Mindfulness and Acceptance Group - part II

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This is a new blog entry on the process of creating a Mindfulness and Acceptance Group at Lehman College using the Mindfulness and Acceptance Workbook for Depression.

I searched this site and reviewed blogs of those who have used ACT in group process, and I found some really interesting information. I thank you all for having the courage to share, and I like to read the comments too because they are so helpful.

The Population I serve - traditional and non traditional college students ranging from 17 to 60. Students in this group range from 20-30.

Group Structure - Nine steps from the book modified into 6 sessions.

Mindfulness and Acceptance Group
The group structure follows the structure of the Mindfulness and Acceptance workbook written by husband and wife team Kirck Strosahl and Patti Robinson. This is a pilot study to see how this group works in a college setting, and if this workbook is transferable to a group format. I created a password protected blog for the students in this group: Mindfulness and Acceptance http://mindfulpractice.wordpress.com/

Wordpress has a new template that makes it convenient to have parents tabs with children, so I can create "session 1" and underneath have "Step 1" and "Step 2"

Really nice.

As introduction on Session 1 , I added "Group Structure" and reminded the group about the text being used, in case they want to buy it. I know some of them have purchased it.

I structured the sessions as followed:

Session 1:
Step 1: Define your values
Step 2: Accept what you cannot change

Session 2:
Step 3: Become a mind watcher
Step 4: Get to know the right and wrong trap

Session 3:
Step 5: Learn that sense making doesn’t make sense
Step 6: Hold your storyline lightly

Session 4:
Step 7: Be Present

Session 5:
Step 8: Create a life vision and plan

Session 6:
Step 9: Make and keep commitments & Life Directions

I wondered why the author chose 9 steps instead of 8 steps or 6. Another therapist at the Counseling Center is using the Mindfulness Based Cognitive Therapy (MBCT) group model which is an 8 step model, very simple, very structured. The book Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse by Zindel V. Segal PhD, J. Mark G. Williams PhD, John D. Teasdale, and Zindel V. Segal has every session so nicely structure. MBCT is an approach to prevent depression. She had trained two years in this model and begun to implement it this year.

As I re-read the MBCT book and it's structure, I realized that I was forcing a book Mindfulness and Acceptance workbook written to be what it wasn't. This book felt more like a book for a therapist than for a regular client suffering from depression.

I found a YouTube video of a young adult documenting herself reading this book, but not really telling us if she was understanding what she was reading, if she could tell us why she was reading the book to us and sharing it on YouTube, or maybe she did, but after a while of hearing her reading, I didn't wait to gain her insight. I moved on. Like me, she felt there was something in this text, that she wanted for herself, but also to share with the world. So she was not giving up on it so easily, and I wasn't either.

The issue I always have is the issue of "jargon" and language. Too much of it. I want to take some of it away, simplify it, or use the old Cognitive Therapy concepts rather than creating new ones. I also see how new books create new words, this can be confusing. I do like when Russ Harris' method of simplifying ACT concepts while remaining true to the original.

I wanted the book to be like the MBCT book, to give me a mindful structure, and simplify the process, but that is not the focus of the book . So, I began to think, "What am I doing?", this book might not lend itself to what I want to mold it too.

I realized that each step with all of the exercises can take at least 2 hours, but our students do not have 2 hours in between classes to attend a group, when they barely can make an hour and a half. Most of our students are single sessions, and our most dedicated student attend from 3-4 sessions throughout the semester. It is the rare student who stays for 6 to 8 or 12 sessions for individual or group.

What theoretical framework can one use when the population serve determines the session length, when the environmental stressors, midterms, finals, and breaks, spring break, national holidays, "Bell Schedule" will create pauses to your structure.

I am lucky to have a co-therapist who is as committed as I am to this process, and who just tries to do the best with whatever comes. I am lucky to have students who are also interested in their wellness, and trust us.

The Group Sessions Continue:

The New York Snowstorm and the mini hurricane affected two of our sessions, and spring break affected our sessions, so we had a chose to use Saturday 4/10 as a catch up and we began to discuss the possibility of switching to Wednesday, as some of the students who were interested could make it on Wednesday.

Saturday - 4/10
Out of ten students who were interested, again, only the regular four students confirmed, but only two showed up. One of the student attending, didn't think she'd be able to make it for future sessions due to the fact that she worked a midnight shift, 12-8 in the morning, and had a long break of 4 hours before our group began. We all understood.

This was a review session - Step1, 2, 3, 4, and Step 5/6 would be reviewed the following week on a Wednesday. I made review PowerPoint slides of steps 1,2,3, and 4, with the main concepts to distributed among the members, but since two of them were missing, I decided that our first Wednesday would be another review as I suspected new members would attend.

Our review session went well, and the two members were grateful that we reviewed the previous sessions and opened for discussion. Our next session would review, Steps 1,2,3,4, 5, and 6.

4/14 Our first Wednesday
We were amazed that when we sent out an email to all potential members, six new members confirmed their attendance to the Wednesday group. All new members, however, had met with the co-therapist of the group and they were familiar with Mindfulness and Acceptance concepts. They also had access to our blog.

We introduced ourselves, did a brief mindfulness exercise, a brief introduction and a brief summary of Step 3, 4, 5, and 6, as we had simplified the review of these steps. Step 3 and 4 can blend, and a few exercises were chosen, and step 5 and 6 were easily blended with a few exercises chosen.
The main point is to understand the population serve, to create exercises that are culturally sensitive to the population served.

The main issue the group brought up was the issue of "rumination" and the difficulty in letting go of "their story line", but when we talked about how both rumination and fusion with one storyline continues how that affects the way they live their lives, they spoke about how it keeps them disconnected and moves them away from the things they value. Other interesting discussions surfaced from this session, and we were amazed at how many students showed up.

Unfortunately, due to my involvement with a larger event, I would not be able to be in the next session, but the therapist who was faciliting the MBCT group, would replace me for the 4/21 session on Mindfulness and Being Present along with the co-therapist.

The switch to Wed. worked, but it was like beginning again. I realized then that I had to let go of the concept of 6 sessions and allow the ending to come when it came. We wanted to end before finals, May 12, and we knew that this might happen, but we also knew that it might not and we all agreed to meet for one more session after finals if needed.