How Using Mindfulness in Therapy Can Help Your Clients

Have you ever left a session with a client feeling like you couldn’t get through to them? Maybe they were checked out, anxious, agitated or even combative? You’re not alone—I’ve definitely had sessions like this.  

The thing is, as humans, if we’re not feeling present and in a place where we’re ready to connect, we won’t. And if we don’t connect, it’s hard to learn, retain, grow, or change. 

Measuring Your Clients’ Emotions

As a registered dietitian who sees mostly clients with disordered eating patterns and eating disorders, I’ve noticed an increase in highly anxious clients over the last two years. It’s made it more difficult for our work together to really land, and for my clients to fully nourish and care for themselves. 

When it comes to the autonomic nervous system, that place of connection and presence is also called the “window of tolerance.” Our window refers to being in the best emotional place for optimal functioning. It’s where we’re regulated and able to effectively manage our shifting emotions. If we’re above the window, or in a state of hyperarousal, we might feel anxious, overwhelmed, and sometimes aggressive. And if we’re below the window, referred to as hypoarousal, we might feel checked out, numb, or disassociated. 

As clinicians, we can help our clients identify where they are in reference to their window of tolerance. If they’re outside of it, we can offer tools to help them come back inside, which makes our sessions more likely to be effective. 

In my practice, I like to check in at the beginning of each session to see how my client is feeling. I also observe their posture, body language, breath and voice pacing, and facial expressions. This check-in and observation give me clear information about where they’re at that moment. I have also found it useful to introduce the window of tolerance concept to clients, to give them language to understand and describe their states and help better regulate themselves in and out of session. 

How Does Using Mindfulness in Therapy Fit In?

Mindfulness is about focusing on our present physical, mental, and emotional states—without judgment or over-identification with any of those states. So, mindfulness practices can be regulating tools we can integrate into our sessions with clients, as well as into their lives outside of sessions. Whether clients are hyper aroused, hypo aroused, or in their window of tolerance, mindfulness practices can help strengthen their connections to their bodies and selves, making it a valuable tool in nutrition counseling and therapy. 

While mindfulness practices can be helpful for a variety of clients and concerns, it can be particularly beneficial for those healing their relationships with food, body, and exercise—whether they have disordered eating patterns or a full-blown eating disorder. This is because mindfulness practices enhance embodiment, interoceptive awareness (or sensing your bodily signals,) and self-compassion. 

Simultaneously, mindfulness helps decrease over-attachment to thoughts and rumination—both of which are common barriers to healing from food and body issues. Practicing mindfulness provides an opportunity for clients in recovery to slow down and reconnect with themselves after their disordered eating or eating disorder has severed that connection. 

How to Start Using Mindfulness in Therapy

Here are some tips and ways to get started using mindfulness in your work with clients. If you’re not a trained yoga or meditation teacher, you can start with these basics. 

Start your own mindfulness practice. 

Mindfulness is an umbrella term, and there’s a lot that falls underneath it—yoga and other mindful movements, meditation, guided imagery, and breathing practices are just a few examples. Find one (or a few!) that resonate with you, and start to incorporate them into your life where you can. Learning about the different kinds of mindfulness and what each entails will help you provide more options and a more full picture to your clients. 

Set expectations with your clients. 

A lot of clients may not fully understand what mindfulness entails, or may have misconceptions about what a mindfulness practice should include. If you and your client decide this is the right route for them, communicate with them about the type of practice you’ll be leading them through, and what they should expect from your sessions. 

Ask for feedback.

If you start using mindfulness in therapy sessions with clients, take the time to process them with curiosity. Ask your clients what their experience was like, and use that information to inform your future practices. 

Ask for permission, and offer choice. 

Mindfulness practices should be optional for all your clients, and this is especially true for clients working through trauma. Let your clients know they can always choose whether or not to do mindfulness, and that they can stop at any time. This will help empower your clients, as well as help them avoid any trauma triggers. Once my clients are used to mindfulness practices with me, I often ask them which they would like to do. Keeping their eyes open or closed throughout the process is always a choice too. 

More Ways to Use Mindfulness

If you’re interested in incorporating mindfulness into your sessions but aren’t sure where to start, here are a few basic ideas you can start with—though it’s still a good idea to take the time to learn more on your own as well. 

Sense engagement

To bring your clients into the moment with you, guide them through each of their five senses. Have them internally name different sources of touch, sight, sound, taste and smell. 

Breath awareness

To bring your clients inward, gently encourage them to simply notice their breathing. Guide them to notice the quality, pace, and sensation of their inhales and exhales. 

Affirmations 

Offer your clients an opportunity to create their own helpful statement to share or write down in session. I like to say, “Fill in your blank: Today, I can ____.”

Grounding

Earlier, we walked through the difference between hyperarousal and hypoarousal, and what clients may be feeling in each of those states. If you notice a client is feeling anxious or agitated (or hyper aroused), here are some techniques you can use for them. 

Guide your clients to bring awareness to their feet connecting to the floor and the parts of their body connecting to the seat. This will help them reconnect to their present moment and place. 

Down-regulating breathing

Have your clients take a breath in and extend their exhales for longer than their inhales (through either the nose or mouth, depending on what feels better for them) for several rounds of breath. 

Self-embrace

Guide your client to give themselves a simple hug. Give them options to rock from side to side, be still or let go of the embrace whenever they like. 

On the other end of the spectrum, here are some practices specifically for clients who are feeling checked out or numb (or hypo aroused). 

Simple movement

Try stretching together in basic and gentle ways, like reaching arms above the head, twisting, and side bending. 

Engage at least one sense in session

As an example, you can encourage your client to hold a cup of warm coffee or tea, and guide them to focus only on the warmth, smell, and taste of the drink. Other examples are listening to uplifting music together to engage the sense of sound, or having a pet or textured fabric in session to engage their sense of touch. 

Upregulating breathing

The breath of joy is one of my favorite breathing exercises. This exercise and others like it can help energize your clients and bring them out of hypoarousal. 

The Benefits of Mindfulness for Clinicians

While all of these techniques are things you can use to help your clients in sessions, they’re also techniques you can use for yourself as well. I think we often forget that as clinicians, we’re also humans with nervous systems. Aside from helping you have more effective sessions, having your own mindfulness practice is one form of self-care, so you can show up fully for your clients and be less likely to burnout or develop compassion fatigue. Practicing mindfulness can also help us regulate ourselves before sessions with clients, so we are showing up in our connected and present places, too.