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Tilburg University the Ethical Space of Mindfulness in Clinical Practice Tilburg University The ethical space of mindfulness in clinical practice McCown, D.A. Publication date: 2013 Link to publication in Tilburg University Research Portal Citation for published version (APA): McCown, D. A. (2013). The ethical space of mindfulness in clinical practice. [s.n.]. 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Download date: 27. sep. 2021 The Ethical Space of Mindfulness in Clinical Practice Proefschrift ter verkrijging van de graad van doctor aan Tilburg University op gezag van de rector magnificus, prof. dr. Ph. Eijlander, in het openbaar te verdedigen ten overstaan van een door het college voor promoties aangewezen commissie in de Ruth First zaal van de Universiteit op dinsdag 14 mei 2013 om 10.15 uur door Donald Allison McCown Jr geboren op 1 oktober 1953 te Bryn Mawr, P.A. USA Promotores: Prof. dr. K. Gergen Prof. dr. J.B. Rijsman Overige commissieleden: Prof. dr. D.M. Hosking Prof. dr. M. Kwee Prof. dr. R. Kuttner Dr. P.T. van den Berg Contents Start HERE: A Final SCENE AS Prologue 9 What a Difference a View Makes 10 Part I: In Search of What’s Already There 15 Chapter 1: The Unique Situation of the MBIs 17 Growth and Proliferation of Identities 19 The Place and Person of the Teacher 24 Chapter 2: Potential Approaches to Ethics in the MBIs 33 Professional Codes 34 The Health Care Ethos 35 The Temptation of Buddhist Ethics 37 Moving Toward a Deeper Understanding of the MBIs 64 Part II: Where Something Ethical Happens 65 Chapter 3: Definitions of Mindfulness in the MBIs 67 A Scientific Definition 69 A Western Social Psychology Definition 71 An “Eastern” Definition 72 A Definition from Neuroscience 75 Turning Definitions Upside Down, or Inside Out 78 A Definition for Co-Creation 80 Not Mindfulness, but Its Pedagogy, Is the Practice 83 Chapter 4: Investigating the Curriculum and Pedagogy 90 Defining the Metastructure of the MBIs 90 Qualities Revealed in the Curriculum 97 Describing the Pedagogy of the MBIs 99 Qualities Revealed in the Pedagogy 107 Toward a Model of the Ethical Space 111 Part III: Dimensions of a Model of an Ethical Space 113 Chapter 5: Describing How an MBI Gathering “Works” 117 Mapping the Work of the Gathering 118 None of these Maps Are the Territory 128 A Review of the Relational View 129 Chapter 6: Building a Multidimensional Model 134 The Doing Dimension 138 Adding the Non-Doing Dimension 151 Adding the Third Dimension 162 The Model of the Ethical Space 167 Part IV: Always Room for More Implications 171 Chapter 7: Putting First Order Morality First 175 Bringing the Gathering Together 176 Letting the Ethical Space Work 180 Tensions in the Ethical Space 185 Maintaining the Ethical Space 186 Using the Ethical Space 189 Chapter 8: Addressing the Urgencies of the MBI Community 191 First: Defining Mindfulness 191 Second: Ensuring Teacher Quality 198 The View from the Ethical Space Clarifies the Urgencies 209 Approaching Conclusions 210 DON’T Stop Now: ONGOING Practice AS EPILOGUE 213 The Potential of Second Order Morality 215 REFERENCES 217 INDEX 233 Start Here A Final Scene as Prologue I am just a part of the circle. In this moment, at the close of a guided meditation, we are silent. We are looking up, eyes meeting sometimes, or looking down, or aside: subtle smiles, conscious solemnity, transparent sadness. I have invited the circle to “say what needs to be said” at the end of this eight-week course in mindfulness. We are already saying most of it in silence. For some, feeling a way into speech may be smooth and direct, for others, it may be a longer passage. And there is always the choice to maintain silence, to share as we are sharing now. We are in a palpable relation that becomes audible at last. “I don’t think I even know everyone’s names, but I feel very close to you all. That’s not anything I expected when I started this class. I need to say thank you to everyone for being here, for being with me in this.” So a theme is established. Then it’s reinforced. “I don’t know why, but practice has been much more profound in some way when I’m with the group. I’m a little worried that I won’t be able to keep it going without you.” Variations arise. “I was so glad to get to class every week, and when I missed, it helped to think of you all when I practiced at home.” And again. “I never would have believed that I could feel so relaxed in a group of strangers.” One particular name, mine, comes into the thank yous quite often, “for guiding us,” or, even more simply, for “holding this space for us.” Yet I find this is turned easily back into the “we” of the class. Very personal stories from our eight weeks together—of struggle and transformation, of pain faced, grief encountered, change begun—get told, and heard, and held once again in empathy and silence. There are also some big surprises. “I never mentioned this, but my husband passed away just a month 9 10 THE ETHICAL SPACE OF MINDFULNESS IN CLINICAL PRACTICE before class started. Just to be here has helped me so much.” And the woman who rarely, maybe never, spoke in class says it all. “This may be the first time that I’ve ever really felt safe and accepted.” I am just a part of the circle. What I need to say has already been said, powerfully, by others. I offer my own confirmation. And silence. In a very short meditation practice—our time is almost up—we offer to each other wishes of unconditional friendliness, peace, safety, health, and ease. When we look up, it’s to say goodbye with our eyes, and hands, and arms, and voices. It’s hard to do, hard to stay with, and yet we find that even this we can do, together. What a Difference a View Makes I’ve been teaching mindfulness-based stress reduction (MBSR) in hospital and organizational settings for a decade. So, I have been just a part of nearly countless circles, each much the same, and yet each unique. And nearly countless times I’ve been struck by the paradox of the view from my seat. I could choose to describe each of the individuals assembled here, with their particular vulnerabilities, pains, and fears. Yet, simultaneously, I could choose to speak of the group’s powerful sense of its interrelatedness—even if unspoken—forming the friendly contours of a container that is each moment alive with promise for each of us. These are two ways of seeing, two ways of talking, that open into different realms of meaning and potential—especially in considering the ethical. In the first, where the circle is a collection of individuals, I am definitively the teacher, the professional, the therapist even, responsible for each one. I see the faces with the stories of their suffering locked inside, behind their eyes, and my first ethical thought is “let me do no harm.” Further, I think, “let me comfort these people who are in my care.” That thought, however, cannot be expressed to them; it’s all on me. I lose my voice. I’m put in that position where I worry about “compassion fatigue” and my ever-diminishing opportunities for self- care. In the second way of seeing/talking, where the circle is defined in relationship, I am part of a group that has co-created ways to bear whatever is there—joy or pain or fear—with each participant in each moment. We have come to trust that we can continue in relationship, Start HERE: A Final SCENE AS Prologue 11 however simply, throughout our time together. The ethical thought that arises for me is directly related to this sense of co-creation: “Here is a safe place where comfort and care can happen—and are happening.” As we tend to our relational process together, I can be certain that the next step I take will be right or (at worst!) quickly corrected. I am indeed the teacher, and have borne responsibility for bringing the group together and sharing what I know of mindfulness. I offer the authenticity of my own mindfulness practice, the authority of what I have learned in working with it (deeply enough to be its author), and the friendship of simply meeting people where they are in the moment without an agenda. So, in this co-creation, I am not an agent who “does” things to the class. I do not shoulder the ethical burden alone. I have my own voice and place in the group that offer me satisfaction. And, rather than fearing compassion fatigue, I look for connection and refreshment. The first way of seeing/speaking is one in which we are embedded through culture, education, and professional training.
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