Using Mindfulness for People
who Support Those with
Enduring Needs
Steve Noone
Neil Sabin
NTW NHS FoundationTrust
Over view
• Discovering the wolf….
Over view
• How should we ‘prepare’ staff for what they
may experience whilst caring ?
• Provide a conceptual overview
• Consider some simple exercises
• Time to share ideas
Staff
Behaviour
Challenging
Behaviour
Staff Negative
Emotional
Reactions
Staff
Behaviour
Challenging
Behaviour
Staff Stress
Staff Negative
Emotional
Reactions
Staff
Behaviour
Challenging
Behaviour
Staff Stress
Staff Negative
Emotional
Reactions
Staff
Behaviour
Challenging
Behaviour
Staff Stress
Staff Negative
Emotional
Reactions
Staff
Behaviour
Challenging
Behaviour
Feelings identified by carers
(R McDonald 2006)
• Good:
Trusted, worthwhile,
skilled, connection,
empathy, happiness,
satisfaction, joy,
excitement, pride, relief,
heart-warming
Feelings identified by carers
(R McDonald 2006)
• Uncomfortable:
Embarrassment,
stupidity, anxiety/fear,
confusion, anger,
sadness, failure,
overwhelmed / dread,
useless, frustration,
disbelief, alarming and
nerve-wracking,
distressed, powerless,
annoyed, shame at own
disgust
Becoming a Resilient Caregiver
McCurry (2006)
• Resigned - asks for no help often
becomes sick and depressed
• Resentful - shocked and bitter will often
blame others
• Resilient - detach themselves and not
take the behaviour personally
Becoming a Resilient Caregiver
• Resilient - detach themselves and not take
the behaviour personally
• Maintain a sense of humour
• Aware of the tender moments in the day
and look for the uplifts that are part of
being a caregiver
Research
• Acceptance and Commitment Therapy
– Occupational Stress (Bond & Bunce, 2000; Bond &
Flaxman, 2006; Bond, Flaxman, & Bunce, 2008)
– (Noone & Hastings; 2009; 2010; 2011).
• Mindfulness and field learning disabilities
– care staff working with aggression, (Singh et al., 2006),
– reduce the use of physical restraint, (Singh et al., 2009)
with forensic services, (Singh et al., 2011)
– with patients with aggression and mental health problems
(Singh, et al.,2007) and clients with learning disabilities
and aggression, (Singh, Wahler, Adkins & Meyers, 2003).
What is ACT ?
• Psychotherapeutic approach built on principles of
behavioural analysis
• Normalises human suffering
• Much of suffering is a consequence of
– verbal evaluation of an event and
– attempt to avoid ones experience
Core Ideas of ACT
• Clean pain: falling down
a hole
• Dirty pain: is trying to
dig
• What happens if
attempting to control is
the problem?
Core Ideas of ACT
• To try and control is to try and stop
experiencing what you are experiencing
• Leads to experiential avoidance
• The real problem is lack of psychological
flexibility
The transcendent challenge of
our time is the objectification and
dehumanization of others
Steve Hayes
Consider these photos
• Just look at each photo and notice what
thoughts pop into your head
• They will be either neutral
• Positive
• ….or negative
Past and
Future
Unclear values
Experiential
Avoidance
Psychological
Inflexibility
Inaction
Fusion
Conceptualized
Self (Ego)
Contact with
the present
moment
Values
Acceptance
Promoting
Psychological
Flexibility
Committed
Defusion
Action
Self as Context
Where to start ?
Structure of Day
• Reflection
– on what I bring to my job
– personal cost of being stressed
– how thoughts operate
• Clarify
– my values and how I want to live my life
• Discriminate
– coping that works and what doesn’t
– between me and my thoughts
• Make a personal commitment to my values
What do you bring to your job
•
•
•
•
•
•
•
•
Patience
Humour
Stay calm
Keep to care plan
Listen
Empathy
Understanding
Share good times
•
•
•
•
•
•
•
Protect rights
Enable development
Ensure safety
Protect dignity
Advocate for person
Energy
Enthusiastic
Relentless Questioning
Throwing Objects
One client attacking another client
Attacked with Objects
Head Banging with fist
Air Swallowing
Withdrawing
Scratching
Biting
Banging head against wall
Spitting
Kicking
Picking own wounds
Hand Biting
Breaking
Furniture
Punching
Screaming
Eye Gouging
Running away
Job Advert
• Wanted:
• Patient, calm, understanding, empathic, energetic,
enthusiastic person, who is able to keep to care plan, protect
the rights of a vulnerable person, ensure the safety of clients
and members of the public,will protect the dignity of
stigmatised people and be a keen advocate.
Job Advert
• To work with people who will:
• Bite, throw objects, scratch, attack you with objects,head
bang with fist, withdraw, bang head against wall, spit, bite
their own hand, run away, break furniture, attack other
clients, kick,eye gouge, scream, ask continuous questions, pick
own wounds, swallow air,
Job advert
• A good sense of humour and a clean driving
license desirable.
• The organisation is committed to promoting a
work -life balance
Structure of Day
• Reflection
– on what I bring to my job
– personal cost of being stressed
– how thoughts operate
• Clarify
– my values and how I want to live my life
• Discriminate
– coping that works and what doesn’t
– between me and my thoughts
• Make a personal commitment to my values
Clarifying
Values
THE SWEET SPOT
Vividly recall a “sweet “memory and get in touch with the emotions. What
is meaningful about this memory?
WHAT MATTERS?
What do you really want? What matters to you, in the big picture? What
do you want to stand for? Is there anything in your life right now that
gives you a sense of meaning, purpose, vitality?
SPEECHES
Imagine your 80thbirthday (or 21stor 50th, or retirement party etc). 3 people
make speeches about what you stand for, what you mean to them, the
role you played in their life. Imagine them saying whatever you most
want to hear.
FORMS & WORKSHEETS
Valued living questionnaire
Bull’s eye
Life compass
Structure of Day
• Reflection
– on what I bring to my job
– personal cost of being stressed
– how thoughts operate
• Clarify
– my values and how I want to live my life
• Discriminate
– coping that works and what doesn’t
– between me and my thoughts
• Make a personal commitment to my values
Past and Future
Unclear values
Experiential
Avoidance
Psychological Rigidity
FUSION
Entanglement
with
categorical,
judgmental
thought
Inaction
Conceptualized Self
(Ego)
Cognitive Defusion
“I used to think that the brain was the most
wonderful organ in my body.
Then I realized what was telling me this.”
-Emo Phillips
Defusion exercises
• Don’t think about chocolate cake! Forget the
numbers
• Objectify the mind – its only looking out for you
• Leaves on a stream/ protestors/ cars in street
• Replace “buts” with “ands”
Past and Future
Unclear values
Experiential
Avoidance
Psychological Rigidity
Inaction
Fusion
We buy into stories of who
we are and who others are
RFT & The Self
The Three Selves
Verbal behavior gives rise to three types of self:
– Object of verbal knowledge
• The conceptualized self
• Self as content
– Process of verbal knowledge
• The knowing self
• Self as process
– Locus of verbal knowledge
• transcendent self
• Self as context or perspective
Structure of Day
• Reflection
– on what I bring to my job
– personal cost of being stressed
– how thoughts operate
• Discriminate
– coping that works and what doesn’t
– between me and my thoughts
• Clarify
– my values and how I want to live my life
• Make a personal commitment to my values
Values Assessment Rating Form
Goals Actions & Barriers
Using mindfulness
with care staff
1. General Introduction to Mindfulness
Staff Training
a. Discussion of staff-individuals with (ID) positive and
negative interactions
b. Discussion of previous training programs t
c. Staff members’ experiences with previous staff training
d. Discussion of staff members’ expected outcomes
e. Discussion of the aims of the mindfulness staff training
f. Review of program requirements: reading, meditation
practice, application of mindfulness, and data collection
g. Maintaining a practice journal
h. Set homework tasks
2. Knowing Your Mind
a. Interactive review of homework
b. Review of mindfulness and mindlessness
c. Identification of instances of mindfulness and
mindlessness during staff-individual with ID interaction
d. Basic meditation techniques for sitting and walking
meditation
e. Meditation practice on Observing Your Mind
f. Discussion of practice on Observing Your Mind and
its applications in staff-individual with ID interactions
g. Set homework practice
3. Focused attention
a. Interactive review of homework
b. Review of focused attention
c. Breathing as focused attention or awareness
d. Meditation practice on Breathing
e. Discussion of practice on Breathing and its
applications in staff-individual
4. Focused Attention on Arousal
States
a. Interactive review of homework
b. Review of arousal states that precede and follow
staff-individual with ID interactions
c. Meditation practice on Arousal
d. Discussion of practice on Arousal and its applications
in staff-individual with ID interactions
e. Set homework tasks
5. Being in the Present Moment
a. Interactive review of homework
b. Review of being in the present moment in the midst
of chaos
c. Meditation practice on Being in the Present Moment
d. Discussion of practice on Being in the Present
Moment and its applications in staff-individual with ID
interactions
e. Set homework practice
6. Beginner’s Mind
a. Interactive review of homework
b. Review of premature cognitive commitment;
bounded versus unbounded reality; conditioned versus
unconditioned responses
c. Meditation practice on Beginner’s Mind
d. Discussion of practice on Beginner’s Mind and its
applications in staff-individual with ID interactions
e. Set homework practice
7. Being One with the Individual
with ID
a. Interactive review of homework
b. Review of being in the ‘zone’ or having a ‘peak
experience;’ being one with the individual with ID
c. Meditation practice on Being One with the Individual
d. Discussion of practice on Being One with the
Individual and its applications in staff-individual with
ID interactions
e. Set homework practice
8. Non-judgmental Acceptance
a. Interactive review of homework
b. Review of acceptance and non-judging; nonjudgmental acceptance of the individual with ID
c. Meditation practice on Non-judgmental Acceptance
d. Discussion of practice on Non-judgmental
Acceptance and its applications in staff-individual
with ID interactions
e. Set homework practice
9. Letting go
a. Interactive review of homework
b. Review of doing one’s part and letting go of
everything else
c. Meditation practice on Letting Go
d. Discussion of practice on Letting Go and its
applications in staff-individual with ID interactions
e. Set homework practice
10. Loving kindness
a. Interactive review of homework
b. Review of acting with loving kindness and
compassion
c. Meditation practice on Loving Kindness
d. Discussion of practice on Loving Kindness and its
applications in staff-individual with ID interactions
e. Set homework practice
11. Problem Solving
a. Interactive review of homework
b. Review the nature of problems and solutions
c. Meditation practice on Problem Solving
d. Discussion of practice on Problem Solving and its
applications in staff-individual with ID interactions
e. Set homework practice
12. Using Mindfulness in Daily
Interactions
a. Interactive review of homework; data collection
b. Putting it all together; review of meditation exercises
and applications
c. Meeting staff members’ expectations; staff-individual
with ID interactions then versus now
d. Discussion on mindfulness in daily interactions
e. Plans for follow-up, keeping in touch, and long-term
practice
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Using Mindfulness for people with Enduring Needs