Impact Of Mindfullness.pdf

Received 02/14/10 Revised 11/03/10 Accepted 11/16/10 DOI:10.1002/j.2161-1939.2013.00045.x

The Impact of Mindfulness and Meditation Practice on Client Perceptions of Common Therapeutic Factors PAIGE BENTLEY GREASON AND LAURA E. WELEARE

Counselor mindfulness practice may help cultivate common therapeutic factors (e.g., empathy, working alliance). Researchers in this quantitative research study identified significant relationships between therapist mindfulness and client perceptions of the therapist's way of being and the working alliance. The impact of meditation training on these variables was also explored. Keywords: mindfulness, working alliance, counseling relationship, common factors

Despite an ongoing debate among theorists (e.g., Crits-Christoph, 1997; Wampold et al., 1997), decades of research continue to support what humanistic counselors have known all along: Common therapeutic factors such as empathy, congruence, and the therapeutic relationship correlate more highly with client outcome than specific treatment modalities (Hubble, Dimcan, & Miller; 1999; Lambert & Barley, 2001; Sexton, Whiston, Bleuer, & Walz, 1997). Counselor education programs have a variety of techniques available for training future covmselors in the external manifestations (e.g., reflecting feelings) of such common factors as empathy, but proven methods for cultivating the "person" of the counselor are still lacking. A need exists for more explicit information on how best to cultivate a way of being in the counselor that will facilitate the type of interpersonal process necessary for change in clients, as advocated by Rogers (1957). A number of theorists (e.g., Andersen, 2005; Germer, 2005; J. R. Martin, 1997; Walsh & Shapiro, 2006) have suggested that naindfulness training for counselors may fill this need. In fact. Dry den and Still (2006) suggested that the approaches of humanistic psychotherapists, such as Carl Rogers, Viktor Frankl, and Fritz Perls, with their emphases on acceptance and nonjudgment, w^ere precursors to the mindfulness approaches seen in counseling Paige Bentley Greason, School of the Arts, University of North Carolina; Laura E. Welfare, Department of Educational Leadership and Policy Studies, Virginia Tech. Paige Bentley Greason is now at the Health and Counseling Center, University of North Carolina-Asheville. Correspondence concerning this article should be addressed to Paige Bentley Greason, Health and Counseling Center, University of North Carolina-Asheville, CPO 2720, Asheville, NC 28804 (e-mail: [email protected]). © 2013 by the American Counseling Association. All rights reserved. Journal of HUMANISTIC COUNSELING • October 2013 • Volume 52

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today. However, empirical data on the impact of mindfuiness on variables of interest to counselors (e.g., empathy) are limited to self-report studies, and the majority of those studies were conducted with the general population or clinical populations, not counselors. This study was designed to fill a gap in the literature by examining the relationship between counselor mindfuiness and client perceptions of common factors. Because many theorists have suggested that mindfuiness may be a critical variable in the counseling relationship (e.g., Andersen, 2005; Fulton, 2005; Germer, 2005; J. R. Martin, 1997; Shapiro & Carlson, 2009; Walsh & Shapiro, 2006), it is important to gather empirical evidence of such a relationship. The study also examines the impact of counselor meditation practice on levels of counselor mindfuiness and client perceptions of common factors. Theoretically, this research is grounded in the principles of humanism: that the relationship is the core component of counseling and that creating an environment that promotes human development requires nonjudgmental acceptance, optimism, and hope on the part of the counselor (Cain, 2001; Raskin, Rogers, & Witty, 2008). The results of this study will provide counselors as well as counselor educators and supervisors with practical information on ways to cultivate the core skills espoused by a humarüstic approach. The direct relationships between counselor characteristics and client perceptions of the counseling experience were assessed using matched information from counselor-client dyads. Eighty-three college counselors and 83 of their clients from universities across the United States participated. Counselors described their demographic information, counselingrelated credentials, professional experiences, and mindfuiness practices on an information questionnaire. In addition, they completed a measure of mindfuiness and a measure of their cognitions about the client. Clients described their demographic information and completed questionnaires about their perceptions of counselor competence, empathy, working alliance, and overall satisfaction. The results provided empirical evidence for the importance of counselor mindfuiness and meditation practice. REVIEW OF LITERATURE Common Therapeutic Factors

Researchers studying the process of change in clients have suggested that more than any theoretical model, a set of common therapeutic elements seems to underlie effective therapy (Kirshenbaum & Jourdan, 2005). These are often referred to as common factors (e.g., Hubble et al., 1999). Lambert and Barley (2001) outlined four general factors that ii\fluence client change: extra therapeutic factors, expectancy effects (i.e., the placebo effect), specific therapy techniques, and common factors. Lambert and Barley stated that the most commonly researched common factors were Rogers's (1957) core

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conditions (empathy, warmth, and congruence) and the therapeutic alliance. Although current researchers acknowledge that Rogers's core conditions may not be sufficient for all clients, they are "helpful to extremely helpful with virtually all clients" (Kirshenbaum & Jourdan, 2005, p. 43). In their review of the current status of the person-centered approach, Kirshenbaum and Jourdan (2005) concluded that client-centered principles permeated the practice of most therapists and that many schools of counseling have begun to recognize that Rogers's conditions may, in fact, be at the core of therapeutic change. Rogers (1957), whose ideas shaped much of counseling's humanism, hypothesized that change will only occur within the context of a relationship, and he further espoused several characteristics of that relationship that he deemed necessary for therapeutic change—the core conditions. These include a state of incongruence in the client, the ability of the counselor to be congruent in the relationship, and the ability of the counselor to communicate to the client genuine empathy and unconditional positive regard. The majority of research into the relationship between empathy and client outcomes has demonstrated a positive correlation (Bohart, Elliott, Greenberg, & Watson, 2002; Orlinsky, Grawe, & Parks, 1994; Sexton & Whiston, 1994). In their meta-analysis of the relationship between empathy and positive therapeutic outcome, Bohart et al. (2002) reported an unbiased effect size of .32, which is considered a medium effect. Watson (2001) stated that after almost 60 years, research findings demonstrate consistent evidence that empathy is "an essential component of successful therapy in every therapeutic modality" (p. 445). Orlinsky et al. (1994) foimd positive relationships between "affirmation," which includes warmth and positive regard, and positive outcomes. Kirschenbaum and Jourdan (2005) reported that research on congruence is more equivocal and suggested that this may be due to the lack of clarity in Rogers's defirütion of congruence. In the current study, the authors measured client perceptions of counselor qualities that Rogers espoused as necessary, including positive regard, empathy, unconditionality, and congruence. In addition to Rogers's core conditions, common factors include the therapeutic relationship itself, which is generally defined as a sense that the therapist and client care for each other and that they can work together toward a shared goal (Lambert & Barley, 2001). In the current study, the researchers (authors) refer to the relationship between the therapist and the client as the working alliance and define the alliance based on Bordin's (1979) integrative model. Bordin outlined three related components considered essential for a strong working alliance: (a) agreement between counselor and client on goals, (b) agreement on the tasks required to achieve these goals, and (c) the development of an interpersonal bond between the counselor and client. Empirical evidence supports the relationship between the working alliance and therapeutic outcome (D. J. Martin, Garske, & Davis, 2000). Furthermore, researchers have shown that the working alliance

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is stronger when clients have therapists who are able to be empathie, communicate unconditional positive regard, and be congruent (Bums & Nolen-Hoeksema, 1992), suggesting that facilitating the development of therapist core conditions may result in a stronger therapeutic relationship and, ultimately, a more positive therapeutic outcome. Despite the strong empirical support for the importance of the common factors, very little research has been conducted on the best ways to cultivate these factors. Researchers have found that current counselor education methods are effective in teaching discrete behavioral skills such as reflection of feelings and attending behavior (e.g.. Baker, Daniels, & Greeley, 1990; Hill & Lent, 2006). Little is known, however, about the development of the less tangible way of being or mental skills (e.g., how to sustain attention, how to observe thoughts) in therapists. Many researchers and critics of counselor education suggest that trairüng programs do not do enough to develop the person of the counselor or the requisite cognitive skills for establishing a strong working alliance (Bergin, 1997; Fong, Borders, Ethington, & Pitts, 1997; Germer, 2005; Nelson & Neufeldt, 1998). Together, this suggests that new training approaches may be needed. Mindfulness meditation practice may nil this gap. Mindfiilness Interest in mindfulness and its potential to alleviate human suffering and increase human connection has increased dramatically in recent years. The number of mindfulness-related articles in various journals, including counseling, psychology, and medical journals, jumped from less than 80 in 1990 to more than 600 in 2006 (Brown, Ryan, & Creswell, 2007). For decades, theorists have proposed that meditation practice of any sort may have a positive impact on the person of the therapist, resulting in a stronger working alliance with clients (e.g., Andersen, 2005; Fritz & Mierzwa, 1983; Fulton, 2005; Germer, 2005; Keefe, 1974; Lesh, 1970; J. R. Martin, 1997; Shapiro & Carlson, 2009; Walsh & Shapiro, 2006). Perhaps because of the clirücal success of mindfulness-based interventions for clients (e.g., KabatZinn, 1982; Linehan, 1993; Segal, Williams, & Teasdale, 2002), researchers have begun to explore the impact that mindfulness and mindfulness meditation may have on counselor development (Greason & Cashwell, 2009; Grepmair et al., 2007; Schure, Christopher, & Christopher, 2008; Shapiro, Brown, & Biegel, 2007). Although theorists still grapple with an operational definition of mindfulness (e.g.. Bishop et al., 2004; Hayes & Shenk, 2004), and different schools of thought emphasize certain characteristics more than others, most researchers and theorists agree that mindfulness is a multifaceted construct. The seminal definition is "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" (Kabat-Zinn, 1994, p. 4). Linehan (1993) defined mindfulness as comprising six skills:

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three skills are related to what the person is doing (observing, describing, and participating) and three skills are related to how the person is doing the what skills (nonjudgmentally, one-mindfuUy, and effectively). Mindfulness represents the opposite of mindlessness, which is characterized by a lack of awareness about current experience and possible preoccupation with the past or the future. Examples of mindlessness include such things as breaking or spuling things out of carelessness, forgetting a person's name as soon as it is uttered, and snacking without being aware of eating (Brown & Ryan, 2003). Theorists consider mindfulness both a skill and a way of being that can be cultivated through formal and informal mindfulness pracfices (Brown & Ryan, 2003; Brown et al., 2007; Cermer, 2005; Shapiro & Carlson, 2009). Mindfulness is a process of observing present moment experience nonjudgmentally without attachment to a particular point of view, resulting in freedom from automatic, habitual views of the self and others (J. R. Martin, 1997). In contrast, when in a nonmindful, "automatic pilot" mode, the individual views various experiences through the lens of judgment, labels, and cognitive schémas informed by past experience (Abreu, 2001; Brown et al., 2007). For example, a counselor operating in an automatic, nonmindful mode may judge a client's frequent comments about his mother as an Oedipal complex and relate to the client as if the client were someone with an Oedipal complex. As all humans do, this counselor is viewing the client's situation through the lens of the counselor's trairüng and past life experiences (Abreu, 2001). In contrast, a cotmselor trained in mindfulness practices might notice his tendency to view the client in a particular way. For instance, he might notice that he is having the thought—this client has an Oedipal complex—and then move back into the process of just observing and being curious about the client's experience. The difference between the two coxmselors is that the first reacts automatically to thoughts as if they were facts—without awareness that they are formed by the counselor's own experiences. The second counselor is aware that the thought has arisen, that the thought is just one part of the continuous fiow of mental acfivity that may influence how the cotmselor responds to the cfient, and that the thought is just a thought—not a fact. Mindfulness can be cultivated through formal or informal practice. Formal practice of mindfulness includes such things as sitting meditation and yoga. Kabat-Zinn (2003) referred to formal meditafion as the "laimching platform" (p. 147) or scaffolding used to culfivate a mindfulness way of being. Informal pracfices can occur spontaneously during acfivifies of daily living or during the therapy session. It involves making a conscious intention to be nonjudgmentally aware of the unfolding of the present moment, whether the present moment is making coffee, eating lunch, or listening to a cfient. Mindfulness meditation practices represent an expansion of traditional concentration meditation practice. The begiruiing mindfulness practitioner starts with learning to sustain focus as in concentration

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practices (e.g., focusing attention on the breath and bringing the attention back to the breath when it has wandered). As this capacity grows, the practice expands from the "laser" focus found in concentration practices to a "searchlight" (Germer, 2005, p. 15) focus that allows all aspects of current experience to be held in mindful awareness. Researchers have found that concentration-based practice is related to an increase in mindfulness (Tanner et al., 2009), suggesting that meditation practice of any sort may result in increased mindfulness. Many of the potential outcomes of being more mindful align with Rogers's core conditions. Cashwell, Bentley, and Bigbee (2007) suggested that mindfulness practice may be beneficial for therapists and the therapeutic relationship in many ways, including erüianced attention and concentration skills; expanded affect tolerance and acceptance; greater self-awareness and empathy; enhanced use of self in counseling; and greater therapist wellbeing. In the aforementioned example, for instance, the counselor practicing mindfulness reduced his vulnerability to habitual modes of thinking by stepping back and seeing the larger picture, thus cultivating the capacity for alternative perspective taking. This wider perspective enhances "psychological freedom" (J. R. Martin, 1997, p. 291) and the ability to relate empathically to the experiences of others. Similarly, Brown et al. (2007) identified six outcomes of mindfulness, including clarity of awareness, nonconceptual, nondiscriminatory awareness; flexibility of awareness and attention; empirical stance toward reality; present-oriented consciousness; and stability or continuity of attention and awareness. Like a musician who spends time honing musical skills before a recital, the counselor who is practicing mindfulness outside the session is likely to bring a honed ability to be nonjudgmentally present to the therapy session. Germer (2005) suggested that given the importance of common factors in the therapy, these potential outcomes could sigrüficantly augment the therapist's capacity for building a strong working alliance. Researchers have found empirical evidence among therapists to support the proposed relationship between mindfulness and qualities that are theoretically related to a strong therapeutic relationship. In a study of mental health therapists in training, Shapiro et al. (2007) found that training in mindfulness resulted in decreased anxiety and increased self-compassion. Similarly, Greason and CashweU (2009) found the mindfulness was related to higher self-reported empathy and ability to control attention in the therapy session among student counselors. Schure et al. (2008) reported similar findings in their qualitative study of counselors in training. Among the general population, researchers have found mindfulness-based approaches helpful in building relationships. Carson, Carson, Gil, and Baucom (2004) found that mindfulness training resulted in an increase in distressed couples' reported satisfaction, relatedness, and acceptance, among other positive outcomes. No studies were found, however, that examine the relationship between client perceptions of counselor core conditions and the working

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alliance with self-reports of counselor mindfuiness. The authors in this study seek to fill this gap in the literature. PURPOSE OF THE STUDY The purpose of this exploratory study was to address an important gap in the covmseling literature regarding the relationship between counselor mindfuiness and client perceptions of the counselor and the counseling relationship. It also explored the impact of counselor meditation practice on counselor mindfuiness, client perceptions of common factors, and client perceptions of the working alliance. The following research questions were addressed in our sample of college counselors: 1. How do levels of counselor mindfuiness compare with levels of nxLndfulness in the general population? 2. What are the relationships between counselor mindfuiness and client perceptions of counselor level of regard, empathy, unconditionality, congruence, and the working alliance? 3. Are there differences in counselor mindfuiness, common factors, and working alliance between counselors with a meditation practice and those without a practice? METHOD Participants

Participants were 83 college counselor-client dyads. A stratified random sample of coUege counseling centers was selected on the basis of the Council for Higher Education Accreditation database (n.d.) of accredited colleges and universities. Sixteen percent (n - 495) of the accredited colleges in each geographic region (i.e.. Middle States, New England, Southern, Western, North Central, and Northwest regions) were included in the initial invitation for participation. An e-mail invitation was sent to the director of each college counseling center (as listed on the university webpage) requesting the director to identify one or two counselors who may be willing to participate in the study. Two weeks later, a reminder e-mail was mailed to the nonresponding directors. Directors who replied with the names of interested counselors were thanked for their reply, and a packet of study materials that included two small tokens of appreciation was mailed (via US Postal Service) to the attention of the interested counselors. Two-hundred and eighteen counselors were identified in this marmer (n = 53 from Middle States, n = 16 from New England, n = 54 from North Central, n = 15 from Northwest, n = 54 from Southern, and n = 26 Western regions). Of the 218 packets mailed, 83 were returned completed, 14 were returned incomplete, and 141 were not returned, resulting in a 38% response rate (i.e., 83/218

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= .38). For the purposes of this study, the college counselors were divided into two groups. The ftrst group (n = 44) reported no weekly meditation practice, and the second group (n = 39) reported having a weekly meditation practice, including such practices as sitting meditation, yoga, and prayer. Instrumentation: Counselors College counselors were asked to complete two assessments for this study: the Five Factor Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006) and the College Counselor Information Form. At the same time, counselors completed the Counselor Cognitions Questionnaire (Welfare, 2006) to answer separate research questions that are not included in this article. FFMQ. The FFMQ is a synthesis of several recently developed mindfulness questionnaires. Consequently, the FFMQ represents the collective understanding among scholars of what mindfulness is and how it should be operationalized. Baer et al. (2006) found that the five mindfulness questionnaires that informed the FFMQ all demonstrated good internal consistency (.81 to .87) and were correlated with one another and with meditation experience as expected. The 39-item FFMQ measures five factors of mindfulness: Observe (i.e., attending to various stimuli). Describe (i.e., putting words on observed experience). Act with Awareness (i.e., focusing attention fully on the current experience—the opposite of absentmindedness), Nonjudge (i.e., accepting current experience without applying evaluative labels), and Nonreact (noticing phenomena without have a reaction to it). All the items of the Nonjudge and Act with Awareness subscales are phrased in the negative and reversed scored (e.g., "I tell myself I shouldn't be feeling the way I'm feeling"). The five factors form a total mindfulness score, which reflects a global measure of mindfulness. The FFMQ uses a 5-point Likert-type scale (1 = never or very rarely true, 5 = very often or always true). Internal consistency factor coefficients range from 0.75 to 0.91, and Baer et al. (2006) reported an estimate of reliability of.96 for the total instrument, with interfactor correlations ranging from.l5 to .34. In the current study, the internal consistency reUabüity for the total scale was .91 as indicated by Cronbach's alpha (see Table 1 for subscale reliabilities). College Counselor Information Form. College counselors described their counseling and supervisory experience, graduate studies, mindfulness practices, and demographic information on a brief questionnaire designed by the researchers for this study. Instrumentation: Clients The cHents completed three measures: The Working Alliance Inventory-Short Form (WAI-SF; Tracey & Kokotovic, 1989), the Barrett-Lennard Relationship Inventory-Other-to-Self (Ver. 2, BLRI-OS-40; Barrett-Lennard, 1995), and

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the College Student Information Form. At the same time, clients completed the Client Satisfaction Inventory and the Counselor Rating Form to answer separate research questions that are not included in this article. WAI-SF. The WAI-SF was developed from the 36-item WAI (Horvath & Greenberg, 1989). It includes 12 items that describe the therapeutic alliance between a counselor and a client. Researchers have found that the WAI-SF and the full-length version are comparable in reliability, validity, and factor structure (Busseri & Tyler, 2003; Tracey & Kokotovic, 1989). The respondent indicates how often each statement is true on a 7-point scale (1 = never, 7 = always). The three subscale scores (i.e.. Goal, Task, and Bond) and total score are used frequently in counseling research. The Goal subscale includes four items about the focus of therapy (e.g., "We agree on what is important for me to work on"). The Task subscale includes four items about the work the counselor and client are doing in therapy to accomplish goals (e.g., "I believe the way we are working on my problem is correct"). The Bond subscale includes four items about the personal relationship between the counselor and client (e.g., "My counselor and I trust one another"). In their study comparing the long and short versions of the WAI, Busseri and Tyler (2003) found that total client scores on the WAI-SF had an internal consistency of .91 at fourth-session ratings and .92 at the final session (Busseri & Tyler, 2003). They also found that subscale reliabilities ranged from .80 to .86. In the current study, the internal consistency reliability as indicated by Cronbach's alpha for the total instrument was .91 (see Table 1 for subscale reliabilities). BLRÎ-OS-40. The BLRI-OS-40 is based on the Barrett-Lennard Relationship Inventory(BLRI; Barrett-Lennard, 1962), which was developed to measure empathy, level of regard, congruence, and unconditionality and has been used extensively in counseling research. It is based on Rogers's (1957) theory of conditions in the counseling relationship that are necessary for therapeutic change and is regarded as one of the leading measures of empathy in the counseling profession (Hill, Nutt, & lackson, 1994). Separate versions of the BLRI are available to assess both counselor and client perceptions of the relationship (i.e., myself-to-the-other and other-to-self), making it singularly indicated for use in this study of client outcomes. In the BLRI-OS-40, clients rate counselors on the extent to which clients felt the counselors understood them in the session; it includes four subscales (i.e.. Level of Regard, Empathy, Unconditionality, Congruence). Items are answered on a 6-point Likert-type scale ranging from -3 {No, I strongly feel that it is not true) to +3 {Yes, I strongly feel that it is true). Barrett-Lennard (2003) reported that there is extensive evidence of reliability for the instrument. For instance, Gurman (1977) averaged the test-retest reliability correlations for each scale from 10 samples and found that the average coefficients were .80 and higher. In the same report, Gurman found an average internal consistency across all four scales of .84. In the current study, the internal consistency reli-

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ability as indicated by Cronbach's alpha for the total scale was .92 (see Table 1 for subscale reliabilities). College Student Information Form. The College Student Information Form includes three items about demographic informafion: age, gender, and race/ ethnicity and was designed by the researchers for this study. Procedure

Following institutional review board approval, college counselors who were named by their directors as agreeing to parficipate received a package that included one college counselor participation packet, one college student participation packet, two tokens of appreciation, and instructions for participation. College counselors were asked to invite one of their current clients to participate in the study. Clients were provided an envelope in which they could seal their responses and were asked to return the sealed envelope to the counselor. The counselor was asked to complete the counselor participation packet and return both participation packets in the envelope provided. In appreciation of their time, clients and counselors were given a travel-size first aid kit (valued at approximately $2.00). Data Analyses

To examine the relationship between counselor mindfulness assessed with the FFMQ, client perceptions of counselor core conditions assessed with the BLRI-OS-40, and the working alliance assessed with the WAI-SF, Pearson product-moment correlations were conducted. To reduce the probability of Type I error (Leary & Altmaier, 1980), a multivariate analysis of variance (MANOVA) was used to explore mean differences in key variables between counselors who reported having a weekly meditation practice and those who reported not having a weekly practice. RESULTS Demographics

The 83 college coimselors ranged in age from 24 years to 69 years, with a mean age of 42.88 years and a standard deviation of 11.69 years (median = 40 years; modes = 28,37, and 49 years). One respondent did not answer this item. Sixty-three (75.9%) of the counselors were White, eight (9.6%) were Black or African American, one (1.2%) was Asian, four (4.8%) were Hispanic, and six (7.2%) identified as other or multiracial. (One participant did not answer this question). Fourteen college counselors (16.9%) were male, whereas 68 counselor participants (81.9%) were female. (One participant did not answer this question). The participants held a variety of mental-health-related degrees. Fifty-eight of the college counselor participants (69.9%) held master's

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degrees (in psychology, n = 10; in counseling, n = 33; in social work, n = 12; in marriage and family therapy, n = 3). Nineteen (22.9%) held doctoral degrees (in psychology, ÍÍ = 14; in counseling or counselor education, n = 5). Five counselors (6%) held other mental-health- or student-development-related degrees, and one respondent did not answer this item. The college counselor participants reported a range of years of experience providing counseling services. The mean years of experience providing college coimseUng services was 6.53, with a mean of 6.67 years of additional counseling experience in noncollege settings (College range = .08 to 38, median = 4, mode = 2; Noncollege range = 0 to 30, median = 4, mode = 0). College coimselors who reported having some sort of weekly meditation practice reported spending 1 to 10 hours per week in formal meditation practice (e.g., yoga, sitting meditation), with a mean of 3.65 hours per week {SD = 2.44). The college client participants ranged in age from 18 to 43 years (M = 23.22, SD = 4.42, median = 22, mode = 21). Sixteen college client participants (19.3%) were male, and 67 (80.7%) were female. Sixty-two clients (74.7%) were White, six (7.2%) were Black or African American, three (3.6%) were Asian, three (3.6%) were Hispanic or Latino, and nine (10.8%) identified as other or multiracial. Mindfuiness of Counselors

Scores for Total Mindfuiness (see Table 2) on the FFMQ had a mean of 147.69 (SD = 15.46). The subscale with the highest average score was the Describe subscale (M = 32.41, SD = 4.41), followed by Nonjudge (M = 31.94, SD = 5.35), Act with Awareness (M = 29.44, SD = 4.45), Observe (M = 29.00, SD = 5.10), and Nonreact (M = 24.80, SD = 4.20). In contrast, Baer et al. (2006) reported mean scores for 268 adults of 26.45 (SD = 5.95), 27.80 (SD = 5.89), 25.21 (SD = 5.80), 24.50 (SD = 4.96), and 20.46 (SD = 3.81) for the five subscales, respectively, demonstrating that coimselor mindfuiness scores are higher than those of the general population. TABLE 2 Five Factor Mindfuiness Questionnaire (FFMQ) Norm Comparison Study Sample (W = 83) FFMQ Subscale Observe Describe Act with Awareness Nonjudge Nonreact Total

M 29.00 32.41 29.44 31.94 24.80 147.69

Norms {N = 268)°

SD

M

SD

5.10 4.41 4.45 5.35 4.20 15.46

24.50 26.45 25.21 27.80 20.46

4.96 5.95 5.80 5.89 3.81

«Baer et al. (2006).

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Mindfulness in Relation to Common Therapeutic Factors

The relationship between mindfulness in counselors and client perceptions of counselor core conditions and the working alliance was examined using a Pearson product-moment correlation (see Table 1). Counselor Observe scores were significantly correlated with three of the four BLRI-OS-40 subscales (Level of Regard, r = .28; Unconditionality, r = .23; Congruence, r = .33) and with Total BLRI-OS-40 (r = .29). Counselor FFMQ Total scores were significantly related to three BLRI-OS-40 subscales, including Unconditionality (r - .26, p < .05), Congruence {r = 23, p < .05), and Total BLRIOS-40 (r = .24, p < .05). Counselor scores on the FFMQ Observe subscale also were significantly related to client perceptions of the working alliance as measured by the WAI-SF (Task, r = .29; Bond, r = .27; Goal, r = .24; p < .05) and with the Total WAI-SF (r = .30, p < .01). As expected, on the basis of previous literature, client perceptions of the working alliance (WAI) and client evaluation of counselor core conditions (BLRI-OS-40) were all significantly related (p < .01). It is interesting that the Empathy subscale of the BLRI-OS-40 was not correlated to any of the mindfulness subscales. Impact of Meditation Practice

To avoid inflating the probability of a Type I error, the impact of weekly meditation experience on levels of mindfulness and client perceptions of counselor core conditions and the working alliance was examined using a MANOVA. As can be seen in Table 3, the meditation group (n = 39) had higher scores on most scales compared with the nonmeditation group (n = 44). Significant differences based on weekly meditation practice were found for the FFMQ Observe subscale, f (1, 74) = 8.40, p < .01, and the WAI-SF Bond subscale, F(l, 74) = 3.07, p < .05. Although these were significant, the practical significance was low, with rf = .10 and rf = .04, respectively. DISCUSSION Theorists have suggested that mindfulness may be an important training tool for cultivating the way of being in counselors that leads to a stronger working alliance and positive client outcomes. Recently, researchers have found evidence to support this hj^othesis. The researchers in this study of college counselors add an important element to this growing body of literature—the client's perspective. The positive correlation between counselor mindfulness, particularly counselors' ability to observe present moment experience, and client perceptions of common factors in therapy provides empirical evidence of the importance of mindfulness. The Observe subscale of the mindfulness measure was positively correlated with client perceptions of counselors' level of regard, unconditionality, and congruence as well as all aspects of the working alliance. Also, counselor scores

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TABLE 3 Means, Standard Deviations, Mean Differences, and Effect Sizes for the Five Factor Mindfutness Questionnaire (FFMQ), Working Alliance Inventory-Short Form (WAI-SF), and Barrett-Lennard Relationship Inventory-Other-to-Self (BLRI-OS-40) Group Total Sample (W = 83) Measure

M

SD

WMP (n = 39) M

SD

FFMQ Observe 29.00 5.01 30.56 4.78 Describe 32.41 4.41 32.64 4.30 Act with Awareness 29.44 4.46 29.28 4.36 Nonjudge 31.94 5.35 31.70 5.38 Nonreact 24.80 0.20 24.90 4.42 Total 147.69 15.46 149.15 16.56 WAI-SF Task 6.08 0.77 6.12 0.82 Bond 6.33 0.72 6.46 0.59 Goal 5.95 0.91 5.89 0.95 Total 6.12 0.71 6.16 0.72 BLRI-OS-40 Level of Regard 24.25 5.10 25.02 4.46 Empathy 23.10 5.93 23.47 6.45 Unconditionality 18.43 6.85 19.00 7.43 Congruence 20.44 6.38 21.68 6.36 Total 86.29 20.71 89.18 20.92

NMP (n = 44) M

SD

MANOVA Results" M Dm SEDiff

F

5.02 27.88 4.55 32.21 4.58 29.58 5.38 32.09 4.04 24.71 146.33 14.43

2.98 0.43 -0.30 -0.32 0.18 2.82

1.08 0.98 0.99 1.19 0.94 3.44

8.40" 0.37 0.32 0.10 0.01 0.70

.10 .01 .00 .00 .00 .01

0.72 0.81 0.88 0.72

0.07 0.24 -0.11 0.07

0.17 0.16 0.20 0.16

0.08 3.07* 0.07 3.47

.00 .04 .00 .01

5.58 23.53 5.49 22.77 17.90 6.34 19.31 6.25 83.55 20.39

1.49 0.71 1.10 2.37 5.63

1.14 1.33 1.54 1.41 4.68

1.64 0.32 0.52 2.47 1.45

.02 .00 .01 .03 .02

6.05 6.22 6.01 6.09

Note. WMP = weekly meditation practice; NMP = no meditation practice; M Diff = mean difference; SE Diff = standard error difference. ^Multivariate analysis of variance for the WMP group compared with the NMP group.

'p< .05. •*p< .01.

of total mindfulness were positively correlated with client perceptions of counselors' unconditionality, congruence, and total scores on the measure of core conditions. The study found that those counselors with a weekly meditation practice of some sort had higher levels of overall mindfulness, higher levels of the mindfulness Observe skill, and higher ratings by clients on all of the core conditions measured by the BLRI-OS-40 subscales (i.e.. Level of Regard, Empathy, Unconditionality, and Congruence) and three of the four WAI-SF subscales (i.e.. Task, Bond, and WAI-SF Total). Moreover, the WAI-SF Bond subscale was significantly different based on meditation practice, suggesting that clients felt more of personal bond to those counselors who had a weekly meditation practice. These findings are congruent with theory and empirical evidence suggesting that meditation practice of some sort results in increased mindfulness skill (Cohen-Katz et al, 2005; Shapiro et al., 2007); the Baer et al. (2006) study found evidence that the FFMQ Observe subscale may be the most sensitive to meditation experience. Baer et al. suggested that the Observe subscale may be assessing a different aspect of mindfulness than the other

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four scales. The Observe subscale includes statements that address awareness of sensations, whereas the other subscales focus primarily on thoughts and emotions. Because the authors in this study foimd a significant relationship between the Observe subscale and client perceptions, awareness of sensations may be an important skill for the effective counselor. The study also provides support for the theorefical relafionship between counselor mindfulness and common factors (i.e., counselor core conditions and working alliance). More mindful counselors may be better able to hold the client in imconditional positive regard as they would be less inclined to make judgments about the client based on the counselor's own ideals or values. Furthermore, mindful counselors may be with clients in a more genuine and congruent way because they won't be as judgmental of their own experience. For example, they might be able to honestly share their feelings of discormecfion from the client rather than hiding those feelings out of shame. Ultimately, this being with rather than doing to may create a covmseUng space where clients feel supported and free to find their own way. The authors in this study found that college counselors, in general, have higher mindfulness scores than the average population as assessed in the development and validation studies of the FFMQ. If mindfulness is indeed an important ingredient in effecfive therapy, then it may be possible that the people who are attracted to counseling as a career are naturally more inclined to be mindful. It may also be an indication that the curriculum in covmselor education programs is already increasing counselor capacity to be mindful despite a lack of explicit mindfulness training. A surprising finding was that coimselors with a meditafion pracfice had slightly lower scores on the Nonjudge and Act with Awareness subscales of the mindfulness instnmient, although the effect size of these differences was insigrüficant {•rf= .00). These nonsignificant differences between groups may have been due to the small sample size or Mmitafions in the instruments. AddifionaUy, those individuals who are more mindful may actually be more aware of times when they are judging their internal and external experience, so they may respond to quesfions about their tendency to judge experience posifively; however, less mindful individuals may answer negafively simply because they are not even aware that they are judging their experience. Furthermore, as menfioned earlier, these two subscaJes are the only subscales that are completely reverse scored. Reverse-scored items on mindfulness instruments are actually asking about mindless states. Several authors suggest that mindless states are probably more common and, therefore, easier to recognize and acknowledge, parficularly among individuals who are more aware of their experience in the first place (Baer, Srrüth, & Allen, 2004; Brown & Ryan, 2003). Another unexpected finding was the low correlation between the Empathy subscale of the BLRI-OS-40 and any of the mindfulness subscales. When differences in levels of perceived empathy were examined based on meditation experience, however, perceived empathy was higher in the meditation group than in the nonmeditation group.

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CONCLUSION Counselors, coimselor educators, and supervisors now have some empirical evidence that meditation practice may help counselors cultivate the way of being proposed by Rogers (1957) and other humanistic theorists as important for effective counseling. In this study, counselors with a meditation practice of some sort had higher scores than counselors without a meditation practice on measures of counselor mindfulness and client perceptions of common factors and the working relationship. Furthermore, counselor mindfulness was positively correlated with the core conditions and the working alliance. On the basis of these findings, mindfulness practice may be helpful ii\ cultivating the characteristics in counselors and in the counseling relationship proposed by humanism as key to client growth. Counselors should consider adopting a personal meditation practice to further develop their core skills. Furthermore, counselor educators and supervisors might consider integrating meditation practices into the education curriculum or supervision recommendations for counseling students and supervisees. The results of this study should be viewed in light of several study limitations. Although the sample does include counselors from across the country and from a variety of racial backgrounds, the sample population is limited to college counselors who agreed to participate and who may not be representative of the counselor population. A larger sample size is recommended for future research. The study asked counselors to have just one client complete the instruments, limiting the range and variability of client responses. Furthermore, information on the length of the counseling relationship was not obtained. Future research should include responses from more than one client and gather information on the length of the relationship. Causality also carmot be assumed. It is unclear whether the meditation practice contributed to the increase in mindfulness or whether more mindful counselors are naturally drawn to meditation practices. Building on these findings, future research could include a randomized experimental design to help determine causality with respect to meditation practice. In addition, qualitative information on the counseling relationship from clients would add a more phenomenological understanding of the relationship between meditation practice, counselor mindfulness, and the counseling relationship. REFERENCES Abreu, J. M. (2001). Theory and research on stereotypes and perceptual bias: A didactic resource for counseUng trainers. The Counseling Psychologist, 29, 487-512. Andersen, D. T. (2005). Empathy, psychotherapy integration, and meditation: A Buddhist contribution to the common factors movement, journal of Humanistic Psychology, 45,483-502. Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills. Assessment, 11,191-206.

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