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
40
35
30
25
N 20
15
10
5
th
.
re
a
at
in
g
E
og
a
Y
t
em
en
M
ov
S
pa
ce
ca
n
S
B
B
od
y
ki
ng
W
al
S
itt
i
ng
0
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
.60**
.11
.37*
-.34*
.52**
.46**
-.19
.11
-.53**
.17
.44**
-.12
.28
-.29
.28
.57**
.16
.26
-.33*
.48**
.57**
.04
.31
-.45**
.44*
FFMQ
Observe
FFMQ
Describe
FFMQ
Awareness
FFMQ
Nonjudge
FFMQ
Nonreactivity
*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
Benefits
Challenges
Therapist Qualities:
Embodying
Mindfulness
Perspectives on
Therapy
Therapist Self-Care
Mindfulness as
Intervention
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
cartographer.” (J)
much
more
sophisticated
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
awareness (11/12 interviewees)
self-
“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; mindfulnessinformed supervision
Main Themes
Enhanced
Attention and
Awareness
Benefits
Challenges
Therapist Qualities:
Embodying
Mindfulness
Perspectives on
Therapy
Therapist Self-Care
Mindfulness as
Intervention
“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, selfjudgement. 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)