CMRP Conference

Therapist Mindfulness Practice and Psychotherapeutic Work:A Mixed-Methods Study

Anthony Keane MSc

April 2011

Background

Common Factors approach client–therapist

relationship is strongest predictor of positive

outcome (e.g. Lambert & Ogles, 2004)

Therapist mindfulness practice may promote

abilities and qualities associated with positive

therapeutic relating (e.g. Crane & Elias, 2006; Hick &

Bien, 2008; Siegel, 2007)

Evidence for benefits of mindfulness practice for

trainee psychotherapists and their clients (e.g.

Grepmair et al., 2007; Schure et al., 2008)

Present Study: Research Questions

1. What, if any, is the impact of personal

mindfulness practice on the work of therapists?

2. Are levels of meditation experience associated

with levels of mindfulness?

3. Are levels of mindfulness associated with the

capacity for empathy?

Method: Design

Mixed-methods

Phase 1: Postal survey (N = 40)

Phase 2: Follow-up interviews (N =12)

Method: Participants

Inclusion Criteria

Qualified (not trainees)

Mindfulness practice at least once per week

Demographics

Gender: 25 females, 15 males

Nationality: 32 Irish, 3 British, 1 Polish,

1 Dutch, 1 Indian, 1 American, 1 Australian

Age: 30–60+ years

Method: Phase 1 Instruments

Mindfulness: Five Facet Mindfulness

Questionnaire (FFMQ) (Baer et al., 2006)

Observing

Describing

Acting With Awareness

Nonjudging of Inner Experience

Nonreactivity to Inner Experience

Method: Phase 1 Instruments contd.

Empathy: Interpersonal Reactivity Index (IRI) (Davis, 1983)

Perspective Taking

Empathic Concern

Fantasy

Personal Distress

Mindfulness and Psychotherapeutic Work

8-item scale (designed for present study)

Open-ended questions

Method: Phase 2 Instruments

Face-to-face follow-up interview (N = 12)

Semi-structured schedule

Results and Discussion:

Selected Quantitative Findings

Predominant Theoretical Orientations

Theoretical Orientation n %

Integrative

26

65

Humanistic–Existential 20 50

Psychodynamic 13 32

Body-Oriented 8 20

Cognitive-Behavioural 7 17

Systemic 5 12

Constructivist 3 7

Others 5 12

Meditation Practice

Characteristic Range M SD

Duration of practice in years 1 – 40 11.4 10.49

Frequency of sessions per week 2 – 20 6.8 3.68

Length of sessions in minutes 5 – 60 30 12.26

Meditation Practice

Characteristic Range M SD

Duration of practice in years 1 – 40 11.4 10.49

Frequency of sessions per week 2 – 20 6.8 3.68

Length of sessions in minutes 5 – 60 30 12.26

Most Frequent Mindfulness Practices

0

5

10

15

20

25

30

35

40

N

Meditation Experience and Mindfulness

Meditation experience positively associated with:

Nonjudging facet ( = .39, p = .012)

Acting With Awareness facet ( = .34, p = .033)

Mindfulness and Empathy

IRI Perspective

Taking

IRI Fantasy

IRI Empathic Concern

IRI Personal Distress

IRI Global

Empathy FFMQ Observe

.60**

.11

.37*

-.34*

.52**

FFMQ Describe

.46**

-.19

.11

-.53**

.17

FFMQ Awareness

.44**

-.12

.28

-.29

.28

FFMQ Nonjudge

.57**

.16

.26

-.33*

.48**

FFMQ Nonreactivity

.57**

.04

.31

-.45**

.44*

*p .05. ** p .01.

Mindfulness and Psychotherapeutic Work

Quality of therapist attention (98%)*

Awareness of own process with clients (95%)

Awareness of dynamics like transference and

counter-transference (78%)

Ability to tolerate difficult emotional states (98%)

Capacity for self-compassion (93%)

Capacity for empathy (83%)

Awareness of self-care needs (93%)

Changed understanding of psychotherapy (68%)

*Percentages refer to proportion of sample who agreed (agree or strongly

agree) that mindfulness had a positive influence in the area specified

Selected Qualitative Findings

Main Themes

Enhanced Attention and

Awareness

Therapist Qualities: Embodying

Mindfulness

Perspectives on Therapy

Mindfulness as Intervention

Benefits

Therapist Self-Care

Challenges

Enhanced Attention and Awareness Mediate Benefits

Heightens attention and awareness (27)*

“Being present” (21)

Greater voluntary control of attention (14)

*Figures refer to number of times sub-theme was mentioned in qualitative

responses in postal survey (N =40)

“The added bit that mindfulness gives is that notion

of taking the time to come in and take your seat,

to feel, ‘Am I present? Am I in my body?’ A lot of

my patients have physical traumas and are

slightly dissociated from their bodies. I’ve learnt to

be grounded to help them ground themselves as

well.” (G)

“Mindfulness meditation uses this fine beam of

attention in a narrow focus and then broadens to

a wider focus. When you are doing that

deliberately with a client, your capacity to explore

their internal geography improves. You really

become a much more sophisticated

cartographer.” (J)

Enhanced Attention and Awareness Mediate Benefits

Heightens attention and awareness (27)*

“Being present” (21)

Greater voluntary control of attention (14)

“Listening deeply”: attunement (22)

Awareness of interpersonal process and use of

“self” (15)

*Figures refer to number of times sub-theme was mentioned in qualitative

responses in postal survey (N =40)

“Mindfulness practice has deepened my levels of

attention to both myself and my client, enabling

me to have greater embodied awareness of the

here and now. This facilitates meeting on a much

deeper level – it can help cut through the dance of

repeated patterns and dialogue. It helps me

respond rather than react or collude with a client.”

(K)

“What I have found is that you’re picking up a lot of

the patient’s transferences. You’re perhaps more

aware of their body language, their tone of voice

you can almost feel the fear, you can almost smell

the depression and it’s really quite remarkable.

Because you’re being empathic and listening, you

also become aware of your own reactions.” (I)

Challenges of Enhanced Attention and Awareness

Personal challenges of heightened self-

awareness (11/12 interviewees)

“That’s been my experience: letting go your ideal

self, letting go your conscious self. So, you really

are coming down off those identifications into a

much more uncertain place.” (G)

“Within a short few months repressed trauma

material arose a bit volcanically and that was very

overwhelming for some time … one of the things

that the practice asks of us is that we find a way

to be with whatever is present no matter what it

is.” (J)

Challenges of Enhanced Attention and Awareness

Personal challenges of heightened self-

awareness (11/12 interviewees)

Emergence of heightened sensitivity: a “double-

edged sword” (5 interviewees)

“I was very sensitive to everything. It was as if every

emotion was magnified. Client stories were very

upsetting – the positive sides were very joyful as

well – it was a double-edged sword. That was

definitely a challenge.” (F)

“I notice that sometimes you go into a room with

somebody and you can almost smell or take on

board what it’s like to be them, and sometimes

you just wish you weren’t feeling it too much. It’s a

very intense way of working – particularly people

who work like I do, psychodynamically or

interpersonally. It’s very useful but also quite

taxing.” (I)

Challenges of Enhanced Attention and Awareness

Heightened sensitivity: “modulates” over time

Value of: support with practice; mindfulness-

informed supervision

Main Themes

Enhanced Attention and

Awareness

Therapist Qualities: Embodying

Mindfulness

Perspectives on Therapy

Mindfulness as Intervention

Benefits

Therapist Self-Care

Challenges

“Embodying Mindfulness”: Therapist Qualities

Qualities and attitudes associated with practice

e.g. compassion, non-judgment, equanimity (26)*

“Embodied” through deepening practice

Transfer to therapy work because:

“mindfulness influences me as a person.” (P)

*Figure refers to number of times theme was mentioned in qualitative

responses in postal survey (N =40)

“All these lovely notions of non-judgement and so

on! One of the hard things that I had to go

through was the level of judgements, self-

judgement. It’s much easier to understand Carl

Rogers now. I’ve known it in a head sense for a

long time, but now in a much deeper and more

embodied way. That fundamental change is

because I had to go through meeting that kind of

stuff within myself in the practice, meeting a lack

of compassion.” (K)

“Embodying Mindfulness”: Nonjudging

Quantitative data

Meditation experience FFMQ Nonjudging

FFMQ Nonjudging IRI Empathy (3 subscales)

Qualitative data

Ongoing integration of nonjudging at personal and

interpersonal levels

“Embodying Mindfulness”: Therapist Qualities

Transfer to therapy work – implicit in presence of

therapist

Therapist as “holding container” – “active

presence” (10)*

*Figure refers to number of times sub-theme was mentioned in qualitative

responses in postal survey (N =40)

“In deepening my practice I find that I can bring an

embodied sense of mindfulness into the subjective

and inter-subjective space – enabling a deeper

listening and holding container which in itself is

therapeutic for the client – enabling a felt sense of

safety, trust and compassion.” (N)

“It’s terrifying. I sit down on my cushion; I don’t know

what’s going to come up here! … I became very

familiar with the fact that no matter what I was

feeling it came and went, was very impermanent,

very much a thing. So I became less dazzled by

my own sordid psyche and, therefore, when I’m

sitting with someone else’s sordid psyche which is

haemorrhaging all over the place, I find it’s just the

heart bleeding. It may need to bleed … I’m

containing the space and keeping it safe.” (E)

Conclusions

Practical Implications

Personal and professional benefits for therapists

Enhances abilities (e.g. attention) and helps

internalise qualities (e.g. empathy) that contribute

to positive therapeutic relating

A resource in occupational health of therapists

Can present challenges – need for appropriate

support and supervision

Conclusions contd.

Methodological Issues

Selection bias and social desirability in

responses?

Value of flexible designs

Future Directions

Perspectives of clients and supervisors

Prospective designs and comparative analysis

Chart individual areas of influence over time

Mind and Heart in the Present Moment

“Mindfulness has enhanced my capacity to be present, to focus, to be still, to listen well, to be compassionate – to be in my heart while using my head”. (O)