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Mindfulness with Dr. Walsh: from relaxation to resilience
Teaching Urging to clients
Teaching Urge Surfing to Clients
This document can be used with the document on urge surfing itself.
It is very difficult for clients to understand urge surfing unless they have an experience of it. Even though the idea of watching cravings coming and going makes sense, it is a skill that can only be learnt through practice. Just as it is easier to coach someone how to kick a football, when they are actually kicking a football is also easier to coach someone as to how to surf urges when they are actually having urges.
We can do this in two ways. Firstly we can create a situation where urges arise and secondly we can respond opportunistically when a craving arises spontaneously in the presence of the therapist.
MANUFACTURING OPPORTUNITIES FOR URGE SURFING
This is not as difficult as it sounds, as there are many kinds of urges apart from drug or sugar cravings. There are urges to scratch, to move, to eat, to drink, to go to the toilet etc. When we reflect on this as it becomes clear that all adults including those who consider they have hopeless addictions have the capacity to have urges come and go without acting on them. After all, unless we are physically ill we can all control our need to go to the toilet!
When we sit with our back supported in a chair or on a cushion on the floor and start mindfulness meditation, sooner or later some sense of discomfort will arise, such as restlessness or an itch. Along with these sensations there will be a urge to move. This is an opportunity to practice urge surfing. So we can notice the difficult sensations that go with this and the thoughts that arise. Instead of acting in our normal way of trying to get rid of this unpleasant feeling, we become curious. We become like natural scientists seeing a strange plant or animal for the first time. We try to describe what we are observing as closely as possible. In this way we replace an aversion with curiosity. So we do this by noticing the physical sensation that goes with the urge as precisely s possible.
If we are guiding a client through this process we then ask them to notice:
The exact physical sensation in the body,
Whether it is tight or loose
It’s temperature whether it is hot or cold.
The location of the sensation,
It’s exact borders
Whether these borders are well defined and firm like the edge of a football or soft and fuzzy like cotton wool.
How these qualities vary with the respiratory cycle
We need to watch it for at least five cycles of breathing to get a sense if it.
Does it get larger or smaller, more or less intense or does the quality of it change?
When we find our mind turning to thoughts - noticing the thoughts and coming back to the physical sensations of the urge.
OPPORTUNISTICALLY TEACHING URGE SURFING
Sometimes when talking to a client an urge arises spontaneously. Sometimes it can be spotted as a subtle smile on the face as the client fondly remembers using the drug or binging on food. At this point, the therapist can say to the client:
“It looks like you might be having an urge to use right now.”
If the client agrees to this, then the therapist can ask them:
“How does this urge feel in your body? Whereabouts is it in your body?”
Then slowly guide the client through the questions that define the sensations or the urge in the body.
At first there will be a resistance and a desire to go into the story about the urges. It is then helpful to explain to the client that we can go into the story later. We can explain:
“It would be good if you could become aware of how this urge feels in your body right now. I’m very interested in knowing exactly how it feels for you. This is an opportunity for you to practice urge surfing. So see if you can just bear with it for a little while.”
Then ask the client to define the edges of this sensation, where they are and the quality of the edges, then the quality of the actual sensation itself including the temperature and finally how it changes with the cycle of breathing. Then you can ask the client if the sensations have changed since first talking about them. Any observation of change is good. It does not matter if the feeling is stronger. What is important is that the client can see the sensation is not one solid unchanging entity.
So having done this, it is worthwhile to then divert the client’s attention a little by talking about the matter at hand that elicited the urge in the first place. After doing this for a few minutes, it is very useful to return attention to the body and ask the client how the sensation feels now. At this point with their increased level of mindful awareness of the physical sensation the client is capable of noticing how the urge has changed. It has often changed dramatically. When a client has had the opportunity to be taken though this three or four times, they begin to have enough faith in the process to practice urge surfing successfully by themselves.
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