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In therapy sessions, lack of genuine curiosity about where the client is coming from, unrealistic or incongruent expectations, and failure to approach the whole person, not only the pathology exhibited, can significantly impact the effectiveness of therapy. That’s why mindful communication, or interpersonal mindfulness, is so important.

Often therapists and clients fail to understand each other. The same way that the bedside manner of a doctor significantly affects the compliance and trust of the client, the various barriers to communication—lack of genuine curiosity about where the client is coming from; unrealistic or incongruent expectations; and failure to approach the whole person, not only the pathology exhibited—can significantly impact the effectiveness of therapy. Often clients do not fully understand the clinician’s explanation of what is needed and are unable to follow the advice given.

Sometimes emotions are seen as a sign of weakness and irrationality, but this perception couldn't be further from the truth. They are essential to being rational (Ciarrochi, Chan, & Bajgar, 2001; Ciarrochi, Chan, & Caputi, 2000; Ciarrochi, Forgas, & Mayer, 2001). They’re a way of seeing how events in the world relate to our values, needs, and desires.

Imagine feeling totally lost with a client. The client has just disclosed an extremely painful story, and you feel stuck about how to respond. Then you get defensive because you don’t know what to do next. What would be your strategy here? Would you break eye contact and instead look at your clipboard and pretend to be making some notes? Would you paraphrase what the client told you just to buy time? Would you get up, walk to your whiteboard, and draw an ABC diagram to avoid the pain you feel in acknowledging the client’s emotional distress?

Editor’s note: The following is a Q&A with Dennis Tirch, PhD, and Laura Silberstein, PhD, co-authors along with Benjamin Schoendorff, MA, MSc of The ACT Practitioner’s Guide to the Science of Compassion: Tools for Fostering Psychological Flexibility. Tirch and Silberstein have collaborated on all responses.  

A Letter from Mark Bertin, MD

By Nick Turner, MSW, Phil Welches PhD

When working with individuals experiencing substance use issues, you will often encounter those who struggle with urges and cravings. Despite a desire to change and taking the initial steps to do so, the person experiences physical, emotional, and cognitive compulsions to use substances, or to use at a level that is not conducive to living a healthy and meaningful life. Urges and cravings are typically experienced as distressing or signs of weakness. Once a person begins to struggle with urges and cravings, those cravings tend to increase in frequency and intensity, which can eventually lead to a lapse back into the substance use cycle.   

Editor's note: The following is the second half of a two-part Q&A with John T. Blackledge, PhD, international ACT trainer, associate professor in the department of psychology at Morehead State University in Kentucky, and author of Cognitive Defusion in Practice: A Clinician’s Guide to Assessing, Observing, and Supporting Change in Your Client. Access part one here.

A recent study published in Medical Care (Serpa, Taylor, Tillisch, 2014) showed that veterans who participated in a nine-week mindfulness-based stress reduction (MBSR) program experienced significant reductions in anxiety, depression, and suicidal ideation from baseline to completion of the nine weeks.


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