Loving Kindness Meditation



The practice always begins with developing a loving acceptance of yourself. If resistance is experienced then it indicates that feelings of unworthiness are present. No matter, this means there is work to be done, as the practice itself is designed to overcome any feelings of self-doubt or negativity. Then you are ready to systematically develop loving-kindness towards others.


Four Types of Persons to develop loving-kindness towards:

  •  a respected, beloved person - such as a spiritual teacher;
  • a dearly beloved - which could be a close family member or friend;
  • a neutral person - somebody you know, but have no special feelings towards, e.g.: a person who serves you in a shop;
  • a hostile person - someone you are currently having difficulty with.


Starting with yourself, then systematically sending loving-kindness from person to person in the above order will have the effect of breaking down the barriers between the four types of people and yourself. This will have the effect of breaking down the divisions within your own mind, the source of much of the conflict we experience. Just a word of caution if you are practicing intensively. It is best if you choose a member of the same sex or, if you have a sexual bias to your own sex, a person of the opposite sex. This is because of the risk that the near enemy of loving-kindness, lust, can be aroused. Try different people to practice on, as some people do not easily fit into the above categories, but do try to keep to the prescribed order.


Ways of arousing feelings of loving-kindness:

  1. Visualization - Bring up a mental picture. See yourself or the person the feeling is directed at smiling back at you or just being joyous.
  2. By reflection - Reflect on the positive qualities of a person and the acts of kindness they have done. And to yourself, making an affirmation, a positive statement about yourself, using your own words.
  3. Auditory - This is the simplest way but probably the most effective. Repeat an internalized mantra or phrase such as 'loving-kindness'.


From Julie Schirmer

Adapted from http://www.buddhanet.net/metta_in.htm




Goldman L, Myers M, and Dickstein, L (Eds). (2000) The Handbook of Physician Health: The Essential Guide to Understanding the Health Care Needs of Physicians. American Medical Association Press.
Covers self-care/prevention, stress & burnout syndromes, relationships, depression/anxiety, substance use, physical illness & disability, and includes a chapter on residents/students needs as well as administrative responses to troubled physicians including a resource list.

Robert J Wicks. (2006) Overcoming Secondary Stress in Medical and Nursing Practice: A Guide to Professional Resilience and Personal Well-Being. New York: Oxford University Press.
Discusses the dangers of compassion fatigue/burnout and vicarious post-traumatic stress disorder in health care settings. Introduces a newly-developed "Medical-Nursing Professional Secondary Stress Self-Awareness Questionnaire" that can be self-administered and reflected upon in private or a small group setting. Includes a unique section on strengthening one's inner life through the use of three core spiritual wisdom approaches drawn from a world religion perspective and provides a description of four types of "voices" one needs to have in one's circle of friends to ensure that balance, perspective, growth, and challenge are fostered in one's personal and professional life. Describes how health professionals can formulate a personally-designed self-care protocol for themselves. Includes an extensive bibliography.



Quill, TE, Williamson, P. Healthy Approaches to Physician Stress. Arch Int Med 1990; 150: 1857-1861.
Qualitiative study of techniques used by practicing physicians to successfully cope. Divides strategies into five categories with specific examples of each.
McCray, LW et al. Resident Physician Burnout: Is There Hope? Fam Med Oct 2008; 40(9): 626-632.

Systematic review of the literature 1966-2007 with a classification of the quality of the research to identify evidence-based interventions to decrease burnout. LeBron McBride J. Making Family Practice Doable in Everyday Life. Fam Prac Man April 2003; 41-44.
Short, practical article with 10 tips for incorporating meaning, greater self awareness, and basic self care.

Levey, RE. Sources of Stress for Residents and Recommendations for Programs to Assist Them. Acad Med 2001; 76 (2): 142-150.
Reviews sources of stress and then outlines the components of a residency assistance program for helping those who may need it.

Addison, RB, Reisenberg, LA, Rosenbaum, P. Psychosocial Support Services for Family Medicine Resident Physicians. Fam Med 2004; 36 (2): 108-112.
Survey of all US FM residency programs of what support services they provide. Gives a good overview of what's out there.


Online Resources:

Stress Management Resources 
This page teaches 65 skills that help you change your environment to reduce stress, relax when you’re under pressure, and cope when there’s nothing you can do about the situation.

The Compassion Fatigue Test
Job related stress with self-test with emphasis on provider related stress.

Life Curriculum
Learning to address Impairment and Fatigue to Enhance patient safety. The LIFE Curriculum is designed to help residency program directors prevent, identify, and manage fatigue and impairment in their residents and fellows. Although intended as a tool for graduate medical education, the curriculum has themes that are pertinent for medical students, practicing physicians, and others in the health professions. This case-based curriculum, derived from a literature review and needs assessments by North Carolina program directors, includes seven vignettes of typical situations to demonstrate impaired performance and inappropriate behavior. Because all the vignettes involve providing clear, timely feedback, an eighth case addresses the facilitation of instructive feedback.

Remembering the Heart of Medicine: Institute for the Study of Health and Illness at Commonweal

SAFER: Sleep Alertness and Fatigue Education in Residency
SAFER, or Sleep, Alertness and Fatigue Education in Residency, is a 37-minute narrated video presentation that provides an introduction to the science of sleep and the effects of sleep deprivation.

Schwartz Center for Compassionate Healthcare

Nationwide nonprofit organization dedicated to strengthening the relationship between patients and their clinical caregivers. The organization was founded by Ken Schwartz, who died of lung cancer at age 40, to promote compassion as he felt it essential to quality healthcare. Institutions can establish through the organization, Schwartz Rounds, which are multidisciplinary discussion groups focusing on difficult emotional and social issues that arise in patient care to improve patient-caregiver relationships. Their website includes evidence that caregivers that participate report feeling less alone in their work, have more energy for their work with patients, and report improved communication.



Physician Health and Wellness. Report of the Council on Ethical and Judicial Affairs, American Medical Association, 2003.

Spickard, A. Gabbe, S & Christensen, J. Mid-Career Burnout in Generalist and Specialist Physicians. JAMA, 2002; 288 (12): 1447-1450.
This article outlines symptoms of burnout, discusses factors which contribute but also (half the article) strategies to prevent in a very concise article.

Thomas, N. Resident Burnout. JAMA, 2004; 292 (23): 2880-2889.
Includes a review of the literature from 1983-2004 focusing mainly on prevalence and contributing factors and ends with a short section on prevention.

Green, M. What (if Anything) Is Wrong with Residency Overwork? Ann Intern Med, 1995; 123 (7): 512-517.
Reviews the rationale for decreasing work hours from multiple perspectives. Includes a list of 94 references.

Colford, JM, McPhee, SJ. The Ravelled Sleeve of Care: Managing the Stresses of Residency Training. JAMA, 1989; 261 (6): 889-893.
Review of stresses of residency, effects, and strategies to reduce on multiple levels.