Mindfulness Meditation in Psychotherapy: A Q+A with Steven Alper, LCSW

Editor’s note: The following interview is with Steven Alper, MSW, LCSW, a psychotherapist and mindfulness practitioner who has taught mindfulness-based stress reduction (MBSR) for twenty-four years. He is the author of Mindfulness Meditation in Psychotherapy: An Integrated Model for Clinicians.

Tell us the story of how you became interested in meditation. Who were some of the teachers who influenced you?

During the mid 70s I had a number of friends who were experimenting with a range of meditative disciplines and spiritual practices during the five years I attended college and lived in the San Francisco Bay Area. I was always curious, but skeptical. 

In 1980 — soon after completing social work graduate school and starting my first clinical job in a day treatment program for people with chronic schizophrenic illness — I received a brochure advertising a weekend introduction to meditation for mental health and health care professionals at a venue on the beach in Santa Monica. It was only fifteen dollars for a three-day workshop which included room, board, and continuing education units. The main presenter was Swami Muktananda — an internationally renowned teacher of Siddha Yoga, a meditative practice in the Kashmir Shaivism tradition — who I’d known of from my Bay Area days. It was a deal I couldn’t pass up, but little did I know it would also change my life forever.

Siddha Yoga literally blew my mind. My experiences with it were blissful, even ecstatic. But I didn’t find it very practical. It was a bhakti, or devotional practice, and I found it difficult to apply in daily life. A friend and mentor suggested I look into Shambhala Training, a meditative practice and teaching developed by Tibetan Buddhist meditation master Chogyam Trungpa Rinpoche, for Western students.

I was extremely fortunate to receive teachings early on in my practice not only from Swami Muktananda and Trungpa Rinpoche, but also from many other eminent teachers including His Holiness the Dalai Lama and Kalu Rinpoche in the Tibetan tradition; Zen teachers Charlotte Joko Beck, Bernie Glassman, and Thich Nhat Hanh; and Western vipassana teachers including Christopher Titmus, Jack Kornfield, Joseph Goldstein, Sylvia Boorstein, and Christina Feldman.

Finally, Jon Kabat-Zinn has profoundly influenced my life and my understanding of the dharma and mindfulness practice, though he would call himself neither a Buddhist teacher nor a spiritual teacher.

Is it necessary for therapists who wish to incorporate mindfulness meditation into their psychotherapy practice to have their own committed practice?

Yes, absolutely! Mindfulness is not just a technique or tool that you put in your “therapist toolbox” and pull out when appropriate to “fix” a symptom, or teach to a client as a coping strategy. Mindfulness is a form of mind/body knowing, like playing the piano, or doing ballet, or skiing.

You can’t learn mindfulness from a book, with intellect and cognition alone. Rather, the mind/body process has to learn mindfulness through direct experience; through a regular discipline of formal mindfulness meditation practice.

For a therapist who doesn’t have a regular mindfulness practice of his or her own, what advice would you give them to get started?

I strongly encourage anyone who wants to get started with mindfulness practice to take a mindfulness-based stress reduction (MBSR) course or participate in a mindfulness-based cognitive therapy (MBCT) group with a really good teacher. It also helps to participate in a local mindfulness practice sangha, or community, in the vipassana, zen, or Shambhala traditions; these can provide ongoing support in establishing a regular discipline of practice, and allow practitioners to experience the power of group practice.

There are also many books and guided meditation audio recordings, which can be very helpful in strengthening one’s meditation practice and deepening understanding.

But ultimately, mindfulness is an embodied knowing, so nothing can fully replace being present in the flesh with a teacher and/or a group.

Why did you write Mindfulness Meditation in Psychotherapy?

I saw the need for a book that presented a rich, nuanced, multi-faceted, and fully integrated model of mindfulness that would be immediately useful regardless of theoretical orientation or preferred techniques. I also wanted to write a book that conceptualized mindfulness as a way of being and relating that undergirds all effective psychotherapy, rather than a specific treatment technique to use with particular diagnoses or symptoms, or to enhance the efficacy of other theoretical approaches and techniques.

Who is this book for?

This book is appropriate for any therapist interested in incorporating mindfulness into his or her clinical practice — formally or informally — as well as for therapists who already incorporate mindfulness in their clinical work, but want to broaden and deepen their understanding and enhance their skills.

The book is also appropriate as a text or adjunctive resource for psychology, psychiatry, social work, counseling, and psychiatric nurse practitioner graduate training courses in mindfulness and/or psychotherapy. It’s appropriate, too, for therapists who just want a resource for self-care, burnout prevention, and resilience.

How is this book different from others that incorporate mindfulness-based approaches or mindfulness meditation in psychotherapy?

This is the only book I know of that presents a comprehensive, systematic, and integrated model of mindfulness that is applicable to most, if not all approaches to psychotherapy. Although other books may state that the therapist’s personal practice is essential, I’m not aware of any other books that explicitly detail the many ways in which the therapist’s personal practice inform the therapeutic relationship and process.

Your book presents a model for incorporating mindfulness in psychotherapy called the Mindfulness Pyramid Model, which serves as a framework for the rest of what you teach in the book. What is the model and why did you feel there was a need for it?

The Mindfulness Pyramid Model visually depicts the four facets of mindfulness practice most relevant to psychotherapy; the three levels of the therapeutic process within which each of the four facets can be incorporated; and how they relate to one another. 

Through experience teaching seminars on mindfulness in psychotherapy, I’ve found that the visual model clarifies the relationships among the many characteristics of mindfulness that are relevant to psychotherapy and the ways that mindfulness practice informs and benefits the therapeutic process.

The four faces of the pyramid represent (a) formal mindfulness meditation; (b) mindfulness skills, inner capacities, attitudes, and perspectives; (c) mindfulness as a method of inquiry and investigation, and a mode of knowing; and (d) mindfulness as a way of being and relating to experiencing. 

The three levels of the pyramid represent the therapist’s mindfulness practice (base); the therapeutic relationship and process (mid-level); and the client’s mindfulness practice (top).

The three levels are hierarchical, in that each level is essential in supporting those above. The book details the four facets of mindfulness practice; describes how they can be incorporated at each of the three levels of the therapeutic process; and provides indications and contraindications for incorporating the different facets of mindfulness at each of the three levels.  

Are there any benefits you’ve experienced in your own personal practice that you’ve been surprised by?

I have learned not to have expectations of my practice, so therefore there are no surprises.

What are some of the benefits you’ve seen in clients when they start to practice?

Through practice, I’ve seen clients experience a greater capacity for distress tolerance; increased ability to dis-identify from self-criticism and other unproductive modes of automatic thinking; enhanced emotion self-regulation; decreased anxiety and depression; and greater joy and ease.

For more about the Mindfulness Pyramid Model, and incorporating mindfulness in psychotherapy in general, check out Steven Alper’s book, Mindfulness Meditation in Psychotherapy.