Hybrid Vigor: Integration of Mindfulness Based Cognitive Therapy (MBCT) into the Therapeutic Community Part 4

What We Have Learned: Mindfulness Meditation and the TC PerspectivennFrom a historical perspective, the social organization of the TC is designed to address the whole person through surfacing and raising awareness of negative behaviors (Arbiter & Mullen, 2002). Remarkable changes in lifestyle are possible when individuals live and work in community where every element has an educational and therapeutic impact on their process (DeLeon, 2000). Mindfulness meditation practices help facilitate self discovery and increase awareness. As students of mindfulness meditation courses develop an increased ability to “dwell within”, they become more conscious of internal and external triggers to negative behaviors. As one student stated, “The Body Scan meditation has helped me become aware of how I respond physically to my emotions. In the past a situation would trigger me and I’d act out without knowing why. I’m learning to be more aware and beginning to respond differently.” This ability to live more fully in the present moment allows every element of the therapeutic community process to have an increased potential for influencing positive change.nnFrom the perspective of drug abuse as a disorder of the whole person involving cognitive, behavioral, emotional, social, and spiritual functioning, it is necessary to live with others in a social setting where all of who they are can be displayed, seen, and changed (DeLeon, 2000). Mindfulness meditation practice not only involves being fully present within yourself, but includes being fully present with others as well. Entering into relationship with other members of the community who are working toward common goals requires being fully present and creating space to help each other identify and modify maladaptive behaviors. We have found that feedback from students in our Community who have not participated in the MBCT course illustrates this point. Several have reported that their roommates or members of their circle who participated in the course are “calmer”, “easier to talk to” or “seem to really listen” as they practice being more mindful in daily activities. This type of observable growth among course participants illustrates the positive effect Mindfulness-based practices has on building authentic relationships. It also stimulates interest and provides an incentive for other students to engage in Mindfulness practices in the Community and to enroll in future MBCT courses.nnPersons living in a Therapeutic Community have many shared characteristics including some or all of the following: poor tolerance for frustration, a desire for instant gratification, low self esteem, difficulty with authority, problems with responsibility, poor impulse control, unrealistic or distorted perception of self, and difficulty coping with feelings (DeLeon, 2000). A person’s struggle to manage their feelings often results from an inability to recognize, communicate, and identify the feelings they experience. Guided mindfulness meditations including the body scan, sitting, walking, and hearing/seeing exercises, helps MBCT course participants to observe the landscape of their thoughts, feelings, and emotions. In this way participants develop a greater awareness and understanding of their feelings, creating an internal space to experience their feelings and observe their thoughts without the need to change anything. This expanded awareness is a result of moving in the direction of one’s experience without resistance or judgment, a process that facilitates responding more effectively to situations that would otherwise cause difficulty. A young woman who participated in our Women’s MBCT course shared her experience of being held hostage and brutally raped before coming to Circle Tree Ranch. She continued to suffer from paralyzing fear, panic attacks, and sleep disturbance as well as feelings of self-condemnation for “putting myself in that situation”. Understandably, closing her eyes in a room full of people, and lying in a prone position was initially impossible for her. She made necessary adjustments to feel safe and courageously continued her practice. Over time she has internalized the concept that “whatever emerges is already there”, and through openness and acceptance she is beginning to experience self-compassion, gentleness, and allowing rather than resisting her experiences. In the follow-up session she reported, “I’ve been more open about my story with my Lodge Circle4 since I was in the meditation course. Being more present helped me open a door I didn’t want to open and walk through it.”nnWithin the Therapeutic Community, recovery is seen as a developmental learning process where the individual is the main contributor to their own change (DeLeon, 2000). Often individuals who enter Therapeutic Communities have long histories of failed attempts to stop their addictive or other maladaptive behaviors. MBCT arose out of an investigation into the cognitive processes that render individuals vulnerable to repeated relapse and recurrence of depression (Teasdale, Segal, & Williams, 1995). As we have begun to integrate MBCT into a residential TC setting, we have observed how the social learning process assists participants as they develop and display newly acquired mindful attitudes and behaviors. Participants are taught how to cultivate direct experiential awareness, together with an attitude of non-judgmental acceptance, towards whatever is present within themselves and with others. Currently about half of the residents and two-thirds of the staff at Amity’s Circle Tree Ranch Therapeutic Community have completed the MBCT course. Peer support and feedback within the community allows individuals to see more clearly when negative responses are being triggered, and to help themselves through helping others.nnThe Therapeutic Community is influenced by values. This fundamental view of right living includes a belief in certain values that are essential to personal growth, health, and well being. Included in these basic precepts is a focus on the here and now, truth and honesty, personal responsibility for one’s destiny, social responsibility, and moral development (DeLeon, 2000). The violation of values and beliefs frequently occurs when a disconnect exists between the person and their actions or reactions, often resulting in maladaptive behaviors. The formal and informal practice of mindfulness as a way of being fully present facilitates increased personal and social responsibility, and the development of a compassionate, non-judgmental attitude toward self and others. This was evidenced by self-reports of participants who discovered how mindfulness training and practice positively altered their behavior. Thus mindfulness practices have the potential to shift one’s perspective and attitude simply by raising consciousness, facilitating moral development.nnDiscussionnnWhen we initiated this project we proposed that integrating Mindfulness-based practices in the Therapeutic Community setting would facilitate physical, emotional, and spiritual healing as individuals develop the ability to dwell within and resolve internal conflicts. Our initial findings, based on qualitative data collected, demonstrate significant personal growth and healing among participants. Following session eight of each course, all participants completed a questionnaire describing their experiences and reactions to the Mindfulness-based practices presented. We chose to assess participants subjective experience immediately following the course to increase the reliability of responses. Participants were asked to rate how relevant the course was to their personal process of recovery within the Therapeutic Community. The mean rating (max=10) was 8.4. This high degree of relevance was also reflected in the low dropout rate (5 out of 86). Follow-up interviews with participants and further Mindfulness Reunions will allow us to determine the degree to which participants maintain formal and informal mindfulness practices. Initial results confirmed that most participants are continuing to integrate skills learned in the MBCT course in their daily lives.nnMindfulness-based meditation requires practice and continued learning in order to develop and reinforce skills. We found that maintaining an environment within our Community which reinforces the use of new skills helps students to generalize their learning and enhances all aspects of the TC experience. Our findings indicate that the synthesis of Therapeutic Community traditions and Mindfulness-Based practices has vast implications as we strive to better meet the needs of specialized populations within our communities.