Home Practice?

I want to write today about home practices.

Home practices are "homework" I give as an adjunct to therapy to make therapy more effective.

I would say "to make therapy more efficient" but efficiency is a tricky idea especially when it comes to mental health: sometimes things change fast and sometimes slowly when it comes to mind. So efficient mental health care is elusive. But effective therapy--therapy you can look back on and say, "I got something out of that!"--that peaks my interest and is something I've been studying and thinking about for a few years now.

In a nutshell, home practices are activities, exercises or guided meditations I recommend people do when not in the office with me. One premise of this is simply that one hour a week (on average) of meeting with a therapist, though helpful, is not that much time. Anything that bolsters it is a good thing. 

I've been particularly interested in meditation practices that augment therapy.

There have been a number of studies over the last 20 years that document meditation's helpfulness when working with particular mental health issues. In certain cases, such as with Mindfulness Based Stress Reduction, an eight week course that utilizes mindfulness meditations as part of a program to manage stress and promote well being, the results have been quite dramatic.

The exploration of home practices has really just begin, though. The MBSR program, as amazing as it is, only uses a small portion of the array of mindfulness practices that exist. There are a number of others out there that are also potentially helpful.

Even the realm of mindfulness meditations is restrictive: though certainly a kind of "gold standard" for mental health promoting meditations, these meditations aren't the only type of helpful meditation out there. It's worth noting that just because one particular style or category of meditation helps one person, it doesn't mean it will help another.

The application of mindfulness to every mental health problem is like taking tylenol for every kind of physical illness. Though no one would argue that tylenol isn't helpful, it's not going to help everything. Traditionally, different practices are given to different types of people based on temperament and problems. As we learn about meditation in the West and apply it to our problems and our ways of understanding, we're learning how to do this.

Along with mindfulness practices, I've also been particularly interested in compassion practices (another heavily studied grouping of Buddhist meditations), and in what I call hypnoyogic practices--yoga nidra and forms of guided imagery--for their usefulness in augmenting therapy. All three of these groups of practices are forms of practice that are part of ancient understandings of how to work with the mind. 

What I've noticed is that people who have been willing to embark on the adventure of some of these practices are finding their therapy more effective. When I've discussed these practices with other therapists, I've gotten similar reports: those who do and stick with the proper practice do get results. 

You may notice I stuck the word "proper" in there. Really, this just goes back to the tylenol metaphor: what works for one person with a particular problem won't necessarily work for another person with another type of problem. I used to think that doing any kind of meditation practice was better than doing no practice. And (and not to contradict myself entirely), there is truth to that notion.  But there definitely cases where an expert is handy. I think anything where a clinically significant mental health issue is at play is a situation where it's best to consult an expert.

Of course, personal preference (and a host of other factors) also should be noted here.

Some people, for whatever reason, do not want me to give them home practices. This is okay. Therapy on its own is also a powerful practice for working with the mind. (If it weren't, I wouldn't be in this field.) Some people also have trouble making time in their schedules or find it difficult to take the risk on these sorts of adjunctive practices. This is also understandable.

That said, meditation isn't just about sitting on a cushion. Back to my old favorite, loving kindness (metta) practices: after you know how to do it, I think metta is just (if not more effective) to do out in the world: while driving, walking, shopping at the grocery store or waiting for a bus. Give it a try. It doesn't take any extra time--you just do it while going about your day.