Mindfulness has been shown not only to decrease professional burnout and compassion fatigue, and raise distress tolerance, but it actually improves patient outcomes.
Mindfulness is not only a gift to ourselves. It’s a way of being that can have far-reaching, positive effects for our patients and clients. Mindfulness is a practice that truly “pays itself forward”; it has been shown to not only decrease professional burnout and compassion fatigue, and raise distress tolerance, but it actually improve patient outcomes.1
The four attributes of mindfulness
I consider mindful practice to be based on four attributes: attending, listening, empathy and self-compassion. Each attribute by itself helps us to be present professionally and personally; together, they are a powerful quartet that allows us to be engaged with those we meet wherever we are, in the consultation room or elsewhere.
1. Attending allows us to “check in” with our own mental processes as we observe what is before us. Self-observation and self-reflection are the fruits of attentiveness. When we give attention to another, we suspend our initial judgments, hold them in abeyance, and see with what can be called “beginner’s mind”. This is a mind that is engaged, curious and open to possibilities; it lacks the often very narrow constraints of “expert’s mind”.
The attentive mind is a courageous one that is not afraid to challenge what we thought we knew, and replace it with what we now see with new clarity. It allows us to respond to things that may be missed with an “automatic” approach; it helps us resolve to consider anew each patient and client before us, regardless of the number of times we have seen them. When we choose to pay attention to someone, we imbue them with importance. Attending allows us to make each patient and client important; no one’s concerns or suffering matters more than another’s. Attending allows us to be engaged with another in equanimity so we are attuned to but not engulfed by their needs.
2. Listening mindfully allows us to hear the concerns of another without using the lens of our own personal bias as a filter. It is common for clinicians to “hear” a client concern against a backdrop of algorithms, whether we practice from a single theoretical basis or utilize several modalities. When we listen with intention, we are able to construct a narrative of the patient and client that is rich and meaningful. We can be present to the cadence of a client’s report, and hear undercurrents of anxiety, resignation and hope; these are all helpful in meeting the client where he or she is and ultimately being of greater service to the patient.
Listening removes us from judging a client who may not be completely adherent to our recommendations, and encourages us to consider that he or she, due to personal circumstances, is doing the best they can. When we listen with intention, we give another that which we all yearn for — the opportunity to be heard deeply without judgment or suggestion.
This type of deep listening is only possible when our own minds are clear enough to hear only what is before us. In our contemporary world where so few are actually listened to, having our words truly heard by another is a particularly welcome gift. Listening also makes room for silence, which allows another to speak his or her mind and heart unencumbered by the listener’s filter. This feeling of being completely held, and of mattering to another, can be transformative.
3. Empathy is an attribute many of us wish to demonstrate. However, much professional burnout and compassion fatigue can be traced to a misunderstanding of what it means to be empathic. We may think we are being empathic when we are merely resonating with another’s emotions. This is not empathy; rather, it involves oscillating with another in a way that is not helpful and may even be detrimental.
Empathy can be defined as understanding another, even when our life journeys vary. With empathy, we can imagine what another is feeling and experiencing. It does not require that we have experienced the same things; it only requires that we be open to another’s experience and search our own for a feeling or thought that resonates with it. To be truly empathic, we need to have one foot firmly entrenched in our own reality, with one immersed in the other’s. When we enthusiastically jump into another’s situation with both feet, we lose the connection to ourselves from which empathy springs. Empathy requires an “I-thou” relationship of two forging a connection based on understanding.
4. Self-compassion means treating ourselves during times of stress as a good friend would. It is one of the most difficult aspects of mindful practice for many veterinarians, due to our innate perfectionism. Perfectionism is considered a maladaptive schema, one of many unhelpful ways of thinking that are learned and introjected (taken in) at an early age (typically before we are five years old).
Perfectionism develops either from a feeling of defectiveness, so that we continually strive harder and harder to prove our self-worth, or from being validated for having been good, so that we continually work to attain that external validation. Although perfectionism carries some benefits, including the academic achievement necessary to attend veterinary school, perfectionists are not only intensely vulnerable to external criticism but are also beholden to a particularly vicious internal critic. The truth is that we can only do what time and resources allow. While many times we turn our attention (and blame) to external factors that limit our ability to practice in accordance with our wishes, self-compassion allows us to see that we are sometimes the limiting factor, perhaps because of a deficient knowledge base, the limitations of what our hospitals can offer patients and clients, etc.
Perfectionists typically believe that self-compassion reduces motivation for excellence or is a sign of weakness. However, research done by Dr. Kristin Neff2 and others has shown that treating ourselves with kindness does not diminish a desire to perform to the best of our ability and actually helps build courage and resilience. When we are self-compassionate, we are more willing to think “outside the box”; and errors (while they are to be avoided as much as possible) are not personally destructive.
Sitting practice for mindfulness
A daily sitting practice is the cornerstone of this intentional lifestyle. Western culture typically involves and rewards constant activity and multi-tasking, so the very act of devoting time each day to simply being with our breath and allowing thoughts to come and go without grasping at them is a counter-cultural and revolutionary way of being.
Most of us wish to be mindful as we go about our daily lives so we seek to walk, cook, eat and work with intention. While we might be able to incorporate mindful practice into all these activities in time, sitting practice allows us to begin the hard work of tolerating a wide range of emotions, including boredom, anger, frustration, happiness and contentment, without escaping from them.
Time spent watching the breath is a laboratory of sorts, in which we practice for life beyond the cushion or chair. Sitting practice allows us to observe whatever comes up, reflect on it and let it go. In the process, we become increasingly able to tolerate thoughts and emotions without needing to escape from them or hold onto them.
Ultimately, mindful practice is a continual journey. We only fail at mindfulness if we assume there is a goal to be achieved, and that at some time in the future we will have fully attained it.
Mindful veterinary practice involves each of us living moment to moment, trying to be an attentive listener who practices empathy for others, and holding oneself gently and with self-compassion. If we come up short one moment, we have the opportunity to try again in the very next moment.
1Krasner MS, Epstein RM, et al. “Association of an education program in mindful education with burnout, empathy and attitudes among primary care physicians”. JAMA 2009. Sep 23;(302), 12; 1284-93. doi 10.1001/jama.2009.1384