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Melodie Frick PhD, LPC-S, NCC, ACS Yvette Castillo, PhD, LPC-S Maria Howell, MA November 13, 2009

Mindfulness Techniques for Counselors in Training: From Enhancing Counselor Efficacy to Connecting and Facilitating Change. Melodie Frick PhD, LPC-S, NCC, ACS Yvette Castillo, PhD, LPC-S Maria Howell, MA November 13, 2009 TCA Conference ~ Dallas, TX. Overview.

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Melodie Frick PhD, LPC-S, NCC, ACS Yvette Castillo, PhD, LPC-S Maria Howell, MA November 13, 2009

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  1. Mindfulness Techniques for Counselors in Training: From Enhancing Counselor Efficacy to Connecting and Facilitating Change Melodie Frick PhD, LPC-S, NCC, ACS Yvette Castillo, PhD, LPC-S Maria Howell, MA November 13, 2009 TCA Conference ~ Dallas, TX

  2. Overview Graduate practicum and internship students often complain of extreme anxiety that inhibits their ability to relax, stay in the moment, and be attuned to their client during counseling sessions. However, few counseling programs directly address the importance of specific mindfulness and focusing skills beneficial for the counseling process and outcome in their curricula. This presentation will examine core attitudinal qualities that underpin mindfulness practice, which are both the stance counselors bring to the practice and a consequence of it. Participants will explore and practice specific mindfulness techniques, and will be able to discuss their experience.

  3. Concept of Mindfulness In Buddhist tradition, mindfulnessis associated with specific methods of meditation and with the qualities of attention, recollection, care, compassion, and circumspection (Shapiro, Oman, Thoresen, Plante, & Flinders, 2008). In contemporary Western psychology, mindfulness is defined as the awareness that arises through intentionally attending to one’s moment-to-moment experience in a nonjudgmental and accepting way (Kabat-Zinn, 2005; Shapiro, Carlson, Astin, & Freedman, 2006).  

  4. Concept of Mindfulness continued In the literature, mindfulness has been referred to in several ways: as a psychological process, as a method or practice, and also as a skill that can be developed (Germer, 2005; Kabat-Zinn, 2005). Mindfulness approaches are not considered relaxation or mood management techniques,but rather a form of mental training to reduce cognitive vulnerability to reactive modes of mind (Shapiro et al., 2008).

  5. Mindlessness Negative automatic thoughts and faulty beliefs present themselves as mindless traps. Relying on assumptions made in the past and not taking the actual situation in consideration (Langer, 2005). Mindlessness is focused attention on contextual cues that “trigger various scripts, labels and expectations, which in turn focus attention on certain information while diverting attention away from other information” (Nass & Moon, 2000).  

  6. Mindfulness Operational Definitions Currently, there is considerable variation in the ascribed meaning and operationalization of mindfulness, not only between the ‘‘classical’’ (Buddhist) and clinical perspectives (Lutz, Greishar, Rawlings, Richard, & Davidson, 2007)but also between different clinical mindfulness researchers. Shapiro’s 3 components of operational definition for mindfulness: Intention - involves knowing why one is paying attention, motivation, and a conscious direction and purpose. Attention - involves the direct, moment-to-moment knowing of what is happening as it is actually happening. The mind is trained to focus, aim, and sustain attention. Attitude - describes how one pays attention, and refers to the accepting, caring, and discerning qualities of mindfulness (Shapiro et al., 2006). Kabat-Zinn considers that attitude is a very important component of mindfulness. He calls mindfulness ‘‘affectionate attention’’ (as cited in Cullen, 2006).

  7. Research Findings Long-term mental practice such as meditation can induce lasting, trait-level changes mediated by structural modifications to the brain(Begley, 2007). Mindfulness-based interventions can increase measured levels of one or more dimensions of mindfulness. Participation in an MBSR intervention was associated with significantly increased mindfulness in nurses and counseling psychology students (Shapiro, Brown, & Biegel, 2007). Trait measures of mindfulness are correlated with a variety of cognitive and affective indicators of mental health, including lower levels of emotional disturbance and higher levels of well-being (Brown & Ryan, 2003).

  8. Research Findingscontinued   Research studies show that the benefits of the mindfulness training include: enhanced levels of mindfulness, reduced reflective rumination, reduced negative affect, improvement of executive cognitive function, working memory capacity enhancement, slower reaction times (RTs) in the affective condition, improved capacity for sustained attention and attention-switching, improved self-regulation and affect (Chambers, Lo, & Allen, 2008). 

  9. Cultivation of Mindfulness Mindfulness practice aims at becoming consciously aware of thoughts as they come and go, at being receptive to all stimulation that may arise(Kostanski & Hassed, 2008). Mindfulness is a process that is taught, that ideally may become a lifelong practiceand a process that remains within the power of the individual to initiate and utilize(Kostanski & Hassed).

  10. Process of Mindfulness Meditation Resting attention on current experience with an accepting and open attitude; Catching/noticing when attention is narrowed to consuming thoughts (e.g., noticing rumination about personal financial problems); Remembering to reorient attention;

  11. Process of Mindfulness continued 4. Reorienting or “switching” attention to current experience without judgment of the previous distraction; 5. Sometimes another step is added, which is labeling, noting or naming the mental state (e.g., fantasy) prior to reorienting the mind (Bishop, Lau, Shapiro, Carlson, Anderson, Carmody, Segal, Abbey, Speca, Velting, & Devins, 2004).

  12. Therapeutic Applications of Mindfulness Mindfulness-Based Stress Reduction [MBSR] Dr. Kabat-Zinn developed the MBSR program over a ten year period with over four thousand patients at the University of Massachusetts Medical Center (Kabat-Zinn, 1990): "This 'work' (MBSR) involves above all the regular, disciplined practice of moment-to-moment awareness or mindfulness, the complete 'owning' of each moment of your experience, good, bad, or ugly. This is the essence of full catastrophe living." (Kabat-Zinn, 1990) MBSR is now used widely to reduce psychological morbidity associated with chronic illnesses and as a treatment for emotional and behavioral disorders (Kabat-Zinn, 1990). Dr. Jon Kabat-Zinn

  13. Mindfulness skills are central to Dialectical Behavior Therapy [DBT]. The skills are psychological and behavioral versions of mindfulness meditation practices (Linehan, 1993). Acceptance and Commitment Therapy [ACT] takes much the same approach, using acceptance, cognitive defusion, and attention to present experience from the point of view of ‘‘self-as-context’’ (Hayes, 1994). Mindfulness Based Cognitive Therapy [MBCT]combines training in mindfulness meditation with cognitive therapy (Segal, Williams, & Teasdale, 2002). A large multi-site randomized controlled trial has shown that this combined approach can significantly reduce the rate of relapse in recurrent major depression (Teasdale, Segal, Williams, Ridgeway, Soulsby, & Lau, 2000). Therapeutic Applications of Mindfulness

  14. Attitudinal Foundations of MBSR Practice Non-judging.We adopt a stance of impartial witness to our experiences. The habit of judging ourselves and others locks us into automatic responses. We become aware of automatic judgements and intentionally take the stance of an objective observer. 2. Patience.We develop patience as a form of wisdom by understanding and accepting that things need to happen in its own time. 3. Beginners’ Mind.We are willing to see everything for the first time, free ourselves from any expectations, be open to new possibilities, get out of automatic pilot, and just enjoy the moment.

  15. Attitudinal Foundations of MBSR Practice continued Trust.By doing mindfulness we develop a basic trust in ourselves, our feelings, and our bodies. When something doesn’t feel right - it is useful to take a moment and explore this warning. The more we develop trust in ourselves, the more we’ll be able to develop trust in other people. Non-striving.We simply allow the present to be as it is by paying attention to what is happening now. 6. Acceptance.We see things as they actually are. It does not mean that everything will be a positive experience. We just have a willingness to see things as they are.

  16. Attitudinal Foundations of MBSR Practice continued Letting go.We intentionally put aside the tendency to elevate some parts of our experience and to reject others. We cultivate attitude of non-attachment. We acknowledge and are aware of whatever arises and passes through without getting entangled in it. Mindfulness practicerequires one’s commitment and willingness to practice on a daily basisin any circumstances. Meditation practice becomes an integral part of our lives and of our own growth as people (Kabat-Zinn, 1990).

  17. MBSR Program Practices Yoga Meditation Mindful Sitting Meditation Body Scan Meditation Walking Mindful Meditation Guided Loving-kindness Meditation Mindfulness in Daily Life

  18. Psychological Processes Underlying Mindfulness Mindfulness practice causes reduced reactivity to negative emotional states allowing exposure to thoughts and emotions that would otherwise engender cognitive defenses (Kabat-Zinn, 1982, 1990; Baer, 2003). Mindfulness practice makes the person have contact with the present moment. Contact with the present moment is non-judgmental and is accompanied by description of thoughts, feelings, and other private events as they occur (Hayes & Plumb, 2007).

  19. Psychological Processes Underlying Mindfulness continued Mindfulness practice as the contact with the present moment may be further explained by the “Self as Context” perspective. Self as Context refers to the transcendent sense of self, or a stance from which one can be aware of ones own flow of experiences without attachment to them or an investment in which particular experiences occur. Self as Context canalso be referred to as theObserver Self. The ability to recognize and describe private experiences is the ability to recognize a “self” that is separate from (not entangled with) one’s private experiences (Hayes & Plumb, 2007).

  20. Psychological Processes Underlying Mindfulness continued Mindfulness practice strengthens attentional control, makes sustained attention longer and improves attention switching (Garavan,1998; Sarter, Givens, & Bruno, 2001). Mindfulness practice directs effort toward increasing awareness and attention, and developing some control and choice to keep the attention where it is or redirect it to some other available object. Acknowledging rather than evaluating thought processes blocks the usual cognitive defences. This results in an increased cognitive flexibility(Hayes, 2003).

  21. The redirection of attention also means less emotional reactivity to the symptoms in the midst of other activities, and a greater sense of control and confidence in dealing with distress (Carmody, 2009). Mindfulness training has the unique additional feature of encouraging participants to learn to broaden the attentional focus(Carmody, 2009). Psychological Processes Underlying Mindfulness continued

  22. Psychological Processes Underlying Mindfulness continued Mindfulness process distances us from our problematic thoughts and emotions, allowing us to address them consciously rather than merely reacting to them (Bishop et al., 2004; Hayes & Plumb, 2007). It is an attentional perceptualshift from the content of the thought toward the thought which is an “event” occurring in the mind. This shift contributes to the reduction of arousal levels and accompanying increased sense of well-being (Carmody, 2009).

  23. Psychological Processes Underlying Mindfulness continued Mindfulness is facilitating the process of recognition of where attention is focused at any given moment, recognition that it can be intentionally directed, and recognition that arousal and well-being are related to the affective quality of the object of attention. Recognition also extends to the components (thoughts, feelings, and sensations) and to the way they associate making up internal experience. Such recognition can be felt as clear seeing. With repeated experience, the mindfulness practitioner begins to recognize their habits of attention.

  24. Psychological Processes Underlying Mindfulness continued This recognition results in attentional resources being less automatically hooked by particular thoughts, feelings, or sensations and their associated cycles. Attention is thus more available to the wider landscape of experience that would otherwise be missed. Repeated practice results in this process becoming the practitioner’s more usual internal experience (Carmody, 2009). Mindfulness practices result in reduced rumination and increased openness to current experience(Teasdale, Segal, & Williams, 2003).

  25. Counselors’ Use of Mindfulness Mindfulness may change counselors’ behaviors, attitudes, and qualities of consciousness important to the therapeutic relationship (Crane & Elias, 2006; Stanley, Reitzel, Wingate, Cukrowicz, Lima, & Joiner Jr., 2006). Counselor’s practice of mindfulness will foster their • increased attention, • acceptance, • non-avoidance of experience, • empathy, • therapeutic alliance, • and meta-cognitive awareness (Stauffer, 2008).

  26. Counselors’ Use of Mindfulness Improves Attention Regulation Through mindfulness practice counselors in training learn how to return attention to the therapeutic relationship and client concerns. They can better focus on the needs of their clients. Ongoing practice of mindfulnessmay be a critical tool for counselors to sharpen their ability to be attentive (Stauffer, 2008). Decreases Emotional Reactivity Mindfulness is a way to decrease emotional reactivity and increase recovery time after emotional reaction(Hayes & Shenk, 2004).

  27. Counselors’ Use of Mindfulness Facing Difficult Experiences vs. Avoiding Mindfulness reduces experiential avoidance with clients (Dalrymple, 2006). Exposure to trauma, stress and burnout can impact attention to and acceptance of clients and clinical experience. Research shows that counselors who are able to work through traumatic events have less compassion fatigue, burnout and distress(Deighton, Gurris, & Traue, 2007).

  28. Counselors’ Use of Mindfulness & Empathy Counselors who grow in mindful awareness of their own struggles in life and mental processes, can more readily identify with and understand the same in their clients (Morgan & Morgan, 2005). Mindfulness decreases self-focused and self-related behaviors and cognitions. It allows counselors to be more present and in a more empathic mode (Stauffer, 2008). Mindfulness may allow counselors and psychotherapists to have greater familiarity with the internal sensations involved in empathy (Ryback, 2006).

  29. Counselors’ Use of Mindfulness & Metacognitive Awareness Metacognitive awareness encourages flexibility of perception and suspension of judgment which are vital aspects of counseling. Counselors increase their ability to get to know and understand the internal landscape (e.g., thoughts, emotions, behaviors) (Hamilton, Kitzman, & Guyotte, 2006). Counselors are able to understand client mental states due to greater access to their own thoughts and subsequent self-knowledge (Morgan & Morgan, 2005).

  30. Conclusion Mindfulness is a path to counselors’ competency. Mindfulness is a powerful strategy for counselors to improve attitudes, behaviors and qualities of mind, essential factors in counseling. Mindfulness training holds both personal and professional benefits for counselors. Practice in counseling courses; demonstrate mindfulness with counselors-in-training Practice in supervision; demonstrate mindfulness with supervisees

  31. Future Research Develop a multidimensional measure of mindfulness, which captures its broad definition (e.g., attitudinal qualities of acceptance and compassion) (Shapiro, et al., 2008). Evaluate pre/post counseling sessions; day of work Examine relationship/effectiveness in reducing/preventing counselor burnout

  32. Contact Information Melodie Frick PhD, LPC-S, NCC, ACS West Texas A&M University 806-651-8234 (office) mfrick@wtamu.edu Yvette Castillo PhD, LPC-S West Texas A&M University 806-651-8233 (office) ycastillo@wtamu.edu Maria Howell MA Oklahoma State University 580- 761-3260 (cell) maria.howell@okstate.edu

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  34. References Chambers, R., Lo, B. C., Allen, N.B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive Therapy and Research,32(3), 303-322. Crane, R., & Elias, D. (2006). Being with what is. Therapy Today,17(10), 31-33. Cullen, M. (2006). Mindfulness: The heart of Buddhist meditation? Inquiring Mind, 22, 28-29. Dalrymple, K. L. (2006). Acceptance and commitment therapy for generalized social anxiety disorder: A pilot study. Dissertation Abstracts International, 66(11), 6267B. Deighton, R. M., Gurris, N., Traue, H. (2007). Factors affecting burnout and compassion fatigue. Journal of Traumatic Stress,20(1), 63-75.

  35. References Garavan, H. (1998). Serial attention within working memory. Memory and Cognition,26(2), 263–276. Germer, C. K. (2005). Teaching mindfulness in therapy. In Germer, C. K., Siegle, R. D., Fulton, P. R. (Eds.), Mindfulness and psychotherapy (pp. 113-129). New York: Guilford Press. Hamilton, N. A., Kitzman, H., & Guyotte, S. (2006). Enhancing health and emotion: Mindfulness as a missing link between cognitive therapy and positive psychology. Journal of Cognitive Psychotherapy,20(2), 123-134. Hayes, S. (1994). Context, contents and the type of psychological acceptance. In Hayes, S., Jacobson, N., Follette, V., & Dougher, M. (Eds.), Acceptance and change: Content and context in psychotherapy (pp. 13-23). Reno, NV: Context Press. Hayes, S. (2003). Mindfulness: Method and process. Clinical Psychology: Science and Practice,10(2), 161–165.

  36. References Hayes, S., & Shenk, C. (2004). Operationalizing mindfulness without unnecessary attachments. Clinical Psychology: Science & Practice,11(3), 249-254. Hayes, S. C., Plumb, J.C. (2007). Mindfulness from the bottom up: Providing an inductive framework for understanding mindfulness processes and their application to human suffering. Psychological Inquiry, 18(4), 242-248. Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation. General Hospital Psychiatry, 4, 33–47. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. NY: Dell Publishing. Kabat-Zinn, J. (2005). Coming to our senses: Mindfulness. NY: Hyperion. Kostanski, M., & Hassed, C. (2008). Mindfulness as a concept and a process. Australian Psychologist,43(1), 15-21.

  37. References Langer, E. (2005). More Tools for Breaking Free – First aid for OCD. In Hymann, B. M., Pedrick, C. (Eds.), The OCD workbook: Your guide to breaking free from Obsessive Compulsive Disorder (2nd ed.)(pp. 117-122). Oakland, CA: New Harbinger Publications. Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: Guilford Press. Lutz, A., Greishar, L., Rawlings, N., Richard, M., & Davidson, R. (2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proceedings of the National Academy of Sciences,USA, 101, 16369-73. Morgan, W. D., & Morgan, S. T., (2005). Cultivating attention and empathy. In Germer, C. K., Siegle, R. D., Fulton, P. R. (Eds.), Mindfulness and psychotherapy (pp.73-90). New York: Guilford Press. Nass, C., & Moon, Y. (2000). Machines and mindlessness: Social responses to computers. Journal of Social Issues,56(1), 81-103.

  38. References Ryback, D. (2006). Self-determination and the neurology of mindfulness. Journal of Humanistic Psychology,46(4), 474-493. Sarter, M., Givens, B., & Bruno, J. P. (2001). The cognitive neuroscience of sustained attention: where top-down meets bottom-up. Brain Research Reviews, 35, 146–160. Segal, Z. V, Williams, J. M. G., Teasdale, J. D. (2002). Mindfulness- based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press. Shapiro, S. L., Brown, K. W., Biegel, G. M. (2007). Teaching self-care to caregivers: The effects of Mindfulness-Based Stress Reduction on the mental health of therapists in training. Training and Education in Professional Psychology, 1, 105-115. Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373–386.

  39. References Shapiro, S. L., Oman, D., Thoresen, C. E, Plante, T. G., Flinders, T. (2008). Cultivating mindfulness: Effects on well-being. Journal of Clinical Psychology,64(7), 840-862. Stanley, S., Reitzel, L. R., Wingate, L. R., Cukrowicz, K. C., Lima, E. N., & Joiner Jr., T.E. (2006). Mindfulness: A primrose path for therapists using manualized treatments? Journal of Cognitive Psychotherapy,20(3), 327-335. Stauffer, M. (2008). Mindfulness in counseling and psychotherapy: A literature review and quantitative investigation of mindfulness competencies (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3295653) Teasdale, J. D., Segal, Z., & Williams, J. M. (2003). Mindfulness training and problem formulation. Clinical Psychology: Science and Practice,10(2), 157–160. Teasdale, J., Segal, Z., Williams, J., Ridgeway, V., Soulsby, J., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615-623.

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