A Counselor Reflects on Therapeutic Mindfulness

Published on 13 March 2024 at 13:58

In this second reflection (first one here), I delve into how mindfulness practices provided a lifeline during my struggle with severe depression. After an experience with Acceptance and Commitment Therapy (ACT) in an outpatient program, mindfulness meditation became a profound catalyst for my healing. 

The Healing of Therapeutic Mindfulness

Mindfulness has strongly entered mental health care and culture in the past few decades. My personal experiences with mindfulness practices led me entering the mental health profession. So, the genesis of this blog was inspired by a desire to understand how these practices are beneficial, yet also limited by the ideas and expectations we bring to "Mindfulness."


Yes, there are good and necessary reasons to critique how our culture uses, abuses, and appropriates mindfulness toward more pernicious, productive ends. But before and mixed-in with any critique I can offer is a deep appreciation. Seen from the vantage point of my own experience, mindfulness-based interventions (MBIs) are capable of producing drastic transformations of physical, mental, emotional, and interpersonal suffering.


The research literature, tentative and buddhocentric as it is, points in this direction, too. As such, the purpose of this post is documenting how therapeutic mindfulness transformed my experiences with depression. There is brief mention of suicide ideation, which may be challenging for some readers.


Modern man no longer communicates with the madman... There is no common language, or rather, it no longer exists; the constitution of madness as mental illness, at the end of the eighteenth century, bears witness to a rupture in a dialogue, gives the separation as already enacted, and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange, between madness and reason, was carried out. The language of psychiatry, which is a monologue by reason about madness, could only have come into existence in such a silence. 

- Foucault, Preface to Madness and Civilization

A Grand Origin

In the most compelling narratives of change and transformation, a single event is often used to punctuate the more mundane, gradual reality operating "behind the scenes."


On the day before the presidential election of 2016, I was hospitalized after walking toward an open, six-floor atrium in a university library with the intention to jump. It was rumored that two unhoused individuals complete their deaths that way each year. "Thinking about"―the truth is, I had thought about my own death almost daily for the prior two years, and sporadically for years before that. This time, though, it was as if my body was simply tired of the stress of suppressing such prolonged contemplation. My body would have continued toward completing that thought if a friend didn't call out my name. Turning to look at him, seeing the concern in his eyes, I woke up into the gravity of my nightmare.


I was shuttled by a police officer out of my dormitory. I was observed by residents and coworkers and supervisors. I had my shoelaces taken away, but I wasn't given grippy socks. I was visited by a friend who gave me chips and candy and a book, one about wormholes and inter-dimensional travel. I wasn't allowed to go outside. I was bombarded by the smells of self-defecating co-inhabitants. I wasn't allowed to poop without supervision. I was given Benadryl to sleep on a cafeteria table in the overcrowded county psychiatric center. When I woke, I was interviewed and told that I could leave after 24 hours, instead of the normal 72 hours. I was picked up by my parents. I was given back my shoelaces. Everything happening to me, as if some strange dream.


As I rode in the back of my parents' SUV, the news of the contentious election rang out from the radio in the background. Leaving the hospital, I silently wondered if I hadn't actually jumped & entered a different, more fractured reality.

An Interlude: Identity and Pathology


When does a diagnosis of mental illness become an identity?


Maybe it's the age. For many of the children that I counsel, the unfortunate truth is that their earliest self-conceptions are woven through by the DSM, which can be cold and dehumanizing if the diagnosis isn't given in a warm, empowering frame. For little first and second graders saddled with ADHD or ODD―or the sinister Bipolar I―their self-image is steeped in disobedience masked as mental illness. 


Maybe it's the chemical explanation, the possible catharsis hidden in absolving your responsibility. It's a well-known experience that diagnosis can feel like an "aha" moment, something of an insight into your sickest and darkest suffering. "It's just a chemical imbalance in the brain" reduces my complicity in this suffering. It's just a matter of medication compliance. If those damn doctors could just get the dosage right, my depression or attention difficulties or mood swings would just go away.


Both operated in the background of my own experience with "dysthymia with major depressive episodes." In retrospect, I am unsure what came first, or how much it actually matters. My childhood was certainly marked with mental abnormalities of rumination and anxiety and low mood masking as high-achievement, yet the medicalized narrative co-opted the messier reality. And all mental illness, as I have come to learn, is accompanied or perpetuated or initiated by narrative, those stories that we and others tell about our self. 


In other words, the complexity of my suffering was explained away as a mental illness. I still remember the catharsis when I was diagnosed, that someone could explain in a few criteria the intensity of mental anguish that I was experiencing. Yet my suffering was mine alone, something to be cured by medication management (despite its severe side-effects). It's consequence―the abdication of self-responsibility―nearly led down an open atrium.


I stagnated for a year after that original incident, stuck in a state of self-medicated stupor. I did not receive quality help until I was again threatened by the prospect of hospitalization.

Acceptance and Commitment in an Outpatient Setting


year passed. I was stuck at rock bottom, continuing to act and behave in unhealthy ways. Combining drugs both prescribed and recreational contributed to deep lows and minimally-perceptible highs. All the while, I felt (was?) trapped in an environment that I could not afford to escape. I pissed away at a job that was beset by scandal, pettiness, and low wages (think: the US national minimum wage in one of the most expensive states in the country). After yet another intense bout with depression, I asked my healthcare provider to connect me with a therapist. During a brief screener, I was told that I must attend an Intensive Outpatient Program. The suicidal scaries, it seems, were still around.


This program was composed of a group of severely depressed, anxious, and panic-ridden individuals. All of us had been provided medical leave for our jobs, if that gives an indication of the severity of mental illness in the room. We were required to attend for five hours a day, four days a week, for two weeks. We began each day by looking over the menu of offerings―a recreational therapy workshop here, a medication consult there, etc.―and by creating a goal for the day. We were told that this program was structured according to Acceptance and Commitment Therapy. Pioneered by Stephen Hayes, the program focuses on values, behavior change, and mindfulness exercises. In fact, during transitions we would engage in a variety of simple mindfulness exercises: a quick body scan, or grounding in the 5 senses.


However, mindfulness was certainly not the primary topic of this group. Thinking errors, medication prescription and compliance, and values clarification―these were the main movers of change. There was also the fact of being in the group itself, of witnessing the universality of suffering that I once thought was mine alone. Watching a prison guard empathize with a stay-at-home mother, I recognized how our strange "disorders" were connected in the immediacy of chronic suffering. Indeed, the majority of my healing was a consequence of clarifying my values, committing to long-term therapy and medication compliance, and modifying my behaviors and environment.

Yet I would be remiss to say that mindfulness played a minor role, as exploring these practices outside of and after my group experience became the very vehicle of dismantling and discarding depression.

Mindfulness, Therapy, and Healing


In this program, our minimal use of "mindfulness" was connected quite well to one of its etymological origins: "sati," of remembering to observe. In ACT, you are mindful of (i.e., you remember to observe) how your thoughts, feelings, and behaviors fulfill or fall short of your values and commitments. Significantly, you are encouraged to use mindfulness practices to confront your discomfort and suffering, so as to reduce the experiential avoidance that so often defines and perpetuates chronic depression and anxiety. In this way, mindfulness practices function as the ultimate CBT coping skill. Consequently, its connection to its traditional roots in different Buddhist systems is somewhat severed―yet this is a post for another time.


Outside of our outpatient group, I continued exploring mindfulness practices through some of the smartphone apps that the therapists and case managers recommended. I also bought some modern-day "dharma books" that preach self-acceptance and intersperse meditation techniques throughout. While I wasn't quite connected to any one system of practice, I was consistently practicing variations of mindfulness of breathing.[1] In its simplest form, you perform mindfulness of breathing by:


  1. Choose a breath location: The nostrils or belly are often recommended.
  2. Stay with the breath location: Counting was a much-used technique for me in the early days.
  3. Notice distractions from the breath location: Perhaps the most crucial step, the "bicep curl for the brain", which is composed of other steps:
    1. Nonjudgmental noticing: Notice the reaction you have to the distraction, including its content. Not suppressing, but not engaging. Or better, noticing your engagement, and using that moment to disengage with distance.
    2. Allowing and accepting: For someone with chronic depression, accepting rather than avoiding is a tough game. So, emotional material often bursts at the seems. An excellent technique for cultivating acceptance is to imagine your thoughts as if they were your best friend disclosing an intimate secret. How would you treat them after such a raw, vulnerable exposure?
  4. Re-engage with the breath location: After noticing the distraction in this way, return to the breath.

In tandem with therapy, medication, and changing my environment, meditation became a central vehicle for self-exploration of emotional stability: that, even when tough psychological material emerged, I could stay tethered to the breath. This process gradually redefined my relationship with suicidal ideation and depression, and what was once scary and life-threatening became minor annoyances. This is what Shapiro and colleagues (2006)[2] call re-perceivingRe-perceiving is the mental act of dis-identifying with thought content after continuously shifting perspectives in mindfulness meditation.


In many ways, my thoughts were little tethers to a larger narrative of self-loathing. The usual response was to flee from these thoughts and their accompanying feelings, opting instead for distraction, pharmaceutical or otherwise. This strategy only strengthened the power of the tethers, wrapping my mind and body in intricate behaviors that did everything they could to further avoid the discomfort, the suffering. Yet with the introduction of this practice of "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" (Kabat-Zinn, 1994),[3] I was able to grow my ability to stay with the difficult material. With each successful sit I frayed the tethers that bound me to my depression, to the story that told me I was depressed. I could just breathe through it, watching it arise and pass away, and arise again and pass away again...


  1. I eventually entered the rabbit hole of the vipassana movement, which is covered in part in the post, "A Counselor Reflects on Depersonalization and Derealization."
  2. Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386. https://doi.org/10.1002/jclp.20237↩︎
  3. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion.↩︎

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