Bit of a different post this week - this is the first essay I submitted for my Counselling and Psychotherapy Practice MA at BSU. Some may find it useful. It includes some ideas of how to integrate mindfulness into counselling.
Using Mindfulness and Meditation in Counselling
Introduction and rationale
Secular meditation and mindfulness practices are currently enjoying a high level of popularity in western cultures, figures from 2018 suggest that 15% of adults in Britain have learned to practice mindfulness (Simonsson, Fisher, & Martin 2021) and 14.2 percent of American adults say they have meditated within the past year, which is a threefold increase from the 4.1 percent identified in a similar study in 2012 (Clarke T. et al, 2018). The precise reasons for this current popularity aren’t clear but it is likely to be due to a number of factors surrounding the increased monetisation of these practices including the development and take up of mindfulness apps such as Headspace, which on its own currently has in the region of two million paying subscribers (Curry, 2020).
Although I strongly believe that mindfulness and meditation are two distinct practices in the meaning they have for the practitioner, the fact that the overwhelming number of studies don’t draw any distinction between them means that it is easy to get caught in semantics without furthering understanding of the issue. To that end, unless noted otherwise, I will adopt a convention, utilised by some other researchers, and refer to mindfulness and meditation together using the acronym MM – for mindfulness meditation. Hopefully this will aid in providing a degree of clarity to the essay whilst at the same time preserving my word count.
Whatever the reasons for this increasingly widespread use of MM it is a commonly accepted view that the systematic use of mindfulness in medicine initially, and then counselling and psychotherapy, started with Jon Kabat-Zinn who started a Mindfulness Based Stress Reduction (MBSR) program to help with medical patients suffering from chronic pain in the US in 1979 (Bodhi, 2011; Sykes, 2015). Kabat-Zinn designed what was then a 10-week program (and what is now 8 weeks long) full of weekly classes, yoga and guided home meditations, based on his own practices and experiences of Eastern philosophies that he was able to ‘prescribe’ to patients at the medical centre where he worked, patients who had been previously identified as being unresponsive to medical interventions by their doctors (Sykes, 2015). This early program appears to have been largely psycho-educational and directive, and the pathological nature of the first patients suggests that one of the goals of Kabat-Zinn's program appears to have been the development of the patient’s acceptance of their condition.
What then is MM? Many attempts have been made to define a definition; Walsh and Shapiro (2006) examined themes contained within these definitions and concluded that meditation was ‘a family of self-regulation practices that focus on training attention and awareness in order to bring mental processes under greater voluntary control and thereby foster general mental well-being and development and/or specific capacities such as calm, clarity, and concentration’. Although this definition doesn’t cater for moving meditation or vipassana (insight meditation) practices found in yoga and tai-chi for example, it strongly resonates with my own personal experience of meditation and accurately describes the sort of MM practices that are experienced in counselling sessions. Mindfulness is a by-product of meditation, in that it may be experienced either as a by-product of a meditative experience or as a goal of certain meditation practices and Kabat-Zinn (2003) has described it as ‘the awareness that emerges through paying attention on purpose’. Whereas meditation can be an intensely formal process as seen in the Zen Buddhist practice for example, mindfulness can be far more 'portable’ and be engaged in wherever the practitioner is with no special equipment or space, and has been simply described as a ‘moment by moment awareness’ (Germer et.al. 2005, cited in Davis and Hayes, 2011).
Among some of the claimed benefits of MM are helping practitioners to manage chronic pain (Kabat-Zinn, 2003), stress reduction and managing unhelpful thought patterns (Vadivale and Sathiyaseelan, 2019). Mindfulness based therapies can also assist with client issues that may be considered purely physiological issues such as diabetes, schizophrenia as well as those problems which affect the physiological and psychological such as eating related disorders and substance use behaviours. (Lee, 2019; Li et. Al., 2017; Fox et al., 2014; Gotink et al., 2016 cited in Fattahi et al., 2021).
I am a very recently qualified person-centred, integrative counsellor utilising Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), psychodynamic therapy and Transactional Analysis from my strong, person-centred core. At time of writing, any description of my practice and clients will refer not only to my private practice but also to my placement, which was a counselling centre offering ‘general’ and specialised counselling services including low-cost sessions with student counsellors, and the clients allocated to me therefrom and this is relevant when discussing issues surrounding integration of MM into my client work in the ‘Reflection’ section below.
My interest in meditation and mindfulness predates my qualification as a counsellor by ten years after I began to explore Buddhism whilst encountering it travelling in the far east. It was actually this exploration that set-in motion a chain of events that eventually led to my qualification as a counsellor. I have a regular meditation practice involving mindfulness of breathing (Anapanasati) and loving kindness (Metta Bhavana) meditations as well as mindfulness practices. I consider myself a ‘secular Buddhist’, in that my practice is part of my own personal philosophy rather than a theistic religion, I don’t mention Buddhism in either the advertising for my practice or during client sessions.
I have undertaken training courses in how to teach meditation but this was for my own personal development rather than a formal therapeutic CPD and other than during a brief training session on ACT, I haven’t received a specific input on integrating MM into a session with a client.
There are different ways a therapist can introduce MM into a session with a client. They can recommend attending a formal meditation class, or lead the client through a guided meditation during the session. They may provide psycho education on mindful grounding techniques to assist in dealing with panic attacks. I believe that all are potentially beneficial for the client.
The aim of this research is to answer the question ‘what are the implications to offering MM to clients within a psychotherapeutic setting?’ I don’t believe MM is a ‘static’ option in the same way that say, giving a client a worksheet could be and that means that there are potential implications in offering it to clients. Running alongside this question I want to discover whether I am suitably experienced to introduce MM concepts and practices into sessions with clients – or are the dominant MM methodologies (MBSR and its offshoots) the only background that a MM psychotherapist can practically and ethically have.
Answers to these questions will directly influence whether I use MM techniques in my practice.
Throughout this essay I use the terms counsellor and psychotherapist interchangeably but this could also include any other term for a therapist who provides talking therapy.
In 1990, some 11 years after Kabat-Zinn’s trial of using MM in a medical setting began, there were a grand total of 12 articles written about the use of MM in medical treatment, five of which had been written by Kabat-Zinn himself (Sykes, 2015). This suggests the trial was not only not attracting any academic reviewers, it wasn’t enticing other researchers to replicate the study. A bibliographic analysis undertaken by Baminiwatta & Solangaarachchi (2021) revealed that from 1966 to 2021, there were 16,581 publications referring to mindfulness in the title, abstract, or keywords. Two thirds of all publications were produced from 2016-2021 and there were 2808 publications in 2020. We can see then that not only is there now a large body of academic work on the subject, it has also increased exponentially since 2006 and is showing no signs of slowing. At the same time this body of literature increased ‘the ratio of literature on Buddhism to that on mindfulness flipped from 4.6:1 before 2008 to 1:1.8 over the following 5 years, and the meditation-to-mindfulness publication ratio dropped from 12.9:1 in 1993–1997 to approximately 1:1 around 2010’ (Valerio, 2016 cited in Baminiwatta and Solangaarachchi, 2021). Valerio goes on to describe this as being evidence that Buddhism has become ‘disembedded’ from the creation of mindfulness. The academic landscape I enter in the search for answers to my research questions about MM therefore is one of increasing popularity, increasing secularity and one where positivism appears to be the dominant methodology.
MM, development of counselling attributes and the therapeutic alliance.
A number of studies have been conducted into the effect of training in MM on trainee counsellors. These have looked at how these therapists’ counselling skills, when given their own MM programs, have influenced their work with clients.
Shapiro et. al (2007) recruited a number of counselling students from a master’s course in the US and allocated them to either a Kabat-Zinn MBSR course or a ‘control’ course of the same duration before measuring the respondents self-report responses on a number of different topics. Perhaps unsurprisingly given the number of other studies that have confirmed the reported benefits of MBSR, it was found that the MBSR group reported the improvement of their mental health, decline in stress and anxiety and an increase in self-compassion. This last benefit is seen as particularly important in this study as ‘compassion for self, as well as for clients, has been posited as an essential part of conducting effective therapy’ (Gilbert, 2006 as cited in Shapiro et. al, 2007). This study involved a relatively small group of 54 respondents across all groups who were overwhelmingly white (77%) and female (89%) which calls into question the applicability of the results and I wonder if the size of the group could have led the researchers to consider carrying out interviews of a smaller sample to gain a deeper understanding of the students’ experiences.
Schure et. al. (2008) carried out a qualitative study over 4 years with counselling students who took part in a 15-week mindfulness program based on and therefore similar to MBSR. At the conclusion of the 15 weeks study the students completed a completely open-ended questionnaire which was then examined for common themes by the researchers. There were 35 respondents of which 77% were female and 85% were white. Some of the themes identified were increased awareness, acceptance of emotions and personal issues, increased mental clarity and increased tolerance of physical and emotional pain. I felt the following two comments from participants in this study really spoke of the therapeutic relationship and the benefits a MM practice could have on it.
‘I am more in-tune with myself…I believe this directly impacts the sense of trust and connection with clients and serves as a model to them’
‘I think that being mindful and more “centered” allows me to look outside of myself more, and observe my clients and my relationship with them more’
Both of these comments speak of benefitting the very core of the therapeutic alliance, what Gelso (2011) calls the ‘real relationship - with its twin components of genuineness (the intent to avoid deception, including self-deception) and realism (perceiving or experiencing the other in ways that befit the other)’. These statements also evidence Roger’s (1957) core conditions, specifically the empathetic connection or relationship between the counsellor and client that he argued was one of the conditions necessary for therapeutic change. Having looked at the effect of standard MM practices on the therapeutic relationship I will now look at what it might look like to have a specific MM practice specially tailored for counsellors.
Interpersonal Mindfulness; For Counsellors
McDonald and Muran (2021) looked at various barriers and benefits to positive therapeutic outcomes for clients. Ruptures, tensions or breakdowns in the therapeutic relationship (Safran, Muran, & Eubanks-Carter, 2011, p. 224 cited in McDonald and Muran, 2021), counsellor empathy, (Elliott, Bohart, Watson, & Murphy, 2019 cited in McDonald and Muran, 2021) and ‘subtly hostile therapist reactions to difficult client communications’ were just some of the factors involved in what they termed ‘interpersonal reactivity’, aspects that could positively or negatively affect the relationship and therefore the outcome. They argued that ‘it makes sense for therapists to cultivate mindfulness both as a pathway to increased therapeutic presence and as a basis for mindfulness in interaction and metacommunication’ and they propose that a specific mindfulness practice (Mindfulness Based Cognitive Therapy (MBCT) – a therapy based on MBSR but specifically adapted for therapists) is taught to trainee counsellors to negate the negative aspects or barriers to interpersonal reactivity and promote and improve the positive this they concluded, is ‘likely to improve their effectiveness as therapists’. In their rationale for the use of MBCT as opposed to MBSR (the two therapies are very similar; the former was developed from the latter and they are both 8 week programs teaching a smorgasbord of different mindfulness practices including different moving meditational exercises) the authors explain that one of them is already an MBSR therapist.
Rather than use MBSR as it comes ‘out of the box’, the authors suggest customising it to fulfil the very specific needs of trainee counsellors. ‘Basic’ mindfulness practice is enhanced by applying the skills gained from mindfulness to ‘interpersonal situations’ or client therapist interactions. This not only develops self-awareness, one of the ‘standard’ benefits of a MM practice, it also gives the students particular skills to learn how to more effectively regulate themselves and their responses to potentially challenging client situations. They also suggest adding a ‘befriending practice’ to the program, which would assist students to develop compassion and sensitivity in the counselling room thereby allowing them to better deal with challenging client communications so as to avoid ruptures in the therapeutic relationship.
McDonald and Muran argue that one of the essential criteria for a specific psychotherapists' mindfulness-based therapy program to be taught to students is that it has its basis in Buddhist philosophy, the context in which MM came into being and this confirms Kabat-Zinn’s (2003) warning against oversimplification and decontextualization in the critical analysis section below. Kabat-Zinn (2011) later explained why, during the development of MBSR he ‘bent over backwards’ to remove the original language of Buddhist teachings so as to avoid the program being seen as either Buddhist or ‘mystical’. It seems then, that establishing distance from the origins of mindfulness and meditation, which was one of the factors that led to the eventual popularity of MBSR and in turn MM practices as medical or psychological interventions, were later seen as holding the practices back or lessening their efficacy. I will look at what it means to reintroduce this context in the form of ‘intention’ next.
According to Shapiro et al. (2006) ‘When Western psychology attempted to extract the essence of mindfulness practice from its original religious/cultural roots, we lost, to some extent, the aspect of intention, which for Buddhism was enlightenment and compassion for all beings’. Shapiro (1992 cited in Shapiro et al. 2006) demonstrated the importance of intention in meditation practice and how outcomes were linked to intention by showing that meditators whose goal was self-regulation attained self-regulation and those whose goal was self-exploration attained self-exploration. ‘The inclusion of intention (i.e., why one is practicing) as a central component of mindfulness is crucial to understanding the process as a whole, and often overlooked in other contemporary definitions.’ (Bishop et al. 2004 cited in Shapiro et al. 2006). Shapiro’s notion of intention appears to be identical to Kabat-Zinn’s ‘context’ and Valerio’s embeddedness, specifically that mindfulness, rather than being an individualistic self-help tool, is a practice that was intended to develop universal compassion from which the individual also benefitted. The reflections of the two students in Schure et. al. (2008), detailed above, hint at this context of MM, universal compassion, but then one could argue that this is to be expected from counsellors who are trained to value a therapeutic alliance.
It has been argued that the theory of ‘relational mindfulness’ may assist in recontextualising MM by highlighting the interpersonal areas of a therapists existing practice. ‘The emerging concept of “relational mindfulness” focuses attention on the often-neglected interpersonal aspects of mindfulness practices. Relational mindfulness focuses not on the individual practices found in most mindfulness-based therapies and traditional meditation techniques, but rather on mindfulness practiced in relationship to other people’ (Konichezky et al., 2022). In this study Konichezky et al. carried out a qualitative thematic analysis on interviews with psychotherapists who have already received formal training in therapeutic MM practices who all have, to varying degrees, a personal MM practice. Of the eight therapists recruited, seven identified as behavioural therapists (CBT/ DBT/ ACT) or psychodynamic therapists or a combination of the two; the eighth was a process work therapist, a humanist school. Seven of the respondents’ MM training was in MBSR, and it’s possible that there is a relationship between behavioural modalities and MBSR which has its roots in the medical model which may attract behavioural therapists and be off-putting to humanist practitioners. That said, the language used by therapists during their interviews speaks very much of the more person-centred practitioner:
‘I sit with my patients and meditate with them. When I first started to use mindfulness I did not practice with my patients. I used to sit and watch them but gradually I started to join them. When I meditate with them I feel a special connection’
The authors conclude that ‘It seems that the mutual practicing of mindfulness generates an experiential field that strengthens the bond between therapist and patient due to an intimate experience that generates a bond of trust and understanding. This in turn enables the therapist to be more receptive and focused on the nuances of the patient’s body and mind thus enabling more empathy and understanding’.
There appears to be very little research that is critical of the use of MM in a therapeutic setting, in fact there is very little that criticises the use of MM at all. There may be some disagreement about how far the beneficial aspects of having a MM practice reach, exactly what it can help with, but that seems to be as far as it goes in terms of therapy. I have also touched on the decontextualization of MM as a potential criticism, but this is a comment on efficacy and how it is believed by some writers that it can be improved by attempting to re-establish its roots, rather than a direct criticism of MM.
Criticisms have been levelled at mindfulness and how it is currently conceptualised and used ontologically. Some political theorists and sociologists have suggested that mindfulness is the new ‘opium of the masses’ (Dawson G., Turnbull L. 2006, cited in Carvalho, 2021), and this, perhaps, has implications for how psychotherapists should be working with MM as much as therapeutic considerations do.
Purser and Loy (2013) described the monetisation and appropriation of mindfulness by corporations, and it’s repackaging as a quick and easy ‘fix’ for Western consumers, a process that some researchers call ‘McMindfulness’ in reference to the fast-food giant, McDonalds, who did a similar thing with food. They go further and describe a situation where MM is actually subverted by big business; ‘corporations have jumped on the mindfulness bandwagon because it conveniently shifts the burden onto the individual employee: stress is framed as a personal problem, and mindfulness is offered as just the right medicine’.
Carvalho (2021) looked at what he calls the ‘political ontological’, aspect of MM trying to bridge the gap’’ between the humanist view of MM, which focusses on the experience of the meditator and the benefits that MM may have given them and the socio-political view of MM as described by Purser and Loy above. Carvalho carries out his study using participant observation and semi-structured interview. He concluded that the two particular forms of meditation tht he was studying ‘lean towards versions of subjectivity that contrast with the paradigmatic modern self, often challenging dualist distinctions between subjects and environments, enacting porous and impermanent bodies and allowing meditators to de-identify with a stable sense of self’. The full implications of this statement will be examined in the critical analysis section below but what seems immediately apparent is the transformative nature of MM practice, not just to improve a particular psychological difficulty, but also, according to this study, of the self. The author doesn’t discuss the implications of losing this stability of self.
The point of this essay is to view my chosen subject, the application of mindfulness and meditation and associated implications in client work, through the lens of my practice. As this is a piece of academic writing, I will be using various structures to assist in providing some degree of academic rigour to my work.
The first structure supports my attempt to work with sufficient academic rigour to fulfil the requirements of a Level 7 course, and that is to identify and fulfil criteria lying within the various definitions of what constitutes research. Research is systematic (Kerlinger, 1970; Stehnhouse, 1975; Bassey, 1990; McLeod, 2003) – that is, it is organised in relation to a particular system suggesting that once a particular ontology, a branch of philosophy that looks at the nature of reality (Ontology - research-methodology (no date)) has been decided on - the next steps will (or certainly should) follow logically and automatically. Research should be critical (Kerlinger, 1970; Bassey, 1990; McLeod, 2003) which highlights the importance of the evaluative element in research. The results of the research should be shared or made public in order that it may advance knowledge of the topic (Stehnhouse, 1975; Bassey, 1990; McLeod, 2003).
The research philosophy I will be following in order to satisfy the above features is one of ontological relativism, which reflects my firm belief that truth is not absolute, in fact it is dependent on time, society and a host of other fluid factors (Baghramian and Carter, 2020) and epistemological subjectivism which argues that truth is internal and therefore dependent on the relationship between the individual and the object (Mills et. al, 2010) . These factors reflect my position as a person-centred and phenomenological practitioner.
I will now discuss methodologies that can be used by reflexive practitioners and highlight the one I have selected to use for my critical analysis.
What then is researcher reflexivity? Also known as ‘critical reflexivity’ or ‘critical subjectivity’, this ‘reflexivity may represent a means of constructing a bridge between research and practice’ (Etherington 2000; Heron 1996; Reason 1994 cited in Etherington 2004). Dewey (1910) introduced the term ‘reflective practice’ and defined it as ‘the active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it’ - Dewey then believed that reflection is an active process, it is considered and focussed on the particular question or experience the person is engaging with. He proposed a set of stages which set out a process whereby the individual progressed from a state where their mind flits between possible solutions to recognising and formalising the experience into a problem to be solved, to identifying suggestions to deal with the problem and gathering evidence to assist with this, to finally testing these suggestions or hypotheses, which can also be done through mental experimentation.
Donald Schon (1983) describes how a reflexive methodology is a form of research; in reflecting on his reaction to a novel situation, whether that be surprise, confusion or puzzlement he combines the results of this reflection with previous experience to ‘generate a new understanding’. Schon describes this process as carrying out an experiment.
Kolb (1984) developed Dewey’s model and Schon’s study further and proposed a four-stage experiential learning cycle which involves the learner moving through all the stages in one direction.
1. Concrete Experience - The learner encounters the subject of their proposed reflexivity. This can be either as the result of a new experience, and therefore the entry point into this cycle, or as the result of stage 4, the active experimentation stage.
2. Reflective Observation of the New Experience - the learner reflects on the new experience in the light of their existing knowledge. Focus is placed on any aspects of the new experience which challenge the existing knowledge.
3. Abstract Conceptualization - Having reflected, the learner conceives of a new idea or modifies an existing one.
4. Active Experimentation - this newly conceived of or modified idea or hypothesis is then tested through a process of experimentation in the real world and the resultant findings are fed back into the cycle at stage 1. (McLeod, 2017)
The main difference between this model and Dewey’s seems to be that the cyclical nature of Kolb means that it is a closed system, the result of the ‘active experimentation’ stage feeds naturally in the ‘concrete experience’ stage. Kolb directly references Schon’s notion of experimentation in stage 4, the reflexive learner is a scientist, evaluating what they have learned by applying it to real life situations.
One of the strengths of this model is its simplicity and how it can be easily visualised. It is also proposes a model of universal applicability; identifying one truth that it argues can be applied to every reflexive learner, but this is also clearly a weakness as a relativist/ phenomenological viewpoint would argue that every person would reflect, and learn from that reflection, differently.
Honey and Mumford (1992) developed Kolb’s model for use with management trainees and associated a ‘learner type’ with each of Kolb’s four stages. The four learner types identified are: activist (Kolb's active experimentation); reflector (Kolb's reflective observation); theorist (Kolb's abstract conceptualisation; and pragmatist (Kolb's concrete experience) (Cassidy, 2004). The idea being that once an individual, with the assistance of Honey and Mumford’s questionnaire, learns their learning type they have a better understanding of the sort of activities that they learn best from. On the face of it this model seems to go part way to addressing the phenomenological concern by recognising learner difference but actually what it seems to do is create a strict, compartmentalised, view of an individual’s experience. Criticisms of Honey and Mumford seem to be more concerned with the fact that researchers have failed to find support for the learning styles they proposed and low levels of consistency of the questionnaire (Duff and Duffy 2002, cited in Cassidy, 2004). The criticism I have of this model lies in the suggestion that a learner’s learning style is sufficiently stable or fixed to be able to categorise it.
Transformative learning is a theory developed by Jack Mezirow (1997) which highlights how an individual's problematic ‘frames of reference’, which is a collection of their existing expectations and assumptions are transformed to make them more inclusive and reflective. Such frames of reference can relate to inter-personal relationships, stereotyped attitudes and political affiliations amongst others. This transformation occurs after critical reflection of lived experience. Mezirow identified a few factors common to a transformational experience; experiencing disorientation following an experience where the outcome didn’t fit an existing schema or frame of reference, a period of active reflection before a plan is identified, developed and applied to a similar situation (Mezirow, 2003).
This model shares several factors with some of the other models described above – Dewey’s emphasis on the active nature of the process, Schon's description of new understanding following the challenge of an existing schema and Kolb’s creation of a plan which followed by a period of active experimentation. There is also commonality between these three theories in their use of a staged approach.
Model used in this essay
As much as Mezirow’s description of the way a new situation will challenge potentially problematic frames of reference spoke very much of my own experiential growth, it was Kolb’s cyclical model that really resonated with me and that’s mainly because it is very similar to one that I used as a Police Officer for many years. Known as the National Decision Model (NDM) it was developed in 1995 by the Committee on Standards in Public Life (NDM, 2014) and it is widely used amongst police services nationally to help make, record and justify decisions and promote learning. Although I couldn’t find any published link between the NDM and Kolb there are a number of similarities in both, most obviously the cyclical nature.
Some stages can be directly transposed between models, Kolb’s active experimentation is the same as the NDM’s take action and review, for example. Kolb’s abstract conceptualisation has been replaced by a concrete direction to consider powers and policies and identifying options and contingencies. The biggest difference is the addition of the code of ethics to the centre of the circle, reflecting as it does, the need for ethical considerations to be at the centre of all decisions and learning.
For this essay I shall be using Kolb’s experiential learning model, but I shall integrate, at its centre, the BACP’s ethical framework as the NDM does with the code of ethics. I do this as I believe that as a counsellor any learning that involves my practice must take place within the ethical framework, the principles of beneficence or the commitment to promoting the client’s wellbeing and non-maleficence or a commitment to avoiding harm to the client are at the heart of any professional decision I make. (BACP, 2018).
Critical Analysis and Reflection (2000)
Reflective learning is an active process that is so much more than merely receiving knowledge, requiring as it does, the development of critical awareness in the socio-political context in which the knowledge is embedded and transmitted and includes an understanding of the learning process itself (Taylor, 2020). In this model learners are as much investigators or research scientists as they are learners.
Carrying out this essay has brought home to me just how much reflective or experiential learning has been part of my professional life long before I undertook my counselling diploma. Schon (1991) begins his preface talking about exploring professional practice and lists work he has carried out outside of psychotherapy which he calls an ‘exploration of professional knowledge’. Whilst I do not want to detract from the main thrust of this essay I feel like my previous experience of experiential, operational, learning is relevant to this piece of work and in a way this link mirrors my use of MM in that both began outside of my professional training as a counsellor.
I will be utilising Kolb’s 4 stages and the BACP code of ethics as suggested by the NDM as section headers with which to focus the exploration of my experience and a critical analysis of the background literature I identified above.
This stage deals with my initial encounter with the subject of my reflexivity. For this essay I will actually look at two encounters, my initial experience of MM and my experience of introducing MM in my work with clients.
My direct experience of MM is especially important due to that fact that I have had no specific training in the clinical use of MM other than as a mindful grounding technique to help clients suffering from extreme anxiety or panic attacks. I developed an interest in Buddhism after travelling round the Far East and on my return to the UK I learnt to meditate from a local Buddhist group. I experienced the benefits that a regular meditation practice can have such as increased concentration, a reduced feeling of stress and greater awareness of my feelings, a sense of mindful awareness rose automatically from my meditation practice.
Britton (2019) in her look at potential harms in MM practices, highlights that very few psychological interventions are universally beneficial and highlights a number of contra-indications to universally accepted MM processes such as self-observation. She argues that researchers have paid less attention to these contra-indications and how they can undermine wellbeing. I have experienced a very small number of negative effects I attributed to my intensive meditation practice over the years but I was able to easily deal with them as I was surrounded by a supportive, experienced, Sangha or Buddhist community.
My experience of MM in my client work has been very limited. Until researching this essay and utilising the experiential learning model, I had not formally investigated what MM would look like in my psychotherapeutic practice, what the ethical considerations may be and what potential harms there may be for clients. I have introduced basic grounding techniques to clients suffering from anxiety or panic attacks and these seemed to be well received. I felt uncomfortable offering more than this due to what could broadly be described as ethical considerations including whether my experience and training were suitable to pass on advice and/or facilitate a client’s MM practice in a clinical setting.
Reflective Observation of the New Experience
The former stage involved me reflectively considering my experience whilst this one invites me to apply the learning I have gained from my research to the reflection on my concrete experience.
The first point that came up for me, very strongly, was how my understanding of learning and reflective practice has been benefitted by reading about the different models of learning I detailed earlier, in particular Kolb’s experiential learning theory and Schon’s notion of the learner as investigator.
Britton’s work on the shadow side of mindfulness and meditation validated some of the concerns I had about using MM in a therapeutic setting. If considering using these techniques or supporting and supervising an existing meditation practice it’s of the utmost importance that a therapist is well aware of the potential outcomes – both good and bad. For example, Britton et al. (2014) report that there appears to be a point in the amount of time ones spends in meditation below which promotes sleep and above which inhibits it.
What was very apparent during my review of the existing literature was the role that context (Kabat-Zinn, 2003) plays in the therapeutic use of mindfulness and meditation practices, this notion also described as ‘intention’ (Shapiro et. al. 2016) and embeddedness (Valerio, 2016) criticises how the westernisation of these practices (or the rise of McMindfulness (Barker, 2021) weakens them by ignoring their original purpose of enlightenment and universal compassion (Shapiro et. al. 2016). Despite the view I have of myself as a ‘secular’ Buddhist, my original learning was firmly embedded in a more traditional Buddhist background, such as being taught the loving kindness meditation from the Karaniya Metta Sutta, one of the Buddha’s teachings.
Reflecting on my experience in the light of the growing call to re-engage MM practices with the Buddhist message, I began to critically reconsider my view of the primacy of MBSR as a therapeutic tool and questioned Kabat-Zinn’s initial ‘separation’, the distillation of the methods from the message in an attempt to make MBSR more attractive to a scientific audience.
Far from being a purely academic exercise, these considerations led me naturally onto Kolb’s next stage and the conception of a ‘new’ idea.
Fundamental to this stage for me, which is concerned with the formation of a new idea or development or modification of an existing one, is the recognition of the potential harm the MM could cause and the need to address the separation of MM practices from the Buddhist message.
In terms of the ‘procedure’ surrounding thinking about my experiences, my research and how they can usefully combine into a novel idea it was important for me to think in terms of process and not outcomes (Gencel et. al, 2021) and this was important for me personally in two respects. Firstly, it reduced the pressure that can sometimes be involved in finding a solution – solution implies finality which in turn suggests the need for perfection. Secondly, it allowed me to look ahead to the next potential iteration of my idea, which means that my focus is on what’s going on for my clients and I, as I take another spin round Kolb’s cycle – and this focus is at the heart of what it means to be a counsellor, for me anyway.
Experiences gained through developing my own MM practices have engendered in me a great respect for any meditative or mindful practice. I understand that these are active processes that have the potential to fairly easily change a practitioner’s perceptions, their view of self and may actually cause changes in one’s brain structure (Powell, 2018) or not (Mesa, 2022). My first thought then, is about the need to highlight to clients the transformative effects that MM practices can have, and not just the widely publicised positive ones. Ensuring that clients have sight of all the issues involved in our work together supports the BACP’s ethical stance on autonomy (BACP, 2018) and promotes their deeper involvement in our work together.
The issue surrounding the need to re-introduce intention into MM practices, to increase their efficacy by developing universal compassion from which the individual can also benefit (Bishop et al. 2004 cited in Shapiro et al. 2006) appears slightly more complex. For a start it requires an element of psycho-education around Buddhist philosophy which may well go beyond a client’s expectations of therapy, may involve an element of self-disclosure and may increase the time a client spends in therapy. Respecting a client’s autonomy is again fundamental here to address these caveats.
The modifications I propose then centre around psycho-education and ensuring that clients are fully involved at the very centre of their therapy.
The final stage in the cycle asks the learner to take her newly conceived or modified idea from the abstract conceptualisation stage and apply it to the real world and test it, before the results are fed back into stage one as concrete experiences. - this newly conceived of or modified idea or hypothesis is then tested through a process of experimentation in the real world and the resultant findings are fed back into the cycle at stage 1. (McLeod, 2017).
Due to the timescale associated with this essay and the size of my modest private practice, I have not yet had the opportunity to apply my conceptualisation to the real world but I have completed a brief ‘thought experiment’ looking at a possible outcome of the active experimentation stage.
What the conceptualization stage has made immediately apparent is that introducing MM into my practice will require a very particular client, or a client with very particular needs. The introduction of the psycho-educational elements discussed above appears to be fundamental to the proper use of MM but I feel they would be very off-putting to a proportion of clients. This would necessitate that I am far more selective than I already am, in who I offer more formal practices to. I would never have said I wasn’t selective in how I introduce MM to my clients before this research.
A further change I have made due to the abstract conceptualization is that I have inserted a paragraph into my therapy contract to cover situations where I offer MM practices to clients, highlighting Britton’s (2019) contra-indications
The introduction of ethical considerations into Kolb’s model is, for me, a very important step. When talking about my clinical work, the suggestion that I carry out experiments as per Kolb’s stage 4, makes me feel very uncomfortable without utilising an ethical framework to base those experiments on. The BACP’s ethical framework’s core principles speak of beneficence – or promoting the client’s wellbeing and maleficence – doing no harm to our clients (BACP, 2018) and this demands that we place our client at the heart of our active experimentation and further, it suggests that we use beneficence as the goal and the reason for the experimentation.
Kolb’s experiential learning model introduces further risk specifically for counsellors. The whole purpose behind this model to provide a system whereby people are able to learn, grow and develop (McLeod, 2017) but it’s not inconceivable that the learner, working individually and reflexively within this model, outstrips their formal learning or CPD and falls foul of the need to work within their competence (BACP, 2018) and this concern is what prompted me to examine this topic. What does my experiential learning journey mean for my competence to introduce MM to clients? This exercise allowed me to use Kolb to focus my reflections, examine my experiences and come to a conclusion as part of the active experimentation stage.
The psychoeducation highlighted above ensures client autonomy, that they are in possession of knowledge relevant to their therapy enabling them to make informed choices about how they engage with it (BACP, 2018).
Conducting this study has been beneficial for me for several reasons, it has allowed me to make far more informed decisions about my use of MM in my therapeutic practice but it has also given me a formal schema which I can use, moving forward, to reflect on my learning.
As I conducted the research, I discovered how many studies into the impact of MM practices actually involved counselling students and the impact that these practices had on them and I enjoyed the direct relevance this had to me as someone who has only recently completed their own counselling studies. Although these studies didn’t directly help to answer my research questions, they did help to highlight how beneficial these practices can be by increasing empathy in therapists (Lesh, 1970) and causing a greater improvement in symptoms for clients between intake and discharge (Grepmair et al., 2007) amongst many other things.
The aim of this research was to answer two questions ‘what are the implications to offering MM to clients within a psychotherapeutic setting?’ and ‘is training in MBSR and its offshoots the only qualification that one can have to offer MM therapeutically’? Essentially, I wanted to explore whether I am able to practically, ethically and safely offer mindfulness or meditation to clients in my private practice now or if not whether there are further steps I need to take.
There are undoubtedly potential consequences in offering MM practices to clients. The rise of McMindfulness has been linked to a number of issues most noticeably in the commodification and westernisation of the original practices (Barker, 2021) and this, in turn, has direct issues for clients. Practices are watered down or weakened by this westernisation as the original purpose of enlightenment and universal compassion are ‘dumbed down’ (Shapiro et. al. 2016). The universal compassion aspect of MM pre-empts its benefits to the individual in the same way that meditation pre-empts mindfulness and to downplay either in favour of convenience is to weaken both.
Britton’s (2014) The Varieties of Contemplative Experience Project describes how meditation is not the quick, no risk, easily mastered discipline it is marketed as; on the contrary it is far deeper and more complex and has caused ‘an epidemic of casualties’ which needs to be incorporated into its teaching and marketing. When Valerio (2016) and others speak of western MM practices being disembedded from the original Buddhist context they are also referring to how the original protections, which can be found in the original teachings and transmitted through the Buddhist community, have been stripped away from the practices. The basis of therapeutic MM seems to be to give a breadth rather than a depth of understanding into these practices and then after a few short weeks assuming the clients know enough to spot any potential difficulties arising. I believe that this focus of breadth over depth, which seems to have been introduced to appeal to western consumers, is yet another example of how original practices have been disembedded from the context they were originally found in.
I found it particularly difficult to find studies within my area of focus that examine MM practices other than MBSR or other therapies that are very closely related to or derived from it. Numerous studies support the notion that MBSR based therapies are successful in helping clients with a large number of mental health and physical problems but I find a fundamental tension within the basic concept of MBSR, that it was formulated in response to the need of the medical model to teach acceptance to those with things ‘wrong’ with them or at the very least help them deal with symptoms that no other medical practitioner could assist them with; as a person-centred practitioner I do not believe my clients need ‘fixing’.
This leads onto my final research question, whether existing literature is explicit or suggestive as to whether my personal experience means that I am suitably qualified to offer MM to my clients or whether I require specific training in MBSR or related methodology. This was a slightly harder question to find answers for. MBSR is such a dominant player in the therapeutic mindfulness field that it can be assumed that any research on MM will be referring to it or a closely linked modality. I believe that answers to this question though, can be found, in part, in the criticisms of MBSR. As discussed earlier, researchers are increasingly critical of the westernisation of MM practices, the deliberate move away from the core teachings of Buddhism. Shapiro et al. (2006) describe how the intention of mindfulness, ‘enlightenment and comp
assion for all beings’, was removed from MM practices with their westernisation.
Having a background in ‘traditional’ Buddhist MM practices means that I have always had this compassionate intention at the core of my own practice and having carried out the literature review can now see the importance of imparting this to my clients. And having been part of a sangha I have experience in spotting and dealing with the contra-indications detailed by Britton (2019), both personally and with my peers. I believe, then, that my experience addresses the concerns raised about MM in general and MBSR type modalities in particular, by the writers I have identified in the literature review, and as a result I am satisfied that I have the knowledge and ethical ‘backing’ to offer meditation and mindfulness as therapeutic tools to my clients.
Conducting my research has raised further questions about my therapeutic use of MM, however. I feel that to offer MM practices to clients which are embedded in Buddhist philosophy would, for me, hugely alter the therapist/ client relationship beyond that I am comfortable with. For example, it w
ould involve far higher levels of directivity and greater self-disclosure on my part than feels right for a person-centred practitioner. Moving forward then, I see my use of MM practices remaini
ng the same as now but I will be exploring whether there is any value in running a separate and specific meditation practice to teach and support clients who specifically request it. In terms of research there are gaps in examining the experiences of clients and therapists in working with non-MBSR MM practices.