6.6 Self-Reflection and Mindfulness Prior to the Interview

Health professionals are susceptible to stress, sadness, anger, and many other emotions. Despite good intentions, your communication will strongly influence your mood, thoughts, emotions, and experience. Self-reflection is essential for recognizing your emotional state and minimizing unintentional miscommunication with clients, i.e., ineffective or nontherapeutic communication.

Some strategies for self-reflection before commencing the client interview are shown below.

As you self-reflect, consider that the environment often intensifies emotions for clients and their families. It can be a place where people experience fear, physical and psychological pain, discomfort, loss, grief, and stress. Clients may hear bad news and confront truths about themselves or experience intense joy and relief. Because such extremes can exist in health care, the client is often more attuned to you than you may know. The client may be telegraphing your body language or intuiting your choice of words. For this reason, health professionals need to be self-aware and temporarily suspend their needs to connect with the client authentically.

Mindfulness

Mindfulness can be a valuable strategy for connecting with clients and authentically being fully in the moment as they respond. Getting caught up in a fast-paced environment and distracted by preceding events is easy. Clients pick up on distractions, and this can undermine trust.

Mindful meditation has been proven to reduce stress among health professionals. Once learned, it can be used anytime and improve therapeutic communication with the client. Most mindful awareness is attending to what is happening around you more deeply. Let us start by thinking about awareness as a general concept.   Awareness involves recognizing or understanding an idea or phenomenon. For example, take a second and think about your breathing. Most of the time, we are unaware of our breathing because our body is designed to perform this activity for us unconsciously. We do not have to remind ourselves to breathe in and out with every breath. If we did, we would never be able to sleep or do anything else. However, if you take a second and focus on your breathing, you are consciously aware of your breathing. Most breathing exercises, whether for relaxing, stress reduction, or meditation, are designed to make you aware of your breath since we are not conscious of our breathing most of the time.
Mindful awareness takes being aware to a different level. Go back to our breathing example. Take a second and focus again on your breathing. Now ask yourself a few questions:

• How do you physically feel while breathing? Why?
• What are you thinking about while breathing?
• What emotions do you experience while breathing?

Mindful awareness aims to be consciously aware of your physical presence, cognitive processes, and emotional state while engaged in an activity. More importantly, it is not about judging these but about awareness and noticing.

Mindful Practice

Mindful practice is the conscious development of skills such as the greater ability to direct and sustain our attention, less reactivity, greater discernment and compassion, and enhanced capacity to disidentify from one’s concept of self (Shapiro & Carlson, 2017).

Attention

Attention involves attending fully to the present moment instead of letting ourselves become preoccupied with the past or future (Shapiro et al., 2014). Attention is being aware of what is happening internally and externally moment-to-moment. Internally, we are talking about what is going on in our heads. What are your thoughts and feelings? Externally, we are referring to what is happening in the physical environment. To be mindful, someone must be able to focus on the here and now. Unfortunately, humans are not very good at being attentive. Our minds tend to wander about 47 % of the time (Killingsworth & Gilbert, 2010). Some people say that humans suffer from a “monkey mind,” or the tendency of our thoughts to swing from one idea to the next (Shapiro et al., 2014). As such, being mindful is partially being aware of when our minds shift to other ideas and then being able to refocus ourselves.

Intention

Intention involves knowing why we do what we do: our ultimate aim, vision, and aspiration. So the second step in mindful practice is knowing why you are doing something. Let us say that you have decided that you want to start exercising more. If you want to engage in a more mindful practice of exercise, the first step would be figuring out why you want to exercise and what your goals are. Do you want to exercise because you know you need to be healthier? Are you exercising because you are worried about having a heart attack? Are you exercising because you want to get a bikini body before the summer? Again, the goal here is simple: be honest about our intentions.

Attitude

Attitude, or how we pay attention, enables us to stay open, kind, and curious. Essentially, we can all bring different perspectives when attending to something. For example, attention can be cold and critical or openhearted, curious, and compassionate. As you can see, we can approach being mindful from different vantage points, so the attitude with which you practice paying attention and being present is crucial (Kabat-Zinn, 1990). One of the facets of mindfulness is being open and nonjudging, so having a cold, critical quality is antithetical to being mindful. Instead, the goal of mindfulness must be one of openness and nonjudgment.

So, what types of attitudes should one develop to be mindful? Fogel (n.d) proposed the acronym COAL when thinking about our attitudes: curiosity, openness, acceptance, and love.

C stands for curiosity (inquiring without being judgmental).

O stands for openness (having the freedom to experience what is occurring as simply the truth, without judgments).

A stands for acceptance (taking as a given the reality of and the need to be precisely where you are).

L stands for love (being kind, compassionate, and empathetic to others and to yourself).

(Seigel, 2007; Fogel, n.d.)

Kabat-Zinn (1990), on the other hand, recommends seven specific attitudes that are necessary for mindfulness:

1. Nonjudging: observing without categorizing or evaluating.
2. Patience: accepting and tolerating things happening in their own time.
3. Beginner’s-Mind: seeing everything as if for the very first time.
4. Trust: believing in ourselves, our experiences, and our feelings.
5. Non-striving: being in the moment without specific goals.
6. Acceptance: seeing things as they are without judgment.
7. Letting Go: allowing things to be as they are and getting bogged down by things we cannot change.

Neither Seigel’s (2007), Fogel’s (n.d) COAL, nor Kabat-Zinn’s (1990) seven attitudes are an exhaustive list of attitudes that can be important to mindfulness. Still, they give you a representative idea of the attitudes that can impact mindfulness. Ultimately, our attitude to mindfulness will largely determine its long-term value. This is why consciously cultivating certain attitudes can be very helpful … keeping particular attitudes in mind is part of the training (Kabat-Zinn, 1990).

Five Facets of Mindfulness

From a social scientific point-of-view, one of the most influential researchers in the field of mindfulness has been Ruth Baer. Baer’s most significant contribution to the field has been her Five Facet Mindfulness Questionnaire.  Dr. Baer’s research concluded that mindfulness has five different facets: Observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience (Baer, R. A., et al., 2006).

Observing

The first facet of mindfulness is observing, noticing, or attending to various internal or external phenomena (e.g., bodily sensations, cognitions, emotions, and sounds) (Sauer & Baer, 2010). When one is engaged in mindfulness, one of the basic goals is to be aware of what is happening inside yourself and in the external environment. Admittedly, staying in the moment and observing can be difficult because our minds always try to shift to new topics and ideas (again, that darn monkey brain).

Describing

The second facet of mindfulness is describing or putting into words observations of inner experiences of perceptions, thoughts, feelings, sensations, and emotions (Sorensen et al., 2018).  The goal of describing is to stay in the moment by being detail-focused on what is occurring. We should note that having a strong vocabulary does make describing what is occurring much easier.

Acting with Awareness

The third facet of mindfulness is acting with awareness or engaging fully in one’s present activity rather than functioning on automatic pilot (Sauer & Baer, 2010). When acting with awareness, focusing one’s attention purposefully is essential. In our day-to-day lives, we often engage in behaviours without being consciously aware of our actions. For example, have you ever thought about your morning routine? Most of us have a pretty specific ritual we use in the morning (the steps we engage in as we get ready in the morning). Still, most of us do this on autopilot without really taking the time to realize how ritualized this behaviour is.

Nonjudging of Inner Experience

The fourth facet of mindfulness is nonjudging of inner experience, which involves being consciously aware of one’s thoughts, feelings, and attitudes without judging them. One of the hardest things for people regarding mindfulness is not judging themselves or their inner experiences. As humans, we are pretty judgmental and like to evaluate most things as positive or negative, good or bad, and so on. However, one of the goals of mindfulness is to be present and aware. As soon as you start judging your thoughts, feelings, and attitudes, you stop being present and become focused on your evaluations and not your experiences.

Nonreactivity to Inner Experience

The last facet of mindfulness is nonreactivity to inner experience. Nonreactivity is about becoming consciously aware of distressing thoughts, emotions, and mental images without automatically responding to them (Galla et al., 2020, p. 351). Nonreactivity to inner experience is related to the issue of not judging your inner experience, but the difference is in our reaction. Nonreactivity involves taking a step back and evaluating things from a logical, dispassionate perspective. Often we get so bogged down in our thoughts, emotions, and mental images that we end up preventing ourselves from engaging in life. For example, one common phenomenon that plagues many people is impostor syndrome or perceived intellectual phoniness (Clance & Imes, 1978). Some otherwise brilliant and skilled people start to believe they are frauds and are just minutes away from being found out. Imagine being a brilliant brain surgeon but always afraid someone will figure out that you do not know what you are doing. Nonreactivity to our inner experience would involve realizing that we have these thoughts but not letting them influence our actual behaviours. Admittedly, nonreactivity to inner experience is easier described than done for many of us.

References

Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006).        Five facet mindfulness questionnaire. Assessment, 13, 27-45.

Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241–247. https://psycnet.apa.org/doi/10.1037/h0086006

Fogel, S. J. (n.d.). Mindful awareness and COAL. Steven J. Fogel blog. https://stevenjayfogel.com/mindful-awareness-and-coal/

Galla, B. M., Tsukayama, E., Park, D., Yu, A., & Duckworth, A. L. (2020). The mindful adolescent: Developmental changes in nonreactivity to inner experiences and its association with emotional well-being. Developmental Psychology, 56(2), 350–363. http://dx.doi.org/10.1037/dev0000877

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. Delacorte.

Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind. Science, 330(6006), 932. doi.org/10.1126/science.1192439

Sauer, S., & Baer, R. A. (2010). Mindfulness and decentering as mechanisms of change in mindfulness-and acceptance-based interventions. In. R. A. Baer (Ed.), Assessing mindfulness & acceptance process in clients: Illuminating the theory & practice of change (pp. 25–50). Context Press.

Shapiro, S. L., & Carlson, L. E. (2017). The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions (2nd ed.). American Psychological Association.

Shapiro, S., Thakur, S., & Sousa, S. (2014). Mindfulness for health care professionals and therapists in training. In R. A. Baer (Ed.), Mindfulness-based treatment approaches clinician’s guide to evidence base and applications (2nd ed., pp. 319–345). Academic Press.

Siegel, D. J. (2007). Mindfulness training and neural integration: Differentiation of distinct streams of awareness and the cultivation of well-being. Social Cognitive and Affective Neuroscience, 2(4), 259–263. https://psycnet.apa.org/doi/10.1093/scan/nsm034

Sørensen, L., Osnes, B., Visted, E., Svendsen, J. L., Adolfsdottir, S., Binder, P. E., & Schanche, E. (2018), November). Dispositional mindfulness and attentional control: The specific association between the mindfulness facets of non-judgment and describing with flexibility of early operating orienting in conflict detection. Frontiers in Psychology, 29, 1–9. https://doi.org/10.3389/fpsyg.2018.02359.

Media Attribution

Duffy, C. (2020, May 12). Hope in work – mindfulness exercise for health care workers [Video]. YouTube. https://www.youtube.com/watch?v=FlUA-_g85aE

Attribution Statement

Content adapted, with editorial changes, from:​

Lapum, J., St.-Amant, O., Hughes, M., & Garmaise-Yee, J. (Eds.)(2020). Introduction to communication in nursing. Toronto Metropolitan University Pressbooks. https://pressbooks.library.ryerson.ca/communicationnursing/

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