Clinical Handbook of Mindfulness (127 page)

Training programs will also need to carefully identify the underlying prin-

ciples of mindfulness practices and their implications for either the general

medical population, or for a targeted clinical diagnosis. We can remember

that the practice of mindfulness is more than a skill set; more than a behav-

ioral intervention and more than a clinical method developed as a way to

work with health care issues. Insight into the application of and implica-

tions for mindfulness grows with the experience of practicing and teaching

it. So, finding ways within each training program to support and reinforce

the instructor’s ongoing personal commitment to practice will be as impor-

tant as the presentation of the intellectual material. This is why at a later

stage, after gaining some experience in facilitating MBSR and MBCT groups,

additional training and supervision can offer incremental opportunities for

gaining deeper perspectives.

In the Buddhist tradition, the engagement with mindfulness is practiced

through long-term personal practice and under the supervision of teachers.

There are a number of centers worldwide that offer teacher-led silent retreats

for those wishing to deepen their practice by engaging in sustained practice

for specific lengths of time. MBSR and MBCT teachers need to find ways

of sustaining their personal practice as well as obtaining supervision of their

teaching with experienced mindfulness-based teachers. Both these processes

can take place within supervision, or by having supervision separate from

personal mindfulness practice being experienced through recognized mind-

fulness teaching centers or with an experienced mindfulness practitioner.

As mindfulness-based approaches in clinical settings grows, more seasoned

practitioners with both a personal mindfulness practice and the experience

of facilitating mindfulness-based interventions will develop. This will pro-

vide a useful and practical support system for training purposes. This is

where having a method of identifying/certifying those clinician/instructors

who have undergone a recognized process of training and who can then

provide supervision and mentorship will be an important contribution to

the field.

Chapter 25 Training Professionals in Mindfulness

471

Representative Training Routes

Mindfulness-Based Stress Reduction Trainings

There are a number of well established training programs in the USA and

Europe that stress the importance of personal mindfulness practice in order

to teach MBSR. In fact the relevance of a continuing mindfulness practice is

emphasized from the foundation programs to full certification as an instruc-

tor in MBSR. One of the best known of these centre is the training programs

offered by the Center For Mindfulness (CFM) in Worcester, MA (Appendix

B). In the CFM trainings, the establishment of a daily mindfulness medita-

tion practice and attendance at silent, teacher-led retreats is a prerequiste for

entry to teacher trainings after the initial 7-day residential training retreat.

An additional requirement is to have trained in a professional field at the

graduate level that encompasses an intellectual knowledge of the scientific

and medical underpinnings for MBSR. Personal psychological development

is encouraged, as well as the experience of body centered movement such

as mindful yoga, tai chi, qigong.

The CFM offers a 7-day residential training retreat. This program is an

intense education in the teaching of MBSR. The retreat provides an oppor-

tunity to explore the practice of mindfulness, the structure of the program,

how to teach and guide others, as well as examine research supporting the

efficacy of the program. The CFM also offers a practicum in MBSR, which

provides the opportunity to attend an MBSR class at the CFM where all

the sessions of the eight-week program are taught by senior instructors.

The practicum offers a rich experiential learning through being a partici-

pant in the group and in observing the instructor teaching. After the group

has ended, practicum participants meet with the teacher for discussion and

instruction.

A further layer of teacher training provided by the CFM is the Teacher

Development Intensive, an advanced eight-day teacher training retreat. This

program is a highly interactive and collaborative learning where MBSR teach-

ing skills are clarified and refined and the structural underpinnings of the

MBSR program are examined. There is an in-depth exploration of the inter-

section between personal mindfulness practice and the teaching of mindful-

ness itself, along with time devoted to exploring those moments of challenge

when teaching. An important component in this training is recognizing how

our modes of mind effect our actions and how they inform our teaching.

Ongoing supervision and consultation is also provided by the CFM.

Mindfulness-Based Cognitive Therapy Trainings

There are also a diverse and growing number of MBCT training programs

currently available in the USA and Europe but referencing them all would

be impracticable. Instead a focus on some generic methods of delivery will

be reviewed by examining MBCT training in North America and the UK.

In North America, MBCT professional training programs are currently deliv-

ered in one or two-day introduction seminars, a five-day training retreat pro-

gram (Level 1) and an eight-day advanced teaching and study retreat pro-

gram (Level 2) (Appendix B). An additional layer of training is also provided

by supervision and consultation from experienced teachers. From the onset,

472

Susan Lesley Woods

teaching revolves around the intersection of didactic material and the experi-

ential. In the one and two-day seminars, exposure to some of the mindfulness

meditation practices that patients will be taken through is as much a part of

the teaching as discussion of the structure and rationales for MBCT.

The five-day professional training program in MBCT (Level 1) is an intense

course that introduces the clinician/instructor to the structure and themes of

MBCT and also provides periods of time devoted to personal mindful practice

alongside the teaching of didactic instruction material. It offers an opportu-

nity to work with the application of mindfulness and the placement of the

cognitive behavioral elements through a course of instructive, experiential,

large and small group teachings. A deliberate focus is placed on the inter-

section of the intellectual grasp of the materials and the experience of the

practice of mindfulness. This emphasis highlights the ways in which as clini-

cians we tend to be more comfortable and used to being taught a method. By

returning to silence and the practice of mindfulness at the end of the day dur-

ing the first few days of the program, the clinician/instructor discovers what

it is to be with thoughts/emotions/body sensations that arise from what is

being taught and experienced.

It is not that the power of the intellect is being discouraged, rather what is

being encouraged, is to meet the nature of mind with openness, receptivity

and patience. In this way the MBCT program is being explored not simply

as a series of techniques, but also as a learning that is taking place on the

inside. This is similar to the experience that will be encountered by MBSR

and MBCT group participants. The domain is one of going back and forth

between experiential awareness and intellectual thought.

As a way to reinforce the efficacy of ongoing learning there are differ-

ent entry requirements for attendance in the Level 1 and Level 2 trainings.

The eight-day level 2 training, is intended for those professionals who have

an established personal mindfulness practice, are aware of the necessity

of personal practice as a platform from which to teach and have attended

teacher-led silent meditation retreats. It is for those clinicians who have

already taught MBCT groups. Much is learned from the experience of facilitat-

ing MBCT groups, not only from the perspective of the practicalities involved

but also from what is being elicited in the instructor during the teaching.

Learning to return to the landscape of mindfulness, rather than be drawn

into the territory of psychologically based interventions is where much of

the instructional nature of this training is placed.

Opening days of silence support the process of mindfulness practice, a

reminder to re-enter mindful awareness as place to be, and from which

to teach. From this place of remembering a focus is held on the intention

and integrity of mindfulness-based experiential learning alongside the under-

standing of the intention and sequencing of the cognitive behavioral ele-

ments. Learning is fostered by the use of large and small groups, dyads and

teacher supervision as well as the return to silent mindfulness practice at the

end of the day through breakfast the following day.

In the UK, there are now a number of avenues for training in MBCT at the

introductory level as well as the more advanced and these are based in sev-

eral centers around the country. The trainings at The Center for Mindfulness

Research and Practice at Bangor University, in Wales, are wide-ranging and

similar in ideology to the programs outlined for North America. However, in

Chapter 25 Training Professionals in Mindfulness

473

addition Bangor offers a master’s degree in mindfulness-based approaches,

which provides two directions for learning; an MSc or an MA. The MSc is

available to those who are interested in scientific research and the MA fol-

lows a more experiential methodology (Appendix B).

The University of Oxford in Oxford offers a master’s of studies degree in

MBCT (Appendix B). It is a part-time program open to mental health pro-

fessionals with psychotherapy experience and is taught over two years. It is

structured around ten three-day teaching blocks and two residential retreats,

five days in the first year and seven days in the second. It includes instruc-

tion in MBCT, an understanding of germane clinical and cognitive psychol-

ogy as well as aspects of Buddhist psychology and philosophy. Placing res-

idential mindfulness retreats within an academic curriculum highlights the

importance of the clinician’s own experiential practice alongside intellectual

learning.

Another avenue of training includes a one-year certificate or two-year

diploma program. The University of Exeter offers such a program (Appendix

B). These training programs provide trainees with both the ability to par-

ticipate in an MBCT group as well as facilitate a group under supervision.

Trainees have the opportunity to learn the theory and research reinforcing

MBCT and be instructed in Buddhist psychology. Once enrolled in these pro-

grams, attendance at a teacher-led silent retreats is expected.

Conclusion and Future Directions

Training in mindfulness-based approaches for clinicians is evolving with

increased understanding and knowledge of what mindfulness actually offers

in a clinical setting. This chapter has focused on just two of the clinical

programs that utilize mindfulness, MBSR and MBCT, because at their core,

they provide a sustained and systematic instruction in mindfulness medita-

tion practice which has important and novel implications for training health

professionals. Mindfulness is not a quick fix or a time limited intervention for

the amelioration of pain and suffering. It is an approach that concentrates on

the study of direct experience and consciousness and is a commitment over

time to nurture the mind toward the possibility of insight and wisdom.

There are many questions in the future about the role of mindfulness in

health care settings. We are at the beginning of our understanding about the

efficacy of mindfulness as a clinical treatment. We are only just starting to

learn about what aspects of mindfulness make a difference in clinical set-

tings. We do not really know what are the elements of competency for its

instruction. Bringing a scientific lens to understanding the various compo-

nents in mindfulness and how best to convey and instruct those elements

in clinical settings will be the subject of further studies
(Baer, 2003;
Baer, Smith, Hopkins, Krietemeyer, & Toney,
2006).
There is empirical evidence that mindfulness practiced over time and regularly, contributes to happiness

and alleviates suffering. There is also preliminary scientific evidence that the

Buddhist practice of meditation can shape the way the brain processes cer-

tain aspects of emotion and thought
(Davidson & Harrington, 2002;
Davidson, Kabat-Zinn, Schumacher, Rosenkranz, et al.,
2003).

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Susan Lesley Woods

MBSR and MBCT employ mindfulness practice as the core to their

programs intervention. Other clinical programs focus on teaching specific

components of mindfulness as a skill set, a way to address suffering along-

side the use of Western therapies. Further clinical studies are needed to bet-