í. One Simple Way to Help lients Face Suffering...Deconstructing Death: Using Mindfulness to Manage Life's Ultimate Transition Joan Halifax, PhD - QuickStart - pg. 1 í. One Simple

Deconstructing Death: Using Mindfulness to Manage Life's Ultimate Transition Joan Halifax, PhD - QuickStart - pg. 1

1. One Simple Way to Help

Clients Face Suffering

One of the most difficult things practitioners have to

deal with is a client facing a terminal illness or life-

changing diagnosis. Here, Joan Halifax suggests a

strategy that we can use to ease clients suffering

and help them feel more at peace with their

diagnosis.

Dr. Halifax: One of the most helpful things is to

have a friend – someone in relationship to you –

whether it is a family member or a social friend or a

professional caregiver whom you really trust and

who has the capacity to bear witness – to be in

presence with you.

This is a role that chaplains in the best of

circumstances play, in interprofessional teams…

Actually I just got back from a big diagnostic

procedure myself with a wonderful doctor who was

trained at Columbia University. The quality of

presence that he offered me as we went over my

tests, even though I wasn’t happy about all the

results -we probably we never are – but

nonetheless, the quality of presence that he offered

me reminded me of how a chaplain or how I would

endeavor to be in presence with a patient who is

A QuickStart Guide: Deconstructing Death: Using Mindfulness to Manage Life's Ultimate Transition

by Ruth Buczynski, PhD

with Joan Halifax, PhD


hearing less than desirable news.

It’s a quality of kindness, equanimity, thoroughness,

and capacity to be in presence with the suffering

with a kind of courage that has you not turn away

from suffering.

That’s what we train for as practitioners – as

meditation practitioners – to have the deep ability

to sit with not knowing as well as to bear witness.

(p. 5 in your transcript)

2. Using GRACE to Cultivate

Compassion

The word grace brings to mind thoughts of

elegance, beauty and peace. But Joan Halifax put a

different twist on it. She uses the five letters in

grace to outline a strategy that can help people

cultivate deeper feelings of compassion and

strengthen the client-practitioner relationship.

Dr. Halifax: What I have done is to try to train

clinicians to touch into their experience at the

physical level, at the affective level, and also in

terms of their own cognitive biases.

It’s a process of attunement before they jump into

diagnosis – before they jump into assessing a

patient’s experience. This would be true whether

you’re a psychologist, a social worker….

I developed a process called GRACE, which I think is


a wonderful intervention. It is a process where any

clinician or educator can cultivate the roots of

compassion as they’re engaged in an interaction

with a patient.

But it doesn’t start with compassion per se. It

actually starts with the ability to gather one’s

attention, and that is often very difficult in a clinical

or medical situation where the attentional base of

the individual is dispersed – very divided.

So, it’s that ability to drop down or to settle in and

gather. That’s the G of GRACE.

The R of GRACE is recalling one’s intention. It just

takes less than a breath for most of us to actually

gather our attention, and it takes a very short micro

-moment to remember why we’re here, which is to

serve the patient – to end suffering in whatever way

possible.

The third step, attunement, is really important, and

it is contrary to how most psychologists and

clinicians are trained.

Instead of immediately attuning into the patient’s

experience, clinicians are asked to attune to what

they’re feeling somatically – to what their own

physical experience is.

Whatever our own physical experience is, generally

that’s at a preconscious level, and that’s telling us a

lot about whether we’re afraid or in a hurry or

anxious or we feel at ease…


Then the next level (of GRACE) is the cognitive.

What assumptions have you made? Can you look

past your biases, past your assumptions – the filters

that are shaping your perception of the individual –

to perceive the individual somatically, affectively,

and

cognitively without those biases determining your

opinion of what will serve? That’s very powerful.

You do this very rapid physical, affective, and

cognitive attunement before you attune into the

patient’s experience, and from that base, you

consider what will really serve.

Out of that insight, you engage. That’s the E of

GRACE. We engage in the interaction whether it is a

clinical interaction or whether it is an interaction

more at the level of relationality. We have this base

that we’re operating from, and that’s really

important.

Clinicians are trained differently. I was trained

differently. Most of us are trained into a diagnostic

perspective immediately.

We just throw our knowledge base at the individual

internally. We drop them into a box, and then we

proceed in terms of our interaction instead of

creating a base of presence that is well-grounded.

GRACE is just a little process that helps the clinician

– or the psychologist or social worker – to internally

help them to slow down and to see what their

assumptions are... (pp. 6-7 in your transcript)


3. How Practitioners Can Develop

GRACE

Sometimes developing GRACE can be difficult

because of old habits or assumptions. Joan Halifax

gives us two strategies that can help make it second

nature.

Dr. Halifax: You have to begin in parts because most

of us have been trained or conditioned to do

(interventions) the opposite way.

First, we work through mental processes – I call it

meditation. I teach in a lot of medical schools so I

call it reflective practice or mind-training.

This helps individuals to cultivate attentional

balance: where attention is able to be clear, where

there is high resolution, where attention is vivid,

where the individual is able to hold their attention

or to give their attention to another individual for

more than a mind moment, where there’s a quality

of non-judgmentality in the attention, and where

the attention is focused, but not so tight that it’s

grasping.

There are many techniques for doing this. The

whole mindfulness movement in this country is a

place where that kind of attention has been trained

in people – Buddhist meditation and the meditation

practices of various other traditions.

Research has been done on attention by people like

Amishi Jha, the neuroscientist, where individuals


who have a high degree of attentional coherence

are able, for example, to orient their attention more

easily.

They’re more able to plan…they’re able to prioritize.

At the very onset, the training of attention is critical.

Yet attention is not everything. You can train a

sharp shooter or a surgeon to have very focused

attention, but you need a strong ethical base, and

that’s carried in the second part of the process of

recalling your intention.

So, recalling intention – and again, this becomes

embodied. It becomes second nature to you, but

often people forget…

In the medical world, it’s getting tougher and

tougher to recall why they’re there – to serve

individuals and to alleviate suffering.

Fostering a strong moral ground is so critical in this

process. That’s a whole area of cultivation having to

do with our aspiration to serve.

It’s not just, “I’m going to help people” – that’s a flip

thought. It’s more of a very deep sense of calling – a

deep sense of meaning in your life – and it becomes

second nature.

Once we return to the aspiration again and again,

it’s as if that’s your north star, and you want to have

a north star in this work because people’s lives

depend on it. (pp. 8-9 in your transcript)


4. The Two Layers of Intention

When it comes to helping people overcome

suffering, our desire to make people feel better, and

help them heal may do more harm than good.

According to Joan Halifax, practitioners need to be

aware of the two layers of intention and use them

to keep treatment balanced.

Dr. Halifax: Intention has two valences.

One is altruistic, where it’s so important that we are

primed to be of service to others.

This is where our lives are characterized by

kindness, where we want to be helpful, where we

have this fundamental concern about the well-being

of others.

At the same time – and it seems paradoxical, but it’s

an absolutely essential component – we have

learned about what it is to be compassionate and

what I’m going to say next seems incongruous.

It’s important that at the same time you do your

best to alleviate suffering, you’re not attached to

the outcome.

You realize – as I did in my work with the dying or

the work that I did years ago in the prison system –

that whatever is going to happen is going to

happen.

You’re going to do your best for the best outcome

possible, but if you’re trying to drive your patient to


a good death or to force the prisoner to be a good

person, the outcome is not going to be one that is

sane.

Without a counter-balance to hold this big picture

quality, those individuals who are driving for an

outcome – and in the work that we do it doesn’t

always happen the way we want it to happen –

experience futility.

And futility drives good people out of the

professions. (pp. 9-10 in your transcript)

5. A More Compassionate

Approach to Denial

Denial is a common coping mechanism for people

facing death or terminal illness. And some often feel

that the best way to ease people through this

transition is to help them learn to accept their fate.

But Joan Halifax explains why a different, more

compassionate approach may be more effective.

Dr. Halifax: I was working with an amazing woman

who had lymphoma, and her caregivers were

feeling quite futile.

She kept saying to them that she wasn’t going to die

and they wanted me to break her denial.

They brought me to her. When I saw her – she was

a brilliant, luminous person – we sat on a couch

together, and she looked right at me and she said,


“You know, I’m not going to die.”

That was a very powerful moment for me. It wasn’t

that I felt she wouldn’t die biologically, but she had

somehow tuned into something inside of herself

which was deathless.

The idea of manipulating her to have her face her

death became something I found to be untenable.

At some level, we all know we’re going to die. All we

have to do is read the newspaper. It’s on the front

of the newspaper every day in various ways.

The truth of impermanence touches our life in

countless ways. If we want to live as if we’re going

to live forever, then I want to respect the right of

the individual to live that way.

Trying to break their denial or push them into…a

perspective that’s more reality based – is not the

most skillful, compassionate, or kind approach.

We, as caregivers, need to face the truth of

impermanence, both in terms of our own lives and

in terms of our patients.

I always say, “Try to uphold the big picture and hold

that individual closely at the same time.” (p. 10 in

your transcript)


6. Healing Fictions, and Their

Effect on Treatment

Often, people use stories to cope with undesirable

realities - such as discomfort, pain, or even death.

These stories have come to be called healing

fictions. Joan Halifax tells us how important it is for

practitioners to acknowledge these healing fictions,

and how they can effect treatment.

Dr. Halifax: Narrative and story are an important

part of how we hold our lives, how we hold our

illnesses, how we hold our relationships, and also

how we hold our projections around death and

dying.

For example, if you’re a person who believes in

reincarnation, I don’t know if that’s fiction or reality.

I really can’t say.

But I can say that the notion of reincarnation could

inspire you to live a more virtuous life. It could also

be the ground where you would want to awaken at

the moment of your death.

You can either not be reincarnated or you could

choose an incarnation which could benefit more

people.

That could be considered a narrative form or a

healing fiction.

The issue of going to heaven and hell is another

healing fiction that feeds our ethical lives in terms


of wanting to be of benefit to others.

Then there are the personal narratives that

individuals devise which have to do with giving

death meaning, giving pain meaning, giving

suffering meaning, creating a context of greater

depth and value to experiences which would

otherwise seem very undignified and terrifying.

That is another kind of healing fiction that allows an

individual to hold a perspective and to share that

perspective with the people who are taking care of

them.

I work a lot with clinicians. I’m especially moved

when a clinician speaks to me about working with a

patient who has an inspired perspective.

This is where the individual is appreciative of their

presence and where instead of the clinician saying,

“Well, Mrs. so-and-so, how are you doing today?”

the first thing the patient says is, “How are you

doing today?”

These narratives structure an individual’s character,

and that affects clinicians – psychologists, social

workers, chaplains, physicians, nurses. This affects

how we are received by our patients, and how we

are in terms of our work. It gives us more resilience.

(pp. 12-13 in your transcript)


7. A Simple Grounding Exercise

That Can Strengthen Feelings of

Security

Since childhood, we've been urged to sit up straight

and avoid slouching. But Joan Halifax suggests that

good posture and a strong back may actually affect

our biology and make people feel more secure.

Here, she shares a strategy for cultivating a strong

back.

Dr. Halifax: One of the most useful exercises that I

share with people is inviting them to sit for a

minute, and let their feet get grounded – connected

to the Earth.

By the way, this grounded mental capacity is

important for all of us as clinicians to bring our

attention to (the anatomy) of the back.

Whether you have a good back or a bad back, the

back represents this capacity to uphold the self in

the midst of any conditions. It represents that

capacity or process we call equanimity – of

profound internal balance. From that ability of

strong back, we then shift our attention to our soft

front – strong back and soft front.

The soft front is our capacity for compassion. Most

of us have a strong front, very defended or subtly

defended, and soft back – kind of a fear-based

response to our world.


What we’re trying to do is to shift that dynamic so

that individuals come to rely on their capacity for

equanimity as well as their capacity for compassion

– strong back and soft front.

My instruction is simple – this is the mini, mini

version. We’re asking people to take a moment

when they’re seated to bring their attention at the

very beginning to their feet and I invite them to get

totally grounded.

This in part has to do with learning how to attune

into the body and to develop a kind of somatic

sensitivity – a capacity to sense into your own

physical experience which mirrors our capacity to

sense into the experience of others.

Tania Singer at the Max Planck Institute in Leipzig is

doing some very interesting research in

neuroscience…

She’s discovered that the same neural networks are

engaged when attuning into your own visceral

experience as when sensing into the experience of

another.

We always think the mind is conditioning the body,

but the body is also conditioning the mind.

When we have this feeling in the body of being

grounded, the parasympathetic system begins to

get activated a little bit more. The cortisol begins to

drop. The sense of security increases…

The strong back is a physical and psychic


experience. From that point of view, it begins to

prime this base of attention as well as equanimity

and strength.

We then have the ventral side, the soft front part of

our body, characterized by the feeling of

compassion and being open.

We’re not turning away. We’re not in a state of

distress in the presence of suffering, but we’re able

to perceive the suffering and to internally transform

it. (pp. 17-18 in your transcript)

8. Personalizing the Approach to

Pain

Every client is different. That's why it's so important

to personalize treatment and approach every

patient in an individualized way. Especially when it

comes to overcoming pain. Joan Halifax gives two

strategies we can give clients to help them find

relief from pain.

Dr. Halifax: There are many approaches to pain.

One of them is distraction.

Distraction means moving your attention away from

the pain, and there are many ways to do that – by

listening to beautiful music, by gazing at a beautiful

painting, through visualization, and so many more.

Another approach is to focus on the pain and to

discover that pain is made of non-pain elements.


There are sensations of sharp or dull or throbbing.

Pain can be focused or spreading.

You begin to deconstruct the experience of pain in

an analytic fashion and discover that pain is

transitory.

It’s always changing in one subjective experience. I

myself would rather be distracted – that’s my

preference, but for other people, putting their

attention on the pain and seeing how it’s changing

might be their preference.

The qualities of one’s experience of pain change

constantly, but these are two simple approaches to

use.

They’re completely opposite from each other –

distraction or focus – and depending on the

individual, one or the other can be quite effective.

Distraction, for example, asks the patient to attend

to their breath. That’s what I do in my dental chair. I

put my entire attention into the breath body, but

for some individuals that doesn’t work. It’s just not

effective. (p. 19 in your transcript)

9. Two Strategies for Cultivating

Gratitude

Joan Halifax talks a lot about people expressing

gratitude when they're facing death. But why do we

wait until it's almost too late? Joan Borysenko


suggests two strategies to help people express their

gratitude more often.

Dr. Borysenko: A natural part of the work at the

end of life is that we start to feel so grateful for

things in our life that maybe we haven’t paused and

felt gratitude for before.

So, it’s a terrific question for all of us, Ruth. “Why

wait till the time of death? How can we feel more

grateful during life itself?”

There are two practices that have meant a great

deal to me over time. The first one I learned from

Brother David Steindl-Rast.

I heard him – it must have been a good twenty-five

years ago – give a practice and I have adhered to it

pretty much every night since that time.

The practice is this: at night, before you go to bed,

think of one thing that you are grateful for that you

have never been grateful for before.

Now, this makes it a mindful practice instead of a

rote practice because you can’t just get ready for

bed and say, “Oh, I’m grateful for my husband/my

wife/my health/that I can pay the bills” or whatever

because it has to be different – you have never been

grateful for it before.

It brings forth mindfulness all day long because you

know you are going to have to do this at night. This

gratefulness practice starts to refine your eyes and

your capacity


for seeing and looking.

Here’s an example. Right now I am looking out my

window and I am seeing a place where there was a

forest fire – but because there was this forest fire,

rock faces that weren’t apparent before – I live on a

mountain – are shining with light now and they are

so amazingly beautiful. I feel that beauty

throughout my body.

When I see beauty, and when we are mindful of

something that is pleasing like that, it is so good for

our health. It releases all the “feel-good” chemicals

and “feel-healthy” chemicals. So that is a great thing

to do before bed at night.

The second practice that I mentioned came from a

healing priest. When I was at Harvard, I used to

really enjoy studying healers from different

traditions, and right in the Harvard medical area

there is a church – in fact it is the church that Ted

Kennedy chose to be buried from – and there used

to be an amazing healing priest there who every

month gave a healing service.

I went to that service, and here is how he started his

sermon. He said, “Take a moment and feel grateful

now for all the things in your life that don’t need

healing.”

I love that because frequently we get so self-

absorbed with all that needs healing. Gratefulness

is the opposite of self-absorption. So, this is really

saying, “Life is such a mystery. Life is so beautiful.

There are so many possibilities. And I get to live it –


what an amazing thing.” (pp. 6-7 in your TalkBack

transcript)

10. Helping Practitioners Better

Attune to Their Own Experience

Attunement is an essential part of Joan Halifax's

GRACE, both for the client and the practitioner. But

before treatment even begins, she urges

practitioners to recognize their own experience and

rid themselves of biases they might not even know

they have. Elisha Goldstein explains how we can

become better at doing this.

Dr. Goldstein: One of the things that can make

practitioners better at attuning is to recognize that

at times in our work, of being of service, there are

going to be some really difficult moments. And the

acceptance of that allows us at times to

acknowledge that, “This moment right now is really

hard. It’s a difficult moment that’s here.”

And that, as an informal practice, is a way of kind of

tuning in and attuning to our experience. Then we

could ask ourselves, “What about this? What’s

happening within me? How can I deepen my

attunement with this?” and we can kind of note,

“What is this feeling of hard like that’s going on

right now?” and we can be aware of what it’s like in

our bodies: “What is the emotional connection with

it? Where does my mind go? Am I self-critical of

myself constantly? Am I blaming other people?


What’s this experience of ‘This is hard’ there?” –

tuning into that.

I mentioned that this is hard, the difficult moment,

because that is the part that our brain often tries to

react and get away from. So that is the hardest one

to tune into. Sometimes love is a hard one to tune

into for some of us, too.

And then we want to attune to our intention of

being of service to people, which is maybe we say to

ourselves, “I’m here to be a service of healing, to

engage in loving-awareness in some way.” So that is

one way of attuning to ourselves, our experience in

difficult moments in particular.

And then with the people that we are with, we want

to do something that is kind of “looking behind the

mask,” as we talked about in a past interview, and

seeing the person that is there – maybe the

difficulties that they have experienced in their past,

the challenges, the senses of failure that they have

had, or maybe the joys, the wonders that they have

experienced, the adventure that has been there.

And that behind these eyes – this person’s eyes and

my eyes – is the same consciousness that we are

looking at each other through.

And so that is a way to attuning to the person,

seeing behind the patient that is there. So we can

attune to ourselves, particularly in the difficult

moments, or in the good moments – but that is one

way of doing it. And we can learn to use that to

tune in and attune to other people, too, because


ultimately, we are really connected. We can’t

separate the energy that is going, flowing from one

person to the next. (pp. 5-6 in your Next Week in

Your Practice transcript)

11. Helping Practitioners Better

Attune to Patients Experience

Not only is being able to understand how we're

feeling and approaching treatment important for

our patients' healing, but we also need to be able to

attune to their experience. We need to know where

they're coming from. According to Chris Germer,

mindful breathing is one way practitioners can

better attune to their patients experience.

Dr. Germer: When we don't want to be with what

we are feeling, we actually disconnect also from our

patients.

So then the question is how do we actually maintain

connection; how do we have like unflinching

empathy; how do we open to the discomfort? You

know, one element is to see it and ask what it is –

but ultimately we can stay with our suffering if we

warm it up, if we warm it up. And that is

compassion practice. Compassion practice is

warming up our awareness.

And so one way of doing that is to track our breaths

in a kind of subliminal way – you know, in the

background, as we are conversing with a patient,


we can track our breaths – but in particular noticing

how the in breath nourishes us, gives us

nourishment, supports us, feeling the lusciousness

of an in breath; and then as we exhale, exhaling

something good for the other person. So this is

called “breathing compassion in and out” – with

every in breath, “One for me;” with every out

breath, “One for you;” with every in breath, “One

for me;” with every out breath, “One for you.”

So we are actually, with every breath, reconnecting,

but we are also warming up the experience so that

we don't get into aversion. This is another way, you

might say, of “loving others without losing

ourselves.” And it is a way of being with the

discomfort without getting overwhelmed by it and

separating from ourselves and others. (pp. 6-7 in

your Next Week in Your Practice transcript)

12. Cultivating Openness

Often, the first step in overcoming obstacles is being

open to them. And unfortunately, it's one thing

many people have difficulty with. Elisha Goldstein

suggest a formal, and an informal practice that can

help people cultivate openness.

Dr. Goldstein: Well, I’ll give you an informal practice

which is something that can be done on the fly and

something that we can use to kind of deepen our

ability to cultivate and that openness, that

spaciousness that is there, that is so important for


getting more freedom.

So one is that when you notice a feeling that is

there, you can acknowledge it and maybe where it

is, where it resides in your body – and you can just

say to yourself – and I am going to piggyback a little

bit on the breathing that Chris had just been

mentioning – where you can say to yourself,

“Breathing in, I’m opening to this feeling that’s

here. Breathing out, I’m letting it be.” So breathing

in, you are bringing the suggestion of opening, and

maybe you are feeling it in your body, opening to

this feeling, so I am not retracting, I am not

contracting, I am not trying to get away from – I am

actually opening to this feeling that is here:

“Breathing out, I’m letting it be.”

And you can say to yourself, “It’s all right,” if it’s a

difficult feeling, “It’s all right. It’s already here. Just

allow myself to feel. It’s okay. It’s already here. Just

allow myself to feel it.” So that is kind of an informal

practice – put your hand on your heart, your belly

while doing that, if that feels okay in that moment.

And then the formal practice is a wonderful practice

call the “Sky of Awareness practice,” which is really

giving the experience of openness to things, where

you are just kind of sitting – and I have a video of

this on my website; people can just do it for free –

which is just you are sitting there and you are

connecting to your breath, and you are just opening

to the world of sound. You are imagining your

awareness as wide as the sky, sounds, and then you

bring in your thoughts as images and voices that are


happening. And then you bring in sensations: you

are imagining your body dissolving in this. So you

have sounds, thoughts, images, sensations – and

you are just settling into this more grounded, open,

receptive place of just allowing things to do what

they do, just come and go naturally.

And so as we practice and repeat that intentionally

over time, we get better and better at settling into a

place of just being open towards that. (pp. 7-8 in

your Next Week in Your Practice transcript)

13. Achieving a "Professional

Rebirth"

With so many patients and only so much time,

there's often very little time for reflection. Here,

Chris Germer explains one strategy that can help

practitioners become more grounded and

remember their core values.

Dr. Germer: I think the really critical thing is this

notion of core values and of vow, making a vow. So

we came into, when we finally started our

professions, there were really core values that were

manifesting themselves but they actually preceded

our profession, and they are actually continuing to

be hot and alive through our professional life, even

when we are burdened with paperwork and so

forth.

So core values are what we call a “red thread” that


runs through our lives, that energizes our lives,

gives our life meaning – and it is something that can

be discovered. So Steven Hayes talks a lot about

this in terms of commitment but basically, finding

out what it is that you would do after all your goals

are achieved; what is the direction – not what your

destination is, but what is your direction after you

achieve it?

So, for example a core value could be compassion, it

could be ecology, it could be honesty, it could be

family – but to connect again and again to the core

values, to ask ourselves, “If I were to die in twenty

years and I was listening to a eulogy said about me,

what would I be really happy and contented to

hear? What would I love to hear and say, ‘Yes, that

person got me, really understands me and I feel

comforted?’” To ask the question, “What are my

core values?” and then to reorient ourselves to that

again and again and again. That is to say, to make a

vow to wake up in the morning and commit to that

value, such as, “May I see God and serve God in all

beings” – you know, “In the midst of paperwork,

may I see God and…” you know, whatever a

person’s core value is – to remind ourselves.

And what that is like, it is just like in meditation

when we return again and again to the breath; we

find ourselves in some sort of strange byways and

we bring ourselves back. In life, when we practice

with a vow, when we return ourselves again and

again to the axis mundi of our lives, to the “red

thread,” our whole life becomes a meditation. That


is how we can renew ourselves – by going to that

place of energy at the very core of our being. And it

is not new; it’s old. We just find it. (pp. 8-9 in your

Next Week in Your Practice transcript)

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í. One Simple Way to Help lients Face Suffering...Deconstructing Death: Using Mindfulness to Manage Life's Ultimate Transition Joan Halifax, PhD - QuickStart - pg. 1 í. One Simple