who do not have their own practices. Both of these problems lead to a very shallow experience of mindfulness. It's not practiced enough to generate the concentration skills needed to become mindful in the moment, and most of the therapists don't know how to manage issues that come up in meditation because they don't do it themselves, and this in turn leads to a rather intellectualized and behaviorally focused transmission of mindfulness. It's a bit of a mess. I think the formulation that ACT uses makes more sense if you're not going to teach meditative skills.
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I'm confused a bit. Are you saying that poorly trained therapists can deliver ACT more effectively than DBT? Or that ACT's mindfulness doesn't rely as much on formal meditation as DBT's mindfulness? I have only a passing knowledge of ACT and until I attended Linehan's conference didn't even realize how central mindfulness was to DBT despite having read her first books and using some of the concepts in treatment for years with good results. Nevertheless I was teaching and practicing mindfulness skills anyway since increasing awareness of self and the moment is a big part of what I have always done with my patients in therapy.
 
LAPsyGuy said:
and they are taught, for the most part, by people who do not have their own practices. Both of these problems lead to a very shallow experience of mindfulness. It's not practiced enough to generate the concentration skills needed to become mindful in the moment, and most of the therapists don't know how to manage issues that come up in meditation because they don't do it themselves, and this in turn leads to a rather intellectualized and behaviorally focused transmission of mindfulness.
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Full model DBT programs include a therapist consultation group, in which the therapists themselves participate in weekly mindfulness exercises. Also, it is recommended that DBT therapists themselves engage in using the skills, including mindfulness, in their everyday lives.
 
smalltownpsych said:
I'm confused a bit. Are you saying that poorly trained therapists can deliver ACT more effectively than DBT? Or that ACT's mindfulness doesn't rely as much on formal meditation as DBT's mindfulness? I have only a passing knowledge of ACT and until I attended Linehan's conference didn't even realize how central mindfulness was to DBT despite having read her first books and using some of the concepts in treatment for years with good results. Nevertheless I was teaching and practicing mindfulness skills anyway since increasing awareness of self and the moment is a big part of what I have always done with my patients in therapy.
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The latter. Both DBT and ACT require a fair amount of training and skill to deliver properly. ACT doesn't have a formal the formal practice component, and I think that was wise.
 
MB8 said:
Full model DBT programs include a therapist consultation group, in which the therapists themselves participate in weekly mindfulness exercises. Also, it is recommended that DBT therapists themselves engage in using the skills, including mindfulness, in their everyday lives.
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I was trained in the full DBT model, and the 5-10 minutes spent on formal meditation during consultation meetings is not enough. I also found the range of meditations to be rather bizarre, sometimes including elements of the secret. This happens because very few of the participants know anything about mindfulness meditation. It ends up being the blind leading the blind in consultation, and I'm guessing that probably doesn't benefit patients. When I asked individual senior staff about their mindfulness practice, they replied with statements like "I just can't seem to keep a practice going, I can't only sit still for a minute," and "I did it a few times and I think I intuitively understand it now." And this was at a well known major bastion of DBT in a major city.

The recommendations for therapist practice are well intentioned, but ineffective. MBSR requires proof of silent retreat and other forms of practice for certification. I prefer that model, if formal practice is to be integrated into a treatment.
 
I'm string to realize that the confusion on this topic stems from the majority of psychologists don't know the source material from which treatments like DBT, ACT, and MBSR were pulled from. Mindfulness was stripped out of a larger psychological system present with Buddhist teachings. Different treatments stripped it out differently. I feel ACT is probably the most complete representation of the larger system. The problem happens when Buddhists like Hayes, Linehan, and Kabat-Zinn trim and secularize a larger religio-psychological system into treatment modalities. It can be helpful, but it's is no longer "mindfulness."

What I've seen people argue here is that it's mindfulness because Marsha uses the word and has published articles saying it is is not logical. I'm looking at her system from the outside, not from her marketing materials. So what has resulted is a large number of people who don't have real mindfulness practices trying to teach mindfulness to others. Much like any craft, mindfulness is also experiential and not completely intellectual, which is what bringing the Buddhist tradition into western scientific tradition attempts to do.
 
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I think I get what you are saying and it might be analogous to the 12 steps being used by treatment professionals outside of the actual 12 step group. It is not the same thing. Not even close. The basis of the 12 step program is to bring about a transformative spiritual experience and that just doesn't mesh well with psychological science and its reductionist tendencies. I think that 12 step lite is more harmful than beneficial for a variety of reasons, is that your contention or perspective about mindfulness lite?
 
smalltownpsych said:
I think I get what you are saying and it might be analogous to the 12 steps being used by treatment professionals outside of the actual 12 step group. It is not the same thing. Not even close. The basis of the 12 step program is to bring about a transformative spiritual experience and that just doesn't mesh well with psychological science and its reductionist tendencies. I think that 12 step lite is more harmful than beneficial for a variety of reasons, is that your contention or perspective about mindfulness lite?
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Yes, that's certainly part of it. Part of the question is: what makes it lite? I find your example of AA compelling, even if the jury is still out with regards to the effectiveness of AA, but you don't address what makes it lite. There's no reason people cannot find therapy to be spiritually enlightening, and I don't believe it's absolutely the case that bringing spiritual concepts into western science dooms them to failure. If science showed that therapists with a sincere mindfulness practice were better and more efficient at teaching mindfulness skills, that might change the "watch one, done one, teach one" ethic for these treatments (and, yes, this is a mild overstatement, but I hope you get my point). It's this ethic, that things are purely behavioral, and ignoring the inherent phenomenological nature of the practices taught. Try teaching somebody to weld after only reading about the techniques in a book or just trying it a couple of times.

The genius of act is that the Buddhist teachings have been digested in a different way. Specific values touchstones instead of wise mind, etc. they've been formulated in a way that allows for the therapist to teach without having a Buddhist practice background. Something DBT fails at.
 
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Anyone interested looking for more info on the Buddhist context of mindfulness and the recent process of secularization might want to check out this free coursera course.

https://www.coursera.org/learn/buddhist-meditation

Gives an overview of Buddhist practices, including mindfulness, and the history of how these practices have been secularized since the 1960's. The course discusses the cultural issues involved from various perspectives, including practicing buddhists and religious studies people. Also covers the current neuroscience research. You get academic, practitioner and scientific perspectives.

It is a lot of information and can be a bit of a slog, but there is worthwhile info for anyone interested in the larger context of the secularized buddhist practices used in many third wave modalities.
 
'Mindfulness with John Wayne' would also be a TV show (or movie) I would watch.
 
smalltownpsych said:
I think I get what you are saying and it might be analogous to the 12 steps being used by treatment professionals outside of the actual 12 step group. It is not the same thing. Not even close. The basis of the 12 step program is to bring about a transformative spiritual experience and that just doesn't mesh well with psychological science and its reductionist tendencies. I think that 12 step lite is more harmful than beneficial for a variety of reasons, is that your contention or perspective about mindfulness lite?
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Is there much good evidence regarding AA's effectiveness as a treatment for substance abuse?
 
futureapppsy2 said:
Is there much good evidence regarding AA's effectiveness as a treatment for substance abuse?
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Hard to tell. AA historically has not allowed much research. The small amount of data out there, though, would suggest that it does not do much in and of itself once you control for motivation. I think there is a cochrane review of it out there.
 
futureapppsy2 said:
Is there much good evidence regarding AA's effectiveness as a treatment for substance abuse?
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AA is not really a treatment program. it is a spiritual program that supports recovery. It is highly effective for those who are members. As Wisneuro said, it can't really be researched well and the people who are motivated to attend also tend to be the people who are staying abstinent. I recommend it as an option for support of a drug free way of life for patients. The key to 12 step group efficacy is likely in social factors more than anything else which is why I don't see the "12 steps" as being very effective outside that social context. In short, if you get connected with a group that supports abstinence, you are more likely to maintain abstinence. I have seen some research to support that, but again correlational problems do apply.
 
LAPsyGuy said:
I was trained in the full DBT model, and the 5-10 minutes spent on formal meditation during consultation meetings is not enough. I also found the range of meditations to be rather bizarre, sometimes including elements of the secret. This happens because very few of the participants know anything about mindfulness meditation. It ends up being the blind leading the blind in consultation, and I'm guessing that probably doesn't benefit patients. When I asked individual senior staff about their mindfulness practice, they replied with statements like "I just can't seem to keep a practice going, I can't only sit still for a minute," and "I did it a few times and I think I intuitively understand it now." And this was at a well known major bastion of DBT in a major city.

The recommendations for therapist practice are well intentioned, but ineffective. MBSR requires proof of silent retreat and other forms of practice for certification. I prefer that model, if formal practice is to be integrated into a treatment.
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Interesting. That certainly was not my experience when I trained in DBT. Perhaps I had a great mentor. Also, the full model DBT consultation team does not intend to "meditate" during consultation.
 
MB8 said:
Interesting. That certainly was not my experience when I trained in DBT. Perhaps I had a great mentor. Also, the full model DBT consultation team does not intend to "meditate" during consultation.
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All the consultation teams I participated in, either as a member or as a consulted engaged in meditation, if only in name only. Perhaps this was idiosyncratic to the sites I visited.
 
Dr. Mr. T said:
Anyone interested looking for more info on the Buddhist context of mindfulness and the recent process of secularization might want to check out this free coursera course.

https://www.coursera.org/learn/buddhist-meditation

Gives an overview of Buddhist practices, including mindfulness, and the history of how these practices have been secularized since the 1960's. The course discusses the cultural issues involved from various perspectives, including practicing buddhists and religious studies people. Also covers the current neuroscience research. You get academic, practitioner and scientific perspectives.

It is a lot of information and can be a bit of a slog, but there is worthwhile info for anyone interested in the larger context of the secularized buddhist practices used in many third wave modalities.
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This sounds interesting, but I would wave most of the readers away from this module. Having people in Tibetan Buddhism explain Theravada practices is odd, especially when the term Lesser Vehicle is used repeatedly. That term is held to be rather insulting to the Theravada tradition. This class is a little like having the Catholic Church give a class on Judaism.
 
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