Journal of Religion & Spirituality in Social Work: Social

Thought

ISSN: 1542-6432 (Print) 1542-6440 (Online) Journal homepage: https://www.tandfonline.com/loi/wrsp20

Mindfulness as Clinical Training: Student

Perspectives on the Utility of Mindfulness Training
in Fostering Clinical Intervention Skills

Annemarie Gockel MSW PhD , Theresa Cain MSW , Shirley Malove MSW &
Susan James PhD

To cite this article: Annemarie Gockel MSW PhD , Theresa Cain MSW , Shirley Malove MSW &
Susan James PhD (2013) Mindfulness as Clinical Training: Student Perspectives on the Utility of
Mindfulness Training in Fostering Clinical Intervention Skills, Journal of Religion & Spirituality in
Social Work: Social Thought, 32:1, 36-59, DOI: 10.1080/15426432.2013.749146

To link to this article: https://doi.org/10.1080/15426432.2013.749146

Published online: 15 Feb 2013.

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Journal of Religion & Spirituality in Social Work:
Social Thought, 32:36–59, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1542-6432 print/1542-6440 online
DOI: 10.1080/15426432.2013.749146

Mindfulness as Clinical Training:

Student Perspectives on the Utility
of Mindfulness Training in Fostering
Clinical Intervention Skills

ANNEMARIE GOCKEL, MSW, PhD, THERESA CAIN, MSW,

and SHIRLEY MALOVE, MSW
School of Social Work, Smith College, Northampton, Massachusetts

SUSAN JAMES, PhD

Department of Educational and Counseling Psychology, University of British Columbia,
and Special Education, Vancouver, British Columbia, Canada

Mindfulness training is increasingly being recommended as a

strategy for fostering therapeutic effectiveness. We used a qualitative
methodology to explore the potential utility of mindfulness training
in helping beginning MSW students develop clinical intervention
skills. Students reported that the training helped them manage
distractions and anxiety, facilitated their ability to attend and
respond to the client, and encouraged them to be more self-aware
and flexible in their thinking in the classroom and in the field.
Mindfulness training may strengthen current cognitive and behav-
ioral training strategies, while providing a means of integrating
affective and sensory learning into the training process.

KEYWORDS mindfulness, social work training, helping skills,

clinical training

Mindfulness is a form of present moment awareness that promotes the abil-

ity to attend to, accept, and work with experience as it occurs (Fulton,

Received April 26, 2012; accepted September 11, 2012.

This research was supported by a grant from the Brown Clinical Research Institute at
Smith College School for Social Work.
Address correspondence to Annemarie Gockel, MSW, PhD, Smith College School for
Social Work, Lilly Hall, Northampton, MA 01063. E-mail: agockel@smith.edu

36
 Mindfulness as Clinical Training 37

2005; Kabat-Zinn, 2003; Morgan & Morgan, 2005). Deeply rooted in more
than 2,500 years of Buddhist philosophy and scholarship, the cultivation
of mindfulness is viewed as essential to achieving spiritual enlightenment
within the Buddhist tradition (Kabat-Zinn, 2003; Siegel, Germer, & Olendzki,
2009). Mindfulness training, accomplished through the practice of medita-
tion, helps the practitioner begin to see and purify the inner workings of the
mind of afflictive thoughts and emotions, preparing the ground for spiritual
realization. Mindfulness training often begins by instructing the trainee to
pay attention to a particular object—most often the breath—and to simply
and gently redirect his or her attention back to the breath when the mind
wanders. As the ability to concentrate grows, the trainee works towards
becoming aware of and exploring other objects of attention such as phys-
ical sensations, emotions, and thoughts, gradually developing the ability to
observe and relate to his or her experience with greater clarity and insight,
rather than simply being caught up in habitual reactions to the experience.
In order to adapt the practice of mindfulness to a Western context, early
translators developed secularized models of this traditional form of spiritual
training to make it broadly accessible to the U.S. population, the majority
of which is Christian. Although the practice has been shown to enhance
personal spirituality in a number of studies (Shapiro, Schwartz, & Bonner,
1998; Walsh & Shapiro, 2006), it is in its secularized form that mindfulness
training has recently been embraced by Western science. Numerous studies
and reviews are increasingly demonstrating the efficacy of mindfulness prac-
tice in promoting mental clarity and emotional and even physical regulation
(Baer, 2003; Shapiro, Brown, Astin & Duerr, 2008; Walsh & Shapiro, 2006).
As a result of this research, mindfulness now forms a core com-
ponent of a number of therapeutic models or interventions including
Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy
(ACT), Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-
Based Stress Reduction (MBSR). Various forms of mindfulness training have
been employed through these models to help clients reduce distress and
regulate affect and cognition, addressing a broad range of psychosocial prob-
lems including: addiction, anxiety, depression, eating disorders, chronic pain,
stress, and suicidality (Baer, 2003; Grossman, Niemann, Schmidt, & Walach,
2004; Hayes, Masuda, Bissett, Luoma, & Guerrero, 2004). The success of this
new wave of mindfulness-based psychotherapies in outcome studies and
controlled trials has made mindfulness a hot topic among clinicians, funders,
and administrators in social service agencies.
More recently, attention has turned to exploring the ways that mind-
fulness training may contribute to the development of clinical skills among
beginning counselors, psychologists, and social workers. According to the
National Association of Social Workers (NASW), social workers provide the
majority of mental health services in this country (Whitaker, Weismiller, Clark,
38 A. Gockel et al.

& Wilson, 2006), making students’ acquisition of clinical skills a priority for
the field. Advocates argue that mindfulness training fosters the development
of many of the skills and characteristics that are pivotal to therapeutic effec-
tiveness (Fulton, 2005; Gehart & McCollum, 2008; Lambert & Simon, 2008;
Morgan & Morgan, 2005), making mindfulness training of potential value as
a pedagogical strategy for clinical instruction.

HOW CAN MINDFULNESS PROMOTE CLINICAL SKILL

DEVELOPMENT?

Mindfulness training is thought to promote the student’s ability to man-

age distractions and to listen effectively, helping the trainee more clearly
understand the client’s needs and experiences (Morgan & Morgan, 2005;
Speeth, 1982). Because the training focuses on helping practitioners directly
experience all mental and physical events with minimal cognitive mediation,
mindfulness training is also thought to promote an openness to experience
as it occurs, helping the student to put aside his or her own agenda and
preconceptions, and allowing for a fuller engagement with the client’s expe-
rience (Bien, 2008; Fulton, 2005). The process of observing and then letting
go of thoughts, feelings, and experiences that mindfulness training involves
may also promote greater flexibility in conceptualizing the client’s issues and
increased creativity in responding to his or her needs in the moment (Epstein,
Siegel, & Silberman, 2008; Fulton, 2005). Meditation, which remains the key
vehicle for mindfulness training, has been found to increase both concen-
tration and information processing. Research with community samples has
shown that meditation increases one’s ability to notice and respond to a
broader range of objects in the field of perception, as well as promoting
creativity and openness to experience (Shapiro, Brown, et al., 2008; Walsh &
Shapiro, 2006).
Mindfulness training is also thought to foster the clinician’s ability to
embody core affective traits such as empathy, warmth, and compassion in
the helping relationship (Gehart & McCollum, 2008; Shapiro & Izett, 2008;
Surrey, 2005). Because students are directed to attend to their feelings and
sensations as well as their thoughts and behaviors in this practice, mind-
fulness training may increase students’ awareness of the role of affect and
physical experience in the intervention process. By learning to approach,
accept, and tolerate their own sensory and affective experience, novice clin-
icians may lose their fear of negative affect over time, expanding their ability
to comfortably entertain a broader range of emotion from their clients in turn
(Fulton, 2005). Specific forms of meditation explicitly focus on developing
the student’s ability to feel love and compassion for and with other people,
while also remaining in touch with his or her own experience (Shapiro &
 Mindfulness as Clinical Training 39

Izett, 2008; Surrey, 2005). This combination of increased emotional aware-

ness, affect tolerance, and empathic rehearsal may facilitate a trainee’s ability
to be emotionally available, warm, empathic, and responsive to the client.
These characteristics in turn are predictive of therapeutic effectiveness across
a broad variety of therapy models (Assay & Lambert, 1999; Lambert & Barley,
2002; Walsh, 2008).
Equally important to therapeutic success is helping the novice clinician
identify and manage negative internal affective reactions to the client,
typically called countertransference within the psychodynamic psychother-
apy tradition (Gelso & Hayes, 2002; Hayes, 2004). Countertransference is
regarded as a key source of ineffective therapist behaviors such as judg-
ing, shaming, blaming, neglecting, or rejecting the client that interfere with
the helping relationship and result in poorer outcomes (Gelso & Hayes,
2002; Hayes, 2004). By learning to observe the process of sensing, feeling,
and thinking as it unfolds, students may be able to more effectively iden-
tify moments in the therapeutic relationship where they are beginning to
react to the client, and to more clearly pinpoint the source of their reactions
(Safran & Muran, 2000; Safran & Reading, 2008). Because mindfulness train-
ing promotes the acceptance of current moment experience, students are
encouraged to welcome and explore rather than suppress these reactions.
The process of attending to their reactions with warmth and interest can
foster emotional self-regulation and promote more effective decision making
in and of itself (Baer, 2003; Grossman et al., 2004; Shapiro, Brown, et al.,
2008). Becoming more aware of their internal affective reactions may further
assist students in identifying personal issues and unmet needs, prompting
appropriate self-exploration and self-care, which can function to reduce the
sources of reactivity in session, further supporting trainee well-being and
effectiveness (Gelso & Hayes, 2002; Hayes, 2004). Thus, mindfulness train-
ing may help students identify and respond to the needs and feelings that
drive negative interactions in session, minimizing their tendency to act out
these reactions.
For all of these reasons, mindfulness training is increasingly being pro-
moted as a potential avenue for addressing many of the most pressing gaps in
our current clinical pedagogy. Methods for training social workers in founda-
tional counseling, helping, or communication skills are derived largely from
research in counseling psychology that reached its apex in the 1960s and
1970s (Dinham, 2006; Hill & Lent, 2006; Richards, Ruch, & Trevithick, 2005;
Trevithick, Richards, Ruch, & Moss, 2004). Cognitive and behavioral strate-
gies that combine didactic instruction, modeling, practice, and feedback form
the mainstay of many foundational practice courses (Dinham, 2006; Hill &
Lent, 2006; Richards et al., 2005). Although students can often demonstrate
the mastery of core listening and communication skills following a course
of instruction, social work research has shown that they don’t necessarily
generalize these skills to their work with clients in field practica, creating a
40 A. Gockel et al.

gap in the transfer of training (Collins & Bogo, 1986; Kopp & Butterfield,
1986). Critics argue that current training programs don’t adequately help stu-
dents to implement their skills largely because there has been no specific
means of fostering the underlying attitudinal and affective components that
are required to fully integrate and apply these skills (Lambert & Simon, 2008).
Mindfulness training may offer a means of filling this gap. It provides
a methodology for training students in basic skills such as attention and
concentration that create the foundation for more complex counseling skills
such as active listening. Mindfulness training also offers a specific means of
cultivating the affective dimension of key therapeutic traits such as empathy
and compassion, for which we’ve heretofore relied only on cognitive and
behavioral strategies. By providing a means of explicitly attending to sensory
and affective learning in the skill development process, mindfulness training
may also help students identify and contain therapy interfering behaviors.
In all of these ways, mindfulness training may complement existing cognitive
and behavioral strategies to help students more fully integrate and enact the
skills that are needed to form and maintain an effective helping relationship.

WHAT DO WE CURRENTLY KNOW ABOUT MINDFULNESS IN

RELATION TO CLINICAL TRAINING?

Despite the growing interest in mindfulness training as a potential clinical

pedagogy, only a handful of researchers have directly investigated mind-
fulness in relation to clinical skill development and very few of their studies
have included social workers. Two existing studies have used cross-sectional
surveys to explore the relationship between mindfulness and counseling self-
efficacy for counselor trainees. Counseling self-efficacy refers to a student’s
belief or confidence in his or her ability to implement counseling skills suc-
cessfully with clients in the near future (Greason & Cashwell, 2009). In 2009,
Hall found that students’ self-reported mindfulness predicted counseling self-
efficacy, accounting for 20% of the overall variance in counseling self-efficacy
for preinternship master’s level counseling trainees. Similarly, Greason and
Cashwell (2009) confirmed this relationship, and found that students’ abil-
ity to sustain attention and to simultaneously attend to multiple points of
focus in the counseling process mediated the relationship between mind-
fulness and counseling self-efficacy among master’s and doctoral students
in counseling internships. These findings are important because counseling
self-efficacy is viewed as a critical early marker of helping skills acquisi-
tion and has been positively associated with counseling performance among
novice trainees (Greason & Cashwell, 2009).
A number of other investigators have tested mindfulness training as
a self-care and stress reduction strategy among medical and counseling
 Mindfulness as Clinical Training 41

trainees. These authors have consistently found that mindfulness training

reduces the negative sequelae of occupational stress such as anxiety, depres-
sion, and perceived stress among trainees, while increasing positive traits that
foster resilience such as mindfulness itself, spirituality, and positive affect
(Jain et al. 2007; Shapiro, Brown, & Biegel, 2007; Shapiro et al., 1998).
However, none of these studies directly addressed the effects of mindful-
ness training on clinical skill development. The two researchers who have
surveyed social work students to date suggest that mindfulness buffered
occupational stress and exhaustion, enhanced coping, and was positively
related to greater mental health in this population (Ying, 2008; Ying &
Han, 2008). However, one of the same researchers found that second year
MSW students reported lower levels of mindfulness, which in turn mediated
declines in mental health and personal competence as compared with first
year MSW students, suggesting the need for an intervention to prevent the
erosion of mindfulness in professional training (Ying, 2008).
Only one existing study has even partially addressed the effects of mind-
fulness training on clinical skill development thus far. Schure, Christopher,
and Christopher (2008) analyzed students’ written responses to two open-
ended questions to explore how a 15-week course of mindfulness training
impacted the professional development of counselor trainees. Students in
this study reported that the training enhanced their ability to pay atten-
tion in session, increased their comfort with allowing moments of silence,
and fostered a more holistic view of the therapy process. Thus, the small
body of existing research on this topic appears to provide some prelim-
inary support for the potential benefits of mindfulness training in clinical
education.
Research on the utility of mindfulness training as a pedagogical strat-
egy for clinical education is really just beginning. Very few researchers
have directly investigated how mindfulness training might facilitate clinical
skill development and none have explored whether it might hinder clinical
skill development in any way. Existing studies introduced the training as a
self-care strategy in a separate class, rather than integrating it directly into
clinical pedagogy, which limited the authors’ ability to assess its effects on
clinical training. Currently, calls for integrating mindfulness training into clin-
ical instruction rest primarily on the hypotheses and anecdotal experiences
of licensed professional counselors, psychologists, and social workers who
have benefited from developing a mindfulness practice in their own lives.
Although there is an ever increasing body of research to support the utility
of mindfulness as a clinical intervention, we simply know very little about
whether mindfulness training may be useful in helping novice clinicians
develop beginning counseling skills. Because this is a new area of research,
we used a qualitative methodology to begin to explore the potential utility of
mindfulness training as part of clinical practice instruction for entering MSW
students.
42 A. Gockel et al.

METHOD
Participants
This exploratory study on mindfulness training was conducted at a graduate
school for social work in a Northeastern state that specializes in training clin-
ical social workers and was approved by the school’s Institutional Review
Board. The current study was nested within a broader study assessing the
effectiveness of the educational strategies used to help incoming MSW stu-
dents develop beginning counseling or helping skills. At the beginning of
the semester all of the incoming master’s students enrolled in foundational
social work practice classes were invited to participate in this broader eval-
uation study. Although not identified as a specific goal of the broader study,
mindfulness training was piloted as an educational strategy in two of seven
foundational practice classes (N = 39). A random sample of 20 students
from classes exposed to mindfulness training were invited to participate in
in-depth interviews to explore their training experiences. Students had a
mean age of 29.3 (SD = 8.86), with a median age of 26.5 and a range of
22–58 years. Fifteen students were female and five were male. Sixteen stu-
dents identified as White or Caucasian, three as Asian American, and one
as Black or African American. Twelve reported some previous exposure to
one or more mindfulness practices (categories are not mutually exclusive)
including: MBSR (1), insight meditation (6), yoga (9), and Tai Chi (1). Of this
group, six reported that they practiced some form of mindfulness at least a
few times per week prior to their enrollment in the foundation practice class.

Procedures
Because the transfer of training from the classroom to the field is a key issue
in the literature, interviews were conducted after students made the transition
from the training environment to their practicum placements and initiated
their work with clients. Students completed their foundational counseling
skills training course in August of 2010, and telephone interviews were
conducted with them at their field internship sites throughout October,
November, and December of 2010. No inducements were offered for stu-
dents to participate in the interviews, but they received modest honoraria
(coffee coupons) for their participation in the broader study. Students’ confi-
dentiality was assured by having a doctoral level research assistant who had
no relationship to the students conduct and audiotape all of the interviews,
which were then transcribed and de-identified by a professional transcription
service, ensuring that students’ identities remained protected.
The interviews were semistructured in design and lasted for an average
of 39 min, with a range of 27 to 58 min. Because the interviews occurred
as part of the broader study on students’ experiences of the educational
 Mindfulness as Clinical Training 43

strategies used in first year practice, the protocol began with general open-
ended questions regarding which teaching strategies students found most
helpful. The primary question was: “When you think back to practice class,
what exercises or experiences in class most helped you develop your clinical
skills and understanding of the counseling process?” Subsequent questions
inquired about the educational strategies that helped students accomplish
specific clinical tasks: “What helped you learn to listen to and be fully present
with your clients?” “What helped you learn to identify and manage your own
reactions to clients?” “What helped you learn to respond in a crisis?” “What
helped you gain confidence about working with clients who are different
from you?” “Did anything hinder your learning?”
If students spontaneously named mindfulness training as a helpful or
hindering strategy, the interviewer then explored their experience of the
training and inquired about what specifically was helpful or hindering about
the strategy. Midway through the interview, students who had not spon-
taneously raised the topic were asked: “If your teacher used mindfulness
exercises in class, how did these exercises help you develop clinical skills
or understand the counseling process?” At the end of the interview students
were once again prompted to comment on anything that helped or hindered
their learning as the interviewer asked: “Is there anything that I didn’t ask
that it would be important for me to know about what helped or hindered
your learning in practice class?”

Structure of the Training

The MBSR curriculum (Santorelli & Kabat-Zinn, 2009) was adapted to provide
10 min periods of mindfulness training followed by 5 min periods of dialogue
in each of 28, 2-hr-long classes for a total training time of 7 hr of instruction.
The principle investigator, a clinical social worker and practice teacher, with
a meditation practice of more than 5 years duration and specific training
in MBSR, adapted and integrated the mindfulness training protocol into the
existing foundational practice curriculum. Although the training draws on the
MBSR model, it is not MBSR, which is a stand-alone program that involves
a much more time-intensive course of instruction and a dedicated period of
daily practice.1
During the initial weeks of class, students were successively invited
to explore an awareness of sounds in the room, their breath, their body
sensations, emotions, and thoughts, and to reflect on how deepening their
awareness of each element of their experience might help them as a student
in the classroom and as a clinician in the field. Walking meditation, periods of
gentle stretching, and physical movement provided an alternative to sitting
meditation as a vehicle for self-observation. Meditations that incorporated
imagery, play, and concentration on a word were used to enhance each
student’s ability to explore a particular aspect of experience or to draw on a
44 A. Gockel et al.

particular quality of his or her own choosing such as strength, joy, or peace to
ground the day’s work. As the course progressed, the training shifted from a
focus on helping students explore the practice of mindfulness for themselves
to using this practice to anchor their clinical work through integrating the
practice before, during, and after clinical training exercises such as role plays.
Loving kindness meditation (Chodron, 2002), which draws on visualization
to help students cultivate empathy for themselves and then for others, and
Tonglen meditation (Chodron, 2002), which invites students to explore the
experience of sitting with suffering, were introduced towards the final half
of the course to help students work on these aspects of the clinical role.

Analysis
The interview transcripts were analyzed by a team of three researchers using
Atlas-TI, including the principal investigator and two doctoral students, one
of whom conducted all of the interviews. Grounded theory as described by
Charmaz (2006) was used as the analytic method, leading to an iterative
process of coding and recoding as data were compared within and across
transcripts and increasingly complex conceptualizations of themes emerged.
The analytic process involved a number of distinct stages. Initially, all of the
investigators read each transcript and created a memo about their impres-
sions of each interview as a whole. Each transcript was then independently
coded by two researchers. Open coding was followed by selective coding
as themes were identified inductively and then developed through multiple
readings of the transcripts. Final codes for each team were synthesized by
the principle investigator, clarifying discrepancies and adding, changing, or
merging codes by consensus. Codes for each team were then audited for
accuracy and consistency by the third investigator, who had not originally
coded the interviews. By examining and comparing specific codes across
interviews, the relationships between codes were defined, and the codes
were divided into major categories, broader themes, and more minor sub-
themes through a consensus of the investigators. Consistent with the tenets
of grounded theory, the analysis resulted in the identification of a preliminary
midlevel theory describing the utility of mindfulness training in clinical social
work education from a student’s perspective. As a final step in the process,
an independent auditor reviewed a random selection of five interviews to
confirm the integrity of the analysis as a whole.

RESULTS

When asked about the instructional strategies that most facilitated their devel-
opment of clinical skills and helped them learn about the counseling process,
17 out of 20 students spontaneously identified mindfulness training as a
 Mindfulness as Clinical Training 45

helpful strategy. The remaining three students, who did not spontaneously
comment on mindfulness training, reported that the strategy was helpful to
their learning when asked about it specifically. No student identified mind-
fulness training as hindering his or her learning process. The vast majority
of students (18) described drawing on mindfulness for themselves, specif-
ically to help them prepare for and perform their role as a clinician more
effectively. Six students integrated mindfulness directly into their work with
clients, teaching clients how to use these skills to attend to their experi-
ence in the present moment and to address anxiety. Eight students reported
that they also used mindfulness strategies specifically for their own self-care
outside of their day-to-day work with clients.
The overarching theme that emerged from the analysis was that mind-
fulness training facilitated a greater ability to be open and attentive to the
learning process and students subsequently integrated and applied mind-
fulness to enhance their ability to attend and be more fully available to
their clients in the field. Two students who had previously been exposed
to mindfulness practice or mindfulness-based therapies prior to the foun-
dational practice course reported that the training didn’t add anything new
to their existing knowledge of mindfulness, although it provided an oppor-
tunity to engage in the practice in class. Pseudonyms are used to protect
participants’ identities throughout the description of the results that follows.

MINDFULNESS TRAINING ENHANCES THERAPEUTIC ATTENTION

Mindfulness Training Enhances Attention and Openness as a Learner
When they were asked how mindfulness training had impacted their experi-
ence in the classroom, students highlighted the way that mindfulness training
primed them to learn by helping them to be both cognitively attentive
and emotionally open to the learning process. They used words such as
“grounded,” “centered,” “rooted,” “zeroed in,” and “present” to describe
how they felt after doing mindfulness training in the practice classroom.
Maya described her surprise in realizing how important mindfulness training
became in facilitating her process of clinical skills acquisition. She says:

I was sort of ambivalent about the mindfulness activities in the beginning.

And towards the end, I just sort of really realized how much those activi-
ties helped me to be present and really helped to facilitate the role-plays
that we did in the class. I felt much more able to—I don’t know—just
be engaged in the moment with the client and to really engage with
curiosity.

Students explained that mindfulness training enhanced their ability to

learn by helping them to manage distractions and calm the anxiety that
46 A. Gockel et al.

could hinder their ability to focus on the mock clients with whom they were
working and the skills they were learning. Jesse talked about the training as
providing a means of helping him redirect his attention away from anxious
self-talk about performing in front of the class, facilitating a greater sense of
receptivity and engagement in the moment by moment unfolding of the role
play he was doing instead. He says:

It helped me feel more connected to the person I was doing the role play
with, just able to focus my attention in on him and what he was saying
as opposed to my attention, I’m like, “Oh shit, what am I saying in front
of the class” and all that stuff.

Students reported that their learning process was significantly impacted

by the atmosphere of the classroom as whole. They described their peers
as “brimming” with a “contagious” sense of anxiety that often pervaded the
atmosphere of many of the 1st year classes at the school. By helping students
identify, address, and to some extent regulate anxiety as well as other dis-
tractions, mindfulness training appeared to help students become more open
and available to connect with one another, creating a more positive learning
environment. For example, in speaking about his experience of mindfulness
training, David said “It zeroed us in as a class and kind of for each other,
I thought that it was palpable, with the feeling it created.” Jan reinforced
the notion that the training had an impact on classroom dynamics when she
observed: “I think it made people feel more human in the class and more
relaxed with each other.” Thus, it was not just the ability to focus attention
that mindfulness training supported, it also appeared to enhance the quality
of the attention students were able to bring to the learning task, creating
an environment where students felt more emotionally connected with one
another and were able to bring a greater degree of curiosity and openness
to the clinical learning tasks before them.
Students also described mindfulness training as helping them to become
more aware of and interested in exploring their feelings and their phys-
ical sensations as a source of information in the learning process and in
the clinical encounter. Maya described her initial reluctance to notice phys-
ical sensations and feelings during periods of mindfulness training because
her previous learning experiences had emphasized the use of cognitive and
behavioral strategies to understand a topic, or to learn and practice a specific
skill. Although the process was initially disorienting because she was being
asked to learn in a completely new way, Maya reported that mindfulness
training legitimized the role of feelings and physical sensations in the clin-
ical learning process. She described the training as helping her expand her
ability to integrate emotional awareness more fully into her day-to-day life,
as well as preparing her to draw on emotional awareness in her work with
clients. She said:
 Mindfulness as Clinical Training 47

. . . so that [mindfulness training] helped me to be more comfortable in

bringing up or just labeling how I feel. It was like why I might feel
that way, and increasing my comfort with that, with just, like, in regular,
casual interactions, as well. And I guess that’s the whole part of being
mindful, and so I’m being mindful, and I’m identifying how I’m feeling
in where I stand in that moment.

Students also discussed the ways in which the use of mindfulness

training as an instructional strategy helped them make the link between
mindfulness as a personal practice and mindfulness as it might apply to their
work with clients in the field. Dorothy, who had an existing yoga and mind-
fulness practice before beginning her social work training, described the way
that the use of mindfulness training as a pedagogical strategy helped her link
her personal practice to her developing professional skills and identity. She
says:

I felt like really anchoring that [mindfulness] in the practice classroom

kinda connected that for me. So, that that’s something that I really do at
the beginning of each session is just kinda grounding myself and I found
that that’s made a huge difference for me. And I think that being able to
do those mindfulness practices in class each day, it’s like it really—and
especially when we did them right before the role plays—were really
useful in that it really—it connected those two things for me.

Mindfulness Training Enhances Attention and Openness as a Clinician

Students reported that they transferred the concepts and practices they
learned through mindfulness training in the classroom to their work with
clients in their practica. They drew on mindfulness as a means of enhancing
their own ability to pay attention to their clients and to connect with their
clients emotionally, so that they could better provide the facilitative condi-
tions of a therapy relationship to their clients. Thus, they reported that they
used mindfulness to enhance their ability to practice key clinical skills or
to accomplish therapeutic tasks in session. For example, when asked how
mindfulness was helpful to her work, Beth said:

I’ve used some of the mindfulness techniques myself so that I can be

more present in sessions and to just kind of let go, or try to let go, of
whatever is going on with me so that I can be—try to be there, and know
that I can kinda come back to my own stuff later on.

Just as in the classroom, students said they drew on mindfulness prac-

tices to manage the anxiety they were feeling as they met with their initial
clients, and to enable them to put distractions such as self-consciousness
48 A. Gockel et al.

aside, so that they could devote all of their attention to the client in front
of them. Students described pausing to take a few moments to center them-
selves by focusing on their breathing and turning their attention inward, both
before and during sessions, to help them become aware of and address their
anxiety, rather than letting it dominate the session. Jocelyn observed:

I would say that the mindfulness strategies were definitely helpful in

trying to be present and face my anxiety and be aware of it when I
feel it coming on, and then kind of come back to the session, and kind
of mastering how does that sort of happen in my own process, and
then being able to come back to be present with the client. I’d say the
mindfulness strategies were the most useful thing.

Students found that mindfulness practices also helped to foster an ability

to recognize and attend to their feelings and their bodies as a source of
information in the clinical encounter. For example, Martin noted:

I tend to, um, get too much in my head about it [clinical work] and not
enough, um, in my body and in–, sort of, instinctive responses. And, I
think, mindfulness is helpful to me to, um, get me out of my head. And
breathing and, um, sort of letting thoughts go by. Both of those things are
really helpful to me in recovering composure, for example, after meeting
with clients.

In some cases this heighted sense of experiential self-awareness led to

more effective self-care after sessions, and in others it helped the student
identify and contain countertransference rather than acting it out with their
client. Michael talked about how mindfulness helped him manage his own
reactions to clients in session:

I think that ties back to the whole being mindful . . . When I sit with
clients and they say something and they, kind of, it rubs me in the wrong
way, I can definitely find myself like, “all right, this is their situation.” . . .
It’s just information that you’re gathering and kind of stopping that, well,
the countertransference that I would feel . . . So then again the being
mindful of “this is upsetting to me,” but I can’t allow it to be upsetting to
me because it was a traumatic event for them. . . . I have to, you know,
monitor myself in being able to stay ever present for them.

Students commented that they sometimes felt overwhelmed by the

responsibility of their new role as a clinician-in-training and expressed
concerns about their ability to be helpful to clients in serious difficulty.
Mindfulness practice seemed to foster a realistic acceptance of their limi-
tations as a trainee that helped them make effective decisions and move
forward in their clinical work. Martin talked about how mindfulness helped
 Mindfulness as Clinical Training 49

him cope with the uncertainties that are part and parcel of the process of
social work practice, especially as a novice clinician. He said:

. . . it has helped me, just in the way that I think about my own mind,
and, um, to not try to wrangle my thoughts. And, um, not try to, um,
establish the kind of certainty that I used to need a lot more than I do, I
think. And, I guess, I guess the “accepting-ness” that I was talking about
before, kind of, the mindfulness exercises that we did [in class], make
that [“accepting-ness”] more possible in practice ...

Students also described mindfulness practice as contributing to their

development of a larger framework for conceptualizing their role as a clini-
cal social worker and for better understanding their interactions with clients
in session. For example, David noticed that mindfulness “became a vocabu-
lary,” an approach to help him better work with his clients. He provided an
example describing how mindfulness helped him see how he was missing
a clinical opportunity by trying to get a young client to behave in session
rather than simply exploring the client’s experience. He says:

And, so myself, my presence was really in the future and kind of my

anxiety was there and I wasn’t with him at that moment. And, I think
the kind of mindfulness, the ideas about, provide me with a way to
understand what happened there, you know? I wasn’t with him, I wasn’t
attuned to him right there in the room. And, if I had been, how much
more communication could’ve happened, you know?

The majority of students (17) reported that they continued to practice

mindfulness at some level after they transitioned from the classroom to the
field, often with informal on-the-spot practice as needed, and for some, more
formally, with defined periods of meditation or yoga. Students stated that the
process of actually doing mindfulness as part of each class helped them inte-
grate the practice into their clinical repertoire so that they began to embody
the attendant skills and attitudes. As the practice became more natural, some
students found it more challenging to identify where or how they might be
drawing on it in their work. For example, Cindy reported, “I find myself kind
of reaching for that [mindfulness] and doing it sometimes even without really
realizing that’s what I’m doing.” Similarly, Jesse observed:

It’s kind of always at the back of my head . . . just the reminder to kind
of let go of whatever you’re thinking about in your personal life, or
whatever questions you’re having, and just zero in and really listen, and
just be mindful of the questions you’re asking, and mindful of what’s
being said. I think just those skills that it teaches you have come through
when I’m sitting there with people.
50 A. Gockel et al.

Although students reported that the regularity of mindfulness training

in the classroom helped them begin to integrate the practice in their clinical
work, different students received the practice at different levels of under-
standing. Some students reported using mindfulness as more of a relaxation
“tool” or strategy for coping with specific situations such as anxiety. This view
of mindfulness may have limited their ability to integrate it into their clinical
work, as students with this understanding tended to have a more circum-
scribed use of the practice. Other students appeared to embrace mindfulness
as a much broader “way of being,” and described integrating it into every
aspect of their personal and professional lives. Students who viewed mindful-
ness in this more holistic fashion often reported receiving a broader range of
benefits from the practice, such as gaining ongoing insights about themselves
and about their clinical work through their practice of mindfulness.
A preliminary, midlevel theory regarding the utility of mindfulness
training emerged from an organization of the themes identified in these
interviews. In accordance with the existing literature, mindfulness training
is conceptualized as contributing to the development of a broad range of
therapist characteristics and skills that are directed toward the self includ-
ing attention, openness, warmth, curiosity, acceptance, emotional awareness,
affect tolerance, cognitive flexibility, and creativity. As these skills are devel-
oped within the self, a foundation is laid to begin applying these skills
to one’s interaction with others, potentially leading to enhanced atten-
tion, openness, warmth, curiosity, acceptance, flexibility, and responsiveness
towards one’s clients. Thus, mindfulness training is conceptualized as fos-
tering the clinical development process by nurturing the development of
intrapersonal skills and attributes that form a foundation for the interpersonal
skills and attributes that foster therapeutic responsiveness.

DISCUSSION

The results of this study provide support for recent suggestions that mind-
fulness training has a contribution to make to clinical education. Participants
in this exploratory study reported that mindfulness training enhanced their
learning in the classroom and was helpful to their development of counseling
skills. No student reported that the training hindered their learning or skill
development in any way, although some students who had previously been
exposed to mindfulness training felt that it didn’t add to their knowledge,
while others reported that it helped them connect their own personal practice
of mindfulness to their role as a clinical social worker. Thus, the integration
of mindfulness training directly into clinical pedagogy may have specific
utility for a variety of students, including those who already have their own
personal practice of mindfulness.
The existing literature focuses largely on speculating about the poten-
tial benefits of mindfulness training for facilitating the development of the
 Mindfulness as Clinical Training 51

clinician as an individual (Bien, 2008; Fulton, 2005; Morgan & Morgan, 2005).
In this study, students reported that the training also affected their learning
in the classroom as a whole by providing a means of reducing their collec-
tive anxiety and helping them feel more connected to their peers. Changing
the atmosphere of the classroom, in turn, appeared to enhance the effec-
tiveness of traditional training exercises such as role plays, which rely on
collaborative engagement for optimal learning to take place. Mindfulness
training may have unique benefits for groups over and above the benefits
of the training to individuals within the group alone. Indeed, many models
of mindfulness-based interventions (MBSR, MBCT, DBT) offer mindfulness
training in a group format, perhaps to take advantage of these benefits.
The reports of students’ experiences of mindfulness training in this study
offer initial evidence to extend many of the specific hypotheses in the liter-
ature on the benefits of mindfulness training for helping professionals to
novice trainees. Students’ reported that mindfulness provided a means of
enhancing their ability to attend to classmates in training exercises, as well
as helping them to manage distractions and maintain their focus on clients
in session. Mindfulness training appeared to play a significant role in help-
ing participants identify, explore, and manage anxiety, both in the classroom
and in the field, as well as fostering a sense of self-acceptance amidst the
vicissitudes of the training process. Thus, mindfulness training may be partic-
ularly useful to beginning clinicians who are much more likely to be derailed
by anxiety and self-consciousness. By providing a means of helping stu-
dents acknowledge and manage anxiety and other distractions, mindfulness
training may free up further resources for the clinical learning process.
Students also linked mindfulness training to an increased awareness
of their own physical and emotional reactions in training exercises and to
the ability to contain these reactions in session with clients. They identi-
fied drawing on mindfulness practices for their own self-care before, during,
and after sessions. Although they didn’t use the word empathy, they identi-
fied mindfulness as helping to establish a “palpable” emotional connection
with their classmates and their clients alike. Students further identified mind-
fulness training as helping them cope with the ambiguities inherent in the
psychotherapeutic process, enabling them to remain flexible in their thinking
so that they could continue to revise their hypotheses to better meet client
needs. Mindfulness training may, therefore, provide an avenue for helping
students cultivate a broad range of characteristics and skills that contribute
to psychotherapeutic effectiveness.
These findings expand upon prior work by Schure and colleagues
(2008) who reported that mindfulness training fostered a more holistic
approach to counseling among student participants, while also enhancing
their attention and helping them to become more comfortable with silence
in their work with clients in session. Schure and colleagues (2008) were
the first to begin to explore some of the potential benefits of mindfulness
52 A. Gockel et al.

training for clinical education as well as self-care, however, their findings

were somewhat limited by the extent of their available data. Their find-
ings were based on students’ written responses to four open-ended journal
questions, only two of which inquired about the effects of the training on
students’ clinical work and future counseling practice. We extended their
efforts by using semistructured interviews to engage our participants in a
discussion of their experiences of the training, enabling us to solicit new
and unexpected observations. For example, we learned that novice trainees
found the training particularly helpful in coping with their anxiety before and
after meeting with clients. We also learned that some trainees had begun to
regard the practice itself and the concepts connected to it as a framework
for understanding their relationships with clients in session. In this way, the
current study adds to both the breadth and depth of existing knowledge
regarding the potential benefits of mindfulness training for novice clinicians
in the classroom and in the field.
The results of this study highlight mindfulness training as a strategy that
can target both cognition and affect at the same time. In students’ quotations
these two domains frequently overlapped, demonstrating the interconnected-
ness of the cognitive aspect of clinical skill development with the affective or
attitudinal aspects of clinical skill development. In the above quotations, stu-
dents reported that attention fostered connection, affect tolerance supported
the development of self-awareness, and acceptance promoted openness and
cognitive flexibility. This suggests that many of the cognitive and affective
qualities that are facilitative of the therapeutic relationship are interrelated
and it may be important to target their development as a cohesive whole.
Mindfulness training then may not only complement standard cognitive and
behaviorally-oriented training strategies by enhancing the affective or atti-
tudinal components of training, but may actually function to support both
aspects of training at once because they are so integrally interconnected.
The transfer of training remains a key issue in clinical education.
Students who master the cognitive aspects of a skill and can execute the
associated behaviors don’t always succeed in applying this knowledge to
their work with clients in the field (Collins & Bogo, 1986; Kopp & Butterfield,
1986; Lambert & Simon, 2008). By conducting the interviews after students
had made the transition to their field practica, we were able to explore
whether the training remained meaningful as they started to put their nascent
skills to use with clients in the field. The majority of students reported that
they continued to draw on the mindfulness practices they learned in class
in their work with clients, most often to prepare themselves for session,
implement specific counseling skills in session, or to take care of themselves
after session. Students linked their ability to draw on these practices to the
daily use of mindfulness in the classroom and they tended to apply them
for the same purposes. That is, they used mindfulness to enhance their abil-
ity to enact specific clinical skills such as attending, listening, empathizing,
 Mindfulness as Clinical Training 53

understanding, and managing countertransference. A small number of stu-

dents placed in practicum settings that used mindfulness-based interventions
reported that the training also helped them feel more confident with these
approaches, and, as a result, they were better prepared to integrate mind-
fulness exercises directly into their work with clients in individual or group
sessions. These findings suggest that the classroom training transferred to
the field and helped to support students’ integration of core clinical skills.
As the influence of mindfulness-based psychotherapy continues to grow,
it will also be increasingly important to develop pedagogical strategies to
prepare students to acquire skills in applying these models of therapy.

Limitations
This exploratory study was intended to begin to map uncharted terrain
regarding the potential issues and impacts of implementing mindfulness
training as a clinical education strategy. Because our exploration of mind-
fulness training was nested within the context of a broader study on the
effectiveness of the educational strategies used to teach beginning helping
skills, the interview protocol was directed towards exploring the breadth
of students’ training experiences. The fact that mindfulness training was
spontaneously identified as a helpful strategy by the vast majority of partici-
pants (17) highlights the impact of this strategy, given that students were not
primed to focus on mindfulness training specifically. However, the fact that
the interview protocol was so general in turn limited the depth and detail we
were able to gather regarding students’ experiences of mindfulness training.
Most participants reported some previous exposure to mindfulness prac-
tice. This may have facilitated the intervention and affected the nature of the
findings. The three participants who didn’t spontaneously name mindfulness
as a helpful educational strategy were asked a presuppositional question
regarding how mindfulness fostered their learning and skill development,
which may have biased their responses. The study is based on student per-
ceptions of the training alone and their perceptions may or may not relate
to the actual effects of the training on clinical skill development, which
have yet to be tested. The sample population was predominantly Caucasian
Americans of European descent, which doesn’t allow for a consideration of
potential racial, ethnic, or cultural differences in the response to mindfulness
training.

Implications for Research

The results of this study support existing hypotheses in the literature suggest-
ing that mindfulness training may facilitate the development of counseling
skills. This pilot project advanced our knowledge by demonstrating that first
54 A. Gockel et al.

year social work students were responsive to the training and found that it
enhanced their ability to acquire foundational helping skills. Clearly, more
research is both needed and warranted. By exploring student responses to
the training, we now know that future researchers may want to investi-
gate the benefits of mindfulness training in helping novice trainees manage
anxiety, distractions, and countertransference in the therapeutic relation-
ship. Other areas of focus should include investigating whether the training
enhances students’ ability to listen and respond to the client with openness,
warmth, and flexibility. Qualitative studies that gather data from students at
regular intervals throughout the training process may provide a greater depth
of understanding regarding precisely how the training is helpful or hindering
in accomplishing specific early learning tasks.
Quantitative studies that build on this initial effort may begin to test
whether students who receive mindfulness training as part of their clinical
practice instruction acquire, integrate, or transfer skills at different rates than
those who do not. Given that some students understood mindfulness at a
more superficial level as a relaxation strategy, while others better grasped
its full implications, it may be important for future researchers to develop
and test a more intensive version of the training that integrates mindfulness
into a broader variety of exercises and encourages longer periods of practice
in conjunction with clinical learning tasks. The growing popularity of mind-
fulness practices such as yoga and meditation may mean that an increasing
number of students have already been exposed to these disciplines in their
personal lives. Future researchers should begin to survey their populations
regarding prior exposure to mindfulness training to provide context to their
results. This may be most important for quantitative studies where authors
can implement statistical controls for prior practices.
Although the concept of mindfulness is rooted in centuries old Buddhist
traditions, this study adapted the secularized version of the training that has
been popularized and researched in a Western context. Perhaps as a result,
students didn’t comment on the spiritual implications of the practice. The
secularized approach to this training has its pros and cons. It makes the
training widely accessible to students of different faiths and of no faith at all.
However, it is difficult to assess what is lost with respect to the structural and
ethical foundation of the practice by removing it from its traditional religious
context. Another potential loss is the opportunity to more explicitly inte-
grate the spiritual dimension of being into the clinical training environment.
There are meditative traditions within many world religions. Another possible
avenue for future study would be to explore the integration of mindfulness in
social work training from diverse spiritual and religious perspectives and to
compare secular versus spiritually-infused versions of the training. Wachholtz
and Pargament (2005) found that spiritually oriented meditation was more
powerful in reducing anxiety, increasing positive mood and spiritual health,
and fostering a greater tolerance for discomfort than the secular form of the
 Mindfulness as Clinical Training 55

same meditation, suggesting that spirituality makes a unique contribution to

the efficacy of meditation training.

Implications for Social Work Training

The results of this study indicate that mindfulness training may provide a
promising pedagogical resource for social work educators. Instructors may
use mindfulness exercises to enhance students’ ability to focus on a par-
ticular task, to manage anxiety in the learning process, and to connect
with one another to potentiate the opportunity for collaborative learning
in the classroom. Mindfulness training may be particularly useful in helping
students accomplish a number of key early learning tasks in foundational
practice classes. Instructors can implement mindfulness exercises before,
during, and after role plays to help students manage distractions and engage
more readily with their mock clients, potentially facilitating their ability to
listen more effectively and respond more fully to the client. As trainees learn
to observe themselves in interaction through mindfulness, they may become
more aware of the body signals, affective reactions, and cognitive biases
that can drive clinical decision-making for better or for worse. Instructors
can help students explore and integrate the lessons to be gained from these
insights, potentially fostering greater curiosity about the client’s experience
on the students’ behalf, increasing their ability to accept, interpret, and man-
age their own physical and affective responses, and encouraging students
to hold their hypotheses more tentatively. Mindfulness exercises that focus
specifically on helping trainees access their unique strengths, develop empa-
thy for the client, and work compassionately with suffering can be used to
enhance students’ ability to further integrate and embody the core traits and
characteristics that facilitate the development of the therapeutic relationship
and provide a foundation for utilizing the clinical skills they are learning.
The potential of mindfulness training as a pedagogical strategy is not
limited to a foundational practice class alone. The principles underlying
mindfulness training and the insights derived from specific practices may
support learning at a number of sites in the curriculum. For example, classes
that focus on contemporary social problems such as racism, sexism, and
other forms of oppression can get bogged down in the factionalism that
occurs as the dynamics they explore surface in the class itself. Mindfulness
exercises may be helpful in slowing down the process and enhancing lis-
tening, as well as helping students regulate anxiety and defensiveness.
By grounding students in the universalities of human experience, mindful-
ness exercises can open the space for a greater appreciation of and respect
for differences, and a closer examination of the particularities of different
forms of oppression and our participation in them. Similarly, the interde-
pendence of seemingly disparate events is a core insight of mindfulness
practice. Drawing on practices that focus on deepening students’ awareness
56 A. Gockel et al.

of this insight may enhance students’ ability to more fully comprehend the
interconnections between micro, mezzo, and macro levels of practice, fos-
tering a more profound understanding of the dynamic interaction between
government policy and client experiences in the field in social policy classes.
In conclusion, mindfulness training holds great promise as a strategy
for enhancing social work education. The current study suggests that mind-
fulness training may contribute to clinical learning and skill development
among beginning social work students. Mindfulness training may enhance
the effectiveness of existing cognitive and behavioral teaching strategies
while addressing some of the central gaps in clinical pedagogy. Mindfulness
training offers a means of helping students sharpen their cognitive capacities
through training their attention, while fostering a greater breadth of percep-
tion and flexibility in their thinking by helping them observe rather than
identify with their thoughts. Mindfulness training also offers a means of inte-
grating sensory and affective skills into the learning process, which may help
students further develop, integrate and embody the helping skills they are
learning through cognitive and behavioral means. Adding the affective and
attitudinal component to the learning process through mindfulness training
may in turn strengthen students’ ability to transfer their clinical skills from
the classroom to their work with clients in the field. Despite its promise, the
research on mindfulness training as a pedagogical strategy is just beginning.
Future studies will be critical in helping to uncover and develop the potential
promise of mindfulness training for social work education.

NOTE

1. A more detailed description of the adapted protocol may be obtained from the first author.

REFERENCES

Assay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors
in therapy: Quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D.
Miller (Eds.), The heart and soul of change: What works in therapy (pp. 23–55).
Washington, DC: American Psychological Association.
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and
empirical review. Clinical Psychology: Science and Practice, 10, 125–143.
Bien, T. (2008). The four immeasurable minds: Preparing to be present in psy-
chotherapy. In S. F. Hick & T. Bien (Eds.), Mindfulness and the therapeutic
relationship (pp. 37–54). New York, NY: The Guilford Press.
Charmaz, K. (2006) Constructing grounded theory: A practical guide through
qualitative analysis. Thousand Oaks, CA: Sage.
Chodron, P. (2002). Comfortable with uncertainty. Boston, MA: Shambhala.
 Mindfulness as Clinical Training 57

Collins, D., & Bogo, M. (1986). Competency-based field instruction: bridging the gap
between laboratory and field learning. Clinical Supervisor, 4(3), 39–52.
Dinham, A. (2006). A review of practice of teaching and learning of communication
skills in social work education in England. Social Work Education, 25, 838–850.
Epstein, R. M., Siegel, D. J., & Silberman, J. (2008). Self-monitoring in clinical prac-
tice: A challenge for medical educators. Journal of Continuing Education in the
Health Professions, 28, 5–13.
Fulton, P. R. (2005). Mindfulness as clinical training. In C. K. Germer, R. D. Siegel, &
P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp. 55–72). New York, NY:
Guilford Press.
Gehart, D., & McCollum, E. E. (2008). Inviting therapeutic presence. A mindfulness-
based approach. In S. F. Hick & T. Bien (Eds.), Mindfulness and the therapeutic
relationship (pp. 176–194). New York, NY: The Guilford Press.
Gelso, C. J., & Hayes, J. A. (2002). The Management of countertransference. In J. C.
Norcross (Ed.), Psychotherapy relationships that work (pp. 267–283). New York,
NY: Oxford University Press.
Greason, P. B., & Cashwell, C. S. (2009). Mindfulness and counseling self-
efficacy: The mediating role of attention and empathy. Counselor Education
& Supervision, 49, 2–19.
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based
stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic
Research, 57, 35–43.
Hall, K. E. (2009). Anxiety and counseling self-efficacy among counseling students:
The moderating role of mindfulness and alexithymia (Doctoral dissertation).
Available from http://search.proquest.com.libproxy.smith.edu:2048/pqdtft/
docview/304960958/previewPDF/13B6DC0A5C7ED3AB75/12?accountid=13911
(UMI No. 3356126).
Hayes, J. A. (2004). The inner world of the psychotherapist: A program of research
on countertransference. Psychotherapy Research, 14, 21–36.
Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP,
and ACT: How empirically oriented are the new behavior therapy technologies?
Behavior Therapy, 35, 35–54.
Hill, C. E., & Lent, R. W. (2006). A narrative and meta-analytic review of helping
skills training: Time to revive a dormant area of inquiry. Psychotherapy: Theory,
Research, Practice, Training, 43, 154–172.
Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz,
G. E. R. (2007). A randomized controlled trial of mindfulness meditation versus
relaxation training: Effects on distress, positive states of mind, rumination, and
distraction. Annals of Behavioral Medicine, 33, 11–21.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and
future. Clinical Psychology: Science and Practice, 10, 144–156.
Kopp, J., & Butterfield, W. (1986). Changes in graduate students’ use of interviewing
skills from the classroom to the field. Journal of Social Service Research, 9,
65–88.
Lambert, M. J., & Barley, D. E. (2002). Research summary on the therapeutic rela-
tionship and psychotherapy outcome. In J. C. Norcross (Ed.), Psychotherapy
relationships that work (pp. 17–32). New York, NY: Oxford University Press.
58 A. Gockel et al.

Lambert, M. J., & Simon, W. (2008). The therapeutic relationship. In S. F. Hick &
T. Bien (Eds.), Mindfulness and the therapeutic relationship (pp. 19–33). New
York, NY: The Guilford Press.
Morgan, W. D., & Morgan, S. T. (2005). Cultivating attention and empathy. In C. K.
Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp.
73–90). New York, NY: Guilford Press.
Richards, S., Ruch, G., & Trevithick, P. (2005). Communication skills training for
practice: The ethical dilemma for social work education. Social Work Education,
24, 409–422.
Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational
treatment guide. New York, NY: The Guilford Press.
Safran, J. D., & Reading, R. (2008). Mindfulness, metacommunication, and affect reg-
ulation in psychoanalytic treatment. In S. F. Hick & T. Bien (Eds.), Mindfulness
and the therapeutic relationship (pp. 122–140). New York, NY: Guilford Press.
Santorelli, S. F., & Kabat-Zinn, J. (Eds.). (2009). Mindfulness-based stress reduction
(MBSR) professional education and training: MBSR curriculum and supporting
materials. Worcester, MA: University of Massachusetts Medical School.
Schure, M. B., Christopher, J., & Christopher, S. (2008). Mind-body medicine and
the art of self-care: Teaching mindfulness to counseling students through yoga,
meditation, and qigong. Journal of Counseling & Development, 86, 47–56.
Shapiro, S. L., Brown, K. W., Astin, J. A., & Duerr, M. (2008). Toward the integration
of meditation into higher education: A review of the research. Retrieved from
http://www.contemplativemind.org/programs/academic/MedandHigherEd.pdf
Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers:
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., & Izett, C. D. (2008). Meditation. A universal tool for cultivating empa-
thy. In S. F. Hick & T. Bien (Eds.), Mindfulness and the therapeutic relationship
(pp. 161–175). New York, NY: Guilford Press.
Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based
stress reduction on medical and premedical students. Journal of Behavioral
Medicine, 21, 581–599.
Siegel, R. D., Germer, C. K., & Olendzki, A. (2009). Mindfulness: What is it? Where
did it come from? In F. Didonna (Ed.), Clinical Handbook of Mindfulness (pp.
17–35). New York, NY: Springer.
Speeth, K. R. (1982). On psychotherapeutic attention. Journal of Transpersonal
Psychology, 14, 141–160.
Surrey, J. L. (2005). Relational psychotherapy, relational mindfulness. In C. K.
Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy
(pp. 91–110). New York: NY: Guilford Press.
Trevithick, P., Richards, S., Ruch, G., & Moss, B. (2004). Knowledge review: Teaching
and learning communication skills in social work education. London, England:
SCIE/Policy Press/SWAPltsn.
Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of
meditation? Comparing the effects of spiritual meditation, secular meditation,
and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal
of Behavioral Medicine, 28, 369–384.
 Mindfulness as Clinical Training 59

Walsh, R. A. (2008). Mindfulness and empathy. In S. F. Hick & T. Bien (Eds.),

Mindfulness and the therapeutic relationship (pp. 73–86). New York, NY:
Guilford Press.
Walsh, R., & Shapiro, S. L. (2006). The meeting of meditative disciplines and
western psychology: A mutually enriching dialogue. American Psychologist, 61,
227–239.
Whitaker, T., Weismiller, T., Clark, E., & Wilson, M. (2006). Assuring the sufficiency of
a frontline workforce: A national study of licensed social workers. Special report:
Social work services in behavioral health care settings. Washington, DC: National
Association of Social Workers.
Ying, Y. (2008). Variation in personal competence and mental health between enter-
ing and graduating MSW students: The contribution of mindfulness. Journal of
Religion and Spirituality in Social Work, 27, 405–422.
Ying, Y. & Han, M. (2008). Stress and coping with a professional challenge in
entering MSW students: The role of self-compassion. Journal of Religion and
Spirituality in Social Work, 28, 263–283.