Daniel Siegel, Clinical Professor of Psychiatry at UCLA, has written a bold book: it is directed towards all mental health clinicians independent of therapy modality or professional background. It engages the reader in a form of “bibliomeditation”, meditating on his on her own mind while reading the book or, in other words, it proposes a form of self-discovery and therapy, all in the name of perfecting our therapeutic relationship with our patients or clients.

The book is structured in 16 chapters, all following the mnemonic acronym “PARTTT. . .”, each chapter crystallizing what it actually takes to be a good healer. It starts with Presence, Attunement, Resonance and then moves to the “TR elements”, like trust, truth, tripod etc. If at this stage you start wondering where this is going and what “tripod” actually means in this context, you meet the first challenge with this author: Professor Siegel is also the Executive Director of the Mindsight Institute in LA. In order to follow his thinking, we have to learn a new language that he has created to redefine the postulated constructs that title each chapter: what John Teasdale calls “metacognitive awareness” and Brown and Ryan call “mindful awareness”, Siegel calls “mindsight”. It refers to our capacity to direct our attention inwards and become aware about thoughts, images, emotions and bodily sensations in a non-judgmental way in the present moment (Kabat-Zinn), without needing to change or alter it in any way. The “tripod” (to hold the inner camera of mindsight) is openness, objectivity and observation: key qualities to becoming a mindful practitioner.

In every chapter, the neurobiological correlates of each quality of the mindful practitioner are explored by reviewing the latest scientific evidence. Results from functional neuro-imaging are used to define and narrow down the neuro-anatomical and neuro-physiological mechanisms. In a nutshell, this book attempts to explain how the mind really works. Here we have a complete epistemological theory of the mind. Graphs and tables are very helpful to explain his model of the mind and in linking it to the brain.

The book also postulates that through regular training and exercise, the brain can be trained to develop and deepen the qualities of a mindful practitioner. Siegel calls this “Neural Integration”. Like a muscle, brain areas associated with empathy or compassion can be made to grow and expand by means of neuroplasticity. This is a potentially revolutionary new addition to the field of mindful practice in psychological therapies. Like a student of classical singing is taught to develop an awareness of the muscular components involved in forming a perfect tone, the mindful therapist could directly deepen neuronal pathways through specific meditation practices, targeting perceived deficits in him/herself by deliberately practising exercises leading to the desired neural change.

The third major claim of this book is that it links mindsight and neural integration to attachment theory and to our capacity for relationships. Thus, it gives mindfulness practices a developmental and personality aspect and defines neural integration as the process of becoming at ease with our inborn temperament and subsequent attachment experiences. In a way, we are encouraged to move into secure attachment within ourselves.

Siegel moves with ease in and out of making references to spiritual traditions. Herein lies one of the difficulties with this book: bold in its attempt to create a model of mind and brain, link it to mindfulness and connect it to attachment theory and personality formation, the book presents itself as a Rosetta stone to translate ancient knowledge of the effects of mindfulness into modern, evidence-based theory.

As with so many studies of functional neuro-imaging, Siegel converts results of co-relational findings of cerebral blood flow into causal explanations and talks about hypotheses as if they were facts. In the tradition of the Buddhist sutras, he groups constructs like “transformation”, “trust” and “traits” into a plethora of mnemonic acronyms and mixes them with his own neologisms of further constructs, like “mindsight”. In combination with reference to functional neuroscience, he creates a complete system that alludes to the Buddhist Noble Eightfold Path to become an enlightened practitioner. Little room is left for reminding the reader that this is bold scientific speculation, that our firm knowledge of the brain and its neurobiology is minute when faced with the infinite complexity of the whole system.

I missed the concept of acceptance, i.e. the non-judgmental observation and “allowing to be” of any experience, good or stressful, without needing to alter or change. Acceptance is a key addition of mindfulness to the traditionally change-oriented psychotherapeutic movement. Siegel talks little of acceptance and returns to advocating change by optimization of our mental and emotional abilities. I cannot help but feel uneasy with somewhat closed systems, be they scientific or spiritual.

Overall, this book gives plenty of food for thought and is a genuine attempt to define good enough therapeutic practice through mindfulness across psychotherapeutic traditions and linking it to what we know so far about how the mind really works.