Keywords

Introduction

The most obscure fact in the use of mindfulness in clinical practice may actually be its most obvious feature—that we learn mindfulness ‘together’. Because the chapters that follow begin to open into the range of applications, this relational basis of mindfulness becomes a central consideration. In any undertaking in the clinical use of mindfulness, there is a teacher and at least one participant. This may be a group, as in mindfulness-based stress reduction (MBSR) or one of the many mindfulness-based interventions (MBI) that are targeted to specific clinical populations, or it may be that a therapist and patient undertake to apply mindfulness in their work together. In any case, we need to develop an understanding of both the person of the teacher and the nature of the relational situation of the pedagogy. Yet, we encounter obscurity in both.

Much of this obscurity might be traced to more than three decades of scientific research that has been modelled on or has aspired to the ‘gold standard’ of the randomised controlled trial (RCT), endowing scientific legitimacy, while factoring out potential ‘teacher effects’, and insisting on a strong individualist view of the pedagogy. Assuredly, this effort has elaborated an evidence base that has been powerfully persuasive in encouraging adoption of mindfulness for a wide range of clinical applications. Yet, much has been and continues to be lost. That is, as colleagues and I have suggested (McCown, Reibel, & Micozzi, 2010; McCown, 2013; McCown & Wiley, 2008, 2009) and as others have concurred (Crane, Kuyken, Hastings, Rothwell, & Williams, 2010; Crane et al., 2014), the concerns in teacher training and pedagogical study are in a different discourse from the outcome studies. The RCT approach assumes the view of mindfulness as an analogue to a pharmaceutical compound. Mindfulness is reified, a thing to be placed ‘inside’ the patient to effect individual change. Moreover, this thing is placed there via a teacher who is simply a delivery vehicle, a ‘vector’, even, that must be pure and controlled.

The intention of this chapter is to attempt to counteract this individualist and positivist view, by exploring the relational dimensions of mindfulness that underlie the activities of teaching and learning it, and in the process to identify and define practical theories and skills for teachers that are valuable across the range of mindfulness-based approaches delivered in groups, as well as in more tailored applications for individuals. These theories and skills will offer answers to essential questions: Who is it that can engage in the use of mindfulness in clinical work with patients, that is, who are we as teachers? How do we understand the rich, non-verbal experience of being together with participants in the classroom or consulting room? How do we know that what we are doing is ‘working’? And what do we do when it is not? As answers to these questions unfold, we will also consider the nature of teacher training, a context for pedagogical theory and practice, a non-foundational ethical stance for clinicians when using mindfulness and an aesthetics of the pedagogy.

All of these explorations will start from the relational dimensions of mindfulness, which is newer theoretical territory in the development of the use of mindfulness in clinician-patient settings. What follows, then, relies on language and descriptions that are mostly different from the more established discourses within the medical, scientific and Western Buddhist communities. It is hoped that this more neutral language will have the dual effect of allowing new descriptions of the space in which teachers and participants practice the pedagogy to come to the foreground while allowing the unresolved tensions between clinical and Western Buddhist framings of mindfulness (e.g. Lindahl, 2015; Monteiro, Musten, & Compton, 2015; Purser, 2015; Van Gordon et al., 2015; Williams & Kabat-Zinn, 2011, 2013) to recede into the background.

Perhaps, for the reader, the most pressing questions are about the person of the teacher—who am I and what do I do? Yet, to best answer those questions, it is necessary to consider another set of questions—how do we understand the experience of being mindful together? It is the context that defines the teacher, not the other way around, as the following section will describe.

Context First: It All Starts With Relationship

In considering the pedagogy of the mindfulness-based interventions, my colleagues and I (McCown & Reibel, 2009; McCown et al., 2010; McCown, 2013, 2014) have adopted a social constructionist view (e.g. Gergen, 2009, 2015), in which relationship defines who we are and what we do in any situation. This approach defines the activities of teaching and learning mindfulness as an ongoing co-creation, involving and affecting all participants. Each instance of co-creation is unique, arising in the moment, and therefore unrepeatable. These characteristics may begin to suggest the challenges to the teacher, as well as the broad margins for engagement and even pleasure.

Confluence

A clear evocation of co-creation comes in Gergen’s (2009) description of confluence . In the dominant discourse of individualism, participants in a class or dyad are seen as autonomous individuals first, bound up in their chosen identities and only (perhaps even grudgingly) accountable to others. In opposition to that discourse, the concept of confluence sees participants as relational beings first, with identities shaped in each instant by the unfolding of the shared activities.Footnote 1 For example, in an MBI class, when the curriculum calls for learning sitting meditation, the participants mutually define meditators who sit quietly and a teacher who ‘guides’ with their voice. Participants know what to do (who they are) in that moment. Then, when the confluence that is formal meditation practice ends, the meditators are redefined as dyad partners that speak aloud to each other. A further change in action, as a plenary dialogue takes form, defines students who speak and listen and a teacher who listens and offers answers or inquires into the student’s experience in the moment. These shifting ways of being are not seen as forced on participants from outside nor are they compelled by inner pressures to act as they do. What happens next in the class is moderated by the relationships throughout the confluence.

Confluence is a philosophical concept, but not as speculative as one might think. With this concept in mind, we can turn to a description, if not an explanation, that makes use of our emerging physiological and neurophysiological understanding of mindfulness.

A Scientific Description

Nearly 30 years after the first study of mindfulness as defined within MBSR, Imel, Baldwin, Bonus and MacCoon (2008) pushed against the dominant discourse and looked at the effect of the relationships in the group on participants’ outcomes. With data from 60 groups—about 600 participants—they applied multi-level statistical modelling to calculate the group effect on the differences in symptom change from pre- to post-intervention while factoring out any teacher effects and adjusting for pre-intervention symptom severity. The effect of the group, they reported, accounts for 7 % of variability in outcomes—a significantly large number. To give perspective, the most significant predictor of outcomes in psychotherapy, the client-therapist alliance, accounts for only about 5 % of variability in outcomes (Horvath & Bedi, 2002).

Such power in being together has always been obvious to MBI teachers, who often hear in last-class reflections how strongly the participants value the sense of support of the class, how much easier they find it to practice with others and how ‘close’ they feel to people with whom they’ve spent precious little time—and whose names they may not even know.

The scientific explanation for this closeness starts with the mirror neurons in our brains that allow us literally to feel in our bodies the movements and even the intentions of those who are with us (Gallese, Fadiga, Fogassi, & Rizzolatti, 1996; Gallese & Goldman, 1998). It may be that a ‘resonance circuit’ (Siegel, 2007) brings us together. It runs like this (Carr, Iacoboni, Dubeau, Mazziotta, & Lenzi, 2003): We become aware of an action or expression in another (it may not even be seen but might be heard or otherwise sensed), which is ‘tried on’ by the mirror neuron system. Next, the superior temporal cortex predicts how that will feel to us. Then, that information goes through the insula to the limbic system, which establishes the emotional tone and returns the information back through the insula to the prefrontal cortex for higher level interpretation—so now we know the situation.

Through this circuit, we feel what others are feeling. What’s more, we know their intentions—their next move. We attune to one another through this circuit. It is active in the bonding of infant and caregiver, of lovers, of family and further outward in social circles. As an evolutionary fact, it is active in our cooperation, our competition and even our fighting (Cozolino, 2006).

This effect of the group helps to describe the quality of a typical pedagogical situation. Yet, we must also consider the effect of the mindfulness practice on the group or dyad in teaching and learning mindfulness. Here the resonance circuit may come into play ‘intrapersonally’ as well as ‘interpersonally’, with meditators attuning to their own intentions and resonating with themselves. The most important part of the resonance circuit in the description that we are developing is the final move of activation of the prefrontal cortex to name the feeling. Activity in the prefrontal cortex reduces negative reactivity by calming the limbic system, particularly the right amygdala—the seat of fear (Creswell, Way, Eisenberger, & Lieberman, 2007; Lieberman et al., 2007).

To most fully explain the pedagogical situation of a mindfulness group or dyad, there is one move left to make: during a formal group practice, some or many of the participants may come to intrapersonal resonance, resulting in a feeling that they might label as peaceful or relaxed. That feeling is evident in their expressions and postures, even in their breathing and speaking, all of which is information available to all in the room. As the formal practice closes and participants look around, whether they are ‘peaceful’ or not, their mirror neurons react to all those who are gathered—peaceful ones included. The whole group has a chance to ‘try on’ the feeling of resonance. That, indeed, creates a unique situation. And we can explain it, in some detail, through Stephen Porges’ ‘polyvagal theory’ (2011).

Porges suggests that not only do we have subcortical reactions to awareness of threats in the environment—the fight or flight reaction to moderate threat or the freeze reaction to overwhelming threat—but we also have a subcortical reaction to awareness of safety. This reaction prepares us for social engagement. It is mediated by the myelinated vagus nerve, which enervates the heart, and the muscles of the head and neck as well. So, when our subcortical threat detection system perceives the environment as safe (as with a group of peaceful meditators), the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system response of fight or flight is suppressed, the heart rate slows and the social response possibilities of the head and neck are enhanced. That is, for better communication, the eyes open further to exchange glances, the eardrums tune to the frequency of the human voice, the muscles of the face and neck gain tone for finely shaded expressions and gestures, while the larynx and pharynx get set for articulate speech. And, for bonding, there is a release of the ‘love hormone’ oxytocin, encouraging approach and embrace.

Now, perhaps, it is possible to consider the group effect described at the outset as so potent for bringing about positive participant outcomes. In the practice of mindfulness, in a class or dyad, we co-create, again and again, an environment that feels safe. The many potentially peaceful faces, postures, voices and gestures help even those who are struggling for emotional balance to move towards social engagement behaviours. In a sense, that response moves through the group as resonance moves through a circuit, bringing openness to approach—making it more possible for the group and each participant to meet the experience of the moment (whether wanted or unwanted) in a friendly way.

Three Descriptions of the Pedagogy

We are back, at last, to consider what the relational dimension adds to teaching and learning mindfulness. What happens when we are together—in a group or dyad—may be more powerful and of more lasting effect than a pedagogy pointed towards some ideal of the individual practicing alone. The space we create together is immensely valuable. Perhaps the neurophysiological story is persuasive for you. Or you may find that other descriptions make more sense, in your experience.

To better understand the qualities of this ‘homeland’ of the teacher and to better prepare for the unique, dynamic and unrepeatable events in class or dyad, let’s walk through three different representations of the pedagogical space and process. First, we will investigate the nonconceptual, embodied ways that we respond to the ongoing flow of the moment in the group that is the background in which the pedagogy takes place. Second, we will examine the ways that we are shaped by the nonconceptual, embodied experiences of the moments of the pedagogy. Finally, we will consider how participants’ capacities for action in the moment grow, change and become potentials for the future.

1. Joint Action

John Shotter, investigating the deep processes of social construction, insists that our living bodies are spontaneously responsive to the ‘others or othernesses’ (e.g. 2012, p. 84) around us, which make up the background in which we are embedded. This background shapes us far more than we contribute to its ever-shifting shape. There is not simply our action or the other’s action, it is ‘joint action’ (1984). Shotter uses resources of the Russian literary theorist Mikhail Bakhtin to describe this as ‘dialogical’, that each in the dialogue is responsive to the other and any utterance is shaped by the prior and anticipated utterance of the other (2008). Shotter thickens this description further through the phenomenology of Maurice Merleau-Ponty, for whom dualisms such as body-mind or self-other are overlapping or ‘chiasmically intertwined’. Thus, we make sense of a situation because the living body can integrate the range of our perceptions and impulses to orient us in the present moment, with others (Shotter, 2011). Joint action is not dependent upon intentions of particular participants (or the teacher). It is, rather, the actuality of the unpredictable exchanges among them and, in fact, can be seen as inviting further actions from any and all. The situation of joint action, then, is dialogically or socially constructed and is in flux from moment to moment. The world of the participants changes with each silence, each word, each motion and each feeling. Shotter (2011) describes it:

But more than simply responding to each other in a sequential manner—that is, instead of one person first acting individually and independently of another, and then the second also by acting individually and independently of the first in his/her reply—the fact is that in such a sphere of spontaneously responsive dialogically structured activity as this, we all act jointly as a collective-we. (p. 58, emphasis added)

Of powerful significance, as we will see as each of the three representations of the pedagogical space and process unfold for us, is the part the collective-we plays in the development of new ontological possibilities. Through the shared activity of the group, Shotter (1984) notes, participants come away with new, different ways of being. Spend time sharing space and activities with musicians, and musician becomes a way of being. Spend time with brewers brewing beer, and brewing becomes a way of being. Share mindfulness practice—being within the experience of the moment in the group—and come away as one who can stay longer (perhaps!) in the present.

This is not the usual way of thinking about pedagogy. As teachers, scientists or clinicians, we are trained to take an intellectual, conceptual approach to our activities. From what is a continuous flow of events, we focus on and abstract particular parts, which become concepts that we can grasp—that we can hold on to in the flow. This allows us to both orient ourselves to general patterns and to create protocols, principles or rules to ensure repeatable responses. Further, through such a process, the conceptual becomes a world in which we live and act. This has undoubted value in certain areas of life: we can fix cars or perform heart surgery; there, we benefit from keeping the sense of continuous flow and change at bay.

In different undertakings, however, continuous flow and change may be the key. In the pedagogy of mindfulness, we are learning to be within the experience of the moment, regardless of its emotional valence for us. We learn to be with the experience of the moment by navigating it, again and again, together, as a group. As Shotter (2012) has it, ‘we turn our intellectual powers in a rather unusual, ontological rather than epistemological direction’ (p. 91). That is, we work on ‘how to get ourselves ready, so to speak, to go out to meet the events confronting us, rather than …working out how, instrumentally, to influence those events themselves’ (Shotter, 2012, p. 91). The overall experience of being a participant in a mindfulness group produces a way of being in the continuously flowing and changing world, as opposed to a conceptual understanding of navigating a mapped and defined account of a world.

2. An Omelette in a Kitchen

The anthropologist Tim Ingold (2008) insists that we do not learn by bringing knowledge from ‘outside’ to ‘inside’ us. Rather, he suggests that we ‘grow into’ knowledge within a relationship located in a specific place with specific objects. As he describes, ‘The minds of novices are not so much ‘filled up’ with the stuff of culture, as ‘tuned up’ to the particular circumstances of the environment’ (2008, p. 117). He refers to this not as learning or education but as ‘enskillment’ and provides the example of a child learning to make an omelette. There is no one right way to crack a given egg, because each egg is different. The child learns the feel for it from hands that are skilled being placed on or over theirs. What is more, this process happens in a particular kitchen, with particular bowls and pans. The knowledge is in the system, not inside the child. Ingold notes that ‘you only get an omelette from a cook-in-the-kitchen’ (2008, p. 116).

Ingold’s image of the knowledge in the system—cooking or being mindful—arises from a powerful critique of the dominant view of beings and their development. Ingold (2006) calls this dominant view the logic of inversion, in which the being’s involvement in the continually changing outside world (consider the moment in the kitchen with egg, bowl and teacher) is seen as a cognitive schema or cultural model installed inside the being that is brought out when needed. Through the logic of inversion, ‘beings originally open to the world are closed in upon themselves, sealed by an outer boundary or shell that protects their inner constitution from the traffic of interactions with their surroundings’, notes Ingold (2006, p. 11). To invert this inversion, then, is to open the being to the world again, to come to experience continual flow and change and to be within each moment, which is, in fact, the central move of the pedagogy of mindfulness. An open being, then, is unbounded, moving in the world along a line (actually many lines) of development, interweaving relationships. Such an unbounded being is tangled, enmeshed with the texture (or textile!) of the world—in the kitchen, classroom or consulting room. Knowing is not inside but all around.

3. Potentials

Gergen’s (2009) concept of confluence, as described at the outset of this section, may now have more resonance. Beings that are open may act jointly in the ‘collective-we’ that Shotter (2011, p. 58) mentions and may interweave to a thick texture in relationship with others, as Ingold (2006) suggests. A confluence and the mutually defining relationships that it comprises bestow on participants ‘potentials’ for being and acting in particular ways, according to Gergen (2009). A participant may attend to another’s way of being as a model, will surely take on a particular way of being and will come to some level of prowess in the coaction of the confluence. Such potentials are not merely cognitive; they are embodied in action, movement, gesture, posture, facial expression, gaze, vocal tone and more. They are established by familiarity, by repetition within particular confluences, and are then available as seems sensible in particular situations. Through experiences, we develop a vast store of ways of being, or multi-being, as Gergen calls it (2009). This is not problematic, as questions of coherence and integration of the many potentials bestowed by relationships do not arise within the discourse of open, unbounded beings. In multi-being, coherence and integration may be valued within specific relationships, but are not essential to some overall self. As Gergen states, ‘For the relational being there is no inside versus outside; there is only embodied action with others. Authenticity is a relational achievement of the moment’ (2009, p. 138).

The pedagogy of mindfulness, then, is a question of potentials that are bestowed within the relationships of the class or therapeutic dyad. Everyone steeps in what is co-created in the confluence. This is not simply true of the participants, clients and patients—whatever word we use—but is also true of the teacher. All of those gathered are part of the confluence, all have potentials from past relationships and all help to bestow further potentials each to each, all to all, each to all and all to each. In this exhaustive situation, it begins to make sense to explore who it is that teaches.

The Teacher: Who (and How) Are You?

If the pedagogy of mindfulness is a relational undertaking, a process by which potentials are endowed among participants, the typical assumptions about the formation and identity of mindfulness teachers for clinical applications must come under rigorous scrutiny. Education and training need to be considered from the capacity to catalyse the central move of the pedagogy, that is, of helping participants to stay within their experience of the moment, however aversive or distracting it may be. This is a subtle and intimidating job that requires tacit as well as theoretical understanding of mindfulness as relational practice. It is not enough to know the practice of meditation for oneself (although this is certainly a requirement), for one must also be skilful with the other participants. It is not enough to be deeply experienced or knowledgeable in one or more meditative or contemplative tradition (although, again, this has significant value), for mindfulness in clinical work is most often presented with secular language and under time restraints that limit contextual explanations. Likewise, it is not enough to have clinical training (although, once more, this is an important background), since the confluence works without diagnoses, therapist/patient hierarchy or instrumental therapeutic moves.

Mindfulness Training

If all of this is the case, how is a teacher to be educated and trained for the subtle and intimidating job of catalysing and maintaining the move of turning towards and being within the experience of the moment? As suggested above, training must be multidimensional while maintaining the singular focus of the pedagogy of mindfulness as the key practice. Through spending time in MBI groups and dyads as a participant, participant/observer, co-teacher and teacher, the teacher in training is endowed with the potentials found within the pedagogy. This ‘steeping’ in the practice of the pedagogy is a definition of teacher training. Certainly, teachers are also endowed with different potentials from steeping in other forms of confluence, such as professional training in a clinical discipline or meditative training in a specific tradition, and these potentials may be more or less germane to MBI pedagogy from moment to moment in a class. Ultimately, however, steeping in the MBI confluence is the most simple, direct and effective mode of teacher training. After all, the practice of the confluence is the pedagogy of mindfulness, and those potentials are constantly being endowed, refined and endowed again to the teacher and all participants.

The priority of steeping in the confluence of mindfulness pedagogy for teacher training does not decrease the importance of the teacher’s personal daily practice of mindfulness meditation and regular retreat attendance. The phrase in the MBI community appears to be ‘having your own practice’ and is a marker of existential commitment to an identity as a diligent and ethically aware MBI teacher. For example, the formal statement of ‘principles and standards’ for teaching MBSR teachers (Kabat-Zinn et al., 2012) states, ‘MBSR instructors need to have their own personal meditation practice and attend retreats in the spirit of ‘continuing education’ and the ongoing deepening of their practice and understanding’. In mindfulness-based cognitive therapy (MBCT), developed on the armature of MBSR, the explicit requirement for therapists of ‘having your own practice’ (Segal, Williams, & Teasdale, 2002, p. 83) is rooted in the developers’ failed attempts to teach without it, as well as with their positive experiences with the senior MBSR teachers at the UMASS Center for Mindfulness, whose existential commitments to mindfulness were embodied in their lives. With such a correlation of personal practice time and commitment as a teacher, it would be simple to move to ‘a more is better’ outlook. However, this has not been the case in clinical application of mindfulness, as demonstrated in an attitudinal statement from the MBSR community. ‘We have had instructors with 5 or 6 years of meditation experience who do very well in the classroom. Conversely, we have met people seeking jobs who have 20 or more years of meditation practice in their background who we did not feel at the time were capable of teaching in the classroom’ (Santorelli, 2001, p. 11–8:4).

We could begin to understand this more deeply by returning to a relational discourse, leaving behind the discourse of personal practice as individualistic and internal. Thus, the practice away from the group, so-called practice in solitude, may be reframed relationally as unfinished dialogue (McCown, 2013). The discourse of self-improvement and self-exploration shifts to ongoing practice of the turning towards and being within the emerging moment that is the central move of mindfulness pedagogy. Meditating alone is then the invocation of dialogue with one’s current and past teachers (necessarily one sided, although with a background of profundity) to maintain that central move.

Likewise, then, requirements for retreat practice may be reframed as steeping in the practice of the pedagogy of mindfulness, so that the potentials endowed are relational in origin and intent. This, of course, problematises retreats that do not use MBI or other clinical mindfulness practice modes. Steeping in alternative confluences cannot endow the same potentials as MBI-style retreats and develops teachers in divergent ways. This is acknowledged to a certain extent, for example, in MBSR training recommendations for developing teachers to attend retreats in the ‘Western Vipassana or other Buddhist mindfulness meditation traditions’ (CFM/retreat), because the experience ‘mirrors and expresses many aspects of MBSR’ (CFM/retreat). When considered in the discourse in which mindfulness is a relational accomplishment, such retreats would endow very different relational potentials versus MBSR. The secular MBI language game and the form of life in which it is instantiated—to borrow useful terms from Wittgenstein (1953)—are significantly different from those encountered in a retreat in Western Buddhism. There, the life world is tinged with more or less Buddhist language, views and actions that would need to be carefully translated for application in the secular arena of the MBIs. This is difficult work and requires significant knowledge of both sides of the translation. Thus, neither retreat practice nor meditation training through resources outside the secular, clinical mindfulness community would be ideal for endowing new teachers with the potentials that are most valuable in secular, clinical uses of mindfulness. On reflection, this may answer the riddle of Santorelli’s (2001) observation that teachers with relatively few years of meditation experience were found who notably outperformed meditators with 20 years or more of experience. The endowed potentials of the former may be traced to secular, clinical sources and, thus, more closely match the language game and form of life in which they come to be actuated. Footnote 2

Clinical Training (and Unlearning)

Because this book is focussed on mindfulness uses in mental health and addictions contexts, it might be assumed that the reader has been trained as a clinician in one of a range of possible disciplines, including psychiatry, nursing, psychology, social work and professional counselling, among others. Such an education has significant value in endowing relational potentials that may be actuated by particular situations that arise, say, in screening interviews with potential MBI participants or with participants who find themselves in great distress during MBI class sessions. In a specific area, that of codes of ethics and rules of professional conduct, a clinical education offers an irreplaceable resource, as will be described in the section on ethics further below. The background knowledge, skills and confidence offered by professional education cannot be gainsaid, yet much of what is required in the application of mindfulness in clinician-patient settings is new and contradictory and often requires of clinicians a process of ‘unlearning’. This section will consider the three areas where unlearning may be necessary, and the section to follow will present an overview of the new skills that may be endowed in the pedagogy of mindfulness.

There are three essential differences between clinical uses of mindfulness and the vast majority of other clinical interventions; they are located in three areas that are immediately problematised by both a relational approach and the application of mindfulness: (1) diagnostic practices, (2) the clinician-patient relationship and (3) the intention of practice.

1. Diagnostic Practices

Kabat-Zinn (2011) foreshadows the difference in the MBIs (and other uses of mindfulness) with the well-known statement made at the start of MBSR classes, ‘We often say that from our perspective, as long as you are breathing, there is more “right” with you than “wrong” with you, no matter what is wrong. In this process, we make every effort to treat each participant as a whole human being rather than as a patient, or a diagnosis, or someone having a problem that needs fixing’ (p. 292). When such expression of disinterest in an imposed and limiting identity is urged by the teacher, freedom and possibility are awakened in participants. Anything may happen. The next moment can be different. We need not rehearse old stories or look for patterns of continuity. Change is happening in each moment and is a resource available to all.

The release from diagnostic identities, particularly those drawn from psychiatric manuals such as the DSM 5, is not limited to the classroom; when the teacher lets go of diagnostic thinking, participants may be endowed with a potential to let go of such constructs in other contexts of their lives as well. Foucault (1995) reminds us that participants tend to subject themselves to the same ongoing scrutiny that is operative in many clinicians’ ways of relating. Once labelled ‘depressive’, for instance, a patient is under surveillance by self and others. The patient comes to feel well, but ‘It may come back!’ Those who subject themselves are never free. Foucault describes how participants take on the limits set by their diagnoses and treatments:

He who is subjected to a field of visibility and who knows it, assumes responsibility for the constraints of power; he makes them play spontaneously upon himself; it inscribes in himself the power relation in which he simultaneously plays both roles; he becomes the principle of his own subjection. (1995, pp. 202–203)

Foucault encourages us to resist such subjectification, and the MBI class or mindfulness dyad may be seen as a site of collective resistance. The confluence, then, is a counter-culture in which it is possible for participants to explore new identities and different ways of being through the central pedagogical move of turning towards and staying within the experience of the present moment.

2. Clinician-Patient Relationship

The pedagogy of mindfulness is inherently democratic. Because the teacher is part of the confluence in practice, that role is more one of catalyst (getting the process started) and steward (maintaining the central move of the pedagogy) than of director. Further, as the class (or dyad) grows in its capacity to be within experience, the urgency of catalytic and stewardship interventions diminishes. In effect, teachers are subsumed more and more in the confluence.

In moving towards such a situation, there are pitfalls for those used to thinking in other clinical modes. The language of mindfulness pedagogy is specific and crucial; the stakes are high. Kabat-Zinn (2004) notes that verbal and non-verbal communication can misdirect the class. For example, there is a tone that he names ‘idealising’, which suggests ‘I know how to do this and I’m going to teach you’. On the contrary, in competent mindfulness pedagogy, the teacher’s language, expression, gesture and posture would convey an invitation to shared exploration, emphasising the not-knowing position of mindfulness—a ‘Well, we can investigate this together and see what comes of it’. Such an approach makes the pedagogy’s central move the focus for the confluence—turning towards and being within the moment’s experience.

Another tension between typical clinical approaches and applications of mindfulness is in the teacher’s use of ‘self-disclosure’. In the confluence, the teacher’s moment-to-moment experience is as formative as any other. Shotter (1995) reminds us that the joint action of the group or dyad proceeds on a moment-by-moment basis of embodied (or practical) responsive understandings:

a structure of presumptions and expectations of a non-cognitive, gestural kind that unfolds in the ‘temporal movement’ of the speaker’s voice…The very act of saying a word in a practical circumstance is a joint action: it is open to the influences of both past and present others at the very moment of its performance, and their influences may be present in it too. (p. 66)

The co-creation of mindfulness depends upon moments of self-disclosure for all participants. The proviso here is that self-disclosure is an expression of the shared pedagogy; it is in and of the moment. The MBI teacher is inevitably transparent and self-disclosing.

3. Intention of Practice

Mindfulness pedagogy diverges—sometimes dramatically—from many established clinical approaches. Kabat-Zinn (2010) suggests the obvious gap, noting that mindfulness is not ‘just one more method or technique, akin to other familiar techniques and strategies we may find instrumental and effective in one field or another’ (p. xi). Rather, he continues, mindfulness pedagogy has ‘a way of being, of seeing, of tapping into the full dimensionality of our humanity, and this way has a critical non-instrumental essence inherent in it’ (p. xi). These statements highlight the essential credo that derives from the moment-to-moment, not-knowing position of the pedagogy: no one needs to be fixed, because no one is broken.

Even in extremis, in deep sadness or intense pain, for example, the central move of the pedagogy may be maintained. This is both useful and potentially a misdirection, depending upon the intention. A ‘staying with’ pain or sadness that is instrumental in intention, seeking a change, a way out, may, in the words of Crane and Elias (2006):

work to subvert a strong internal and external tendency to look for certain (sometimes quite fixed) kinds of improvement or resolution of difficulties. This is a tendency that can play out in therapeutic and mental health contexts in familiar and unhealthy ways for both practitioners and clients at times. (p. 32)

However, a ‘staying with’ that rests on not knowing and existential curiosity works in a different register, to provide the individual—and the group—with:

the possibility to experience a sense of “OKness” in the midst of “not OKness,” is a broader influence offered by the meditative traditions, which can inform not merely process but also potentially a different approach to content. (p. 32)

The pedagogical move of turning towards and being within experience often brings participants to a choice point. Does one allow the experience? Or does one change it if that is possible? The teacher does not decide in some calculated way what is best; rather, the participant assumes the responsibility. The quality of intention in this situation is of curiosity and fearlessness.

For clinicians who begin their MBI teaching with a history of meditation training and practice from specific spiritual traditions, adjusting to the differences inherent in the pedagogy of mindfulness may be challenging. For clinicians without such histories, the pedagogy of the MBIs may become home ground. In fact, becoming a teacher may even call into question their identity as a ‘clinician’. There is a possibility that steeping in mindfulness pedagogy could potentiate a shift of paradigm away from conventional diagnostic theory and hierarchical practice in medicine (e.g. Sauer, Lynch, Walach, & Kohls, 2011) and mental health care (e.g. Grossman, 2010). As a start, we might point to the choice that UK training programmes for MBSR and MBCT (Crane et al., 2010) have made to use the term ‘teacher’ rather than ‘therapist’ for those trained. The mindfulness pedagogue may be seen as a clinician working at the extreme edges of the clinical paradigm—or, perhaps, beyond the edges. As such, pedagogues apply a unique set of skills, which are worth profiling .

The Teacher’s Skills: Stewardship, Guidance and Inquiry

As my colleagues and I found in trying to identify and categorise the skills of the teacher (McCown et al., 2010), even with an almost elemental scheme of four, it is difficult to divide the skills, as each includes the other three to some extent. For example, stewardship of the group requires not simply concrete actions but also language choices that help to catalyse the co-creation of the pedagogy of mindfulness. The teacher may use figures of speech and rhetorical turns that they bring or extract from the conversation in the confluence. This connects stewardship closely to the language-centred skills of guidance and homiletics. Further, the skill dubbed inquiry generates language, gesture and other non-verbal expressions in the moment in the class, and these, in turn, shape guidance and homiletics and ultimately stewardship. The four skill sets belong ultimately to the confluence—yet they start with the teacher. Let us consider them in a logical order for their interrelationship.

Stewardship

The word itself comes from sty-ward, the Old English term for the one who guards the meeting hall. The word denotes the action of the person and connotes the humility of the service. This is evident to those who teach, as we are often left to take down tables and set up chairs in a repurposed clinical space, making a circle and ensuring what comfort we can. That circle is emblematic of the stewardship skill set. The circle creates an outside, upon which the world beyond the group may act; likewise the circle has an inside, which belongs to the group, the confluence, and eschews hierarchy in the way of King Arthur’s Round Table.

Stewardship skills are applied on both sides of the circle. The outside skills are mainly concrete—recruiting, organising, finding a meeting space and tending the space before and after the session. The inside skills are those of maintaining the central move of the pedagogy of turning towards and being within the experience of the moment.

Outside Skills

These are skills of the working as well as possible with a world that may not understand or be concerned with mindfulness meditation. Worldliness, compromise, business acumen, may come into play. Depending on the teacher’s situation, demands may include entrepreneurial skills of setting up a programme, finding a setting and space. Even marketing, public relations and advertising may need to be accessed. How might it be possible for the teacher to accomplish these tasks while maintaining a mindful balance? This part of stewardship may be more challenging than it at first appears.

Recruiting and screening are perhaps the most important stewardship skills. The question is not so much who is appropriate for the group as it is who may be inappropriate. Screening out those who have a potential to be disruptive is mostly unseen by participants, yet it is essential for their safety, comfort and possibilities for transformation. Well-honed clinical skills are an advantage here. Exclusion of potential participants should be considered carefully, and a teacher’s honest appraisal of their own skill in maintaining the central move of the pedagogy in difficult situations is paramount.

Hayes and Feldman (2004) state the issue clearly; the judgment is of participants’ abilities to face their own negative material while suspending use of their current coping strategies to try on new possibilities. This is a tall order for anyone. The teacher must feel confident that, with help as required, this is possible. As such, a teacher’s exclusion parameters will no doubt change over time and with greater endowment of potentials will come to allow more and more inclusion.

For beginning teachers, some rules of thumb may be useful. The exclusion criteria used by the UMASS Center for Mindfulness (Santorelli, 2014) are clear and offer confidence for teachers with differing levels of clinical training. They specifically exclude folks in active addiction or in recovery less than a year and patients with suicidality, psychosis (refractory to medication), post-traumatic stress disorder, major depression, other psychiatric disorders if they interfere with group participation and social anxiety unworkable in a group environment. Exceptions are individual—if the participant is highly motivated and engaged in supportive professional treatment and agrees to the teacher communicating with the professionals and the professionals agree to act as primary care givers and first contacts in emergencies, enrolment may be considered. Other exclusion issues include language comprehension, logistical possibilities of attendance (not related to physical impairment) and scheduling issues that would result in missing three or more classes. It cannot be emphasised enough that the teacher’s intuitive feel for the participant and confidence in their skills must always be the deciding factor.

The final outside skill is that of caring for the space, literally, meaning the room and its furnishings. The room may be made as comfortable and attractive as possible, yet ‘fussiness’ about décor and overcontrol of temperature fluctuations and outside noise may ultimately become distractions and undermine the central move of the pedagogy. It is often worth making statements about obvious ‘drawbacks’ to the physical set up, noting that we practice for real life, which is seldom perfect or the way we would prefer. The message that most supports the pedagogy is that ‘we do what we can and accept what we must’. The setting of the circle of chairs or cushions marks the transition from outside to inside skills, so it will be taken up next.

Inside Skills

A circle of chairs or cushions is indeed the emblem of stewardship. The use of a circle (or some other sensitive arrangements of seating that allow participants to see and experience one another’s expressions, gestures and postures) optimises the potential for social engagement responses, as described using theories from Porges (2011) above, and thereby aids in establishing a space that supports the pedagogy of mindfulness. It is stewardship skills that begin the process and keep it going. The circle, particularly, undercuts the sense of anyone, even the teacher, having a preferred seat. All have equal potential, and all can see themselves as part of something larger. In fact, a stewardship skill is to turn participants towards each other, rather than towards the teacher, by establishing the value of the other members. This can be achieved through the use of dyads and small groups, to process experiences before dialogue in the larger group takes place. These conversations develop more fluidity in relationships around the circle—especially as participants are asked again and again to talk to someone they have not yet talked with—while also establishing that there are no experts, no right answers, yet there is wisdom to be found.

As the capacity of the group to stay with the central move of the pedagogy develops, it is often tested, by the environment, dramatic distractions or emotion or conflict within the gathering. The teacher’s skill here is simply the pedagogy of mindfulness—aiding the group in turning towards difficult experiences as they arise or letting go of attractive experiences as they pass. Take a simple example of an outside distraction that cannot be avoided, say, a series of fire engines passing with sirens in the street, the teacher can (in good voice) ask the group to ‘drop in’ to meditation and to pay attention to what is in their awareness moment to moment. When the distraction has passed, the group can engage in small group and plenary dialogues around the experience. In this way, an extraordinary experience becomes an ordinary example of mindfulness practice, and participants come away with new potentials.

If the group is tested in its dialogues by conflict, crosstalk or dominating participants, the teacher may invoke stewardship skills of a formal approach to conversation that may equalise the situation. First is to remind all that the mindfulness skill in dialogue is located in listening. Then a formal practice for dialogue could be introduced. A simplified version of the subgrouping technique from Systems-Centred Therapy (Agazarian, 1997) may be valuable, as may a basic approach to Council Circle (Zimmerman & Coyle, 1996).

In subgrouping, as part of mindfulness pedagogy, the instructions to the group are three. First, participants are asked to come to awareness of the body and to maintain that awareness throughout the process of listening and speaking. This move brings them into the moment and helps ensure that whatever is spoken is present-focussed, not rushing off into past or future. Second, one person is speaking and all are listening. The listeners are asked to attempt to make a connection between what is being said and their own present-moment experience. If this is possible, they may choose to speak of that experience—to build on what has been said. Third, then is the instruction for when the participant does not connect to what is being said. They are asked to simply hold their own truth, in quiet, listening while those who have connected explore their topic. They are also told that when one exploration is complete, they may bring in a difference, which may then be explored with others. Using this technique, slowly and without conflict, all sides of a topic may be given voice.

Council Circle again makes listening a mindfulness practice and offers opportunities for participants to be aware of their inner reactivity and the unfinished dialogues we call thinking and to be with those in quiet while others speak. The process is simple. A talking piece moves around the circle. The participant with the talking piece may speak or offer silence, while the others in the group listen. There are four basic intentions involved in the practice. When translated into the language of mindfulness pedagogy, they might be stated: (1) speaking the truth of your present-moment experience; (2) listening by being present with your whole being for what is spoken by the other; (3) expressing what is true for you, without elaborating with story or analysis; and (4) do not rehearse as the talking piece nears you—keep returning your attention to the speaker and trust that what you need to say (or not say) will come to you. This is a mindfulness practice that endows the potentials to be found in keeping one’s own counsel over time.

In both these practices, it may be noticed that participants are free to choose to be silent. This highlights what is perhaps the most important stewardship fact: participation is not easy to define. Folks may be quiet during spoken dialogues and yet be deeply engaged with their own unfinished dialogue. They may be transformed by what looks like simply sitting in the circle.

Homiletics

Another word study reveals that homiletics , at its Greek root, denotes friendly conversation and connotes dialogue in a group assembled to talk together—which is how it has come to its specific modern use referring to making sermons. Today, the word suggests much more of a sense of hierarchy than is intended in the usage here. The skill is definitely not one of sermonising, not of speaking from expertise, but rather of a curious collaborator in conversation. In the practice of the skill, the teacher, who does have information to impart, starts from the ‘text’ that the group creates in dialogue and explores and illuminates that text. As Santorelli (2014) describes it:

rather than “lecturing” to program participants, the attention and skill of the teacher should be directed towards listening to the rich, information laden insights and examples provided by program participants and then, in turn, to use as much as possible these participant-generated experiences as a starting point for “weaving” the more didactic material into the structure and fabric of each class. (p. 9)

The experiences of the participants become living texts that are available for all to appreciate and interpret. A class, in fact, is a democracy of texts, because each participant has the opportunity to be an author. This increases the sense of deep sharing. Whether or not a participant speaks, he or she is nevertheless involved with this form of study. Thus, when the teacher is required by the curriculum to deliver specific information—say, describing the stress response—the teacher attempts to solicit contributions and conversation. For example, participants might be asked to imagine a scene, such as being stuck in traffic and late for a meeting, and to respond with the body sensations, thoughts and emotions that appear. The teacher then has references to heart rate, breathing, muscle tension, anxiety, catastrophic thoughts and many more contributions with which to work.

Another literal form of text is often used skilfully in the pedagogy of mindfulness within the MBIs: poems, stories and children’s books (e.g. Baer & Krietemeyer, 2006; Segal et al., 2002). Read aloud, with mindful listening as a practice; such texts bring the group together. The wisdom of a poem or story is not the teacher’s wisdom, so the democracy of texts asserts itself. Further, the content and the ideas shared around any text are a form of wisdom that is available to all.

Guidance

Guidance is simply using language to catalyse the pedagogy of mindfulness. The forms of that language are different from teacher to teacher, yet there are considerations that would seem to be inherent in the practice. Kabat-Zinn (2004) developed a style that is replicated in many of the MBIs. It is designed to support participant’s understanding of mindfulness and is a feature of the pedagogy. He identifies four ways that language, expression, gesture and posture can undermine both understanding and practice. First, the teacher could convey ‘striving’ for things to change, as in ‘if you did this long enough, you’d be better’. Second, the teacher may be ‘idealising’, as in ‘I know how to do this and I’m going to teach you’. Third, the participant may hear an offer of ‘fixing’, implying that there is something wrong with the participant that mindfulness is meant to address. Fourth, the participant may detect ‘dualism’, assuming that there is an observed and an observer.

Guidance, then, must avoid placing these stumbling blocks in participants’ paths. Further, and this is the most salient characteristic of the MBI style, teachers’ language must reduce the resistance of participants. This is achieved by inviting the participants, rather than directing them. In a discursive analysis of a Kabat-Zinn audio recording of the body scan practice for MBSR, Mamberg, Dreeben and Salmon (2015) identified three features of language use that are of interest here. What they call ‘inclusivity’ involves the use of the first person plural in guidance, rather than second person, implying that all in the group are participating together. It sounds like ‘Now, let’s let the focus of our attention move on…’. What they call ‘process over ownership’ involves, among other tropes, the use of the definitive article, rather than first or second person possessive. That is, ‘Raising the left leg’, not ‘your left leg’, which suggests that the action is already underway and participants may join in, or not. Bringing us to the third feature, which Mamberg et al., call ‘Action without agency’. This involves the inevitability of the present participle, together with constructions that diminish rather than intensify the call for doing. It sounds something like ‘If you’re ready, just raising the left leg and perhaps noticing…’. The impression on the participant is that, come what may, these actions are taking place in the present in the room. There is a sense of joining, a sense that reflects the concept of confluence.

A less specific and therefore potentially more flexible way of considering language use comes from the work of the sociologist Richard Sennett, who, across two books, The Craftsman (2009) and Together (2012), works towards an understanding of the very real practices that humans use to foster cooperation. When craftspersons are confronted with resistance from their material or when diplomats are working with difficult relationships, both have strategies that can be applied to the situation of an MBI teacher guiding meditation. Perhaps it is possible to read Sennett’s description here as useful in encountering MBI participants:

Applying minimum force is the most effective way to work with resistance. Just as in working with a wood knot, so in a surgical procedure: the less aggressive the effort, the more sensitivity. Vesalius urged the surgeon, feeling the liver more resistant to the scalpel than surrounding tissues, to ‘stay his hand’, to probe tentatively and delicately before cutting further. In practicing music, when confronted by a sour note or a hand-shift gone wrong, the performer gets nowhere by forcing. The mistake has to be treated as an interesting fact; then the problem will eventually be unlocked. (2012, p. 210)

The concept of minimum force may be used to shape the language of guidance, and specifics will follow. As an aside, however, the concept is wonderfully applicable to a teacher’s own development: mistakes are simply interesting facts to be explored, not overcome. Sennett even notes that the use of minimum force links to mastering the tools one has—whether leaning to drive a nail, bow a cello or begin a meditation session. Reducing aggression towards oneself as teacher will shift the environment in the classroom.

In applying minimum force to dialogical or collaborative situations, such as the MBI classroom, there are three distinctive insights that Sennett (2012) offers from diplomatic practice, which deserve serious consideration as rules of thumb. First, one may refrain from insisting on one’s own ideas and take on another’s view of the situation. From whose position are we guiding? Second, one may deploy the ‘subjunctive mood’ in one’s language: the ‘what if…’ and ‘perhaps…’ way of talking that opens possibilities for dialogue—that is, as an unfinished dialogue experienced by the participant. Third is that technique known as ‘sprezzatura’, recommended by Baldassare Castiglione, in that sixteenth-century diplomat’s Book of the Courtier. Sprezzatura is a lightness of touch, a nonchalance that makes it difficult for others to find offence in what one says. In the MBI classroom, such lightness and such a sense humour are a powerful unguent. The reference is not to comedy—teachers don’t need to do ‘schtick’—but to the generation of a pleasant and informal atmosphere.

As this eschewing of comedy in favour of humour suggests, guidance is not performance. The language and expression of guidance arises within the experience of the teacher, who uses their own moment-to-moment experience of the practice they are leading to understand the environment in which the meditation is unfolding. That is, the teacher is a ‘sensor’, an instrument reading the quality of the confluence, using their embodied understanding of the practice and the group to shape their speaking in the moment. Yet it is not only the teacher’s experience that is voiced. The language, expression, gesture and posture are considered, to allow an infinite range of possibilities for participants’ subjective experiences, as well.

On a concrete level, the teacher senses and uses whatever arises in the environment, say, hallway sounds of whispered conversations or noisy groups or squeaky cart wheels—even the sounds and substance of HVAC systems can bring participants closer to their experience.

The most important of all manifestations of guidance is the specific meditations provided as audio recordings for participants to use in their ‘homework’ practice between classes. Language choices and expressive speaking must carry the entire experience. Because a practice will be listened to repeatedly, the recording needs to offer many layers of information, direction and permission to explore the new moment. In fact, permission to explore may be expanded, subtly, beyond the allowance offered in the classroom, since the home contexts from week to week, even year to year, will vary widely. A recording cannot become a document; as much as possible, it should allow the living moment to unfold, beyond any scripting or attempts to control experience.

Inquiry

As noted above, inquiry and dialogue are salient features of the MBIs: ‘It is recommended that a significant amount of time in each class be dedicated to an exploration of the participants’ experience of the formal and informal mindfulness practices and other weekly home assignments’, suggests Santorelli (2001). The reference is not to plenary dialogue sessions but rather to teacher-participant engagement that inquires into a subjective experience. What is it like for this person, right now? Bringing tacit knowledge into language in this way may offer insights not only to the participant so engaged but to all of those listening as it happens.

Inquiry is a collaboration of two parties that incorporates the confluence. The interlocutors work from a ‘not-knowing’ position that is not directed towards any fixed outcome. The process is about recognising and knowing what is happening. It is, from the teacher’s seat, an offering friendship. Stephen Batchelor (1997) describes this offering from a Western Buddhist context, parsing the participant’s experience of a skilful inquiry:

[F]riends are teachers in the sense that they are skilled in the art of learning from every situation. We do not seek perfection in these friends but rather heartfelt acceptance of human imperfection. Nor omniscience but an ironic admission of ignorance… For true friends seek not to coerce us, even gently and reasonably, into believing what we are unsure of. These friends are like midwives, who draw forth what is waiting to be born. Their task is not to make themselves indispensable but redundant. (pp. 50–51)

The friendship of inquiry is expressed not only through a willingness to accept whatever comes but also through a genuine curiosity—expressed in the open questions that characterise inquiry. ‘How was it for you?’ is a simple but ultimately unfathomable starting point. The participant may respond tentatively, and the teacher may prompt another, perhaps deeper, exploration—‘Can you say more about that?’ A process of reflection and speech may reveal new ways of encountering the world for the participant.

Inquiry is not a late-in-the course undertaking, but rather may be entered into from the start, as in this exchange during class one (McCown & Ahn, under review):

Participants around the circle introduce themselves with more or less detail about ‘What brings you here?’ And the moment comes for ‘I’m Maria, and I don’t think I can do this’.

‘What’s this’, asks the teacher.

‘This course… being quiet and meditating and stopping my thinking… I’ve never been able to manage that. My mind is racing all the time, like now. I’m always full of worries, so every time I try to stop and be quiet like I know you’re supposed to, it just gets that much louder in my head. And so I can’t sit still. At home, I’d already be up and doing something, washing dishes, doing laundry, something to distract me. That’s the only thing that works…’.

‘So Maria’, the teacher reflects, ‘That’s not what I’m seeing in the present moment. I’m seeing someone who is focused and engaged and sitting in one place’.

‘I guess’, she says.

The teacher suggests, ‘Can you put the story you’re telling on hold for a moment, and simply check in with what it’s like for you right now?’ Then, looking around the group, the teacher connects others to the inquiry, saying, ‘This is something you all can try, too. Maybe there’s a way that you can explore this idea for yourself’.

Turning back to Maria, the teacher offers potential for exploration, ‘Maybe checking in to how it is now—in this moment. Just knowing that you’re sitting here, feeling your feet on the floor, and feeling the chair holding you…. Maybe closing your eyes, if that’s comfortable…’. A long ten seconds of quiet, and then, ‘Taking a little while with it… Noticing your body and where it’s touching down’. Another longer pause, and then, ‘So how is it with you right now, Maria? In this moment, without your story?’

‘Right now, it’s not too bad… It’s OK. I know I’m still in the chair, and my mind feels less racy’, she says.

‘So, maybe the thought ‘I can never be still’ is just a thought, a part of a story that’s not true in this moment?’

Maria says, ‘I guess so’.

‘It’s a possibility’, the teacher says and turns to the rest of the group. ‘Do you see this difference Maria is noticing, between a story about what’s happening in the moment and what you can find out is happening when you pay attention?’ Hands go up around the circle. ‘That’s a way of thinking about mindfulness. It’s always available, even when your mind is racing… Thanks, Maria, for being willing to do this’.

Maybe there was no shattering revelation, yet Maria worked towards some new experiences. What’s more, the other participants engaged in their own ‘unfinished’ dialogues and noticed whatever they noticed—perhaps something important to them. Inquiry is subtle work, shared work and work that no one may own or control.

A Space to Hold Us: The Ethical Work of the Group

As my colleagues and I (McCown et al., 2010) analysed the pedagogy of the MBIs in order to write the first textbook about teaching mindfulness and as we went on to help develop curricula for training MBI teachers, we identified the key qualities of what I have come to call the ‘ethical space’ of mindfulness in clinical practice (McCown, 2013). These qualities are located in both the actions of teaching and the unspoken framing of the space by the teacher for the participants. The model I have suggested has seven key qualities, divided into two dimensions and one quality that pervades all others. It may sound like the ethical space is an abstraction, a construction of the confluence. This is not the case, however. The space of which I speak is an actual architectural volume—a place where people act together in site-specific ways. This will be evident in the description of each dimension, perhaps more in the ‘doing dimension’ than in the ‘non-doing dimension’, yet each is made concrete. A graphic depiction of the space may be helpful in orienting to the different dimensions.

The Doing Dimension

There are three qualities of action that define the work of the MBI confluence. These qualities are endowed by participation in the pedagogy of mindfulness, the ongoing attempt to turn towards and stay within the experience of the present moment.

figure a

The interweaving of the doing and non-doing dimensions is ultimately infused with the quality of friendship, which can be compared to Aristotle’s concept of perfect friendship, teleia philia

‘Corporeality’ foregrounZds the experience of the body, which participants quickly recognise as different from the typical modes of investigation in mental health interventions. Mindfulness meditation at its foundation is a practice of the body. Participants recognise that it is founded on available sensations—particularly of the breath moving in the body. This sense of the body brings the participants into intimate contact with their ongoing experience—one cannot feel sensation in the future or the past—and helps make aesthetic and affective experiences available and tolerable for participants to explore directly and through dialogue.

‘Contingency’ deconstructs these experiences, particularly of aversive affect. In the formal and informal practices of the confluence and the homework, participants track the arising and subsiding of their emotions, the feelings in their bodies and the sometimes oppressive awareness of their thoughts. Participants see how sensations continually change and pass away. They encounter and are often able to turn towards and be within distressing moments of affect. When this can be investigated, particularly through observation of the affect as body sensation, the tendency towards change becomes evident. Things may be ‘worse’ or ‘better’ in the moment, but they are constantly moving. It is that kind of experience that helps to deconstruct an emotion—what is it really?—and that opens for participants different possibilities for self-regulation. Finally, they notice the instability of the stream of thought. In such a situation, insight and meaning may arise.

‘Cosmopolitanism’ holds any new insight or meaning. The term is chosen to describe the acceptance of the meaning that arises in the moment, without a drive to abstract it, reduce it or fit it into any system or set of values. Meaning, in other words, is revealed as contingent. This is a particularly consequential quality, because mindfulness practice often opens participants to the spiritual dimension of their lives. Although empirical evidence is thin in the literature of the MBIs, a meta-analysis of controlled trials (Chiesa & Serretti, 2009) found five studies that measured aspects of spirituality and results suggesting that MBSR significantly enhances spirituality compared to inactive but not active control groups. Two studies not in the meta-analysis (Carmody, Reed, Kristeller, & Merriam, 2008; Greeson et al., 2011) also suggest significant spiritual engagement. Teachers using mindfulness with participants are witness to a great deal more of this kind of meaning-making than researchers, and cosmopolitanism is one way of allowing such meanings to unfold in the classroom.

The Non-doing Dimension

In the dimension of ‘non-doing’, it would be easy to focus on the teacher as the actor establishing the qualities. Yet, as I hope you’ve seen in our explorations of the pedagogy, that is not usually the case. In the illustration of inquiry with Maria, above, the non-doing qualities are actually inherent in and activated through actions within the confluence.

‘Non-pathologising’ refers to that defining perspective that ‘if you are breathing there is more right with you than there is wrong’. Ideally, no labels are invoked in the dialogues that are spoken aloud, and there is a possibility to allow the unfinished dialogue called thinking to be deconstructed and any pathologising self-surveillance to be undermined as well.

‘Non-hierarchical’ certainly refers to the teacher’s position of not-knowing when confronted with participants’ experiences, and it also refers beyond the teacher, to describe the group relationship in dialogue—the rule that no one needs to be fixed because no one is broken is the key. One can impose meanings on one’s own ever-changing experience, yet no one is the expert on the unfolding of the present moment. To phrase it in American vernacular speech, the teacher is as clueless as anyone else and is committed to exploring whatever experience is available ‘within’ the confluence.

‘Non-instrumental’ may be the most difficult to grasp of the qualities. The class does not practice the pedagogy of mindfulness in order to be changed or transformed in a particular way. Participants don’t practice ‘because’ or ‘in order to’ but rather as exploration of the unknown of the present moment. This does not, however, rule out transformation. In fact, transformation may be seen as the nature of the confluence. Together, participants are observing that all contingent structures of sensation, affect and thought deconstruct themselves as they unfold within the ethical space and its associated qualities. Guided by the unfolding relationships in the moment and steeping in the experiences of silence, practice, spoken and unspoken dialogue, participants may come to be endowed with new potentials—that change life in and out of the confluence.

The Character of the Confluence

Friendship is neither a dimension nor a quality; rather it is the total character of the confluence of the pedagogy of mindfulness. It is not ‘held’ by the teacher in some way; it is not a choice to be friendly. Rather, friendship is a ‘possibility of being’ arising through the practice of the pedagogy, which participants steep in and may be endowed with and carry away from the confluence. Friendship, then, may be reflected in actions in relationships of other confluences and even in relationships of unfinished dialogue—the care and compassion for self that is a strong characteristic of the MBIs (Kuyken et al., 2010) and, by extension the secular, the clinical pedagogy of mindfulness.

Ethics in the Ethical Space

The ethical space arises from the group or dyad’s practice of the pedagogy.

Gergen (2009, 2011) would say that participants are fully immersed within a first-order morality, which means the confluence has defined and may create its own goods, which become new ways of being, which Gergen has dubbed ‘potentials’, for participants. Those in a first-order morality cannot act otherwise than in accordance with those goods: the confluence, the ethical space and a first-order morality are identical. However, participants and teacher all have potentials from other first-order moralities as well—allegiances to other communities. Gergen (2009) suggests that such instability of allegiance can be problematic. However, teachers of mindfulness may also find this fact congenial; their allegiances (potentials) as psychologist, social worker, nurse or physician are available if required.

When the confluence is steeping in the pedagogy of the MBIs, the qualities of the ethical space are evident, and the teacher is a seamless part of that. However, should a participant find themselves incapable of maintaining the key move of the pedagogy, even with assistance from the teacher, that participant may enact other potentials from other first-order moralities, disturbing the confluence. In such a case, the teacher may ‘step out’ of the ethical space and align instead with the ethical code of their particular profession—potentials from another first-order morality.

It is also possible that it is the teacher that lacks the capacity to maintain the key move of the pedagogy in a particular situation or encounter. In this case, the teacher may ‘step out’ of the ethical space and actuate ethical potentials of a clinical professional identity. The character of this stepping out is different than the first, in that the impulse is to protect the teacher rather. Such reflexive self-protection does also protect the participants—offering codified control in an ambiguous situation.

Within the co-created ethical space, the participants steep in the potentials of the confluence. They grow more and more in capacity to turn towards and be within what is arising in the moment. Therefore, the less the participants or teacher ‘step out’ and interrupt that steeping, the more ‘trust’ in the practice develops within the relationships of the gathering—endowing valuable potential in all. Yet, stepping out is a live option for all, as well. There is safety in both the ethical space and within the alternative first-order moralities of the health-care professions, with well-accepted professional and legal commitments. We might say that the ethical space as first-order morality is transparent to participants and is a useful pragmatic situation for teachers.

Sublime Moments: The Aesthetic Work of the Group

Clinical work with mindfulness is different from mindfulness in education and organisational development and, particularly, from personal development and spiritual practice. There is an aesthetic experience available in clinical applications that is not easily found in the others. It can be described as a form of the sublime. Imagine a confluence that is well steeped in the central move of the pedagogy, so that the participants find it possible to approach aversive moments of experience. Imagine, as well, that one particular participant is willing to enter into dialogue—inquiry with the teacher—about an emerging experience. It might sound something like this, arising from the continuation of the introductions from a first class that appear above:

‘What brings me here is my panic disorder… Oh, my name is Jessica… sorry’, says a young woman. ‘My therapist thinks that this course can help me not react so big and fast. I start to get anxious, and I don’t like the feelings I get… they scare me… and so I need to take something, or call my Mom or my boyfriend, before I end up in a panic’.

‘That doesn’t sound like the easiest way to be’, the teacher ventures.

‘It’s tiring… for everyone’, she says.

‘How is it with you right now?’ the teacher asks. ‘Is there anxiety here?’

‘Yeah, a bit’.

‘Would you be willing to explore it, just a little, in a mindful way? Maybe there’s a way to be with it that’s different than what you’ve been doing. You’re in charge, so you can stop any time, OK?’ (The teacher has been very much reading the person and the opportunity in the group in the moment, before making this attempt to engage.)

‘OK’, says Jessica.

To the group, the teacher says, ‘While Jessica and I explore her experience, maybe you can find a way— not to watch, exactly, yet to be connected to your own experience. I suspect that quite a few of you may be interested in ways to be with anxiety. Yes?’ Hands sprout around the circle. Jessica looks around, maybe settling a little more in her chair.

‘So, Jessica, are you still noticing some anxiety?’ the teacher asks.

‘Some, yeah’, she says quietly.

The teacher asks, also quietly, ‘If you bring attention to your body right now, can you feel where that anxiety is showing up? Just take your time and feel into it…’.

Quickly she answers, ‘In my back. That’s where it’s been a lot recently. It sort of moves around…’.

From the teacher, ‘Can you bring your attention there? And see what you find out about that feeling?’

‘That’s scary, but I’ll try’. A longish pause. ‘OK, I am… I’m paying attention’.

‘And what is the feeling like?’

‘It’s like, constricted… tight’.

‘Do you know anything more? Like how big the area is, or, maybe, what shape it is…’. And the teacher waits quietly, with a curious and patient expression and attitude.

With her thumbs and forefingers Jessica makes a long, horizontal oval. ‘It’s a rectangle, about this big, in the centre of my back. It’s really tight’.

‘OK’, says the teacher. ‘You’re right there with it… I wonder if you can find a way to give it a little room, to open some space around it? Maybe you can use your breath to soften around it…’. She looks puzzled, and the teacher elaborates. ‘Can your breath go to that part of your back when you breathe in? Do you know what I mean?’

‘I think so… Yeah’

‘So when you breathe in, letting some space open up around that rectangle…and when you breathe out, letting it stay soft…’. Jessica, the teacher and the participants in the space breathe in the quiet for thirty seconds—a long time. The teacher asks, ‘What more do you know about that spot now? Anything?’

‘It’s gotten smaller’, Jessica replies. ‘Much smaller… It’s like the size of my finger, now’.

‘So it changed… You gave it space and it stopped taking up so much space in you. OK. Maybe you want to keep in touch with it, keep breathing and softening’, the teacher says to Jessica. Then to the whole group, ‘That’s sometimes what happens. It’s not a guarantee of a particular outcome not a technique to get rid of something. Jessica was just paying attention to what was there, opening space for it to be, and for herself to see what it was. The willingness to be with… and to pay attention to her experience is the important thing here. Her courage in showing up for it… that’s what matters’.

This was not an easy dialogue for Jessica. Nor was it easy for the other members of the class to have their own incomplete dialogues as they watched and listened. This was not so much an encounter of teacher and participant as it was an encounter of the class with an affective charge—the question of turning towards and being within one’s own anxiety. This was an initial steeping in the deeply human, seriously committed, way of being that it is possible to experience in a mindfulness-based group or therapeutic dyad. One potential description of such experiences is of the sublime.

The term is borrowed from aesthetics and rendered with particular connotations for mindfulness pedagogy. A detailed discussion of the history of the many uses and interpretations of the sublime is far beyond the scope of this chapter (e.g. Shaw, 2006). However, Burke’s (1759/1999) view of the sublime and its activities on the person offers a historically influential and useful discussion. His attempt at definition makes ‘terror’ a central idea. It might be found in overwhelming natural phenomena, such as storms at sea or ascents of mountains. The inexpressibility of such views and experiences takes them beyond the rational and carries one, as observer, beyond oneself. The ego is diminished, the ‘I’, is reduced, and one is more open to the experience. In mindfulness pedagogy, the term sublime may be used to point to those moments when participants confront more of the fullness and contingency of human existence—the possibilities of death and madness, to name the extremes—than is typical for in a classroom. In the scene above, the affect for many may have been strong and may have opened them to Jessica’s and their own experience of anxiety. Along with this opening may arise, as well, a contradictory or paradoxical sense of pleasure, which, Burke suggests, is possible when there is space for observation. The ability to observe that which imbues a sense of terror is not merely a requirement for experience of the sublime; it is also the central move of the pedagogy of mindfulness—the turning towards and being within the experience. Mindfulness, then, makes the experience of the sublime possible for the participants of a class or dyad.

The sublime has particular value for the teacher in the MBIs or other modes of mindfulness application; when it is part of the experience of a session, it may be assumed that the pedagogy is ‘working’ and that participants are steeping—being endowed with potentials for living in more profound and authentic ways.

The experience of the sublime is in contrast to the beautiful, as Burke (1759/1999) notes. Shaw (2006) quotes Burke pithily that:

Where the sublime ‘dwells on large objects, and terrible’ and is linked to the intense sensations of terror, pain, and awe, the focus of the beautiful, by contrast, is on ‘small ones, and pleasing’ and appeals mainly to the domestic affections, to love, tenderness, and pity. Crucially, with the sublime ‘we submit to what we admire’, whereas with the beautiful ‘we love what submits to us. (p. 57)

The beautiful is what brings us closer together through our agreement on the pleasure of an experience; the sublime does bring us together but through terror—as if the participants all faced a fearful prospect together. Continual experience of the beautiful, not interspersed with the sublime, therefore, may be considered as a measure of the weakness of a mindfulness group or dyad. When the currency, so to speak, of the experiences of the participants is restricted to the beautiful, the steeping, the development of potentials is likewise restricted. We might use the sublime-beautiful distinction to distinguish the effective use of mindfulness in clinical practice from other applications. The clinical uses are different because they are sublime. In other uses, such as in business, organisations or education, where, for many reasons, the default is to the pleasure of togetherness and shared taste, the beautiful dominates, and the capacity for endowing new potentials is in consequence reduced.

Conclusion: Continuous Development

When mindfulness is seen as a relational achievement, the considerations for using mindfulness in clinician-patient settings become clear: the pedagogy is the practice, and the practice has no end. Together, whether in a group or a therapeutic dyad, patients and clinicians (or, better, participants and teachers) co-create a space in which it is possible for all to turn towards and be within their experience of the moment. The space is living and responsive, with a neurophysiological background that may create a safety that resonates throughout the group and allows deep social engagement (Porges, 2011). Participants and teachers are able to steep in that atmosphere, that space, and as a result are endowed with potential ways of being that comprise mindfulness, ways that they may bring to old, new and different situations in their lives.

There is a balance and reciprocity in the pedagogy and the formation of teachers in clinical mindfulness applications, particularly the MBIs. Just as participants are changed and shaped through the availability of new potentials, so too are teachers developed by being in the classroom, and that development has no end. The skills of caring for the group and its space, of speaking in ways that reinforce the practice of the pedagogy, of guiding formal meditation practice and of inquiring into participants’ moment-to-moment experience become, once a teacher has been introduced to them, self-reinforcing. That is, the skills assist the co-creation of the space in which participants and teacher simply ‘are’ together: ‘being is relational’.

When all are engaged in the pedagogy, learning to turn towards and be within each moment of experience, it is likely that the qualities of the ethical space arise. Participants connect more closely to bodily experiences, which helps to deconstruct emotions as feelings. They are continually expecting and tracking change, as they learn to live in contingency. Further, they are making their own meaning from their experiences, rather than having meanings imposed on them. And it is the non-doing in the pedagogy that helps the environment as well. There is little interest in people’s diagnoses from the teacher or other participants, which allows participants to distance the diagnoses as well and to come with beginner’s mind to the possibility of each moment. No one can be one-up on another—not even the teacher—since all are experts on their own experience. And, within the pedagogy, mindfulness practice does not aim to cause or create anything; rather, it is an expression of curiosity and courage, an openness, a willingness to turn towards and be within how it is in the moment, whether pleasurable or aversive. A space with such qualities is inherently a space where participants and teacher can be friendly towards their experience and towards others. It may be that a clear definition of the pedagogy of mindfulness is perfect friendship, teleia philia, in which the friends are together turned towards the good, rather than towards each other. The good certainly is the central move of the pedagogy—turning towards and being within each moment of experience.

The pedagogy reinforces itself: friendship deepens friendship. It also allows participants, individually and as a reflective group, to encounter that which might terrify them in any other context. Thus, the sublime becomes a measure of the transformative power of the pedagogy in a group or dyad. Touching the extremes offers that paradox of being broken open and becoming more whole, together.