Transcription of Mindfulness, #120
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Dr. Dreher: It’s important to understand that mindfulness is as much as any an experience. It’s I think, the present moment that has the greatest potential to give us a sense of belonging and value within ourselves and in whatever work we’re doing around in our life. Be aware of what you’re doing right now.
Maureen: I think a lot of people can benefit from just learning the skills about how to sustain their attention in a different way and how to be gentle with themselves when they’ve lost their focus, and how to bring their focus back to whatever it is that they had been intending on resting their attention on.
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Dr. Lisa: This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour & Podcast show number 120, Mindfulness, airing for the first time on Sunday, December 29th, 2013. Our guests today include Dr. Joe Dreher, clinical associate professor at Tufts School of Medicine, affiliated with the Maine Medical Center and Maine Health, and Maureen Callnan, mental health clinical nurse with a specialty in mindfulness and memory issues.
As we move into a new year, many of us are taking time to count our blessings and look forward to blessings ahead. We are best able to know the bounty of our lives when we are fully present enjoying the moments as they come to us. Today we speak with experts in the field of mindfulness who are helping educate healthcare providers and patients about being more fully present. We hope that our conversations may give you an opportunity to count your blessings from 2013 and consider the importance of mindfulness in the year ahead. Thank you for joining us.
A known doctor, Joe Dreher, George Dreher who is a clinical associate professor with Tufts School of Medicine located here at Maine Medical Center for many years. In fact, Dr. Dreher was one of my teachers and my advisor when I was a family medicine resident at the Maine Medical Center. I felt like I got to know him a little bit more when I spent time up at Mayo Hospital in Dover-Foxcroft even though he had already gone by that time when I was spending time as a resident. I understood where he had been as he had processed through being a family doctor then and then deciding to go back into medical education training and become a psychiatrist.
It’s great fun for me to have Dr. Dreher across the microphone from me today to talk about a subject that I believe is pretty dear to his heart and that is mindfulness. Thanks for coming in.
Dr. Dreher: My pleasure.
Dr. Lisa: Dr. Dreher you started your whole, I guess, adult career in the Navy as part of the Submarine Corps. I’m fascinated by this because I don’t think I knew this about you. You’ve come a long way from submarine and this is part of medical school to now working with Tufts School of Medicine. Why did you become a submariner?
Dr. Dreher: I was greatly motivated by the draft. It was during Vietnam and I actually got into the Navy one week before I was to be reporting for act of duty in the army. My family had a background in the Navy and I’ve always been fascinated by submarines so it was a natural choice.
Dr. Lisa: From being in the Navy and spending time in … Were you in Vietnam proper or were you just training and working State side?
Dr. Dreher: I was in the submarine in the North Atlantic playing tag with the Russians. Did that for 3-1/2 years and actually while I was in the Navy had the opportunity to spend time with some physicians and decided to change my career path from doing oceanography research at Scripps in La Jolla, California to going to medical school.
Dr. Lisa: That was going to be my question, which is how did being in the Navy and this interesting turn of, twist of faith called the draft. How did that propel you into this career as a doctor?
Dr. Dreher: I enjoy working with people and I enjoyed science a lot. As I spent some time reflecting on all this in the Navy and visiting some of my previous college professors, I became aware that life of working with people as a physician was probably going to be more satisfying to me than a life involving teaching in science, but a little more abstract in some ways. I made the choice and headed for medical school.
Dr. Lisa: You took a dramatic turn. You went first into family medicine and then you decided that you wanted to go into psychiatry. That required going back to … Essentially went back to school getting more training. Where did that come from?
Dr. Dreher: In the middle of all that I was also doing a lot of work in Addictions. I was aware in family practice and even more so in Addictions how much psychiatry played a role in the wellbeing of people. It also gave me more of an opportunity to spend time with people and patients. I decided that would be the best way, the next logical step. It was a very difficult decision because I really enjoyed family practice and the work I was doing there. I had also enjoyed Addictions but I could just feel that there was something more I wanted to learn so I went back.
Dr. Lisa: You’ve also done work with palliative care and end of life issues. You’re not really choosing the easy things.
Dr. Dreher: I think I’m probably a fringe physician. I always get involved with things that are not quite mainstream. Family practice wasn’t really mainstream, Addictions wasn’t mainstream, palliative care, ethics. They’re all things that I feel are very important parts of medicine and need to be paid more attention to, and it just drew me in. I find them very interesting areas. They all seem to have a lot to do with the suffering of people and trying to find ways to alleviate that, particularly the emotional suffering.
Dr. Lisa: What you’re describing is I guess fringe medicine. It is really actually core to people and our humanity and yet it does get shunted off to the fringes because it’s easier for us just to say, “Okay. Well, here’s an ear infection. Here’s an amoxicillin.” Rather than, “Here’s an ear infection, here’s a parent who smokes, here’s a parent who’s unemployed, here’s a grandmother who’s depressed.” It’s easier to deal with that one thing rather than the whole. Was that one of the reasons why you decided to spend more time on the fringe because you wanted to look at this bigger picture?
Dr. Dreher: The term fringe for me implies not anything good or bad but rather that American medicine is understandably very good at technology and very good at finding treatment and cures for a various sort of diseases which is an important thing to do. I’m concerned, in the process, the doctor-patient relationship has become lessened and that folks who are in primary care, family medicine, internal medicine, pediatrics have not been well taken care of, compensated, listened to in the process of making decisions about what we need in healthcare in America.
The medical systems around the world that are doing more for their patient’s overall health and spending a lot less money have a better primary care system. Where a primary care doctor really has time with patients and can really provide not only the, if you will, technological medical care they need but also the personal care. Certainly it’s very great to have all the technology available we have here for the more complex illnesses, but without the foundation of primary care, it’s somewhat a tail wagging the dog in my opinion about how healthcare probably would be best delivered.
We’re in a frantic race now to try and catch up and build enough primary care practices to allow the planned healthcare systems in this country to function in a more, not only economical, but I think actually productive way particularly in preventing disease which is one thing the family medicine I know does a really good job with. I say fringe just because it’s fallen out that way due to all the kinds of forces that I’m sure I don’t understand. There’s not all bad things by any means about the way it’s fallen out but a balance would be good.
Dr. Lisa: You’ve seen a lot of changes between the time that you went in to medicine and the time that … I guess in theory you’ve quote “retired” unquote, which I think is not entirely true. You’re no longer practicing clinical medicine as of this past summer but you’re still actively involved in the teaching program. What have you seen as far as physician attitudes, behaviors, wellbeing? Because I know that a very important piece of this for you is physician and provider wellbeing.
Dr. Dreher: You are correct that I’ve stopped doing official clinical medicine and my focus now is trying to help the providers themselves. Physicians, nurses, physician assistants, nurse practitioners. All of whom are under tremendous pressures and losing a lot of what gives them meaning in their work. The more this occurs and the more burned out those folks are becoming, the more they’re going to be leaving medicine sooner or the more prone they are to make mistakes or other things that we don’t want to have happen.
The shift has just been for me from, if you will official patients to another whole group of people who are suffering just as patients do and trying to help them. The change has been for I’m sure many reasons that we can’t get into here. Part of it is because medicine has become a business model. That’s partly because of the expense of it and trying to provide care and not spend as much money without doing so by putting providers in a row where they don’t have enough time to spend with each patient, or really to attend to the details of the patient’s needs. It’s something that we’re struggling with right now.
I think we’re going from a fee-for-service model where we get paid for everything we do to hopefully something that’s more holistic and is really looking at the whole patient’s needs and the populations of patient’s needs, and preventing illness as much as we’re treating it. I think when we get there things will be much better but this transition time is very tough on providers and the administrators who are trying to run the system as well. I’m trying to do what I can to help modulate that a little bit.
Dr. Lisa: I assume that that’s part of the reason why mindfulness appeals to you?
Dr. Dreher: It’s always appealed to me to try to help myself be more centered and clear when I’m working with patients. I find it’s one of the useful tools to help the providers I’m working with and there are many others as well. Mindfulness is a powerful tool but it also takes some time and effort to learn it and make it part of your life to a point where it becomes a constant background part of one’s self. It can make a big difference. There are things one can do in little ways to be mindful to help you re-center during the day and reground yourself, and that’s what I’m trying to work with folks on. Again, this is only one of the many tools we’re trying to find to use to help providers be healthier.
Dr. Lisa: Here on the Dr. Lisa Radio Hour & Podcast we’ve long recognized the link between health and wealth. Here to speak more on the topic is Tom Shepard of Shepard Financial.
Tom: I’d like to take this opportunity to wish you and yours a holiday season filled with an abundance of love and gratitude. Be thankful for the things in your life that matter most and enjoy your time with family and friends. From all of us here at Shepard Financial, happy holidays.
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Dr. Lisa: Let’s take a step back and define what mindfulness is specifically or as specific as you would like to be. Because I think a lot of people believe that being mindful is just being sort of paying attention, which it does in a more simple way but it means something more than that.
Dr. Dreher: It does. There’s a lot of discussion about what this means. There’s actually books written on just that, what’s mindfulness about. To me it’s trying to be present in each moment as it occurs without judgment and with as much awareness as you can bring to that moment. It’s very natural and our society reinforces our focused on worrying about the past or worrying about the future and ending up losing the moment we have right now. We are trying to accomplish something in this moment such as working with a patient. It’s good to be able to as much as you can put aside the past and future focus and bring more of yourself to what you’re doing at the moment.
Awareness or noticing is another way to consider the basics of it and you take that awareness and noticing and then do some work and training yourself in it. One form of such training would be meditation, there are others. Then you become aware of what your mind is doing as you go through your day and how much you may be adding unnecessary [plurifiration 00:15:31] to what’s being thought about and worried about and what’s really true and what’s really present before you, and using that presence then be more effective whenever you’re trying to do and being less fanatic yourself.
There’s a win-win for both the person who is doing it and for whatever person or product they’re working on. That’s a short outline to it. There’s a lot more to it obviously.
Dr. Lisa: One of the reasons that I know or became aware that you are working on mindfulness was that you and I had a conversation several years ago about how I had been incorporating mindfulness in my practice. As you know, I did Mindfulness-Based Stress Reduction fellowship with Jon Kabat-Zinn’s program at the University of Massachusetts when I was a preventive medicine resident. When I came back into medical practice, I spent a lot of time working with patients on their breathing. That was the basis of my attempt to help them self-heal.
You’ve done a lot of work with medical students, residents and physicians on mindfulness and it’s looked slightly different because it’s a different population. Tell me how you’re incorporating mindfulness in the work that you’re doing.
Dr. Dreher: Reflecting on a comment you just made about the breath. That’s frequently used as part of a mindfulness training because you always have it with you and it reconnects you with your body. One thing that I believe we all can do and particularly people in an intellectual professional do is become lost in our minds and lose track of the many other facets of who we are as a person. Of which being aware of one’s body is a good anchor if you will to come back to, to pull you away from all the ups and downs and in and outs of the mind which is always going.
The anchor can be used, the breathing anchor can be used for meditation practice but it can also be used in very brief ways. If you’re going from one task to another just stopping for a moment, physically stopping and let yourself catch up to where you are, taking a breath or two and using the out breath as a relaxation process to bring you to this moment. Just be there for it, just a second or two, and collect yourself to then be ready to bring all of yourself into the next project.
There’s one example of ways to be mindful. The important thing about this is that it works much better if you do some training if you will to become present. Just telling somebody well stop, breathe, be and you’ll be in better shape doesn’t work. It’s like giving somebody a pair of tennis shoes and say, “Okay, run a marathon.” You got the shoes but you need to practice and learn how to run in them and be with them. When you do that and also get a more in tune with your body and all the other aspects of yourself. Then when you do the stop, breathe, be, they all sort of ruse for a second and really slow down the monkey mind that’s always going and bringing you to the present moment.
With providers there’s a number of things we’re underway with. We’ve been doing a course in mindful practice in Maine Medical Center for providers, nurses, physicians, respiratory technologists, physical therapist for about 3 years now. We have one going on right now. It’s a 12-week course where people learn some mindfulness tools, but then also look at how they have been dealing with the stressors in practice such as how they deal with professionalism or the lack of it in other people. How they deal with suffering or death and dying and bringing all those things into a quieter place or class to look at them in how they cope with them and reminding them about how they cope with the well many times. Particularly if they’ll let themselves just sit down and remember when they did these things well.
Cultivating that memory of skill renews many aspects of themselves besides just technology and just knowledge base. It really renews the parts that allows them to be a healer and that’s what’s really, I think, key for us not to lose as medicine forges its new role in our society and around the world. It’s to remain healers and not just good technologist.
Our work focus on that, our work in physician health and resilience is taking a bit of a different track. Still hoping to use mindfulness some but really looking at what it is that gives professionals, in this case providers in medicine, a sense of autonomy, a sense of mastery and a sense of meaning or purpose in their work. Then how to promote those three things so that their work doesn’t become empty and they don’t become as burned out.
There’s been some very interesting research in how rather minimal time spent with physicians particularly in attending to the meaning in what we do really renews them in a deep way and allows them to be much more satisfied in their daily work even though the stressors may be the same. It’s how they bring themselves there and how they live within that stress that makes all the difference. There’s a lot of research going on around the country trying to find ways to do this that aren’t too time consuming or too expensive. It’s interesting how some various minor things such as more opportunities for peer to peer connection can really make a big difference in folk’s daily work.
It’s those kinds of things that we’re trying to begin to find and find ways to incorporate in what we’re doing, in our practices and in the practices themselves looking yet inward to see what they can do. We’re having a conference on October 17th inviting several people from major practices around the Portland region to come together and start thinking about what is it that we might be able to do within our own practices, but also work with each other collaboratively to build up these resources that will save the people we’re trying to have be well enough to save others and heal them.
Dr. Lisa: How are the providers responding to this idea of mindfulness? It’s been I know having worked in this field for many years it can a challenge to do all the things that we’re supposed to do and then also simultaneously take a moment to sit down and breathe. Because there’s always this feeling of being rushed, there’s always this feeling of having to multitask to almost an extreme degree. What do people say when you say, “Okay, now we’re going to learn about mindfulness and this is important. And we’re going to fit this into your curriculum somehow.”
Dr. Dreher: It’s interesting that when I have conversations with physicians and talk about what’s causing their burn out and their dissatisfaction, they all are enthusiastically agreeing with it. They would all like to find some ways to change that. Many of them are open to ideas to try out of which mindfulness is one. Many just can’t click with that idea and want to try other things and that’s fine too.
What I’ve learned is that just working with the physicians alone is not likely to make an adequate change so that they can back away from the edge of burn out. That’s why I’m trying to work with physicians and the administrative systems to find ways they can work together on this program. Because the administrative systems are also aware that when physicians are burned out and tired they make more mistakes. Patient satisfaction drops, prescription practices are not as good. There’s all kinds of clinical things that have been shown to be less well done by a burned out provider even if the patient doesn’t know they’re burned out. The systems also want to correct this, not to mention it is just the right thing to do to try and help their employees if you will be in better health.
The difficulty with suggesting mindfulness as a treatment for this is first of all, is not everybody is in to mindfulness. It won’t click for them and that’s fine. Second of all, when I say mindfulness everybody thinks they go off somewhere and meditate for 6 weeks on the top of an isolated mountain in a cave which is not what I’m thinking at all. It’s learning how to do it a little bit everyday in your life.
Another example, I teach a course to medical students called the Healer’s Art and particularly by Rachel Naomi Remen. One of the really neat exercises there is the Three Question Journal where at the end of the day you literally think about your day going backwards from where you are now, backwards into the day and think about what inspired you in that day and just write it down. Then start again from where you are going backwards in the day and find what intrigued you and write that down. Then again, starting from where you are in the evening usually going backwards in the day and find what surprised you.
Just doing that and writing those three things down will help people be aware of the many fascinating things of how many in the day inspiring things that are lost in the rush. If you do that on a routine basis in the evening, after a while you’ll start to notice it as it occurs in the day. You’ll have these little pockets of the feelings of renewal and a sense of meaning in what you’re doing. It will help you through the day.
I’m not pretending that all these things are going to make everybody’s life happy and wonderful. There’s going to be a lot of stress still but I think of it as a tachometer where there’s on a car, there’s a red line. You get above a certain RPM and that’s where the engine starts to fall apart. I’m just trying to help people move back from the red line a little ways and keep them practicing in a way that they’re happy, their patients are happy and they’ll stay in practice longer. We need as many docs as we can get right now and anything to help the doctors do better, feel better in a small way I think will help all of the system be better as well.
Mindfulness is a nice tool but it comes in many different forms. You can be mindful of what you’re reading. Instead of talking during a meal or reading a newspaper or reading the back of a cereal box, sit there and really just taste the food. Chew it a few times and look at the food before you eat it and just appreciate it. I think appreciating the moments you have during the day. If you’re caught in a traffic jam, okay, appreciate the taillights flashing on or off in front of you. Finding something to just settle you down and not get all rived up when you can’t do anything about it or enjoying the things you do have. Time with the people you care about. Some time outdoors.
There’s these little pockets we can all find in our day to be a little more aware of the day and of our lives and slow down for a few minutes. That can be helpful. Mindfulness comes in many different shapes and forms and there isn’t any activity that I can think that you couldn’t use a little mindfulness for and just be aware what you’re doing right now.
Dr. Lisa: Dr. Dreher, how can we find out more about the work that’s being done in mindfulness in medicine through Tufts School of Medicine and the Maine Medical Center here in Portland?
Dr. Dreher: We’re just beginning locally and there’s many things we’d like to do and are trying to mindfully choose amongst them with our limited resources. I would suggest if people want to learn more about this that when you discuss the Mindfulness-Based Stress Reduction would be a great place to start.
The Maine Medical Center Learning Resource Center provides what they call MBSR course a couple of times a year. There are great practitioners in the community who do this. A number of them Nancy Hathaway is one I know who does this kind of work.
You can probably go to the website for the Mindfulness-Based Stress Reduction program on the University of Massachusetts and they’ll have a list of people who’ve been certified by them to teach. That would be a convenient way I think to start. That is filled with the most fuel because it’s really based on the physiology and science of awareness and not requiring one to take a transcend or a spiritual approach to it, although that may arise from it. That’s where I would start, MBSR.
Dr. Lisa: Dr. Dreher, thank you for coming in today and speaking with me. Thank you for also being my teacher, my mentor and my advisor when I was a family medicine resident back in the day. We’ve been speaking with Dr. Joe Dreher, clinical associate professor with the Tufts School of Medicine and affiliated with the Maine Medical Center right here in Portland.
Dr. Dreher: Thank you.
Dr. Lisa: As a physician and a small business owner, I rely on Marci Booth from Booth Maine to help me with my own business and to help me live my own life fully. Here are a few thoughts from Marci.
Marci: On this the last episode of 2013, I wish you all a happy, healthy and above all prosperous new year. As you enter into 2014, take a moment each day to give thanks and appreciate the joy that is all around you. Happy New Year. I’m Marci Booth. Let’s talk about the changes you need, boothmaine.com.
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Dr. Lisa: During the holiday season, one of the things that we like to think about is how we can make it through and then enjoy ourselves and enjoy our families and be looking forward to the New Year in a way that really generates wellbeing. This individual who is sitting across the microphone from me today is well-versed in the area of wellbeing and mindfulness. This is Maureen Callnan who is a mental health clinical nurse and specialist in mindfulness and memory issues. Thank you for coming in and talking to us today.
Maureen: Thanks for having me.
Dr. Lisa: Maureen, you are a board-certified psychotherapist and a psychiatric nurse practitioner. You work in private practice and at the Maine Medical Center. You’ve earned an undergraduate degree in psychology, a master’s degree in nursing and you’ve done post-graduate work in psychotherapy at Boston College. You likely could have chosen any way of looking at this and yet something about mindfulness called to you. What is it about mindfulness that you found so intriguing?
Maureen: I think the road that I took in getting to this particular specialty or therapeutic modality is that I had been working in cognitive behavioral therapy for quite some time and wanted to expand that work. At about the same time, which was about 10 years ago, there were some researchers who were looking to develop what’s called the maintenance therapy for people who were struggling with chronic depression. We had good therapies to help people out of acute episodes but what they were really looking for is how could we prevent relapse situations from happening? About the same time a researcher in Canada and a couple in England have hooked up Jon Kabat-Zinn’s program Mindfulness-Based Stress Reduction and they were intrigued.
They thought, “Well, what would happen if we put together the mindfulness approach with cognitive behavioral therapy?” Then they moved into what’s called mindfulness-based cognitive therapy. It appealed to me both professionally and personally. I think it really enhanced cognitive behavioral therapy. It made it more useful for different stages of illness with depression. I think it just brought wellness skills to individuals that were struggling with mental illnesses and also people that were not necessarily struggling with mental illness but just experiencing emotions that were difficult to get through.
Dr. Lisa: We’ve discussed cognitive behavioral therapy before. I believe it was on a show related to anxiety. For people who aren’t as familiar with cognitive behavioral therapy or mindfulness work, can you describe what those two are and the similarities and differences?
Maureen: Cognitive behavioral work is about developing the skills to really take a look at your thinking. Could we all have an inner dialogue that’s chatting away all day long throughout the day? Some of the things that we tell ourselves are very accurate and factual and some of the things that we tell ourselves are completely non-accurate and not factual. What happens when we go through depression or if we’re struggling with anxiety? Our distortions in how we see ourselves in the world around us will become more magnified.
Cognitive behavioral therapy is really to address that very predictable thought process change. You help a person learn how to challenge and become more flexible with their thinking and also to change their behaviors, sometimes just to add more fun or enjoyable activities into their daily schedule or weekly schedule.
In contrast but also very complementary, what mindfulness brings is that it really brought more attention to how you check in with yourself throughout the day and really monitor that inner dialogue. Because it’s so familiar to us, a lot of times where we have this chatting going on in our head that we’re just barely aware of. The mindfulness skills which is really about just paying attention in a particular way really helps bring attention to that. Also, there’s a softness or a kindness that goes in that checking in with gentle curiosity. Sometimes that works very well with the harshness that can go with anxiety or depression where sometimes we can be very hard on ourselves for hardly any reason at all.
Dr. Lisa: Can you give me an example of some of the things that we tell ourselves that could be possibly harmful?
Maureen: A lot of times they can be things about who we are in general in which we’ll doubt our worth. If I’m not exceeding in this part of my life then I’m worthless, or if I’m not loved by this person then that might mean that I’m not loveable at all. Really kind of extremes in terms of one part of our experience may really magnify to have a lot of meaning in terms of who we are in that moment.
Dr. Lisa: In that situation how would you work with cognitive behavioral therapy and mindfulness to help people to pay attention more and to rethink things?
Maureen: One of the things that I think is particularly helpful with the mindfulness combined with the CBT is that part of my work in the groups that I’ve done, we invite people to have what’s called the formal practice where they may be sitting down and doing a mindfulness meditation for 5 minutes, 45 minutes. They choose the length of time but then to try really stick with that. What that does it’s a formal practice of really tuning in to what happens with the mind when you try to sit down and focus on one thing. What most people discover is that the mind then wants to go all over the place with a busy mind. That’s okay. It’s really about just paying attention and noticing.
Then there’s also informal practices of perhaps you’re going to try to brush your teeth and keep your mind on brushing your teeth while you’re brushing your teeth. Often what people notice is that in the matter of 2 minutes they may have thought about twelve different things other than brushing their teeth during an exercise.
How that then translates into helping therapeutically is that the more vulnerable a person is to depression and often that vulnerability is about the number of depressions, of depressive episodes that they’ve been through, the more easily it is for a sad mood. Even a tint of a sad mood can hijack a person’s attention and get them on to one of these thought patterns that really aren’t accurate, and in a long scheme of things aren’t really doing them any favors. It helps with the attention of noticing, “Oh, I’ve left this conversation and I’m now in my head thinking about something completely different,” in which the theme of it is I’m not doing so great or I’m not such a great person.
The first part is the awareness and the second part which is more the CBT is then being able to challenge the thought process. Maybe you’d say to yourself again in your head, “Hey. Is that really accurate? Is that really true?” Sometimes you’ll say, “Oh yeah, it’s really true.” Then another step would be well, what evidence do you have to support that? What evidence do you have to support that because I don’t have a date tonight, I’m going to be alone for the rest of my life. Kind of phrases that are intended to help interrupt some of that automatic thought process.
Dr. Lisa: Most of us have people in our lives and have experienced these ourselves but really have people in our lives that have the sort of mantra that they come to their life with. I’m too fat, I’m not good enough, nobody loves me and it can be really hard as … I mean it’s hard enough for us as individuals to deal with our own stuff. It can be really hard to deal with somebody who has this mantra that we want to help. We feel compassion towards but nothing we say ever seems to help change their mind. How do you work with that?
Maureen: That’s also an area in which the two modalities differentiate. With CBT, I think sometimes that sounds a lot like how we talk with a friend who’s being very harsh on themselves and in which we might try to talk them out of coming to the conclusions that they’re coming to. Really challenge their thinking, see if they can broaden that.
With the mindfulness approach, it’s really not about getting in there and wrestling with the thought but rather it’s about changing the relationship with the thought that they have. With this approach it’s less of a fix it kind of approach and more of a just notice it. With that, if I’m sitting across from someone and they start to talk about their weight and how they feel about that in terms of their worth I might just say, “Okay, so just notice the judging.” In that moment I don’t want them to get caught up in the content of their appearance or how they smart they are. I just want them to notice that they’ve now moved into judging.
What happens once people have really spent some time with this work, they’ll just smile and say, “Oh yeah. Hmm? How did I get there?” Then they’ll go right back to where they were before that thought hijacked them out of the present moment.
Dr. Lisa: There’s also some noticing of ourselves and how when somebody else is sitting in front of us says something about themselves as bad says, “I don’t like my weight or nobody loves me.” We also can notice how it makes us feel as individuals and that can go a long way toward not trying to fix it and not feeling frustrated because we really often can’t.
Maureen: Yeah, absolutely. Yeah.
Dr. Lisa: The goal of the Dr. Lisa Radio Hour is to help make connections between the health of the individual and the health of the community. The goal of Ted Carter Inspired Landscapes is to deepen our appreciation for the natural world. Here to speak with us today is Ted Carter.
Ted: A world lives within you. No one else can bring you news of this inner world. That’s something by John O’Donohue in Anam Cara. That struck me particularly strongly the other day when I was reading this book. I create places in the landscape that are looks within places. Places where deep introspection calls to you. I also create spaces that are looks without places. They’re places of projection and as you look out into the landscape from a particular place, it’s all about what can be in my life. Where am I going, what’s ahead of me?
I try to honor the spirit of the land and the spirit of the human being that inhabits that land and try to really create spaces that allow you both of those perspectives. They’re quite different and it’s part of the human journey. I think that the land and the landscape can really honor that journey through careful placement and careful consideration. You too can have a landscape that really speaks to who you really are and what you really want in this world. I’m Ted Carter and if you’d like to contact me I can be reached at tedcarterdesign.com.
Dr. Lisa: The Dr. Lisa Radio Hour & Podcast understands the importance of the health of the body, mind and spirit. Here to talk about the health of the body is Travis Beaulieu of Premier Sports, a division of Black Bear Medical.
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Dr. Lisa: Using the breath is an important part of re-centering. This is something that is used in most major spiritual practices. It’s something that’s really very easy to do. Do you work with this in your population of clients?
Maureen: Absolutely. One of the things that I say to folks is that the breath is always with us. It’s not like we have to worry about whether or not we have a particular tool in our briefcase or our pocket. We always have the breath. I think sometimes folks can be rather skeptical because it’s a simplicity of just pausing and dropping into our breaths. I just invite that and say, “Okay. You know, you don’t have to be completely on board with this. That’s okay.” What I do invite people to do is just try it. Utilize the breaths to help you to pause. Utilize the breath to help you to cope when you’re going through a stressful moment and then just see what happens.
Basically, I invite them to not necessarily trust me or what’s been written about for hundreds, thousands of years but rather to just trust their own experience. A lot of times either in that session or they’ll come back and say that there’s really something to this.
Dr. Lisa: There is a practice involved with this. It’s not something that magically transforms itself overnight.
Maureen: Yeah, absolutely. Yeah, I was talking with a person this morning and I said, “You know, it’s not like it’s a magic pill.” You can’t just hope that by wanting to be better or wanting to be more comfortable that you will be. There’s a lot of effort that goes into this work. The efforting can be very different in terms of what’s going on at that moment in terms of what’s needed.
Dr. Lisa: The end of the year during which we’re celebrating holidays but we’re also looking into the New Year and we’re thinking about our family dynamics. Say you’re celebrating Hanukkah with your aunt who you’ve never gotten along with or you’re celebrating Christmas with your father and you feel like he judges you. That can be particularly challenging as can starting a new year thinking I need to change myself, I need to this differently, I need to do that differently. How do you work with clients who come in and talk to you about the stressors of all of that? Are there specific things that you suggest to people?
Maureen: I think in terms of the Christmas, Hanukkah holidays I think one of the things that gets in the way again is how much we are in our head around those holidays. Thinking about the way that they should be with the future orientation of okay, this is how my culture says that they’re supposed to be. Beautiful, amazing food, fun times with family. We put a lot of expectation on how an experience is supposed to be as opposed to just allowing the holiday to unfold in whatever way it’s going to unfold and just trying to enjoy the pleasant moments. Also to be able to trust that we can get through the unpleasant moments such as being able to feel the twinge of rejection that might happen if there’s a critical statement, but just to know that okay, that’s one part of this whole experience.
I can feel that, I can pause and allow that, investigate it if I need to and then move on. That’s kind of the foreword or future part that can get in the way. I think also there are a lot of individuals in which they are looking backward and they are thinking about the holidays that they’ve been through either as children or adults that weren’t great holidays. There’s that regret that’s coming up around that.
Again, the skills are very similar in terms of noticing that you’re in your head, noticing that you are remembering an event or you’re recall of that event as opposed to truly being present for this holiday and just being open to whatever it is that’s going to happen. Kind of letting go of striving and just the attitudes of allowing and letting be. I talk about those a lot in December.
I think in terms of the pressure that we can put on ourselves in terms of goals for the New Year, I think a lot of the time that can really create opportunities for our inner critique to just have a heyday. What I invite people to do is absolutely to put together the goals but also to do that in a soft way. In that maybe some of these goals you’re going to find yourself moving towards, maybe some you won’t. Then also to balance that with values and to really think about what’s valuable in your life in terms of how you spend your time, the people that you choose to be with and the characteristics of yourself that you want to develop.
With that it’s not so much a goal of, “Oh, I’m going to exercise 5 days a week in 2014.” It’s really about thinking about the core characteristics of who you are and developing some kind of practice for being able to check in periodically and just asking yourself, “Am I living or did I live this day in a way that was consistent to my values and trying to have a balance between the two?” The inner critique has a more difficult time when we’re moving or trying to live in a way that’s consistent with our values than it does when we are putting together goals or traditional new year resolutions.
Dr. Lisa: These can also be important things to remember. Again, as we’re talking to other people in our lives, if we focus more on the fact that all we really have any ability to change is the way that we perceive things, the way that we feel things. If we’re constantly frustrated by the people in our lives and the way that they are doing things then that really doesn’t get us anywhere. If we focus in on our values, in our own lives and how we want to live then we wind up feeling better about things and possibly impacting some sort of change.
Maureen: Absolutely, yeah. Sometimes when I’m working with a person who’s really struggling with the way someone else is living their life, I just ask them that question, in whose business are you in? Sometimes it can be pretty tempting to try to work on someone else’s self-improvement plan or how they could be a better person. It really protects us from doing our own work. Sometimes just gentle reminders of where’s your attention? What are you focused on? Are you trying to manage something that’s beyond your control, and then bringing it back to self and what is it that I can do in this moment? Is it really about not doing anything at all? Maybe it’s about just being with the feelings that are coming up as I react to someone else’s behaviors or life choices.
Dr. Lisa: The holidays are particularly good for getting us all distracted. It seems like distraction can be on one hand a very good thing, another hand kind of debilitating. How do you deal with distraction when it comes to this time of year? How do you deal with people who are chronically distracted, people who might have some ADHD, people who might have some issues with not being able to be fully present long term?
Maureen: I think in particular with ADHD, one of the things that I’m really concerned about is how the person perceives themselves. Because I think a lot of times this is a childhood illness. They have a lot of practice of really being harsh with themselves related to their difficulty with attention and that they take it very personally and develop or have the vulnerability to develop beliefs about themselves that aren’t true. I think a lot of the work is really about helping that person come to a place where they can accept who they are, difficulties and strengths as well and then trust that they can dabble in this work as well.
With the mindfulness approach, when the developers for this particular therapeutic modality were starting they didn’t want to use the word meditation. They were trying to skirt around that and they were calling it attention control. They were trying to teach people attention control rather than meditation and then finally they got to the point where they just let that go. Whether it’s a person just who is not necessarily struggling in significant ways with their attention or someone who is with ADHD, I think a lot of people can benefit from just learning the skills about how to sustain their attention in a different way and how to be gentle with themselves when they’ve lost their focus, and how to bring their focus back to whatever it is that they had been intending on resting their attention on.
Dr. Lisa: This can be useful also during busy times of the year where just being able to acknowledge that things are a little busier than usual, that we might get a little distracted but it’s okay. We don’t need to judge ourselves. We can pull ourselves back to a place of centeredness.
Maureen: Right, absolutely. I think in addition to that in terms of the distraction, one of the things that happens is that the more distracted we are the more vulnerable we are for these negative tapes to come in and take hold. If we go into the holidays knowing that that’s a vulnerability and at the end of a stressful weekend we’re feeling a little crazed just in terms of, “Oh, I can’t juggle all this. I can’t … How can I start Monday with the weekend that I just have. I wasn’t … I don’t feel rested or restored.” Then just part of our awareness says, “Oh yeah.” That can be part of the holidays, yeah. It doesn’t mean that I’m losing it or anything else. It’s just part of when there’s a lot that’s happening and we’re more likely to be distracted, we’re also more likely to get caught up in these negative thought loops.
Dr. Lisa: Maureen you have a private practice right here in Portland.
Maureen: I do.
Dr. Lisa: How can people find out more about your private practice or the work that you’re doing locally?
Maureen: They can find me via Psychology Today and I also have a website which is just maureencallnan.com. If anyone still uses the telephone book, I’m in the yellow pages.
Dr. Lisa: I know there are people who are out there still using the telephone books. That is very helpful. For those of you who might be interested in calling Maureen, her last name is spelled C-A-L-L-N-A-N. We’ve been speaking with Maureen Callnan who is a mental health clinical nurse and specialist in mindfulness and memory issues. This is certainly an important topic for us all and I am very pleased that you’re offering this type of work to the people in our community.
Maureen: Yes and thank you so much for the opportunity. It’s really meaningful work and it’s great to have the opportunity to have a few moments to talk about it.
Dr. Lisa: You have been listening to the Dr. Lisa Radio Hour & Podcast show number 120, Mindfulness. Our guests have included Dr. Joe Dreher and Maureen Callnan. For more information on our guests and extended interviews visit D-O-C-T-O-Rlisa.org. The Dr. Lisa Radio Hour & Podcast is downloadable for free on iTunes. For a preview of each week’s show sign up for our e-newsletter and like our Dr. Lisa Facebook page. Follow me on Twitter and Pinterest and read my take on health and wellbeing on the Bountiful blog.
I’d love to hear from you so please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows. Also, let our sponsors know that you’ve heard about them hear. We are privileged that they enable us to bring the Dr. Lisa Radio Hour to you each week. This is Dr. Lisa Belisle. I hope that you have enjoyed our mindfulness show. Thank you for allowing me to be a part of your day. May you have a bountiful life and happy 2014.
Speaker 1: The Dr. Lisa Radio Hour & Podcast is made possible with the support of the following generous sponsors: Maine Magazine, Marci Booth of Booth Maine, Apothecary by Design, Premier Sports Health a division of Black Bear Medical, Dr. John Herzog of Orthopedic Specialists, Sea Bags, Mike LePage and Beth Franklin of RE/MAX Heritage, Ted Carter Inspired Landscapes and Tom Shepard of Shepard Financial.
The Dr. Lisa Radio Hour is recorded in the studio of Maine Magazine at 75 Market Street Portland, Maine. Our executive producers are Kevin Thomas and Dr. Lisa Belisle. Audio production and original music by John C. McCain. Our assistant producer is Leanne Ouimet. Our online producer is Katy Kelleher.
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