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Learning mindfulness : dialogue and inquiry from an action-theoretical perspective Dyer, Brenda Lee 2011

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LEARNING MINDFULNESS: DIALOGUE AND INQUIRY FROM AN ACTION-THEORETICAL PERSPECTIVE  by Brenda Lee Dyer B.A., B.Ed., The University of Western Ontario, 1982, 1993 M.A., Oxford University, 1992 MA, The University of British Columbia, 2006  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (Counselling Psychology)  THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) December 2011 ©Brenda Lee Dyer, 2011  Abstract The processes of learning mindfulness were explored in this case study by analyzing the transcripts of teacher-student interactions in the Dialogue and Inquiry periods of a MindfulnessBased Stress Reduction (MBSR) course. The following research questions guided the inquiry: What is the process of learning mindfulness through Dialogue and Inquiry of an MBSR course? How does the social learning of mindfulness in Dialogue and Inquiry construct the experience of mindfulness? The qualitative “action-project method” was used to collect and analyse the data which were comprised of class dialogues, self-confrontation interviews (video process-recall interviews) and weekly logs gathered over nine weekly sessions. The analysis of these multiperspectival data offered a comprehensive insight into the mindfulness-teacher and students‟ internal cognitive, emotional and somatic processes in learning (and teaching) mindfulness, their individual and joint goals concerning mindfulness, behavioural manifestations of mindfulness, and lastly, the social meanings of mindfulness. The action processes identified and described in the findings of this study suggest that, while the mindfulness project was the super ordinate class joint project, it was embedded in and constituted by a concurrent relationship project made up of teacher-student, student-student, and self connections. The mindfulness curriculum was to a large part embodied by the teacher, who initiated many of the actions in the dialogue in a teacher-led inquiry, drawing the students into joint sub-ordinate projects of noticing (attention), describing (language) and understanding (insight). Further, the joint projects of helping (compassion) and relating (connection), often implicit and spontaneous, informed both the mindfulness and relationship projects. The findings offered theoretical, pedagogical and clinical implications for the teaching and learning of mindfulness. The study also shifted the gaze from mindfulness as an individual cognitive phenomenon to a dynamic relational process.  ii  Preface The research reported in this study was approved by the University of British Columbia Behavioural Research Ethics Board according to certificate number H08-02364.  iii  Table of Contents Abstract ........................................................................................................................................... ii Preface............................................................................................................................................ iii Table of Contents ........................................................................................................................... iv List of Figures ................................................................................................................................ ix List of Abbreviations ...................................................................................................................... x Acknowledgements ........................................................................................................................ xi Chapter 1: Introduction ................................................................................................................... 1 Background: Understanding Mindfulness ................................................................................... 2 Gaps in Our Understanding of Mindfulness ............................................................................... 4 Purpose of this Study................................................................................................................... 8 Research Design .......................................................................................................................... 8 Chapter 2: Literature Review ........................................................................................................ 12 Conceptualizing Mindfulness .................................................................................................... 13 Definitions ............................................................................................................................. 13 Components of mindfulness .................................................................................................. 15 Attention .......................................................................................................................... 16 Acceptance ....................................................................................................................... 17 Social or interpersonal mindfulness ...................................................................................... 18 Mechanisms of Change in Mindfulness-Based Interventions ................................................... 21 Mindfulness ........................................................................................................................... 23 Acceptance ............................................................................................................................ 23 Decentering ............................................................................................................................ 24 Emotion-regulation ................................................................................................................ 26 Self-compassion..................................................................................................................... 28 Working memory................................................................................................................... 29 How Mindfulness is Learned .................................................................................................... 32 Stage models .......................................................................................................................... 32 Participant goals for learning ................................................................................................. 37 Group effects ......................................................................................................................... 38 Proposed attachment processes in learning mindfulness ....................................................... 42 The Pedagogy of Mindfulness: How Mindfulness is Taught .................................................... 47 iv  Early notions of teaching mindfulness .................................................................................. 48 What is taught in MBIs .......................................................................................................... 49 Mindfulness as a teacher/therapist characteristic .................................................................. 50 The role of dialogue and inquiry in mindfulness-based stress reduction .............................. 57 Contextual Action Theory ......................................................................................................... 61 Buddhist concepts of intentionality ....................................................................................... 63 Western concepts of intentionality ........................................................................................ 64 Action theory ......................................................................................................................... 66 Mindfulness as an action ....................................................................................................... 67 Mindfulness as a project ........................................................................................................ 69 Mindfulness as a joint action and project .............................................................................. 69 Mindfulness as a career ......................................................................................................... 70 Conclusion................................................................................................................................. 71 Chapter 3: Method ........................................................................................................................ 73 Rationale for Research Method ................................................................................................. 73 Rationale for Research Design .................................................................................................. 76 Participants ................................................................................................................................ 77 Recruitment ........................................................................................................................... 77 Description of participants..................................................................................................... 79 Data Collection .......................................................................................................................... 80 Dialogue from MBSR course ................................................................................................ 81 Self-confrontation interviews ................................................................................................ 82 Supplementary data ............................................................................................................... 84 Recording and transcription................................................................................................... 85 Data Analysis ............................................................................................................................ 85 Steps in data analysis ............................................................................................................ 87 Purpose of member-checks and collaborative coding ........................................................... 91 Researcher‟s Subjectivity .......................................................................................................... 93 Issues of Representation ............................................................................................................ 96 Ethical Considerations............................................................................................................... 97 Criteria for Evaluating the Worth of the Study ......................................................................... 97 v  Chapter 4: Findings ....................................................................................................................... 99 The Context: Life Projects of Six Participants and Teacher ................................................... 102 Ruth‟s life-projects .............................................................................................................. 103 Participants‟ life-projects of “getting rid of pain” ............................................................... 105 Seeking peace and well-being ............................................................................................. 107 Doing it right (self-improvement) ....................................................................................... 109 Enhancing relationships ....................................................................................................... 110 The Mindfulness Project ......................................................................................................... 111 The sub-ordinate joint attention project (noticing with gentle kindness) ............................ 111 Noticing what was unnoticed .......................................................................................... 113 Noticing thoughts and stories.......................................................................................... 117 Separating thoughts and feeling states ............................................................................ 118 Noticing the body............................................................................................................ 120 The sub-ordinate joint language project (describing) .......................................................... 127 Creating a new story: Shifting narratives........................................................................ 127 Language project and paying attention ........................................................................... 130 Language project and amplification of affect ................................................................. 131 Language as support for approaching experience ........................................................... 132 Language project and present-moment experience......................................................... 133 Using language to re-present a day of joint mindful silence .......................................... 137 The sub-ordinate joint insight project (understanding) ....................................................... 142 Understanding what mindfulness is ................................................................................ 143 Understanding the mind of another................................................................................. 147 Insight from the body ...................................................................................................... 149 Jointness of the insight project ........................................................................................ 152 Understanding the nature of the mind ............................................................................. 156 Understanding our stories ............................................................................................... 158 Relationship Project ................................................................................................................ 161 The subordinate joint compassion project (helping) ........................................................... 162 Self-compassion as a joint goal....................................................................................... 163 Compassion as expressed in helping action .................................................................... 168 Compassion as a spontaneous emotion ........................................................................... 171 Group regulation of participant distress .......................................................................... 171 vi  The subordinate joint connection project (relating and connecting) ................................... 175 Seeking connection through common experience .......................................................... 176 Finding connection after losing it: Rupture and repair ................................................... 178 Getting connected in D & I: From distress to calm ........................................................ 183 Spontaneous feelings of connection................................................................................ 188 Internalizing the connection with the teacher ................................................................. 189 An example of a failure of the relationship project ........................................................ 190 Chapter 5: Discussion ................................................................................................................. 193 Situating the Study .................................................................................................................. 193 Summary of the Findings ........................................................................................................ 194 Contributions to the Literature ................................................................................................ 195 Repositioning mindfulness .................................................................................................. 195 Methodological contributions. ............................................................................................. 196 Support for emerging pedagogical models of mindfulness ................................................. 199 McCown, Reibel and Micozzi (2010)............................................................................. 199 Crane (2009, 2010) ......................................................................................................... 201 Illustration of key processes in learning mindfulness ......................................................... 202 Acceptance-based change .............................................................................................. 202 Self-compassion ............................................................................................................. 203 Emotion-regulation ......................................................................................................... 204 Narrative ......................................................................................................................... 205 Conceptual understanding ............................................................................................... 208 Attachment processes...................................................................................................... 210 Attunement ................................................................................................................... 211 Mentalizing................................................................................................................... 211 Language ..................................................................................................................... 213 Theoretical Implications ......................................................................................................... 217 Clinical Implications ............................................................................................................... 219 Implications for counselling ................................................................................................ 219 Implications for teaching mindfulness ............................................................................... 222 Limitations of Study ................................................................................................................ 224 Future Research ....................................................................................................................... 227 vii  Conclusions ............................................................................................................................. 231 References ................................................................................................................................... 233 Appendix A: Advertisement for Participation ............................................................................ 250 Appendix B: Telephone Screening ............................................................................................. 251 Appendix C: Letter of Consent for Participants ......................................................................... 253 Appendix D: Demographics Form .............................................................................................. 258 Appendix E: Procedures for Taping and Interviewing ............................................................... 260 Appendix F: Summary of MBSR Course Design ....................................................................... 263 Appendix G: Weekly Questionnaire (Post-class) ....................................................................... 264 Appendix H: Template for Participant Logbooks ....................................................................... 266 Appendix I: Example of Member-check Summary of Joint Actions and Projects ..................... 268 Appendix J: Master List of Codes for Analysis .......................................................................... 271  viii  List of Figures Figure 1. Data collection from the three perspectives on the action of learning mindfulness ….80 Figure 2. Dialogue and inquiry in MBSR: Joint super-and sub-ordinate projects ……….....…100  ix  List of Abbreviations ACT DBT D&I FFMQ MAAS MBCT MBI MBSR SC  Acceptance and commitment therapy Dialectical behavior therapy Dialogue and inquiry Five-factor mindfulness questionnaire Mindful attention awareness scale Mindfulness-based cognitive therapy Mindfulness-based intervention Mindfulness-based stress reduction Self-confrontation interview  x  Acknowledgements I acknowledge and thank the members of my research committee, Dr Richard Young for his patient and wise counsel and guidance through the dissertation process, and Dr Beth Haverkamp and Dr Mark Lau for their careful, thorough questioning and discussion. I am also indebted to my research associates – my team of interviewers and coders, Celine, Kristen, Amy, Irina, Jovita and Laura, and my team of loyal friends and colleagues, particularly Dianne and Sandra, who have engaged in many fruitful and supportive discussions about my work. A special thanks also to Dave who helped me with the pragmatics of the technology of data collection. I also want to thank the two funding agencies who supported me with scholarships and grants – the Social Sciences and Humanities Research Council of Canada (SSHRC) for its Canada Graduate Scholarship, and the Mind and Life Institute for the Francisco Varela Grant. Additionally, I am grateful for the three opportunities to attend the Mind and Life Summer Research Institute as a Research Fellow, which was truly enlivening in all respects and contributed to my progress on this study. I am deeply grateful for the generosity, expertise, and love of the mindfulness teacher who participated in this study, and the student-participants who contributed so enthusiastically. The data collection was a challenging and rich journey, and joyful at times because of all the wonderful personalities of the class. Finally, I offer gratitude to my parents, sister, and many dear friends for supporting and encouraging me over the last several years.  xi  Chapter 1: Introduction In the 2000-year old Buddhist scripture, the Pali Canon, the following story is told: Ananda said to Buddha, “This is half of the spiritual life: having admirable people as friends, companions and colleagues.” Buddha answered, “Not so, Ananda. Not so. Having admirable people as friends, companions and colleagues is actually the whole of the spiritual life.” (Upaddha Sutta SN 45.2) This story may challenge our image of the Buddhist meditator as a solitary figure removed from the distractions of social interaction. Buddha goes on to explain how this community of friends will support the individual in the “noble eightfold path” of the spiritual life, “right mindfulness” – clear seeing -- being one of the eight components. The view of mindfulness as it has been held in Western psychology since the early 1970s is quite different. It has been regarded and researched as an individual attentional skill -- “the non-judgmental observation of the ongoing stream of internal and external stimuli as they arise” (Baer, 2003, p. 125) -- rather than a process embedded in a social context and bearing social meanings. Despite its historical roots in Buddhist notions of inter-subjectivity (Wallace, 2001), mindfulness has been only very recently viewed by a handful of Western researchers as a part of an interpersonal process. This nascent shift in conceptualization has implications for the construct of mindfulness itself, how it is learned, and its mechanisms of change in physical, mental and spiritual health. My curiosity in this topic was ignited by the interpersonal process of the question and answer period of a mindfulness-based cognitive therapy (MBCT) workshop I attended several years ago. At that time, what I noticed was the kind but dispassionate attitude of the facilitator, who appeared uninterested in the conceptual questions and opinions of the participant, asking instead about the participant‟s direct and present experience. Also noticeable was the initial look of confusion on the face of the participant in the midst of that interaction. Eventually, after a few minutes of dialogue, something seemed to shift, as if a knot of some kind was gently loosened, 1  and both parties appeared to settle down into a more attuned state. I wondered what their internal experience was in those moments, and I was intrigued by what might be happening in the space between them, and what that might have to do with mindfulness. Background: Understanding Mindfulness It can be said that all scientific inquiry is about systematically observing and understanding a phenomenon in some way, whether the focus is on definition, measurement, explanation, analysis, description, interpretation of lived experience, and so on. There has been a longstanding interest by Western health clinicians and researchers in understanding mindfulness and its applications to physical and mental health treatment. We can find an interest in Buddhist psychology by Western psychologists as early as William James (1890), but the specific focus on the use of mindfulness in psychotherapy does not appear in the research literature until the 1970s. Since then the primary way of understanding mindfulness has been through attempts to define and measure it and its health outcomes. The definitions of mindfulness are various and under ongoing revision (e.g. Shapiro, Carlson, Astin & Freedman, 2006; Mikulas, 2011), and there are to date at least eight self-report measures, also subject to critique and ongoing revision (e.g. Grossman, 2008). Most of the research on mindfulness in the past three decades has been outcome research showing the efficacy of mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR) and MBCT in helping to alleviate a variety of physical and mental health problems such as stress, depression, anxiety, eating disorders, chronic pain, and borderline personality disorder. This outcome research has been summarized in several reviews and meta-analyses (Baer, 2003; Bishop, 2002; Brown, Ryan & Creswell, 2007; Coelho, Canter & Ernst, 2007; Grossman, Nieman, Schmidt & Walach, 2004; Hofman, Sawyer, Witt & Oh, 2010). Despite various  2  research concerns over the decades with poor control groups and small sample sizes, moderate to good effect sizes have been reported in the meta-analyses (e.g. Hofman et al, 2010, report a moderate effect size of Hedges g = .63 for the overall sample based on 39 studies of mindfulness-based interventions and a robust effect size of Hedges g = .97 for patients with anxiety disorders). A considerable part of the initial efforts in understanding mindfulness has been demonstrating satisfactorily that the MBIs are indeed efficacious in mental and physical health treatment. However, there are questions about how the MBIs exert these positive effects, both in terms of mechanisms of change, and regarding the role of the various components of the multifaceted programs. There is mounting evidence that mindfulness increases as a result of the MBIs, and that the formal meditation practice itself contributes to both the increase in mindfulness and the outcomes. For example, Carmody and Baer (2008) found that the total number of minutes reportedly spent alone in home meditation practice was significantly related to the extent of change in mindfulness, symptoms and well-being. Kabat-Zinn and colleagues (1998) found that a brief mindfulness meditation intervention guided by audiotape (e.g. without teacher or group support) during ultraviolet light therapy increased the rate of resolution of psoriatic lesions in patients with psoriasis. Certainly the formal meditation practice itself appears to bring benefits, but we are still not sure how, and how or even if the other components of the MBIs have contributing or particular effects. Recent correlational and process research has highlighted the complexity of our growing understanding of mindfulness and how it works, for example, through mediators of self-compassion, or emotion-regulation (e.g. Baer, 2010). Lastly, most recently, the role of context has been acknowledged as a potential way to extend our scientific inquiry into the phenomenon of mindfulness. Some researchers have  3  returned to Buddhist sources to reference the rich Buddhist psychological context in which mindfulness can be understood (Grabovac, Lau & Willett, 2011; Grossman & Van Dam, 2011). Further, Shaver, Lavy, Saron and Mikulincer (2007) spoke of the Buddhist concept of the social embeddedness of mindfulness. They remind the reader that mindfulness techniques were historically taught in conjunction with the “four immeasureables” – compassion, lovingkindness, empathy and equanimity, and express concern that “American psychologists have lifted mindfulness out of this rich context … and applied it in a more individualistic, less socially connected and more ethically neutral way” (p. 266). This latter suggestion has started to run through the current literature as a subtle but repeated call for expanding our ways of both conceptualizing and researching mindfulness by positioning it within a social, historical and/or religious context. Gaps in Our Understanding of Mindfulness Thus, while researchers continue to investigate mindfulness through increasingly sophisticated outcome, measurement, and correlational designs, it may be, as is implied by Buddha's response to his disciple Ananda, as important to seek an understanding of mindfulness as a socially embedded process. Traditionally, mindfulness as a Buddhist meditation practice has been taught in a social-relational context, the so-called “sangha” (community), by a spiritual teacher, with the goals of self-liberation, compassion and wisdom1. In the modern evidencebased psychological interventions, MBSR or MBCT, mindfulness is taught in a group setting by a psychologist or health practitioner, with goals such as stress-reduction or depression relapse prevention. It seems somewhat paradoxical that something as apparently individual and private as an intrapsychic state of consciousness has been taught through deeply relational means in 1  It should be pointed out that while foundational principles may be similar across the various schools of Buddhism, there are many different doctrinal points and styles of practice. One core similarity that unites all of the Buddhist schools is the reference to the crucial importance of the sangha.  4  group settings. Dimidjian and Linehan (2003), noticing the historic precedence of group meditation practice, suggested that it may be important for future research “to address whether the group format is an essential quality of teaching mindfulness in the clinical context” (p. 169). The social and relational aspects of the experience of mindfulness in the group format of MBSR have been overlooked. More specifically, there has been almost no formal research on how mindfulness is actually taught and learned, although of course its teaching methods have evolved over thousands of years within the Buddhist contexts, and more than thirty years within the highly self-reflective and professional MBSR/CT community. The most obvious feature of the MBSR curriculum is the formal meditation practice itself and it has been assumed that this formal practice is the key vehicle for learning. Yet there is the assumption throughout the literature that mindfulness is also learned through social interactions with the mindful teacher2. For example, Segal, Williams and Teasdale (2002) proposed that “participants in MBSR programs learn about mindfulness in two ways: through their own practice and when the instructor is able to embody it in the way issues are dealt with in the class” (p. 56). Similarly, Dimidijian and Linehan (2003) said “it may be important to conceptualize and account for the possible role of therapist modeling in addition to and independent of any direct skill acquisition that mindfulness training may produce” (p. 169). The potential importance of mindfulness as a teacher or therapist characteristic can be understood within the rich research done in counselling psychology on therapist characteristics and common factors. It has been demonstrated that qualities of the counsellor such as warmth, acceptance and empathy, are potent predictors of positive counselling outcomes (e.g. Imel & Wampold, 2008; Lambert & Barley, 2002). That mindfulness may be 2  The term “teacher” rather than therapist is used in this dissertation, even though MBSR is often delivered by psychologists, psychotherapists and social workers. The word teacher is used by Kabat-Zinn and Santorelli, and conveys the nature of the teaching and learning of skills undertaken in MBSR.  5  another one of these so-called “common factors” has been made by a host of other researchers and clinicians (Crane, Kuyken, Hastings, Rothwell & Williams, 2010; Kabat-Zinn 1990, 2003, 2005; Leary & Tate, 2007; McCown, Reibel & Micozzi, 2010; Rosch, 2007) but to date has been empirically investigated in only a few studies (e.g. Grepmair et al., 2007). Investigating the experience of the interactions between a mindful teacher and the students with a view to understanding the role of teacher mindfulness in the learning process will have implications not only for pedagogical, but also counselling, contexts. Further, it is not only the influence of the mindful teacher that is of interest: what do the students bring to this venture? We actually do not have a full understanding of what exactly is learned in the manualized 8-week MBSR or MBCT group, how it is learned, and how participants integrate this learning in the context of their relationships and lives. Surprisingly little has been documented about group participants‟ lived experience of the individual, social and spiritual meanings of mindfulness as it is learned and experienced in the MBSR/CT groups. There have been only a few qualitative studies undertaken to investigate students‟ experience, and these have been focused on self-reported outcomes/benefits (e.g. Smith, Graham & Senthinathan, 2007) rather than process, or on the individual, rather than relational or social, experience (e.g. Mason & Hargreaves, 2001; Santorelli, 1992). Finally, rather than a uni-directional banking model of education, where a mindful teacher “deposits” mindfulness into the empty vessels of students, or even “models” a particular attitude which students then attempt to copy, it may be useful to inquire into the jointness of the teacher-student interaction and how mindfulness may be learned dynamically through this interaction. It may be generative to investigate the subjective experience of mindfulness as it is taught by the teacher, learned and experienced by the student, and potentially enacted in the  6  “space between” teacher and student. This investigative focus on the jointness of the teacherstudent interaction in learning mindfulness may have direct implications for practice for teachers of MBSR. Further, such an investigation may bear theory and practice implications for counselling psychology, with its long history of research attention to the importance of the therapeutic relationship and the working alliance as strong predictors of counselling outcomes (Gelso & Carter, 1985, 1994; Horvath & Bedi, 2002). One unique arena of the enactment of mindfulness interpersonally in the MBSR/CT group context is the extended question-answer period, or what is called dialogue and inquiry (D & I), between teacher and student. This is not a conceptual or content-based discussion period and neither is it a Socratic questioning of beliefs as in cognitive-behavioural therapy. Surprisingly little has been documented about this component of the MBSR and MBCT programs. McCown and Reibel (2009) claimed “much of the transformative effect of MBSR may be potentiated by dialogic encounters in the classroom … this activity is an extremely important and dynamic element in participants‟ experiences of MBSR that has not been adequately addressed as part of the process in MBSR research” (p. 324). We do not know much about the teacher and the participants‟ lived experience of this social interaction, the role of the relationship between the teacher and the students in the dialogue, and how the relationship relates to the learning and experience of mindfulness. Neither do we know if the dialogue and inquiry is simply talking “about” mindfulness, or is another way to experience mindfulness. How mindfulness, which is often construed as a non-conceptual state of being, is experienced and constructed through the language of the dialogue and inquiry, has not been investigated.  7  Purpose of this Study This dissertation sought to investigate, describe and understand the processes (cognitive, affective and behavioural) and meanings (purposes) of mindfulness as constituted through teacher-student dialogue in an MBSR course. By doing so, the nature of mindfulness as a social phenomenon was illuminated, in particular, how mindfulness is constructed, learned and experienced interpersonally both in the teacher-student dyads and among group members. The two main research questions guiding the inquiry were: What is the process of learning mindfulness through the dialogue and inquiry (D & I) period of the MBSR course? How does the social learning of mindfulness in the D & I period construct the experience of mindfulness? Research Design In choosing a method and research design for this investigation, I sought a method of inquiry that would be resonant with my own moderate constructivist (more specifically, social constructivist) epistemology, one which would acknowledge humans as both “constructed” and “constructing” beings, as Martin and Sugarman (1997, 2000) have described. That is, within this constructivist epistemology and ontology, humans are seen as potently constructed by language and social context but at the same time as able to construct meaning and take agentic action through their embodied intentionality. One could of course investigate the learning of mindfulness by self-report questionnaires or retrospective interviews, yet these methods seemed limited in their capacity to access the more dynamic, contextualized and intersubjective dimensions of the phenomenon of learning mindfulness. Hick (2009) expressed his doubts that conventional research methodologies could indeed capture such an experiential and elusive phenomenon. He went on to say: Perhaps mindfulness can be researched, but I imagine that it would have to make use of methods that are quite different from those commonly used in the social sciences. Such a 8  research initiative would need to proceed from an embodied, open-ended, reflective mode. Embodied mode refers to reflection that brings mind and body together. Openended reflection denotes a reflection in which one is aware that the reflection itself is a form of experience that can be done mindfully. (p. 16) This study used contextual action theory (Valach, Young, & Lynam, 2002) as its theoretical lens and the qualitative action-project method (Young, Valach, & Domene, 2005) as its method of inquiry, in an attempt to investigate mindfulness within a constructivist theory and through a method which is itself embodied and reflective. This theory and method is also resonant with the leading-edge research interest in addressing context in the investigation of mindfulness. In extant literature, it is rare to view mindfulness in its simplest terms as an action. Hayes and Shenk (2004) come closest to this as behaviourists, in their suggestion that mindfulness is a “psychological act of the whole organism, interacting in and with a context considered both historically and situationally” (p. 251). Also, from a phenomenological approach, Depraz, Varela and Vermersch (2000) referred to the gesture of mindfulness. Yet to see mindfulness as an action is both clarifying and generative. Viewed from an action theory paradigm, the action of mindfulness can be construed as being goal-directed and intentional, and as having three perspectives of manifest behaviour, internal processes and social meaning. Within action theory, mindfulness can be viewed as enacted, not as something to be pinned down, measured or defined, but as a goal-directed process which occurs and changes over time, and is both intrapsychic and interpersonal, bearing social meaning. A single case-study approach was chosen (Stake, 1995), with the case identified as a group; specifically, a group gathered to learn mindfulness. Case study research seeks to explore phenomena related to what people actually do in their day-to-day lives, with the objective to develop as full an understanding of the particular case as possible, or as Stake put it, “catch [its] particularity and complexity” (1995, p. xi). The hermeneutic movements of action project 9  method, applied to case study design, involve both a rich, meaning-focused interpretation of the case, and also the use of empathy in understanding and representing the emotional and interpersonal worlds and context of the participants of the case. Although patterns were interpretatively sought, at the same time, effort was made to represent the richness of the details of the particular lived experience of the individuals within the case of the group. To answer the two main research questions, a sub-question more specific to action-theory was articulated: What actions, projects, and careers3 do the teacher and students engage in during the D & I period over the 8-week course period, and how do these relate to the learning of mindfulness? How mindfulness is learned relationally was investigated by videotaping an 8week MBSR course and analysing the transcripts of the teacher-student interactions during the D & I periods using video-based interviews with teacher and students to inform the analysis. Using action-project method to investigate a mindfulness-based group experience was a window into student and teacher‟s internal cognitive and emotional processes in learning (and teaching) mindfulness, their individual and joint goals concerning mindfulness, behavioural manifestations of mindfulness, and lastly, the social meanings of mindfulness. In conclusion, although it has seemed important in the last several years of research to isolate the essential and nonessential components of mindfulness, attempting to put aside what Olendzki called its “cultural elaborations” (2005, p. 241) and pin down in a more or less static way its core essence, this “denaturing” of mindfulness (Grossman, 2010) has taken us only so far in our understanding. Current approaches of using self-report to understand mindfulness have been limited to viewing mindfulness as an intrapsychic experience. Yet beyond this, mindfulness as it is taught in MBSR is embedded in a rich social context, and, as an action, is dynamically 3  These terms are specific to action theory and will be defined in Chapters 2 and 3, but it is important to note that the term “career” within this theory does not necessarily involve an occupational meaning, but rather, refers to longterm, even life-long, goal-directed projects.  10  constructed in the moment, over time, in individual and joint projects and careers. Qualitative methodology such as the action-project method is an appropriate way to access people's lived experience of the learning and practice of mindfulness, and may indeed be what is needed to coax the elusive phenomenon of mindfulness into a research forum where it can be understood and appreciated in its complexity. Such a lens may challenge and develop some of the current assumptions about the nature of mindfulness and how it works. It also potentially shifts the gaze from mindfulness as an individual cognitive mechanism to a dynamic, transactional, relational process. A greater understanding of the interpersonal and socially constructed nature of mindfulness may improve the way it is taught in educational, medical, and psychotherapeutic contexts. It also adds to the recent research on the possible role of therapist mindfulness as a common factor in psychotherapy (e.g. Grepmair et al., 2007), contributing to the growing literature on the importance of the therapeutic relationship (Fulton, 2005; Lambert & Barley, 2002).  11  Chapter 2: Literature Review The current literature and understanding of the role of Dialogue and Inquiry (D & I) in the learning of mindfulness in MBSR is extremely limited. This chapter attempts to situate the small existent body of knowledge within a broad review of the literature on mindfulness relevant to the study of the social and relational aspects of the experience and learning of mindfulness. In order to build a rationale for my study, I have had to draw upon bodies of literature which are only indirectly related to the focus of my study. Hence for each subheading, I have tried to clarify the reasons for including what may seem only tangentially related. The difficulty of this undertaking only serves to underscore how overlooked the social and relational aspects of the experience of mindfulness has been, and how this study addresses an important gap in the literature. First, theoretical approaches to the construct of mindfulness itself are reviewed, including its definitions and its posited components. The construct of mindfulness has been heavily investigated but the learning of mindfulness has not. Indeed, these two things – mindfulness and the learning of mindfulness – are not unrelated if one learns mindfulness only by experiencing it. Since the construct is much-debated, the question inevitably arises as to which construct the teacher is presenting, and how this is being understood by the participants. In a sense, the history of the debate about “what mindfulness is” – as it has been constructed in religious, medical, psychological and even popular discourses such as the media – informs the context of the learning experience of the participants in the study. None of them arrives on the first day of the course without pre-understandings of what mindfulness is. Thus a brief review of the construct is important in situating not only the reader‟s but the participants‟ potential understanding of what mindfulness might be from a conceptual point of view.  12  Second, putative mechanisms of change in the mindfulness-based interventions (MBIs) such as MBSR are described, based on several key empirical studies which attempt to address how the MBIs might achieve their positive health outcomes. These studies look at what appears to change as a result of the MBIs, and the association of these changes with the measured health outcomes. Delineating the posited change mechanisms of the MBIs helps to set the complex context for the learning of mindfulness, which the writer suggests is not a discrete and finite action but rather, a pervasive and multi-faceted process which is possibly associated with the proposed mechanisms in ways we do not yet understand (e.g. overlapping with, antecedent to, or perhaps even consequential to them). Third, viewing the experience of mindfulness from the learner/client‟s perspective, various models and theories of how mindfulness is learned are presented. Next, viewing mindfulness from the teacher/therapist‟s perspective is reviewed, how mindfulness is taught explicitly and implicitly, based on both psychological and educational/pedagogical theories and research. Finally, contextual action theory is presented as the theoretical framework for this investigation. The major constructs of action theory are outlined, and the rationale for positioning mindfulness as an action and a joint project is explained. Conceptualizing Mindfulness Definitions. The English word “mindfulness” was not commonly used in psychology until after the publication of Nyanoponika Thera's The heart of Buddhist meditation in 1962 which offered for the first time a popular English translation of Pali4 scriptures about the training of mindfulness. While similar meditative practices can be found in the contemplative traditions of all world religions, mindfulness meditation as it has been incorporated in current Western 4  Pali is a Middle Indo-Aryan dialect used as the literary and liturgical language in which the scriptures of Theravada Buddhism were written down in Sri Lanka in the 1st century BCE. It is not spoken today other than in some of the liturgical chants.  13  psychological interventions has its roots in a 2500-year old tradition of Buddhist spiritual practice. The English word mindfulness has been used as a translation for at least two quite different concepts in Buddhist psychology: most commonly to refer to the Pali word sati, which connotes awareness, attention, and remembering (Bodhi, 2011; Seigel, Germer & Olendzki, 2009), and less commonly, to refer to the Pali word, vipassana, which literally means clear seeing or insight. It is these Pali concepts and the school of Theravada Buddhism from which they arise, which form the general Buddhist frameworks of MBSR and MBCT. Kabat-Zinn (2011) explained that he decided to omit specific Buddhist terminology in his development of the MBSR program and instead present the meditation practice itself in a secular fashion, in a way that would make psychological sense to Western clients, and be accepted by the Western medical community. It is interesting to note that there are examples of indigenous Asian psychotherapies, such as Morita therapy in Japan (Ishiyama, 2002; Kora & Sato, 1958), which incorporate Buddhist beliefs and terminology (such as the Japanese Zen concept of arugamama, “as-is experiencing and embracing reality” which appears to approximate the Theravadin notion of sati, bare attention) with no need to either secularize the content or translate its meaning, as in Western contexts. The translation of mindfulness, in language, theory, and practice, to Western psychological contexts, has resulted in a rich but sometimes bewildering range of interpretation of what it is. Western researchers have primarily viewed mindfulness to be an individual, intrapsychic skill or ability but have disagreed about whether it is behavioural, cognitive, perceptual or affective. According to a behaviourist view, mindfulness is an act which cannot be understood independent of contextual events (Hayes & Shenk, 2004). Others described mindfulness as a cognitive or metacognitive stance (Bishop et al., 2004; Teasdale, Segal & Williams, 1995).  14  Sternberg (2000) saw mindfulness as a cognitive style; part state and part trait. Within the cognitive conceptualization, mindfulness is seen as an attentional skill or process. In a seminal outcome study by Kabat-Zinn, Lipworth and Burney (1985) on the use of mindfulness in chronic pain management, mindfulness was defined as a “highly developed, coherent, systematic and multimodal utilization of attention” (p. 165). Brown and Ryan (2004), on the other hand, cautioned that the fact that mindfulness “can be brought to bear on thought, emotions, and other contents of consciousness means that it cannot be reduced to them,” and that, “simply put, if mindfulness involves observing thought, including thoughts about thoughts, it cannot be thought” (p. 243). According to them, the mode of operation of mindfulness is perceptual rather than cognitive. More recently, with the burgeoning interest in emotion demonstrated across psychology and other disciplines, there has been a shift from the conceptualization of mindfulness as a cognitive skill or ability to examining the impact of meditation on emotional processes, such that Goldin and Gross (2010) declared that “an emotion regulation framework may help clarify the processes that underlie MBSR … as distinct from those implicated in … cognitive-behavioural therapy” (p. 83). In other words, there is a shift to seeing mindfulness within an affectivecognitive psychological model, and as an emotion-regulation tool rather than a cognitive skill per se. Indeed, mindfulness is viewed in Buddhism as a foundation for cultivating affective balance (Wallace & Shapiro, 2006). Components of mindfulness. A much-discussed issue around the construct of mindfulness is how to differentiate implicit components of the construct from likely outcomes of having learned mindfulness. For example, is acceptance an intrinsic part of mindfulness or a result of practicing mindfulness? Brown and colleagues (2007) critiqued the available measures  15  of mindfulness on their failure to “de-confound mindfulness from both its antecedents and consequences” (p. 215.) Yet other researchers (Kabat-Zinn, 2003) emphasize the need to include the attitudinal components of mindfulness (such as friendliness or compassion) as well as attentional ones, in the construct and accompanying measures. Attention. All definitions and current measures of mindfulness include an attentional component. Several studies have investigated the mechanisms of mindfulness through the objective measurement of attention. An example is the work of Jha, Krompinger and Baime (2007), who theorized that the two stages of mindfulness meditation (concentration – paying selective attention to breath, and receptive – whole field of awareness is open to present experience) correspond to Posner's model of dorsal and ventral systems of attention (e.g. Posner & Rothbart, 1992). They then looked at differences in attentional processing, as measured by Fan, McCandliss, Sommer, Raz and Posner's (2002) Attention Network Test (ANT), between 3 groups: a control (n = 17), a beginner's mindfulness group (n = 17) and a group of adept meditators (n = 17). The beginners participated in an 8-week (3 hours a week) MBSR course (which would train mainly in concentration) while the adepts participated in an intensive fulltime one month retreat (which would train mainly in receptive awareness). All participants took the ANT and their response times were measured before the start and shortly after completion of the meditation program. The hypothesis that the first stage of mindfulness training, concentration practice, would utilize the dorsal system of attention, and be reflected in higher scores in that portion of the ANT was confirmed, as was the hypothesis that the more advanced stage of mindfulness training, receptive awareness, would utilize the ventral system of attention and be reflected appropriately in the ANT scores measuring that aspect of attention. The beginner's group (MBSR participants) improved in orienting (concentration) scores relative to the control  16  participants, as predicted, the adept group (retreat participants) differed significantly in their alerting (receptive) performance compared to the control and the MBSR participants, and also the magnitude of their scores at Time 2 was significantly higher than at Time 1. Chiesa, Calati and Serretti (2011) reviewed 23 studies on the effects of mindfulness practice on objective measures of cognitive functions such as attention, memory and executive functions. Overall, these studies observed similar results as Jha and colleagues (2007): early phases of mindfulness training are associated with significant improvements in selective attention, whereas later phases are associated with improved unfocused sustained attention. The significant correlations between mindfulness meditation and increased attentional skills are supported by neuro-imaging brain studies which show activation in pre-frontal cortical areas of the brain during and after mindfulness practice (Cahn & Polich, 2006; Ivanovsky & Malhi, 2007); and significant thickening in particular cortical regions in long-term meditation practitioners (Lazar et al., 2005), suggesting that attention, intention, and sensory perception may be implicated. Acceptance. Almost all definitions of mindfulness also include acceptance as a component. Kabat-Zinn‟s seminal working definition (1994) referred to paying attention “in a particular way,” which he has variously specified as nonjudgmental, accepting, curious, and compassionate. Brown and Ryan (2004) contested Bishop and colleagues‟ (2004) operational definition of mindfulness which has two factors, attention and acceptance. Based on their earlier validity research on a self-report measure of dispositional or trait mindfulness, the Mindful Attention Awareness Scale (MAAS; Brown & Ryan 2003), they conceptualized mindfulness as “the presence or absence of attention to, and awareness of, what is occurring in the present moment” (p. 824). Their fundamental conception of mindfulness differs significantly from that  17  of Bishop et al.‟s, in that they construed mindfulness as a trait rather than a state. Their instrument, the MAAS, assesses trait mindfulness in everyday life. An exploratory factor analysis was done on MAAS scores from a sample of 313 undergraduates. They initially found two factors of presence and acceptance, but in further validity research across several large samples, found that the acceptance factor provided no explanatory advantage over that shown by the presence factor alone. They concluded that acceptance is functionally redundant as a distinct component of mindfulness. Thus they conceptualized mindfulness as a one-dimensional construct based on attention. Interestingly, Coffey et al. (2010) found that, when investigating what mediates mindfulness and mental health outcomes in individuals with no formal mindfulness training (e.g. by measuring mindfulness as a dispositional difference), acceptance had much stronger effects on other mediating constructs such as emotion-regulation than did attention. Thus, the role of acceptance in the construct and measurement of mindfulness continues to be discussed. Social or interpersonal mindfulness. In a critical review of the limitations of current mindfulness scales, Grossman (2008) concluded that self-assessment of mindfulness using currently available instruments is problematic. He suggested that we need to return to assessing mindfulness through qualitative inquiry, both in order to develop better objective measures, and also simply in order to understand the construct itself in a more holistic, multidimensional way. In particular, he noted that the current psychological conceptualizations of mindfulness appeared to privilege cognition and attention while overlooking social or interpersonal factors: “Qualitative analysis . . . may elucidate how cognitive aspects of attention are intrinsically linked to ethical and social behaviour in Buddhist thought, a notion rather alien to Western cognitive science” (p. 407). It is this linking between individual and social aspects of mindfulness that the  18  present study endeavors to investigate. Given the lack of agreement about the construct, its definition and its measurement, it may be illuminating to look at mindfulness from a wider perspective than its individual, intrapsychic dimensions. The relatively recent idea of social or interpersonal mindfulness draws on literature from developmental psychology, attachment theory and relational dynamic therapies. Daniel Siegel (2007) is the leader in this approach, combining humanistic and developmental assumptions with new findings in neuroscience about the power of preconscious, emergent emotional states, mindfulness and the human ability to connect with others. Siegel hypothesized that mindfulness, as a self-regulatory process of focused attention, is at the same time a form of inter-personal attunement. Within the framework of attachment theory, he proposes that mindfulness and secure attachment are overlapping or even mutually constitutive processes: When we view mindful awareness as a way of cultivating the mind's awareness of itself, it seems likely that it is harnessing aspects of the original neural mechanisms for being aware of other minds. As we become aware of our own intentions and attentional focus, we may be utilizing the very circuits of the brain that first created maps of the intention and attention of others . . . We can propose that the interpersonal attunement of secure attachment between parent and child is paralleled by an intrapersonal form of attunement in mindful awareness (p. 26). This theory is supported by more traditional research into the role of attentional processes in normal development and socialization. For example, Rueda and Posner (2004) reviewed research that shows that children's ability to maintain attention, control distress and to mentalize – the socalled executive functioning of the prefrontal cortex – is a feature of healthy attachment and normal socialization. Mindfulness, as an intrapsychic attentional process thus may be implicated, as Siegel suggests, in healthy social development. This complication of the separation of intra and inter-personal processes finds familiar ground in Buddhist philosophy. Wallace (2001), in his discussion of intersubjectivity in Indo-  19  Tibetan Buddhism, explained that according to the Buddhist worldview, each person does exist as an individual, but the self does not exist as an independent ego, but rather as a “matrix of dependently related events” (p. 209). The ways in which we perceive ourselves and others are not private, but rather, public and consensual, “inextricably related to the community of language-users and thinkers with whom I share a common conceptual framework” (p. 210). Similarly, Rosch (1997) commented that “inner and outer worlds can be experienced as an interdependent co-defining whole. The self (or nonself) discovered by mindfulness meditation is not private . . . but exposed, interconnected and known” (p. 197). From this point of view, mindfulness itself, whether it is seen as a state, trait, attitude or process, is also inevitably public, consensual, and related to context. In summary, the construct of mindfulness as it has been referred to in Western psychology since the 1970s is theorized most commonly as an individual, intrapsychic cognitive or metacognitive skill. It is agreed that its main component is attention. Several researchers have added that another important component of mindfulness is an accepting, nonjudgmental attitude. Yet the construct of mindfulness is still not agreed upon. Further, there is recent interest in repositioning mindfulness as a socially embedded phenomenon (Grossman & Van Dam, 2011; Shaver, Lavy, Saron & Mikulincer, 2007), as it appears to be understood within Buddhist psychology. It is interesting to reflect on the complexity of the task of teaching mindfulness, considering the lack of agreement about what it is. To complicate these already complex understandings of the construct of mindfulness, once we turn to the way mindfulness is most often taught (and indeed, researched) in Western psychological contexts -- through the multifaceted mindfulness-based group interventions -- we can see how challenging it is to understand the nature of mindfulness as a singular phenomenon experienced individually.  20  Mechanisms of Change in Mindfulness-Based Interventions To consider the mechanisms of change in the complex MBIs is surely different than in mindfulness per se. One of the most interesting yet challenging problems of researching mindfulness as it is taught and learned through these group interventions is that so many other helpful things are also being potentially taught and learned simultaneously and interpersonally. Indeed, it is possible that the excellent outcomes of these interventions rely on the synergy among the complex components, not solely on the mindfulness learned through the formal meditation exercises. Understanding how mindfulness may be learned relationally through an MBI might indeed involve an awareness of this complex synergy and what is known about it to date in terms of the hypothesized mechanisms of change. The importance of Kabat-Zinn's work cannot be overestimated in terms of bringing mindfulness into the scientific arena, and introducing a working definition of mindfulness which is still often used today. By manualizing mindfulness in his 8-week “Mindfulness-based stress reduction” program (MBSR), Kabat-Zinn made it possible to carry out controlled and replicable outcome studies. His definition of mindfulness guided the research in the 90s: “paying attention in a particular way: on purpose, in the present moment, nonjudgmentally” (1994, p. 4). The four main mindfulness-based interventions (MBIs) that have developed – mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1982, 1990), mindfulness-based cognitive therapy (MBCT; Segal et al., 2002), acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999), and dialectical behaviour therapy (DBT; Linehan, 1993) – are all integrated, multi-modal therapies in which mindfulness is explicitly taught as a central therapeutic ingredient, but which include other cognitive, behavioural, psychoeducational and social/relational elements.  21  With the development of several self-report measures of mindfulness in the last decade, it has been possible to begin to look at how the MBIs work, the actual mechanisms through which the interventions may exert their curative effects. The following are some key studies on the mechanisms of change in the MBIs. These studies are explanatory or process research which explore the change processes in the MBIs, that is, what changes as a result of the MBI intervention, and if these potential mediators are correlated with the reported outcomes of reduced symptoms, and enhanced well-being. Recently even more fundamental questions have been posed, like if participants become more mindful or more accepting. Generally, the research suggests that learning mindfulness (defined as attention plus acceptance) leads to increases in decentering, emotion regulation, self-compassion, enhanced working memory, etc., which then mediate the positive health outcomes (Baer, 2010). That is, these skills (states, processes, etc., depending on the measure) are posited as consequences of mindfulness. What is of interest in this study is that it has been assumed that the mindfulness is learned in the formal mindfulness meditation exercises of the MBI, and the D & I has been overlooked in its potential influential role. The possibility arises that some of these proposed mediators may be promoted in the D & I, contributing to mindfulness, or even independent of mindfulness, or perhaps as mechanisms in learning mindfulness. For example, perhaps participants become more emotionally-regulated through the relational actions of the D & I, and then are able to learn mindfulness more easily, and/or be more mindful. The main mechanisms of change posited in recent research on the MBIs are described below, with the aim of providing a context of the complexity of how participants change in the MBIs. Learning mindfulness during D & I may or may not involve some of these mechanisms.  22  Mindfulness. An obvious question of whether or not mindfulness increases as a result of participating in an MBI has only been possible to answer with the development of the measures in the last decade. In a non-randomized, cohort-controlled design (Shapiro, Brown & Biegel, 2007), students were enrolled in one of three graduate courses, stress and stress management, psychological theory, and research methods. The MBSR intervention was offered as part of the Stress course (n=22), and the other two were control groups (n = 54). Pre and post-course measures included mindfulness (Mindful Attention Awareness Scale, MAAS), and six other measures of emotional well-being. Participants in the MBSR class showed significant improvement on all 7 outcomes, relative to participants in the control groups. In order to test whether pre to post change in mindfulness predicted change in any of the outcomes for the MBSR group, simple regression models were constructed. Across the seven distress and wellbeing outcomes, significant relations between change in mindfulness and change in outcome were found in four models (drop in rumination, trait anxiety, and perceived stress, and increase in self-compassion). There have been other studies which showed that mindfulness increased as a result of participating in an MBSR program: Carmody and Baer (2008) found mindfulness scores increased significantly pre- to post, in the sample of 121 MBSR participants, based on the FFMQ mindfulness scale, and Dobkin and Zhao (2011) found a significant increase in mindfulness in their sample of 83 MBSR participants, using the MAAS scale. Acceptance. Although acceptance is considered by most researchers as a part of the construct of mindfulness itself, rather than a consequence, there has been some research attempting to measure acceptance discretely as a potential mediator of change in the ACT intervention. In ACT, “psychological flexibility” implies the attitude of acceptance and is used to describe the willingness to experience unpleasant stimuli while choosing behaviours in the  23  service of desired goals and values. Hayes, Luoma, Bond, Masuda and Lillis (2006) found that increases in psychological flexibility (as measured by the Acceptance and Action Questionnaire, AAQ; Bond et al., 2009) are important mediators of the therapeutic change in ACT. While the two constructs, mindfulness and acceptance, have been separately defined and researched, there is much overlap not only in the conceptualizations, but in the methods that attempt to facilitate them. Decentering. The concept of decentering is not a new one. The term was used by Hollon and Beck (1979) in the early days of cognitive therapy to describe the way of relating to thoughts as transitory phenomena which do not necessarily reflect reality or self-worth. Deikman‟s (1982) eloquent description of the “observing self” is a psychological and spiritual expression of this position. Teasdale and colleagues (2002) referred to decentering as “metacognitive awareness,” which they see as being at the heart of the MBCT course. It appears to be synonymous with the term reperceiving which was introduced by Shapiro, Carlson, Astin and Freedman (2006), who posited it as the primary mechanism of change in MBIs. Within their triaxiomatic model that defines mindfulness as a state that involves intention, attention, and attitude, the mechanism of reperceiving allows an experience of “what is” instead of a commentary or story about what is, facilitating “a deep, penetrative non-conceptual seeing into the nature of mind and world” (Kabat-Zinn, 2003, p.146). They postulated that reperceiving may foster additional mechanisms, such as self-regulation, values clarification, and exposure that subsequently influence the outcomes of mindfulness practice. Recently, Fresco and colleagues (2007) have made it possible to study the process of decentering through their adaptation of Teasdale‟s Experiences Questionnaire (EQ, unpublished). Carmody, Baer, Lykins, and Olendzki (2009) measured mindfulness and  24  decentering in a group of 309 participants in MBSR, using the FFMQ and the EQ, pre and post intervention and found that both variables increased significantly while various measured symptoms such as anxiety significantly reduced. They found that mindfulness and decentering, as measured by the FFMQ and EQ, were very highly correlated both before and after MBSR, raising questions about how distinct these constructs are, and whether they develop simultaneously or sequentially over the 8-week period of mindfulness practice. Recent functional neuroimaging studies of MBSR have provided evidence of neural markers of decentering. For example, Farb and colleagues (2007) found reduced narrativeconceptual self-focus, and increased experiential-sensory self-focus, at post MBSR. Medial prefrontal cortical (mPFC) processes have been characterized as supporting narrative selfreferencing of identity over time, whereas viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule appear to be involved in an experiential, present-moment self-reference. In this study, participants (in a pre-MBSR waitlist group and a post-MBSR group) were asked to respond while in the scanner to reading trait-related adjectives by first reflecting on what the adjective meant about them as a person (narrative focus) and then by monitoring their moment to moment experience in response to the adjective (experiential focus). The post MBSR participants had reduced activity in the mPFC and increased recruitment of the right lateralized cortical network during the second task, and were significantly better than the untrained participants in “uncoupling” the right insula and mPFC in order to resist the automatic tendency of the narrative-generating mind. It was hypothesized that in the so-called experiential mode of self-referencing, one‟s experiences are treated as transient mental events that can be simply observed rather than integral to the self. Williams (2010) emphasized that this decentering is not the same as dissociation, but rather, is “seeing something as it is, without  25  further elaboration, for example seeing thoughts as mental events … rather than seeing them as having meaning for the integrity of the self” (p. 4). Further investigating the role of meta-awareness in mindfulness, Hargus, Crane, Barnhofer and Williams (2010) examined whether mindfulness training made a difference in the way depressed participants described a previous crisis involving suicidal thoughts and plans. They defined meta-awareness as “the ability to decenter” (p. 39). Before and after treatment in a randomized controlled trial of MBCT (vs. treatment as usual), they assessed the specificity and meta-awareness of severely depressed participant‟s verbal descriptions of their thoughts, feelings and body sensations during the time prior to their crisis. Specificity was measured by a “relapse signature specificity measure” devised by the principal researcher and rated by both him and two independent raters. The meta-awareness was measured using an adapted version of the Measure of Awareness and Coping in Autobiographical Memory (MACAM; Teasdale et al., 2002). They found that specificity decreased in the group that did not have treatment but was maintained in the treatment group, and that the MBCT group showed significantly greater meta-awareness in descriptions of crises, post-intervention, compared to the control group. To strengthen these findings, a comparable active treatment group should be used. Also, a dismantling study would be helpful since we cannot assume that the greater metawareness shown in discursive description is due solely or even at all to the formal mindfulness meditation per se. It may be an outcome of other components in the treatment, for example, the D & I component in which participants speak about their experience. Emotion-regulation. The construct of emotion regulation is under debate, but one approach emphasizes awareness and acceptance of emotion as it arises rather than controlling or reducing negative emotions (Gratz & Roemer, 2004; Thompson, 1994). This conceptualization  26  overlaps with the construct of mindfulness in its emphasis on observing and describing emotions without judgment. It is obviously related to the posited mechanism of acceptance, but particular to the acceptance of emotion. MBIs appear to promote emotion regulation. Gratz and Tull (2010) suggested that through the process of observing and describing one‟s emotions in the MBIs, clients will increase contact with emotions, increase their emotional awareness, gain a greater ability to identify, label and differentiate between emotional states, and increase their willingness to experience emotions rather than avoid them. They posited that mindfulness training may also promote the decoupling of emotions and behaviours, promoting behavioural control. By developing a measure based on an acceptance-based conceptualization of emotion regulation (DERS; Gratz & Roemer, 2004), it has been possible to examine the potential mediating role of emotion regulation in MBIs. Although few studies to date have looked at changes in emotion regulation in MBIs, there are some preliminary studies. For example, Leahey, Crowther & Irwin (2008) found improved emotion regulation as measured by the DERS in their pre-post treatment for binge eating with a ten-week mindfulness-based cognitive behavioural group. It is important to continue to examine the conceptual overlap between mindfulness, acceptance and emotion regulation. Coffey and colleagues (2010) explored the construct of mindfulness and its association with the construct of emotion regulation by doing exploratory and confirmatory factor analyses on mindfulness and emotion regulation data measured by the FFMQ and DERS in a non-clinical sample of undergraduate students. They found that the constructs to be overlapping and pointed out that the FFMQ (Baer et al., 2006) which has five-factors, and the DERS (Gratz and Roemer, 2004) which has six factors, draw upon the same theoretical model of mindfulness and emotion (Linehan,1993). For example, both constructs had factors of acceptance and awareness. They went on to query that some of the  27  factors identified in the FFMQ might be sequelae of mindfulness rather than mindfulness per se. For example, the ability to identify and label emotional experience may be consequences of present-centered attention and acceptance of one‟s experience, which as they point out is Bishop and colleagues‟ (2004) definition for mindfulness, and perhaps a maximally parsimonious definition for the construct. Self-compassion. Self-compassion appears to be closely related to mindfulness; both are fundamental concepts in Buddhist psychology. The Self-Compassion Scale (SCS, Neff, 2003) measures three components of self-compassion: treating oneself kindly (self-kindness), recognizing that suffering is part of the common human experience (common humanity), and maintaining awareness of pain rather than avoiding it (mindfulness). Neff posited that these three components of self-compassion are mutually constitutive and facilitative. Kabat-Zinn (2003) pointed out that the word for mind and heart is the same in Asian languages and that mindful attention “includes an affectionate, compassionate quality within the attending, a sense of openhearted friendly presence and interest” (p. 145). He would presumably include compassion/self-compassion within the construct of mindfulness. However, other researchers find it important to separate the central elements of mindfulness from what they perceive as the consequences of practicing mindfulness, and the potential mediators of the MBSR health outcomes (Bishop et al., 2004, Brown et al., 2007). There is evidence that MBSR training leads to increases in self-compassion (Shapiro, Astin, Bishop & Cordova 2005, Shapiro et al., 2007). These are preliminary studies and more rigorous mediation analyses need to be conducted to identify if self-compassion is a mediator of change in MBIs, and whether mindfulness and self-compassion make independent contributions  28  to better psychological outcomes such as reduced symptoms of anxiety or depression, or if they are too heavily overlapping to make this claim. Working memory. In research which takes a new (and ironically, ancient) angle on mindfulness, Jha, Stanley and Baime (2010), remind us that one of the Buddhist meanings of mindfulness, as sati, involved not only a present-moment focus but a “nonforgetfulness of the mind”: “It is striking that the historical framing of mindfulness, as the mental mode of remembering to attend to information most relevant to present-moment experience while remaining undistracted, is akin to the cognitive neuroscience construct of working memory” (p. 208). They posited that working memory capacity may be a useful functional marker of mindfulness, and argued that future research should include a focus on the relationship between mindfulness and working memory in terms of understanding the mechanisms of change in the MBIs. Most recently, Jha, Stanley, Kiyonaga, Wong and Gelfand (2010) compared the influence of an 8-week mindfulness-based course on working memory between two military cohorts, one control group (N =17) and one experimental group (N = 31) during the four month, high-stress period of pre-deployment military training. Within the experimental group, those who reported low mindfulness practice time had working memory performance degradation (as measured on the operation span working memory task; (OSPAN; Unsworth, Heitz, Schrock & Engle, 2005) while those who reported high practice time had improvements in working memory performance over time. In addition, only minimal fluctuations in affect were observed in the group reporting high practice time. The researchers concluded that “nonforgetfulness” (e.g. working memory) may be an aspect of mindfulness itself, or something that mediates mindfulness and the MBSR  29  outcomes. As is very common with outcome studies of mindfulness, there was unfortunately not an active comparison group to control for group/social effects. The complexity of processes of change in the MBIs can be observed from this brief survey. A general critique of most of these correlational studies is the reliance on self-report measures of mindfulness and the accompanying issue of demand characteristics. People may respond positively to questionnaire items because they become aware of the expected benefits through the MBSR course. It is also possible that there is a particular “mindfulness discourse” (e.g. of acceptance or compassion) which is inculcated through the course, which then is more linguistically/ conceptually understandable to participants by the end of the course as they take the post-measure. Most problematic perhaps are the disparate working definitions of mindfulness informing the test construction. Another common limitation in mediation analyses include the problem of causal sequence: it is possible, for example, that improved well-being leads to increased mindfulness rather than vice versa, or that improved emotion-regulation resulting from specific aspects of the D & I, or non-specific group effects, may lead to increased mindfulness, rather than vice versa. Lastly, a question remains concerning the highly overlapping definitions of several of these mechanisms. For example, the constructs of mindfulness, decentering, and emotion regulation all include nonjudgmental observation of experience. Most pertinent to this study are the questions remaining about whether some of these posited mediators, rather than consequences of mindfulness, are actually part of the construct of mindfulness or important as antecedent conditions for the learning of mindfulness. This is not known. Even the question about whether formal meditation practice (usually considered the crux of the MBSR program) is correlated with increased mindfulness has not been answered definitively. Dobkin and Zhao (2011) comment that “even though the literature is clear about the  30  importance of being mindful, it is not yet forthcoming with regard to what contributes to becoming more mindful in people who take the MBSR program” (p. 26). Shapiro and colleagues (2008) found that while reported amounts of sitting meditation did not predict changes in mindfulness as measured by the MAAS, participating in the MBSR program did. On the other hand, Carmody and Baer (2008), using the FFMQ, found that the total number of minutes reportedly spent in home practice was significantly related to the extent of change in mindfulness, various mental health symptoms, and well-being, supporting the assumption that individual mindfulness practice in itself (apart from group effects) has salutary effects. It may be that mindfulness is learned in a variety of ways (formally, informally, individually, socially) and in different ways by different people. When we consider the processes of teaching and learning mindfulness, these posited mechanisms of change may be involved. That is, perhaps students learn to be mindful by learning to be more self-compassionate, learning to de-center, or learning to regulate their emotions. Thus, the mediation literature has been reviewed with the aim of building a background of what is currently posited as the processes by which change occurs when people get together in a group to learn mindfulness, as in MBSR or MBCT. Which components of the multi-modal MBIs – bodyscan, sitting meditation, mindful yoga, didactic psycho-education, the D & I -- are more or less responsible for these changes remains to be investigated. The role of the D & I in supporting or enhancing these mechanisms is unknown. While greater refinement in mediation analyses, and the future use of dismantling studies, will help answer these questions, it is the purpose of this qualitative inquiry to investigate how the teacher and students‟ lived experience of these, and/or other processes operating in the D & I, may illuminate our understanding of how mindfulness is learned relationally in MBSR. In this section, the processes  31  of learning mindfulness were indirectly explored through what appears to change during and as a result of the MBSR intervention. In the subsequent section, the small literature which addresses the learning of mindfulness more directly is reviewed. How Mindfulness is Learned In comparison to the wealth of outcome research and the growing body of process (correlational) research, there is relatively sparse literature specific to how mindfulness is learned. Grossman (2011) pointed out that the learning of mindfulness is understood from the earliest Buddhist discourses as an “extremely gradual developmental process” (p. 233). He went even further to say that mindfulness “is really not a construct as we traditionally understand it in Western psychology, but at depth, a way of being” (p. 234). If we define mindfulness as a process rather than a property or state (Mikulas, 2011), it may be somewhat artificial to differentiate between mindfulness and the learning of mindfulness. It is learned as it is experienced and practiced. There have been a few qualitative studies, described below, which attempted to explore the experience of mindfulness from the learner-practitioners‟ point of view. These studies tended to conceptualize the learning process as phasic but non-linear and as involving a shift in selfconcept. The question of group effects has come up many times in the literature but there is only one study to date that attempts to explore the role of group effects, particularly group cohesion, both in the learning of mindfulness and more generally in the positive health outcomes of the MBIs. Lastly, a recent theoretical interest in mindfulness and how it is learned comes from developmental psychology and attachment theory. Stage models. Kornfield (1979) sought to analyse the “range and patterns of experience commonly noted by beginning meditators” in order to familiarize Western psychologists with  32  normal meditation experiences. Data was collected through questionnaires and the meditation teacher's records of student-teacher interviews. There were three groups of students: one group practiced mindfulness for only two weeks (n = 100), the second group for three months (n = 63) and the third group was a control group who were non-retreat students who attended weekly Buddhism classes (n = 21). Follow-up questionnaires were sent to the students after their completion of the retreat to collect data on how they perceived themselves as being changed or unchanged by the retreat. Finally, the data was compared to descriptions of progress in meditation found in traditional Buddhist texts. Although Kornfield called his research “a phenomenological study,” unfortunately there is no reference to any formal phenomenological method, so that in terms of current standards of assessing the trustworthiness of the findings (e.g. Morrow, 2005), the design has methodological limitations. However, taking into consideration the early time period and the seminal nature of his investigation, the study has merit. It is not stated how the very substantial body of data were transcribed and analysed, but Kornfield reported that 22 categories of experience were generated. He said “for simplicity, these were divided into basic categories according to sense modality”(p. 44) and then sub categories were generated. Using sense modalities as the basic categories from the beginning seems to be an obvious example of how the researcher's preconceptions about mindfulness meditation were leading the analysis (rather than letting the categories emerge from the data). There is no evidence of reflexivity on the part of the researcher. Each of the categories is supported by ample quotations from the participants‟ questionnaires and interviews, providing relatively rich description for a short article. Kornfield's conclusions convey several interesting points despite the significant methodological limitations. He noted, for example, that the outcomes of mindfulness were much  33  more than simple relaxation (e.g. as attributed by Benson, 1975) but instead included alertness and enhanced perception, and that there was a non-linear learning process over the period of three months which included periods of regression and restructuring. Most traditional Buddhist accounts are based on experienced meditators rather than beginners, so in this way, Kornfield's study offers important findings which pertain to the learning of mindfulness. During the three months, a growing equanimity and calmness in the face of extreme bodily and mental changes was self-reported and the follow-up reports included reports of long-lasting changes in openness and equanimity. These subjective reports of increased equanimity have been subsequently validated in neurological research which shows a significant “left-hemisphere shift” as a shortterm outcome of mindfulness meditation, indicating a more open “approach” response (rather than avoidance) of unpleasant stimuli (Davidson et al, 2003). Thus this early qualitative study with its in-depth reporting deserves recognition for eliciting significant data and suggesting underlying mechanisms which have been subsequently validated by more sophisticated research designs. Possibly because of the assumptions of the researcher, there is no mention of participant reports of awareness of interpersonal or social aspects of their learning process, even though the three-month retreat included regular private interviews with the teacher. There have been a few qualitative explorations of the MBSR/MBCT group process. The first one was done in 1992 by the current director of Center for Mindfulness, University of Massachusetts Medical School, Saki Santorelli, as his doctoral dissertation. He did an individual and cross- case analysis of the experience of 8 adults learning mindfulness meditation in an MBSR course. Eight participants were interviewed at the end of week 1, week 5, and week 8 (final week) and then eight weeks after completion about three topics: their subjective experience of learning meditation, the application of meditation in daily life, and the effects of MBSR on  34  their perception of self. The study examined the experience of participation within the theoretical framework of “self knowledge development theory” (Alschuler, Evans, Tamashiro, & Winstein, 1975) to understand how people at differing stages of self-knowledge experienced and used mindfulness training. The participants were administered the Experience Recall Test (ERT), a measure of self development, before the course. These were coded by an independent expert coder who determined each participant's stage of self-knowledge. The data consisted of the ERT scores, the interview transcripts, the researcher-participant's observations of participant behaviours during the class (field notes) and his personal log. Santorelli (1992) found that participants had particular experiences and struggles with the MBSR course according to their level of self-knowledge. He also found that both the formal meditation (skill development) and informal meditation (daily life) formed an interactive learning cycle which appeared important in the creation of change. He described the process as a phasic nonlinear cycle of learning involving stages of regression, restructuring and reintegration. The merits of this study include a thorough and even elegant conceptual framework and literature review. The attempt to understand the experiences of learning mindfulness through a particular theory, self knowledge development theory, was generative of a new perspective on mindfulness training. The data base was rich and the representation of participants' experiences was well supported with quotations in the individual and the cross-case analyses. Santorelli meticulously documented his methodology, describing interviewing (semi-structured), data coding, individual and cross analysis, and an assessment of trustworthiness of findings. Researcher reflexivity was accomplished through his self-reflective personal log, peer debriefing and participant feedback. How much of the findings emerged from the participants' experience and how much was driven by Santorelli's theoretical basis is debatable. The ontological assumptions of the self as separate,  35  and the privileging of individual experience, for example, guide Santorelli‟s conclusions about MBSR as a self-education model. The influence of the teacher and the group is not addressed. However, it must be said that it is one of the most rigorous of the qualitative studies done on mindfulness, and yielded interesting findings. A small grounded theory study of MBCT was undertaken (Mason & Hargreaves, 2001) to explore the “process by which MBCT may bring therapeutic benefits.” In particular, Mason and Hargreaves were interested if Teasdale's theoretical cognitive framework (Interacting Cognitive Subsystems, Teasdale & Barnard 1993), which Teasdale suggested could explain the effects of MBCT, would be borne out by participants' reports of their lived experience. The authors report their steps in data collection and analysis, following the protocols of grounded theory research of Strauss and Corbin (1990). Seven participants were interviewed in two phases. Following grounded theory analysis of the first round of interviews, the themes and questions that emerged were used to guide a second round of interviews. The codes, categories and subcategories were supported by in depth quotations from participant's interviews. The authors attempted to bracket their own cognitive orientation in psychotherapy to allow the categories to emerge into the grounded theory. In the resulting theory, the category “coming to terms” was placed at the heart of the therapeutic process of MBCT. This category involved internalizing the course skills that were taught, and applying it to their daily lives. It also involved an experience which the authors called “discovery/surprise” which they hypothesize is akin to Teasdale's notion of “meta-cognitive insight” whereby practitioners of mindfulness have the lived experience of thoughts as events rather than reality. In terms of what these findings tell us about the learning of mindfulness, it appears that for these participants, an experience of meaning-making, or “insight,” related to a  36  de-centering shift in identity, was an important aspect of their experience of the program. Further, the application of the meditation skills to daily life was an aspect of the participant‟s learning process, which was also found by Santorelli (1992) to be important in his participants‟ reported experience (described above). The authors point out as a critique of their own model that they did not incorporate the role of group support and interpersonal process adequately since they had an implicitly individualist orientation. Each of the seven participants had described group support as being important. Participant goals for learning. A qualitative study on MBCT (Smith, Graham & Senthinathan, 2007) suggested its perceived usefulness for prevention of recurring depression in older people (aged over 65) and raised questions about the goals of learning mindfulness. In this study, 30 participants in three MBCT groups were interviewed at assessment, post-course and one-year follow up. Participants were asked about their expectations and then about their actual experiences following the course. A content analysis was undertaken, identifying several themes which appear to be the various outcomes of the course, such as more acceptance, calmness, feeling more energetic, and changes in identity. The authors claimed to have used grounded theory but in fact do not describe a grounded theory design (e.g. did not aim for saturation in data, did not report using reflexivity in the analysis, do not create a theory based on the data analysis). Despite these methodological weaknesses, the data were rich and indicated significant self-reported improvements. Pertinent to the questions of the current study, Smith and colleagues (2007) noted that despite the rich information from the semi-structured interviews, there was not much light shed on how mindfulness training helps. The authors speculated that this is partly due to the inherent difficulty of conceptualizing and describing mindfulness, since, from their view, it is designed in  37  part to circumvent the verbal dominance of consciousness. Participants often said that “it was difficult to explain.” This reported difficulty may point to the limitations of retrospective selfreports in understanding the process of mindfulness, and contributes to the rationale of choosing action-project method as the method of inquiry for the current study since action-project method attempts to access the phenomenon (learning mindfulness) in a more immediate and less retrospective way. Another interesting finding of Smith and colleagues was that several participants said post-course that they had not really understood the aims of the MBCT course beforehand. The issue of the goals of mindfulness is an area that has not been addressed in research; for example, what are the hopes and goals of participants before they undertake mindfulness training, how do these compare to the goals of the teacher/therapist, and how are these negotiated over time. This collaboration may be an important part of the learning process, and was addressed in the current study. Group effects. Surprisingly there has been almost no research examining the group‟s influence on MBSR process and outcomes despite several calls in the literature to do so. McCown, Reibel and Micozzi‟s (2010) “practical guide for clinicians and educators” of MBIs presents a theoretical model of teaching mindfulness based on the experience of the authors‟ own reflective practice as MBSR teachers. They touched upon both well-established tenets of MBSR teaching and more contemporary concepts such as the potential roles of intersubjectivity, emotional resonance, and group effects in the learning process, pointing out that the “group format dominates the MBIs, yet we know very little about the importance of that format” (p. 28). They wondered if the dynamics of a mindfulness class are quite different from those of either a group therapy or adult education model and posit that the difference may lie in the teacher‟s embodiment of mindfulness which contributes to creating a “group mindfulness” based on the  38  human capacity to resonate/attune to self and others (drawing from Siegel, 2007). They suggested that, as individual participants self-regulate through mindfulness practice, there may be a simultaneous group regulation. As people in the group experience intrasubjective resonance, others may be soothed through intersubjective resonance, posited as occurring, for example, physiologically and unconsciously through the social engagement subsystem described by Porges (2001) involving the polyvagal reaction to perceived safety. They further hypothesized that the group relationship involves attachment processes of “rift and repair” (p. 111), which when held within the group container, contribute to both intra and inter-subjective regulation. Also proposed in their pedagogy is a relational construction of mindfulness: There is no true definition of mindfulness – they are all working definitions, shaped by the assumptions, aims and strategies of those at work in the moment ... Teacher and participants will hold many different working definitions throughout their time together, moving from basic shared language to highly nuanced tacit understandings coconstructed in practice and dialog. (p. 62) Many of the observations that McCown and colleagues offer as experienced MBSR teachers are what we might see as professional “common sense” hypotheses, informed by their self-reflective classroom practice and retrospective participant feedback. Their book is rich with observations that might generate future research, including their claim that teacher-student, and studentstudent, relational processes are important in the learning of mindfulness. Imel, Baldwin, Bonus and Maccoon‟s (2008) study on group effects in MBSR was the first empirical study exploring how the group format of the teaching of mindfulness may be important. After controlling for pretreatment severity, they examined change in symptom scores (in such things as anxiety and depression) from pre- to post-intervention, for 606 adults in 59 MBSR groups. All participants in the data set were taught by one of seven instructors with similar MBSR training. Multilevel models were used to examine the extent to which the groups  39  differed in the amount of self-reported change. They found that group accounted for 7% of the variability in the General Symptom Index. The results revealed no evidence of a significant teacher effect (probably due to the rigorous training required of all teachers). They concluded that it is possible that “something about the group” impacts the ability of the individual to learn and practice specific mindfulness techniques and also influences outcome through nonmindfulness pathways, e.g. expectation of change or group cohesion. The authors concluded, “MBSR does not appear to be simply an individual intervention delivered in a group setting, but rather its methods and effects occur at the individual and group levels …Group variables are not merely a statistical nuisance to be controlled in the hopes of detecting the direct effects of meditation techniques, but important treatment variables worthy of clinical attention and empirical investigation” (p. 742). Indeed, it is this “something about the group” and its relationship to the learning of mindfulness that is the focus of the qualitative inquiry of this study. A small study by Moore (2008) was innovative from the point of view of how mindfulness may or may not be learned in a group without a teacher. Moore looked at the effects on a group of first year clinical psychology students of the practice of brief mindfulness exercises, undertaken without a teacher, on three variables: perceived stress (measured by Perceived Stress Scale, (PSS14: Cohen, Kamarck & Mermelstein, 1983), mindfulness (measured by the Kentucky Inventory of Mindfulness Scale (KIMS; Baer et al., 2004), and self-compassion measured by the Neff Compassion Scale (NCS, Neff, 2003). Ten participants met for fourteen short sessions (10 minutes) but there was no teacher facilitating the group and no group discussion. Rather, a mindfulness script was read aloud by a volunteer group member. Significant increases were reported in some but not all of the subscales of the measures: in the  40  Observe subscale of the KIMS (but not Describing, Acting with awareness or Accepting without judgment), in the self-kindness subscale of the SCS (but not on subscales of self-judgment, common humanity, isolation, mindfulness or over-identification with thoughts), and none in the measures of perceived stress. These studies are quite inconclusive, particularly because of the small sample size. Based on this small study, it appeared that mindfulness as taught and experienced briefly through a written script did not effect changes typical of the other MBIs. Allen, Bromley, Kuyken and Sonnenberg (2009) used a thematic analysis to investigate 20 participants‟ subjective experience of what was helpful, meaningful and difficult about the MBCT program. They did this in order to come to a better understanding of the psychological mechanisms by which MBCT works, based on reports by participants 12 months after the end of the program. Their procedures of analysis were described thoroughly, contributing to the trustworthiness of the findings. As well, a multi-perspectival coherence check was undertaken at various stages of the analysis, which included researchers, therapists, and participants. Four overarching themes were identified: control, acceptance, relationships and struggle. Relevant to the current study was the reported importance of group support within the “acceptance” theme. Participants commented that other people in the group were like a “mirror” or “echo” (p. 420) and mentioned that they were encouraged by favourable comparisons made between themselves and others in the group. The authors observed that in the participant accounts, “the development of awareness, acceptance and behavioural change has a basis in both specific MBCT techniques, i.e. the mindfulness practice, and non-specific factors, i.e. group processes” (p. 424). They wondered if these are mutually reinforcing elements in the learning process, and recommended more research into “how these specific and non-specific factors interact in complex group interventions like MBCT” (p. 424). The inquiry into the relational processes of the dialogue  41  component of MBSR that is undertaken in the current study develops these suggestions made by Allen and colleagues. Proposed attachment processes in learning mindfulness. There is a growing interest in the possible connection between mindfulness and attachment processes. Dan Siegel, in The Mindful Brain (2007), has been most influential in building a theoretical case for this relationship. Attachment, as defined and described by Bowlby (1969/1982) and Ainsworth, Blehar, Waters and Wall (1978), is the biologically based and evolutionary system which motivates an infant to seek proximity to its caregivers and to maintain communication with them. The safety and nurturing provided to the infant goes beyond physical needs, since at the level of mind, attachment “establishes an interpersonal relationship that helps the immature brain use the mature functions of the parent‟s brain to organize its own processes” (Siegel, 1999, p. 67). Siegel (2007) posited that the intrapersonal form of attunement in mindfulness (attuning to oneself) is paralleled by the interpersonal attunement of secure attachment, and that the same neural circuitry is involved. Siegel pointed out that the nine basic prefrontal cortical functions believed to be involved in secure attachment between parent and child (e.g. self-regulation, attuning to others, empathy, modulating fear, responding flexibly) are also involved in mindfulness processes. Also, the capacity to "mentalize" is theorized to be fundamental in secure attachment, and Siegel suggested that the same capacity (and its neural pathways) is utilized in mindfulness (cultivating the mind's awareness of itself) and in interpersonal attachment (cultivating the mind‟s awareness of other minds). These hypotheses are indirectly supported by magnetic resonance imaging (fMRI) research done by Lazar et al (2005) which showed an association between mindfulness meditation experience and increased cortical thickness in brain regions associated with attention  42  and the integration of emotion and cognition (right anterior insula and PFC/ BA 9/10) when comparing advanced meditation participants with matched controls. Siegel proposed that secure attachment may promote mindfulness traits and called for research into these associations. For example, he wondered if secure attachment as measured by the Adult Attachment Interview could be viewed as an aspect of the internal attunement of mindfulness (2007, p. 206). Although he did not suggest that the inverse may be true, his hypothesis begs the question about the effect of mindfulness training on attachment style. Published around the same time was David Wallin‟s book Attachment in Psychotherapy (2007), which aimed to link attachment theory to relational psychotherapy processes, and the psychology of mindfulness. Similar to Siegel, Wallin argued that the systematic practice of mindfulness – to focus nonjudgmental attention on present experience – strengthens the “reassuring sense of an internalized secure base” (p. 159). In mindfulness practice, one attempts to focus on one‟s own inner experience “repeatedly losing and regaining this focus” (p. 161) with compassion, mimicking the actions of an attentive loving parent to child, or therapist to patient. Saron and Shaver (2006) investigated this relationship between mindfulness and attachment in their longitudinal study of 60 adults randomly assigned to one of two 3-month, full-time meditation retreats in Colorado (one wait-list control group). This is part of large study called the Shamatha Project, and the results of the pre-retreat assessment battery and analysis are summarized in Shaver and colleagues (2007). Correlations were done between the scores on the FFMQ (Five-facet measure of mindfulness; Baer et al., 2006) and an attachment insecurity and avoidance scale (Experiences in Close Relationships scale, ECR; Brennan, Clark & Shaver, 1998) along with regression analyses in which each of the mindfulness subscale scores was regressed on attachment anxiety and avoidance. All five facets of mindfulness were significantly  43  predicted by the two attachment dimensions. Attachment anxiety was significantly associated with lower scores on three of the five mindfulness facets: nonreactivity to inner experience, acting with awareness, and nonjudging of experience. Avoidant attachment was significantly associated with all five mindfulness facets (the three mentioned plus attending to perceptions/thoughts/feelings and describing with words).The two attachment dimensions accounted for 42% of the variance in the total mindfulness score. That is, the more attachmentanxious participants were less capable of taking a nonreactive, nonjudgmental stance towards their experience. The more avoidant participants were less mindful in general. As a correlational study, these findings did not reveal the direction of the association between attachment security and mindfulness, but the findings are important in that they represent the current trend in the conceptualization of mindfulness, as an interpersonal as well as an intrapsychic phenomenon. A more recent publication of some of the Shamatha Project findings adds more support to the attachment-mindfulness link. Sahdra and colleagues (2011) examined the impact of meditation-training-induced improvements in self-regulation, operationalized in terms of response inhibition, on self-reported adaptive socio-emotional functioning in the Shamatha Project participants. Adaptive functioning (AF) was operationalized as a single latent factor underlying several self-report measures including one of anxious and avoidant attachment (Experiences in Close Relationships scale, ECR; Brennan et al., 1998). Their findings supported their hypothesis that meditation practice would benefit socioemotional functioning by enhancing executive control, but they commented that other features of the meditation training environment such as social support from the group and the ongoing relationship with the teacher may also have contributed to the positive outcomes. This may particularly be the case in the self-reported attachment scores.  44  If it is true that attachment and mindfulness are related, pertinent to this study on how mindfulness is learned and experienced relationally is the question of how attachment is learned and experienced, and how this process has been investigated empirically. This question is an area of research too vast to do justice to here, but a brief summary of the literature may help to further position the research questions guiding this study. At the most basic level, attachment occurs through a caregiver‟s responses to the infant‟s signals, and the infant‟s adaptation to the caregiver‟s responses. It can be said that secure attachment is “learned” through the child‟s experience of having its needs and feelings noticed and responded to consistently, resonant with the child‟s state of mind, and in a manner that is comfortable (not ignoring, intruding or punishing). If these interactions are repeated enough, they become, according to Bowlby (1988), encoded as an internal working model, an internal “secure base” from which to go out into the world to explore and relate with others. Schore (1994) expanded on the role of affect attunement in secure attachment: a contingent communication which is more than just perceiving the verbal and nonverbal signals of the other, but also the ability to allow one‟s state of mind to be influenced by that of the other, so that the infant “feels felt” by the caregiver. He suggests that this attunement is a psychobiological state and that the alignment of states is contingent, co-influential and constantly changing with alternating moment of engagement and distance. Siegel spelled this out in his observation that “an attuned other knows when to “back off” and stop the alignment process” (1999, p. 71). He says at the most basic level, secure attachment is established by the two individuals sharing a nonverbal attunement (alignment of states of mind/affect through communication with facial expression, vocalizations, body gestures and eye contact) in a  45  mutually co-regulating dance of engagement and disengagement, and a verbal communication which indicates acknowledgement of the other‟s state of mind (p. 89). Of interest to this study is McCluskey‟s (2005) interest in attachment as “goal-corrected empathic attunement” which she analysed by viewing simultaneous images of caregiver and client with particular attention to facial expression and posture. She pointed out that Carl Rogers (1953) and the Chicago group, while making significant contributions to psychotherapy process research, focused on the individual behaviour and personal characteristics of the therapist and not the counselling interaction per se. She, conversely, views psychotherapy as a careseeking/ caregiving process which activates the dynamics of attachment, and places her attention on the words, non-verbals, posture and vitality affects5 captured on video as the careseeker and caregiver respond to each other. The goal-corrected empathic attunement is an interactive process of continual rupture and repair. There have been several ways of studying and evaluating attachment processes: 1) between infants and their caregiver through the Ainsworth or Infant Strange Situation (Ainsworth et al., 1978) which codes infant response to the mother‟s return after separation, 2) in adults through the Adult Attachment Interview (AAI, George, Kaplan & Main, 1996) which assesses an adult‟s current “state of mind with respect to attachment” (Main 1995, p. 437), and 3) in infant-caregiver (Murray & Trevarthen, 1986; Stern, 1985) and client-therapist (McCluskey, 2005) dyadic interactions through still-frame/simultaneous video. When considering how mindfulness might be learned through similar or even overlapping processes as attachment, it may be possible to use similar measures. For example, the Adult Attachment Interview protocol could be seen as approximating the Measure of Awareness and Coping in  5  By vitality affect, McCluskey means a person‟s “sense of liveliness and involvement … often accompanied by a change of colour and muscle tone of the face” (p. 10).  46  Autobiographical Memory (MACAM; Moore et al, 1996) used by Hargus and colleagues (2010) to evaluate the capacity of depressed adults to take a decentered and mindful stance when speaking about their past experience. The goal-corrected empathic attunement in psychotherapy tracked and posited by McCluskey (2005) as creating earned attachment security in adult clients, might be likewise viewed from the lens of mindful therapeutic interactions, as posited and observed in recent conceptualizations of mindfulness in the therapeutic relationship (e.g. Hick & Bien, 2008). Fine process research using behavioural ratings of dyadic interactions such as that done by McCluskey on attachment in therapy has not been attempted in the investigation of relational mindfulness in psychotherapy. The Pedagogy of Mindfulness: How Mindfulness is Taught Apart from the professional training resource manual on MBSR (Santorelli & KabatZinn, 2001/2007), there had been little published on the pedagogy of mindfulness until 2009/2010 when a few articles and books appeared on the topic (Crane, 2009; Crane, Kuyken, Hastings, Rothwell & Williams, 2010; McCown et al., 2010; Woods, 2009). Despite the lack of formal research on the learning and teaching of mindfulness, there is a depth of reflective practice and informal classroom research which underlies the course delivery. The Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School has been training health care professionals in MBSR since 1981 with intensive residential training retreats and supervised internships. A connected and parallel commitment to professional training in MBI delivery can be observed in the U.K., where there has been endorsement of the use of MBCT for depression-relapse prevention by the National Health Service, and currently three UK universities offering post-graduate training in delivering MBSR and MBCT. There are curriculum guidelines for both MBSR and MBCT in terms of what is  47  taught, and an agreement across the MBIs that the personal characteristics of the teacher are paramount. In the most current writing cited above, an interest is expressed in the relational processes of teaching and learning mindfulness, and an agreement that the D & I component of MBSR and MBCT may be important in this regard. Early notions of teaching mindfulness. Deatherage (1975) was among the first to mention the use of mindfulness as a psychotherapeutic technique. He used a case study approach to investigate the impact of teaching mindfulness to five psychiatric patients. He defined mindfulness as a self-regulatory cognitive mechanism and saw it as an individual skill that the client could master: “While the psychotherapist … can point the way for the client, only the client can carry out the psychotherapeutic process. Therefore, this [mindfulness] technique is virtually a self-treatment regimen” (p. 134). Deatherage taught a simplified form of mindfulness meditation in the session itself, for example, asking the clients to sit quietly and observe their breath, for some minutes. Then clients were asked to undertake various homework assignments such as watching the second hand of a clock and noticing when and how one's concentration was lost and naming the interruption. He reported five cases in his article, describing the intervention, the clients' self-reported effects and his observations. He concluded that “thought and emotion contemplation” can aid clients in self-regulation by interrupting their own cognitive and/or emotional habitual negative processes, inspiring insight into the link between intention and action, identifying a fuller range of present-moment emotions, and resourcing a calm, peaceful center which can exist simultaneously with anxious or depressed thoughts. Although this is a case study design and therefore the results are not generalizable, Deatherage's suggestions of the possible mechanisms of change of mindfulness are forerunners to those made in later, more sophisticated studies. Also noteworthy is that despite Deatherage's own personal mindfulness  48  practice, he did not address the potential impact of his own mindfulness on the client, instead describing the use of mindfulness as a “self-treatment regimen” rather than a potentially relational one. This seminal study represents a conceptualization of the teaching and learning of mindfulness as the didactic verbal instruction of a self-regulation technique. What is taught in MBIs. Mindfulness has been traditionally taught in Buddhist6 contexts through the practice of vipassana sitting meditation. In this formal practice, the practitioner takes an upright sitting posture and attempts to maintain attention on a particular object, which for beginners is usually the somatic sensation of breathing. Each time attention drifts away from the breath to thoughts, feelings and sensations, the practitioner notices this nonjudgmentally and brings his or her attention back to the breath. As the ability for attentional focus develops, the practitioner is instructed into the heart of vipassana practice, choiceless awareness, which is simply noticing whatever thoughts, feelings or sensations arise, watching these with curiosity and detachment, without elaboration or action. In this way, thoughts, feelings and sensations are not suppressed, but rather, experienced and observed impartially. The “ultimate purpose” of the systematic cultivation of mindfulness, as the “heart of Buddhist meditation” (Thera 1965, p. 44), is insight (vipassana). According to Buddhist scriptures, insight is the direct realization of certain truths of existence, such as the impermanence of all phenomena. Rather than an intellectual or conceptual understanding, it is said to be an embodied knowing which arises naturally from mindfulness practice, and which leads to liberation from suffering. In the didactic instruction of the MBIs, the verbal instructions given by the teacher for the various mindfulness exercises (sitting meditation, mindful walking, mindful yoga, and a bodyscan which involves systematically scanning the body for sensation) invite focus of 6  There is a rich diversity of styles of meditation practice, both within and across the various schools of Buddhism. The practice described here, used in MBSR, is derived from the Theravada Buddhist context, and its evolution as “Insight Meditation” in the West.  49  attention on particular present-moment experience such as sensations, breathing, or sounds in the environment. When thoughts, emotions, urges, discomfort, or other experiences arise, participants are encouraged to observe these with curiosity (or gentle kindness, acceptance, nonjudgment). Brief mental labeling is suggested, such as silently saying “boredom” “itchy” as one observes their inner or outer experience. Teaching mindfulness inherently involves some kind of conceptualization of what mindfulness is. Mindfulness appears, across the various MBIs, to be viewed as a process that includes paying attention to present moment experience, and bringing an attitude of acceptance, kindness and curiosity. Mindfulness as a teacher/therapist characteristic. There have been many remarks in the literature that mindfulness can only be learned from a teacher who is mindful. A unique emphasis on teacher characteristics has been made explicitly from the early beginnings of MBSR. Along with a more traditional content-based curriculum outline is this caveat by KabatZinn in the MBSR training manual: In order for a class or for the program as a whole to have any meaning or vitality, the person who is delivering it must make every effort to embody the practice in his or her own life and teach out of personal experience and his or her own wisdom, not just in a cookbook fashion out of theory and out of thinking mind. Otherwise, the instruction becomes a mechanical didactic exercise at best and the true virtues of the mindfulness approach will be lost. We never ask anything of our patients that we are not asking of ourselves to a greater degree, moment to moment and day by day (Santorelli & KabatZinn, 2001/2007, Curriculum outline, para.4). There are accompanying guidelines for assessing the readiness of a teacher which, along with the extensive formal training at the Center for Mindfulness, include a daily meditation practice, a minimum of three years of consistent meditation practice, two silent 10 day retreats, as examples of the sort of embodied practice expected of teachers. In a section entitled Standards of Practice, Kabat-Zinn went on to describe the required “attitudinal qualities” of the teacher: non-judging, patience, a beginner‟s mind, trust, non-striving, acceptance, and letting go. He said these 50  qualities “lend themselves to the cultivation of mindfulness” and are “central to the pedagogical approach of MBSR.” He explained that “the gradual process of embodying such qualities relies on the intention of the instructor and on his/her commitment to life-long learning. In turn, such a personal commitment on the part of the instructor becomes the basis for the awakening of these attitudes in the minds and hearts of the class participants” (Program Standard 6d). Thus the personal characteristics of the MBSR teacher are deemed crucial to the teaching of mindfulness itself. This assertion has been picked up by various subsequent researchers. For example, Segal and colleagues (2002), when first developing the MBCT intervention, spent time observing sessions of MBSR at University of Massachusetts Center for Mindfulness and noted “the remarkable ways [the MBSR instructors] were able to embody a different relationship to the most intense distress and emotion in their patients. [They went] further in their work with negative affect than we had been able to do in the group context by staying within our therapist roles” (p. 56). They concluded that “a vital part of what the MBSR instructor conveyed was his or her own embodiment of mindfulness in interactions with the class . . . Participants in the MBSR program learn about mindfulness in two ways: through their own practice and when the instructor him-or herself is able to embody it in the way issues are dealt with in the class” (p. 56) and “the MBCT instructor‟s own basic understanding and orientation will be one of the most powerful influences affecting this process. Whether the instructor realizes it or not, this understanding colors the way each practice is presented, each interaction handled” (p. 65). That one needs to teach mindfulness from one‟s own meditation experience has indeed become a widely-held assumption within the mindfulness community. Woods (2009) echoed that while some aspects of mindfulness can be taught through the intellectual transmission of concepts,  51  “there is a large part of mindfulness that can only be truly discovered and communicated when the clinician/instructor embodies this approach whole-heartedly” (p. 463). There is a growing body of research which investigates the characteristics and influences of the mindful teacher/therapist, although this is an area of research which still holds many questions. The interest in mindfulness and the therapeutic relationship was expressed as early as 1970, when Lesh published a study in the Journal of Humanistic Psychology on the relationship between empathy in counsellors and Zen meditation practice involving mindfulness of breathing. Using three groups (meditators, n = 16; nonmeditators favorable to meditation, n = 12; nonmeditators opposed to meditation, n = 11) and a variety of psychological tests (e.g. empathy, degree of openness to experience), Lesh found that the group that practiced meditation over a four-week period improved significantly in their empathy ability as measured on the Affective Sensitivity Scale (Kagan, Krathwohl & Farguhar, 1965). This scale involves the participant watching a videotape of a counsellor-client interaction, and marking on an answer sheet the feeling that is being expressed by the client. The study is unique in its use of observer behavioural rating rather than self-report to measure empathy. This relationship between therapist mindfulness and empathy has been supported qualitatively by more recent interview-based studies of therapists who are also long-time meditation practitioners (e.g. Aiken, 2006; Alvarez, 2008). These first-person accounts describe how mindfulness practice had enhanced qualities such as empathy, compassion, and nonjudgment, that the participants deemed necessary in their therapeutic work. Both studies (Aiken, 2006; Alvarez, 2008) revealed a complex interaction between therapists‟ mindfulness practice and their therapeutic practice. Indeed, participants regarded their therapeutic practice as an inherent part of their spiritual practice of mindfulness. Similarly, Bruce and Davies (2005), in  52  their qualitative study of the experience of hospice caregivers with a Zen meditation practice, found that their participants reported mindful presence was not an instrumental therapeutic tool, something embodied in one's individual self to be “applied” to interpersonal encounters, but rather was interdependent and co-constructed. In this way, “meditation practice served caregiving, whereas caregiving served meditation in a doubling or mutuality” (p. 1336). There have been a few quantitative studies on the impact of mindful therapists on client outcomes, each with very different outcomes and conclusions. Stanley and colleagues (2006) investigated the relation between therapist mindfulness as measured on MAAS and client treatment outcome in a university clinic utilizing manualized, empirically supported treatments (mostly CBASP, a form of cognitive therapy, with a few interpersonal and DBT). Twenty-three trainee psychologists and 144 clients were included. The MAAS was used to assess therapists' mindfulness, and Clinical Global Impressions (CGI) and Global Assessment of Functioning (GAF) were used to assess clients' pre and post symptom severity and/or general functioning. Surprisingly, there was a significant negative correlation between mindfulness scores and the GAF scores, indicating the clients of therapists with low mindfulness scores show greater global functioning at termination. The explanation offered is that awareness of internal and external cues perhaps distracts the therapist from the agenda of adherence to the manual-based therapies. As a correlational design, this study was well done and prompted generative findings. However, one limitation is that the measure of mindfulness used, the MAAS, measures “everyday mindfulness” (e.g. dispositional or trait mindfulness) as a one-faceted construct (moment to moment attentional awareness). This may in fact be measuring a different construct than what ensues from formal mindfulness training as taught through MBSR or MBCT.  53  Stratton (2006) also examined the relationship between therapist mindfulness and client outcomes in an unpublished doctoral dissertation. His correlational study used 24 therapists and their client outcome data over 2 years, measuring therapist mindfulness with the MAAS. He did not find any correlations. He concluded that the lack of correlation might be due to the imprecise construct of mindfulness and its measurement. He suggested that future research might require a qualitative investigation of the interpersonal transactions occurring between therapist and client, and attempt to identify therapist behaviours that may evidence mindfulness. He postulated that the mindfulness state of the therapist while delivering therapy may be different from mindfulness as a trait outside of therapy as measured by the MAAS. The study by Grepmair and colleagues (2007) yielded very different conclusions. They used a randomized, double-blind controlled study to examine the relationship between mindfulness in psychotherapists in training and treatment results of their patients, at a German training institute for depth-psychology-based psychotherapy. The treatment results of 124 inpatients, treated for 9 weeks by 18 therapists, were compared. The therapists were randomly assigned to 1 or 2 groups, those practicing Zen meditation (MED; n= 9), or a control group (noMED, n = 9) which was waitlisted for the daily morning meditation practice at another point in their training. Both the patients and the therapists7 were blinded to these conditions. A Japanese Zen master who was likewise unaware of the reasons for introducing meditation at that time led the group meditation, which took place daily before the workday began. The in-patient, integrative psychiatric-psychotherapeutic plan included individual psychotherapy, group gestalt  7  The therapists were “blinded” in the sense that they were not aware that client outcomes were going to be measured in association with whether or not their therapist had attended the meditation, and both groups of therapists participated in meditation, the control group later on in the schedule. The meditation was considered part of the training of the therapists. Since it was a teaching and research site, all therapists-in-training were there with the agreement that they were also part of a multi-faceted research project. The objective of the data collection was revealed to the therapists and patients after completion.  54  therapy, group psychodynamic therapy, progressive muscle relaxation training, sports, and nutritional counselling. The results of treatment were examined using the Session Questionnaire for General and Differential Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behaviour (VEV) and the Symptom Checklist (SCL-90-R). Compared to the noMed group (n = 61), the patients of therapists from the MED group (n = 63) had significantly higher evaluations for individual therapy 2 STEP scales, clarification and problem-solving perspectives. Their total cores were also significantly higher for the VEV. Furthermore, the MED group showed greater symptom reduction than the noMED group on the Global Severity Index and 8 SCL-90-R scales. The Grepmair study is one of the most convincing studies on the positive effects of mindfulness in therapists on client outcomes. The double-blinding prevented the common issue of demand characteristics influencing the data. The sample size (n = 124) is larger than most mindfulness studies. The research venue itself (a psychiatric hospital/training clinic) provided important controls (e.g. daily group meditation practice for the treatment group of therapists) that are difficult to achieve in less structured settings. However, the lack of an active comparison group which would control for the potential group effects is an obvious weakness in the design. By sitting together each morning, meditation techniques aside, the therapists in the experimental group may have benefited in unidentified ways (inter-subjective emotion regulation, group cohesion, time for self-reflection on client cases). This study, despite its excellent design in other respects, is one of many examples of how the lack of an active comparison group in meditation research limits the conclusiveness of findings. In a dissertation study, Wexler (2006) examined the relationship between therapist mindfulness and the quality of the therapeutic alliance. Therapist mindfulness was measured  55  with the Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003) and the therapeutic alliance by dyadic ratings from the Working Alliance Inventory (WAI; Horvath and Greenberg, 1989). Nineteen therapist-client dyads were used. Significant positive correlations were found between both client and therapist perception of the alliance and therapist mindfulness, both in and out of therapy. Bruce (2006) used a larger sample size in his dissertation which was a similar design, and received much different results. He examined the correlations between therapist mindfulness (measured by the MAAS and the Five Factor Mindfulness Questionnaire, FFMQ, Baer et al 2006), and therapeutic alliance (measured by the Working Alliance Inventory ) and therapeutic outcome (measured by various scales such as Hamilton Depression Rating Scale, Structured Clinical Interview for DSM-IV ). It was hypothesized that mindfulness enhances treatment outcome through the therapeutic alliance, and that mindfulness is linked with the alliance through therapist qualities such as empathy, attention, or affect regulation. Thirty-five therapists and 183 clients participated. To the researcher's surprise, the results were non-significant. While he conceded that it is possible that mindfulness has no positive effects on therapeutic alliance or outcomes, he argued that the findings may reflect the limitations of the self-report measures of mindfulness. Bruce pointed out that in particular, the measures do not tap into the "heart" qualities of mindfulness such as friendliness, warmth, curiosity and openness that may be especially helpful to therapists. These aspects of mindfulness are referred to as the attitudinal components of mindfulness (Shapiro et al., 2006). Bruce also pointed out an interesting paradox that may affect the measurement of mindfulness, which is that more mindful individuals might score lower on self-report measures of mindfulness because they are more aware of how much of the time they are not mindful. He suggested that fine-grained process research is necessary,  56  where videotapes of counselling sessions are coded to examine what happens in “mindful” therapy. In summary, attempts at clarifying the relationship between therapist mindfulness and the therapeutic alliance, and client outcomes, have been generative of more questions than answers. There are conflicting results from similar studies. In some cases, it appears that mindfulness and therapeutic alliance are positively correlated and in other studies, not. Similar discrepancies appear in the fledgling research on the association between therapist mindfulness and client outcomes. A common conclusion by researchers is that we still do not know how to measure mindfulness in therapists. Existing measures focus on the attentional aspects of mindfulness rather than the attitudes of friendliness, compassion, and equanimity which are suggested by Buddhist conceptualizations. It is recommended by more than a few researchers that qualitative designs, including process research involving not only self report but videotaped behavioural observations, might shed light on what happens in therapy done by mindfulness practitioners. Further, there has been no study which attempts to find associations between therapist and client mindfulness by measuring mindfulness in both the therapist and the client, before and after the intervention. Indeed, how mindfulness in the teacher/therapist is related to student/client mindfulness is not understood. The role of dialogue and inquiry in mindfulness-based stress reduction. We can note that in all these studies, the attention is on teacher/therapist characteristics, rather than what the student brings to the learning of mindfulness. If we concede that all learning is intrinsically relational, we might turn our attention to the relational space in MBSR, particularly the interactions between teacher and students, and also among students in the group. Rather than viewing the teaching as a uni-directional movement from mindful teacher to unmindful student,  57  we might instead wonder about how mindfulness is jointly constructed. The MBSR curriculum includes individual mindfulness meditation practice, didactic psycho-education, and D & I. It is the D & I that presents the most explicit opportunity for relational learning of mindfulness. In the MBSR Standards of Practice, Kabat-Zinn, commenting on the role of the D & I, says, “It is essential that a significant amount of time in each class be dedicated to an exploration of the participants‟ firsthand experience of the formal and informal mindfulness practices … This requires the instructor to sharpen her/his ability to listen closely, allow space, refrain from the impulse to give advice, and instead, to inquire directly into the actuality of the participant‟s experience” (Santorelli & Kabat-Zinn, 2001/2007, Program Standard 6c). Kabat-Zinn implies that the D & I is a pivotal part of the MBSR curriculum, yet research thus far has focused almost exclusively on the practice of mindfulness as it is enacted privately by the participants in the formal meditation exercises. It has been noted that the D & I offers an opportunity for the instructor, who is ideally embodying mindfulness, to serve as a model for the participants. According to Woods (2009), “it is only through the instructor‟s own experience with mindfulness practice that she/he improves the possibilities of representing these qualities of acceptance, nonjudgment, kindness … in their fullness” (469). One wonders, however, if the embodiment serves more than a representation, a demonstration or model. Crane and colleagues (2010) used the term embodiment in a different way. They said that mindfulness is communicated by the teacher in the process of teaching: “the teachers themselves are in the mode that participants are being invited to experiment with” such that “the whole teaching process becomes an “in vivo” experience of mindfulness” (p. 78).  58  It is of note that the pedagogical models based on reflective practice that are presented in Crane and colleagues (2010) and McCown and colleagues (2010) stress the importance of the D & I component, but this has not been taken up in the research. McCown and colleagues (2010) claimed, “Much of the transformative effect of the MBIs may be potentiated by dialogic encounters with participants in the group... This is an extremely important and dynamic element in participants‟ experiences in the MBIs that has not been adequately addressed part of the process in empirical research” (p. 127). They distilled an interrelated set of teaching intentions for MBSR (experiencing new possibilities, discovering embodiment, cultivating observation, moving towards acceptance, and growing compassion) and hypothesized that the teaching intentions of “cultivating observation” and “moving towards acceptance” are most exercised in the D & I component. Further, they mused that considerable learning may be happening in the students who are silently observing the dyadic exchanges between teacher and other students: Although direct inquiry with the teacher is the most perceptible form of exploration in each session, it would be unwise to privilege it as the main vehicle for moving towards acceptance. Given the environment of intersubjective and intrasubjective resonance participants who seem to be simply watching the inquiry into another‟s experience may actually be doing deeper work. They may be working along and accepting and changing in ways they may never report... This unseen activity is a part of the co-created curriculum too, whether or not it ever receives outward expression or acknowledgement (p. 180-181). They concluded that the D & I is “an invitation to the innate wisdom of the other to show itself, to be known in experience and language” (p. 130) and the value is not only insight but in “loosening the grip of habits of thought” which is pivotal in the teaching intention of “cultivating observation.” Not all researchers have acknowledged the D & I to be of particular or unique importance in the learning of mindfulness, or worthy of research interest. In fact, it is often brushed over. For example, Imel and colleagues (2008) in their investigation of potential group effects in MBSR 59  referred to it as a “review of homework with a discussion of any related difficulties.” And Wizer (1995) even said that from his observation of the seven MBSR courses he investigated for his research, there is very little social or relational activity. He denied the possibility of group effects for that reason: An initial criticism of the published literature about [MBSR] was in regards to the implicit assumption that it was the activity of mindfulness meditation which was responsible for the positive therapeutic change that were reported and not other factors. The MBSR is a group intervention and therefore should partake of the same therapeutic factors which are associated with group process. The results of this study contradict this initial criticism. … Participant talk takes up only 30% of total class time, far less than one would find in a psychotherapy or support group. .. Undirected sharing, very common in psychotherapy groups, made up less that 1% of the total class time… In the MBSR there was little encouragement of interpersonal process during a whole class period and some instructors even discouraged this. In some of the classes it was extremely rare for a participant to speak to another participant …The [MBSR] is not psychotherapy or support group but instead a skill development group and as such is a form of psychoeducational intervention… Like other psychoeducational skill development groups, such as assertiveness and communication groups, it is pedagogical in format with an emphasis on the practical application of what is learned. (p. 80) While it is possible that the D & I component of the MBSR curriculum was not as saliently developed in 1994 when Wizer did his study, it is also possible that he underestimated its relational potency. Undirected sharing and member-member talk (cross-talk) is indeed not part of the D & I, and MBSR is not a psychotherapy or support group, but this does not mean that there is no interpersonal process. The D & I, which has been overlooked in research, and only now is being specifically acknowledged by clinician/teachers as an important part of the learning process in MBSR, has a unique interpersonal process which is neither typically psychotherapeutic nor simply didactic skills-oriented. The question remains, What is the process of learning mindfulness through the D & I period of the MBSR course?  60  Contextual Action Theory In the exploration of how mindfulness is constructed and experienced interpersonally both in the teacher-student dyads and among group members during the D & I period of MBSR, this study used contextual action theory (Valach et al., 2002) as its theoretical lens. This final section of the literature review begins with a brief summary of contextual action theory. Then mindfulness is situated in contextual action theory, first by assessing the place of intentionality in mindfulness, and then by proposing mindfulness as an action, a project and a career. Young and colleagues‟ action-project method (2005) then is presented as a unique qualitative methodology for investigating the lived experience of the action of mindfulness, and answering the research questions of this study. Contextual action theory is a highly integrative conceptual framework for understanding human experience. The underlying philosophical approach in contextual action theory is a moderate constructivist one in which knowledge is viewed as constructed rather than discovered, and constructed through action. Action is the core construct of the theory and is seen as comprised of three perspectives: behaviour, thoughts and emotions which steer the behaviour, and social meaning. Social meaning refers to the fact that behaviour is always “about something” (Valach & Young, 2004) and this intentionality is not derived in a vacuum but is socially negotiated and consensual. Social meaning “embeds action within a contextualized view of human experience so that society‟s meaning is made real in the action of its members” (Penner, 2011, p. 63). This means that most behaviours (apart from basic reflexes and responses of the autonomic nervous system) are not only steered by the actor‟s internal world (thoughts and emotions) but arise from (and contribute to) their social context. In this way, context is not  61  separate from action as a structural setting or environment, but rather, is constituted in and through it. Contextual action theory also offers a framework for understanding human experience over time. First, action and joint action refer to intentional goal-directed behaviour. When several actions occur over a mid-length period of time around a common goal, they form a project or joint project. Finally, when projects coalesce into a longer-term goal-directed process, sometimes even a life-long one, we refer to career. Career in this sense does not necessarily carry an occupational meaning. Examples of careers might be long-term life-projects of dealing with illness, or parenting, or spirituality. Viewed from this paradigm of contextual action theory, the action of mindfulness can be construed as being goal-directed and intentional, and as having three perspectives of manifest behaviour, internal processes and social meaning. A factor that seems to bridge the various definitions of mindfulness is that of intentionality. Indeed, intentionality appears explicitly or implicitly in all of the proposed definitions of mindfulness. For example, Bishop and colleagues (2004) expanded on their operational definition of mindfulness, explaining that the first component, attention, is “an intentional effort to observe and gain a greater understanding of the nature of thoughts and feelings” and the second component, acceptance, involves “a conscious decision to abandon one's agenda to have a different experience” (p. 236). Similarly, Germer (2005a) said that mindfulness always includes an intention to direct attention somewhere. He describes the advanced practice of mindfulness, choiceless awareness, in which attention moves without attachment among the changing elements of experience: “Even choiceless awareness includes intention, in this case, the intention not to choose, but to stay aware of where our attention resides” (p. 16). In a compelling model of the mechanisms of mindfulness, Shapiro and  62  colleagues (2006) posited intention as one of three main components. It may be useful to compare the place of intention in Buddhist and Western philosophy in order to investigate the possibility of mindfulness as, first and foremost, a phenomenon of intentionality. Buddhist concepts of intentionality. Olendzki (2005), a scholar of the early Buddhist tradition and Executive Director of the Barre Center for Buddhist Studies, contended that in order to understand mindfulness, one needs to understand the historical setting of mindfulness and its philosophical underpinnings in Buddhist psychology. He outlined the Buddhist understanding of the most elemental unit of human experience as comprised of five interdependent factors: contact between a sense organ and a sense object, the awareness of that object (consciousness), perception, feeling and intention. In Buddhist psychology, Olendzki explains, intention has a precise meaning: “Intention has to do with the attitude taken towards what is happening in experience” (p. 247). It is associated with doing rather than knowing. When one makes a choice to move or speak, for example, intention manifests as action. Intention thus includes the notion of choice or volition, but, paradoxically, is often initiated habitually or even sometimes unconsciously. “A disposition to respond, mentally or behaviourally, to circumstances in a characteristic or patterned way is an expression of a subtle, passive influence of intention.” This is because of the Buddhist notion of karma, which is the understanding that a person is continually shaped by his or her previous actions. “It is from the background of accumulated patterns that intentions, perceptions and feelings in the next moment are shaped. Every action is thus conditioned by all former actions and every action also has an effect on all subsequent action” (p. 248). Thus our volitional actions spring from habituated dispositions and learned behaviours. Even so, intention is an “active and  63  creative function that has a great impact on how the moment‟s experience is organized and presented by the mind” (p. 247). From this brief overview of how a moment of experience is constructed through the five factors mentioned above, including intention, we can see that from the point of view of Buddhist psychology, a “person” is regarded as a process of continually changing responses and revisions of meaning. The Buddhist tradition thus views self-identity as an “elaborate construction project” (p. 244) involving the accumulation of millions of moments of experience as described above. As we develop, our conditioned reflexes ignore new details in incoming phenomena as we attend to ongoing projects at the macro-level of construction: “In simpler terms, we are so invested in the larger picture of goals, strategies, and the validation of assumptions and belief systems that we are in the habit of relating to sensory and cognitive detail as means toward an end” (p. 253). The Buddha construed that human suffering is constructed in each moment in these reflexive and unconscious ways, and offered mindfulness meditation (vipassana) as a cure. By bringing intentional attention to the stream of phenomena, we “reverse our tendency to lean ahead into the next moment, to rush forward to the level of macro-construction … By observing the move from arising phenomena to thought creation, we begin to reveal the highly constructed nature of [our] experience … A range of options for learning and growing becomes accessible” (p. 253). One could go as far as to say, from this Buddhist perspective, everyday human functioning has become deadened by unaware habitual responding, and the practice of mindfulness, as an act of intentionality, recovers it as a crucial element in human mental health. In summary, intentionality within Buddhism is tied to action, which can be more or less mindful or habitual. Western concepts of intentionality. A major influence on our current understanding of intentionality is the perspective of the conceptual work of the German phenomenologist, Husserl  64  and his student Brentano. According to Husserl, consciousness is intentional, which does not mean deliberate or willful, “but sheerly a directedness towards the external object and an openness to the world” (Depraz, 2001, p. 170). Richardson (2002) went on to explain the notion of intentionality as being necessarily tied to socio-cultural meaning: “intentions … are associated with the construction of meaning in that they are understood in relation to the interpretive and symbolic systems provided by culture” (p. 487). She drew from cultural psychology (Ratner, 1997) in her view of intention and action as one unit, with intention referring to the state of consciousness comprising directedness towards the world, and action comprising what a person might actually do (p. 488). This echoes the Buddhist notion of intention as an attitude taken towards experience, associated with doing rather than knowing. It is interesting to note that intention may be at least partly if not wholly implicit. Libet (1999) found that people become aware of the intention to act 350 milliseconds after the brain has readied itself to act, and 200 milliseconds before motor activity. In other words humans can veto an action but one's intention to act is formulated in the brain before one become aware of it. This could be construed as more evidence for the extreme social constructionist stance that intentions are never freely chosen but are reflective of social forces acting on the individual. This is not unlike the Buddhist notion of karma, whereby individual intention and action in each moment is not free, but rather, dependent on the myriad of contextual influences of the moments before. However, Richardson drew from the literature on the relational, emergent and embodied nature of human action (e.g. Chodorow, 1999; Polkinghorne, 2000) to challenge this epistemological conclusion of limited personal agency. Somewhat similarly, within Buddhist psychology, despite being influenced by karma, human intentionality is present in every moment of thought, always new, and creatively shaping our experience. While Richardson emphasized  65  the relational aspect of human experience as bringing about a potential for new, joint intentionality, mindfulness practice, an embodied training in breaking conceptual and perceptual habits, also provides the space for new intentions that Richardson is requesting, as it trains individuals to control and choose behaviours by interrupting habitual thought and affect streams and by increasing awareness of brain activity. Indeed Richardson's rendering of the emergence of new intentions in subjective experience sounds remarkably like mindfulness practice itself: The emphasis here on the emergence of new intentions … is quite different from the emphasis on goal-directed behaviour . . . While some new intentions might, in fact, lead to future goals, the point here is to shed light on the significance of a process in which the generation and identification of new intentions is related to an open-minded and adaptive orientation to external and internal realities. (p. 489). In order to posit mindfulness as an intentional action which promotes the emergence of new intentions, we need to locate it in the paradigm of action theory. Action theory. Buddhist psychology and the mindfulness tradition assume that our suffering has its origins in our basic human drives, for the most part unconscious and beyond our control. Desire is the compulsion to pursue pleasure and avoid pain. Mindfulness teaches us to uncover these insatiable desires, and sit with pleasure and pain without being run by them. Choiceless awareness means that rather than pursuing and avoiding, we are able to experience all of life more fully and with less suffering. Baer (2003) noted that mindfulness is associated with non-striving. This seems at odds with action theory with its emphasis on agency, goals, and movement over time. However, action theory and Buddhist psychology have commonalities in their contextualist world view. Germer (2005a) described how the paradigm for mindfulness is contextualism, as defined by Stephan Pepper (1942). The contextual worldview assumes that action and change are fundamental conditions of life, which overlaps with the notion of  66  impermanence in Buddhist psychology; all reality including the self is constructed within a particular context, which is similar to the Buddhist concept of no-self; change is continuous and events are multidetermined, which can be seen as roughly approximating the Buddhist term of “dependent co-origination” (Germer, 2005a, p. 26). Richardson's (2002) description of action without new intention as being a “tendency to repeat and carry forward old story lines to which one has become habituated” (p. 489) echoes the definitions of karma given earlier. Likewise, Dannefer (1999) rather cynically observed that “the reality of intentional human action is that it is largely hyper-habituated, unreflective, and routinized, and that it reproduces existing structures, both personal and social” (p. 105). Yet the recognition of intention, action, goals, projects and careers in even such habituated and destructive processes as drug addiction (Valach & Badertscher, 1996) carries fundamentally optimistic implications for human capacity for agency and creativity. And within Buddhism, although karmic action is conditioned by previous actions, every moment of experience contains both habituated responses and the creative and active factor of intentionality. Mindfulness as an action. In action theory, action is seen as “goal-directed, intentional behaviour” (Young, Valach & Collin, 1996, p. 213).The goals of action rather than their causes are emphasized. Mindfulness as an action is probably best understood as one of Germer's “moments of mindfulness” which he described as involving awareness which is nonconceptual, present-centered, nonjudgmental, intentional [my italics], participatory, nonverbal, exploratory, and liberating ( 2005a, p. 9). As discussed above, intention is considered in Buddhist psychology as one of the five components of a moment of conscious experience, and while most Western models of mindfulness are attentional models (e.g. Bishop et al., 2004; Teasdale et al., 1995), they include an explicit or implicit acknowledgement of intention as a fundamental aspect of  67  mindfulness. In terms of mindfulness being goal-directed, this is somewhat paradoxical. Bishop and colleagues (2004) say that “much cognition occurs in the service of goals” (p. 236) and that our thoughts and behaviours function in a goal-oriented way to reduce the discrepancy between what is and what is desired. According to them, mindfulness, on the other hand, “teaches us to disengage from goals” (p. 236). However, there is surely the overreaching goal of paying attention to present experience. Further, Shapiro and colleagues (2006) spoke of the superordinate goals in Buddhism of enlightenment and compassion for all beings, and Shapiro (1992) found that meditation practitioners had goals of self-regulation, self-exploration and selfliberation. Clients of mindfulness-based clinical interventions may be advised to let go of their goals of feeling better or more relaxed (Kabat-Zinn, 2003, p. 148), but paradoxically, must commit to the goal of dropping these goals and instead attending to their present-moment experience. Kabat-Zinn referred to this emphasis on nonattachment to outcome “a radical departure from most clinical interventions” (p. 148). Yet while mindfulness embodies nonattachment to outcome, it still is initiated intentionally and with the goal of present awareness. In action theory, action is conceptualized as being cognitively and socially regulated and steered (Young et al., 2005). In reference to mindfulness as an action, as discussed earlier, current researchers simply do not agree about whether it is steered by cognitive, meta-cognitive, perceptual, or some other undefined mechanism in consciousness itself. It is one of the purposes of this study to explore the ways it may be socially steered. Although it may appear to be the private experience of an individual while he or she is meditating or engaged in a mindfulness exercise, as it is practiced in relationship, it becomes a richly social enterprise. In this case, relational connection becomes the object of mindfulness (Surrey, 2005). There are other possible  68  social meanings for actions of mindfulness, depending on the practitioner and his or her context. For example, achieving therapeutic goals involve socially sanctioned views of mental health, while aspiring to spiritual goals also involves socially negotiated “ideal” or spiritual qualities such as compassion, wisdom, or empathy. Mindfulness as a project. Mindfulness is not a one-time action. In spiritual circles, it is referred to as a practice, which involves formal daily sitting but also an intention to be mindful in daily life activities. The action of mindfulness, then, is repeated each time -- hundreds or thousands of times -- attention is returned to the object of awareness. This action of noticing when we are escaping (e.g. through daydreaming or auto-pilot behaviours) and returning with full attention to the present moment is performed without judging the pleasant or unpleasant qualities of the object of awareness (e.g. the thought, the feeling, or the sensation). As an action performed over time, it can be seen as a project. According to Young and colleagues (2005), a project “represents a series of actions, constructed as having common goals, over a midterm period of time” (p. 217). A mindfulness project could include such things as daily sitting practice, the intention to be mindful in daily activities, weekend or 10 day retreats. Mindfulness could also be seen as a part of other life projects, for example, stress-reduction or self-care projects, spiritual-growth projects, compassion-building projects, or enlightenment projects. Mindfulness as a joint action and project. Joint action refers to the intentional behaviour of a dyad or group of people attempting to realize a common goal or engage in a common process (Young et al., 1997). Mindfulness can be construed as a joint action in its traditional context of students practicing mindfulness meditation within a close relationship with a spiritual teacher and a community. This is congruent with the conceptualization outlined above of the social/relational meanings of mindfulness. Another way in which mindfulness could form  69  a joint action or project is in therapy. Surrey (2005) posited “relational mindfulness” as part of the therapeutic alliance, whereby “both the therapist and patient are working with the intention to deepen awareness of the present relational experience, with acceptance” (p. 92). She described a mindful therapist as gradually and organically inviting the client into mindfulness, without explicit meditation instruction: While the therapist's focus remains on the experience of the patient, both patient and therapist are engaging in a collaborative process of mutual attentiveness and mindfulness in and through relational joining . . . This view of therapy as co-meditation offers new possibilities for the therapeutic enterprise. Through the relationship, the therapist offers the patient the possibility of staying emotionally present with the therapist, perhaps staying with difficult feelings for “one more moment” . . . Psychotherapy becomes mindfulness practice, and mindfulness becomes a collaborative process … (p. 95). Ryback (2006) suggested that the intentionality and the jointness of mindful human connection set mindfulness in the historical context of humanistic psychology. Mindfulness as a career. Career, in action theory terms, represents “an organization and construction of projects that exist over the long-term and/or have a highly significant place in one's life” (Young et al., 2005, p. 217). If an individual's mindful actions and mindfulness projects, taken for spiritual, personal or therapeutic reasons, can be seen over the long-term to inform a life purpose, we might describe this as a mindfulness career. Kabat-Zinn's poignant description of mindfulness as a career demonstrates his reluctance to have mindfulness meditation represented simply as a method or technique: Mindfulness meditation is not simply a method . . . It is both the work of a lifetime, and paradoxically, the work of no time at all – because its field is always this present moment in its fullness. This paradox can be understood and embodied only through sustained personal practice over days, weeks, months, and years (2003, p. 149). Viewing mindfulness, then, as an intentional goal-directed action which can form a project, a joint project or a career, helps to set this phenomenon within a dynamic context over time and invites the exploration of its potentially social aspects. 70  Conclusion This chapter has sought to position the action-theoretical exploration of the relational processes of learning mindfulness within the wider literature on mindfulness, its construct and posited mechanisms of change, and what is known currently about how mindfulness is learned and taught, particularly through the multi-faceted mindfulness-based interventions such as MBSR or MBCT. Several questions and gaps in the research were identified in the process of review, including the construct of mindfulness itself, whether or not the identified mechanisms of change in the MBIs are distinct or part of the construct of mindfulness, which components of the MBIs are responsible for which aspects of learning mindfulness, and what significant conditions does the group format (as opposed to individual or dyadic format) of the MBIs cultivate for the learning of mindfulness. Most pertinent to the research questions of this study are the identified gaps in our understanding of the social interactions between teacher and student (and between student and student) as they engage in learning mindfulness. Although the importance of the explicitly relational component of MBSR, the D & I, has been alluded to several times in the last two years in theoretical and pedagogical models of mindfulness, there has been no empirical investigation to date of the role of the D & I in the learning of mindfulness. Finally, this chapter gave an overview of contextual action theory and how it is an appropriate theoretical framework from which to investigate the actions, projects and joint projects of learning mindfulness. Almost all research on mindfulness to date has been conducted using self-report retrospective interviews, self-report measures, and neurological instruments such as f-MRI, and much of this research has been conducted with the focus on the individual, and mindfulness as experienced internally. Action theory and action-project method provides a  71  different way of extending and enriching our understanding of what mindfulness is and how it is experienced not only as an internal, individual cognitive or metacognitive technique, state or trait, but as an interpersonal phenomena with goals, behavioural (verbal and non verbal) elements, and social meanings. It seems important to re-construe “participants” as including the teachers/therapists as well as the students/clients. There is a dearth of research on the lived experience of the providers of the MBSR program. If we conceive mindfulness as a coconstructed phenomenon between student-teacher, it is illuminating to attempt to understand the experience of the students and the teacher, their goals, emotions, thoughts, and behaviours, as they participate in the learning of mindfulness. The next chapter will expand on action theory in more detail, and provide a summary of the principles of action-project method and how it was carried out in this study.  72  Chapter 3: Method This research was undertaken using the qualitative action-project method embedded within action theory (von Cranach & Valach, 1983; Young et al., 2005) in order to answer two main research questions: What is the process of learning mindfulness through the dialogue and inquiry period of the MBSR course? How does the social learning of mindfulness in the D & I period construct the experience of mindfulness? To answer these questions, the individual and joint actions, projects and careers of the MBSR teacher and participants during the dialogue and inquiry (D & I) period were observed and analysed over the 2-month period of an MBSR course. These questions guided my inquiry into the contextualized, relational nature of mindfulness as it is learned and practiced through D & I in MBSR. This chapter offers first a rationale for the research method and design used to explore the research questions. Second, it explains how participants were recruited and describes the teacher and students who chose to participate in this case study. Data collection and the process of coding and analysis are described. Finally, issues of researcher subjectivity, and standards of trustworthiness and rigor are addressed. Rationale for Research Method Contextual action theory (Valach et al., 2002) views human experience as based on intentional action which is informed and energized by cognitions and emotions, and which has social meaning. Humans enact their intentions through body language and verbal language. A phenomenon such as mindfulness, which has been variously posited as an intra-psychic cognitive skill, an attitude, an attentional skill, a perceptual ability, or a personality trait, can also be understood as an intentional action. Further, when mindfulness is enacted behaviourally (verbally and nonverbally) and jointly, as in the dialogue segments in the MBSR group, it can be  73  observed and analysed, through the action-project method (Young et al., 2005) in order to illuminate aspects which may have, until now, eluded more conventional research methods. Action-project method has been useful in researching the individual and relational meanings of everyday activities such as parenting (Young et al, 1997), and friendships (Haber, 2005), and less ordinary behaviours such as attempted suicide (Valach & Badertscher, 1997). It has been used in the analysis of conversations in dyads such as adolescent-peer, parent-child, and counsellorclient to identify joint actions and projects concerning issues such as career and identity formation which are mutually constructed within the dyad. It offers a way of investigating the actions of the mindful teacher8 and student as they undertake a dialogue "about" mindfulness in the effort to learn mindfulness. It also provides a theoretically consistent framework for observing the process of learning and practicing mindfulness over time, that is, over the 2-month period of the MBSR course. There are, of course, different available methods to study conversations, for example, symbolic interactionism, and the related language and social interaction (LSI). Neither of these methods includes in their theoretical framework the role of intention, joint intention, or motivation. The assumption of these methods is that intention and motivation are private individual processes that require speculation to be studied (e.g. Goffman, 1959), so instead, they give primacy to language as a visible performance which can be objectively evaluated. On the other hand, contextual action theory posits that both individual and joint intention are constituted in the action of language itself, and thereby are observable components of the self (and its attributes such as mindfulness) as it is constructed relationally through conversation. Other 8  Note the assumption that the teacher is mindful. "Mindful teacher" here really means a teacher with a personal mindfulness practice. In the MBSR Professional Training manual (Santorelli & Kabat-Zinn, 2001/2007), it is recommended that MBSR teachers are "committed to ongoing growth and learning that includes a consistent, daily mindfulness practice, continued engagement in extended mindfulness meditation retreats, and active participation in continuing professional education, training and development."  74  qualitative methods, such as phenomenology and narrative, share with action project method the social-meaning perspective. However, those qualitative methods are retrospective, not accessing the action of the phenomenon as it occurs. Retrospective interviews can tend to be summative, subject to “narrative smoothing,” and in some cases, interviewees have reported that in fact, they find it difficult to put their subjective and perhaps pre-conceptual/pre-verbal experiences of mindfulness into words (e.g. Smith et al., 2007). Further, although social meaning and context may be addressed in those qualitative methods, the phenomenon under study is often assumed to be an individual rather than social or relational one, and context a structural "container" rather than an integral part of the action itself. Action method aims to access the action under investigation – in this case, the learning of mindfulness – as it occurs, both through videotaping the class dialogue, and then interviewing participants as soon after the dialogue as possible (directly after the class). It addresses social meaning and context by investigating not only individual, but joint, actions in terms of intentionality and goals – what the behavior is “about.” Action-project method has been used to research dyadic joint action processes across time. The notion of group action is conceptualized within contextual action theory (Valach et al., 2002, von Cranach, Ochsenbein & Valach, 1986) as not simply providing a context for the individual, but as comprising a network of goals, action steps and projects which is constantly co-constructed by the group members. Although group joint action is theoretically positioned within contextual action theory, it has not been empirically investigated to date with actionproject method. This study thus breaks new ground in its attempt to apply action-project method to a group process. Using action-project method to investigate a mindfulness-based group experience provided a window into teacher and students‟ internal cognitive and emotional processes in  75  learning (and teaching) mindfulness, their individual and joint goals concerning mindfulness, behavioural manifestations of mindfulness, and lastly, the social meanings of the mindfulness project. The process of learning mindfulness over time from a qualitative perspective has received little attention in the research literature. Action-project method provided a way to monitor a joint mindfulness project over a two month period. Rationale for Research Design The study was undertaken as an instrumental single case-study approach (Stake, 2000), choosing the group (including the teacher) as the case under investigation. This is in an effort to bridge the gap in the mindfulness research of the social and contextual meanings of mindfulness, since almost all extant research has chosen the individual as the case or focus of study, and has viewed the development of mindfulness as an individual process. The case of the MBSR group was observed and explored by looking at the dialogues of six teacher-student dyads in depth and supplementing this data with multiple sources of related data – the whole class dialogue involving ten students and the teacher (occurring during the D & I), self-confrontation interviews with six “target” students and the teacher (held following each weekly class), post-session questionnaires, and weekly logs kept by all ten student-participants. The purpose of the case study approach is not generalization, but rather, an in-depth investigation of particular cases of the target phenomenon. In an instrumental case study, the actual case, although inherently valuable, is of interest to the degree that it facilitates our understanding of the phenomenon, in this case, the learning and practice of mindfulness as a joint project. That is to say, the particular persons selected as dyads, and the particular group selected as the case, are not considered representative of the entire population, as in requirements for generalization in quantitative research. Each case will offer rich information which may be  76  transferable to other contexts. In this study, the case was the group itself, and the individual dyads (teacher-student) represented in-depth aspects of the case. An instrumental case study approach was compatible with the purpose of action-project method which is to describe, rather than explain, a phenomenon. Further, the thick description required in case study research was provided by action-project method, with its multiple sources of data. Participants Recruitment. All MBSR teachers in the community (as listed on the www.mbsrbc.ca website) were initially contacted by email and asked if they might potentially be interested in a volunteer research project involving the relational learning of mindfulness. The ones who replied were then contacted by phone and asked first of all about their level of training and experience teaching MBSR, and then engaged in discussion about various possible study designs that would be workable for the teacher, and potentially benefit the students, while serving the research questions. It was desirable to have a teacher who had, at the minimum, completed the 7-day basic training offered through the University of Massachusetts Center for Mindfulness, and who had taught the course at least three times. These criteria were deemed important in terms of maximizing the likelihood that the course would be offered in a way that was consistent with the course curriculum as suggested by the Center for Mindfulness. Of these teachers, one volunteered to run the entire 8-week MBSR group for free. Her training and experience exceeded the minimum criteria for inclusion as a teacher-participant. This teacher had in fact completed the highest possible level of training for MBSR teaching (8-week internship, Advanced Teacher Trainer Program, Supervised Training Program, all at University of Massachusetts Medical Center for Mindfulness) and had taught the MBSR course many times over the previous ten-year  77  period. It was decided that, in accordance with purposive sampling9, this volunteer teacher would likely provide the type of learning experience that the study was aiming to investigate. A small stipend was paid in recognition of her significant contribution. Twelve volunteer participants were then recruited with a posted notice displayed in several locations such as graduate counselling psychology programs, community centers, libraries, and counselling agencies in the Vancouver area (Appendix A). Typically the MBSR group is between 15 and 30 students (Santorelli & Kabat-Zinn, 2001/2007, MBSR Standards of Practice: Key Characteristics), although the teacher said that she had taught the program to a class as small as eight. There were a few elements to consider in choosing the group size of twelve: approximating a size that is typical for MBSR, having enough participants to make up a core in the event of absences or drop-outs, and also working with the pragmatics of the available classroom space and taping equipment. Brief screening telephone interviews with the interested participants were undertaken to explain the nature of the study and discuss inclusion and exclusion criteria (Appendix B). One inclusion criterion was that they would need to be willing, if asked, to participate in the capacity of a “target student” and be interviewed after each class. That is, while all twelve participants were volunteers, some of them contributed extra time beyond that of attending the course, by staying after the class for interviews. They were told of the considerable time commitment for participation in the study, as well as the potential risks and benefits. Informed consent of both the teacher and all students was obtained before data collection began (Appendix C). Volunteer “target students” were solicited before the first class for the duration of the course. Six of the 12 participants volunteered for this extra commitment of time, four were designated as the main 9  That is, rather than randomly choosing the teacher, I sought to choose one who would most likely teach an MBSR course which illustrated the process in which I was interested, as Denzin and Lincoln put it, a group where “the processes being studied are most likely to occur” (2000, p. 370).  78  target students, with two as back-up in case of absence or fatigue of the others. A brief demographics questionnaire was completed by all participants before the beginning of the first class (Appendix D) in order to be able to assess the diversity of the group in certain typical dimensions such as race and socio-economic class. Description of participants. Participants included teacher and students. The teacher was not concerned with maintaining anonymity in this report, but efforts have been made to disguise the identity of both her and the student-participants. Fictitious names have been given to all. The teacher had a background in the helping professions, and clinical research. The first twelve participants to reply, and meet the screening criteria, were invited to participate in the study. The male participant was over 60 years old, and the mean age of the female participants was 37 years old (ranging from 25 to 51). All of the initial twelve participants had earned undergraduate college or university degrees, and five participants had earned, or were currently working on, a graduate degree. Occupations included accountancy, success coach, business consultant, author, school counsellor, artist, and student. Two were unemployed. In terms of cultural or ethnic background, four of the twelve were born outside of Canada, and described their background as Persian, Russian or Anglo-Saxon. The remaining eight were born in Canada and described their background as “Canadian” or Anglo-Saxon. Thus the group had a considerable age spread, but was not diverse in gender, educational level or ethnicity. The course started with twelve participants, but Paula and Jan dropped out in session 4, and Barbara in session 6. Paula and Jan were not target students but their contributions to the D & I for the first three sessions were included in the analysis (since it is a group analysis). As a designated target-student, Barbara agreed to allow her data from sessions and self-confrontation interviews to be used in the analysis. Her contribution and the fact that she dropped out were considered significant,  79  particularly in regard to the relationship project. Including Barbara, the ten participants had an average attendance rate of 89%. Data Collection Following the ethical approval of the University of British Columbia‟s Behavioural Research Ethics Board, the data collection for the study included audio and video-taped class dialogues, interviews, questionnaires, and personal logs (Figure 1). The data  Figure 1. Data collection from the three perspectives on the action of learning mindfulness. Adapted from “Perspectives on action and corresponding data collection sources in the actionproject method” by R.A. Young, L. Valach and J.F. Domene (2005). The action-project method in counselling psychology. Journal of Counselling Psychology (52), p. 219. Copyright 2005 by the American Psychological Association. Reproduced with permission from APA.  80  were collected by the doctoral student and by three paid research assistants. One of these had considerable experience with the action-project method due to being previously employed as research assistant on an action project research team. I trained the other two in a single-workshop prior to beginning the study. They were given a printed copy of procedures (taping and selfconfrontation interview guidelines) (Appendix E). I listened to each self-confrontation interview after each class, in order to ensure the interviewing protocol was being followed adequately. The MBSR course was run in a conference room on the campus of the University of British Columbia, and the interviews were conducted in research rooms in the same building. Dialogue from MBSR course. One 8-week MBSR group (Appendix F) was offered free of charge February - April 2009. This course was run according to the curriculum guidelines given by the University of Massachusetts Center of Mindfulness, except that each class was 2hours rather than 2 ½ hours in length. This was at the teacher‟s request, due to her schedule. The D & I period of each class, which is the most obviously "social" or interpersonal segment, was the focus of this study's exploration of mindfulness. Based on the researcher‟s prior experience of MBSR, it was estimated that the D & I would last for approximately 40 minutes as a relatively discrete component of each 2 hour class. However, the teacher of this course infused dialogue and inquiry throughout each class. Even the psycho-educational parts of the class often included brief exchanges between teacher and students regarding their personal experience of mindfulness. The category “dialogue and inquiry” was then re-defined as a verbal exchange between teacher and a participant, lasting for the minimum of a minute, which was about their lived experience of mindfulness practice. Consequently, as is typical with emergent qualitative design, a change in the initial plan was made and it was decided to tape (video and audio) and transcribe the entire class from beginning to end to ensure that no potentially valuable data was  81  missed. However, in terms of coding, any segments of the class which were purely psychoeducational and/or experiential (e.g. guided meditation) were not coded. The video cameras were turned off during the periods of time that participants were engaged in experiential mindfulness exercises which involved no direct verbal exchange. Videotaping those meditation periods was not only unnecessary, but also might have felt intrusive to the participants. Three digital camcorders were positioned in the classroom, one focused on the teacher, and the other two focused on four of the target students. The target students were asked at the beginning of each class to sit in seats designated for optimal videotaping. One researcher was responsible for managing the camera focused on the teacher, and the other two research assistants were responsible for taping two student participants each (a total of four target students each class). As they ran the cameras, researchers were also expected to keep track of the starting and ending time of D & I interchanges between teacher and target students. The main researcher decided at the end of each class which minutes of dialogue would be used for the self-confrontation interviews. In this naturalistic design, the dyadic exchanges could not be predicted or controlled and were often fleeting in nature. The choice of exchanges was thus decided based on the length of the exchange (the longer, the better, in terms of data coding and analysis) and the attempt to represent all four target students. Self-confrontation interviews. Six students and the teacher were tracked in-depth over the period of the 8-week course. Four of the target students were the main focus, and two were considered back-ups in case of absence or fatigue. Naturally occurring videotaped exchanges between the teacher and four of the six target students during the D & I periods were used in self-confrontation interviews following each weekly class. These exchanges between the teacher  82  and a particular student typically lasted anywhere between one and ten minutes, but usually two to three minutes, and for the purposes of self-confrontation, a five-minute segment was chosen. Longer than that was deemed too onerous for the students since five minutes of exchange necessitates 15-20 minutes of interview. Following each class, the students and teacher engaged in self-confrontation interviews (lasting approximately 15 minutes for each student, and 30 minutes for the teacher) based on these brief exchanges. Participants were split up (one interviewer with the teacher, one with each student) and taken into different rooms where they watched the video recording of their conversation from the D & I period. Using the selfconfrontation method, the researchers played the video recording and stopped it at approximately one-minute intervals. Each interviewer was provided with a list of possible questions to ask during the interview (Appendix E). At each 1-minute interval, the following question(s) were asked: “What were you thinking or feeling at this point in the conversation?” "What was happening for you during that minute?" This self-confrontation interview was audio-recorded and transcribed. The purpose of the self-confrontation interviews is to access participants‟ internal processes (thoughts and emotions) during the observed joint action of the dialogue. As the participants watch the video of themselves in dialogue, they, in a lay or naïve way, interpret their own, and the other‟s, action. From their comments, we can understand what the observed action meant to them, that is, their perception of the joint intentionality of the action. Altogether, there were nine self-confrontation interviews of approximately 30 minutes each with the teacher, and 36 self-confrontation interviews with students of approximately 15 minutes each (approximately fifteen hours in total of self-confrontation interviewing). It proved impossible to count on accessing a full five-minute round of D & I between teacher and each  83  target participant. Sometimes the exchange lasted only a minute or two. In these cases, students were interviewed on a five minute segment of the D & I, even if for part of that five minutes, they were silent and listening to another dyad working. This proved to yield interesting findings in terms of the internal processes of students when they were not directly engaging with Ruth. Ethical care and respect for the participants‟ well-being (including the teacher) was taken and sometimes the length of the interviews was limited due to fatigue of participants. A unique feature of this study was the ecological validity achieved by recording and analysing a construction of mindfulness through dialogue as it naturally occurred in the MBSR group. As is typical in an emergent and naturalistic design, decisions were made along the way, in consultation with the doctoral supervisor, for appropriate adaptation within the procedures of data collection in action-project method. Investigating the dialogue process through initial invivo videotaping and subsequent self-confrontation interview yielded rich data of the inner (and manifest) experiences of both teacher and students. Supplementary data. All students were asked to complete a brief questionnaire after each class (Appendix G) and to keep a log book (Appendix H) recording their experience of practicing mindfulness during the week. The post-class questionnaires served to provide a window into all students‟ internal processes (not only the target students), albeit a small window. The weekly logs contributed an element of context for the D & I, and a better sense of the lifeprojects of each participant and how they were making sense of what they learned in class. The logs also afforded a context for students to voice their sometimes-negative experiences of learning mindfulness, which they did not voice in class. Thus there was not only the sub-text of the self-confrontations to add to the narrative of the class dialogue, but also the subtext of the  84  weekly logs. Much of the information from these supplementary data sources turned out to be somewhat redundant, but additive information was integrated into the Findings. Recording and transcription. The entire class was video and audio-taped and the D & I periods were transcribed verbatim by the author, primarily from the audio-recording but with constant references to the video-recording. As many nonverbals as were discernable on videotape (smiles, nods, frowns, pauses) were noted. However, due to the cramped quarters of the classroom and the limitations of the video-taping equipment, it was not possible to capture all of these. Self-confrontation interviews were audiotaped and transcribed by the author. To prepare for the action-method style of coding, transcripts of the D & I were broken down into 1-minute segments, to correspond to the self-confrontation interviews which pertained to that minute. Data Analysis The data analysis for this study employed a method for analyzing joint actions that was initially proposed by von Cranach and colleagues (1982) and has been refined over several research studies (e.g. Young, Valach, Dillabough, Dover & Matthes, 1994; Young et al., 1997, Young et al., 2008) and explicated as action-project method (Young et al., 2005). Data was analysed with a coding system based on individual goals of both teacher and students in the process of learning and practicing mindfulness, joint goals, and the means used to reach these goals. Data from three main sources was accessed (whole group dialogue data, teacher-target student dialogue data, and self-confrontation interview data), along with a supplementary data source of post-class questionnaires and weekly logs which were used to build the context for the D & I. Data was analysed within the three dimensions of action as conceptualized in action theory and action-project method. These three dimensions are: action systems, levels of action and perspectives on action (Young et al., 2005).  85  Action systems refer to individual action, joint action, and projects. Individual actions incorporate goals, functional steps and elements. When these actions occur between people, they are called "joint actions" and are similarly comprised of joint goals, functional steps and elements. When a series of actions are linked over time by common goals, they are referred to as a project, or a joint project. Projects are made up of intentional actions over a time period, and have an end point (when the goals are achieved). According to contextual action theory, most projects that humans undertake are social in nature, involving more than one individual (Valach et al., 2002). If goal-oriented actions in the form of projects are more long-term they can be called careers in the non-occupational sense. The second dimension of action is the hierarchy of levels. There are three levels within an action or a project: the goal, the functional steps and the elements. The highest level is the goal of an action, which is its meaning and is based on the overall intention of the people involved in the action. The next level is made of the functional steps which are a sequence of verbal and nonverbal behaviours with a common function. These functional steps move people towards their goal. Lastly, at the lowest level of action are the conscious and unconscious verbal and nonverbal elements involved in a behaviour (eg asking a question, moving closer or backing away). The third dimension of action is the perspectives of manifest behaviour (e.g. language), inner processes (cognition, emotion) and social meaning (e.g. what it means to the student and teacher to engage in the action). These perspectives are non-hierarchical. Manifest behaviour of an action is often language but can also be non-verbal. The inner processes involve the cognitions and emotions that steer, regulate and energize the behaviour. The social meaning involves the goals and intentionality of the individual in her social context.  86  The D & I and self-confrontation interview transcripts for each dyad provided the joint project findings, the functional steps and the elements used to enact them. These data were analysed according to the action-project method as described in Young and colleagues (2005). Joint and individual participant goals, the action steps (functions) engaged within the conversation in order to achieve the goals, and the action elements (specific behaviours such as language) employed to move through the functional steps were identified. All data were transcribed and coded top down (identifying the overall goal of the sequence of action) and from bottom up (coding of specific elements and steps that make up the action). Steps in data analysis. These were the steps in the analysis process: 1. Top-down preliminary analysis (preliminary identification of goals). Working session by session, and dyad by dyad (6 possible dyads), the researcher first identified each dyad‟s (teacher-student) overall joint goal for the action (particular minutes of dialogue of a particular session). This was done by reading the transcript of the dialogue while watching the video recording, in order to get a holistic understanding of the conversation. The largest goal of segments of the dialogue was noted, by asking "What are the teacher and student trying to do together in this dialogue?" "What is this conversation about?" This initial approach to the data is a top down step, by first looking at the overall conversation and positing a general goal based on the conversation itself. This was done on hard-copy print-outs of the D & I transcript, with each dyad‟s exchange blocked out in pen. 2. Further identification of preliminary goals and projects. Next, the self-confrontation interview data were referred to. Still using the hard-copy print-out of the D & I dialogue, the dialogue was read again, but this time minute-by-minute, referring to the  87  corresponding self-confrontation interview data. An overall intentional framework for the joint actions of each dyad was posited, with preliminary individual goals and joint goals. This preliminary analysis was conducted by the researcher and then revised in consultation with the supervisor. 3. Member-check of preliminary goals and projects. Typically in action-project method, a brief meeting between the researcher and participants is held midway in the data collection to confirm what the researcher has observed as joint goals and projects. At this time, the participants will have the chance to provide feedback, correction or elaboration. In order not to interrupt the learning process of the participants, this step was left to the end of the course, when each target student and the teacher was emailed a one-page summary of the preliminary, top-down individual and joint goals and projects identified thus far through the D & I and self confrontation interviews (Appendix I). These projects were identified pre-coding (due to the logistics of the time required for the coding and analysis) by reading the transcribed dialogues and self-confrontation interviews and identifying goals and joint goals for each dyad, top-down. Target students and teacher replied saying that the summaries accurately reflected what they were aware of doing during the D & I. In the case of the joint actions of Jackie and Ruth, which involved the suggestion of an implicit attachment project (later called the joint connection project), both Jackie and Ruth each replied saying that although they had not been aware of this operating as a project for them, the description “resonated” and made sense to them, and was “interesting.” This preliminary stage of the analysis was done concurrently with the data collection for the 8-week MBSR course. Since all transcription was also necessarily done within this time framework, it was a very tight turn-around time in order to have the  88  preliminary summaries of goals and projects ready for participants by the end of the 8week course. 4. Coding-step one. Then the data from the dialogue was coded and analysed minute-byminute from the bottom up, using the qualitative analysis software, HyperResearch (version 2.8, 2007) to organize and store the coded data. This level of analysis, which was undertaken on the minutes of the D & I dialogue which had related self-confrontation interviews, was undertaken by the doctoral student and a research assistant who was highly experienced10 in action-project method coding and analysis. Each phrase (from the session dialogue) of each speaker was coded according to a list of microelements. This code list was derived from a pre-existing code list from another action-theory research project and was adapted slightly to better fit the conversational pattern of mindfulness dialogue. Eight codes were added to the existing list of 65, including such codes as “asks for body sensation” “describes body sensation” (Appendix J). These codes represent behavioural (language) elements that best described what the participant was doing in each segment. For the first few sessions, the coding of elements (first step of the coding procedure) was done individually by the main researcher and the research assistant and then checked to establish agreement at this level of coding. Once the segments were coded at the element level, the second step of the analysis began. 5. Coding and analysis - step two. In this second, interpretative step, it was determined collaboratively what the dyad was doing together and individually within the segment, by asking the question, “Why might he or she have used these elements?” to posit a functional step, minute by minute. Next, continuing to work collaboratively, in order to  10  The RA had developed expertise in action-project method by serving on the primary investigator‟s research team for three years.  89  access the participants‟ internal processes and get a better understanding of functional steps and goals, the self-confrontation interview transcripts were referred to for each participant for the particular minutes of the conversation being analysed. The questions, “Why did they use that functional step?” and “What are they doing together?” guided the collaborative identification of the goals and joint goal. Joint goals were thus systematically identified through dialogue analysis informed by the unspoken dimension of thoughts and feelings as contributed through the self-confrontation interviews. Coding and analysis for this stage was done after the data collection for the whole MBSR course was complete, and took several months. 6. Coding of all D & I transcripts. Minutes of the D & I which did not have accompanying self-confrontation interviews were also coded to the level of functional step (goals were not identified without the self-confrontation data) by two other research assistants hired to complete this step. 7. Writing of narratives. Once all coding was completed and the functional steps and goals and joint goals identified, a narrative was written for each session which attempted to describe the joint actions and projects enacted in the D & I for that session. This was a moment-by-moment interpretive analysis of the process of learning mindfulness from both the teacher‟s and the students‟ perspectives. In a hermeneutic process, the author moved between the bottom-up collaborative coding (organized in HyperResearch), the transcripts of the in-session dialogues, the self confrontation data about their internal processes, the supplementary data from questionnaires or weekly logs, and finally, the theoretical framework of action theory. Each of the nine narratives was approximately 20 pages long. An attempt was made to capture not only the dyadic joint goals and projects  90  (teacher-student) in the particular session, but the group joint goals and projects. This was possible because there was considerable overlap in the minutes used for selfconfrontation, such that two or more participants and the teacher often commented on the same minute. 8. Identification of group (joint) projects. In the writing of these session narratives, the longer-term aspects of joint projects and career became apparent, as goals and joint goals were pervasive or repeated over sessions. It was observed that although the content topics and type of meditation practice varied from session to session, the same joint goals were engaged in the D & I over time. Thus it was not difficult to identify five subordinate joint projects directly from the bottom-up coding, since these five projects were present from the beginning to the end of the 8-week course. What was more subtle was the expression of the participants‟ individual “life-projects,” their personal histories that became part of the intentional framework of the course. Since personal stories were discouraged in the dialogues, these individual projects were less observable, yet became salient enough by the end of the course. The member-check summary of individual goals and projects that was given to participants near the end of the course included the topdown identification of these more personal projects, articulated prior to formal coding and analysis, but the life-projects became more identifiable in later stages of analysis when all data sources were included and actions and projects were viewed over time. Purpose of member-checks and collaborative coding. Within the interpretive/ constructivist paradigm of this application of action-project method, a few points should be noted. The primary purpose of the member-checks of the preliminary analysis (at the end of the data collection but before the in-depth coding process) was not to confirm the researcher‟s  91  accurate understanding of the participants‟ experience (as in a post-positivist approach). Rather, more in line with philosophical hermeneutics, the member-checks acted as an opportunity to deepen and broaden the researcher‟s and participants‟ understanding by entering into an active co-constructed process (Haverkamp & Young, 2005). While the participants actually did not offer different or new understandings to those presented in the preliminary one-page summary, in the case of the teacher and one participant, their comments that they were not aware of the implicit attachment project but that it made sense to them and was “interesting,” involved the deepening of participants‟ understanding of their process. An example of how the researcher‟s understanding of participant process was deepened was in the unexpected member-check with the participant who decided to leave the project early (described on page 191). Thus there was a dialectical understanding of the phenomenon in question. A similar hermeneutic process is eventually followed in the collaborative coding. Actionproject method is unusual in that, while in the broadest sense it is a constructivist (and even social-constructionist, depending on the application) method, it does contain some post-positivist aspects. The initial bottom-up coding of the elements (the first stage of coding) is one of these. Language is initially coded in meaning units according to what Valach and colleagues (2002) describe as “structural” linguistic elements (p. 61) which are not context dependent. An example of a code is “asks a question.” The primary researcher and RAs did this level of coding separately, then checked it for agreement. After a few rounds of element-coding, the agreement between raters is typically very high. This stage is concerned with accuracy and serves a double purpose of “slowing” down the researchers‟ interpretive questions and understandings, anchoring them in the data.  92  It is after this initial step of coding that the hermeneutic loop of collaborative interpretation and understanding begins. Moving between the coded elements of the language units, the larger over-all meaning of the dialogue, and the meanings expressed in the SC interview, the researchers work together, in an interpretive discussion, in deciding the goals and joint goals of the minute of dialogue. This is done collaboratively, not with the purpose of “accurately” ascertaining the goals, but instead, in engaging in a deepening process of understanding the goals. Because the goals and joint goals are based in social meaning, which is (from the interpretive/constructivist approach) always constructed rather than essential, we construct our understanding of the social meaning from the sources available to us: both the participants‟ naïve understandings of their own intentionality as they watch their own actions on videotape in the SC interviews, and our naïve understandings of the same. Thus the collaborative analysis, in the end, does not seek accuracy through consensus or validation, but rather, seeks the rich, deep understanding that results from the collaboration of musing, discussing, and moving from part-to-whole, and whole-to-part in the data in an interpretive fashion. Researcher's Subjectivity It is acknowledged that the data was analysed by the writer, who has knowledge of mindfulness theory and practice. As a long-time practitioner of mindfulness meditation, and a counsellor trained in mindfulness-based therapies, I have assumptions about the nature of mindfulness and the process of learning mindfulness. Indeed, it is because of my lay observations and experiences of the mindful interactions between teacher and student (and therapist and client) in the past, that I was inspired to investigate these interactions more systematically in a research forum. While my own understanding of mindfulness no doubt informed my interpretation of the data, I aimed for researcher reflexivity in staying aware of how  93  my preconceptions may influence my conclusions. In particular, the issue of demand characteristics has often dogged researchers of meditation and spirituality. If teachers, students, and researchers are invested in the protection of certain spiritual beliefs and practices, or in appearing like a "good meditator," these motivations inevitably colour their reports of the researched phenomenon. On the other hand, it is this very subjectivity that is included in the "social meaning" of action-project method, and is an important part of the action of mindfulness that I am attempting to investigate. That is, perhaps trying to appear like a good meditator is part of learning mindfulness in an MBSR group. Thus, what may be negatively perceived in another research design as demand characteristics in participants, or bias in researcher, is included in the social context of the phenomenon under investigation in action-project method. What is important that the researcher is aware of how her biases and pre-understandings are being enfolded into the interpretation. I kept a journal during the data collection about my observations, reactions, questions and experience. I became aware of a rather romanticized view I held of the “spiritual teacher.” I tried to hold this view lightly and allow the emergent findings to inform my own subjective preconceptions and conclusions. An example of an expectation I held initially was that the teacher would be aware of and refer to her own emotions of “loving-kindness11.” Instead, when asked in SC interviews about how she was feeling, the teacher sometimes referred to those emotions, but more often said that she was not “feeling” as much as being present, as in Session 3, when she says “It‟s not emotional. It‟s more noticing, attending, wondering, staying open” (RuthSC29). Becoming aware of how the teacher‟s experience was different from my assumptions was  11  Loving kindness is one of the “Four Immeasurables” (brahma-vihara), the Buddhist virtues or attitudes which are cultivated through meditation: Loving kindness, compassion, empathy and equanimity (Thera, 1965, p. 76).  94  important in trying to understand the role of the attitudinal and/or emotional aspects of mindfulness (e.g. acceptance, nonjudgement, loving kindness, etc) in this particular case. Another important part of the process of reflexivity was the collaborative nature of the data collection and analysis. I was not attempting to pin down, in an objective or essentialist manner, the phenomenon but rather, was interested in how it was constructed in the group by the participants, and even how the research assistants, by virtue of being there in the hermeneutic circle as it were, understood it. The RAs who assisted in the data collection (taping, interviewing and coding) had many observations and questions about the process which I noted and reflected on. Their common questions to me were “what is mindfulness, exactly?” and “what‟s the point of mindfulness?” Their curiosity informed their attentiveness in interviewing, as we all engaged in investigating what the group was doing, and what their actions were “about,” that is, what the meanings of mindfulness were for this group in particular. The RA who worked closely with me to collaboratively code and analyse was an essential part of the hermeneutic. She did not participate in the data collection and was relatively unfamiliar with mindfulness theory and practice, and at the same time was very experienced in the coding and analysis procedures of action-project method. She provided an important “outsider” perspective and, for example, would sometimes refer us back to the basic bottom-up coding of the elements, and the self-confrontation data, if we strayed too far interpretively in her opinion. So while “accuracy” was not our goal, the process of interpretation was not without parameters. We aimed to stay grounded in the data and returned again and again to view particular moments of the video, or re-read the transcripts, to stay close to the participants‟ recorded experience.  95  Issues of Representation Following the action theory framework as previously described, the findings are represented as the joint projects that were identified almost as themes are identified in conventional content analysis. Within each project, the particular functional steps and the elements employed by the teacher and students are described. Specific behaviours, language (verbal and non verbal) and internal processes (thoughts and feelings) and personal meaning (goals) are reported. Quotations from transcripts are provided as illustration. Also, attention was paid to changes that occurred in the projects over time, and how the project of interest is situated in the life of the participants (e.g., is it central or peripheral, how does it relate to other projects in which the individual is also engaged?). These descriptions demonstrate how mindfulness is learned, taught, practiced and/or otherwise experienced in the teacher-student, and group relationships. Since the group was the case, it was considered initially to not refer to individuals by pseudonyms but rather more anonymously (e.g. Student 1, etc.). However, since the study was about learning mindfulness as a social and relational process, it was decided to give participants pseudonyms and attempt to capture to some extent the colourful mix of personalities and relationships that emerged over the 2-month period. This seemed the most appropriate way to represent the learning process, particularly when a relationship project was identified as one of the main super-ordinate joint projects. Participants did not learn mindfulness in an anonymous setting with nameless people. By using pseudonyms and removing personal indicators of identity, confidentiality was preserved as much as possible while still attempting to capture the personal flavour of the process.  96  Ethical Considerations Approval from the Behavioural Research Ethics Board, UBC, was obtained. The three ethical issues that appeared most important were confidentiality, limiting intrusion in the participant's learning process during their participation in the MBSR program, and limiting undue cognitive and physiological demands of an intensive process. Confidentiality was protected by using pseudonyms and changing identifying markers. I brought an ethical awareness and concern to the representation of participant stories, seeking to minimize potential discomfort, for instance by disguising the rare examples of so-called “negative” reactions to other participants. It is the researcher's opinion that participants' learning processes was not curtailed by the study but rather enhanced, since the processes of action-project method required a level of mindfulness and thus provided "extra practice" in learning mindfulness. I attempted to be flexible in my demands of the participants during the process, sometimes cutting the interviews short when fatigue was observed, providing refreshments each session, and always giving target participants the option of declining interviews at the end of each class. Criteria for Evaluating the Worth of the Study Qualitative research has various possible standards of establishing the worth or merit of a study (Morrow, 2005; Sandelowski, 1986). Generally, for the action-project method, rigorous findings result from rigor in the application of the method itself, and rigor in the way the current research project offers defensible reasoning in the interpretations offered (Young et al., 2005). Trustworthiness was assessed in a few ways. The first step was by the member-check which occurred just before the end of the course, during which participants (including the teacher) had the opportunity to question, change or add to the preliminary findings of the researcher. The ongoing questionnaires and weekly log also offered participants the opportunity  97  to give ongoing feedback on the process of the project. Second, accessing multiple data perspectives (the dialogue itself, the self-confrontation interview data, and the log books) contributed richness, breadth and depth to the data. This method includes a detailed audit trail of the research process that can be consulted if necessary. Third, the coding and much of the analysis was conducted by two or more researchers at any one time, providing an ongoing check against systematic distortion due to individual bias while at the same time not aiming for “accuracy” per se, but rather, a rich interpretative co-construction of meaning. At the later stages of analysis, researcher interpretative conclusions were presented several times to the doctoral supervisor and revised after questioning and discussion about alternative ways to understand the data. Another criterion of worth is coherence, the way different parts of the interpretation create a complete and meaningful picture. Internal coherence was assessed through the memberchecks, and through collaborative consultation and analysis with research assistants and the supervisor. Further, action-project method is situated within a theoretical framework which encourages an ongoing hermeneutic movement between research findings and action theory. External coherence, how the interpretation fits against existing research, will be assessed by the academic community in the dissertation defense. Lastly, the criterion of pragmatic usefulness, whether or not the conclusions are useful for teachers and counsellors and in what ways, was addressed in the discussion of the findings in Chapter 5.  98  Chapter 4: Findings The first research question that was explored in this study is, “What is the process of learning mindfulness through the dialogue and inquiry period of the MBSR course?” To answer this question, I observed the individual and joint projects that the teacher and students engaged in during the dialogue and inquiry (D & I) of MBSR. The observation and analysis of these projects illuminated the overt and covert goals of the teacher-student mindfulness experience over the 8week period, particularly the joint goals which underlie the social action of learning mindfulness through dialogue and inquiry. Answering this question also illuminated how the teacher-student relationship contributed to the learning of mindfulness. The second, related question is, “How does the social learning of mindfulness in the D & I period construct the experience of mindfulness?” In answering this question, I sought to describe and understand how mindfulness was constructed in the D & I through the joint actions and projects of teacher and students. Although the purpose of the study was not to ascertain if mindfulness was learned relationally (the joint or relational construction of action is an ontological assumption within action theory), the findings demonstrate a richness of relational processes. Indeed, while the mindfulness project was the super ordinate class joint goal – all participants joined the group course in order to learn mindfulness – it was embedded in and constituted by a concurrent relationship project. Perhaps the most interesting finding is that the very process of mindfulness which participants endeavoured to learn and practice in the “individual” formal meditation exercises of, for example, the body scan or the sitting meditation, was replicated, amplified and embodied in the subsequent dialogues with the teacher, through the sub-ordinate joint projects of attention, language, insight, compassion and connection. The D &  99  I component can thus be seen as a relational way of practicing mindfulness which yielded experiences and embodied insights which may in fact be difficult to access alone. Figure 2. Dialogue and Inquiry in MBSR: Joint super- and sub-ordinate projects  The findings of this study are described within the hierarchical model of contextual action theory (Figure 2). At the widest and most general level of career12, each participant entered the MBSR course with individual goals connected to ongoing life projects which contributed to a context for the group‟s experience of learning mindfulness. These life projects, shared in the form of stories and personal examples, often formed the curriculum of the class, as the teacher responded to whatever was offered in the moment by the participants to execute the 12  The reader is reminded that within contextual action theory, “career” refers to an ongoing life project, not necessarily related to occupation. Examples of careers may be an illness career, a parenting career, a spirituality career. For the purposes of this study, I will use the term “life-project” rather than career.  100  dialogue and inquiry. Whether the D & I was about the immediate experience of a mindfulness exercise just completed in class, or about homework experiences of practicing mindfulness, the participants‟ individuality flavored their contribution. However, it is of interest that although each participant brought his or her unique history and goals to the mindfulness project, their individual story was not important in the same way as it might be in a psychotherapeutic process or support group. Instead, these stories were used by Ruth and the group as means to an end, as ways to learn and practice mindfulness. Ruth often asked the participants to notice what is “underneath” the story – thoughts, emotions and body sensations. Nonetheless, these individual stories – familiar human narratives of pain, suffering, and stress – created an ongoing context for the group‟s actions, and in fact an extemporaneous curriculum. There were some commonalities in these individual life-projects across the participants, which will be described in the first section. At the second level of organization of action, the learning of mindfulness by the teacherstudent dyads and the group in the Dialogue and Inquiry component was enacted through two super-ordinate joint projects: the mindfulness project and the relationship project. While a salient project in its own right (with some actions and sub-projects not explicitly oriented to learning mindfulness), the relationship project was inextricably intertwined with the mindfulness project and indeed was the vehicle for learning mindfulness in the D & I. Finally, within these two super-ordinate projects we find several other class joint subordinate projects, which operated as functional steps to achieve the goal of learning mindfulness. The subordinate projects most explicitly supporting the mindfulness project were attention (noticing with gentle kindness), language (describing), and insight (understanding). The subordinate projects most explicitly supporting the relationship project were compassion  101  (helping) and connection (connecting or relating). The personal stories (connected to the longerterm life-projects) of the participants were retold through these subordinate joint projects. That is, participants learned and experienced mindfulness in the context of their life issues and concerns (life-projects), through the relationship project formed dyadically between the teacher and each participant and also across the group, and most specifically, through the subordinate joint projects. It will be important to keep in mind that the division into levels and types of projects is only a heuristic for representing and understanding the complex processes involved: in fact these processes were highly overlapping, mutually constituted and dynamic, and should not be reified into any essentialist, separate or static building blocks. The Context: Life Projects of Students and Teacher In contextual action theory, context is viewed not as a “thing” to be separated out and controlled, but rather, the field in which action takes place (Valach et al., 2002). The action processes of learning mindfulness are understandable in relation to other actions and projects within which they are taking place. We might conceptualize this field in an MBSR course as made up of a number of contributing influences: the historical and religious background of Buddhism, for example, or the pedagogical zeitgeist at the time of the creation of MBSR in 1979, or the philosophical assumptions behind mind-body medicine. Of particular relevance to this study‟s research questions was the contribution of the participants‟ life-projects -- their wider goals for participating in the course -- to the group context for the mindfulness project. Each participant entered the MBSR group not to learn mindfulness for its own sake but with wider reasons which were connected to their own particular history. These reasons, ranging from reducing pain to finding peace, were stated explicitly in the first meeting when Ruth asked them directly why they had joined the group. As the weeks went by, and participants brought  102  examples of attempts to practice mindfulness in their daily life to the D & I, it became clearer what each participant was seeking through their participation in the mindfulness project. Indeed, based on the nine session dialogues, the self-confrontation interviews, and the supplementary data of questionnaires and weekly logs, it would be possible to write quite detailed “case studies” of each target participant, including the teacher. However, since the focus of this study is not individual but rather joint processes of learning mindfulness in a single-case study of the group, attention was instead placed on commonalities across the participants in terms of the life-projects which brought them to the group, and also how these participant life projects joined with the teacher‟s life-projects and intentions. This is important in understanding and describing the particular context for the action of learning mindfulness in this case. In different guises and stories, all participants sought to get rid of something unpleasant: physical aches and pains, insomnia, chronic pain, sadness, self-criticism, and the stress of daily life. At the same time, they all hoped that mindfulness-training would bring them a sense of peace. This pushing-away of pain, and longing for peace, formed part of the context for the learning of mindfulness from the students‟ perspectives. Other common participant life-projects included self-improvement, and relationship enhancement. Exactly how these participant lifegoals were met by Ruth and one other, and transformed through the process of mindfulness in the D & I, is elaborated in detail later in this chapter. But in brief, participants were paradoxically invited to include what they were trying to get rid of, and to stop seeking peace. Ruth’s life-projects. What life-projects did Ruth bring to the group context? We learn that she had a background in education and the helping professions and had many years of interest and training in mind-body alternative treatments. Her own mindfulness practice was a life-project, and she self-disclosed a few times to the group about her daily life struggles with  103  practicing mindfulness in midst of automatic stress patterns of overwork or overeating. She mentioned a few times in SC (self-confrontation interview) that the course was not as much a content for her to deliver to students as an experience for her to facilitate, from a position of her own mindful practice: RuthSC13 15: ... This is only about practice. It is only about practice. And there‟s no difference between teaching or facilitating and participating. There are all one and the same. So it‟s a shared ... it‟s a definitely shared experience. It‟s not something that you could ever pretend if it didn‟t happen for you ... It has to be recognized as a shared experience . . . ... as part of the human condition. (Session 4) She was intentional during the sessions about being as mindful as possible as she led the D & I. For example, in the first session‟s SC, she said, “I was trying to be with my breath and my body and in touch with my feet and in the body, present” (Ruth4). Yet for Ruth, mindfulness is not just valuable for its own sake, but ultimately for the insight and liberation it potentially offers. She emphasized to the class several times that the purpose of the cultivation of mindfulness is liberation from automatic patterns of suffering: Ruth210: It is unconscious. It‟s my pattern, just below the level of awareness that drags me to do this. And so the fact that we‟re noticing what we‟re doing that‟s dragging us to do this -- If we can back up a little bit and see what that sensation starts like, then we could make a decision around it. (Session 5) In her SCs, she sometimes expressed her wider intentions – that is, not just to teach mindfulness, but why she wanted to teach mindfulness. The desire to help others motivated her. In her SC, she often mentioned feelings of compassion for participants. For example, as she noticed Paula‟s harsh self-punitive attitudes, she had “a feeling of how hard and sad it is that we‟re so hard on ourselves, and a recognition that I can be as hard on myself as anyone. So I really felt an openheartedness, feeling an empathy and a basic human compassion for this kind of behaviour” (RuthSC6, Session 1). Embodiment, personal meditation practice, insight and compassion 13  There are two data sources of quotations used in this study: self confrontation interviews, and D & I. Quotations from the self-confrontation interviews will be noted by the letters SC and then the line number from the transcript.  104  appeared to be powerful life-projects for Ruth. The person of the teacher was an undeniable part of the context of this MBSR group. The manualized14 curriculum of the MBSR course was not “delivered” separately from these life-projects and goals of the teacher (or the participants) but rather, inextricably embedded in them, and enacted through them. Participants’ life-projects of “getting rid of pain”. All participants expressed their desire to get rid of various unpleasant issues in their lives, and discomfort or unwanted thoughts during the mindfulness practice. For example, Maria‟s presenting goal for learning mindfulness was to reduce work stress. As the course went on, we come to see how stressful it was for Maria, an up-beat, high-energy person, to acknowledge so-called “negative” feelings, particularly sadness. For example, near the end of the course, she was faced with strong feelings of sadness after the all-day retreat: Maria23: Yeah, sad. Ruth24: Sad Maria25: I woke up in the morning totally sad, I didn‟t know if I‟d had a dream that was sad or what. I was just incredibly sad this morning. Ruth26: This morning. Ruth began very tentatively by just repeating words as minimal encouragers, with the goal of getting Maria to stay with the feeling. She said in her SC that she was trying “to get her to look within and see what it is and just sit with it, just sit with it, be present with it” (RuthSC9). Maria, on the other hand, reported in her SC that she felt “shy” “out of her comfort zone” and “a little bit not wanting to share” (MariaSC5). This intensified a few minutes later when she exclaimed in her SC that she “hated” these moments of interaction with Ruth and found them almost unbearably painful (MariaSC23). Of the group, she was the most enthusiastic member over the 2-month course, explicitly trying to help Ruth and others, and yet also seemed the slowest to 14  McCown et al (2010) refer to the MBSR curriculum as a “template program” rather than manualized, based on an outline which is, in Kabat-Zinn‟s words, not a “cookbook” manual (Santorelli & Kabat-Zinn, 2001/2007, Curriculum Outline Introduction).  105  embrace the invitation to include strong unwanted emotions. She commented she was surprised how these sad feelings surfaced at the end of the course, and we are left wondering how her “positive thinking” life-project might incorporate them after the course. Getting rid of, rather than feeling, sadness appeared to be her goal. Gerald had a salient “pain story” which he alluded to often. He wished to reduce his chronic pain and explained in Session 4 that the way he had tried to do this, with limited success, was by ignoring it: “I‟ve trained myself to focus on other things ... just won‟t go there” (Gerald34). What ensued was Ruth gently and kindly drawing Gerald into a joint mindful exploration of his pain. The complex joint actions involving mindfulness and Gerald‟s pain story will be demonstrated in detail in later sections of this chapter. Perhaps the most intriguing and sometimes humorous example of a participant‟s goal of getting rid of pain was Gail who hoped that mindfulness-training would offer a way to eradicate insomnia, fear, stress, yawning, and other discomforts. This goal was enacted in each week‟s session when Gail fidgeted, wept and yawned throughout each mindfulness exercise, and then in the D & I tenaciously demanded from Ruth a solution for her embodied distress. Ruth instead, each time, offered the mindful alternative of allowing and observing it. This difference between their intentions produced a kind of tug-of-war between them over the whole 8-week course. Ruth poignantly asked her in session 5, “what would happen if you didn‟t fight?” This question encapsulates the action of mindfulness and was particularly salient for someone like Gail whose bodymind seemed to hold the residue of the “fight” response. It often appeared that Gail misunderstood the course curriculum, driven by her desire to get rid of discomfort. This gave Ruth a chance to embody, time and time again, the patient, consistent, repetitive offering of curiosity and nonjudgmental attention to Gail that she was inviting all the participants to give to  106  themselves. There were many humorous moments in the push-pull between Ruth and Gail: Gail423: All my thoughts were about “how do I stop yawning?” Evryone424: Laughter Ruth425: How do I stop yawning, ok. Gail426: And the deeper I was breathing, the more I was yawning and the more I was tearing. Ruth427: Could you stop trying? Gail428: Well, I guess. But I would just continue yawning then. Ruth429: Well maybe that‟s ok. Gail432: I just don‟t know why nobody else does it! Like what‟s wrong? Me and my yawning. Ruth433: It just is. Gail434: Ok. Ruth435: Would that be ok? Gail436: I was hoping that somebody would just yawn once. Ruth437: Well I broke into a hot flash, does that count? Evryone438: Laughter Gail439: (laughs) Yes it does. Ruth440: Ok. That‟s how my body handles energy. Gail441: Ok Ruth442: Everyone has their own unique way. Just be gentle and notice. Seeking peace and well-being. Participants also framed their goals in terms of wanting peace. In Session One, Gail stated “I hope this course can help me find peace with myself more.” In her SCs, she often made note of and celebrated moments of “calmness” and relaxation which, as is described in later sections, both Ruth and other participants helped to co-construct with her. Jackie also sought well-being and peace. She explained in the initial introductions of the first session that she was taking the MBSR course to learn how to “appreciate what I do have and be in the moment and take time out for myself” because “I am always on the go, doing all these things at the same time and [trying] to get me to where I want to go.” Although she did not state explicitly that she wanted to become more aware of and connected to her body, this quickly became the salient way that Ruth and Jackie work together to achieve Jackie‟s goals. Maria similarly wanted a sense of ease. In session 2, she commented on her preference for “nice” “pretty” moments: 107  Maria184...I found it easier to be mindful when I saw something pretty or like um, it was just a nice day and the sun was shining. And it was easier to be in that moment. On the rainier days when I didn‟t really want to be outside (laughter) it was harder to be mindful. Ruth187: Ok. Did you notice anything about those days? When you were not happy with that moment? Ruth said in her SC that in this moment, she deliberately chose to “direct her attention to the unpleasant,” “to explore that moment”; this is a good example of how two individual goals meet and become joint (or not). Paula sought relaxation. She reported struggling with the bodyscan, moving and fidgeting in an attempt to find a comfortable position: Paula132: So if I‟m not feeling comfortable on my back, is it ok to be on my side? Ruth135: So there‟s one thing that you‟re saying there about not being able to relax. Remember how we said last week that the purpose of this is not to relax. It‟s nice if it happens as a by-product but it‟s not to relax. It‟s not to relax; it‟s to notice feeling states that come up in your everyday life. Paula136: Do you really, do you really ... I missed that part completely. Ruth137: Laughs Evryone138: Laughter Tasha139: I missed that part too. We do not know the reason that Paula dropped out of the course after Session 3, but it is possible that she did not see how her goal of relaxation was going to be met by this paradoxical approach of mindfulness. On the contrary, Gerald appeared to embrace the paradox. He aimed to “get back to the centre I used to have” (Gerald28, Session 1) and waxed eloquent by mid-course about his having “found a path” (GeraldSC22, Session4). He appeared to have a larger life-project of spirituality. Barbara stated a similar goal in the first session, “I just want something to centre myself in my daily life” (Barbara14). Over the weekly sessions, she described her very busy professional and family life. Her goal of becoming more centred through the MBSR course apparently was not achieved: she dropped out after Session 6, explaining to the researcher that she did not “connect” with the teacher or the MBSR curriculum. In particular, she reported with  108  disappointment that she did not find the classes “soothing or peaceful.” Her weekly logs described a constant level of exhaustion and stress in her daily life and the questions “am I doing this right? Is this helping?” were asked several times in her weekly written reflections on mindfulness practice. Doing it right (self-improvement). Several participants described the MBSR course as a part of a self-improvement life-project. The desire to be competent in their lives showed up in the way they tried to learn mindfulness. For example, in Session 2, Jackie told Ruth that she worried she wasn‟t doing the homework right: Ruth201: When it wasn‟t so good, you thought it wasn‟t right? Can you say a little bit about how that felt? When you thought it wasn‟t the right thing. Jackie202: I just felt like there was a lot of like pressure and like feeling guilty about it and one day I had this huge assignment to finish for a class and I was trying to eat at the same time and be mindful and transcribing – it doesn‟t work. It‟s too much like multitasking. I was aware of all the things that came up, like “I committed to this, I have a responsibility” and “I should be able to do it” or “Just do it” but then “No I don‟t have time!” Ruth203: Ok. And those mind states – see if they are familiar. Are they familiar? Jackie204: Yeah. Ruth205: Do you know them? Jackie206: Yeah. Ruth207: Next time, if you could look in the body. Look in the body-mind and see what goes on there too, in response to those mind states. Just notice. What‟s going on there? But with a gentle kindness. Jackie commented in her SC that she found this exchange was helpful in increasing her awareness of her habitual patterns: JackieSC4: Yeah, it was really meaningful. It made me more aware of that dialogue that I have with myself and the expectations that I have. And then what happened at the end was really interesting. When Ruth asked me, Are those feelings familiar, is that familiar to you? And it‟s incredibly familiar, like that‟s how I go through my life, like have high expectations and commit to things and then get them done... Lindsay‟s self-improvement goals became salient as the weeks went by. She was gripped by a perfectionism and self-critical attitude that seemed to be made worse at times by “trying” to be  109  more self-compassionate. She was especially frustrated by not “understanding” mindfulness to her satisfaction. In session 7, when Ruth asked her how it felt not to be perfect, Lindsay turned scarlet and bowed her head in apparent shame. In her self-confrontation she explained, “I hate the fact that I can‟t be perfect” (LindsaySC41). Thus Lindsay‟s life-project of perfectionism was involved even in her learning of mindfulness. Enhancing relationships. Although none of the participants said outright that enhancing their relationships was their goal in taking the MBSR course, all participants brought examples to the D & I from their interpersonal lives outside the class, sharing how they were or were not able to be mindful in communication with others. This was an explicit homework assignment only one week, but participants consistently tried to apply what they were learning in class to their relational world. Each participant appeared to have a life-project of maintaining or improving relationships. This is strikingly apparent in the weekly logs. Gerald pondered in his log for Week 3, “While chatting with my best friend, I was wondering if all good relationships are based on mindfulness. It seems to me that this would be true 90% of the time.” He described in detail the process and results of his intention to be mindful in conversations with his colleagues, wife, son, friends. For him, mindful communication consisted largely of mindful listening. Other participants remarked how they practiced speaking while trying to stay aware of their inner experience: “I was aware of tightness in my stomach and chest, I was trying to feel my feet and stay present in my body. By paying attention to what was going on for me, I was able to say in a calm manner that I needed to walk away for a few minutes” (Paula, weekly log 2). An exception to this was Laurie, who found herself less inclined as the weeks went on to engage in conversations at all. She became curious about the role of language and communication in mindfulness and said in her weekly log for week 7, “I‟m curious as to how the  110  life would function without verbal interaction... I am often finding myself without words to talk to anybody, and a surfacing of emotions that I have never dealt with.” It is clear that all participants, even Laurie who seemed to be conflicted about how to be with others, were relationally motivated, and looked for ways to apply mindfulness interpersonally. Thus, the context for the mindfulness project is laid and dynamically created over time by the individual life-projects brought by participants and teacher. The Mindfulness Project The teacher and all 10 participants gathered together in order to learn mindfulness – the mindfulness project. As explained in the previous section, this joint project was not an end in itself, but was informed by wider life-projects of both teacher and participants. Somewhat paradoxically, the life-projects provided a way to learn mindfulness, that is, something to be mindful of. The students‟ individual goals for learning mindfulness, which were expressed in their personal stories and examples that make up the content of the D & I, contributed to the context of the mindfulness project. As these personal stories were brought forward in the D & I, Ruth invited participants to tell a somewhat different story, what we might call a mindfulness narrative. General, opinionated thoughts, memories and stories were de-constructed into a descriptive, particularized and embodied discourse. The D & I of this MBSR class appeared not to be a simple class discussion period. Mindfulness was enacted through dialogue, specifically through the sub-ordinate joint projects of attention, language and insight. The sub-ordinate joint attention project (noticing with gentle kindness). Paying attention without judgment is the basis of the mindfulness practices themselves (bodyscan, sitting meditation, walking meditation, mindful yoga). But it is not only in these formal exercises that participants learned to pay attention nonjudgmentally. In the D & I which followed these  111  exercises, the teacher worked with participants to help them become more aware of their inner experience of body sensations, thoughts and emotions. The key phrase which was repeated dozens of times was “just notice with gentle kindness.” Ruth invited them to report on what they noticed, helping them to access retrospectively what they may have overlooked, ignored, forgotten, or pushed away, and to do so with friendly curiosity. The repetitive phrase “with gentle kindness” was picked up and used often by students themselves, and they commented on its salience in their self-confrontation interviews. For example, at the end of the course, Jackie says in her final SC interview that “gentle kindness” are “a couple of key words that I‟ve really remembered from [what] Ruth has said” (Jackie SC 12, Session 9). Betty commented in her post-class questionnaire in session 9, “Noticing the details of my experience makes my life more real.” This project most specifically and repetitively involved noticing cognitions, body sensations and emotions without judgment. It also involved, as the course proceeded, noticing the habits of their mind, the impermanence of their experience, and the embodied nature of experience, and so was connected to the insight project as participants came to an embodied and experiential understanding of how they construct their experiences. The attention project was also inextricably interwoven with the language project since it was through describing their experience, in the D & I component, that the participants noticed and accessed their experience. It should come as no surprise that “attention” was one of the subordinate projects, occurring at the functional level, of learning mindfulness: paying attention has been seen as an essential part of the construct of mindfulness in several models (e.g. Baer, 2004, Lau et al., 2006, Linehan, 1993). In this sense, it might be said that the attention project is somewhat of a found construct. What is of interest is how an apparently private and individual cognitive capacity such as attention is enacted as a joint action.  112  Noticing what was unnoticed. The first extended D & I of Session 1 was focused on the perceived difficulty of the bodyscan, with participants reporting their difficulties with the apparent hope that Ruth will tell them how to make it easier next time. Ruth met each participant‟s description of their body sensations, thoughts and feelings with curiosity and nonjudgment, using the language elements of repeating, paraphrasing, asking for clarification, and suggesting: Barbara206: My attention got stuck in my chest. Ruth207: In your chest? Barbara208: And I couldn‟t get out of that. And then I also felt my mind started racing. Ruth209: Ok. And did you notice where your mind was going to? Barbara210: Everywhere. Ruth211: Everywhere? Every which way? Barbara212: Everywhere. It was speeding. Ruth213: Ok. . . What we‟re trying to do is notice where it goes. Just notice where it goes. It doesn‟t matter where; it could go anywhere, just notice. Ruth initiated the nonjudgmental attention project with “just notice …it doesn‟t matter where.” In her SC, we learn how intentional her response is: RuthSC1: Um I‟m conscious of trying to make sure that I am able to explore their experience fully without judging ... . It‟s really important to allow people to explore and so I was consciously trying to be present with her experience and trying to draw it out … In this first interaction with Ruth, Barbara seemed most concerned simply about expressing herself (linking to the language project), but this is an example of how, in the midst of the intention to put experience into language, participants noticed what was previously unnoticed – the attention project. Barbara was surprised to realize that she did not know what, or more specifically, “where” her thoughts were. BarbaraSC1 Um, I thought her exchange was helpful because um I was telling her that my mind was racing and she was asking me, “where were you going?” and I had to think about that and realize I had no idea, it was just all over the place. So her telling me to try and think of where it is, where my mind was going, was helpful to me.  113  Together, their joint goal was to help Barbara notice her experience without judgment, and to articulate it. An individual participant goal that became apparent in this initial class was looking for outcomes, to feel better as a result of mindfulness practice. Maria reported that after the bodyscan, her body tension dissolved (Maria220) and Lindsay noted that the bodyscan “had a lot of benefits” (Lindsay218): Lindsay218: For me, I started today with a pretty bad headache so it was really hard for me to concentrate because all I could feel was the pounding in my head but as we went through, I started noticing that that was becoming less and less and less so by the time we actually got to the head, I could still feel the tension of the headache, but it‟s not anywhere like it was when we started so even though I couldn‟t completely follow that, it had a lot of benefits (laughs). Ruth219: Ok, ok. So you noticed some relief.... Anyone notice tension in the body that they were not aware of? Ruth simply reflected these “positive outcome” observations back to them without evaluation and directed them to what they may be overlooking (for example, tension). In her SC, she noted that “it‟s better to try and draw things out with gentle curiosity” (RuthSC2). She also noted that in this segment she was trying to stay present: “I was trying to be in my breath and my body and in touch with my feet and in the body, present” (RuthSC4). So while the joint goal was to explore the participants‟ experience of the bodyscan mindfully, there were somewhat opposing individual goals; the students were drawn to looking for positive outcomes, while Ruth attempted to stay present with whatever they describe, with curiosity and nonjudgment, and to invite them to include what is unpleasant, what they would prefer not to notice. In session 5, Gerald described his feelings of “expansiveness” during the sitting meditation: Gerald138: Everything was expanding. Ruth139: Uhuh  114  Gerald140: And yet the breath was smaller . . . I heard somebody walking on the sidewalk. As well as some car going by. And the rain. And then the elevator click. So I could hear more Ruth141: Uhuh Gerald142: but it didn‟t bother me. But it was like the breath was very small and easy. The thoughts were still tumbling. They would sort of tumble and I‟d just let it go. Ruth143: Uhuh, uhuh. So would you say it was an expansiveness? Gerald144: Yeah. Feeling kind of ... noticing more. Ruth145: Spaciousness? Gerald146: Yeah. Gail did not know what to make of this. In her SC, she wondered at the difference between her experience and what Gerald was describing: GailSC22: I was thinking because he was saying that he was listening to the car driving, the people walking, and I thought, “oh my god, I didn‟t hear any of this”. I didn‟t hear any of it, I was so tuned out, and my brain was turned off so how could he hear this, and I was surprised actually with myself. Like, was I so much in trance or? RA28: Uhuh, surprised that you didn‟t hear ... and that another person had a different experience GailSC23: Yeah. So I felt, I don‟t know, it wasn‟t irritation. I felt kind of different with myself, like what, not disappointed, I don‟t know how to describe the feeling. Like, “how come I didn‟t hear that?” In this minute, Ruth was helping Gerald recall what he noticed and to label the quality of his ineffable experience. Gail‟s goal was to evaluate herself by comparing to others, probably to see if she was doing it right. It is also an example of the jointness of the attention project even outside the immediate teacher-participant dyad. By comparing her experience with what Gerald reports – “how come I didn‟t hear that?” -- Gail noticed what was unnoticed. In session 6, Ruth entered into dialogue with Barbara who shared her experience of being able to manage her performance anxiety through breathing and acceptance. Ruth84: So you made some space (nodding) around it? Barbara85: Yeah Ruth86: That‟s neat. And how did you do that? Barbara87: Just breathing. Being aware that this wasn‟t the end of the world. There were different options to look at, to try to get it going Ruth88: Uhuh, uhuh (nodding)  115  Barbara89: And if not, it was still a piece that I was passionate about and I could perform without it. Ruth90: Well, good for you. How did it feel when you were able to do that? Ruth reported feeling satisfied, and having a “heartfelt kind of pleasure” (RuthSC5) hearing about Barbara‟s “joy in finding control over her situation” (RuthSC2). With her phrases “that‟s neat” and “good for you,” she departed from her more usual non-evaluative attitude, presumably caught up in the pleasure of sharing Barbara‟s positive story. In an earlier SC, she commented on this kind of “lapse” in non-judgment by saying, “I‟m conscious of trying to make sure that I am able to explore their experience fully without judging and without labelling it which I did there, I called it “normal” which was not appropriate” (LinSC1, Session1). In this SC, however, she focused on how intentional her interaction was in terms of helping Barbara notice how she was able to cope with an anxious situation: RuthSC6: Yeah, I was trying to get at how she made a space around it. If she used her breath. Because I think it basically all boils down to the breath and that‟s about all there is to it. It‟s just taking some space and time and using breath to make distance. To put it in a nutshell. That was what I was trying to draw that out of her. RA7: To make sure that she was aware of the steps that she took? Ruth7: Uhuh. That she was aware of it and that others would um realize that this was how it was done. RA8: Ok, that‟s right. Ruth8: It‟s not just for her; it‟s for the whole class. Barbara, on the other hand, reported being less intentional. She said that at the time of experiencing and managing the anxiety, she was “not being mindful of the mindfulness” (BarbaraSC5): RA2: ... What do you recall about what Ruth was sharing? BarbaraSC1: Well it made me remember what happened ... Because up to that point, I hadn‟t really thought about it. I hadn‟t looked at it that way. This is an interesting comment in terms of the difference between the original experience and the retrospective account in the D & I. In this case, Barbara admitted that she did not intentionally  116  use mindfulness for self-regulation in her anxious performance. Ruth‟s goals were to help Barbara notice how she “created the gap” (e.g. how she interrupted a chain of reactive anxiety). In other words, Barbara appeared to become more mindful of the experience, more aware of what was previously unnoticed, in retrospect. The capacity for intentionality is expanded through the attention and language projects. Jointly, they explored her experience and taught the class through Barbara‟s example. Noticing thoughts and stories. In the D & I of the first session participants shared their experiences with the bodyscan, which were largely “difficulties,” for example, feeling distracted by noise, or the room temperature. Ruth asked if anyone had made up any stories about the environmental noise which occurred during the bodyscan meditation: Maria294: Yup. Ruth295: What was your story? Would you share with us? Maria296: Yeah, I was just kind of wondering who they were and what they were doing here and are they studying or are they the janitor, or are they robbing the place? Evryone297: Laughter Ruth298: Ok. Ok. So the story that comes up. So that‟s another thing I‟d ask you to notice, is this commentary of the mind. The mind commentary. Is it a story about something? What is it going on about? While they were exploring their experience of the bodyscan, Ruth had a goal of teaching inclusion of present moment experience and helping the participants pay attention to their automatic mind commentary. She did this by making use of what is happening in the class situation, in this case, hallway noise. In her SC, Maria noted, MariaSC1: ... So it was interesting to have somebody ... to kind of hear what you‟re saying and be able to form some kind of, not an opinion, but just you know “notice it” instead of offering any sort of advice or changing it ... She went on, MariaSC6: ... And then I was at first embarrassed about relating my story because I felt kind of bad about like I was not focused, I was totally listening to the people and I was reminded of the story about breaking into the place. I did this whole kind of story going 117  on. When she said, “Ok notice this story, and sort of think about that internally”, it made a lot of sense, it made me feel a lot less guilty about being unfocused. Then Ruth moved on to speak with Lindsay: Ruth310: . . . So if you can, get in touch with both the sensation and the story. But with ... I want to say it again, with a gentle kindness. Just a gentle kindness. Kind of like an impartial observer, just simply notice, there‟s not right, there‟s not wrong, just notice. Just a bare awareness. Even as Maria listened silently to Ruth and Lindsay, she was actively receiving Ruth‟s instructions and also relating to what others were sharing. Maria noted in her SC, MariaSC12: Um, it feels different because it‟s not directly to me but the teacher has a way of actually making everything seem that it‟s to everyone. So that kind of input is great, like introspectively thinking about ok, you know, “notice everything” um yeah. Listening to the other people talking and again trying to relate that back to my experience, making it more helpful. Separating thoughts and feeling states. In session 3, they turned to a theme in the MBSR curriculum of “pleasant experiences.” By reporting on their homework exercise, which was to notice pleasant experiences and fill out a log noting body sensations, thoughts and emotions, the students engaged in a joint exploration with Ruth of what a “pleasant” experience meant to them, or in other words, how “pleasant” is constructed experientially. Ruth repeatedly asked them to de-construct “pleasant” into underlying thoughts (beliefs), emotions, and body sensations. While doing this, students often became aware of what they were NOT aware of at the time; in other words, the experience of “mindfulness” was sometimes constructed in contrast to the more familiar “mindlessness.” Participants reported various experiences including finding it difficult to notice body sensations attached to pleasant experiences. For example, Betty commented, “The question of “how were you feeling in your body at that moment?” was very difficult for me. It‟s more in my head than in my body” (Betty 102). Ruth‟s attention turned to Tasha‟s comment: Tasha166: I had one thought, um, my feelings were kind of the same, the sort of pleasantness, but I sort of wondered, is that what we‟re supposed ... is that sort of our 118  natural state we‟re supposed to be, that sort of peaceful state … but then all these other negative thoughts crowd in and get you away from the peacefulness. It‟s sort of like the absence of the negativity you‟re left with the peacefulness? Ruth167: uhuh Tasha168: (Pause). I don‟t know, I just wondered. Ruth169: What do you think? Tasha170: Um, um, it could be. Could be. Ruth171: (nods) Uhuh. Check and see for yourself what it is. What prevents those pleasant feelings from being there more often. The joint goal between Ruth and Tasha was to help Tasha explore her experience, particularly to notice how pleasant feelings may be interrupted by negative thoughts. Ruth said in her selfconfrontation that she was wondering how to re-direct her: RuthSC7: I was thinking that was a lovely thought, a lovely description. But I‟m also aware that she‟s sort of asking me for some kind of answer, some kind of spiritual teaching. And I don‟t want to give that. It‟s not my role. So I‟m thinking of how to give that back to her. One emotion steering this exchange was enjoyment. They began smiling and laughing, and Ruth reported, “I am enjoying her description. It‟s such a human tendency she‟s talking about” (SC11). Another emotion was curiosity. Tasha used the phrase “I wondered” twice. Meanwhile, what was happening in the group mind? We have SC for Gerald, whose goal for this minute as he silently listened to Tasha was to “track” her feelings: GeraldSC7: “[I am feeling] curiosity. Really curious about more than what she's saying, kind of wanting to know, thinking about deeper than what she's saying, watching her body language, watching the way that she was there herself.” At this moment, he appeared not to be following content as much as the nonverbal process. We note that he was engaged in the attention project, this time directing his attention to another participant. Later in his SC, Gerald noted his enjoyment of the spaciousness of the interaction in D & I, and how this supported his ability to pay attention: Gerald20-22: Yeah, yeah, it's, what I'm finding in the course and what, one of the things I like about Ruth is that she creates enough space for me to kind of not only hear what she's saying but give me enough processing time to actually catch up with myself. 119  Because although I'm a very fast thinker, my feelings are sometimes slower than my thoughts, but she gives me enough time to notice both. So I get to notice both mental process and feelings. Gerald‟s description underlines the fact that the D & I is a process of noticing – as he said, he “gets to notice both mental process and feelings” during his interactions with Ruth. Noticing the body. In session 1, Paula interacted with Ruth to get reassurance and relief from the guilt that she has for taking time out from her busy schedule: Paula224: I couldn‟t get over the guilt that I was taking time out Ruth225: ah! Paula226: Taking all this time to do it, like I should be doing something else Ruth227: Ok... So that will be something interesting for you to look at. Yeah. Did you notice what that felt like in the body? Where guilt was? Paula230: Mmm. Just thoughts. Ruth231: Thoughts? Paula232: Yeah, just thoughts. Ruth233: See if you can notice where in your body that was. Because there‟s a feeling that goes with that. (smiling, nodding). While their joint goal was to explore the emotional and physical experience of the bodyscan, here again, we can see competing individual goals: Paula expecting reassurance or relief from the guilt and Ruth directing Paula‟s attention to the body sensation underlying the feeling of guilt. Ruth spoke at length in her SC about this moment, saying that she was noticing Paula‟s “rigidly structured formatting”: RuthSC6: ... I was thinking that just from what she was saying, how hard she probably was on herself. And I was thinking, I hope she‟s able to discover this for herself, I hope she‟s able to find it and I hope that it will come through her self-discovery ... [I had] a feeling of how hard and sad it is that we‟re so hard on ourselves ... As Ruth and Paula worked jointly to access Paula‟s inner experience – her thoughts and her unnoticed body sensations – Ruth‟s action was steered by a compassionate curiosity which is the attitude that she is inviting Paula to have towards herself.  120  The joint attention project was enacted by Jackie and Ruth with particular emphasis on Jackie‟s awareness of body sensations. This appeared to involve nonverbal implicit processes as well as verbal. She and Ruth developed a nonverbal rapport which had a somewhat different nuance than in the other dyads. There was significant eye contact, smiling and nodding between them during the exchanges and from the observers‟ point of view, a harmonious rapport. Jackie had difficulty at first following the directions for tracking body sensations and labelling them. In two sessions in particular, her dialogue with Ruth involved Ruth cueing Jackie with questions about body sensation, Jackie reporting, Ruth affirming, validating, mirroring, asking follow-up questions in a nonjudgmental manner and Jackie reporting further. Jackie eventually reported a feeling of excitement and insight when she became more able to access and label body sensations such as heart beat, breathing, and tenseness. In session 3, Jackie explained to Ruth that it had been difficult to notice and describe how “pleasant” feels like in her body: Jackie239: Um, yeah, I think it was easy to pinpoint the pleasant moments, but I think it was difficult to really say where I was feeling it in my body. And I‟ve noticed that before, even before this class, when people ask me questions related to my body like what does it feel like, I have no idea. Ruth responded by directing her to body sensations: Ruth240: Uhuh. Ok. Can you try to go in there and just check and see? (audibly breathes). If you use the breath, it is often helpful to bring you into the body. Take a minute taking a breath in, and coming into your body just for a second, and just feeling you know, your heartbeat, what‟s going on with your heartbeat, or any kind of tightness in the body ... Just keep looking, keep looking. It‟s often fairly elusive. And it‟s often not that significant really. It‟s just a very tiny shift, just tiny, but just a tiny shift that will, once you notice it, it‟s huge. But it‟s just that we often just discount it because it‟s not so huge. Their joint goal was to explore Jackie‟s awareness of body sensations such as breathing, heartbeat, and muscle tension associated with “pleasant”. Ruth explained in her SC that she is  121  aware of Jackie‟s difficulty, and she wondered if Jackie is looking for a more “dramatic” sense of her body: RuthSC26: I was noticing how difficult this is for her. She hasn‟t spoken tonight. I wonder if she is able to access her body sensations much and I wonder if she is frustrated. She‟s young, and maybe she‟s looking for something more dramatic. I get the sense that she is used to feeling things more dramatically and looking for something more dramatic. Maybe it‟s hard for her to feel the small stuff. You know, a lot of what we talk about is pretty boring! Jackie confirmed this frustration in her SC: JackieSC15: I was almost a little bit frustrated because I don‟t know how to describe things with my body in regards to those exercises. And even in the workbook, I left half the questions about the body blank with a question mark because honestly didn‟t know. And then it was really interesting I thought like as soon as Ruth started talking about you know, your heart beating and say like your breathing and simple things like that and ... if someone tells me what to focus on, I feel like I can focus on it. In this minute Ruth turned her attention to the whole group, and invited them to pay attention to small sensory details of their experience: Ruth 242: ... Anyone notice that, that pleasant was just little? (some murmurs of assent). Just really little. You know, when I go to pet my cat, sometimes I can just feel my heart open, and I can just feel the warmth come, and when I do that, even just for a second, just to appreciate her for a second. Just a very gentle shift, just gentle, just feel your heart open. It‟s like that. Just feel this kind of shift. Not huge. But it is a huge feeling really when you pay attention to it, it‟s a lovely feeling just to see an animal, or see a child. Jackie commented in her SC how helpful Ruth‟s instruction was: JackieSC32: At the beginning when she was talking about how it‟s very gentle feelings and I was thinking about that with my mind and I just thought well that makes sense they can be really specific full on signals in your body but it could be something as simple as what she was describing and I think that‟s really good to know because sometimes I feel like it has to be this like really big intense feeling. But it sounds like there‟s just little things I could start paying attention to um that are still reactions in terms of your body. Um so I thought that was really good to hear that, that‟s it‟s just the little things sometimes. And then as Ruth was describing um petting her cat, and what that felt like, and it took her some time to describe that, and I thought about um our family dog, our parent‟s dog and just kind of like picturing him and petting him as well and kind of what that feels like um so that was definitely something I could relate to.  122  She seemed to understand conceptually Ruth‟s point that “it‟s just the little things sometimes” and then even vicariously experienced, through Ruth‟s description, the sensory pleasure of petting her dog. Then Ruth moved into leading a brief heart-focused meditation: Ruth244: Yeah (nods, smiles). Actually, so, let‟s just do that a second, let‟s just try an exercise. And I‟m going to get you to uncross your legs and take a deep breath and sink down into your body-mind and for a second feel your heart beat, feel your heart in your chest. Keeping the breath deep and slow and even. In your mind‟s eye bringing awareness to a person or a pet that you love unconditionally, no strings attached, you just love this person or pet unconditionally. In your mind‟s eye, just see their eyes and allow that feeling to grow in your body (pause). And then just open your eyes. Anyone feel anything? Betty245: I noticed myself smiling (laughs). Ruth246: Smiling? Betty247: Yeah. Ruth248: Ok. So smiling. Ok. Karen249: I feel a warmth Ruth250: A warmth Karen251: Yeah, like building ... Ruth252: Like your heart is almost ... opening? Yeah? So a warmth Lindsay253: I started to feel teary. Ruth254: Teary? Yeah? Paula255: Shivers in the body. Ruth256: Yeah. Ok. Betty257: A fullness. Ruth258: Did you feel anything, Jackie? Jackie259: Smiling Ruth260: Smiling, ok, so a lightness and a smiling, and opening. Ok. So that‟s “pleasant”, just an opening. So all “pleasant” in our life, that tiny little feeling associated with all of the pleasant, if we notice, just attending to it, the shivers, the warmth, the heart opening, it‟s all there. In her SC, she revealed she chose this exercise intentionally to help Jackie experience positive affect and accompanying body sensations: RuthSC28: Oh yes, I chose it really for her. Knowing that it would be helpful for everyone. But for her especially. Jackie reported in her SC that through the heart meditation, she was able to understand conceptually and experientially the small body sensations of pleasure:  123  JackieSC39: I think at first I was trying to get really grounded, uncross my legs, and then just focusing on my heartbeat and so there wasn‟t really much going on, I was trying to stay focused in the moment, focusing on what she was saying, and then um we talked about this just before, how then we were prompted to think of something that we love unconditionally and I thought of our dog right away and it was really easy to picture, and I remember I was just smiling ... it‟s just a positive feeling good. I wasn‟t distracted by anything else at all, any thoughts, automatic feeling of happiness and wanting him there... I felt pretty relaxed and feet grounded and just focus[ing] on one thing. In Jackie‟s post-class questionnaire, she commented that this interaction with Ruth was helpful in regards to her goal of learning mindfulness. She wrote, “I learn by interacting with others . . . [The interaction] grounded me since it made me focus on myself, my thoughts, my emotions and my body.” When Ruth was asked about her own feeling state during this exchange, she said that she was in a state that is neither emotional nor cognitive: RA23: And as you‟re listening to her and noticing how she is struggling, how do you feel emotionally? Any heart feelings, compassion, or? RuthSC29: Hmm. Not exactly. When I‟m teaching, it‟s more ... not really cognitive, but more conceptual somehow, I‟m paying careful careful attention, I‟m staying present with each person and each comment, at the same time somehow deciding what the best way to respond is. But it isn‟t really a decision, it just comes ... like from some other place. It‟s not emotional. It‟s more ... noticing, attending, wondering, staying open. There is a curriculum I am following, of course. The curriculum and content I learned in Massachusetts so I‟m following that. But otherwise, responding in the moment to whatever comes up. In the next session, Jackie arrived eager to share her breakthroughs regarding tracking her body sensations during the week. She said in her SC, “this whole body connection vs. disconnect was pretty enlightening, so I wanted to share that” (JackieSC2). Here Ruth and Jackie engaged in typical mindfulness dialogue, with Ruth guiding Jackie into a report of body sensations: Ruth15: Ok. What kinds of things did you notice in the body? Jackie16: (sighs) Well my heart racing and my breath like changing or being shorter or even the way that I talk, it was high-pitched... Ruth17: Uhuh Jackie18: All kinds of changes. Ruth19: Hmmm. Where was your breath?  124  Jackie in her SC explained that she found it difficult to “put words” on her experience but indicated that she was sensitive to Ruth‟s nonverbals as encouragement to continue: Jackie6: Um I think I was just really trying to explain what those physical sensations felt like ... it was still a struggle to put words on it as I started to remember things ... And I also could sort of tell that, I mean, I felt like I was kind of making sense of it saying, because Ruth was kind of nodding and just like even though it‟s not really agreement it was like “ok, I get what you are trying to say”. So that was to me a little bit of encouragement to keep digging and to keep trying to remember and explain ... We can see here how the attention and language projects are intertwined. Jackie reported it was “a struggle to put words on it” as she “started to remember things,” underlining the iterative and joint process of remembering, noticing, and languaging. The attention project was quite intensely jointly constructed, as the teacher and participants work hard in the D & I to access the participants‟ lived experience. There were some conflicting teacher-student goals. The attention project was led by Ruth, and participants join it because of their commitment to the larger mindfulness project. Particularly at the beginning of the course, participants were attached to their individual goals of solving the problems they brought to the class, with the hope that mindfulness meditation will make these unpleasant or difficult experience go away. They do not particularly want to pay attention to unpleasant things. In contrast, Ruth‟s approach, repeated over and over, was to include everything, even the socalled problem. She repeatedly invited them to “just notice” their unwanted thoughts, emotions, or body sensations: stress, insomnia, sleepiness, mind commentary, noise, annoyance because of the noise, racing mind, tension, guilt, yawning, irritation, stories. In the first session, Ruth invited them to “notice” 48 times, and added “with gentle kindness” 12 times. Thoughts, commentaries, stories, body sensations and emotions which were ignored or pushed away were brought to remembrance with Ruth‟s patient insistence.  125  In other words, Ruth helped the students to notice. While “on the cushion” (that is, during formal meditation), they were individually attempting to pay attention to each sensation or thought as it arose in their private inner experience. While “off the cushion,” in the D & I, Ruth encouraged and reminded and coached them to pay attention with gentle kindness to their inner experience, while simultaneously paying friendly compassionate attention herself to their every response. Not only her guidance but the dialogue, language itself, supported their growing ability to notice. Along with learning to pay attention to their experience through the dialogue with the teacher, participants also practiced by listening with kind attention to each other‟s reports on inner experiences. That is to say, participants practiced observing the contents of each other‟s mind in the same way that they practiced observing their own minds. Karen reported in the postclass questionnaire for Week 2, “I noticed how much I was comparing my experience to others as they spoke, and judging myself rather than just noticing with gentle kindness.” In the selfconfrontation interviews, participants reported many times that moment after moment, as they were sitting silently, they were trying to “be present” “to pay attention” “to listen” “to notice” what their classmates are reporting. This intention to pay attention appeared to be amplified a hundred-fold by Ruth, who was aiming to attend to each participant‟s report with kind, curious, nonjudgmental attention. Laurie commented in the post-class questionnaire for Week 1, “I noticed the nonjudgment of the instructor when I myself felt judgmental.” Ruth not only modelled but embodied the attention that they were invited to inculcate during formal mindfulness practice. She said in SC that she was “just noticing in a curious open way” (RuthSC5, Session3), and not only paying attention to the participant, but also to her own inner experience: “I‟m just noticing this sense I have of  126  something not being quite authentic” (RuthSC4). So participants noticed their own body, thoughts and emotions; they noticed each other, they noticed Ruth, and they were noticed by Ruth. This “noticing” was done with an attitude of kind acceptance. As each experience was met by kindness and curiosity, we can wonder how this relational crucible of attention may have fostered individual and group mindfulness. The sub-ordinate joint language project (describing). It is obvious that the D & I depends on language. It is dialogue after all. But what does the joint action of describing have to do with mindfulness? Just as participants internally notice and label their thoughts and feelings as part of their “private” mindfulness practice, so they externally noticed and labelled in dialogue with Ruth. It is through the joint action of describing the participants‟ inner experience – finding words for it – that their ability to access and notice with nonjudgment was exercised and potentially enhanced. For some participants, this movement from right-brain experiencing to left-brain languaging was unpleasant, yet Ruth patiently invited them again and again to find words for their experience. In the post-class questionnaire for Week 5, Lindsay wrote that she “shared in order to become more aware.” It is important to note that language is being used not only for the purpose of communication between teacher and student, but also, as a tool for the student to notice what he or she is and is not noticing. Creating a new story: Shifting narratives. There is a marked contrast between how the participants tended to speak generally, conceptually, and sometimes melodramatically, and Ruth‟s specific, descriptive, body-centered, speech. She appeared curious about the ordinary sensory details of their experience and at the same time, generally maintained a neutral tone. She facilitated a different type of narrative: participants presented a general “story” and then she helped them “re-present” this in a bottom-up, body-focused narrative. That is to say, one way  127  Ruth achieved her goal of teaching mindfulness through dialogue was through a two-part process of first giving space for participants to speak and then leading them more deeply through questions into their embodied experience. The first part involved giving non-evaluative space for people to report their experience, which was reflected in her large number of action elements of acknowledges, repeat, and paraphrases. The second part involved a repetition of elements such as “asks for body sensation” “asks for cognition” “asks for emotion” “asks for clarification.” These two steps (presenting their story, and re-presenting it) were almost invisible as they occurred, but because Ruth repeated this dozens of times in the session, it stood out saliently in all session transcripts. Through these action elements, Ruth responded to the participants‟ experience with a nonjudgmental present-moment curiosity about their thoughts, feelings and sensations. When they described their experience, she typically first mirrored it back to them in a neutral “noting” fashion, just as they learn to do eventually in their own mindful relationship with themselves. The mirroring was done with nods, eye gaze and smiles (unfortunately I was not able to always consistently transcribe these due to limitations in recording equipment), paraverbals, or simple repetition of words and phrases. With step two, the questioning (e.g. “asks for body sensation”), a kind of scaffolding communication, began, with Ruth leading the participant into verbalizing their embodied experience. A poignant example of step two was Ruth and Gerald‟s joint exploration of his chronic pain: Gerald34: Whereas I try to focus on all the things that are working but it actually stirred it up, stirred up the feeling of being really, um, old and feeling like a victim and focusing on the pain. So I got really frustrated with it. But frustrated with myself too that I couldn‟t manage it. ... Because I‟ve trained myself to, not to ignore it so much but to focus on other things. Ruth35: Now it sounds like that might have been a bit of story about it, right? Gerald36: Yeah. Ruth37: Getting old and Gerald38: Yeah, it was. Ruth39: So is that the story? 128  Gerald40: Um, the story‟s been about, um, “is it going to get worse?” We see Ruth taking a nonjudgmental curious approach to Gerald‟s experience as she guided him to separate body sensation from emotion from cognition (story): Ruth 47 ... Just the sensation, just the bare sensation. What‟s going on there, without the story, just the sensation of it. Gerald48: Um, helplessness. Ruth49: Ok. But isn‟t that the story as well? Gerald50: Yeah. Ruth51: Ok. The actual feeling, the actual sensation in the body. What is it? Gerald52: (pause) Apprehension, anxiety. Ruth53: Ok, apprehension and anxiety, those are the emotions that are coming. Good. But that‟s still not ... I‟m guessing that‟s still not the actual feeling. The actual feeling that stirs it up. What pushes that button? Gerald54: Pain. Here Ruth drew Gerald into approaching his pain, noticing it with gentle kindness (attention project). He had stated a few minutes prior that he had dropped the homework of looking at painful experience – “nope, not going to do it” (Gerald34) but in this moment, he and Ruth jointly approached the pain: Ruth55: Ok. So the pain. Can ... it‟s really a hard thing to ask you to do, but it really is an important thing, is to be with the pain. (Gerald sighs). Be with the pain and notice that it arises in the body. And just notice that. Notice that and it‟s really good that you‟re noticing the story as well. So keep a tab on that too. But see if you can separate the one from the other. Just see if you can look at the one without the story. (Gerald sighs). Just, do you notice what happens to the sensation when the story starts? Gerald56: Yes. Ruth57: What happens? Gerald58: It gets worse. Ruth59: Ok. Ok. Gerald60: gets worse. Ruth61: Ok. So when you ended up in the wheelchair Gerald62: laughs Ruth63: Where is that, where is that, in terms of past, present, and future? Gerald64: That‟s in the future. Ruth65: Ok. So we‟ve left the moment and we‟ve gone to Gerald66: to the future. Ruth67: Gone to the future. And so it‟s excellent that you‟re noticing that... Pain is one of the more difficult things to work with. But if you look at it really, really closely, you  129  might notice that there‟s um almost a wall. Is there a sensation around it like pushing it away? Gerald68: Yup, yup. Ruth69: Ok. Gerald70: Yeah, and pushing up against it too. Ruth71: Ok. Pushing up against it. Ok, and if you can soften those walls a little bit and almost open to it. Jackie reported in her SC that she was intrigued by this exchange and was able to apply what Ruth was teaching Gerald to her own life: JackieSC14: . . . I found it really interesting what we started talking about and how I guess people ... somehow try to make sense of what they are going through and come up with these stories that Ruth was referring to and um like with every example he was giving, and with all the feedback that she was giving, it just made a lot of sense of what she was trying to say, it was almost a step-by-step analysis of like, “ok this is how you feel but that‟s part of the story”, and then ask him another question and he‟d say something else and then again she said “well that‟s still part of the story” and it made me think ... I‟m sure I have stories like that too. Um around certain emotions and sensations. Language project and paying attention. The language project appeared to support participants in paying attention. The intertwining of the language and attention projects was demonstrated in session 2, when Maria engaged with Ruth in the joint action of describing her uncomfortable experience of the bodyscan. She struggled to find the words to do so. Their joint goal was to describe Maria‟s feelings of discomfort in the bodyscan: Maria116: It doesn‟t seem to work for me, I still focus on the part that was being held. Ruth117: Ok. What does it feel like when it feels uncomfortable? Maria118: Um, I don‟t know that it‟s uncomfortable, it‟s just that I feel frustrated with not being able to shift that focus until there‟s a new point to shift the focus to. Does that make sense? Ruth119: (nodding.) Uhuh. What does frustrated feel like? Can you say? Maria120: Um, Yeah, I kind of feel like you (nodding towards another student), like a fleeting tightness, like ooooh, and then it‟s over Ruth121: (nods and smiles) Ok. Can you see if you can slow that down a little bit and just observe it intensely. And feel the feeling come up and then see what that looks like for you. Whatever it is.  130  Here we note that Maria not only reportedly had trouble in the bodyscan itself, with moving her attention from sensation to sensation, but again in the subsequent D & I, finding the words to describe this. In her SC, Maria reports that she was striving to describe her experience “clearly:” MariaSC1 Um I know I was trying to be very particular about relating my experience, not the right way, I wasn‟t concerned about that, but about making sure that I kind of got it all out. At the same time, Ruth was aware of her difficulty and, through language, was trying to help her get closer to the actual feeling of discomfort by directing her to body sensation: RuthSC4: This feeling of angst that was arising and being unable to let go of it, needing to go to another place first. So I was hoping to help her come in touch with this feeling of discomfort or whatever it was. In fact, Maria found it difficult to find the words: MariaSC4 ...It was frustrating when I was asked to explain frustration because I couldn‟t find words to do that. It was more of a feeling but then the question was “how are you feeling” and it was “aaaaarrgh”. That was how I was going to explain frustration. So it was interesting. What Ruth implies when she invited Maria to “slow it down a little bit and just observe it intensely” is that the difficulty in subsequently putting words on her experience may reflect a initial lack of attention during the exercise. This is one way language can act as a flag or tool in facilitating awareness, or more exactly, meta-awareness. Language project and amplification of affect. In session 3, another aspect of the joint language project was demonstrated, that of not only describing but possibly amplifying affect. Ruth typically drew out their reports by her action elements of acknowledges, reflects body sensation, repeats: Tasha114: I noticed a lot of my pleasant feelings in my body just felt the same, every time except for once, the feeling was just sort of like peaceful, relaxed, light, spacious each time, each day. Except for one day, one day my son played his first song on the guitar and I just felt so, sort of full and warm and proud. And that was the only one that was a different pleasant feeling. All the others were just sort of relaxed. 131  Ruth115: Uhuh. So you felt full, and warm Tasha116: Uhuh and tingly Ruth117: Ok. Tasha118: Yeah, Sort of bursting, that‟s how I felt, I guess I was proud. Ruth119: Ok. And the others were light Tasha120: Yeah Ruth121: Light, spacious you said. Tasha122: Relaxed, warm. And um, sort of peaceful. Sort of peaceful and content. Ruth123: Uhuh. Uhuh. Words describe and sometimes amplify the original experience. Language as support for approaching experience. Yet another version of how the joint project of “describing” might facilitate mindfulness is as an anchor in helping participants approach rather than avoid unpleasant experience. In Session 4, after a brief meditation, Ruth asked the group how their week went, and Betty started the D & I by saying that the “unpleasant experiences” homework was difficult since she would normally “just let go” of negative feelings and felt frustrated by having to log them. Ruth gently directed Betty‟s attention from evaluation to description of body sensation: Betty4: I found that little things that I would normally just let go Ruth5: uhuh Betty6: the fact of having to “oh yes I have to remember that”... And then writing it gave much more focus than I would usually give it, so I found that really difficult. Ruth7: Ok. Ok. What did you notice in your body? This habitual avoidance of unpleasant feelings appears to be made more conscious when it is interrupted by the language project. The engagement of this project sometimes led to a transformation of affect, as is Gail‟s case in Session 2: GailSC16: ... She asks me to talk about how I felt. I talk about fear. And uh the more I was talking about it, the less I felt it. My body was more relaxed. By not describing unpleasantness, participants are presumably trying not to notice (feel, experience) the unpleasantness. The converse – describing and simultaneously noticing through describing – appeared to have a salutary effect at least in some cases. 132  Language project and present-moment experience. Sometimes the language project appeared to interrupt or impede present-moment experience. Session 5 provided an interesting example of a portion of D & I between Lindsay and Ruth in which the joint projects of attention and language did not unfold as usual. Ruth entered into dialogue with Lindsay who described her experience of “sitting through” unpleasant sensations in the meditation. Ruth began in her usual fashion by using elements of “acknowledges” to give Lindsay space to describe her experience: Lindsay88: At times, um for the most part I could stay still, but at times I really felt my body wanting to respond somehow physically, particularly I kept wanting, having the sensation that I needed to clear my throat. Ruth89: Ok Lindsay90: and at one point it just happened and I went oops and before I was even aware, I had done it. And so for the rest of the time, I was able to feel the sensation, I was able to say, no don‟t, don‟t. Let it go. Ruth91: Ok The inquiry deepened. Ruth became more active, using “asks for body sensation” “provides information” “states a plan,” trying to help Lindsay process her experience by focusing on the body and by explaining why it is important to do so. Ruth95: Ok. When you could feel this feeling in your throat, did you feel it? Did you actually see it from the inside out? Lindsay96: Um, I sort of visualized the throat, the larynx, is that the larynx? My anatomy was many years ago ... I could sort of see fluid on the back of it and that‟s what I wanted to clear was that fluid I could see on the back. Ruth97: It‟s not so much that you‟re not allowed to move. If you really have to, of course you can. It‟s just to notice this feeling that pulls you and drags you into an automatic response. Her goal was to help Lindsay make sense of her experience and to understand what mindfulness is and its purpose. On the other hand, Lindsay‟s goal in this minute was to describe her experience as accurately as possible, in a kind of performance for the group. She used an abundance of elements (expresses curiosity, elaborates, describes body sensation, expresses  133  uncertainty, asks for information), and says in her SC that she was seeking to find the right words out of a “need to be perfect and correct all the time” (LindsaySC15): LindsaySC11: Um the part where I was struggling to where I was talking about the throat I was trying to I remember at the time I was “is it called the larynx, is it not called the larynx?” and I was concerned with being correct . So I was hesitating in what I was saying because I didn‟t know whether I was correct in calling it the larynx or not and then I did and kind of made that joke afterwards cause I use humour to hide my insecurities so it‟s an automatic response for me and yet I know that I kind of do it because I was insecure about whether that was the correct word or not. In the next minute, Ruth used Lindsay‟s example to teach the concept of impermanence. She did this by helping Lindsay focus on the process of the body sensation arising and subsiding, through direct instruction and giving Lindsay space to share. Lindsay108: Or you know, those types of things came up periodically as well, again, I just sort of went, “oops, there it is, don‟t do it, don‟t do it, don‟t do it” (laughs) and then eventually it wasn‟t there anymore. Ruth109: Eventually it passed, right? Lindsay110: Yeah. Ruth111: It arises and falls away. Lindsay112: Yeah. In her SC as she watched the video of these minutes, Lindsay said she did not remember anything about her thoughts, feelings or body sensations at that time. Her goal in session appeared to be to maintain her image of being correct and perfect. It is interesting that Lindsay did not remember what was happening for her in these minutes, perhaps because she was focused on providing the description and did not really hear what Ruth was saying. The relational sequence of “notice-describe-understand” was not followed through: Lindsay seemed to fixate on describing and did not (based on her report in the SC) receive Ruth‟s contingent communications, particularly those inviting her to insight (in this case, the principle of impermanence).  134  This exchange between Ruth and Lindsay led into an interesting comment by Laurie on language and mindfulness, as she described her frustration with the emphasis in MBSR to describe one‟s experience (in this case, through homework). Laurie148: It is really interesting to try to write about this. I‟ve been resisting (laughs). And even to talk about it sometimes. It‟s a really strange sensation. Because even the language that we use is really cognitive and really ... I mean even if I write a feeling, like “I‟m angry”, “I‟m ...” Well, I‟m not angry, I don‟t know what angry is, I could tell you what‟s kind of going on within my body or I don‟t know, it‟s just been interesting to try to afterwards go in and try to describe it. She then described her frustration at a recent family reunion with all the storytelling: Laurie152: ... And all the stories, right, and just to hear all the stories that were going on like on a group level and on a group level people were playing into these things and then that desire to leave the room and you can sense that if everyone leaves the room the story‟s going to continue that we‟ve been telling about our family for ages and ages and ages and then to have at that moment. Is this useful? All this talking? Of course, one of the observations in the findings of this study is the difference between reporting body sensations (concrete, sensory, present moment focused) and telling family stories (much more retrospective, global, thematic), but one might wonder if there was a covert message here from Laurie to Ruth about the role of the D & I – “Is this useful? All this talking?” Ironically, Laurie showed a propensity for lengthy storytelling herself in class. This is the paradox of using dialogue & inquiry to learn mindfulness: participants are asked to shift from experiencing to reporting/languaging, a shift from right to left brain, which Laurie (and later, Barbara) found frustrating, and yet which appears to be part of the mindfulness project, at least as it is constituted in this particular MBSR group. Laurie went into much more detail about her frustration with the language project, in her weekly logs. In Week 5, she wrote: I find sometimes that even explaining it in class I get quickly into ego and playing with judgments and feelings of superiority/inferiority. I also find that the prospect of putting labels on our experiences that we call feelings is often a substitute for having the 135  experience itself. The most important thing about the group has been the actual experience of meditating together. The Dialogue is often related to ego. That is part of the group experience I find frustrating. I enjoy the experience of meditation but the reflecting on the meditation I find can be a distraction from the experience itself. Then in week 8, she commented: I believe that in explaining the events after they happen we are doing basically the same thing as when you notice yourself paying attention to your breath and at that point you are no longer paying attention to your breath. Laurie‟s reflections point to the larger philosophical question about consciousness and whether language is necessary for self-awareness, and also the role of language in mindfulness. Interestingly, this begs the question of how mindfulness is experienced and constructed relationally through language. Laurie wrote in her Week 1 log, “I‟m aware that when I‟m on my own, I‟m much more mindful than when I am in conversation,” and in Week 6, “I‟m curious as to how life would function without verbal interaction.” Although since Laurie was not a target student, we did not have SC data on her interactions, her weekly logs and questionnaires were revealing and provided disconfirming evidence as to the helpfulness of D & I for learning mindfulness. Laurie not only appeared to prefer the “private” meditation experience to the relational D & I, but did not consider the D & I to involve mindfulness per se. However, at the same time, she admitted that after a few minutes of private meditation experience, she became restless and often gave up in her at-home practice. In Week 8 log, she wrote, “During sitting meditation, I have many thoughts like „how long will this last?‟ This is definitely mirrored in other areas of my life. I like to finish things. As much as I say I‟m about process, I find it hard to stay with the process.” So in fact it appeared that Laurie was struggling with the larger mindfulness project, not simply the language project, and both the intrapsychic and interpersonal (joint) aspects of these projects. The high level of self-reflection in Laurie‟s logs  136  indicated that she was grappling with the meanings of mindfulness, including the role of language, for her own life. Using language to re-present a day of joint mindful silence. Session 8 was a 7-hour silent “all-day” meditation retreat, with about an hour at the end of the day of D & I. This particular D & I was qualitatively different than the ones in previous sessions. It followed 6 hours of silent mindful experience and the group appeared more quiet and meditative than usual when Ruth opened up the dialogue by asking, “How is everybody?” The hour of D & I in this session involved the attention and language projects without as much time spent on insight. In the first 30 minutes of D & I, Ruth and the participants jointly created a re-presentation of their experience through simple description of sensory details. There were several features of the discourse itself that were observable to the researcher and RA while watching the videotape later: a hushed tone, more pauses, and a slower tempo of speaking. Some participants referred to these features in their SCs. On a linguistic level, Ruth‟s responses, particularly at the beginning, were short, simple, and repetitive, and from the researcher‟s perspective, some of the use of language by both teacher and students was poetic in nature. Ruth‟s responses to participants in this D & I involved a lot of mirroring and acknowledging. She did this by repeating words and phrases in a strikingly repetitive way: Ruth8: How was it being quiet all day? Maria9: It was easier than I thought it would be. Ruth10: Was it easier? Maria11: Yeah. I built it up to be scarier than it was. Actually it wasn‟t so bad. Ruth12: Yeah, ok. It wasn‟t so bad? Karen13: I had a hard time on my walk. I always look at people when I pass them and say hi. It was a struggle to not do that today. I felt quite rude. Ruth14: Did you? Karen15: Yeah. Ruth16: Yeah. Ok.  137  She also engaged in simple questions about mundane aspects of the day, for example, their lunch: Ruth26: Did you find out anything interesting about your food? Karen27: Lots of different flavours. Jackie28: My sandwich was frozen. Evryone29: laughter Ruth30: Oh dear. Jackie31: I was like, “Ok”. It just meant I had more time to eat. Betty32: I noticed my lunch was noisy Evryone33: laughter Ruth34: Noisy? Betty35: I had lots of crunchy things. In the silence, it was really odd Evryone36: laughter. Ruth37: What did you have? Betty38: Carrots and cucumber and a snack bar. All noisy. This initial interaction set the tone for the next 30 minutes. There was a sense of wonder over mundane things, beginning with describing their lunch. Ruth asked simple questions about what they noticed, and responded with apparent curiosity, interest and sometimes excitement. Her goal was to help the participants describe their lunch experience mindfully. The group worked together at reconstructing their lunch experience through the five senses. Then Ruth‟s goal shifted to invite participants to reflect mindfully on their experience of the walk. She started an exchange with Lindsay with the question “What did you find out there?” Lindsay responded with a description of watching baseball, focusing on the sense of sound: Lindsay50: Um, well I went to the little park over behind the golf course and there were people playing baseball and I love baseball and so even though I was just standing watching the game, just hearing the bat, hearing the ball in the glove, those are all sounds that have pleasurable moments for me, so, just hearing the sounds and as I walked around the park and got closer to the diamond where they were playing, it just got louder and louder. Their joint goal was to recreate Lindsay‟s experience in the golf course. However, in her SC, Lindsay recalled that as she interacted with Ruth and described her experience, she began to feel strong emotions of nostalgia. She reported that in the baseball park experience itself, she was in a  138  detached observer perspective, but when recalling it in the D & I, and telling a story about it, feelings of passion, envy and nostalgia come up: LindsaySC7 ... I felt the passion more when I was talking about it. It was stronger when I was talking about it. Because when I was watching them or listening to the sound, I was trying to stay somewhat detached but at the same time it was interesting that that was what my ear kept hearing. Didn‟t hear the birds, it was hearing the baseball. Then when I was talking about it, it was like yeah, that‟s when I really felt the passion just sort of start to come up through me. Like, where did that go? Those sounds were just so fantastic ... I think when I was out there and I saw them, I registered that I saw them, but I didn‟t actually connect to any feeling when I saw them. It was just like I saw them, they were playing baseball, isn‟t that great. The stronger feeling came when I was talking about it. This poses interesting questions about the differences between the mindfulness experienced during the immediate experience compared to that experienced during dialogue. It also raises a question about whether some participants are able to engage in the jointness of the D & I more than others. At least in this instance, it seemed that Lindsay was not very present with Ruth, but mostly attending to her own inner experience and her memory of the ballgame. A simple exchange ensued among participants and Ruth. Her goal was to invite participants to reflect mindfully on their walk, and she achieved this by being curious about the mundane details of the walk: Ruth51: Uhuh. Mmmm. Anyone find any lovely animals? Children? Plants? Karen52: Lots of birds, I could really hear the birds, especially when I got off [the main street]. It was beautiful. Tasha53: It was really peaceful. The trees and everything was there and just growing. Ruth54: Everything was there, just growing by itself. Tasha55: Yeah, the world was just carrying on no matter what we were doing. Gail56: I saw two ducks. Ruth57: Two ducks! Gail58: So beautiful. I never realized how beautiful ... one was so bright and colourful, with a beautiful green silver head, I guess that was the male. Female was not as bright. I was watching them; I sat down and watched them.  139  Ruth expressed keen interest – “two ducks!” she exclaimed in response to Gail‟s sharing. Lindsay seemed to enjoy this moment even as she sat silently. She observed, with humour, in her SC, that she had also seen two ducks: LindsaySC11 [I was] sort of wondering, “Oh are those the two same ducks that I saw?” So I guess you would call that a curiosity as to whether there was that shared experience even though I didn‟t see her at all. Were those ducks still sitting in the same spot? (laughs) The “observing self” appeared to have been engaged both in their original experiences and in their re-tellings. Lindsay delighted in watching the ball game, Gail in watching the ducks. Tasha observed “the trees and everything was there and just growing,” and Ruth paraphrased, “Everything was there, just growing by itself.”15 Gail continued, using language in a poetic way: “[The tree] was huge, I closed my eyes, the breeze on my face, I heard birds. I felt like I was a child”16 (Gail62). Ruth responded simply with acknowledging, first giving Gail space to recall and recreate the park experience. She then commented, “That‟s neat. That‟s how children are all the time. They‟re that present. It‟s play. And we stop playing as we get older” (Ruth65). As Lindsay listened, she resonated with Gail‟s description of the park, saying in her SC, “And so it was like a “yes” kind of sigh, in full agreement with her so there was that emotional attachment to the city, and the fact that „aren‟t we fortunate that we live in this place‟, that kind of a feeling” (LindsaySC15). She goes on to say that Ruth‟s reference to childlike play also was of interest to her, since she recognized it as an important current life project: “Yup. When the concept of play was being discussed, in my mind, I was running another story in my head, because that‟s a topic, play, is a topic that I‟ve been trying to um incorporate that into my life as an adult, and I‟ve been struggling to do it.” (LindsaySC18). Karen shared her wonder at a magnolia tree: 15  Probably coincidentally, Tasha‟s description and Linda‟s paraphrase are reminiscent of the famous Zen poem: Sitting silently, Doing nothing, The spring comes, And the grass grows by itself. 16 By poetic is meant such stylistic features as short phrases, repetition, references to nature, iambic rhythm, all presumably unconscious on the part of this speaker.  140  Karen66: There was one tree I went by, it was a magnolia tree, the flowers on it were just about as big as my head. I just stopped and stared at it. It drew me in, it was so beautiful. Bright pink. That was a surprise. Ruth67: Was that the first time you‟ve seen it like that? Karen68: That big, yeah. Like I love those trees, always admired them, but this one – In the space of a few minutes, adjectives with positive valence such as “lovely, beautiful, peaceful, colorful, love, admired” were used, resulting in what appeared to be a joyful celebration, through shared description, of the beauty of nature. Then the group shifted to a celebration of the most unexpected observation, the vibration of Karen‟s eardrums: Ruth117: ... How was the listening meditation? Karen118: It felt weird. Ruth119: weird? Karen120: I don‟t know if it was the air conditioning or something but I actually felt my eardrums vibrate. Ruth121: Aaah! Karen122: It was the weirdest sensation. Ruth123: You could feel your eardrums vibrate Karen124: Yeah! Ruth125: And your eardrums are vibrating all the time. Karen126: And I‟ve never been aware of it. Ruth127: Isn‟t it something? Karen128: Yeah. Ruth129: I always find that with the raisin exercise. I can actually feel the raisin when I swallow it and it seems like a huge thing. Same with the eardrums, they are always vibrating. So neat! Here we see Ruth listening actively and even going so far as to gently celebrate Karen‟s description, with the elements of “expresses curiosity” and “expresses joy” (“aaah”, “isn‟t it something?”, “so neat”). In her SC, she waxed even more celebratory of the “miracle” of the eardrums, as she said, a “tiny moment” but “a huge, huge thing”: RuthSC28: Just how neat it is that these things happen all day long for all of us and we never notice the subtle nuances of what‟s going on. RA29: So you thought that was neat. RuthSC29: Yeah, that she was able to find that. Yeah, there‟s a few moments that when you‟re mindfully present that you just never forget. Just these tiny moments. They are so miraculous and they are few and far between that you have such a vivid recollection of  141  your discovery of what is happening. I thought it was lovely that she was able to feel her eardrums vibrating. It‟s a huge huge thing. In Maria‟s SC, she says that she was “just listening, interested in Karen‟s story about her eardrums and how they were vibrating, just intently listening, not focused on anything else. Just present” (MariaSC1). She also noticed how quiet the group is: MariaSC36 It seemed everyone was sort of in the same boat as me, nobody was being all that talkative . . . A different level today, just a lot mellower. Maria also commented on the shift from silence to speech. She noted that speaking was more of a cognitive or “intellectual” process, and that putting words on her experience was challenging: MariaSC39 ... It was definitely a lot more intellectual when we were coming back to speech, and during the silence I found it to be more emotional and introspective. So it was an interesting gear shift to do the circle at the end . . . I feel that I had to pull the focus away from that in order to outwardly express. So the silence was definitely more conducive to looking inside. And then having to switch gears and put something out there was definitely a different feeling. In the cycle of these overlapping joint projects – noticing, describing, and understanding – the language project, “switching gears and putting something out there,” appeared a key part of the learning of mindfulness in the D & I. The sub-ordinate joint insight project (understanding). There are many examples in this MBSR group of teacher and participants seeking understanding, and experiencing small and profound realizations. Some of these were self-understandings, related to participants‟ unique histories; others were more universal observations of the nature of the thinking mind, for example. While these insights were at one level experienced individually, on another level they were jointly constructed, as Ruth pointed out, “It‟s not just me working with [each participant], it‟s everyone working with everyone else” (Session 4, RuthSC122). Indeed one of these insights, the concept of Buddhist anatta, translated as no-self or interconnectedness, was experienced and  142  commented on in various ways by participants as the course evolved. The joint project of insight appeared to be an important functional step of the mindfulness project. Understanding what mindfulness is. One aspect of the insight project as it operated as a functional step to achieve the super-ordinate goal of learning mindfulness, was to begin to understand what mindfulness is. This was not as straightforward as one might think. Ruth gave a fair bit of conceptual explanation in the first session, directly referring to Kabat-Zinn‟s definition of mindfulness as “paying attention on purpose in the present moment without judgment.” However, a more complete conceptual and embodied understanding of mindfulness unfolded and was co-constructed across the two month course, through the mindfulness exercises themselves, through engaging in D & I about their experiences, and through observation of and comparison to other‟s reported experiences. An exchange between Paula and Ruth in Session 2 demonstrated the common misunderstanding of what mindfulness is, and the moment of understanding it in context of one‟s lived experience. Paula was complaining how hard it was to be mindful when she was physically uncomfortable, and Ruth pointed out that paradoxically this is in itself mindfulness: Paula124: . . . at home I can‟t find a comfortable space, on my side, on my back, so really not finding a place that‟s comfortable and I‟m curious about what that‟s about then um, it‟s hard to be mindful. Ruth125: (Nodding) But the very fact that you‟re noticing that is being mindful. Paula appeared not to have heard or understood despite Ruth‟s goal of “providing Paula the right cues for her to find insight” (RuthSC18), as she carried on in a self-critical fashion to describe her mind wandering. Ruth in her SC revealed that she is noticing Paula‟s self-judgment: RuthSC14: I still have a sense that Paula is very hard on herself and um just a very strong sense that she‟s very punitive with herself and so I was kind of wanting to reach out and somehow help her gain insight which you can‟t do, you have to allow people to come to their own place with it.  143  Their joint goal was to explore her experience of the bodyscan, but Ruth had the more specific intention to help Paula come to a deeper self-insight: RuthSC31-33: And I was thinking when she was describing her state of complete discomfort that if she could come to the realization, and I‟m guessing, is that that‟s how she feels a lot of the time is complete discomfort, I was trying to cue her to come that realization for herself, to see if she‟s familiar with that state of discomfort. They continued to explore her experience. Ruth‟s goal was to help Paula find out if her mental state is familiar, in order to bring insight, and she did this by guiding Paula in identifying her thinking process. Paula wanted feedback from Ruth about whether she was “doing it right” and she achieved this goal by describing her cognitive experience of the bodyscan which involved her mind wandering: Paula126: I drift away from the bodyscan with those thoughts and they take me somewhere else and I try to come back and I‟m like “wait a minute! I thought we were on my knee!” Really paying attention to how fast my mind can lift away from what I‟m actually doing Ruth127: (nods) But that‟s the nature of mind again, Thinking mind. That‟s what it‟s groomed to do. That‟s what you‟re doing in school, right, is thinking, using it to ....So you said some important things and I want to just follow up on a little bit. You were saying that at home you have this general state of discomfort? Paula128: (Sigh). I‟m on the floor and I notice that I‟m more comfortable when I‟m on my side than when I‟m on my back. In the subsequent minute, Paula had an important realization about mindfulness. The joint goal was to explore what mindfulness is, with Ruth trying to reinforce that noticing discomfort is part of the practice of mindfulness. When Ruth finally said, “Remember how we said last week that the purpose of this is not to relax ... it‟s to notice feeling states that come up in your everyday life” (Ruth135), Paula was surprised. In her SC, Ruth commented that Paula was revealing a common misperception about mindfulness, that it “is some kind of tranquil state where you‟re completely removed from all of your troubles” (RuthSC71), whereas it is really about “be gentle with oneself ... just notice whatever is” (RuthSC73). She added that as she saw  144  something seem to click for Paula, she felt happy: “I feel just open. My heart just feels really warm. It feels like a really warm-hearted openness” (RuthSC62). This understanding of mindfulness – that it is about noticing, not about fixing – may be either conceptually difficult or emotionally unpalatable judging by the length of time it takes participants to embrace it. In Session 3, participants continued to struggle with it. Lindsay reported to the class on her confusion about what mindfulness really is, and her frustration about trying to do it right: Lindsay388: . . . But throughout the week I had a number of very challenging things happen to me and I was trying to figure out how to use mindfulness while these challenging things were going on and I was actually getting very frustrated and agitated, because I thought, “well darn it I‟m taking this class, why can‟t I figure how to do it, and what is it, and when do you use it, and how does it look, and if I‟m being mindful does that mean that I‟m not feeling angry” All of those types of things. So I was really quite agitated through most of the week, trying to figure out what exactly this was and what it looks like and how I practice it” Ruth explored this with Lindsay, inviting her to simply notice her experience: Ruth396: And so, what you were really doing was the practice of mindfulness. Lindsay397: By allowing myself to feel agitated and frustrated and all of that? Yeah. Ok. Ruth398: What did you notice in your body when you were agitated? Lindsay399: Um . . . there was definitely some anxiety and worry that showed up as tightness in my stomach. Here we can see that understanding the meaning of mindfulness being negotiated as a joint goal, which becomes a joint project over the 2-month period of the class. Lindsay approached mindfulness in an instrumental way, trying to figure out “how to do it” in order to get rid of unpleasant feelings: Lindsay415: . . . I don‟t really know what to do with it [feeling of agitation] yet, how to apply mindfulness to it, because before whenever I would feel it, I would just try to push it away and ignore it. Ruth416: Ok Lindsay417: So now I‟m trying to figure out how to live with it, deal with it, work with it.  145  Ruth418: And so what we are going to practice is just looking at it, just looking at it, just allowing it to be and noticing. That‟s the first step for anything, is noticing. And then we will try a few techniques to work with it. But mostly using the breath. And just noticing. That‟s pretty much all there is to it. The whole thing is noticing, bringing awareness to our experience, with a gentle kindness. The gentle kindness is always tough. In Lindsay‟s post-class questionnaire, she commented on finding this interaction with Ruth helpful: “Her response did help me understand that even though I was frustrated, being aware of it was part of being mindful.” By Session 8, some participants reported a growing ability to sit still and “let the thoughts come and go.” Betty said, “It‟s actually just this week that I‟m finally getting the gently letting the thoughts come and go. I used to notice them and think, „oh no! I‟m off track.‟ That kind of reaction, and now it‟s just „oh! a thought.‟ I‟m finally just now getting that” (Betty78). She went on to describe this realization as “a relief” (Betty80). With Ruth‟s response, “That‟s neat!” she celebrated Betty‟s awareness. Gail listened silently, and in her SC, expressed some envy of Betty‟s realization: GailSC1 I remember when Betty was talking about being gentle with herself, about her thoughts, that when she had to actually bring herself back to the moment, she was getting more and more gentle with herself, she was practicing being gentle. I was thinking about my experience. I‟m still not as gentle as I want to be. When my thoughts fly away and when I‟m not where I‟m supposed to be ... [I felt] a little bit disappointed with myself. I was happy for Betty, good for her; she must have worked really hard to get there. Here we can see Gail in a nutshell: ironically judging herself for being judgmental (“I‟m not as gentle as I want to be”) and outcome-focused, with an admiration for the hard work of Betty. Her goal seems to be to compare herself with Betty and measure her own progress. Although her attitude was apparently self-critical, at the same time, she was clarifying what mindfulness is and perhaps benefiting from Betty‟s insights.  146  In the all-day retreat, the D & I at the end of the day was not focused much on the insight project, but rather, attention and language. However, Lindsay continued to struggle with the meaning and purpose of mindfulness. Ruth101: ... Did anyone just hate this day? Just hate it? No? No one just hated it? No violent reactions to it? Lindsay102: I caught myself a few times saying “What‟s the purpose?” Ruth103: Ah, ok. Lindsay104: Trying to figure out what I‟m supposed to be getting out of it. Is there supposed to be an aha moment out of it? Ruth105: uhuh Lindsay106: And then having to just let go of that expectation and say, “it is what it is”. Ruth107: Uhuh Ruth used the elements of “acknowledges,” which is her way (functional step) of giving space to participants to describe their experience. We can surmise that Lindsay was indirectly asking Ruth to tell her what the purpose of the day is, or perhaps even more generally, the purpose of mindfulness. Ruth appeared unfazed in the session, yet in her SC, she reported that in fact she was quite surprised by Lindsay‟s question, “I was taken aback that she didn‟t see the purpose for it. I was thinking, hmm. I was kind of taken aback” (RuthSC20). Ruth resisted any temptation to provide an answer for Lindsay, saying in her SC, “that was surprising to me at this stage, but you know, the penny doesn‟t drop until it drops and then maybe I think a lot of things become clearer. I‟ll be interested to see what she has to say tomorrow” (RuthSC21). They continued in dialogue for 2 minutes, with a joint goal of exploring Lindsay‟s experience of confusion, without coming to any conclusion. Ruth added in her SC, “”I think there would be no sense for me answering that, so I want to see what comes up for her. Maybe when I first started this, I would have wondered what the purpose was” (RuthSC23). Understanding the mind of another. It is not only the participants who strive to understand: one of Ruth‟s most commonly expressed intentions was to understand the  147  participants‟ experiences. In the first session, for example, Laurie described her experience of the bodyscan in a dramatic way, to get Ruth‟s feedback. In her SC, Ruth says that she was trying to understand how “Laurie‟s mind works”: RuthSC15: Um, I think more I was uh was interested in ... I wasn‟t really quite getting what [Laurie] was trying to say about the releasing that was happening. She had an interesting way of describing what was going on for her and I was more interested in understanding that a bit more fully. She seems to have um . . . Sometimes when I talk to people I get what they‟re saying and sometimes you don‟t quite get it and so I was trying to explore it a little bit more with her as I still wasn‟t quite understanding what she was saying. Their joint goal was to explore the experience of the bodyscan, with Ruth‟s goal as “really truly getting what she‟s telling me” (Ruth SC19). Similarly, in session 3, Ruth and Gerald engaged in D & I to understand how Gerald‟s mind works in business communication from the perspective of mindfulness. Ruth‟s emotion was curiosity: RuthSC18: I was so curious listening to his description of his mind states. I was wondering if he was really present with the client or if there was part of him that was present and part of him that was more on autopilot or outcome focused or something. Yet he was aware of it all, and that intrigued me. I was just listening there, trying to understand his particular mind-state and his own understanding of how his mind works. She asked specific questions to help Gerald clarify his experience, evidenced by her use of the elements paraphrases, asks for hypothetical scenario and invited him to contrast his report of his mindful conversation with one that is not. In his SC, Gerald reported trying to be very truthful: RA42: . . . Ok, how did it feel talking about that in this moment? You mentioned that you were trying to be very truthful. GeraldSC40: Um, revealing, very revealing, just kind of dropping any, being without barriers, in a sense, not trying to look good but saying this is how I do it. They continued to dialogue, examining the issue of whether it‟s possible to be “in the moment” in business negotiations as opposed to strategizing: Gerald202: ... Being a consultant, so often part of my brain is in strategy Ruth203: (nods) ok  148  Gerald204: And that strategy and analysis of what the client is saying becomes very important when I come back to the offering. So part of my brain is not there.... Ruth213: Ok. Is there any way you could maintain contact and strategize later? Is that possible? Gerald214: (Pause) I don‟t know. From Ruth‟s SC, it is clear that she was again curious, “wondering”: RuthSC19: Again, I'm wondering if there's a way that he can work more mindfully, or if there is some kind of experiment he might do, just to change things up a bit. But I'm getting the sense that he is very aware of how his mind is working, even if it is splitting somewhat. Gerald reported in his SC that he is also wondering: GeraldSC46: ... at the end of the minute, I was curious, very curious, thinking, ok could I do this? Gail and Maria listened silently, but reported in their SCs that they were very engaged through comparison of Gerald‟s experience to their own. They silently joined Ruth and Gerald in the investigation of how our human mind works in situations involving negotiation and anticipating outcome. There was a sense of curiosity and enjoyment among these four during these minutes. Insight from the body. In Session 2, Ruth provided a rationale for paying attention to body sensation, saying that small feelings of discomfort often make up an unconscious pattern which “forces us to do what we normally do... And so if we can get really intimately familiar with that, then we can start to notice, „what does it make me do?‟ It‟s like a gentle observation” (Ruth121). Maria listened carefully (she reports she was “very intensely focused” MariaSC8), and added, “That was valuable advice. It was like, yeah, I should think about not just „that‟s uncomfortable‟ but „why‟….” (MariaSC6). This was a concept that appeared hard to grasp at least for some participants. For example, it is not until Session 4, and after a long struggle in D & I with Ruth, that Gail appeared to somewhat understand the significance of paying attention to the body. Their D & I exchange continued for several minutes, with Gail giving opinions and  149  judgments about a situation at work, and Ruth asking her again and again to notice her body sensations. Gail commented that she is aware that Ruth may have been a little irritated: Gail21: Yes I think she was trying to direct me and I even felt her irritation with my excessive attention with my cognitive part versus feelings because she kept bringing me back and I kept going away. Maybe it‟s me, maybe I‟m just taking it personally, but because she was sitting close to me, I was picking up her energy that she was a little irritated... I was just thinking, “I have to stay more in my body, I have to pay more attention” and I didn‟t take it too personally but it was a good reminder for me. Ruth gave some direct teaching in this minute, giving a rationale for setting aside the story content and looking for associated habitual body responses. Ruth183: Ok. So what I wanted to say was that the story, the stories will vary but what comes up in the body will be the same. Ok? And this is the way we are. The stories will change. It‟s kind of like all the stories are a laboratory for your life and that‟s what we‟re trying to do in this course is really get familiar with how we react, not in response to any particular story but just notice what comes up for you in terms of how you handle things and how your body responds. This resonated with participants. Gail reported she has an “aha moment”: GailSC124: ...That‟s when I had an aha moment when she said, “ I want you to see a pattern in how your body feels so that you can recognize it next time” she said, “because our body does the same thing”. I was listening to her. Uh, it‟s very consistent, if you learn how to listen to the signals, you will ... so what‟s she‟s trying to tell us, for us to get connected to our body language and what is that signal and uh that was very valuable information and I was very focused on her. I was listening to what she was saying. Barbara also used the term “aha moment”: BarbaraSC25: ... I really related to what she was saying, that how the stories will all be different but the way we react is the same and to take notice of that so I thought that was a really important thing. Almost like Aha! An aha moment. One wonders if the very difficulty of the interaction between Gail and Ruth bears the fruit of insight for not only Gail and Barbara but for the others who are listening. Even though Gail reported that she felt anger, confusion, and disappointment in these moments, she made an effort to respond to Ruth‟s questions. On the one hand, she wanted to tell her story of perceived success and get validation, and on the other hand she wanted to learn mindfulness. In terms of a 150  joint goal, Ruth was trying to give Gail the guidance about mindfulness that she is seeking, and at the same time Gail wanted to continue to tell her story. There appeared to be a power struggle of sorts, but Gail was open to receiving (in a contingent back-and-forth loop) what Ruth is offering, and in the end reports a “valuable” understanding, as does Barbara who was participating silently as she observed. We see Ruth session after session patiently directing all the participants back to the body, and away from positive outcomes, nourishing the opportunities for insight. Again in Session 6, Ruth wanted to get Gail to “look within to see what is forcing her to move” (RuthSC40). They engaged for several minutes, apparently fruitlessly. Ruth asked, “What would happen if you didn‟t wipe your tears?” (Ruth 360). At the end, Gail reluctantly agreed to “experiment” with not moving during the meditation, but in her SC she said, “I said “yes” but ... I wasn‟t very confident about a positive outcome. I‟m going to give it a try but you know just to see how it‟s going but I knew that it was going to be very hard” (GailSC9). How interesting it is to turn to Gail‟s SC for the next few minutes, when Ruth referred to the phrase, “wherever you go, there you are.”17 Ruth explained, “There‟s this tendency to think that, for example, if it‟s not good here, change jobs or change cities. Has anyone done that ever?” (Ruth395). This led into a brief discussion, involving mainly Gerald, about the pointlessness of constantly changing environments to seek pleasure, relief, happiness. Ironically, this relates directly to how Ruth conceptualized Gail‟s constant fidgeting. In Gail‟s SC, it was revealed that although she has not made this connection herself between her embodied experience of discomfort and what Ruth is teaching, she still related, in a more literal way, to the issue Ruth is addressing: GailSC25: Yeah, wherever you go, there you are. And I thought, oh my god, wherever you go ... I take myself with me. That was so ... a lot of thoughts came to my mind when she was saying that. Especially my relation with me. . . I was focused on why I was 17  From Kabat-Zinn, J. (1994). Wherever you go, there you are. Hyperion: New York.  151  running. Because other areas of my life are pretty taken care of. I have a good job and good relationships and career and I do what I love but my personal life is unresolved. And I was trying to see in my mind ... I have to make this city my home. She went on to explain that listening to Ruth and making these connections internally, brought her a sense of realization and relief: GailSC28: After she read the story, there was a big realization. RA32: Ok, ok. Any feelings associated with that? Gail29: Um, I would say feeling of relief that I‟m in control now. I‟m in control of my life, I don‟t have to travel, I don‟t have to trust external voices to solve my problems. RA33: So it was a relief. Gail30: Yes I felt relief. I can stay here. This is me, this is my life. RA34: Wonderful. Anything else you want to add? Gail31: No. It was a good session. I was really tired. I was sick, I was in bed. I didn‟t want to let Ruth down. I‟m glad I came. This is a poignant “inside view” of Gail‟s experience of the class. Even though it was apparently still not making sense to her on many levels, and she was feeling physically ill and tired, she was putting forward her best effort. It is interesting that Gail partially grasped the concept of the pointlessness of constantly moving to seek relief, but not as it applies to her struggle with her own body. And despite not “getting” some of the main points of the curriculum, she was actively drawing conclusions and making meaning from what was being offered her. We can see again that while there were differing individual goals operating, for example, between Ruth and Gail, the super-ordinate goals, or projects, to be exact, of relationship, and learning mindfulness, engaged them and carried them forward jointly. Jointness of the insight project. A dramatic example of the jointness of the insight project occurred in Session 5 following a sitting meditation. In this D & I, we can observe Gail struggling with her embodied lack of peace, Lindsay‟s frustration with Gail‟s persistent struggle, and how Ruth uses Gail‟s difficulties to teach mindfulness to the whole class. This excerpt demonstrates how the insight project was enacted among the class as a joint project, not just  152  individually and also not just dyadically between teacher and participant. Gail described her bodily discomfort of yawning and tearing through the sitting meditation, bodily reactions which she had mentioned in each and every session. Rather humorously, in her SC, Lindsay commented that she is tired of hearing about Gail‟s yawning: LindsaySC32: Um at the beginning of that, um, there was some impatience and frustration. Because we hear about her yawning every week and so part of me was going “ok here we go again”. So I was a little impatient with that, what she was sharing, because it was nothing new. Ruth listened patiently for a few rounds, helping Gail describe her experience, and then used the element “asks for speculation” – “what would happen if you didn‟t fight it” – in a sense, inviting Gail to approach rather than avoid the unpleasant sensations: Gail130: And I was fighting my yawning as always. And I was holding it, and then eventually it would come up as a huge yawn. So I couldn‟t force it anymore, I mean I couldn‟t hold it anymore, Ruth131: Ok Gail132: And I just let it ... I was ... I had the same experience at home, my nose was running, my tears, lots of, I cry everyday for forty five minutes. Ruth133: What would happen if you didn‟t fight it? If you didn‟t fight with the yawning? Gail134: It‟s just very distracting, I‟m trying to sit and not think. By this point of the course, Gail (and presumably at least some of the others) was still not really getting conceptually or experientially what Ruth is presenting as mindfulness. It seems from Gail‟s ongoing SCs that there were moments of understanding, but in the sessions, she tended to lapse into very similar attitudes (outcome-driven, positive thinking, and avoidance) and stories (usually either about discomfort or about success). With Gail‟s words, “I‟m trying to sit and not think”, Ruth leaned forward, using her hands for emphasis along with her “no‟s”. She speaks for 2 minutes, very unusual for her: Ruth135: No. No. We‟re not trying to not think. That‟s not what we‟re trying to do. That‟s really important to clear that up. We are not trying to not think. We‟re just letting the thoughts come as they come and bringing awareness to them. It‟s the awareness to the thought. So the thought comes, and it might feel like it‟s almost automatic. But just notice 153  the content, notice the content and return to the breath. And so the purpose isn‟t to clear the mind at all. It‟s simply to notice whatever is, whatever is, including feelings, if your foot is cramping, as opposed to taking the cramp away, simply if you can bring awareness to the cramp, as it arises, as it tightens and as it fades away. So really just a gentle observing, not to force it to be different than it is. Not to force it. Not to force the yawn not to come if it wants to come, and has to come, just simply notice the feeling that makes that yawn want to come. Staying with the breath. But just shining a flashlight in there and then by doing that, we can get a glimpse of what drags us all over the place, just getting a glimpse of what drags us. Here we can see Ruth highlighting several key aspects of the mindfulness project: noticing (attention), gentleness (acceptance) and “getting a glimpse of what drags us” (insight). In Gail‟s SC, she reported that she actually enjoyed this part of the session, and that she felt relieved by what she saw as Ruth‟s permission to yawn: GailSC6: ... There was a realization that I shouldn‟t have forced it or stopped it, I should have allowed, just don‟t ... if the yawn is coming, yawn if you want, let it be. The RA commented to Gail that in the video, Gail appears to relax in this moment, settling back in her chair, and Gail agreed that she felt more relaxed, hearing that she does not need to fight against the yawning. The joint goal was to explore what mindfulness is, with an accent on the “awareness and acceptance.” As Lindsay observed the interaction between Ruth and Gail, she was busy drawing insight from it: LindsaySC32 ... Um but then when Ruth sort of said, “no we‟re not trying to stop the thoughts” ... Ruth has said that in different weeks but for some reason it was just sort of sitting with me a little bit more this week, that it was like, “right, it‟s ok if we have the thoughts, we‟re supposed to have the thoughts, we‟re not supposed to get to an empty mind state, that‟s not what this is about”. So it was just kind of sitting with me a little bit more strongly. I was just sort of getting ahold of that a little bit more, saying “oh right!” And every week she‟s been saying it and every week it‟s sort of been becoming stronger and stronger and stronger, my understanding of that. .. At the beginning of this whole process I had the impression that mindfulness meant especially when we were meditating that mindfulness was emptying our mind and just being focused on breathing all the time and these thoughts that we had going through our brains, that those were things that we were supposed to stop, that we weren‟t supposed to have those and I wasn‟t quite grasping the concept that “no no no no, we let those thoughts come in ...”  154  It is interesting to note how Gail‟s lack of understanding at this point in the session was actually helpful in the larger joint insight project, judging by the benefits Lindsay reportedly received. What started as a “oh no, here we go again, with Gail‟s yawning” turned into a significant moment of understanding for Lindsay. In fact at the end of that SC minute, she commented she had a sense of relaxation, of contentment, in this moment, “a sense of, I don‟t know if validation is the right word but it‟s sort of a sense of contentment, like „ok I‟m on the right track‟” (Lindsay SC37). At least Lindsay and Gail moved from frustration to relaxation, and we might speculate that the whole group had been engaged in this movement to relaxation. Lindsay had been saliently involved since Session 3 in the question of what mindfulness is, and this exchange between Gail and Ruth appears to enrich her efforts: LindsaySC34: It‟s ok to have the [thoughts]. The goal is not to stop them. So that‟s been something that‟s been growing for me, that the thoughts themselves are fine, that the goal is to not continue on the path with the thoughts. And so you know that‟s, that‟s again, it‟s not new what Ruth was saying but every time she says it, I think it reinforced for me what mindfulness is and what it isn‟t. We can say that Ruth‟s goal was to teach Gail how to be mindful, what mindfulness is. She did this by giving Gail space to describe her experience, and inviting her to look at her experience from a different perspective. Gail‟s goal was to get some relief from her embodied distress. By letting the yawning “be ok”, she was able to find some peace. In her SC, she said, “I felt better when I actually shared with her and when she said to me that I didn‟t have to hold my yawning” (GailSC3). Lindsay‟s goal appeared to be more specifically to understand mindfulness as it applies to her own life. The joint goal among them was to process Gail‟s experience of discomfort from a mindfulness perspective, and to better understand what mindfulness is. We can see how Ruth teaches the whole class through the interaction with one participant, Gail, and how at least Lindsay, if not everyone, was able to participate and benefit from Gail‟s frustrated  155  pursuit of embodied peace. Later, in the same session, Gail asked Ruth if “mindfulness” can be learned once and for all: Gail211: Is there any way to develop this habit as a permanent habit? Or is it a lifelong .. Ruth212: It‟s lifelong. It‟s not a quick fix, this work. Not a quick fix. Gail213: Too bad Ruth214: I know (laughs). Gerald215: Does it come in a pill form? Evryone216: Laughter Ruth217: It doesn‟t come in a pill form (laughs). It‟s exactly this: it‟s looking within at these fleeting little things that pull us. Listening to Gail and Ruth‟s exchange sparked off in Gerald a profound realization, “a little sad” accompanied by “a kind of relief” about mindfulness not being a permanent solution to trouble, but rather, an ongoing way of life, “like brushing your teeth”: GeraldSC22 ... But it was kind of a recognition, it was a little sad and just recognition, “ok, so this is it, it‟s kind of like this, it‟s like brushing your teeth, you have to do it.” I guess I thought the work had been done, but it‟s never done. It was kind of, “ok”. ...In a way the acceptance is a kind of relief. I feel like I‟ve discovered a place out of the places I‟ve been in. In other words, I‟ve found a path. So it feels really good that I‟ve found a path. Again we can see how insight (in this case, acceptance of impermanence) was facilitated jointly among the group, this time via Gail‟s yearning for a permanent solution to her restlessness and discomfort. Understanding the nature of the mind. At the end of Session 3, the D & I continued after the sitting meditation to explore the nature of the mind, how “the seductive thinking mind” operates, how it is necessary and functional, and how it can also be unhelpful. Tasha noticed that during the meditation, her mind was busy with thoughts that were not helpful. Ruth normalized this cognitive pattern as “the nature of mind”: Tasha304: It just seems pretty useless, all the thoughts I was having. They weren‟t productive. Ruth305: Were they kind of going in a circle?  156  Tasha306: Yeah. They were just like random things that really wouldn‟t solve anything or ... just there. Ruth307: But it‟s the nature of mind, right? The nature of mind is to think. Ruth went on to ask an ontological question about the reality of these thoughts: Ruth295: . . . The thinking mind, do you get a sense of just how frenetic these thoughts are? They are so busy and there are so many of them. How real do you think they are? Lindsay296: How real are our thoughts? Ruth297: Uhuh. (long silence) Maria298: I kind of notice that they are not real at all next to some white space, like when you actually have that moment when you are focusing on your breath. You kind of realize that all that junk that‟s kind of floating through your head just is ... junk. Ruth299: Uhuh. Maria300: But usually it seems very important. Ruth301: Uhuh. So just a glimpse of white space. At the end of Session 3, the D & I focused on the joint group goal of identifying and understanding the “nature of mind.” There was a growing sense of “the human mind" as opposed to “my mind.” Gerald made an observation right after the sitting meditation about the parallels between Ruth‟s instructions and his inner experience. Ruth drew this out to illustrate the universality of cognitive processes: Ruth263: So how was the quality of the mind? Gerald264: It was like you timed “go back to your breath” synchronized with when I was thinking Everyone265: Laughter Gerald266: That was weird! (laughs) Everyone267: Laughter Ruth268: (laughs). How do you think I would know that? Everyone69: Laughter Gerald270: Well you‟ve had a little experience. Ruth271: Because my mind is gone too (laughter). You can only teach it from your mind. And that‟s the state of mind, in two seconds and it‟s gone. Where all did it go? Here Ruth emphasized that she was able to synchronize her words with their thoughts, not because of some expertise or psychic ability, but because her mind was also wandering, and that is its nature.  157  Understanding our stories. In session 6, Gerald responded to Ruth‟s invitation to share their weekly homework experience of “making a gap”. He described a frightening experience he had with a driver who expressed “road rage” and recounted how he had attempted to respond calmly rather than reacting impulsively. He told the dramatic story for a few minutes with Ruth using only elements of “acknowledges.” In his SC Gerald stated that his intention in telling the story was to “to find out, yeah, did I do it [leave a mindful gap] the right way? I guess I was looking to see if I did it the right way.” He quickly shifted next in session to a more obvious “positive outcome” twist to the tale, in which he described the situation of going to a scheduled doctor‟s appointment right after the frightening road rage incident, being told his blood pressure was dangerously high, and being able to reduce his blood pressure through mindful breathing. Gerald explained in his SC that he wanted to demonstrate how helpful mindfulness had been for him: I‟m also at that point trying to ... I‟m actually talking about how much benefit I‟m getting out of this course... in telling it to Ruth, I was really saying, “Look, this stuff is really working for me, this has been really good. (GeraldSC15) This is an excellent example of how Ruth often would accentuate an aspect of the story that the participant was not addressing (e.g. avoiding). She brought Gerald away from the positive outcome, and back to the negative event: Gerald18: I pulled it right down by meditating. Ruth19: You were able to do that. Wow. Gerald20: I said I‟m going to lower this blood pressure. Right down. Ruth21: Amazing. How did you feel while that man was yelling at you? Did you notice? Gerald22: Um, well I didn‟t like it. I did feel afraid. Ruth23: Yeah. Gerald24: At the same time, I could feel, I was starting to feel aggressive. Ruth25: Uhuh. On a certain level, their goals were at cross-purposes here: Gerald wanted to demonstrate how useful mindfulness is, and how successfully he exercised his ability to be mindful through 158  lowering his blood pressure, while Ruth wanted to redirect his attention back to the road rage incident and identify the connection between the two stories. As usual, she was not as interested in apparent “positive outcomes” as in the participant‟s awareness and insight: RuthSC35: Yeah, because I‟m thinking that um he was actually holding that stress within for the whole time. So I was trying to get back to that incident to see if he could make those links. How he was holding that tension and pressure within during those times. ... I‟m not sure if he actually went back far enough and was able to put that all together. However, on a more general level, their joint goal was to process Gerald‟s experience more deeply and in this, they appear to be successful, based on Gerald‟s SC: RA26: Ok. And so in this interaction you were saying that what she‟s offering you is some clarification. So her first set of questions were taking you right back to the feeling at the moment of the high intensity. Were you able to go right back to that feeling? What was it like for her to ask you to go back to that feeling? Do you recall any reaction to that question? GeraldSC23: Um. I was less emotionally “in” so I wasn‟t experiencing the emotion. I had a bit more understanding or maybe because I‟d talked about it and then she brings it back up, it wasn‟t quite as emotional. Ruth continued to give Gerald space to describe his experience, with a few questions: Ruth39: It could have been quite dangerous. Gerald40: Yeah. Ruth41: Well. Do you think it would have been different if you had responded how you normally would have? Gerald42: I don‟t think I would have remained as calm and collected. Ruth43: Uhuh. How did you do that? Did you breathe? Gerald44: Yup. In his SC for these minutes, Gerald reported that Ruth‟s questions helped him “clarify what I‟m experiencing”. We can see how putting words on experience is an important part of both awareness and insight: GeraldSC22: Hmm. From a ... well I felt really heard and understood by her. She really got connection with where I was and where I was feeling it. That‟s what I felt anyway. And um I find when she kind of interacts with me with those kinds of questions it helps me …even what I‟m experiencing because some parts of it I don‟t know what I‟m experiencing… Gives me a way of understanding what I‟m experiencing and um that gives me more trust to continue doing it and um I really enjoy it. And the ... because I did 159  have both the feeling quite afraid in the car but also at the same time right on the edge of getting really angry but wanting to manage that because it was, it felt dangerous and it felt difficult. And I was using the breath to kind of keep the space there. He went on to pinpoint what he appreciates so much about Ruth‟s teaching style: GeraldSC25: I really pay attention to her interactions not just with me but with everyone. How she facilitates, or if you want, teaches the group by asking questions for clarification, deeper understanding, and I know that when I‟m on the other end of it, I learn more of where I am in the process and what it takes to do this work, in the sense of “here it is, I‟m in this and I don‟t know what it is” and I‟m noticing all these differences and I want to understand what the differences are and so she asks questions and I get a point of reference back to myself. She kind of reflects it back to me and that helps me sort it out. And I watch her do that with other people. In the way that she gives no answers but she asks questions but typically the questions for most people seems to create answers for other people. So she helps create answers for people without giving answers. Although I‟ve noticed that some people, early on particularly, wanted actually a direct answer. So I try to engage to get the response not to get the answer. To get the question that I need. Much of the D & I appears to be about participants “getting the question that they need,” rather than the answer, to facilitate their abilities to pay attention, find words for their experience, and understand their experience. Something that became more and more saliently observed by the researcher as the session dialogues were transcribed and analysed was the relatively systematic sequence of the three actions of notice, describe and understand. The temporal order of these actions makes sense, as they are somewhat contingent on each other. And of course, as has been pointed out, sometimes in the process of describing, for example, more noticing was possible, and the actions become quite intertwined rather than sequential or linear. However, there was a noticeably repetitious and even formulaic sequence that unfolded in the dialogues. It would start off with Ruth asking what they noticed (in meditation) and the participants describing this (usually at first in quite global, opinionated, or judgmental ways). A second loop was then begun, with Ruth asking certain types of questions to help them notice and describe more specifically, less judgmentally,  160  and more focused on sensory details. The final step, which became more frequent in later sessions, was Ruth asking the question, “And what do you think that was about?” or “Do you notice that pattern happening in your everyday life?”, in other words, questions which facilitated understanding. For example, in Session 2, after engaging with Maria in the joint actions of noticing and describing, Ruth turned her attention to the class and commented that avoiding discomfort can lead to an unconscious pattern which then leads to unhelpful behaviours, and “if we can get really intimately familiar with that, then we can start to notice, „what does it make me do?‟ (Session 2, Ruth 121). In this moment, Maria, though silent, was moved towards insight, reporting in her SC that she was struck that “I should think about not just „that‟s uncomfortable‟ but „why‟” (Maria SC6). The three sub-ordinate joint projects most saliently associated with the mindfulness project appeared relatively systematically engaged, as opposed to free or spontaneous conversation or discussion. Relationship Project Even though the relationships among teacher and participants were temporary and to a large extent, a means to an end as a way to learn mindfulness, a relationship project developed as a highly overlapping but distinct joint super-ordinate project. That is to say, relationship was more than a context for the mindfulness project. Sitting together with the joint goal of learning mindfulness, participants began to care about each other, to experience spontaneous feelings of compassion, for example, as they listened to each other‟s struggles, or feelings of irritation as they listen for the umpteenth time to someone‟s repetitive narrative. In her SCs, Ruth expressed feelings of curiosity and caring for the participants that goes beyond teaching them to be mindful. Likewise, participants early on were interested in Ruth as a person, and became engaged in trying to get her approval, feedback or attention. Gail said in Session 6, “I was sick  161  [but] I didn‟t want to let Ruth down” (Gail31). On the other hand, one participant, Barbara, decided to leave the mindfulness project because she experiences a failure of the relationship project. It could be said that the relationship project is important in ways common to all psychoeducational and therapeutic groups: the feelings of universality, for example, identified as a therapeutic factor by Yalom (1985) in his work on group psychotherapy. However, there are certain elements of the relationship project that served to underline and embody specific principles and phenomena that appear important in the learning of mindfulness, such as selfcompassion, universality of certain cognitive habits/patterns, interdependence, and emotional regulation. These will be described in this section under two headings, the subordinate joint compassion project, and connection project. The sub-ordinate joint compassion project (helping). Although the compassion project operated as a sub-ordinate joint project of the wider relationship project, it simultaneously supported and informed the mindfulness project. There are many ways this project operated. First, the aim of self-compassion was jointly enacted every time Ruth engages participants to notice and describe “with gentle kindness.” Participants sought and practiced self-compassion in the dyadic and group relational context. Secondly, in the form of action taken explicitly to help others, the compassion project was enacted with enthusiasm by members who were sociallymotivated to contribute to the MBSR group process. We can surmise that most or even all the group members participated at times out of the motivation to support each other. Based on the self-confrontation data, we have several examples of Maria and Lindsay, in particular, acting with the overt motivation of helping Ruth and the group in the mindfulness project. Thirdly, the compassion project appeared to be enacted implicitly at times to help others. From selfconfrontation data, we know that compassion arose spontaneously in teacher and in participants,  162  in the form of a warm openhearted longing for the other‟s relief from suffering. In this latter category, compassion may be described, in action-theoretical terms, as an emotion which energizes or motivates action. Lastly, another way the compassion project was engaged implicitly is when the group appeared to move towards regulating an individual participant in distress. Self-compassion as a joint goal. In the first session, Ruth finishes explaining the homework by advising, “And if the mind wanders away, the important thing is to notice where the mind goes. Not so much that we need to do anything with it but just notice gently where it goes to” (Ruth186). In her SC, Jackie commented that she was “drawn” to Ruth‟s “permission” to approach her experience with gentleness, drawn, as it were, into the compassion project: JackieSC 24 ... when she was talking, when she was saying ... “just notice and don‟t judge and let things be as they are” ... I‟m so drawn to phrases like that because I feel it‟s so difficult for me actually do them and carry them out, so for somebody who actually almost give permission ... to say, “it‟s ok, it‟s as it is and just let it be and just listen to it” um that was like really nice to hear. It is simple as that and it is ok. In Session 2, Ruth repeated an invitation for gentle kindness to another member, Paula: Ruth207 . . . With a gentle kindness, almost like you would the puppy that you‟re walking. You wouldn‟t yell at the puppy, right? Jackie reflected on how important this exchange was for her because it linked into a life-project of trying to be more accepting and self-compassionate, and how hearing these words also made her feel “more calm”: JackieSC10 ... It started with Ruth saying that you need to accept it, be gentle and kind towards yourself and I think to me that has a lot of meaning because that‟s where I know I need to work towards and that‟s where I think the last couple of years I really tried to look at that and try to incorporate it into my life but I know that it‟s such a big challenge because I think I focus so much on achievement and other people and doing things the right way that it‟s hard to give myself permission to you know just be as I am, like as she said, like just being gentle towards yourself, so I loved hearing that, I find it so validating, and it‟s ok to do that, um... and not only that realization but also like really just it was like  163  it made me in a way like more calm. Because there was somebody in her position saying it‟s ok, just be gentle, giving me permission. Ruth noted how intentional her invitation was in this moment, in response to both Jackie‟s earlier sharing and Paula‟s self-critical comments: “A reminder. Because both these young women were really beating themselves up about not getting it right, so I thought it was important to reemphasize that point” (RuthSC144). In Jackie‟s final SC interview in the Session 9, she commented that Ruth‟s invitation to self-compassion has been salient for her over the course: JackieSC12: So she started with gentle kindness, those words. I think there are a couple of key words that I‟ve really remembered from the things that Ruth has said. Gentle kindness, I don‟t hear other people say that and I think it‟s such a nice way of thinking of things. ... The fact that she continues to remind us to don‟t question, just be gentle towards yourself and accept it, have a look at what‟s going on but don‟t be harsh. For me, that means a lot, to not judge and question myself or others. So something so little that she said in that minute, it just makes a lot of sense. Jackie is not the only one who responded to Ruth‟s invitation to self-compassion. Lindsay often referred to it as a salient goal and indeed project in her life. For example in Session 2, she described washing her face mindfully and gently and realizing “that is a metaphor for other areas in my life and how I treat myself … to be more gentle with myself, more loving, more caring.” (Lindsay 243). Laurie also found the compassion project to be important: Laurie150 ... And I‟m still curious about all the moments that I‟m still beating myself up and not noticing it. Like I‟m always curious to find other ones where I‟m like, “oh yeah, in that place too, I can have gentle kindness”. It‟s almost nice to notice the painful moments in a sense and have that brought to consciousness. (Session 4) In this description, Laurie highlighted the attention project (noticing) which is accompanied by the intention to have compassion for what she notices, and Ruth commented in her SC for this minute that she was appreciating Laurie‟s sharing, “I thought she was saying it beautifully and if other members were hearing her that would be very valuable teaching” (RuthSC30). Likewise,  164  Maria listened to Laurie‟s sharing with curiosity and feelings of connection, saying, “I was thinking about how that plays out in my own life, what extent do I do that?” (MariaSC5). There is an exchange between Ruth and Lindsay in Session 7 which demonstrated how the project of self-compassion was worked on jointly, intertwined with the language project, and how for both Ruth and Lindsay it became strained. This D & I was a little different than usual, in that it was less sensation-focused and more an inquiry into behavioural and mental patterns. The topic was the notion of “choice.” Lindsay first rejected and then accepted an invitation to examine the role of choice in eating patterns: Ruth288: Well, there‟s a balance really, in many respects. What about the food? Lindsay289: Don‟t look at me Everyone290: Laughter. Ruth291: Oh? Ok. Lindsay292: No, food‟s my bad.... well that‟s a challenging area for me. Ruth293: Ok. Well, are you aware of what comes in? Ruth‟s goal was to begin exploring the topic of food with Lindsay in a non-judgmental way, and Lindsay‟s goal initially was to recover from the sense of shame: LindsaySC28: Um, the beginning part of it, um, where I said, Don‟t look at me, don‟t talk to me, I forget exactly what I said but when I initially went “whoa,” um, there was definitely almost a bit of embarrassment, a little bit of guilt, because um I really, I really do struggle with food issues and I can‟t seem to get control of it and and I feel bad about myself that I can‟t get control of it. Ruth reported in her SC that from the beginning of this exchange, her attention was alerted to Lindsay‟s self-judgment, with a desire to temper that: RuthSC11: I‟m aware that she labelled the choices “bad” and I was trying to get to the end of her story so I could think of some way to change the way in which she was viewing it. Ruth attempted to understand Lindsay‟s perspective and to lead her into a more self-accepting perspective. She did this by listening actively to Lindsay‟s sharing while trying to think of a “way to diffuse it so it wasn‟t self-punitive” (RuthSC10). 165  Lindsay296: Um, I make a lot of bad food choices for myself, not necessarily bad choices in terms of nutrition but because of some food sensitivities that I have to pretty common food items, like wheat and gluten and dairy, to be the best my body can be, I should be avoiding all of those completely. But in society, that‟s very hard to find foods where I can avoid those major food groups completely. Ruth297: Hmm Lindsay298: So I often make the easy choice because it‟s good, it‟s satisfying but in the long term it‟s not doing my body very much good. Ruth299: Who says that? Is that how you feel? Ruth offered in her SC that she was focused on finding a way to work with this in a nonjudgmental and helpful way. She was hoping that if she could make this less personal, that Lindsay would be able to get some distance from it: RuthSC7: Um, yeah. A little bit although I felt that I kind of got off track in the conversation because I usually try to avoid people divulging their personal information and it was kind of, the way she was relating the story was leading her to kind of place of beating herself up. And so I was trying to think of a way to diffuse it and make it not personal. At the same time, Lindsay was aware of trying to be less self-critical in the language she chooses: LindsaySC28: . . . During the session, I caught myself starting to refer to it one way and then I rephrased it. So I was being cautious about how I was trying to describe the food issues because I have been viewing them as, I‟ve been viewing myself as a victim, to these food issues, so I‟m trying to rephrase it so I‟m less of a victim. So I caught myself rephrasing during the session. They were both working on moving Lindsay towards a less self-critical perspective. Ruth wondered if Lindsay‟s self-criticism is based on personal comparison, external opinion, or a real evaluation of her body‟s response to food: RuthSC14: Why is she calling it bad? What‟s the reason behind the “bad” and is this something she read or somebody told her she should or is there something from her body that says it‟s not right for her? RA15: Do you have any recollection of how you were feeling as she was talking about this topic that was so uncomfortable for her? Ruth15: Um, a little bit that we were getting into too much of a personal story because it‟s not so much the personal story but more ... I was trying to get what happens in the body in response to the food as opposed to [a confession].  166  Likewise, Lindsay reported in her SC that she was more comfortable moving away from the personal story, LindsaySC31 . . . And I started off being very judgmental with myself too. And then I lessened. It became more clinical as opposed to personal. The initial reaction was very personal and then as I went on, I became more clinical and detached from it. She described the movement towards detachment came from her being mindful “about the words I use and about how I deal with food.” She did not seem aware that Ruth was also working to draw her towards that stance of the observing self. In the next moment, Lindsay had another personal reaction. Ruth had attempted to bring Lindsay‟s attention to her self-punitive attitude, with the hope that she could be kinder to herself. She said in her SC: “Um, I was hoping that was enough to kind of diffuse the self-punitive aspect of it and yelling at herself for not being perfect with this diet and so I was hoping to draw it out by pointing out that most of us aren‟t either” (RuthSC18). However, Ruth‟s intended effects did not materialize: Lindsay302: But also, if I‟m really paying attention and am able to keep these foods out of my diet for a period of time, I do feel the physical difference as well. But it‟s very challenging to keep some of those major food groups out of my diet. Ruth303: It‟s challenging to be perfect? Lindsay304: (grimaces, blushes and squirms). Yes. In session, Lindsay turned red, bowed her head and appeared ashamed. In her SC, she related: When Ruth said something about “you mean you‟re not perfect,” then it was sort of this sense of “no I‟m not.” So there was ... I was judging myself. I was feeling really ... it wasn‟t that she said anything to make me feel bad, it was just internally, I went “no I‟m not perfect”. I can‟t get this under control. So I was disappointed in myself. And that‟s why ... I didn‟t know I‟d done it at the time, but as I‟m watching this, when she said, I see that I looked away from her. I put my head down. I broke eye contact with her. So again, I wasn‟t conscious of having done that physical stuff in the class but at that moment, “Yeah I‟m not perfect” so having to acknowledge that. I think the last time you interviewed me I talked about perfection and how that ... it‟s an impossible thing and yet I‟m always striving for it. So this is sort of that pattern. (LindsaySC37). Lindsay seemed to have a small “shame-attack” in response to Ruth‟s well-intentioned comment. She added, in her SC, “I hate the fact that I can‟t be perfect” (LindsaySC41).  167  Here we can see the complex dance involved in relational mindfulness. Ruth‟s goal was to diffuse Lindsay‟s self criticism, which she attempted to do through normalizing Lindsay‟s experience as human imperfection. Lindsay in fact had had, for a few minutes, a goal of tempering her own self-criticism through deliberate word-choice. Yet she eventually regressed to shame, despite both of their best efforts in their joint goal of working with Lindsay‟s negative self-talk. The group balanced this vulnerable and painful moment with humour, as Gerald, Tasha and Karen quickly chime in with light comments and laughter. Humour may be used as an explicit or implicit functional step in the compassion project, to help soothe a fellow participant. Ruth‟s SC for this moment is particularly poignant. She and Lindsay had worked hard together for minutes on the project of self-compassion and being more comfortable with inevitable imperfection. In a moment of vulnerability herself, she relates in SC how exhausted she is in this session, feeling a bit daunted by the participants‟ apparent fatigue and quiet responses. When asked how she was feeling at this moment in the session, she reported: Ruth20: “I‟m really not on top of my game today” (laughs) ... That was the general theme of it. I mean part of it was mis-timing, cause I saw the clock in the hallway and it‟s 10 minutes faster than my own clock is and so I called the meditation shorter than I [intended]. In an interesting parallel process, Ruth‟s self-compassion could also have been potentially challenged at this point, but while she expressed in the SC an awareness of her inevitable limitations as a teacher, she did not engage in self-criticism. Compassion as expressed in helping actions. Maria and Lindsay seem particularly motivated to be good group participants and helped Ruth and the others through their participation. They reported in their self-confrontation interviews that many of their decisions to speak up in the D & I were driven by their desire to support Ruth and the other members. In session 4, we can see Maria and Ruth working together to help the group. In minute 17, Maria 168  shared her experience with the homework and Ruth guided her deeper into her experience by an empathic paraphrase: Ruth137: Ok. So you double beat yourself up. Maria138: Absolutely! Evryone139: Laughter. Maria140: But I noticed that I was beating myself up, which I think was a little bit different a