The Inside Out Group Model: Teaching Groups in Mindfulness-Based Programs

The teacher monitors the immediacy of their felt experience within the boundaries of their body—with a particular emphasis on raw sensory data arising through interoceptive (awareness of visceral stimuli originating inside of one’s body) and proprioceptive capacities (awareness of the position of the body). This will include the feeling of contact of body with ground, sensing the feeling tone of sensory experience, and attuning to subtle shifts in emotional valence in response to contact with individuals and the group as a whole. Thoughts are also part of immediate experience, and a key part of monitoring the inside processes is to recognize thoughts as thoughts, to choose which thoughts to engage with, and to repeatedly reconnect to and sustain connection with the sensed physicality of bodily experience. In this way, the teacher is less prone to having their attention hijacked by thoughts that trigger constriction or identification around a particular theme—such as a sense of “I’m not good enough” or “that participant is annoying,” etc. Inside, for the purposes of this paper, thus refers to the teacher’s conscious connectivity to the immediacy of their inner experience (somatic, cognitive, and affective) with a focus on their inside responses to themselves, individuals, and the group while teaching.

In parallel with this inside connectivity, the teacher connects to the moment-by-moment arising of what is seen, heard, and sensed with individuals, the group, and in the surrounding space. Out involves awareness of the processes and activity arising in the space, outside the boundaries of the teacher’s body. The boundary between inside and outside to some extent is arbitrary and dissolves with mindfulness practice. However, the key point here is that the teacher has an integrated and inclusive awareness of processes emerging within and without the boundary of their body and is attuned to the interplay between them. The teacher also responds to all inside and out phenomena that arises within the teaching context through an embodied understanding of its nature, i.e., recognition of it as arising and passing process, rather than as narrative to engage or identify with (Shapiro et al. 2018).

The teacher can shift their attention between an orientation towards inside experiencing, and an orientation towards out experiencing according to what is needed at a given moment (Young 2016). This comes together to “achieve the co-created flowing disposition” which gives rise to the capacity to respond to the moment-to-moment unfolding of the MBP group (McCown 2016, p. 21). The manifestation of this practice of inside and out mindful connection is seen and felt by participants through the teacher’s bodily expression, speech, attitudes, and behaviors—and is a way of expressing embodied practice.

An example of inside out embodiment at work can come from the act of seeing. When an MBP teacher scans round the circle of participants (out), they may see signs of engagement and interest, and/or distractedness and boredom. This may be quickly followed by a movement into the conceptual mind (inside) and an interpretation of “they are bored because…” which trigger a negative judgment about their teaching. This movement from what is actually seen to interpreting and judging can distance the one who sees, thinks, and judges from the ones who are seen, and whose actions are interpreted. MBP teachers cultivate the capacity within these challenging moments to turn towards inside sensations and recognize the internal felt sense within the body, as a means of interrupting potential reactivity and personal identification, and instead reconnecting to the wider sense of emerging experience in the “body” of the group. As Ray (2016) wrote “‘Knowing from the inside’ involves setting aside the bright daylight world of the thinking mind and learning to view—to viscerally sense—our life from within the half-light of our body” (p. 2).

Teaching from inside out embodiment is a dynamic process, with the teachers’ attention shifting from internal phenomena (inside) to external phenomena (out), and from embodied connectivity to moments of conceptualizing, akin to what may arise during a formal mindfulness practice. Inside out embodiment while teaching involves recognizing moments of getting caught in thinking, and repeatedly returning to a live connection to the present moment experience of self, the participants, and the group. Speeth (1982) describes a similar process during her psychotherapeutic practice: “There is meta-information that tells me how my attention is fluctuating from inside to outside and back again, and how the beam of my awareness is focusing narrowly or opening panoramically” (p. 99). Surrounding all this is the capacity to recognize in a kindly way what is here, giving specific attention to elements of what is arising when needed, and cultivating a meta-perspective on the overall flux of experience. This latter skill is similar to the practice of choiceless awareness in mindfulness meditation practice, in which one does not purposely direct the attention towards a chosen object, but cultivates an openness to whatever moves into the field of awareness moment-by-moment, either inside or out (Young 2016). This capacity to shift the attentional system is systematically trained during the practice of mindfulness meditation, and intentionally brought as embodied practice to the MBP teaching process.

The first model of group theory described comes from Tuckman’s (1965) four stages of group development, which are as follows: (a) forming, (b) storming, (c) norming, and (d) performing, which can be used as a map of how the MBP group may develop. When a group first comes together (forming), participants characteristically experience anxiety, and show a level of reserved-ness and dependence on the teacher. This is a time when teachers need to offer clear and firm boundaries to build a sense of containment and safety—and to facilitate connections with their fellow group members. This phase can then evolve into storming when participants develop a sense of their place in the group, and start to test their interactions with the teacher, and her capacity to hold the group safely, and with fellow participants. Each group is different and may storm in the first week, some groups—especially those outside of therapeutic work and in experiential education such as some MBPs—may not storm in a clearly defined way or indeed, storming could serve as a performing function in some groups (Bonebright 2010). There is some research suggesting that group storming can arise within the MBP process as participants’ resistance to turning towards their own psychological processes (Cormack 2017), which, in the authors experience, most often arises during the first two sessions, or at the half-way point (Week 4 or 5) in an MBP course.

The third stage is norming, when participants become used to their roles and established group norms. Within an MBP, norming might be seen when participants learn what to expect during practice and inquiry. Performing follows when participants have formed bonds within the group and can work collaboratively. The group needs less teacher input, and participants support each other more independently in their discoveries about mindfulness practice, and show a deepening capacity for reflection. Tuckman added a fifth and final stage at a later date, called adjourning (Tuckman and Jensen 1977), which describes the ending of a group. In MBPs, this takes place as the program finishes, the group dissolves, and participants separate to take what they have learned into everyday life practice (often with an internalized sense of their group).

When the MBP teacher is aware that these developmental stages are at work within the group, and welcomes them as normal, healthy aspects of group development, she is able to respond skillfully to the needs of the participants and better support the ongoing development of the group. There is broad agreement that groups do develop and grow in relatively predictable and consistent ways (Bonebright 2010; Heinen and Jacobson 1976). However, as Miller (2003) pointed out, it is important to recognize that group development is more complex then linear models such as Tuckman’s (1965) might imply—the priority for the teacher is to respond to what is actually arising rather than ideas about what could be happening. Furthermore, group process theories such as Tuckman’s (1965), although very useful, do not always consider the context of the particular MBP group, such as the location (clinical, educational, yoga studio), and the cultural or contextual issues within the group.

Second, Berne’s group Imago theory (1963) highlights the importance for the group leader to acknowledge the conditioning and resultant unconscious projections that each participant (and the teacher) brings with him or her into the group. These are influenced by early family experiences and other personal group histories. The unconscious dynamics that influence roles and interpersonal behaviors get played out in the group, as well as how the teacher engages with the group (Amaro 2015). This is a complex area that highlights the hidden influences teeming under the surface of group process. Berne’s group imago is a way of acknowledging and concretizing this and describes the ways the group leader can support and make sense of the development of the group, without needing to know the detail of the group members’ backgrounds. Clarkson (1991) usefully links the stages of development of a healthy group imago with Tuckman’s group development theory. In the context of MBPs, the group imago model underlines the importance of the teacher cultivating awareness and compassion for group and individual behaviors that arise, as well as their own, knowing that their influence is often historical and unconscious.

The work of behavioral psychologists is also of relevance here, in relation to how the teacher may shape the behavior of the group by reinforcing particular contributions from group members which align with the group norms which are being encouraged (Crane et al. 2014), and which support the cohesiveness of the group, and inter-member solidarity (see Liberman 1970).

What is it that enables MBP teachers to read the group? The theoretical understandings summarized above (and others) are part of the answer—which allow the teacher to place the processes that are arising within the group into the context of wider understanding. Significantly though, the teacher needs to digest these theories in a way that releases them from consciously holding concepts as they teach. Once they are integrated as a coherent aspect of embodied practice—reading the group can then emerge and be recognized in relevant moments. Externally, there are visual, non-verbal body language clues from individual participants—e.g., folded arms, voice tone, leaning back or forward, avoiding eye contact (out). Internal sensory responses within the teacher can alert them to shifts within the group—perhaps through noticing slight butterflies in the belly, or maybe a sense of holding the breath (inside). All these belong to the experience of the teacher—but they may well be triggered by a resonance with feelings within the group. Just as an emotion has an inevitable expression in sensations in the body, so different reactivity arising in individuals in the group creates a resonance in the teacher (and probably in the group as a whole: McCown et al. 2010). By noticing and deliberately attending to this resonance, the whole group, including the teacher, is enabled to settle and hold whatever is arising.

The following description illustrates the process of reading the group. It shows the way in which reading can inform decisions made by the teacher, and how this in turn can impact on group process.

At a pre-course orientation session for an MBP group, a student (we will call him Mark) was absent. Then in week one, Mark arrived thirty minutes late, so at the end of the class, the teacher engaged with Mark to offer orientation information, and to emphasize the importance of arriving on time. In week two, Mark arrived on time but seemed disengaged; his small group was slow in returning to the large group, he whispered to his neighbor a couple of times, and it was difficult to engage him in eye contact. The teacher felt some internal discomfort at this, although also recognized that this was likely to be storming, a usual part of group development. He intentionally monitored the impact of Mark’s actions on the wider group. He could not discern anything obvious, but knew from his knowledge of forming that having a disengaged group member would likely affect the wider group. Mark was absent for week three, and the teacher noticed that the group was more open, responsive, engaged, and relaxed during this session. The teacher’s impression was that without Mark, the group was forming nicely and even beginning to move into a norming development phase.

In week four, Mark was present and the teacher noticed a subtle but definite shift in the engagement of the group from the previous week. In general, they seemed less confident with Mark in the room, and the teacher observed some participants looking towards Mark while they were speaking, as if to gauge his reaction. The teacher sensed that the group was looking to find ways of re-forming, and that it was important to help Mark settle into the group. To help facilitate this he emailed Mark and asked if there was anything he could do that might help him engage with the course and gain benefit from it. They had a productive exchange. In week five, the teacher read the body language of group as being more relaxed, and his internal experience resonated with that. Mark appeared to fit in better and his responses in the group were more in line with the others. An important topic opened up following one of his contributions within an inquiry that engaged many group members. The teacher surmised that the performing stage was happening. The rest of the course continued with the group appearing engaged, steady, open, authentic, and inclusive. Mark’s joining of the group was on one level an individual process, but it proved to be instrumental for the group as a whole. This was facilitated by the teacher reading the development of the group, assisted by his own internal sense of what was happening at the time, and what he needed to do to support Mark, himself, and the group as a whole.

It is through skillful holding that safety builds, MBP teachers need to help the group to form—and be aware of how holding develops as the group matures. Holding is most tangible at the start of the course when the group is forming (Tuckman 1965) at which stage the teacher helps build trust through a warm welcome, well held boundaries, and safe connections.

To facilitate the group during the forming stage, teachers can help build the group community and ethos by ensuring practical arrangements are clearly in place. They take responsibility for the smooth running of the class by establishing external boundaries such as the layout of the venue, toilet locations, dates, arrangements, and that cost and time structures are clearly communicated. Internal boundaries play their part in how group members relate to each other, and this starts before the group has even met, with teachers ensuring appropriate group membership through orientation sessions and written contact.

At the beginning, participants are dependent on the teacher for direction about norms and expectations of behavior. The inside out embodied mindful practice of the teacher is vital in holding the group throughout the MBP, and this is especially important in the forming stages when establishing safety. As well as holding the group, the teacher must also hold herself, and be attuned to and tolerate feelings that may arise during teaching (inside). Speeth (1982, p. 158) wrote of the capacity of the therapist to “feel deeply and give those feelings no expression at all, as well as the ability to feel deeply and express it genuinely and spontaneously.” It is embodied awareness that enables the MBP teacher to discern what will serve in any given moment. Teachers may feel anxious about their teaching, feel deep compassion, concern, or frustration towards a participant, while at the same time holding the intention that all feelings and responses can be skillfully held in awareness in order to offer continuity of embodied presence, and to help establish a sense of safety within the group. Every encounter with individual group members, especially at the forming stage, will be evaluated consciously or unconsciously by each person in the group. Participants are alert to authenticity, respect, compassion, and safety from the teacher, particularly in the first few MBP classes. The teacher therefore has a responsibility to manage their own process (inside), and know when it is skillful to self-regulate by pulling attention back into themselves to regather and reconnect. This example of embodied holding may enable group members to develop this as a personal skill for themselves, which has parallels with the imitative behavior theme from Yalom and Leszcz (2005).

As the MBP group becomes established with the forming of safe connections within the group, the priority shifts to holding a process which enables participants to wholeheartedly engage with the work they have come to do. If participants feel safe in the group, they will be more likely to take risks alongside others and learn new ways of relating to themselves and others through mindfulness. Taking risks may include encountering challenging experiences, and this requires the teacher to continue to embody steady confidence in the process of MBP learning. Holding has a physical component that requires the teacher to regularly visually scan around the group in order to stay in contact with the whole circle (out)—not just to those who are talking, or those the teacher is drawn to, or those she may feel unsure of. Present moment attention helps the teacher to respond to what arises, sensitively noticing the moments that require a particular intervention, or times when skillful holding involves no words at all, except perhaps a pause held kindly (inside out embodiment).

Additionally, there is a need to oversee the complicated web of relationships that exist in a group in order that everyone feels included and able to encounter the learning offered (Mindell 1997). Every group has a way of marginalizing some behaviors and group members and valuing others. This may well reflect wider social attitudes and unconscious bias. Regardless of good intentions, the process of making quick perceptions based on race, gender, and other characteristics is part of our implicit and automatic patterning, which in turn is informed by social conditioning (Fiske 2002; Magee 2016). The MBP teacher needs to be alert to ways of including those who may be at the margins, for “the more ‘at home’ the margins feel, the more they can learn” (Lakey 2010, p. 32). A strong responsibility for each MBP teacher is to undertake training on the influence of social context, non-discriminatory practice, and unconscious bias and make it an ongoing practice to proactively bring awareness to these processes and their influence on how relationships are formed, and how they interrupt connection (See Magee 2016 for an exploration of engaging mindfully with personal bias). This awareness building is part of resourcing the teacher to recognize how their own personal patterning influences their capacity to hold the individuality of participants, while also holding the wider group process in ways that are responsive and respectful (inside out embodiment). It is by actively including all members in the group, and recognizing our own habitual biases as MBP teachers and how we might work with them, that we establish safety and a feeling of inclusiveness for all participants.

At the heart of skillful group holding is the capacity to notice those who withdraw to become almost invisible in the group circle, and seek to include them gently, even if they choose to stay on the side-lines. Importantly, there is no need for everyone to speak to develop a sense of sharing and participation. Throughout the teaching process, the teacher can draw out shared aspects of participants’ experiences in ways that are inclusive to the whole group; and can develop participatory teaching processes that do not require speaking into the whole group.

An MBSR course had been running for five weeks and the participants appeared to be doing well. After a full sitting practice, the teacher opened an inquiry process—starting with a “horizontal” invitation “Would anyone like to share a word or two that describes some part of their experience in that practice?”. The group were used to this process and someone offered “Sleepy and dull.” The teacher scanned around the circle with the question, “Anyone else felt sleepy and dull?” and acknowledged nods and “yes” from a few people. Then he asked, “Did anyone feel anything a bit different to sleepy and dull?” And a young woman, (let’s call her Jane) who tended to be quite reserved, caught the teacher’s eye and quietly said, “I felt very sad.” These words produced one of those moments familiar to MBP teachers, when the group as a whole appeared to hold their breath and there was a sense of time hanging, as if no-one knew (including the teacher) what might unfold next. The teacher kept his attention gently with the young woman, while being aware of feelings in the wider circle and within his own internal experience. “Might you bring the breath softly to this sadness?” he asked Jane. He then noticed her body language which signaled that she was uncomfortable being the focus of the group’s attention in this moment. So, in order to create a sense of safety for her and the group, he looked around and added “Let’s all of us turn towards whatever is going on for each one of us right now with a short practice.” A couple of minutes later, as he observed that things appeared to settle within Jane, and as the group also appeared to look and feel more grounded and steady, the teacher concluded with “This is an example of the way we can bring the breath and our practice to hold intensity gently—and how as a group we can support each other, connecting in kindness to hold whatever is going on.” And with some nods from the group acknowledging what had been said, the teacher sensed Jane was steadier, so did a short inquiry into the feel of the sadness and how she had been relating to it, before they moved on to the next part of the program. The teacher thus deliberately held the group to help participants feel safe in a tender moment, while also allowing for learning and connection within the space.

An MBCT program was being taught to people with cancer, there were seven people with cancer in the group, and a partner of one of the participants. Several of the group were fairly young, were experiencing considerable anxiety, and had somewhat low levels of self-confidence. The partner of a participant (we will call her Mary) was an older woman who had recently retired from a senior position in which she had considerable authority. She contributed her views rather stridently in the sessions, often repeating that mindfulness wasn’t her thing but that she wanted to be there for her partner. During the inquiry process, the teacher found it hard to engage Mary and observed that she was asleep during most of the formal practices and was doing very little home practice—yet she dominated the small groups and wider discussion. The teacher took her concerns to her mindfulness supervisor, admitting she felt frustrated and unnerved by Mary. She and her supervisor considered various approaches, which the teacher tried without much impact “Well,” said her supervisor, “There is only one option. Maybe you need to consider letting go of trying to approach this differently and open your heart to this woman who is clearly motivated by her love and concern for her partner. Practice kindness towards her and the others in the group as best you can.” The teacher followed this advice and was surprised to find feelings of genuine befriending towards Mary. She no longer felt nervous of her and realized that Mary’s intentions for attending the course were loving. In week seven, Mary fed back that something rather surprising had happened. A close friend phoned her following a very sad traumatic event. Mary told the group that she had sat and listened to her friend—and unusually for her—hadn’t offered any advice but had just been there for her. “It was a new experience for me,” she said. “I was just mindful I suppose.” The group stepped in to affirm her and there was a definite sense of warm connection in the room.

Befriending was cultivated first within the teacher’s practice. Mary herself would not have been aware of this process, but it enabled the teacher to open to Mary and her situation rather than see her as a difficult participant. The teacher was able to be more wholeheartedly accepting of Mary, which impacted her inside process, and supported her to be a more skillful teacher within the group. The direct impact of this befriending process upon Mary is unknown, although she experienced a significant shift towards the end of the course, which she attributed to mindfulness.