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25

Training Professionals in

Mindfulness: The Heart of Teaching

Susan Lesley Woods

“The most practical thing we can achieve in any kind of work is insight

into what is happening inside of us as we do it. The more familiar we

are with our inner terrain, the more surefooted our teaching – and

living – becomes.”

Parker Palmer

There is currently substantial interest in the use of mindfulness-based

approaches in clinical practice. This raises a number of interesting questions

regarding the training of health professionals. There are a number of treat-

ment modalities utilizing mindfulness but not as yet collective agreement

as to the components and characteristics of mindfulness as they relate to

the clinical setling. Furthermore, some mindfulness-based clinical programs

employ mindfulness practice as the key to their approach, while others use

mindfulness as a set of skills. The heart of mindfulness, however, is more

than a clinical method or skill set, and because of this presents some atyp-

ical challenges for professional training. This chapter will outline the ways

in which some mindfulness-based trainings are distinctive from other profes-

sional training programs.

Health care professionals are used to being instructed in particular theo-

ries and techniques and then gaining direct experience from the application

of those techniques in clinical practice. And, indeed, some aspects of mind-

fulness can be taught through our usual ways of communicating knowledge

via the transmission of concepts and through intellect. But there is a large

part of mindfulness that can only be truly discovered and communicated

when the clinician/instructor embodies this approach whole-heartedly. By

this, we mean going beyond method to connect to heart, “meaning
heart

in its ancient sense, as the place where intellect and emotion and spirit will

converge in the human self”
(Palmer & Parker, 1998).
This places a different emphasis on clinical learning because it means delivering mindfulness

from a position that resonates with an authenticity about what the practice

brings to the life of the clinician. Unfortunately, it is beyond the scope of this

chapter to comment on every clinical program that incorporates aspects of

mindfulness-based practices. So, the focus will be on just two, mindfulness-

based stress reduction (MBSR)
(Kabat-Zinn, 1990)
and mindfulness-based

cognitive therapy (MBCT)
(Segal, Williams, & Teasdale, 2002).
Because these two programs emphasize the practice of formal and informal mindfulness, it

allows us to discuss elements of mindfulness as they are taught in the MBSR

463

464

Susan Lesley Woods

and MBCT programs and how these are embodied by the teacher. Through

embodiment, the teacher models a way of communicating a sense of unity

and integration about the experience of mindfulness and her/his relation-

ships in the world; one that offers an genuine presence. From this position,

we can address key questions about training.

MBSR is the foundational program upon which many other clinical

approaches have been based. MBSR and MBCT are fundamentally the same

but are different in the clinical groups they are intended for and the way in

which learning is targeted. These two programs, delivered in a group for-

mat, provide a rigorous training in formal daily mindfulness meditation and

how to integrate its practice into daily living. MBSR works with patients who

present with a broad range of medical, psychological and stress related diag-

noses. MBCT, targets a specific clinical population, those who are vulnerable

to a relapse of depression and adds an additional component, elements of a

traditional psychological treatment, cognitive behavior therapy.

The Heart of the Matter

Mindfulness originates from the Buddhist contemplative tradition. It has

been described as an, “awareness that emerges through paying attention

on purpose, in the present moment, and nonjudgmentally to the unfold-

ing of experience moment by moment.”
(Kabat-Zinn, 2003;
Baer, 2003).

Dimidjian and Linehan have posited that key components of mindfulness

can be categorized into “(1) observing, noticing, bringing awareness; (2)

describing, labeling, noting; and (3) participating.” They also identify three

characteristics embedded in the way one engages with these activities, “(1)

nonjudgmentally, with acceptance, allowing; (2) in the present moment,

with beginner’s mind; and (3) effectively”
(Dimidjian & Linehan, 2003).
This constructive description of what constituent components and characteristics might be embedded in mindfulness is helpful in bringing some clar-

ity to the factors we are practicing with and engaging in when teaching

mindfulness.

The practice of mindfulness offers a means to directly observe the nature

of thoughts, emotions, and physical sensations and the ways in which they

either contribute to happiness, or to suffering. Attention is directed to the

examination of all experience as it arises in the present moment. It is not

a passive process but rather a kindhearted and intentional engagement of

wakefulness. With sustained practice, it is possible to see the many ways

we get hijacked by wishing things to be different from what is actually

present. As a result of continuing effort, energy and patience, this “aware-

ness” presents the possibility of less reliance on self-absorbed thinking, emo-

tions and behaviors and wider choices especially when presented with stress-

ful situations or difficulties.

Until recently, in the west, little emphasis has been placed on the study of

the human mind in understanding the role of positive mental states and emo-

tions. Instead psychology has paid attention to negative mood and thought

disorders and to the development of a range of psychological interven-

tions that are designed to work with unhelpful modes of mind. Directing

Chapter 25 Training Professionals in Mindfulness

465

attention towards investigating those mental states that engender happiness,

loving-kindness, compassion, joy, generosity, and equanimity has been largely

neglected. Also ignored, until recently, have been methods of teaching such

positive mind states as kindness and compassion in the establishment and

development of the therapeutic relationship. Instead the focus has tended to

rely on a sense of constructive neutrality informed by a particular theoretical

technique or a blend of various methods as a way to work through material

presented in therapy
(Freedberg, 2007).

In both Western psychology and Buddhist contemplative tradition, emo-

tions and mental constructs are seen as strong influences in how people

think and behave. Several schools of Buddhism teach that some qualities of

mind are more helpful than others for creating long lasting happiness and

transformation
(Goleman, 2003).
Craving, hatred, holding onto a sense of

“I,” “me,” or “mine” are seen as harmful states of mind, whereas expending

effort on strengthening and developing attention, concentration, and mind-

fulness lead to equanimity and wisdom based on an understanding of con-

ditions leading to happiness and unhappiness (Ekman, Davidson, Ricard, &

Wallace,
2005).
When the Dalai Lama was asked what might contribute to

healthy states of mind, he responded, “cultivating positive mental states like

kindness and compassion definitely leads to better psychological health and

happiness.”
(Dalai Lama & Cutler, 1998).

Although compassion is a central theme in psychotherapy it is not clearly

defined or understood and yet it is considered to be a core component of

moving toward health and healing
(Glaser, 2005).
Compassion is most gen-

erally understood as a sense of sympathy and concern for the suffering or

misfortune of another along with an ability to resonate with that sorrow. It

is not to be confused with feeling sorry for someone, which carries with

it a sense of superiority. Instead, a pre-cursor for the establishment of com-

passion is empathy, the appreciation for the feeling experience of another

and the understanding that as human beings we will all encounter difficul-

ties from time to time. Kindness and compassion when extended toward

oneself and directed outwards toward others, tend to relax the judgments

we have of ourselves and of others and is characterized by a deep state of

caring.

Caring and compassion play important roles in our work as clinicians. It

has been suggested that taking care of oneself, as well as caring for clients, is

particularly relevant in carrying out effective therapy
(Gilbert, 2006).
Evidence suggests that when health care professionals are dissatisfied with

their jobs and are experiencing psychological distress, patient care suffers

(Shanafelt, Bradley, Wipf, & Black, 2002).
Working as a health professional brings its own unique stressors, particularly for those whose work consistently involves them working with clinical populations with high levels of

suffering. When Shapiro et al., facilitated an eight week MBSR program for

therapists in training, the results indicated a reduction in perceived stress.

In addition, participants in this study demonstrated higher levels of positive

affect and self-compassion
(Shapiro, Brown, & Biegel, 2007).
These preliminary results appear to offer health professionals a way to develop a healthier

response to the effects of stressors in their own lives and when working with

clients.

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Susan Lesley Woods

Elements of teaching in MBSR/MBCT

A. Embodied Awareness

Early on in the MBSR and MBCT programs an exploration of body sensa-

tions is highlighted. This is not usual territory in psychological treatment.

The body as a container and resource of information and wisdom is often

neglected. In the MBSR and MBCT programs, the intuitive intelligence of the

body is re-discovered, emphasized and supported not only through what is

being encountered in meditation practice but also through the mindful move-

ment aspects of the programs. Too often the body is only noticed when phys-

ical pain or discomfort is present. Simple mindful movements can remind us

that we can move for the joy of being in motion for its own sake and can help

ground us in our bodies. Incorporating specific attention and awareness to

movement as a vehicle of knowledge provides a reservoir of information.

This can alert us to somatic connections before we are made aware of them

cognitively which in turn can identify proactive ways of taking care of our-

selves . Those who wish to teach the MBSR and MBCT programs will need to

have a personal system of mindful movement like yoga, tai chi, qigong.

When the teacher of MBSR and MBCT communicates a stance of open-

hearted awareness towards all that is being encountered in the moment

through the practice of mindfulness, including body sensations, a different

relationship to pain and suffering emerges. In reinforcing the relevance of

each moment rather than seeking to change or dispute what is arising or

trying to make sense of the past or predict the future, a different frame of

reference is highlighted. In traditional psychological approaches, interven-

tions typically assume that something is amiss which needs to be fixed or