Suggested APA style reference information can be found at http://www.counseling.

org/library/

Article 14

Mindfulness Matters: Practices for Counselors

and Counselor Education
Paper based on a program presented at the 2011Association for Counselor Education and
Supervision Conference, Nashville, TN, October 28, 2011.

Karen L. Caldwell

Caldwell, Karen L., is a Professor at Appalachian State University. She has

taught graduate students in counseling and family therapy since 1993. Her recent
research has focused on the development of mindfulness through movement-
based practices and applications of mindfulness in counseling clients with
disorders of eating.

Introduction

Effective counselors employ an array of skills. Carl Rogers (1975) believed that
the counselor’s ability to be congruent, accepting, and empathic is necessary for clients to
be able to change, and these skills are routinely taught in counselor education. Later in
his life, Rogers also articulated the need for a quality of presence that is an essential
aspect of client-centered therapy. In an interview published by Baldwin (2000), Rogers
referred to the essential nature of presence, of the counselor’s “being”:
I am inclined to think that in my writing I have stressed too much the three
basic conditions (congruence, unconditional positive regard, and empathic
understanding). Perhaps it is something around the edges of those
conditions that is really the most important element of therapy – when my
self is very clearly, obviously present. (p. 30)
This therapeutic presence is more a quality of relationship than a set of skills, and it is
more difficult to introduce into counselor education programs than basic skills training.
There is abundant research evidence that empathic responding and related skills
can be taught by combining instruction, modeling, and feedback. While easily taught,
these skills are not necessarily internalized by students (Lambert & Ogles, 1997; Lambert
& Simon, 2008). Greason and Cashwell (2009) concluded from their review of literature
that counselor education training has focused on external and observable behaviors such
as mirroring and reflection of feeling rather than cultivating the internal habits of mind
needed to control attention and respond with both cognitive and affective empathy. In
addition, other counselor educators have noted that students’ development of cognitive
complexity has been a haphazard process and piecemeal (Choate & Granello, 2006;
Fong, Borders, Ethington, & Pitts, 1997). Mindfulness practices have been used to train
Ideas and Research You Can Use: VISTAS 2012, Volume 1

other health care practitioners in attention and empathic response and may be useful in
counselor education programs. The purpose of this paper is to describe the characteristics
of mindfulness, review the literature on mindfulness practices used in the education of
health care practitioners, offer several exercises that can be used in counselor education
as means of developing mindfulness, and encourage research into this promising
educational practice.
What Is Mindfulness?

Kabat-Zinn (1994) described mindfulness as “paying attention in a particular way:

on purpose, in the present moment, and non-judgmentally” (p. 4). This is a human
capacity that was described by the American psychologist William James (1890) as
essential for excellence in education:
The faculty of voluntarily bringing back a wandering attention, over and
over again, is the very root of judgment, character, and will. No one is
compos sui if he have it not. An education which should improve this
faculty would be the education par excellence. But it is easier to define
this ideal than to give practical directions for bringing it about. (p. 424)
While it may have been true in James’ time that there were few practical directions for
training attention so that one could be “master of one’s self,” mindfulness practices
developed in a number of religious and contemplative traditions are now widely available
and the subject of numerous research studies.
Mindfulness includes concepts such as awareness, attention, and consciousness,
all of which defy decades of Western scientific efforts to refine and achieve consensus
definitions. For example, contemporary researchers in Western psychology have defined
mindfulness as a self-regulatory capacity (Brown & Ryan, 2003), a skill involving
acceptance of one’s internal experiences (Linehan, 1994), and a skill of meta-cognition
(Bishop et al., 2004). Brown, Ryan, and Creswell (2007) described mindfulness as a
“receptive attention to and awareness of present events and experience” (p. 212). Mindful
processing involves a state of mind wherein attention is kept to a bare registering of the
facts observed. This is contrasted with a conceptual mode of processing in which
cognitive schemas, beliefs, and opinions are imposed, often automatically, on everything
encountered.
Even with the lack of definitional clarity, the practice of mindfulness skills has
been found to lead to increases in self-focused attention as well as changes in
characteristics of attention so that it becomes less biased, more flexible, and nonreactive.
Mindfulness is an important building block that facilitates change in the emotional realm
(Davidson, 2010). Dispositional mindfulness as well as mindfulness interventions
consistently have been found to be associated with a number of measures of emotional
well-being (Greeson, 2009). Mechanisms of action in this inverse relationship between
mindfulness and psychological distress also have been investigated and include a
mediating role for rumination and non-attachment (Coffey & Hartman, 2008; Jain et al.,
2007; Ramel, Goldin, Carmona, & McQuaid, 2004), experiential avoidance (Lavender,
Jardin, & Anderson, 2009), and cognitive reactivity (Raes, Dewulf, Van Heeringen, &
Williams, 2009). Self-regulation of emotions through greater emotional awareness,
acceptance, and the ability to correct or improve unpleasant mood states are additional

2
Ideas and Research You Can Use: VISTAS 2012, Volume 1

pathways suggested by other researchers (Baer et al., 2008; Feldman, Hayes, Kumar,
Greeson, & Laurenceau, 2007).
Over the past 20 years, the practice of mindfulness has been increasingly used to
treat a range of mental health disorders including depression, anxiety, substance abuse,
eating disorders, attention deficit disorders, and personality disorders (reviewed by Baer,
2003). Aspects of mindfulness practice have been incorporated into Acceptance and
Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), Mindfulness-based
Cognitive Therapy (Segal, Williams & Teasdale, 2002), Addiction Treatment and
Relapse Prevention (Marlatt & Gordon, 1985), Dialectical Behavior Therapy (Linehan,
1993), and Mindfulness-based intervention for Eating Disorders (M-BEAT; Kristeller &
Hallett, 1999; Wolever, 2009).
In addition to the practice of mindfulness in mental health treatment, there is
tantalizing evidence from a recent randomized controlled trial that clinicians who develop
mindfulness through the practice of meditation have clients with better outcomes
compared to clinicians who don’t have a meditation practice (Grepmair et al., 2007). This
study examined the course and treatment results of 124 mental health inpatients treated
for 9 weeks by 18 psychotherapists-in-training. Half of the therapists were randomly
assigned to be part of a meditation group, and the other half did not practice meditation.
The patients also were randomly assigned to the meditating or non-meditating therapists.
Patients assigned to the therapists who meditated showed significantly better results than
patients assigned to therapists who did not meditate on measures of somatization,
insecurity in social contact, obsessiveness, anxiety, anger/hostility, phobic anxiety,
paranoid thinking and psychoticism. No significant differences in outcome were found
between the two groups on measures of their perception of distrust and the feeling of
being used (paranoid thinking). In addition to the health benefits that come with
meditation for clinicians themselves (e.g., Greeson, 2009; Hoffman, Sawyer, Witt, & Oh,
2010), promoting mindfulness in mental health counselors shows promise as a useful tool
for improving the treatment results of their clients.

Mindfulness in Health Care Education

There is growing interest in mindfulness to develop relational skills of health care

providers. Several authors have advocated the importance of mindfulness in the
cultivation of healing presence in physicians (Epstein, 1999; McDonough-Means,
Kreitzer, & Bell, 2004). The research base for the effectiveness of mindfulness in the
training of health care providers in the United States began in the 1970s. Lesh (1970)
found that counseling psychology students who engaged in a meditation intervention
were able to demonstrate increased empathy in comparison to students who were on the
wait-list. Shapiro and Brown (2007, as cited in Shapiro & Izette, 2008) reported that
counseling psychology students who went through the eight-week Mindfulness Based
Stress Reduction course (MBSR; Kabat-Zinn, 1990) significantly increased in empathy.
These results were similar to those of a randomized controlled study of medical students
(Shapiro, Schwartz, & Bonner, 1998) and a study of nursing students (Bruce, Young,
Turner, Vander Wal, & Linden, 2002). Mindfulness facilitates empathy through (a)
reducing stress, (b) increasing self-compassion, and (c) loosening identification with
personal subjective experience. Although not specifically about mindfulness as a training

3
Ideas and Research You Can Use: VISTAS 2012, Volume 1

practice, Greason and Cashwell (2009) surveyed 179 master’s level counseling interns
and doctoral counseling students to determine their levels of mindfulness, attention,
empathy and self-efficacy. In this study, mindfulness was a significant predictor of
counseling self-efficacy and attention was a mediator of that relationship.
Several different approaches to incorporating mindfulness training into the
curriculum of mental health practitioners have been reported including integrating
mindfulness into existing courses (Gehart & McCollum, 2008; McCollum & Gehart,
2010), a 6-week curriculum (Kramer, Meleo-Meyer & Turner, 2008), and a complete 3-
unit course (Schure, Christopher, & Christopher, 2008).

Integrating Mindfulness Into the Curriculum

Gehart and McCollum (2008) introduced mindfulness into both of their marriage
and family therapy education programs, one accredited by the Council for the
Accreditation of Counseling and Related Programs (CACREP), and one accredited by the
Commission for Accreditation of Marriage and Family Therapy Education (COAMFTE).
The mindfulness practices fit within two-semester practicum courses which are their
students’ first clinical experiences. Instruction began with a rationale for integrating
mindfulness into the curriculum. Students were required to engage in 5 minutes of a
mindfulness practice for 5 days a week and journal about their experiences. In-class
discussion and in-class guided and unguided meditations were also included in the
course. Themes from a qualitative study of students’ experiences in these courses
included students’ increasing ability to be present in sessions (McCollum & Gehart,
2010). Students’ also reported being better able to balance being and doing modes in
therapy as well as developing acceptance and compassion for clients and themselves.

A Six Week Training Module

Kramer et al. (2008) described a six week Interpersonal Mindfulness Program
(IMP) based on Insight Dialogue (ID), a formal practice of interpersonal meditation.
Their meditation instructions/guidelines are to Pause, Relax, Open, Trust Emergence,
Listen Deeply, and Speak the Truth. In a practice session, after some individual
meditation, participants pair up and a contemplation topic is introduced. An example
could be the topic of aging or dealing with disappointment. Partners trade roles talking
about the topic and mindfully listening, bringing awareness to thoughts, emotions, and
body sensations as they arise in the moment. During the dialogue a bell is rung
occasionally to bring the meditators back to silent mindfulness and help further establish
the meditative quality of their interactions. A loving kindness meditation is used at the
close of each IMP class period and ID sessions.

A Complete Course
Schure et al. (2008) described a 4-year qualitative study on the influence of
teaching hatha yoga, meditation, and qigong to counseling graduate students. Participants
in the 15-week, 3–credit mindfulness-based stress reduction course reported positive
physical, emotional, mental, spiritual, and interpersonal changes and substantial effects
on their counseling skills and therapeutic relationships.

4
Ideas and Research You Can Use: VISTAS 2012, Volume 1

Experiential Exercises

Experiential exercises demystify the concept of mindfulness and create

opportunities for practicing mindfulness in the counselor education curriculum as well as
daily life. Initial practice in group settings is beneficial in normalizing the discovery of
how active and distracted our minds typically are as well as normalizing the difficult
emotions and thoughts that can be noticed by participants. The first two exercises can be
practiced alone. If practiced alone, decide on a brief period of time, 5 to 10 minutes, to
devote to this practice. Find a place where you will not be disturbed by others, and set a
timer with a gentle alarm so that you can devote your attention to the object of
mindfulness.

Mindfulness of Breathing
Attending to the sensations of breathing is a time-honored way to bring your
attention back to the present moment, because the breath is a constant part of living.
Assume a sitting posture that will encourage alertness with eyes either closed or opened.
Set an intention to be kind towards yourself and draw your attention to the sensations of
breathing. What are the qualities of your breath: shallow or deep, fast or slow, ragged or
smooth? Where in the body do you notice the sensations of breathing: coolness or
warmth in the nostrils or back of the throat, the rib cage rising and falling, the diaphragm
sinking and rising? Your attention will inevitably wander, and when you notice this,
congratulate yourself on noticing that your mind has wandered. This is how you train
mindfulness. Gently bring your attention back to the sensations of breathing.

Mindfulness of Eating
Bringing mindful awareness to the food we eat is another practice that is fairly
easily incorporated into daily life since we must eat to live. As you begin this practice, set
an intention to be accepting towards yourself and your experience. Devote your attention
to each moment of the process of eating. Place a few raisins in your hand. If you don’t
have raisins, any food will do. Imagine that you have just arrived from planet Mars and
you have never eaten this food before. Explore the food with your senses before you put
it in your mouth. What do you smell? What do you see? What do you feel? What do you
hear? Before you place the food in your mouth, become aware of the impulse to move the
food towards your mouth. Refraining from biting into the food, place the food in your
mouth and notice how the food enters your mouth. How does it come to contact your
tongue or palate? What is the texture, the smell, the taste of the food? Is there a point in
time that more saliva collects in your mouth? When you’re ready, intentionally bite down
on the food and continue to notice the textures, smell, and taste of the food. Chew slowly
enough so that you can be aware of how the food changes in consistency and taste as you
chew. Before you swallow, become aware of the intention to swallow. See if you can
notice the sensations of swallowing the food, sensing the movement down your throat
towards your stomach. If at any point your attention wanders from the sensations of
eating, gently bring your awareness back to the present moment and the sensations of
eating. It is the practice of bringing the attention back to the present moment, over and
over again, that strengthens our human capacity for mindfulness.

5
Ideas and Research You Can Use: VISTAS 2012, Volume 1

Mindfulness of Communication
This two-person exercise is useful in basic skills classes to teach the importance
of being fully present and mindful while listening to another person. The first part of this
exercise involves one partner being purposefully mindless, and the second part involves
being purposely mindful. At first, partner A will share something significant about his or
her day, and partner B will try to be mindless, doing whatever he or she normally does to
disconnect during communication. This can be accomplished in a very short period of
time (30 seconds). Partners can then switch roles. Debriefing questions for this part of the
exercise can be focused on what the partners noticed, what they did in order to be
mindless, and how easy or difficult it was. The second part of the exercise involves
mindful listening. Partner A again shares something significant about his or her day, and
partner B will listen mindfully, as fully present to the communication as possible.
Partners then again switch roles. Debriefing questions can again be focused on what the
partners noticed, what they did in order to be mindful, and how easy or difficult it was.
How were the conversations similar and how were they different?

Final Considerations

While mindfulness meditation practices were initially part of a religious or

spiritual context, these practices can be taught without reference to their religious roots.
In secular educational settings, this distinction is important to avoid placing students in
the position that they are being forced into a religious practice. Before incorporating
mindfulness practices into the counselor education curriculum, students need a rationale
for engaging in practices that don’t initially appear to be relevant to the practice of
counseling. This rationale can include the importance of self-care for clinicians as well as
the impact of the practices on development of empathy. In addition, an ongoing practice
of mindfulness is important for developing an experiential understanding of the
mindfulness based interventions used in mental health clinical practice.
The field of research into the effectiveness of mindfulness in counselor education
is wide open. We need to know which forms of practice may be most effective in the
counselor education curriculum as well as how much practice is needed and the timing of
practice. Further research can help counselor educators deliver mindfulness training
components more effectively.

References

Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and

empirical review. Clinical Psychology: Science and Practice, 10, 125-143.
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., . . . Williams,
J. (2008). Construct validity of the five facet mindfulness questionnaire in
meditating and nonmeditating samples. Assessment, 15(3), 329-342.
Baldwin, M. (2000). Interview with Carl Rogers on the use of the self in therapy. In M.
Baldwin (Ed.). The use of self in therapy, 2nd ed (pp. 29-38). New York, NY:
Haworth Press.

6
Ideas and Research You Can Use: VISTAS 2012, Volume 1

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., . . .
Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical
Psychology: Science & Practice, 11, 230-241.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its
role in psychological well-being. Journal of Personality and Social Psychology,
84, 822-848.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical
foundations and evidence for its salutary effects. Psychological Inquiry, 18(4),
211-237.
Bruce, A., Young, L., Turner, L., Vander Wal, R., & Linden, W. (2002). Meditation-
based stress reduction: Holistic practice in nursing education. In L. E. Young &
V. E. Hayes (Eds.), Transforming health promotion practice: Concepts, issues,
and applications (pp. 241-252). Victoria, British Columbia, Canada: Davis.
Choate, L. H., & Granello, D. H. (2006). Promoting student cognitive development in
counselor preparation: A proposed expanded role for faculty advisers. Counselor
Education & Supervision, 46(2), 116-130.
Coffey, K. A., & Hartman, M. (2008). Mechanisms of action in the inverse relationship
between mindfulness and psychological distress. Complementary Health Practice
Review, 13(2), 79-91.
Davidson, R. J. (2010). Empirical explorations of mindfulness: Conceptual and
methodological conundrums. Emotion, 10(1), 8-11.
Epstein, R. M. (1999). Mindful practice. Journal of the American Medical Association,
282(9), 833-839.
Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J. (2007). Mindfulness
and emotion regulation: The development and initial validation of the Cognitive
and Affective Mindfulness Scale-Revised (CAMS-R). Journal of
Psychopathology and Behavioral Assessment, 29(3), 177-190.
Fong, M. L., Borders, L. D., Ethington, C., & Pitts, J. (1997). Becoming a counselor: A
longitudinal study of student cognitive development. Counselor Education and
Supervision, 37, 100-114.
Gehart, D. R., & McCollum, E. E. (2008). Teaching therapeutic presence: A mindfulness-
based approach. In S. Hick & T. Bien (eds.), Mindfulness and the therapeutic
relationship (pp. 176-194). New York, NY: Guilford.
Greason, P., & Cashwell, C. (2009). Mindfulness and counseling self-efficacy: The
mediating role of attention and empathy. Counselor Education & Supervision, 49,
2-19.
Greeson, J. (2009). Mindfulness research update: 2008. Complementary Health Practice
Review OnlineFirst. doi:10.1177/153210108329862
Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007).
Promoting mindfulness in psychotherapists in training influences the treatment
results of their patients: A randomized, double-blind, controlled study.
Psychotherapy and Psychosomatics, 76, 332-338.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy.
New York, NY: Guilford Press.

7
Ideas and Research You Can Use: VISTAS 2012, Volume 1

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-
based therapy on anxiety and depression: A meta-analytic review. Journal of
Consulting and Clinical Psychology, 78, 169-183.
Jain, S., Shapiro, S. L., Swanick, S., Rowsch, S. C., Mills, P. M., Bell, I., & Schwartz, G.
E. (2007). A randomized controlled trial of mindfulness meditation versus
relaxation training: Effects on distress, positive states of mind, rumination, and
distraction. Annals of Behavioral Medicine, 33, 11-21.
James, W. (1890). Principles of psychology (vol. 1). Retrieved from
http://psychclassics.yorku.ca/James/Principles/
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind
to face stress, pain, and illness. New York, NY: Delacorte Press.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in
everyday life. New York, NY: Hyperion.
Kramer, G., Meleo-Meyer, F., & Turner, M. L. (2008). Cultivating mindfulness in
relation: Insight dialogue and the interpersonal mindfulness program. In S. Hick
& T. Bien (Eds.), Mindfulness and the therapeutic relationship (pp. 195-214).
New York, NY: Guilford.
Kristeller, J. L., & Hallett, C. B. (1999). An exploratory study of a meditation-based
intervention for binge eating disorder. Journal of Health Psychology, 4(3), 357-
363.
Lambert, M., & Ogles, B. (1997). The effectiveness of psychotherapy supervision. In C.
E. Watkins (Ed.), Handbook of psychotherapy supervision (pp. 421-446). New
York, NY: Wiley.
Lambert, M., & Simon, W. (2008). The therapeutic relationship: Central and essential in
psychotherapy outcome. In. S. F. Hick, T. Bien, & Z. V. Segal (Eds). Mindfulness
and the therapeutic relationship (pp. 19-33). New York, NY: Guilford.
Lavender, J. M., Jardin, B. F., & Anderson, D. A. (2009). Bulimic symptoms in
undergraduate men and women: Contributions of mindfulness and thought
suppression. Eating Behaviors, 10(4), 228-231.
Lesh, T. V. (1970). Zen meditation and the development of empathy in counselors.
Journal of Humanistic Psychology, 10, 39-74.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality
disorder. New York, NY: Guilford Press.
Linehan, M. M. (1994). Acceptance and change: The central dialectic in psychotherapy.
S. C. Hayes, N. S. Jacobson, V. M. Follette, & M. J. Dougher (Eds.), Acceptance
and change: Content and context in psychotherapy (pp. 73-90). Reno, NV:
Context Press.
Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Maintenance strategies in
the treatment of addictive behaviors. New York, NY: Guilford Press.
McCollum, E. E., & Gehart, D. R. (2010). Using mindfulness meditation to teach
beginning therapists therapeutic presence: A qualitative study. Journal of Marital
& Family Therapy, 36(3), 347-360. doi: 10.1111/j.1752-006.2010.00214.x
McDonough-Means, S. I., Kreitzer, M. J., & Bell, I. R. (2004). Fostering a healing
presence and investigating its mediators. Journal of Alternative and
Complementary Medicine, 10, S25-S41.

8
Ideas and Research You Can Use: VISTAS 2012, Volume 1

Raes, F., Dewulf, D., Van Heeringen, C., Williams, J. M. G. (2009). Mindfulness and
reduced cognitive reactivity to sad mood: Evidence from a correlational study and
a non-randomized waiting list controlled study. Behaviour Research and Therapy,
47(7), 623-627.
Ramel, W., Goldin, P. R., Carmona, P. E., & McQuaid, J. R. (2004). The effects of
mindfulness meditation training on cognitive processes and affect in patients with
past depression. Cognitive Therapy and Research, 28(4), 433-455.
Rogers, C. (1975). Empathic: An unappreciated way of being. The Counseling
Psychologist, 5(2), 2-10.
Schure, M. B., Christopher, J., & Christopher, S. (2008). Mind-body medicine and the art
of self-care: Teaching mindfulness to counseling students through yoga,
meditation, and qigong. Journal of Counseling and Development, 86, 47-56.
Segal, Z. V., Wiliams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive
therapy for depression: A new approach to preventing relapse. New York, NY:
Guilford Press.
Shapiro, S., & Izett, C. (2008). Meditation: A universal tool for cultivating empathy. In S.
Hick & T. Bien (Eds.), Mindfulness and the therapeutic relationship (pp. 161-
175). New York, NY: Guilford.
Shapiro, S., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress
reduction on medical and premedical students. Journal of Behavioral Medicine,
21, 5881-599.
Wolever, R. (2009). Mindfulness-based approaches to eating disorders. In F. Didonna &
J. Kabat-Zinn (Eds.). Clinical handbook of mindfulness (pp. 259-287). New York,
NY: Springer Science + Business Media.

Note: This paper is part of the annual VISTAS project sponsored by the American Counseling Association.
Find more information on the project at: http://counselingoutfitters.com/vistas/VISTAS_Home.htm