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2. Teaching mindfulness to psychotherapists in clinical practice: The
Mindful Therapy Programme
CAMERON AGGS1
* & MATTHEW BAMBLING2
1
Mindfulness Training Australia, Maroochydore and Brisbane, Australia, and 2
Australian Catholic University, Psychology,
Virginia, Australia
Abstract
Introduction: Initially proposed as a treatment modality for psychological disorders, mindfulness is now being promoted as a
means of enhancing both therapist self care and therapeutic efficacy. The degree to which mindfulness can be learned by
therapists to manage their own and clients’ processes in therapy is as yet unknown. This study examines training outcomes
of a standardised introductory mindfulness programme for mental health professionals. Methods: Forty-seven mental health
professionals completed an eight-week mindful therapy (MT) training programme and associated measures. Results:
Compared with baseline scores, participants demonstrated knowledge acquisition on all measures, including increased
mindfulness in clinical work, increased capacity to intentionally invoke mindful states of consciousness, and higher
participant ratings of well-being over the course of training sessions. Discussion: This research provides preliminary evidence
that a brief, standardised mindfulness training programme can achieve acceptable knowledge and skills outcomes for
therapists that can aid their therapeutic practice. Of note, increased ‘therapeutic mindfulness’ in this study resulted from
changed mindfulness ‘attitudes’ (i.e. a more accepting and equanimous orientation within therapeutic work) as opposed to
a clear demonstration of increased attention-regulation skills. The implications of these and other results for programme
development and wider research are discussed.
Keywords: mindfulness; Mindful Therapy Scale; therapist well-being
Introduction
There has been increasing interest in the therap-
eutic potential of mindfulness in recent years
(Kabat-Zinn, 2009). Mindfulness can be described
as the practice of being present with the immediate
experiences of our lives. Mindfulness states of mind
are cultivated through the self-regulation of attention
on moment-to-moment experience, underpinned by
attitudes of acceptance, curiosity, and non-judgmental
warmth (Shapiro, Carlson, Astin, & Freedman,
2006). Central to this capacity is the ability to inhibit
secondary appraisals (Segal, Williams, & Teasdale,
2002), and to return one’s attention to the present
moment when distracted (Bishop et al., 2004).
To date mindfulness has been incorporated into
psychodynamic (Safran & Reading, 2008), cognitive
and behavioural (e.g. Hayes, Strosahl, & Wilson,
1999; Roemer & Orsillo, 2008), humanistic (e.g.
Andersen, 2005), attachment-based (Wallin, 2007),
and positive psychology frameworks (e.g. Hamilton,
Kitzman, & Guyotte, 2006). Mindfulness-Based
Stress Reduction (MBSR; Kabat-Zinn, 1982),
Mindfulness Based-Cognitive Therapy (MBCT;
Segal et al., 2002), Dialectical Behaviour Therapy
(DBT; Linehan, 1993), and Acceptance and Com-
mitment Therapy (ACT; Hayes et al., 1999) appear
to be the most widely used modalities.
In addition to its role as a clinical intervention,
mindfulness may have applications to increase both
the well-being and effective practice of therapists. In
relation to well-being, a study conducted by May
and O’Donovan (2007) found that higher levels of
mindfulness was associated with increased work
satisfaction, as well as decreased burnout among
mental health professionals. In addition, therapists
participating in MBSR courses have demonstrated
*Corresponding author. Email: cam@bemindful.com.au
Counselling and Psychotherapy Research, December 2010; 10(4): 278Á286
ISSN 1473-3145 print/1746-1405 online # 2010 British Association for Counselling and Psychotherapy
DOI: 10.1080/14733145.2010.485690
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3. reductions in stress, state and trait anxiety, negative
affect and rumination, as well as increased self-
reported empathy, positive affect and self-
compassion, when compared with controls (Shapiro,
Astin, Bishop, & Cordova, 2005; Shapiro, Brown, &
Biegel, 2007). There is also preliminary evidence to
suggest that therapists might enhance client out-
comes after they have received mindfulness training
(Grepmair, Mitterlehner, Loew, Bachler, et al.,
2007; Grepmair, Mitterlehner, Loew, & Nickel,
2007). However not all studies have shown a
positive correlation between therapist mindfulness
and client outcome (Stanley, Reitzel, Wingate,
Cukrowicz, Lima, & Joiner, 2006).
Mindfulness training protocols for clinicians re-
ported in the literature have been provided using a
curriculum based on Zen meditation practice (e.g.
Grepmair et al., 2007; Grepmair et al., 2007), or
within modality specific frameworks such as MBSR.
These training formats often do not include a focus
on therapy-related skills. This may be problematic
given findings that in certain circumstances (e.g.
when therapists in training are using manualised
treatments), higher levels of therapist mindfulness
may be counterproductive (e.g. Stanley et al., 2006).
To address this issue, a new clinically focused
mindful therapy (MT) programme has been devel-
oped to teach mindfulness relative to therapy
specific skills.
In this new programme mindfulness skills are
first taught in relation to therapist practice and self-
care. They are then applied within the context of
empirically supported therapeutic relationships
skills. These include managing the therapeutic
alliance, client-centred delivery of therapeutic tech-
niques, therapist empathy, working through rup-
tures and strains, as well as the use of the Self (for a
review see Norcross, 2002). There is considerable
evidence pointing to the importance of therapist
specific and relationship variables with relation to
client outcome (Lambert & Simon, 2008), and
considerable overlap between these skills and mind-
fulness processes (Germer, 2005). This provides a
robust rationale to focus on these aspects in MT
training.
An important issue with progressing this research
is that none of the existing published measures of
mindfulness contain items relating to mindfulness
within the therapy setting. As a result, a clinically
specific mindfulness measure (the Mindful Therapy
Scale: MT-S) has been developed for this study to
evaluate therapists’ mindfulness relative to therapist-
client variables. It is expected that the development
of a therapist specific MT programme will provide
the basis for further investigations into whether
teaching mindfulness to therapists translates into
enhanced client outcomes, and if so what skills or
processes might be the mechanisms in predicting
outcome.
Hypotheses
After completing the MT training programme parti-
cipants will have significantly higher post-training
declarative knowledge scores compared to baseline.
Participants will also demonstrate attitude change
with respect to using mindfulness within client-
related work. In addition, participants’ data will
reflect significantly higher post-training ratings of
well-being compared to baseline. Participants will
also have a significantly higher post-training capacity
to invoke a mindfulness state compared to baseline.
Lastly, after completing the MT training pro-
gramme, participants will indicate through self-
report a significantly higher capacity for in-session
mindfulness compared to baseline.
Method
Aims
The current study aims to examine whether a
clinically focused mindfulness training programme
for therapists can be standardised and taught to
clinicians, as evaluated by (1) skill and knowledge
acquisition, and (2) attitude change among thera-
pists who complete the programme.
Participants
The lead author, as part of a research project for
a higher psychology degree, provided five separate
training programmes to participants at the Queens-
land University of Technology over a 14-month
period. Seventy-seven participants commenced the
mindful therapy (MT) training programme, and
58 (74%) completed six to eight sessions of the
programme. Consistent with Shapiro et al. (2005),
six sessions constituted the minimum training con-
sidered necessary to acquire core knowledge and
skills, and provided the minimum session number
cut off for data used in this study. Forty-seven
participants attended an optional time delayed ninth
session where follow up post-measures were admi-
nistered. A cross-section of course drop-outs (n04)
Teaching mindfulness to psychotherapists in clinical practice 279
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4. were followed up. The most common reason parti-
cipants stated for dropping out was difficulty mana-
ging the travel and time commitments of attending
training. Participants beginning training included
45 psychologists, eight social workers, seven clinical
nurses, four counsellors, two occupational therapists
and two psychiatrists.
Participants were 96% female with a mean age of
40.24 years (SD013.84). Seventy-eight percent
(78%) were Caucasian, and 22% were of Asian
descent. Over 80% of participants indicated that
they had either little or no history using mindfulness,
either as a personal practice or as a client-related
technique. Nine percent (9%) of participants were
recruited from the same degree cohort as the lead
author (group 1), 10% were recruited from a local
psychology practice (group 2), and 81% of partici-
pants were recruited via email sent through university
contacts to community-based mental health workers
(groups 3Á5). Diverse professional and employment
settings of participants protected against recruitment
bias. Anonymity of responses was achieved through
de-identification of coded data.
Design and procedures
A repeated measures training design, utilising a
within-subjects comparison of pre- and post-course
data was used for this study. The three-module
programme was delivered at weekly intervals of 1.5
hour sessions over an eight-week period. Each
training session typically consisted of two new topics
(40 minutes in total), up to three experiential
exercises (30 minutes in total), and a group discus-
sion (5 minutes). Weekly training sessions included
discussing homework assignments towards the be-
ginning and end of each training session (10 minutes
total).
Manual and programme development
The workshop content consisted of mindfulness as a
personal practice (module I); mindfulness as a
psychotherapy process skill (module II); and an
introduction to mindfulness as an intervention
(module III). The module one content (weeks 1Á3)
was concerned with enhancing participants’ declara-
tive and experiential knowledge of mindfulness. The
theoretical content of this module was drawn from
the IAA model of mindfulness proposed by Shapiro
et al. (2006), and was informed by research con-
ducted by Baer, Smith, Hopkins, Krietemeyer, and
Toney (2006), relating to facets of mindfulness
derived from available mindfulness measures. The
experiential content of this module was informed by
guided meditations used in the MBSR protocol
(Kabat-Zinn, 2005).
In module two (weeks 3Á5), participants were
presented with an overview of the ‘relational mind-
fulness’ framework proposed by Surrey (2005). In
this module, therapists applied their growing under-
standing of mindfulness skills to psychotherapy
processes, such as maintaining the therapeutic alli-
ance, working with ruptures and strains, and for
enhancing ‘process empathy’ (Bohart, Elliott,
Greenberg, & Watson, 2002, p. 90).
The module three sessions (weeks 6Á8) included
opportunities for participants to practise delivering
the Three-Minute Breathing Space technique (Segal
et al., 2002). In addition, this module focused on
therapist and client factors relevant to the integration
of mindfulness into therapeutic work. In the final
week, participants were provided with a list of
resources for facilitating ongoing engagement with
mindfulness education and practice.
Measures
Mindful Therapy Questionnaire. The Mindful Ther-
apy Questionnaire (MT-Q) was designed for this
study due to available mindfulness measures being
general and not specific to counselling and psy-
chotherapy practice. To measure participants’ atti-
tudes towards using mindfulness, participants on
MT-Q were asked to rate their confidence using
mindfulness with clients, their intentions to inte-
grate mindfulness into their work, and how rele-
vant they saw mindfulness within therapeutic
settings. Each question was measured on a 1 (not
at all) to 10 (extremely) scale. In addition, three
questions requiring written responses were developed
to evaluate participants’ learning outcomes from the
programme. These questions assessed participants’
knowledge of mindfulness relating to: (a) ‘attending
skills’ of mindfulness; (b) mindfulness attitudes (see
Shapiro & Carlson, 2009); and (c) the relationship
between mindfulness and psychotherapy process
skills.
Each question was analysed using a coding system
based on the learning objectives of the first two
modules of the training programme. Responses were
rated by the lead author and co-rated by an
independent rater for accuracy. The rating system
was based on a four- and five-point scale where (0)
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5. indicated ‘Demonstrates no understanding/no skills
identified’ to 3/4 (‘Demonstrates excellent under-
standing/all skills and attitudes identified’). The lead
author determined rankings of acceptable responses
and a table of these responses were provided to the
co-rater. The co-rater was a practising psychologist
with experience in mindfulness practices. Rater
training was provided to ensure understanding of
the concepts and rating method. Inter-rater relia-
bility was .95, which is considered to indicate a high
level of reliability (Landis & Koch, 1977).
Mindful Therapy Scale (Modified from the Five Facet
Mindfulness Questionnaire; Baer et al., 2006). The
24-item Mindful Therapy Scale (MT-S) was de-
signed for the present study as there was no suitable
pre-existing published measures to assess in-session
therapist mindfulness (or ‘therapeutic mindful-
ness’). Constructs measured on this inventory
mirror those on the original questionnaire (Baer et
al., 2006), and related to non-reactivity to inner
experience (example: ‘When I am with clients I can
have strong feelings and emotions without reacting
to them’); Observing/noticing/attending to sensa-
tions/perceptions/ thoughts/feelings (example: ‘I no-
tice how my emotions express themselves through
my body when I work with clients’); Acting with
awareness/automatic pilot/concentration/ non-dis-
traction (example: ‘At times I struggle to tune into
my clients’); Describing/labelling with words (ex-
ample: ‘When I am with clients I have trouble
thinking of the right words to express how I feel
about things’); Accepting/non-judging of experience
(example: ‘I can be highly self-critical in relation to
my clinical work’).
The overall Mindful Therapy measure evidenced
good reliability for the full-scale score (Cronbach’s
Alpha of .79). Reliability estimates for sub-scales
varied with .71 (non-react), .83 (observe), .75
(describing), .57 (non-distract), and .62 (non-
judge/accept). These estimates are lower than relia-
bility estimates (range .75Á.91) reported by Baer
et al. (2006). Copies of the MT-S can be obtained by
request to the corresponding author.
The Five-Minute Mindfulness Scale (FMMS). The
FMMS was developed by the lead author to measure
participants’ capacity to enter into and maintain a
mindful state upon request. Items on this measure
relate to ‘Non-distraction’, ‘Attention switching’,
‘Letting-go/non-elaboration of thoughts’, and ‘Com-
fort and ease of the practice’ (which was interpreted
as a measure of mastery). Each individual construct
is measured by a single question measured on a
1 (very difficult) to 10 (very easy) scale. The
reliability estimate for the FMMS was an alpha of
.84. The scale included items such as ‘Thoughts,
feelings, and sensations were allowed to rise and pass
freely’ (Letting-go), and ‘Sustaining attention on
immediate experience’ (Non-distraction). An alter-
native measure for ‘invoked mindfulness’ is the
Toronto Mindfulness Scale (Lau et al., 2006) which
was not known to the research team at the time of
this study. However, the FMMS mapped onto the
training concepts taught in the study directly there-
fore has a high degree of suitability.
Stress and tension ratings. A simple participant stress
measure was developed by the lead author as a pre-
and post-rating of each session’s impact on stress
levels. The measure is comprised of two items
relating to stress and tension, rated on a 10-point
scale. 1 (Not at all stressed) to 10 (very stressed), and
1 (no tension) to 10 (significant tension). The stress
and tension measure was administered prior to and
at the end of training each week. Responses were
tallied and divided by the number of training
sessions in order to deliver estimates of the average
pre and post rating following every session.
Participant Satisfaction Survey. The Participant Sa-
tisfaction Survey contains seven items, each scored
on a 1 (Strongly disagree) to 10 (Strongly agree) scale,
with the exception of the question regarding parti-
cipant expectations, which is measured on a 1 (Fell
below expectations) to 10 (Exceeded expectations) scale.
It was administered subsequent to training with
other post-measures in the ninth week at follow-up.
It contained statements such as ‘I will draw upon the
skills I have used in this course in my therapeutic
work’ and ‘I got less/more out of the course than I
expected.’
Ethical considerations
This study received ethical clearance by the Queens-
land University of Technology ethics committee. All
participants were informed of their right to withdraw
from the study without penalty. Informed consent
was obtained from all participants prior to their
involvement in the first session of the course.
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6. Results
Treatment of data (MT-S)
The results of data testing supported the assumption
of normality, with skewness and kurtosis ranges being
within acceptable limits (B 2). These assumptions
were upheld by visual inspection of histograms.
Probability levels were maintained at .05 for multiple
analyses due to the a priori nature of the hypotheses.
Whereapplicable,datawerereversecodedbeforescoring.
Mean, standard deviation and t-test results for the
Mindfulness and Learning Outcomes Measure
Participants’ knowledge of mindfulness was assessed
by obtaining qualitative responses on the MT-Q
which were coded by themes, and then rated for
accuracy in line with the course content by the
programme facilitator and co-rater. Results of the
three questions were pooled to create a total knowl-
edge construct (see Table I). Compared to baseline,
participants’ total knowledge had increased signifi-
cantly post training (pB.01). Significant preÁpost
differences were observed for each individual con-
struct (all p valuesB.01).
Mean, standard deviation, and t-test results for attitude
change on the Mindful Therapy Questionnaire
Compared to baseline, participants’ confidence with
integrating mindfulness into therapeutic work was
significantly higher at post review (pB.01), as
was participants’ perceptions of the relevance of
mindfulness in relation to their therapeutic work
(p0.01). No change was demonstrated in partici-
pants’ intentions to integrate mindfulness within
their therapeutic work (see Table II).
Mean, standard deviation, and t-test results for the Stress
and Tension Measure
The results of t-tests revealed that participants
reported feeling significantly lower levels of stress
after training sessions when compared to their
ratings immediately prior (pB.01). The same pat-
tern of results was true for participants’ scores on
perceived tension (pB.01).
The average reduction in mean stress scores across
participants was 36.5%. The average reduction in
tension during training sessions was 33.9%
(Table III).
Mean, standard deviation, and t-test results for the Five-
Minute Mindfulness Scale
The FMMS measured participants’ capacity to
invoke mindfulness on request. Compared to base-
line, participants’ scores on the non-distraction con-
struct increased significantly post-training (p0.01),
as did scores on constructs relating to attention
switching (p0.01), letting-go/non-elaborative aware-
ness (pB.01) and for mastery (pB.01) (Table IV).
Table I. Mean, standard deviation and t-test results for the
Mindfulness and Learning Outcomes Measure.
Pre test Post test
M SD M SD df t p
Total knowledgea
2.28 1.38 7.15 2.01 46 13.37 .01
Mindfulness and
psychotherapy
process skillsb
.60 .83 1.83 2.20 46 5.67 .01
Attending skillsc
1.02 .71 3.11 1.07 46 10.86 .01
Mindfulness
attitudesd
.66 .64 2.19 .71 46 11.60 .01
Note: M0mean; SD0standard deviation; df0degrees of free-
dom; t0t value, p0significance level; a
scores range from 0Á11;
b,c
measured on 0Á4 point scale; d
measured on a 0Á3 point scale.
Table II. Mean, standard deviation, and t-test results for attitude
change on the Mindful Therapy Questionnaire.
Pre test Post test
M SD M SD df t p
Confidence 3.85 2.63 6.13 1.83 46 6.10 .01
Relevance 7.38 2.03 8.23 1.53 46 2.56 .01
Intentions 7.64 1.92 8.00 1.70 46 1.08 .29
Note: Scales measured on a 10-point scale. M0mean;
SD0standard deviation; df0degrees of freedom; t0t value,
p0significance level.
Table III. Mean, standard deviation, and t-test results for the
Stress and Tension Measure.
Pre test Post test
M SD M SD df t p
Stress 4.41 2.15 2.80 1.60 264 9.76 .01
Tension 4.78 2.16 3.16 1.66 262 10.30 .01
Note: Scales measured on a 10-point scale. M0mean;
SD0standard deviation; df0degrees of freedom; t0t value,
p0significance level.
282 C. Aggs & M. Bambling
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7. Mean, standard deviation, and t-test results for the
Mindful Therapy Scale (MT-S)
Analysis of t-tests for the MT-S revealed that
participants reported significantly greater in-session
mindfulness on the global ‘Mindful Therapy’ mea-
sure post training when compared to baseline (p0
.01). Relative to baseline, significant differences
were found on scores of the non-judging/acceptance
(p0.02) and the non-reactivity/equanimity con-
structs (pB.01). No significant differences were
found on measures of non-distraction, describing
with words, and observing/internal attunement (see
Table V).
Range, mean, and standard deviations for the
Participant Satisfaction Survey
The Participant Satisfaction Survey was adminis-
tered as part of the week 9 post-review. Whether the
course met participants’ expectations was measured
on a 10-point scale, where a score of five or six
indicated ‘met expectations’. The programme met or
exceeded expectations in 97.4% of cases. Results
from other items also indicated high levels of
satisfaction with the programme (see Table VI).
Discussion
The current study evaluated mindfulness training in
relation to measures of therapist well-being, skill and
knowledge acquisition, programme acceptability,
and attitude change. Results provide preliminary
evidence that a brief, standardised mindfulness
training programme can achieve acceptable knowl-
edge and skills outcomes for therapists that can aid
their therapeutic practice.
Regarding knowledge acquisition, participants
demonstrated significantly higher post-training de-
clarative knowledge scores when compared to base-
line. Compared to responses given prior to training,
participants’ scores were on average more than three
times greater when measured post-training. Despite
large improvements, scores on the mindfulness and
psychotherapy process skills measure were not par-
ticularly high when measured post-training. Contin-
ued research and program development will be
required to make this material more accessible to
future participants.
The hypothesis that mindfulness training in this
study would be associated with positive participant
attitudes regarding integrating mindfulness into ther-
apeutic work was partially supported. Participants’
Table IV. Mean, standard deviation, and t-test results for the Five-
minute Mindfulness Scale.
Pre test Post test
M SD M SD df t p
Non distraction 5.27 1.97 6.28 1.95 46 2.79 .01
Attention
switching
6.94 1.71 7.78 1.18 46 2.72 .01
Letting go/
non-elaboration
6.13 2.23 7.26 1.40 46 2.85 .01
Mastery (comfort
and ease)
7.41 1.81 8.49 1.23 46 4.29 .01
Note: Scales measured on a 10-point scale. M0mean;
SD0standard deviation; df0degrees of freedom; t0t value,
p0significance level.
Table V. Mean, standard deviation, and t-test results for the
Mindful Therapy Scale (MT-S).
Pre test Post test
M SD M SD df t p
Full scale score 6.36 .95 6.70 .90 46 2.70 .01
Non-judging/
acceptance
6.17 1.15 6.53 .99 46 2.46 .02
Non reactivity/
equanimity
6.68 1.03 7.28 1.15 46 3.41 .01
Observing/Internal
attunement
6.27 1.60 6.62 1.63 46 1.22 .23
Non-distraction 6.74 1.57 6.70 1.53 46 .24 .81
Describing 5.98 1.57 6.39 1.43 46 1.50 .13
Note: Scales measured on a 10-point scale. M0mean;
SD0standard deviation; df0degrees of freedom; t0t value,
p0significance level.
Table VI. Range, mean, and standard deviations for the Partici-
pant Satisfaction Survey.
Item Range M SD
I would recommend the program to other
mental health professionals
5Á10 8.67 1.31
I am disappointed that I took this course 1Á3 1.31 .61
I will draw upon the skills I have used in this
course in my therapeutic work
5Á10 8.94 1.24
I will continue to maintain a regular mind-
fulness practice
5Á10 8.51 1.32
I feel like there has been no meaningful
growth in my understanding of mindfulness
as a theoretical construct during this course
1Á7 2.31 1.69
I felt more relaxed after most mindfulness
sessions
6Á10 9.03 1.06
I got less/more out of the course than I
expected
3Á10 7.71 1.39
Note: Measured from 1 (strongly disagree) to 10 (strongly agree);
M0mean; SD0standard deviation.
Teaching mindfulness to psychotherapists in clinical practice 283
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8. ratings of the relevance of mindfulness within clinical
settings and confidence in using mindfulness within
client related work were significantly higher when
measured post-training compared to baseline. In
comparison, no change was found in relation to
participants’ intentions to integrate mindfulness
when measured at post-review.
Null results for intentions may have been due to
ceiling effects associated with high pre-training
scores, which were 7.64 out of 10 at the beginning
of training, and were 8 out of 10 at endpoint,
indicating no statistical difference. The most likely
explanation for this result is that participants
already had a positive intention to integrate mind-
fulness into their practice, and as a result the
training had no effect. Overall, findings support a
positive participant attitude regarding the use and
suitability of mindfulness in clinical and counselling
practice.
Stress management and compassion fatigue are
particularly pertinent issues for health professionals
(Shapiro & Carlson, 2009). Consistent with pre-
dictions, reductions in the perception of stress and
tension were large in this study, with the observed
decrement on these measures being over 33% in
both cases. These findings were consistent with
results from the Participant Satisfaction Survey
(PSS) administered during the week nine follow-
up, which indicated that participants felt more
relaxed after mindfulness training sessions.
As well as hypothesising positive results in the area
of knowledge acquisition, attitude change, and well-
being, this study predicted gains in the area of
mindfulness-based skill acquisition. A key marker
of skill acquisition was whether mindfulness training
would be associated with an increased capacity to
enter a mindful state on request, and higher per-
ceived mindfulness with clients. Consistent with
predictions, participants in this study demonstrated
a significantly higher post-training capacity to invoke
a mindful state of consciousness when compared to
baseline scores. These results are consistent with
previous research indicating positive effects of mind-
fulness training on measures of ‘invoked mindful-
ness’ (Anderson, Lau, Segal, & Bishop, 2007), and
provides additional support for the assertion that
mindfulness is a skill that therapists can learn
(Shapiro et al., 2007).
In relation to in-session clinical mindfulness
behaviour, this study found significant positive
change in the global ‘Mindful Therapy’ score, in
addition to positive changes on the two indices
relating to mindfulness attitudes (non-judging/
acceptance and non-reactivity/equanimity). In rela-
tion to the acceptance construct, participants in this
study reported being less judgmental of their pro-
cesses in therapy, as well as those of their clients
when compared to baseline. Relative to the non-
reactivity/equanimity construct, participants re-
ported an increased capacity to let go of unsettling
thoughts, feelings, or images as they arose, and
reported feeling more relaxed within therapeutic
work compared with baseline scores.
In contrast, no preÁpost differences were observed
on the three indices relating to attention-regulation
and noting skills of mindfulness. This suggests that
training did not significantly impact upon partici-
pants’ ability to remain focused on their clients
during therapy, to retain an awareness of internal
events, or to put their perceptions into language,
when these skills were measured as independent
constructs. The findings that in-session attending
skills did not improve over the course of training are
inconsistent with results from the FMMS, which
showed an increased ability to evoke these skills on
demand.
The finding that participants’ mindful attitudes
improved over the course of training whereas atten-
tion-regulation skills did not is, however, consistent
with research proposing the independence of these
constructs (Cardaciotto, Herbert, Forman, Moitra &
Farrow, 2008), and null results for the effects of
a short course in mindfulness training (MBSR) on
attention control (Anderson et al., 2007). If these
construct are indeed independent, then it is possible
that different periods of training may be required to
address these facets.
Within the context of high scores of intentions to
integrate mindfulness into therapy work, the find-
ings that therapists can evoke the attending skills of
mindfulness, but often do not, is also reconcilable
with the observations of Feldman (2004), that
perhaps the most challenging aspect of being
mindful is remembering to be mindful. Potentially
developing visual cues to be placed in therapists’
offices (such as a picture of a figure meditating, or
a leaf on a river, or small meditation bell for
example) may be one way of priming this remem-
bering function and making mindful therapy more
likely. Greater attention to training development
and further research is required before definitive
284 C. Aggs & M. Bambling
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9. conclusions regarding generalisability of state-based
attending skills can be made to therapy settings.
Limitations
There are a number of factors that limit the
generalisability of these results. The primary limita-
tion of this study is that it has relied on new
measures that require further empirical validation.
While not a significant problem in training research,
no control group was used in this study. Further
studies that include a control condition, perhaps
comparing MT with a modality specific mindfulness
programme (e.g. MBSR) with randomised partici-
pant allocation, may provide a more effective eva-
luative design.
The present study was conducted with a self-
selected sample, a small percentage of whom were
known to the primary researcher. This calls into
question the possible role of demand characteristics,
and the likelihood that participants had pre-existing
positive attitudes towards mindfulness. However,
sample validity can be argued based on the con-
siderable heterogeneity of participants’ professions
and employment settings, and uniformed average
findings across measures. There was no long-term
follow-up of participants and therefore the perma-
nence of training effects remain unknown. Future
studies should include follow up at six and 12
months to examine skill retention and application
in practice.
Implications for practice
Mindfulness-based approaches are gaining signifi-
cant popularity with clinicians. Existing training
opportunities have traditionally not focused on
therapy skills and client work issues. This study
demonstrates that mindfulness training for therapists
enhances skills thought important for clinical work
such as state-based attention regulation skills, and
the capacity to bring a more accepting and less
reactive orientation towards client-related processes.
Results from this study suggest that training cogni-
tive capacities, such as attention control, does not
occur rapidly and therapists should allow additional
time and practice to master this skill. We conclude
that therapists can benefit from relatively brief
training programs in mindfulness that focuses on
clinical work. The implication for practice is that
clinicians seeking mindfulness training may gain
additional benefit by the therapy specific approach
used in this study.
Future research
Current findings provide further support for the
assertion that mindfulness is a multidimensional
construct (Baer et al., 2006; Cardaciotto et al.,
2008), and that measuring mindfulness with a
multidimensional assessment tool is appropriate.
Until now, non-therapy related measures have been
used in the few studies that have attempted to
evaluate therapist mindfulness. The current study
used the new multidimensional Mindful Therapy
scale (MT-S) which measures mindfulness in rela-
tion to their therapeutic work specifically. While
overall scale reliability was acceptable, subscale score
alphas were variable. While it is likely results of the
scale are valid, further empirical refinement and
validation of this measure is required before it could
be accepted as a standardised measure in future
clinical mindfulness research.
Acknowledgements
Thanks to Mr David McLennan for his contribution
as co-rater for this study and to Ms Deanne
Armstrong for her editorial assistance. Thanks also
to Dr John McLean for helpful feedback on an
earlier version of the manuscript.
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Biographies
Cameron Aggs is the director of Mindfulness
Training Australia. He is a psychologist in private
practice in Maroochydore, Queensland, and an early
intervention and parenting specialist with Child and
Family Health, Maroochydore. He has been in-
volved with mindfulness practices for over a decade.
He can be contacted at cam@bemindful.com.au.
Matthew Bambling is a senior lecturer in
clinical psychology and course coordinator for
Master and Doctorate of Clinical Psychology ACU
National, Brisbane Campus, Queensland, Australia.
Matthew has published in the fields of supervision,
psychotherapy outcome, training of therapists and
mental health and health psychology. Matthew can
be contacted at matthew.bambling@acu.edu.au
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