Compassion, It's Not Just for Those We Serve: Using Mindful Self Compassion (MSC) in our Motivational Interviewing (MI) Practice.
As practitioners of Motivational Interviewing (MI), we aim to help others through compassion. Whether we are trainers, case workers, supervisors, physical therapists or play other roles, we practice MI as a skillful way to express our desire to be of benefit to others. We are united by our aim to reduce suffering and increase happiness in those we serve. But do we extend this same compassionate intention to ourselves?
I think that this is an important question, especially in the current landscape in which helping professionals find themselves these days. The COVID pandemic has caused stress of isolation, division, and uncertainty. And helping professionals are hard to find these days. A full third of US nurses are predicted to leave the workforce by the end of 2022 (Mills, 2022), and there is a growing shortage of mental health workers despite an increase in need for these services (Barna, 2022). Other COVID related stressors relate to the cost, scarcity or unpredictability of childcare.
I have experienced these stressors first-hand, and I have noticed how these factors can impact the way I show up with others. Since COVID, I more often find myself less than fully present in conversations at work and fatigued during client visits. Worse, I often judge myself for these stress-related behaviors. For example, I might shame myself for not being 100% with others at work. My self-judgment, feeling of isolation, and over-identification can make me less effective with those I am aspiring to help.
In the world of MI, I was always taught about compassion as “a way of being” that was focused on helping others through empathy and non-judgment. Like many in the mental health field, the stance of caring for and supporting others who are suffering came easily to me. In a way, practicing compassion towards others helped me to foster compassion for myself. But in the my 10 plus years in the community mental health, I have never put much thought into how I would practice compassion towards myself (other than a vague concept of “self care”). Practicing compassion for myself was a blind spot.
Mindful Self Compassion (MSC) is a research-based approach to helping us practice compassion for ourselves so that we can be more effective in practicing compassion with others. Those of us who are in helping professions frequently have high exposure to severe trauma and suffering of others. Hearing about or otherwise witnessing trauma repeatedly over time can be depleting and even result in secondary trauma. MSC can help prevent or reduce some of the effects of this exposure, such as burnout and compassion fatigue, that are so prevalent among helping professionals (Atkinson, Rodman, Thuras, Shiroma, & Lim, 2017; Eriksson, Germundsjö, Åström, & Rönnlund, 2018; Wasson, Barratt, & O’Brien, 2020). Just as a blacksmith skillfully applies fire to metal to increase iron’s toughness and temper, we can apply MSC practice to develop and maintain our resilience as care takers and professionals. The three elements of MSC (mindfulness, common humanity, and self kindness) can give us the courage to continue to serve others while also protecting space to care for ourselves.
Mindfulness
Mindfulness is one of the three elements of Mindful Self Compassion, and a form of mindfulness mediation or check-in is often the first step in many of the MSC practices. Mindfulness has been defined in many ways by many thinkers. Tara Brach describes the mindfulness in the psychotherapeutic setting as:
…the intentional process of paying attention, without judgement, to the unfolding of moment-to-moment experience. It is the opposite of trance, a word I use to describe the ways in which we – therapist and clients alike – live inside a limiting story about life (Germer & Siegel, 2012, pg. 37).
Kristen Neff states that mindfulness in MSC is “Clear seeing and nonjudgmental acceptance of what’s occurring in the present moment. Facing up to reality, in other words” (2011, pg. 80). The facing up to reality component of the mindfulness practice is emphasized in MSC. We need to start to face our own pain, suffering, and circumstances. The practice of mindfulness in this sense takes courage. We intentionally notice that our energy and mood has been drained after a grueling day of back-to-back zoom meetings. Instead of reaching for a distraction or numbing out, we face our feeling with curiosity and boldness. We “meet ourselves where we are” in terms of our pain and our suffering in this way. We need awareness of what is going on so that we can understand what a good response might be. Just the act of noticing suffering with the desire to help end that suffering is already a form of compassion.
I recently had an experience that relates to this. I made a major change in my career trajectory, this was a hard decision that I had thought through on my own and with my family over many months. This was undoubtedly the right decision. Eventually I submitted my letter of resignation. Even though I had made this decision, thought it through, and even submitted my resignation letter, I still had a vague feeling of unease, ambivalence, or hesitation about it all. I would avoid thinking or talking about it. During one of the MSC mediations I noticed that I was experiencing sadness, fear, and grieving related to this change. I am going to miss those I work with; this will be a positive change but also a big loss for me. Noticing these feelings was like “facing up to reality.” And it was not until I really stopped to notice these feelings that I was actually able to feel present and resolved with my decision.
Common Humanity
The connection to humanity is another of the three MSC elements. We often find ourselves trapped in our own mind, caught up in our own identity or “selfness.” As part of this basic human tendency, we tend to think that we are alone in our suffering. But in reality, we all experience pain and suffering – this is a normal part of human existence. When we think that we are alone in our suffering and pain, we tend to experience another layer of suffering – shame, loneliness, hopelessness, or other experiences. Over identification with ourselves can cause us to have tunnel vision focused on our individual suffering alone, and this can quickly lead to a downward spiral. Neff writes that “When we’re in touch with our common humanity, we remember that feelings of inadequacy and disappointment are shared by all” (2011, pg. 62). MSC reminds us that we are social creatures with an instinctual need to feel that we belong and connected with others, recognizing the universality of human suffering helps us to build that feeling of belonging and connectedness.
For example, recently I shared with a colleague that I have had severe anxiety when grocery shopping – this was a fact that I was somewhat embarrassed and ashamed of. I had even been told by a previous therapist that “it is funny you have anxiety when you are around a bunch of people who are in a hurry and probably aren’t paying any attention to you.” I felt alone in this experience. But when I opened up about this vulnerability to my colleague, she made a facial expression and body language stance that indicated “yeah, that is pretty normal for a lot of us.” When I asked her is she had ever experienced anxiety at grocery stores she said “yes, all the time. Sometimes I don’t go to the store because of it,” she said this is such a matter-of-fact manner that it just seemed like a normal part of the human experience. It seemed that she was saying “of course you have anxiety in the grocery store. The amount of choices in the cereal aisle alone is enough to make any person second guess themselves. Who wouldn’t have stress and anxiety with all those shoppers hurriedly driving their grocery cart in all directions, food prices doubling, and that weird grocery store muzak!” I was honestly so astonished by her response that I did not know what to say.
Somehow I had gotten stuck in my head thinking that I was the only person who experienced stress and anxiety in this situation, but of course the reality is much different. This connection to humanity normalized my experience, it made me feel connected to others. After this conversation I felt a big weight was removed. My anxiety related to grocery shopping will undoubtedly still be there, but I can feel connected to other shoppers who may be having similar experiences to me – we are suffering together and not alone. Somehow this makes it all more manageable and less lonely.
Self Kindness
The final of the three elements of MSC is self kindness. Neff explains that this term refers to being “gentle and understanding with ourselves rather than harshly critical and judgmental” (2011, pg. 41). Self kindness invites us to aim our Rogerian “unconditional positive self regard” back on ourselves. This approach means that we accept that fact that we will make mistakes, we are not perfect - this is OK and normal for human beings. Neff often refers to her aspiration of becoming a “compassionate mess,” perhaps meaning that she aspires to accept she is an imperfect being and life is hard. Despite and because of this, she aspires to practice compassion and loving kindness with herself and others.
The example for self kindness did not come as easy to me as examples when I lacked self kindness. I am a person who is very accustomed and skilled at using kindness and compassion with those I serve, but when I reflect on my own self talk (the dialogue inside my mind), my approach is very different. When I make a mistake, my typical internal response is one of a “tough father” who is encouraging me to toughen up and push through. This voice can at times cause me to feel shame, inadequate, or weak. This internal self-critic wants to motivate me to “do better,” but the harsh approach taken by this grumpy old man leaves me feeling defeated and unmotivated. Other times when I make mistakes, I am able to notice the mistake and hold it lightly without the harsh critical voice. It is those times that I am more easily able to get up, brush myself off, and work to address the mistake.
MI and MSC
The MI spirit invites us to adopt a way of being with others that embodies compassion, acceptance, partnership, and evocation (or empowerment). We make the intention to focus on others, on their terms, in a collaborative manner, with empathy and a desire to help to help them discover their motivation. Often the MI practitioner is encouraged to reflect on their own biases, preconceptions, and other internal conditions that might be barriers to practicing the MI spirit with others. Even as self-reflection is often encouraged in MI trainings, the client is the one who is being helped. The MI practitioner works internally in order help to the client, it’s almost as if we “take ourselves out of it.” It leaves me to wonder where "the self" goes at those times.
MSC is of course more self-oriented but not selfish. Kindness, Connectedness, and Mindfulness are practices that we apply to our own thoughts and feelings – it’s an inside job. In MSC we are invited to evoke from ourselves our feelings, thoughts and experiences. We are asked to face ourselves and our suffering with acceptance of our imperfections as a “compassionate mess.” MSC encourages us to partner with aspects of our inner dialogue and “make friends” with some of the more challenging aspects of ourselves. The compassion in MSC starts with our own selves and then extends out to those we serve, our families, and all of humanity. MSC participants are often guided in their practice of MSC by a therapist or a teacher, but all guides are required to have their own practice.
I believe that my practice of MI would greatly benefit from addition self compassion. When I use MI with others, they often open up about some very heavy experiences, feelings, and memories. Trauma, violence, severe mental health symptoms, and other stories of suffering emerge. Anger, hopelessness, tears and fear are often present in our conversations. Without deliberate practice, these aspects of being a MI practitioner can lead to compassion fatigue, burnout, and other issues. Considering the impact that these heavy conversations can have, I suspect that I and other MI practitioners sometimes veer away from conversations about suffering as a way of self-protection (consciously or not). I think that MSC can support us in our courage and ability to be present with the suffering of others, and perhaps if we practice MSC we can be more helpful to others. If we are more present with ourselves, we can be more present with others. If we are able to accept ourselves and the reality of our suffering, we can better accept others and their experiences of suffering. By practicing MSC ourselves we can feel more connected with, and thereby have more compassion for, those we serve.
The MI Spirit is how I aspire to show up with others. And on a good day I feel like I am able to be present with Compassion Acceptance, Partnership, and Empowerment. Other days I may fall short despite my aspirations. MI trainings talk much about the importance of adopting and using the MI Spirit, little time is spent on discussing how to maintain unconditional positive regard for others on a daily basis. I believe that MSC holds the promise of doing just that, by practicing MSC we are more likely to have a “Good MI Day” where we can live up to the MI spirit. I hope that by practicing mindful self compassion with myself, I will also be empowered to have deeper conversations with others, and that I will be able to respond skillfully in the presence of others’ suffering.
Works Cited
Atkinson, D. M., Rodman, J. L., Thuras, P. D., Shiroma, P. R., & Lim, K. O. (2017). Examining burnout, depression, and self-compassion in veterans affairs mental health staff. The Journal of Alternative and Complementary Medicine, 23(7), 551-557.
Barna, M. (2022, January). Mental health workforce taxed during COVID-19 pandemic: Worker shortage hinders access. The Nation's Health, 51(10) 1-14.
Eriksson, T., Germundsjö, L., Åström, E., & Rönnlund, M. (2018). Mindful self-compassion training reduces stress and burnout symptoms among practicing psychologists: A randomized controlled trial of a brief web-based intervention. Frontiers in psychology, 9, 2340.
Germer, C. K., & Siegel, R. D. (2012). Wisdom and compassion in psychotherapy: Deepening mindfulness in clinical practice. The Guilford Press.
Kneff, K. (2011). Self-compassion : the proven power of being kind to yourself. New York : William Morrow.
Mills, S. (2022, March 16). Wisconsin Hospital Association: 'The nursing shortage has arrived.' Wisconsin Public Radio. https://www.wpr.org/wisconsin-hospital-association-nursing-shortage-has-arrived
Wasson, R. S., Barratt, C., & O’Brien, W. H. (2020). Effects of mindfulness-based interventions on self-compassion in health care professionals: a meta-analysis. Mindfulness, 11(8), 1914-1934.
