Thursday, January 13, 2011

MINDFULNESS, PSYCHOANALYSIS, COGNITIVE BEHAVIOUR THERAPY AND BORDERLINE PERSONALITY DISORDER

In November 2010 some 230 psychodynamic psychotherapists (formerly known, and sometimes still referred to, as psychoanalysts or psychoanalytic psychotherapists) met in Sydney, Australia to hear from Dr Jonathan Shedler (pictured opposite), Associate Professor at the University of Colorado Medical School, who has gathered the first impressive evidence in 80 years that talking therapies of the psychoanalytic kind may work.

''The public has been told only new symptom-focused treatments like cognitive behaviour therapy have scientific support,'' he said. ''The actual evidence shows that psychodynamic therapy is highly effective.''

Dr Shedler published in the American Psychologist in 2010 a review of 160 studies of psychodynamic therapy (click on this link to find the paper), which is a less intensive form of classical Freudian psychoanalysis. The review not only countered the universal criticism of a lack of scientific evidence for psychoanalysis but also demonstrated it had substantial and lasting treatment benefits.

''Therapy is a way of coming to know the part of ourselves we don't fully know,'' Shedler said, who is scathing in his criticism of cognitive behaviour therapy (CBT). In the words of Shedler, ''The notion you can get rid of distressing feelings through working with reason and rationality alone is neurologically unsupportable.''

Now, I am not suitably qualified to pass judgment on either psycho-dynamic therapy (psychoanalysis) or CBT except to say that it appears to be the general consensus of opinion that when CBT works, it works fairly quickly and cost-effectively, whereas other forms of psychotherapy (including but not limited to classical psychoanalysis, insight-oriented psychotherapy and other forms of “talk therapies”) tend to take much longer.

However, what Shedler says above regarding the use of reason and rationality alone to treat what are inherently irrational states of mind seems intuitively, and self-evidently, plausible to me.

Now, there is considerable evidence, referred to in previous blogs, that Mindfulness can be a useful mechanism, whether in the form of an adjunct therapy or otherwise, for treating depression, anxiety and certain mood disorders. Mindfulness does not rely upon reason or rationality per se. Having said that, Mindfulness is not irrational or contrary to reason but simply transrational or supramundane ... that is, it grows out of, but also transcends, ordinary reason or rationality.

Mindfulness involves the use of the following three ordinary, everyday “skills” (but with a heightened state of self-awareness):

  • observing … that is, giving bare and curious attention to what is what is happening in one’s body, mind and consciousness … with choiceless awareness;
  • describing … that is, [in some Mindfulness "traditions" and practices] using techniques such as “noting” (eg “thinking … thinking”) and “labelling” (eg “sad”, “angry”) - without judgment, condemnation or criticism of any kind - what is happening in one’s body, mind and consciousness ... OR simply acknowledging - without anticipating or reflecting upon it - whatever be the sensation of the moment in the immediacy of its arising or vanishing;
  • participating … that is, practising, whilst paying full and undivided attention to, certain activities (including but not limited to ordinary, everyday activities such as eating, reading and watching TV) in a manner that enables one to step back and otherwise disengage from what is what is happening in one’s body, mind and consciousness, thus enabling oneself to de-stress, detach and disengage from mental clutter and to have a clear mind.

For some time now I have been interested in the work and writings of Marsha M Linehan (pictured below), who is
an American psychologist and author of such books as Cognitive-Behavioral Treatment of Borderline Personality Disorder (New York: Guildford Press, 1993). Linehan is a Professor of Psychology, Adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington and Director of the Behavioral Research and Therapy Clinics.


Lineham has developed a system of psychotherapy known as Dialectical Behavior Therapy (DBT), which is a type of psychotherapy that combines behavioural science with concepts of acceptance and Mindfulness derived from both Eastern and Western contemplative practices.

As regards the practice of Mindfulness, Linehan sees it as being a core skill in her type of CBT for Borderline Personality Disorder (BPD), which is a mental disorder that affects some 2 to 5 per cent of the population at some stage in their lives.

For more on BPD watch this quite helpful YouTube video:


People affected by BPD frequently experience distressing emotional states (often involving confused and contradictory feelings and emotions as well as deep feelings of insecurity), difficulty in relating to other people, self-harming behaviour and problems with impulse control. Mindfulness can be of assistance here by reason of the fact that Mindfulness leads to enhanced and more objective self-awareness.

By means of the regular practice of Mindfulness, aided and assisted by one or other of the various forms of psychotherapy and possibly medication (in the form of mood stabilizers) as well, people with BPD can gradually become more aware of what is happening in their body, mind and consciousness … in the present … on a moment to moment basis ... and more centred and grounded in the "here and now".

In time, the mind slows down, and one learns not to automatically engage in self-introspection of an obsessional kind, self-criticism and self-condemnation, and not to act impulsively and unthinkingly based on what are often ill-founded mental judgments as to whether one likes or doesn’t like what one is experiencing or encountering in daily life.

Equally importantly, one learns that, when painful or otherwise unpleasant feelings or memories arise, one need not become caught up by them but can let them drift or float away. In other words, there is a shift in focus and one's persepective of thinking from being in the past and future to being fully engaged in the present. Further, one learns to be an objective observer and witness of oneself in the "time at hand" … with emotional equanimity and tranquillity.

NOTE. This blog sets out a simple form of mindfulness sitting meditation.


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