Clinical Consulting for Therapists

I approach clinical consultation in the spirit of oral traditions where teaching stories are passed around between community members as a way to grow knowledge and skill from the collective wisdom of many. 

I work with licensed clinicians as a clinical consultant using what I have learned from my own experiences with clients, and from the wisdom and support that has been offered to me by my mentors. My approach to working with clients is sourced from: psychodynamic psychotherapy, sensorimotor psychotherapy, contemplative psychotherapy, contemplative practices, parts work, Jungian and archetypal dream work, active imagination, neuropsychology, feminism, embodied social justice, authentic movement, expressive arts, astrology and breath work.

I recently wrote this article which can give you a taste of how I incorporate contemplative psychotherapy and contemplative practices into my work with my psychotherapy clients:

Mindful Sensitivity and Tonglen: Clinical Allies

By Fiona Brandon, MPS, MA, MFT

What happens when psychotherapeutic work is vitalized in session by an infusion of contemplative dynamism? This question has led me to be surprised and encouraged by the many ways in which Buddhist contemplative practices come alive -- overtly and covertly -- in session with my psychotherapy clients. In my experience, contemplative practices can infuse the therapeutic container with a supportive evocative spaciousness that gives clients the ability to relate to, and gain insight from, more raw and edgy psychological material instead of being overwhelmed. Let me share two clinical examples where mindful sensitivity and tonglen respectively moved clients to face into uncomfortable life experiences with curiosity and care while inspiring more compassion towards themselves.

Mindful Sensitivity

A female client in her 40s, who has a meditation practice, asked that we begin session with a short meditation to help her ground. On this particular day she requested mindful sensitivity, the second foundation of mindfulness. I guided us to scan our bodies and bring into awareness how we react to unpleasant, pleasant, and neutral somatic sensations. The practice encouraged us to look at how we might automatically push away or try to fix the unpleasant; hold onto the pleasant; and ignore neutral sensations. Consciously relating to these three types of sensation is a way to understand and take responsibility for how we might unconsciously react to them, and come to learn more skillful ways to respond instead.

I ended the meditation and my client began to talk about memories of expressing anger towards her parents when she was a young girl. We had been working together for a number of years, and we knew that her verbal aggression was a way to defend against the emotional neglect she experienced from her family. My client continued and named that it was difficult to acknowledge and relate to the part of her that holds anger and resentment towards her family. Because we had just worked with mindful sensitivity, I asked my client if she would be open to noticing what happens when she doesn’t try to push away, fix or change this part of her? I asked if it would be ok to give space to the anger? I referred back to her experience of working with the unpleasant sensations in her body, and wondered if she could bring the same quality of mindfulness to the part of her that holds her anger? Could she get curious about this part that she perceives as unpleasant and difficult to tolerate? Could she notice the particulars of her experience of aversion and her desire to push it away?

Using the earlier experience of mindful sensitivity as a reference point, my client began to connect with her anger using the active and enterprising perception of mindfulness. She noticed out loud how she experienced the fluctuating physical sensations associated with her anger; she noticed that these sensations evoked meaningful mental images that gave her a more palpable way to access and dialogue with her anger; and she eventually noticed that she could have an experience of anger, without overidentifying her sense of self with anger. These insights, sparked by mindful awareness of the unpleasant, helped my client to consciously move from being ashamed and overwhelmed by her anger to accessing more compassion, understanding, interest and care towards this aspect of herself.

Tonglen

I also work with clients who have no experience or desire to meditate, and even with these clients contemplative practices can be instrumental. One such client, a man in his early sixties, struggles with feeling ineffectual and powerless when his adult daughter gets overtaken by anxiety and paranoia. My client longs to be able to “fix” his daughter so he would no longer have to manage her when she gets highly dysregulated.

As I listened to him share his painful experiences of his daughter’s anxiety, I spontaneously began to practice tonglen; taking in the awareness of my client’s suffering on the in-breath, and on the out-breath exhaling compassion and care to him. I repeated this over and over as he shared his emotions. And this gave me an idea. Without ever naming the practice of tonglen, I asked my client if he was open to getting curious about the part of him that feels small and incapable in the face of his daughter’s struggles? Would he be willing to explore (breathe in) the part of him that feels defeated and offer it care and compassion (exhale)? He replied he was open to trying.

I encouraged my client to notice his feelings of inadequacy and then visualize sending care and compassion to this deeply ingrained negative self-view. My client described sending compassion into a tight grey knot of fear and worry. I encouraged him to toggled back and forth between contacting the inadequacy and then sending it compassion. He repeated this over and over again, creating a dynamic nurturing exchange between his suffering and his ability to feel compassion towards himself.

As the session progressed, I asked what he noticed as he extended compassion to the knot? Did it stay the same or was there some shift that happened? Was the knot as solid and impenetrable as he originally thought? My client replied that he began to notice a softening towards his belief that he was under grave emotional threat when confronted with his daughter’s mental health challenges. He began to open to the possibility that he could soothe himself when he feels powerless with his daughter, and maybe even one day be able to do this in her presence. We began to explore the possibility of my client being able to feel secure in himself even if his daughter is overwhelmed. And how being able to accurately perceive his daughter’s mental state is an act of compassion towards himself and his daughter because it can point him towards skillfully addressing his needs as well as hers in any given situation. Overtime, my client began to feel more confident that his daughter’s anxiety did not have to be a profoundly dysregulating experience for him, but that he could actively work on using tools to regulate himself in her presence.

These are only two examples of how infusing the therapeutic container with the impelling healing technology of Buddhist meditation can be used in session to help clients actively engage with their more unsettling parts, and find some relief and insight in relating to them as opposed to being overwhelmed and fearful of them. I am inspired by inviting contemplative practices into the therapeutic space as they can encourage promising awakenings for clients and therapists alike. 

I can be reached at 415.721.3355 or by email to discuss clinical consultation. To learn more about my thoughts and approach to psychotherapy, you can read the articles on my psychotherapy blog.