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The Mindful TherapistReview - The Mindful Therapist
A Clinician's Guide to Mindsight and Neural Integration
by Daniel J. Siegel
W. W. Norton, 2010
Review by Brian McElwain, Ph.D.
Dec 20th 2011 (Volume 15, Issue 51)

Daniel Siegel, M.D., co-director of the Mindful Awareness Research Center and clinical professor of psychiatry at the UCLA School of Medicine, has published both popular and professional books based on his pioneering work in the field of interpersonal neurobiology and its application to parenting and psychotherapy.  He is also among the most prominent of Western writers in the current literature on mindfulness and its implications for psychology.  Much of that rapidly growing body of literature draws inspiration from and makes frequent reference to Buddhist psychology and practice.  In contrast, The Mindful Therapist: A Clinician's Guide to Mindsight and Neural Integration, avoids reference to the ancient wisdom of Buddhism and instead finds its basis of support in Western scientific research—especially that which fits with the interdisciplinary sweep of interpersonal neurobiology.  Siegel is clearly conversant with Buddhist psychology and practice (e.g., he names Jack Kornfield and Jon Kabat-Zinn as colleagues), but here he seems to be implicitly making the point that empirical Western science provides plenty of evidence to support mindfulness practice, i.e., one need not become Buddhist nor even read Buddhist literature to make effective personal and professional use of mindfulness (and in that respect, his approach is consonant with the truly groundbreaking development of Mindfulness-Based Stress Reduction by Kabat-Zinn).

The Mindful Therapist is "therapy for therapists" in at least two senses: 1) practicing psychotherapists are clearly the target audience as there is much here that is "inside therapy" on both subjective and objective levels and 2) if a therapist were to seriously engage in the suggested exercises that are incorporated in each chapter of the text, that therapist can expect to be personally challenged to develop greater depth and integration of insight into their own past and present experiences.  Each chapter blends objectively-oriented summaries of relevant research findings in "Brain Basics" with practical guidance in the more contemplative, subjectively-oriented "Mindsight Skills."  As a practicing clinical psychologist, I find Siegel's characterizations of the psychotherapeutic process to be both congenial and evocative.  As a psychologist who's always looking for accessible ways to help introduce beginners from a variety of backgrounds to the basics of mindfulness practices, I know that I will be referring to this text for ideas in the future.  So on the subjective side of the spectrum, this text hits all the right notes for me—but, on the objective side, things get more complicated.  On one hand, there is a lot of exciting, truly fascinating neuroscience research being done that Siegel effectively summarizes and integrates into his conception of the work of a "mindful therapist."  On the other hand, by the second chapter, I felt need of a neuroanatomy refresher course as I was unable to keep up with Siegel's fast and furious references to various brain locations and structures.  To be fair, in the vast majority of chapters I was able to follow the thread through the "Brain Basics" sections, but I am a clinical psychologist with an interest in these things and I'd expect that a general reader would get bogged down and confused too frequently.  This problem could have been remedied with a few well-timed and sufficiently detailed drawings and brain images to clearly illustrate the various brain structures in question.

Despite this criticism, however, there is more than enough here for me to strongly recommend this book to practicing psychotherapists with an interest in mindfulness and/or contemporary neuroscience research.  Personally, I know that I will be re-reading this book (something I very rarely do) and taking close notes so that I can remember and systematically apply various aspects of this approach in my own work—and my personal life, too.  The book is brimming with insights as well as Siegel's beloved acronyms to serve as mnemonic devices.  To cite a few examples, Siegel rightly places the establishment of a strong therapeutic relationship front and center in this book as the text is structured by the PART acronym that breaks down into the following elements which serve as chapter titles: Presence, Attunement, Resonance, Trust, and eleven more TR words ranging from Trauma to Transpiration.  "Mindsight" is Siegel's neologism pointing to "a process that enables us to monitor and modify the flow of energy and information within the triangle of well-being" (pp. 261-2), i.e., empathic relationships, a coherent mind, and an integrated brain.  SIFT (sensations, images, feelings, and thoughts) is used to remind us of the aspects of our internal worlds that we can learn to monitor with an attitude that embodies COAL (curiosity, openness, and acceptance equal love), the essence of a mindful state of being.  Beyond mindsight, the other key concept on which the text is built is integration, i.e., the "linking of differentiated parts of a system."  FACES (flexible, adaptive, coherent, energized, and stable) reminds us of the cognitive and behavioral markers of neural integration.  Further, by the intentional cultivation of mindfulness, we can stimulate neuronal activation and growth (SNAG) toward greater neural integration.  This is the profoundly hopeful message of neuroscience research supporting the concept of neuroplasticity, i.e., our experiences change the physical structure of our brains by strengthening neural circuits that are repeatedly activated.  Thus, the intentional creation of states of mindfulness can, over time, lead to the solidification of mindfulness as a relatively effortless trait—and mindful therapists are more effective therapists.

The bottom line?  The Mindful Therapist is an impressive integration of the objective and subjective aspects of the work of psychotherapists that makes significant contributions to the rapidly expanding literature on mindfulness in psychology and psychotherapy.  And I, for one, am excited to re-read this text and explore more of Siegel's work on mindsight and interpersonal neurobiology.


© 2011 Brian McElwain


Brian McElwain received a Ph.D. in Clinical Psychology from Duquesne University in Pittsburgh, Pennsylvania.  Brian is a staff psychologist in Counseling and Psychological Services at Humboldt State University in Arcata, California.


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